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Persistent Endothelial Lung Damage and Impaired Diffusion Capacity in Long COVID
Andreas T Asimakos1, Alice G Vassiliou1, Chrysi Keskinidou1
1First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece.
Insights
Endothelial dysfunction markers are elevated in long COVID patients, impacting lung function and physical capacity. Soluble adhesion molecules like sICAM-1 and sVCAM-1 correlate with reduced lung diffusion and exercise tolerance.
Area of Science:
- Cardiovascular Biology
- Pulmonology
- Infectious Diseases
Background:
- Long COVID, a persistent condition post-SARS-CoV-2 infection, presents diverse symptoms.
- Endothelial activation and dysfunction are implicated in COVID-19 severity and mortality.
- The role of endothelial biomarkers in long COVID sequelae requires further investigation.
Purpose of the Study:
- To investigate the association between endothelial activation/dysfunction biomarkers and long COVID syndrome.
- To explore the relationship between endothelial markers and functional capacity in long COVID patients.
Main Methods:
- Observational study including 68 long COVID patients and a healthy control group.
- Measurement of 13 endothelial biomarkers in both groups.
- Assessment of fatigue, dyspnea, lung diffusion capacity (DLCO), and 6-minute walk test (6MWT) in long COVID patients.
Main Results:
- Long COVID patients exhibited higher levels of endothelial activation/dysfunction markers compared to controls.
- Soluble intracellular adhesion molecule 1 (sICAM-1) and soluble vascular adhesion molecule 1 (sVCAM-1) showed significant negative correlations with DLCO and 6MWT.
- sVCAM-1 demonstrated a strong negative correlation with 6MWT (r = -0.504, p < 0.0001).
Conclusions:
- Endothelial activation/dysfunction plays a role in the pathophysiology of long COVID.
- Endothelial biomarkers, particularly sICAM-1 and sVCAM-1, may serve as indicators of impaired lung and functional capacity in long COVID.
- Integrating endothelial biomarker assessment with clinical tests can enhance understanding of long COVID mechanisms.
Abstract:
Since the beginning of the pandemic, both COVID-19-associated coagulopathy biomarkers and a plethora of endothelial biomarkers have been proposed and tested as prognostic tools of severity and mortality prediction. As the pandemic is gradually being controlled, attention is now focusing on the long-term sequelae of COVID-19. In the present study, we investigated the role of endothelial activation/dysfunction in long COVID syndrome. This observational study included 68 consecutive long COVID patients and a healthy age and sex-matched control group. In both groups, we measured 13 endothelial biomarkers. Moreover, in the long COVID patients, we evaluated fatigue and dyspnea severity, lung diffusion capacity (DLCO), and the 6-min walk (6MWT) test as measures of functional capacity. Our results showed that markers of endothelial activation/dysfunction were higher in long COVID patients, and that soluble intracellular adhesion molecule 1 (sICAM-1) and soluble vascular adhesion molecule 1 (sVCAM-1) negatively correlated with lung diffusion and functional capacity (sICAM-1 vs. DLCO, r = -0.306, p = 0.018; vs. 6MWT, r = -0.263, p = 0.044; and sVCAM-1 vs. DLCO, r= -0.346, p = 0.008; vs. 6MWT, r = -0.504, p < 0.0001). In conclusion, evaluating endothelial biomarkers alongside clinical tests might yield more specific insights into the pathophysiological mechanisms of long COVID manifestations.
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