key: cord-350317-a9qd3xdr
authors: Xu, Qiannan; Chen, Lihong; Li, Xia; Zheng, Jie
title: If skin is a potential host of SARS-CoV-2, IL-17 antibody could reduce the risk of COVID-19
date: 2020-11-05
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.10.084
sha: 
doc_id: 350317
cord_uid: a9qd3xdr

nan

To the Editor: In the era of the coronavirus disease 2019 pandemic, debates have emerged on whether biologics might increase the risk of contracting the disease 1 . IL-17 is a biologic that is widely used in dermatology. There were reports that viral reactivation, although extremely low, could be detected during the use of IL-17 antibody 2 . This led to concerns in using the IL-17 antibody because it was believed that it could make patients more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). When we read the article named Skin is a potential host of SARS-CoV-2: a clinical, single-cell transcriptome-profiling and histological study in a recently published issue 3 , a question occurred to us: If skin is a target of SARS-CoV-2, what might be the consequence of using the IL-17 antibody?

ACE2 is the main entrance receptor for SARS-CoV-2. The expression of ACE2 is associated with the potential risk of making the target tissue susceptible to infection by SARS-CoV-2. Therefore, downregulating the expression of ACE2 could lower the risk of COVID-19. To evaluate the influence of IL-17 antibody on skin ACE2 expression, we randomly selected five psoriasis patients who were treated with IL-17 antibody (Taltz, Eli Lilly and Company). The skin lesions of these patients were biopsied on week 0 and week 8 and prepared for RNA sequencing. The skin ACE2 expression of patients who underwent the antibody therapy for 8 weeks (0.36 ± 0.10, n=5) was downregulated when compared with that at week 0 (1.24 ± 0.50, n=5), when the IL-17 antibody treatment was just started (P < 0.05, paired t-test). To confirm the result, we also selected three patients to compare the skin ACE2 expression at weeks 0 and 8 with immunofluorescence. Immunofluorescence staining revealed that the fluorescence intensity of ACE2 was downregulated in the skin at week 8 (0.84 ± 0.26, n=3) when compared to that before the IL-17 antibody treatment (9.23 ± 2.33, n=3, P＜0.05; unpaired t-test). Hence, either the mRNA or protein of ACE2 obtained from psoriasis patients can reveal that IL-17 antibody treatmentremarkably reduces ACE2 expression.

Our work above proves that the IL-17 antibody treatment during the COVID-19 pandemic is not contraindicated. Elevated ACE2 expression and detection of SARS-CoV-2 in the skin 4 of COVID-19 patients implied skin was a potential host of SARS-CoV-2. After IL-17 antibody treatment, the skin ACE2 expression was downregulated which meant IL-17 antibody could lower the risk of COVID-19 through lessening the cells which could interact with SARS-CoV-2. Additionally, IL-17 antibody could reverse the deteriorated barrier and inflammatory status in the skin of psoriasis patient which meant less microbe infection.Herein, the specific microbe could be SARS-CoV-2. Till now there is no evidence that COVID-19 can be spread by contact with skin. However, SARS-CoV-2 could survive on skin for 9h 5 , which indicated that SARS-CoV-2 might transmit through skin in the certain skin status like psoriasis. Thus, whether IL-17 antibody could reduce the COVID-19 risk through reversing the inflammatory skin status with deteriorated barrier and preventing SARS-CoV-2 transmitting should be further discussed.

Should biologics for psoriasis be interrupted in the era of COVID-19?

Risk for hepatitis B and C virus reactivation in patients with psoriasis on biologic therapies: A retrospective cohort study and systematic review of the literature

Skin is a potential host of SARS-CoV-2: a clinical, single-cell transcriptome-profiling and histological study

Epub ahead of print

SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases

Survival of SARS-CoV-2 and influenza virus on the human skin: Importance of hand hygiene in COVID-19

The authors have declared that no conflict of interest exists. None of the authors has any financial interest in any products, devices or drugs used in the manuscript. There is also no conflict of interest related to any commercial associations or financial relationships.