A Link Between Endothelial Dysfunction and SARS-CoV-2 Infection in Patients With COVID-19

Kazumi Fujioka

Department of Radiology, Nihon University School of Medicine, Tokyo, Japan

Dr. Kazumi Fujioka, Department of Radiology, Nihon University School of Medicine, Tokyo, Japan.

Keywords: ARDS; ACE2; SARS-CoV-2; COVID-19; Endothelial Disease


The emerging coronavirus disease 2019 (COVID-19) by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a worldwide outbreak, leading to a major threat to public health. The respiratory failure from acute respiratory distress syndrome (ARDS) as the major cause of mortality and multi-organ failure as other causes of mortality have been revealed in patients with COVID-19. The expression of angiotensin-converting enzyme 2 (ACE2) in the respiratory epithelium, vascular endothelium, and other cell types are recognized and can play a role as a primary mechanism of SARS-CoV-2 entry and infection process. It has been described that host cells infected by SARS-CoV-2 cause ARDS, sequentially stimulating the immune response or cytokine storm, vascular damage, and thrombosis in all arterial beds. It has been thought that clinical manifestations of COVID-19 in the severe stage present an endothelial disease and a systemic disease. In this article, the current knowledges of the link between endothelial dysfunction and SARS-CoV-2 infection have been reviewed. A close association between endothelial dysfunction and SARS-CoV-2 infection has been indicated in patients with COVID-19. The author also emphasizes that COVID-19 may be an endothelial disease and a systemic disease especially in the severe stage. In addition to antiviral and anti-inflammatory treatments, a new therapeutic strategy of use of nitric oxide (NO) focusing on the vascular tone of the endothelial dysfunction may be a potential treatment in patient with COVID-19 especially in the moderate and severe stages.

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