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ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection

View ORCID ProfileLingli Zhou, Zhenhua Xu, View ORCID ProfileGianni M. Castiglione, Uri S. Soiberman, Charles G. Eberhart, Elia J. Duh
doi: https://doi.org/10.1101/2020.05.09.086165
Lingli Zhou
aDepartment of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD USA
cState Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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  • ORCID record for Lingli Zhou
Zhenhua Xu
aDepartment of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Gianni M. Castiglione
aDepartment of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Uri S. Soiberman
aDepartment of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Charles G. Eberhart
aDepartment of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD USA
bDepartment of Pathology, Johns Hopkins University School of Medicine, Sun Yat-sen University, Guangzhou, China
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  • For correspondence: eduh@jhmi.edu ceberha@jhmi.edu
Elia J. Duh
aDepartment of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD USA
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  • For correspondence: eduh@jhmi.edu ceberha@jhmi.edu
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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 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 indicate 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.

Competing Interest Statement

The authors have declared no competing interest.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.
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Posted May 09, 2020.
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ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection
Lingli Zhou, Zhenhua Xu, Gianni M. Castiglione, Uri S. Soiberman, Charles G. Eberhart, Elia J. Duh
bioRxiv 2020.05.09.086165; doi: https://doi.org/10.1101/2020.05.09.086165
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ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection
Lingli Zhou, Zhenhua Xu, Gianni M. Castiglione, Uri S. Soiberman, Charles G. Eberhart, Elia J. Duh
bioRxiv 2020.05.09.086165; doi: https://doi.org/10.1101/2020.05.09.086165

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