ACE2 protein levels were significantly elevated in MASH without fibrosis ( P = 0.02; Figure 3A ) and were also increased in simple steatosis although this did not achieve significance compared to normal healthy liver controls ( P = 0.33; Figure 3A ).
Mechanisms of injury at the cellular level remain unclear, but it may be significant that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes COVID-19, uses angiotensin-converting expression enzyme 2 (ACE2), a key regulator of the ‘anti-inflammatory’ arm of the renin-angiotensin system, for viral attachment and host cell invasion.