Interestingly, in contrast to worse outcomes in ACE2-high colon expressing adults, we15 and others22 previously reported worse clinical phenotypes, such as increased risk of macroscopic inflammation with deep ulcers15 and the development of disease complication (stricture and penetration)22, in a subset of pediatric CD patients with low ileal ACE2 expression compared to those with high ACE2 expression. The gene discussed is ACE2; the disease is Cowden disease.