Indications of Persistent Glycocalyx Damage in Convalescent COVID-19 Patients: A Prospective Multicenter Study and Hypothesis

Abstract

The COVID-19 pandemic is caused by the SARS CoV-2 virus and can lead to severe lung damage and hyperinflammation. In the context of COVID-19 infection, inflammation-induced degradation of the glycocalyx layer in endothelial cells has been demonstrated. Syndecan-1 (SDC-1) is an established parameter for measuring glycocalyx injury. This prospective, multicenter, observational, cross-sectional study analyzed SDC-1 levels in 24 convalescent patients that had been infected with SARS-CoV-2 with mild disease course without need of hospitalization. We included 13 age-matched healthy individuals and 10 age-matched hospitalized COVID-19 patients with acute mild disease course as controls. In convalescent COVID-19 patients, significantly elevated SDC-1 levels were detected after a median of 88 days after symptom onset compared to healthy controls, whereas no difference was found when compared to SDC-1 levels of hospitalized patients undergoing acute disease. This study is the first to demonstrate signs of endothelial damage in non-pre-diseased, convalescent COVID-19 patients after mild disease progression without hospitalization. The data are consistent with studies showing evidence of persistent endothelial damage after severe or critical disease progression. Further work to investigate endothelial damage in convalescent COVID-19 patients should follow.

Combining L-Arginine with vitamin C improves long-COVID symptoms: The LINCOLN Survey

“…Strikingly, elevated levels of circulating endothelial cells persisted in recovered COVID-19 convalescent patients [100] , denoting long-term detrimental effects of SARS-CoV-2 infection on endothelial function. Actual signs of endothelial damage (denoted by glycocalyx damage) have been reported in convalescent COVID-19 patients after mild disease progression without hospitalization [101] . Other studies evidenced that sustained endotheliopathy is common in convalescent COVID-19 subjects [102] , and that Long-COVID symptoms, specifically non-respiratory symptoms, are mainly due to persistent endothelial dysfunction [103] .…”

Sulodexide Significantly Improves Endothelial Dysfunction and Alleviates Chest Pain and Palpitations in Patients With Long-COVID-19: Insights From TUN-EndCOV Study

“…In a review about the pathogenesis of COVID-19 through the lens of an undersulfated and degraded epithelial and endothelial glycocalyx, the prevention and treatment protocols proposed were to preserve and repair epithelial and endothelial glycocalyx integrity ( 33 ). This objective seems to be relevant to the patients with post-COVID-19 with persistent glycocalyx damage and endothelial dysfunction ( 34 , 35 ).…”

Approach to the management of COVID-19 patients: When home care can represent the best practice

“…In fact, a well-controlled, mild, and transitory eustress could activate a healthy response in an organism toward diseases where the oxidative stress is able to heavily damage the glycocalyx. This is more evident in pathological conditions such as COVID-19 and so-called "long COVID", which affects different organs, and where conditions of vascular damage are long-lasting and find little benefit from traditional therapies [65,66]. Epigenetics, translational research, and regenerative medicine, as well as personalized medicine, are the main avenues for future research directions, capitalizing on what we have learned because of the terrible losses during this pandemic; reaffirming the importance of patient safety, pharmaceutical care, and medical liability once the real etiopathogenesis of COVID-19 is understood.…”