Angiotensin-converting enzyme 2, the SARS-CoV-2 cellular receptor, is widely expressed in human myometrium and uterine leiomyoma

Alexon M Racilan; Wiviane A Assis; Maíra Casalechi; Ananda Spagnolo-Souza; Marcelo A Pascoal-Xavier; Ana C Simões-E-Silva; Helen L Del Puerto; Fernando M Reis

doi:10.1177/2284026520954068

Angiotensin-converting enzyme 2, the SARS-CoV-2 cellular receptor, is widely expressed in human myometrium and uterine leiomyoma

J Endometr Pelvic Pain Disord. 2021 Mar;13(1):20-24. doi: 10.1177/2284026520954068.

Authors

Alexon M Racilan¹, Wiviane A Assis¹, Maíra Casalechi¹, Ananda Spagnolo-Souza¹, Marcelo A Pascoal-Xavier², Ana C Simões-E-Silva³, Helen L Del Puerto⁴, Fernando M Reis¹

Affiliations

¹ Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
² Department of Pathologic Anatomy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
³ Department of Pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
⁴ Department of Pathology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Abstract

Objective: Angiotensin-converting-enzyme 2 (ACE2), the cell surface receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is found in a variety of reproductive tissues. The present study evaluated whether uterine fibroids and normal myometrium express ACE2 and, if so, at which tissue compartments.

Methods: We included 13 premenopausal women (age range 33-50 years, median 40 years) with uterine fibroids undergoing elective hysterectomy or myomectomy. Samples of leiomyoma (n = 12) and normal myometrial tissue (n = 8) were analyzed by immunohistochemistry for protein localization or by real time PCR for mRNA detection.

Results: In normal myometrium, ACE2 immunoreactivity was localized in smooth muscle fibers, arteriolar walls, and endothelial cells. In uterine leiomyoma, ACE2 staining was more intense in smooth muscle cells than in the extracellular matrix, and was also present in vascular endothelium. ACE2 mRNA was detected in myometrium as well as in fibroid samples.

Conclusion: Human myometrium and uterine leiomyoma express ACE2 mRNA and have abundant distribution of ACE2 protein in their smooth muscle cells and microvasculature.

Keywords: ACE2; COVID-19; SARS-CoV-2; fibroid; myometrium; uterine leiomyoma.