— Background: A human severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to be responsible for coronavirus disease 2019 (COVID-19). Pulmonary complications has been considered as the classical clinical manifestations until symptoms on the extra-pulmonary organs may also occur recently, which might be linked to the presence of angiotensin-converting enzyme 2 (ACE2) receptor. Objective: This article evaluates clinical manifestation of COVID-19 and the presence of ACE2 receptor by looking at its interaction to SARS-CoV-2. Methods: 27 articles in English have been selected through search engine PubMed and Google Scholar by using specific keywords. These articles include research journals, case report, systematic review and meta-analysis, and textbooks. Result: Pathogenesis of COVID-19 begins with the binding of spike protein SARS-CoV-2 to ACE2 receptor of host cells. Clinical manifestation of COVID-19 is no longer limited to the pulmonary system but also extra-pulmonary systems since ACE2 receptor abundantly distributed on the other organs. Further, genetic variations of region binding protein of viral spike protein and ACE2 receptor may predispose clinical manifestation of COVID19.  Conclusions: Dynamic interplay between SARS-CoV-2 and receptor ACE2 has great implication to the clinical symptoms. Genetic variation of spike protein SARS-CoV-2 play role not only for cross transmission but also its virulence, while genetic variation of human receptor ACE2 influences its susceptibility or resistance against the infection.
Keywords: ACE2 receptor, Coronavirus Diseases-19, clinical manifestation, SARS-CoV-2, genetic variation.