Vascular Manifestations of COVID-19 -Thromboembolism and Microvascular Dysfunction

Abstract

The coronavirus pandemic has reportedly infected over 22 million individuals and caused over 778,000 deaths worldwide. Thisnovel coronavirus, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although primarily causessignificant respiratory distress, can have significant deleterious effects on the cardiovascular system. Severe cases of the virusfrequently result in respiratory distress requiring mechanical ventilation, often seen, but not confined to, individuals withpre-existing hypertension and cardiovascular disease, potentially due to the fact that the virus can enter the circulation via thelung alveoli. Here the virus can directly infect vascular tissues, via TMPRSS2 spike glycoprotein priming, thereby facilitating ACE-2-mediated viral entry. Clinical manifestations, such as vasculitis, have been detected in a number of vascular beds (e.g. lungs, heart,and kidneys), with thromboembolism being observed in patients suffering from severe coronavirus disease (COVID-19), suggestingthe virus perturbs the vasculature, leading to vascular dysfunction. Activation of endothelial cells via the immune-mediatedinflammatory response and viral infection of either endothelial cells or cells involved in endothelial homeostasis, are some of themultifaceted mechanisms potentially involved in the pathogenesis of vascular dysfunction within COVID-19 patients. In this review,we examine the evidence of vascular manifestations of SARS-CoV-2, the potential mechanism(s) of entry into vascular tissue and thecontribution of endothelial cell dysfunction and cellular crosstalk in this vascular tropism of SARS-CoV-2. Moreover, we discuss thecurrent evidence on hypercoagulability and how it relates to increased microvascular thromboembolic complications in COVID-19.

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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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DOI

https://doi.org/10.3389/fcvm.2020.598400

Repository URI

http://researchrepository.napier.ac.uk/Output/2689474