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Review
. 2021 Nov 3;22(21):11920.
doi: 10.3390/ijms222111920.

The Role of Endothelium in COVID-19

Mihaela Ionescu  1 , Anca Pantea Stoian  2 , Manfredi Rizzo  2   3 , Dragos Serban  4 , Domenico Nuzzo  5 , Laura Mazilu  6 , Andra Iulia Suceveanu  7 , Ana Maria Dascalu  8 , Irinel Raluca Parepa  1
Affiliations
Review

The Role of Endothelium in COVID-19

Mihaela Ionescu et al. Int J Mol Sci. .

Abstract

The 2019 novel coronavirus, known as severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) or coronavirus disease 2019 (COVID-19), is causing a global pandemic. The virus primarily affects the upper and lower respiratory tracts and raises the risk of a variety of non-pulmonary consequences, the most severe and possibly fatal of which are cardiovascular problems. Data show that almost one-third of the patients with a moderate or severe form of COVID-19 had preexisting cardiovascular comorbidities such as diabetes mellitus, obesity, hypertension, heart failure, or coronary artery disease. SARS-CoV2 causes hyper inflammation, hypoxia, apoptosis, and a renin-angiotensin system imbalance in a variety of cell types, primarily endothelial cells. Profound endothelial dysfunction associated with COVID-19 can be the cause of impaired organ perfusion that may generate acute myocardial injury, renal failure, and a procoagulant state resulting in thromboembolic events. We discuss the most recent results on the involvement of endothelial dysfunction in the pathogenesis of COVID-19 in patients with cardiometabolic diseases in this review. We also provide insights on treatments that may reduce the severity of this viral infection.

Keywords: COVID-19; SARS-CoV-2; complications; endothelium; pathogenesis.

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Conflict of interest statement

The authors declare that the current research was conducted independently in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. A.P.S. is currently Vice President of Romanian National Diabetes Committee, and she has given lectures, received honoraria and research support, and participated in conferences, advisory boards, and clinical trials sponsored by many pharmaceutical companies, including AstraZeneca, Boehringer Ingelheim, Medtronic, Eli Lilly, Merck, Novo Nordisk, Novartis, Roche Diagnostics, and Sanofi. M.R. is a full-time Professor of Internal Medicine at the University of Palermo, Italy, and currently Section Editor in Chief for the International Journal of Molecular Sciences and Medical Director, Novo Nordisk in Eastern Europe; he has given lectures, received honoraria and research support, and participated in conferences, advisory boards, and clinical trials sponsored by many pharmaceutical companies, including Amgen, Astra Zeneca, Boehringer Ingelheim, Kowa, Eli Lilly, Meda, Mylan, Merck Sharp & Dohme, Novo Nordisk, Novartis, Roche Diagnostics, Sanofi and Servier. None of the above had any role in this article, which has been written independently, without any financial or professional help and reflects only the authors’ opinion, without any role of the industry.

Figures

Figure 1
Figure 1
Proposed mechanism of endothelial dysfunction in SARS-CoV-2 infection.
Figure 2
Figure 2
Effects of endothelial dysfunction in COVID-19.
See this image and copyright information in PMC

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