RESUMEN
The global propagation of SARS-CoV-2 leads to an unprecedented public health emergency. Despite that the lungs are the primary organ targeted by COVID-19, systemic endothelial inflammation and dysfunction is observed particularly in patients with severe COVID-19, manifested by elevated endothelial injury markers, endotheliitis, and coagulopathy. Here, we review the clinical characteristics of COVID-19 associated endothelial dysfunction; and the likely pathological mechanisms underlying the disease including direct cell entry or indirect immune overreactions after SARS-CoV-2 infection. In addition, we discuss potential biomarkers that might indicate the disease severity, particularly related to the abnormal development of thrombosis that is a fatal vascular complication of severe COVID-19. Furthermore, we summarize clinical trials targeting the direct and indirect pathological pathways after SARS-CoV-2 infection to prevent or inhibit the virus induced endothelial disorders.
Asunto(s)
COVID-19/patología , Endotelio Vascular/patología , SARS-CoV-2 , Adolescente , Adulto , Anciano , Enzima Convertidora de Angiotensina 2/fisiología , Animales , COVID-19/sangre , COVID-19/complicaciones , COVID-19/fisiopatología , COVID-19/terapia , Ensayos Clínicos como Asunto , Células Endoteliales/patología , Células Endoteliales/virología , Endotelio Vascular/inmunología , Endotelio Vascular/fisiopatología , Proteína HMGB1/fisiología , Humanos , Macaca mulatta , Ratones , Neuropilina-1/fisiología , Estrés Oxidativo , Especies Reactivas de Oxígeno , Receptores Virales/fisiología , Receptores Depuradores de Clase B/fisiología , Índice de Severidad de la Enfermedad , Transducción de Señal , Síndrome de Respuesta Inflamatoria Sistémica/patología , Síndrome de Respuesta Inflamatoria Sistémica/fisiopatología , Trombofilia/etiología , Trombofilia/fisiopatología , Factor A de Crecimiento Endotelial Vascular/fisiología , Vasculitis/etiología , Vasculitis/inmunología , Vasculitis/fisiopatología , Adulto JovenRESUMEN
High-mobility group box 1 (HMGB1) is a nuclear protein involved in DNA replication, transcription, recombination, and repair. In the extracellular space, the HMGB1 plays an essential role in the onset and perpetuation of inflammation, belonging to the group of damage-associated molecular pattern (DAMP) molecules, also called alarmins. For this, HMGB1 has been studied in several acute and chronic inflammatory diseases as an early biomarker of inflammation. An increased concentration of HMGB1 has been detected in serum, as the expression of systemic inflammation, and in specific samples (such as stool, synovial fluid, nasal lavage fluid, sputum, and cerebrospinal fluid), as the expression of local production, in several infectious and/or inflammatory diseases. These data are particularly important because they open new futuristic possibilities for target therapies, potentially also for the COVID-19 treatment.