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ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection.
Ocul Surf. 2020 10; 18(4):537-544.OS

Abstract

PURPOSE

Conjunctival signs and symptoms are observed in a subset of patients with COVID-19, and SARS-CoV-2 has been detected in tears, raising concerns regarding the eye both as a portal of entry and carrier of the virus. The purpose of this study was to determine whether ocular surface cells possess the key factors required for cellular susceptibility to SARS-CoV-2 entry/infection.

METHODS

We analyzed human post-mortem eyes as well as surgical specimens for the expression of ACE2 (the receptor for SARS-CoV-2) and TMPRSS2, a cell surface-associated protease that facilitates viral entry following binding of the viral spike protein to ACE2.

RESULTS

Across all eye specimens, immunohistochemical analysis revealed expression of ACE2 in the conjunctiva, limbus, and cornea, with especially prominent staining in the superficial conjunctival and corneal epithelial surface. Surgical conjunctival specimens also showed expression of ACE2 in the conjunctival epithelium, especially prominent in the superficial epithelium, as well as weak or focal expression in the substantia propria. All eye and conjunctival specimens also expressed TMPRSS2. Finally, Western blot analysis of protein lysates from human corneal epithelium obtained during refractive surgery confirmed expression of ACE2 and TMPRSS2.

CONCLUSIONS

Together, these results suggest that ocular surface cells including conjunctiva are susceptible to infection by SARS-CoV-2, and could therefore serve as a portal of entry as well as a reservoir for person-to-person transmission of this virus. This highlights the importance of safety practices including face masks and ocular contact precautions in preventing the spread of COVID-19 disease.

Links

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Authors+Show Affiliations

Zhou L
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Xu Z
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Castiglione GM
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Soiberman US
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Eberhart CG
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, USA. Electronic address: ceberha@jhmi.edu.
Duh EJ
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: eduh@jhmi.edu.

MeSH

AdultAgedAged, 80 and overAngiotensin-Converting Enzyme 2Blotting, WesternCOVID-19ConjunctivaDisease SusceptibilityEpithelium, CornealEye Infections, ViralFemaleHumansImmunohistochemistryMaleMiddle AgedSARS-CoV-2Serine Endopeptidases

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32544566

Citation

Zhou, Lingli, et al. "ACE2 and TMPRSS2 Are Expressed On the Human Ocular Surface, Suggesting Susceptibility to SARS-CoV-2 Infection." The Ocular Surface, vol. 18, no. 4, 2020, pp. 537-544.
Zhou L, Xu Z, Castiglione GM, et al. ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection. Ocul Surf. 2020;18(4):537-544.
Zhou, L., Xu, Z., Castiglione, G. M., Soiberman, U. S., Eberhart, C. G., & Duh, E. J. (2020). ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection. The Ocular Surface, 18(4), 537-544. https://doi.org/10.1016/j.jtos.2020.06.007
Zhou L, et al. ACE2 and TMPRSS2 Are Expressed On the Human Ocular Surface, Suggesting Susceptibility to SARS-CoV-2 Infection. Ocul Surf. 2020;18(4):537-544. PubMed PMID: 32544566.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection. AU - Zhou,Lingli, AU - Xu,Zhenhua, AU - Castiglione,Gianni M, AU - Soiberman,Uri S, AU - Eberhart,Charles G, AU - Duh,Elia J, Y1 - 2020/06/13/ PY - 2020/05/09/received PY - 2020/05/24/revised PY - 2020/06/11/accepted PY - 2020/6/17/pubmed PY - 2020/12/15/medline PY - 2020/6/17/entrez KW - ACE2 KW - COVID-19 KW - Conjunctiva KW - Cornea KW - Human KW - Ocular surface KW - SARS-CoV-2 SP - 537 EP - 544 JF - The ocular surface JO - Ocul Surf VL - 18 IS - 4 N2 - PURPOSE: Conjunctival signs and symptoms are observed in a subset of patients with COVID-19, and SARS-CoV-2 has been detected in tears, raising concerns regarding the eye both as a portal of entry and carrier of the virus. The purpose of this study was to determine whether ocular surface cells possess the key factors required for cellular susceptibility to SARS-CoV-2 entry/infection. METHODS: We analyzed human post-mortem eyes as well as surgical specimens for the expression of ACE2 (the receptor for SARS-CoV-2) and TMPRSS2, a cell surface-associated protease that facilitates viral entry following binding of the viral spike protein to ACE2. RESULTS: Across all eye specimens, immunohistochemical analysis revealed expression of ACE2 in the conjunctiva, limbus, and cornea, with especially prominent staining in the superficial conjunctival and corneal epithelial surface. Surgical conjunctival specimens also showed expression of ACE2 in the conjunctival epithelium, especially prominent in the superficial epithelium, as well as weak or focal expression in the substantia propria. All eye and conjunctival specimens also expressed TMPRSS2. Finally, Western blot analysis of protein lysates from human corneal epithelium obtained during refractive surgery confirmed expression of ACE2 and TMPRSS2. CONCLUSIONS: Together, these results suggest that ocular surface cells including conjunctiva are susceptible to infection by SARS-CoV-2, and could therefore serve as a portal of entry as well as a reservoir for person-to-person transmission of this virus. This highlights the importance of safety practices including face masks and ocular contact precautions in preventing the spread of COVID-19 disease. SN - 1937-5913 UR - https://www.unboundmedicine.com/medline/citation/32544566/ACE2_and_TMPRSS2_are_expressed_on_the_human_ocular_surface_suggesting_susceptibility_to_SARS_CoV_2_infection_ DB - PRIME DP - Unbound Medicine ER -