Hepatic angiotensin-converting enzyme 2 expression in metabolic dysfunction-associated steatotic liver disease and in patients with fatal COVID-19

Figure 3 Hepatic angiotensin-converting enzyme 2 protein expression is elevated in metabolic dysfunction-associated steatohepatitis without fibrosis and correlates with hepatocyte lipid droplet content. A: Computational quantification of hepatic angiotensin-converting enzyme 2 (ACE2) immunostaining in tissue sections across the histopathological metabolic dysfunction-associated steatotic liver disease (MASLD) spectrum. Metabolic dysfunction-associated steatohepatitis (MASH) - fib = MASH without fibrosis, MASH + fib = MASH with fibrosis. Data was analysed using the Kruskal-Wallis test and Dunn’s post-hoc multiple comparisons (Normal vs MASH - fib: P < 0.05; other comparisons not statistically significant); B: Correlation between histological fibrosis (picrosirius red-positive area) and hepatic ACE2 protein levels (ACE2-positive area) across the MASLD spectrum assessed by Spearman’s rank correlation coefficient: r_s = 0.3, I = 0.09, not statistically significant); C: Correlation between lipid droplet content (lipid droplet-positive area) and hepatic ACE2 protein levels (ACE2-positive area) across the MASLD spectrum assessed by Spearman’s rank correlation coefficient: r_s = 0.5, P = 0.01). ACE2: Angiotensin-converting enzyme 2.