COVID-19-Associated Endothelial Dysfunction and Microvascular Injury: From Pathophysiology to Clinical Manifestations

Maria Paola Canale; Rossella Menghini; Eugenio Martelli; Massimo Federici

doi:10.1016/j.ccep.2021.10.003

COVID-19-Associated Endothelial Dysfunction and Microvascular Injury: From Pathophysiology to Clinical Manifestations

Card Electrophysiol Clin. 2022 Mar;14(1):21-28. doi: 10.1016/j.ccep.2021.10.003. Epub 2021 Oct 30.

Authors

Maria Paola Canale¹, Rossella Menghini², Eugenio Martelli³, Massimo Federici⁴

Affiliations

¹ Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Center for Atherosclerosis, Policlinico Tor Vergata, Rome, Italy.
² Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
³ Department of General and Specialist Surgery "P. Stefanini", Sapienza University of Rome, Italy; Division of Vascular Surgery, S. Anna and S. Sebastiano Hospital, Caserta, Italy.
⁴ Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Center for Atherosclerosis, Policlinico Tor Vergata, Rome, Italy. Electronic address: federicm@uniroma2.it.

Abstract

Coronavirus-19 disease (COVID-19) affects more people than previous coronavirus infections and has a higher mortality. Higher incidence and mortality can probably be explained by COVID-19 causative agent's greater affinity (about 10-20 times) for angiotensin-converting enzyme 2 (ACE2) receptor compared with other coronaviruses. Here, the authors first summarize clinical manifestations, then present symptoms of COVID-19 and the pathophysiological mechanisms underlying specific organ/system disease. The worse clinical outcome observed in COVID-19 patients with diabetes may be in part related to the increased ADAM17 activity and its unbalanced interplay with ACE2. Therefore, strategies aimed to inhibit ADAM17 activity may be explored to develop new effective therapeutic approaches.

Keywords: ACE2; ADAM17; Covid-19 clinical manifestations; Endothelial dysfunction; Systemic inflammation.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

COVID-19*
Humans
SARS-CoV-2
Vascular Diseases*