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Endothelial dysfunction in COVID-19: Current findings and therapeutic implications.

  • Nägele MP Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
  • Haubner B Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
  • Tanner FC Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
  • Ruschitzka F Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
  • Flammer AJ Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland. Electronic address: andreas.flammer@usz.ch.
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  • 2020-11-08
Published in:
  • Atherosclerosis. - 2020
COVID-19
Coronavirus
Endothelial dysfunction
Renin angiotensin system
SARS-CoV2
Statin
English Coronavirus disease 2019 (COVID-19) increases the risk of several non-pulmonary complications such as acute myocardial injury, renal failure or thromboembolic events. A possible unifying explanation for these phenomena may be the presence of profound endothelial dysfunction and injury. This review provides an overview on the association of endothelial dysfunction with COVID-19 and its therapeutic implications. Endothelial dysfunction is a common feature of the key comorbidities that increase risk for severe COVID-19 such as hypertension, obesity, diabetes mellitus, coronary artery disease or heart failure. Preliminary studies indicate that vascular endothelial cells can be infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and evidence of widespread endothelial injury and inflammation is found in advanced cases of COVID-19. Prior evidence has established the crucial role of endothelial cells in maintaining and regulating vascular homeostasis and blood coagulation. Aggravation of endothelial dysfunction in COVID-19 may therefore impair organ perfusion and cause a procoagulatory state resulting in both macro- and microvascular thrombotic events. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and statins are known to improve endothelial dysfunction. Data from smaller observational studies and other viral infections suggests a possible beneficial effect in COVID-19. Other treatments that are currently under investigation for COVID-19 may also act by improving endothelial dysfunction in patients. Focusing therapies on preventing and improving endothelial dysfunction could improve outcomes in COVID-19. Several clinical trials are currently underway to explore this concept.
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  • English
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hybrid
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https://sonar.ch/global/documents/152455
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