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Is the Endothelium the Missing Link in the Pathophysiology and Treatment of COVID-19 Complications?
Castro, Pedro; Palomo, Marta; Moreno-Castaño, Ana Belen; Fernández, Sara; Torramadé-Moix, Sergi; Pascual, Georgina; Martinez-Sanchez, Julia; Richardson, Edward; Téllez, Adrián; Nicolas, Josep M; Carreras, Enric; Richardson, Paul G; Badimon, Juan José; Escolar, Gines; Diaz-Ricart, Maribel.
  • Castro P; Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.
  • Palomo M; School of Medicine, University of Barcelona, Barcelona, Spain.
  • Moreno-Castaño AB; IDIBAPS, Barcelona, Spain.
  • Fernández S; Josep Carreras Leukaemia Research Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Torramadé-Moix S; Barcelona Endothelium Team, Barcelona, Spain.
  • Pascual G; Barcelona Endothelium Team, Barcelona, Spain.
  • Martinez-Sanchez J; Hematopathology, Pathology Department, CDB, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain.
  • Richardson E; Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.
  • Téllez A; Barcelona Endothelium Team, Barcelona, Spain.
  • Nicolas JM; IDIBAPS, Barcelona, Spain.
  • Carreras E; Hematopathology, Pathology Department, CDB, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain.
  • Richardson PG; Arrels Centre Dental, Badalona, Spain.
  • Badimon JJ; Josep Carreras Leukaemia Research Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Escolar G; Barcelona Endothelium Team, Barcelona, Spain.
  • Diaz-Ricart M; Frank H. Netter M.D. School of Medicine At, Quinnipiac University, North Haven, CT, USA.
Cardiovasc Drugs Ther ; 36(3): 547-560, 2022 06.
Article in English | MEDLINE | ID: covidwho-1258224
ABSTRACT
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vascular Diseases / COVID-19 Type of study: Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Cardiovasc Drugs Ther Journal subject: Vascular Diseases / Cardiology / Drug Therapy Year: 2022 Document Type: Article Affiliation country: S10557-021-07207-w

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vascular Diseases / COVID-19 Type of study: Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Cardiovasc Drugs Ther Journal subject: Vascular Diseases / Cardiology / Drug Therapy Year: 2022 Document Type: Article Affiliation country: S10557-021-07207-w