Increased Angiotensin-Converting Enzyme 2 and Loss of Alveolar Type II Cells in COVID-19-related Acute Respiratory Distress Syndrome.

In contrast to ACE2, pulmonary expression of ACE ( Figure 1C , lower panel, with detailed immunostaining provided in Figure E1 in the online supplement) was decreased in COVID-19–related (0.64% [0.27–1.64] of total tissue area) and COVID-19–unrelated ARDS (0.71% [0.057–1.54]) ( Figure 1D ) compared with controls (2.11% [0.84–5.14]; P = 0.057 and P = 0.0323, respectively) ( Figure 1B ), although this did not reach statistical significance for COVID-19–related ARDS lungs ( Figure 1E ).

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