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Angiotensin converting enzyme 2 gene expression and markers of oxidative stress are correlated with disease severity in patients with COVID-19

Alobaidy et al., Molecular Biology Reports, doi:10.1007/s11033-023-08515-0
May 2023  
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Analysis of 40 COVID-19 ICU patients and 40 matched healthy controls, showing significantly lower melatonin levels in COVID-19 patients.
Alobaidy et al., 24 May 2023, Egypt, peer-reviewed, mean age 60.7, 6 authors, study period September 2021 - March 2022. Contact:,,,,,
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Angiotensin converting enzyme 2 gene expression and markers of oxidative stress are correlated with disease severity in patients with COVID-19
Afraa S H Alobaidy, Mona Elhelaly, Maggie E Amer, Rasha S Shemies, Azza I Othman, Mohamed A El-Missiry
Molecular Biology Reports, doi:10.1007/s11033-023-08515-0
Background Oxidative stress is thought to play a significant role in the pathogenesis and severity of COVID-19. Additionally, angiotensin converting enzyme 2 (ACE2) expression may predict the severity and clinical course of COVID-19. Accordingly, the aim of the present study was to evaluate the association of oxidative stress and ACE2 expression with the clinical severity in patients with COVID-19. Methods and results The present study comprised 40 patients with COVID-19 and 40 matched healthy controls, recruited between September 2021 and March 2022. ACE 2 expression levels were measured using Hera plus SYBR Green qPCR kits with GAPDH used as an internal control. Serum melatonin (MLT) levels, serum malondialdehyde (MDA) levels, and total antioxidant capacity (TAC) were estimated using ELISA. The correlations between the levels of the studied markers and clinical indicators of disease severity were evaluated. Significantly, lower expression of ACE2 was observed in COVID-19 patients compared to controls. Patients with COVID-19 had lower serum levels of TAC and MLT but higher serum levels of MDA compared to normal controls. Serum MDA levels were correlated with diastolic blood pressure (DBP), Glasgow coma scale (GCS) scores, and serum potassium levels. Serum MLT levels were positively correlated with DBP, mean arterial pressure (MAP), respiratory rate, and serum potassium levels. TAC was correlated with GCS, mean platelet volume, and serum creatinine levels. Serum MLT levels were significantly lower in patients treated with remdesivir and inotropes. Receiver operating characteristic curve analysis demonstrates that all markers had utility in discriminating COVID-19 patients from healthy controls. Conclusions Increased oxidative stress and increased ACE2 expression were correlated with disease severity and poor outcomes in hospitalized patients with COVID-19 in the present study. Melatonin supplementation may provide a utility as an adjuvant therapy in decreasing disease severity and death in COVID-19 patients.
Author contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ASA, MEE, MEA, RSS, AIO, MAEM. The first draft of the manuscript was written and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB). This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Data availability All data generated or analyzed during this study are included in this published article. Declarations Conflict of interest The authors declare that they have no conflict of interest to declare. Ethics approval The study protocol was carried according to Institutional Ethics Committee of Mansoura University, Egypt (approval number sci-Z-ph-2021-60) which performed in compliance with the ethical guidelines outlined in the 1964 Helsinki Declaration. Patients have signed informed consent form. Consent to participate Not applicable. Consent to publish Not applicable. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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