ACE2 localizes to the respiratory cilia and is not increased by ACE inhibitors or ARBs

Ivan T. Lee, Tsuguhisa Nakayama, Chien Ting Wu, Yury Goltsev, Sizun Jiang, Phillip A. Gall, Chun Kang Liao, Liang Chun Shih, Christian M. Schürch, David R. McIlwain, Pauline Chu, Nicole A. Borchard, David Zarabanda, Sachi S. Dholakia, Angela Yang, Dayoung Kim, Han Chen, Tomoharu Kanie, Chia Der Lin, Ming Hsui TsaiKatie M. Phillips, Raymond Kim, Jonathan B. Overdevest, Matthew A. Tyler, Carol H. Yan, Chih Feng Lin, Yi Tsen Lin, Da Tian Bau, Gregory J. Tsay, Zara M. Patel, Yung An Tsou, Alexandar Tzankov, Matthias S. Matter, Chih Jaan Tai, Te Huei Yeh, Peter H. Hwang, Garry P. Nolan, Jayakar V. Nayak, Peter K. Jackson

Research output: Contribution to journalArticlepeer-review

147 Scopus citations


The coronavirus SARS-CoV-2 is the causative agent of the ongoing severe acute respiratory disease pandemic COVID-19. Tissue and cellular tropism is one key to understanding the pathogenesis of SARS-CoV-2. We investigate the expression and subcellular localization of the SARS-CoV-2 receptor, angiotensin-converting enzyme 2 (ACE2), within the upper (nasal) and lower (pulmonary) respiratory tracts of human donors using a diverse panel of banked tissues. Here, we report our discovery that the ACE2 receptor protein robustly localizes within the motile cilia of airway epithelial cells, which likely represents the initial or early subcellular site of SARS-CoV-2 viral entry during host respiratory transmission. We further determine whether ciliary ACE2 expression in the upper airway is influenced by patient demographics, clinical characteristics, comorbidities, or medication use, and show the first mechanistic evidence that the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARBs) does not increase susceptibility to SARS-CoV-2 infection through enhancing the expression of ciliary ACE2 receptor. These findings are crucial to our understanding of the transmission of SARS-CoV-2 for prevention and control of this virulent pathogen.

Original languageEnglish (US)
Article number5453
JournalNature communications
Issue number1
StatePublished - Oct 28 2020

Bibliographical note

Publisher Copyright:
© 2020, The Author(s).


  • Age Factors
  • Angiotensin Receptor Antagonists/therapeutic use
  • Angiotensin-Converting Enzyme 2
  • Angiotensin-Converting Enzyme Inhibitors/therapeutic use
  • COVID-19
  • Cilia/metabolism
  • Coronavirus Infections/pathology
  • Endothelial Cells
  • Gene Expression/drug effects
  • Goblet Cells/metabolism
  • Humans
  • Lung/pathology
  • Pandemics
  • Peptidyl-Dipeptidase A/genetics
  • Pneumonia, Viral/pathology
  • Respiratory System/metabolism
  • Sex Factors
  • Sinusitis/metabolism
  • Smoking

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Journal Article
  • Research Support, N.I.H., Extramural


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