Is the Endothelium the Missing Link in the Pathophysiology and Treatment of COVID-19 Complications?
Por:
Castro, P, Palomo, M, Moreno-Castano, AB, Fernandez, S, Torramade-Moix, S, Pascual, G, Martinez-Sanchez, J, Richardson, E, Tellez, A, Nicolas, JM, Carreras, E, Richardson, PG, Badimon, JJ, Escolar, G and Diaz-Ricart, M
Publicada:
1 jun 2022
Ahead of Print:
1 jun 2021
Resumen:
Patients with COVID-19 present a wide spectrum of disease severity, from asymptomatic cases in the majority to serious disease leading to critical care and even death. Clinically, four different scenarios occur within the typical disease timeline: first, an incubation and asymptomatic period; second, a stage with mild symptoms due mainly to the virus itself; third, in up to 20% of the patients, a stage with severe symptoms where a hyperinflammatory response with a cytokine storm driven by host immunity induces acute respiratory distress syndrome; and finally, a post-acute sequelae (PASC) phase, which present symptoms that can range from mild or annoying to actually quite incapacitating. Although the most common manifestation is acute respiratory failure of the lungs, other organs are also frequently involved. The clinical manifestations of the COVID-19 infection support a key role for endothelial dysfunction in the pathobiology of this condition. The virus enters into the organism via its interaction with angiotensin-converting enzyme 2-receptor that is present prominently in the alveoli, but also in endothelial cells, which can be directly infected by the virus. Cytokine release syndrome can also drive endothelial damage independently. Consequently, a distinctive feature of SARS-CoV-2 infection is vascular harm, with severe endothelial injury, widespread thrombosis, microangiopathy, and neo-angiogenesis in response to endothelial damage. Therefore, endothelial dysfunction seems to be the pathophysiological substrate for severe COVID-19 complications. Biomarkers of endothelial injury could constitute strong indicators of disease progression and severity. In addition, the endothelium could represent a very attractive target to both prevent and treat these complications. To establish an adequate therapy, the underlying pathophysiology and corresponding clinical stage should be clearly identified. In this review, the clinical features of COVID-19, the central role of the endothelium in COVID-19 and in other pathologies, and the potential of specific therapies aimed at protecting the endothelium in COVID-19 patients are addressed.
Filiaciones:
Castro, P:
Hosp Clin Barcelona, Med Intens Care Unit, Barcelona, Spain
Univ Barcelona, Sch Med, Barcelona, Spain
IDIBAPS, Barcelona, Spain
:
Univ Barcelona, Hosp Clin, Josep Carreras Leukaemia Res Inst, Barcelona, Spain
Barcelona Endothelium Team, Barcelona, Spain
Moreno-Castano, AB:
Barcelona Endothelium Team, Barcelona, Spain
Hosp Clin Barcelona, CDB, Pathol Dept, Hematopathol, Villarroel 170, Barcelona 08036, Spain
Fernandez, S:
Hosp Clin Barcelona, Med Intens Care Unit, Barcelona, Spain
Torramade-Moix, S:
IDIBAPS, Barcelona, Spain
Hosp Clin Barcelona, CDB, Pathol Dept, Hematopathol, Villarroel 170, Barcelona 08036, Spain
Pascual, G:
Arrels Ctr Dent, Badalona, Spain
:
Univ Barcelona, Hosp Clin, Josep Carreras Leukaemia Res Inst, Barcelona, Spain
Barcelona Endothelium Team, Barcelona, Spain
Richardson, E:
Quinnipiac Univ, Frank H Netter MD Sch Med At, North Haven, CT USA
Yale Univ, Sch Med, Dept Surg, New Haven, CT 06510 USA
Tellez, A:
Hosp Clin Barcelona, Med Intens Care Unit, Barcelona, Spain
Nicolas, JM:
Hosp Clin Barcelona, Med Intens Care Unit, Barcelona, Spain
Univ Barcelona, Sch Med, Barcelona, Spain
:
Univ Barcelona, Hosp Clin, Josep Carreras Leukaemia Res Inst, Barcelona, Spain
Barcelona Endothelium Team, Barcelona, Spain
Richardson, PG:
Harvard Med Sch, Dana Farber Canc Inst, Jerome Lipper Multiple Myeloma Ctr, Div Hematol Malignancy,Dept Med Oncol, Boston, MA 02115 USA
Badimon, JJ:
Mt Sinai Hosp, Cardiol Dept, Cardiovasc Inst, New York, NY 10029 USA
Icahn Sch Med Mt Sinai, Cardiovasc Inst, AtheroThrombosis Res Unit, New York, NY 10029 USA
Escolar, G:
Univ Barcelona, Sch Med, Barcelona, Spain
IDIBAPS, Barcelona, Spain
Barcelona Endothelium Team, Barcelona, Spain
Hosp Clin Barcelona, CDB, Pathol Dept, Hematopathol, Villarroel 170, Barcelona 08036, Spain
Diaz-Ricart, M:
Univ Barcelona, Sch Med, Barcelona, Spain
IDIBAPS, Barcelona, Spain
Barcelona Endothelium Team, Barcelona, Spain
Hosp Clin Barcelona, CDB, Pathol Dept, Hematopathol, Villarroel 170, Barcelona 08036, Spain
Green Published, Bronze
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