Carrying APOL1 G1 allele is associated with cardiovascular complications during COVID-19 in an admixed population.

Abstract

BACKGROUND: The APOL1 G1 and G2 alleles were selected in the Sub-Saharan African population by conferring resistance to trypanosome infection. However, these alleles are associated with kidney diseases, and their role in cardiovascular complications remains uncertain. A second hit mediated by an inflammatory state is necessary for APOL1-mediated phenotypes. Thus, this cross-sectional study investigates the association of APOL1 alleles with COVID-19 outcomes such as cardiovascular complications and kidney injury in an admixed population. Whole-genome sequencing was performed for 485 patients with different outcomes from a Biobank in Southern Brazil. RESULTS: COVID-19 individuals presented median age of 51 years, 281 were hospitalized, and 10.9% had CKD previous to the infection. Global ancestry inference revealed 12.8% of African ancestry. The G1 allele frequency was 2.7% and G2 allele was 1.2%. Local ancestry inference evidenced African ancestry in the locus of APOL1 alleles. The G1 allele frequency was higher among patients with severe outcomes. The presence of this allele was associated with kidney injury (OR = 2.78; 95% CI = 1.04-7.42; p = 0.041) using a minimally adjusted model and cardiovascular complications with a minimally (OR = 4.61; 95% CI = 1.61-13.19; p = 0.004) and fully adjusted model (OR = 4.59; 95% CI = 1.41-14.96; p = 0.011). Four individuals carried two alleles (three G1/G1 and one G1/G2) and three of them progressed to severe COVID-19 developing kidney injury. CONCLUSION: APOL1 risk alleles are present in the Brazilian population due to genetic admixture and the G1 allele was associated with COVID-19 outcomes.