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Updated: May 10, 2025
Methods for Acute and Subacute Murine Hindlimb Ischemia
Published on: June 21, 2016
COVID-19 and acute limb ischemia: latest hypotheses of pathophysiology and molecular mechanisms
Chengjun Yao1,2, Yanzhao Dong1, Haiying Zhou1
1Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Insights
This study explores the complex mechanisms behind acute limb ischemia (ALI) in COVID-19 patients, highlighting vasospasm, hypoxia, and inflammation. It also reviews potential treatments for this severe coronavirus complication.
Area of Science:
- Vascular Medicine
- Infectious Diseases
- Pathophysiology
Background:
- Coronavirus disease 2019 (COVID-19) is a multi-system illness with severe complications.
- Acute limb ischemia (ALI) is an emerging complication of COVID-19, often indicating a poor prognosis.
Purpose of the Study:
- To elucidate the pathophysiology and molecular mechanisms of COVID-19-associated ALI.
- To identify risk factors and therapeutic strategies for COVID-19-related ALI.
Main Methods:
- Review of existing literature on COVID-19 and ALI.
- Analysis of molecular pathways including hypercoagulability, vasospasm, hypoxia, acidosis, ACE2, inflammation, and platelet activation.
- Discussion of genetic, age, and gender risk factors.
Main Results:
- Hypercoagulability and thrombosis are key, but vasospasm, hypoxia, and acidosis also contribute significantly to ALI pathogenesis.
- The angiotensin-converting enzyme 2 (ACE2) pathway, inflammation, and platelet activation are implicated molecular mechanisms.
- Potential risk factors and therapeutic targets like IL-6 blockers, calcium channel blockers, and ACE inhibitors are identified.
Conclusions:
- Understanding the multifaceted mechanisms of COVID-19-associated ALI is crucial for effective management.
- Targeting pathways like IL-6, ACE2, and addressing vasospasm, hypoxia, and thrombosis may improve patient outcomes.
Abstract:
Coronavirus disease 2019 (COVID-19) is a multi-system disease that can lead to various severe complications. Acute limb ischemia (ALI) has been increasingly recognized as a COVID-19-associated complication that often predicts a poor prognosis. However, the pathophysiology and molecular mechanisms underlying COVID-19-associated ALI remain poorly understood. Hypercoagulability and thrombosis are considered important mechanisms, but we also emphasize the roles of vasospasm, hypoxia, and acidosis in the pathogenesis of the disease. The angiotensin-converting enzyme 2 (ACE2) pathway, inflammation, and platelet activation may be important molecular mechanisms underlying these pathological changes induced by COVID-19. Furthermore, we discuss the hypotheses of risk factors for COVID-19-associated ALI from genetic, age, and gender perspectives based on our analysis of molecular mechanisms. Additionally, we summarize therapeutic approaches such as use of the interleukin-6 (IL-6) blocker tocilizumab, calcium channel blockers, and angiotensin-converting enzyme inhibitors, providing insights for the future treatment of coronavirus-associated limb ischemic diseases.
