Increased ACE2 Expression in Bronchial Epithelium of COPD Patients who are Overweight

Objective Mortality from coronavirus disease 2019 (COVID-19) is increased in patients with chronic obstructive pulmonary disease (COPD). Furthermore, higher BMI is related to severe disease. Severe acute respiratory syndrome coronavirus 2 utilizes angiotensin converting enzyme 2 (ACE2) to gain cellular entry. Methods Whether ACE2 bronchial epithelial expression is increased in COPD patients who have overweight compared with those who do not was investigated by RNA sequencing. Results Increased ACE2 expression was observed in patients with COPD with overweight (mean BMI, 29 kg/m(2)) compared with those without overweight (mean BMI, 21 kg/m(2)) (P = 0.004). Conclusions Increased ACE2 expression may cause increased severe acute respiratory syndrome coronavirus 2 infection of the respiratory tract. Overweight COPD patients may be at greater risk for developing severe COVID-19.