BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly spread from China in 2019/2020 to all continents. Significant geographical and ethnic differences were described, and host genetic background seems to be important for the resistance to and mortality of COVID-19. Angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism (rs4646994) is one of the candidates with the potential to affect infection symptoms and mortality. METHODS: In our study, we successfully genotyped 408 SARS-CoV-2-positive COVID-19 survivors (163 asymptomatic and 245 symptomatic) and compared them with a population-based DNA bank of 2,559 subjects. RESULTS: The frequency of ACE I/I homozygotes was significantly increased in COVID-19 patients compared with that in controls (26.2% vs. 21.2%; P = 0.02; OR [95% CI] = 1.55 [1.17-2.05]. Importantly, however, the difference was driven just by the symptomatic subjects (29.0% vs. 21.2% of the I/I homozygotes; P = 0.002; OR [95% CI] = 1.78 [1.22-2.60]). The genotype distribution of the ACE genotypes was almost identical in population controls and asymptomatic SARS-CoV-2-positive patients (P = 0.76). CONCLUSIONS: We conclude that ACE I/D polymorphism could have the potential to predict the severity of COVID-19, with I/I homozygotes being at increased risk of symptomatic COVID-19.

Czech Technical University Faculty of Biomedical Engineering Sítná 3105 Kladno Czech Republic

Czech Technical University Faculty of Biomedical Engineering Sítná 3105 Kladno Czech Republic; Department of Preventive Cardiology Institute for Clinical and Experimental Medicine Videnska 1958 9 Prague Czech Republic

Department of Preventive Cardiology Institute for Clinical and Experimental Medicine Videnska 1958 9 Prague Czech Republic

Experimental Medicine Center Institute for Clinical and Experimental Medicine Videnska 1958 9 Prague Czech Republic

Institute of Health Information and Statistics of the Czech Republic Palackeho namesti 4 Prague Czech Republic; Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Kamenice753 5 Brno Czech Republic

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