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Damage to endothelial barriers and its contribution to long COVID

Xiaoming Wu1, Mengqi Xiang1, Haijiao Jing1

  • 1Department of Hematology, The First Hospital, Harbin Medical University, 150001, Harbin, China.

Angiogenesis
|April 27, 2023
PubMed

Insights

Endothelial injury and dysfunction are key drivers of severe COVID-19 and long COVID. This review explores how damage to endothelial barriers in various organs contributes to persistent symptoms after SARS-CoV-2 infection.

Area of Science:

  • Cardiovascular Biology
  • Infectious Diseases
  • Pathology

Background:

  • COVID-19, caused by SARS-CoV-2, presents ongoing global health challenges, exacerbated by emerging viral variants.
  • A significant portion of individuals recovering from acute infection develop persistent symptoms, termed long COVID.
  • Endothelial injury and dysfunction are consistently observed in both acute COVID-19 and convalescent patients across multiple study types.

Purpose of the Study:

  • To elucidate the role of endothelial barriers in the pathogenesis of long COVID.
  • To highlight the knowledge gap concerning organ-specific endothelial barrier damage and its sequelae.
  • To review the mechanisms of endothelial injury and dysfunction in the context of SARS-CoV-2 infection.

Main Methods:

  • Review of clinical, autopsy, animal, and in vitro studies.
  • Analysis of the structural and functional changes in endothelial cells and barriers.
  • Focus on the impact of endothelial barrier damage on different organ systems.

Main Results:

  • Endothelial injury manifests as increased permeability, glycocalyx shedding, and barrier disruption.
  • During acute SARS-CoV-2 infection, endothelial damage leads to microthrombi and multiple organ dysfunction.
  • Persistent endothelial dysfunction in convalescence is a significant contributor to long COVID development.

Conclusions:

  • Endothelial barriers play a critical role in the diverse manifestations of long COVID.
  • Understanding organ-specific endothelial dysfunction is crucial for addressing long COVID.
  • Targeting endothelial injury pathways may offer therapeutic strategies for long COVID recovery.

Keywords:
Antithrombotic therapyEndothelial barrierLong COVIDVaccination

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