Vascular endothelial injury exacerbates coronavirus disease 2019: The role of endothelial glycocalyx protection

Abstract

Reports continue to describe the biological, epidemiological, and clinical characteristics of infection with the SARS-CoV-2 and the related disease, coronavirus infection 2019 COVID-19. To date, however, information about the clinical characteristics of patients with COVID-19 who require ICU care remains inadequate or uncertain. A few recent reports have described some characteristics of severe cases of this disease. One study reported that patients in Wuhan, China, who were older than 65 years and presented with

Vascular Endothelial Glycocalyx Damage in COVID-19

“…SARS-CoV-2 directly invades vascular endothelial cells and causes systemic inflammatory microvascular endothelial disorders such as leakage of plasma components from microvessels, intramicrovascular blood clotting and thrombus formation, and excessive release of inflammatory cytokines following vascular endothelial dysfunction [ 16 ]. It might play a central role in the pathogenesis of ARDS [ 20 ] and multi-organ failure [ 21 , 22 , 23 ]. Such a wide variety of serious pathologies can be explained by the concept of “systemic inflammation-reactive microvascular endotheliosis (SIRME)”, in which the VEGLX is rapidly and systemically disrupted ( Figure 4 ).…”

Microvascular dysfunction in COVID-19: the MYSTIC study

“…Elegant in vitro experiments and autopsy studies revealed that SARS-CoV-2 binds to amply expressed angiotensin-converting enzyme 2 (ACE2) receptor and infests directly the endothelial cells [5,6]. This finding has fueled the hypothesis that COVID-19 is actually a vascular illness and that systemic leakiness and adhesiveness of the dysregulated vascular endothelium might play a central role in the pathogenesis of ARDS and multi-organ failure [7][8][9].…”

Viremia and Interaction of Endothelial Cells, Erythrocytes, Leukocytes and Platelets in Type 2 Diabetes Mellitus and COVID-19: A Closer Look at Proposed Mechanisms

“…Note that on the right ½ of this image there are ruffles suggestive of the periodicity of the protrusions of the endothelial glycocalyx (ecGCx) and how to the far-right these ruffles are absent and the vascular wall is smooth. Additionally, note the insert on the far left-hand side of this image, which depicts a transmission electron micrograph (TEM) of a lanthanum nitrate (LAN) perfusion fixed hippocampal continuous capillary with multiple periodic protruding electron dense staining of LAN to demonstrate the periodic nature of the protruding ecGCx (arrows) [62]. The SARS-CoV-2 virus and its ribonucleic acid (RNAemia) are represented and illustrate the increased entry into the regions, which have sustained attenuation and loss of the ecGCx.…”

“…The SARS-CoV-2 virus is capable of causing EC activation and dysfunction and act synergistically with underlying pre-existing comorbidities such as T2DM. The important role of an intact and functioning ecGCx barrier is not to be underestimated and plays a key role in the development and progression of COVID-19 with increased morbidity and mortality [62,63]. Knowledge is still accumulating in regards to the protective functions of the ecGCx as it applies to not only the integrity of EC functions but to each and every cell.…”