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. 2021 May 28;12:653045. doi: 10.3389/fphys.2021.653045

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Copyright © 2021 Kaur, Yogeswaran, Muthumalage and Rahman.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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SARS-CoV2 infection leads to increased ACE2 activity and serum cytokine levels in smokers. Serum samples from healthy individuals and COVID-19 positive patients with smoking history were compared for ACE2 activity and levels of inflammatory cytokines/chemokines. The results pointed toward increased ACE2 activity and altered AngII and Ang1–7 levels in the serum of COVID-19 patients as compared to normal individuals. The altered AngII and Ang1–7 levels could also be a result of non-ACE2 dependent mechanisms which is not studied here. Increased levels of pro-inflammatory cytokines/chemokines in COVID-19 positive patients with smoking history, indicates a heightened immune response on SARS-CoV2 infection in smokers. We also found evidence for lowered serum furin and altered lipid profiles amongst COVID-19 patients, which may or may not correlate with the ACE2 activity. These alterations can lead to heightened inflammatory response and lung remodeling with smoking/vaping history.