Fortini Francesca, Vieceli Dalla Sega Francesco, Marracino Luisa, Severi Paolo, Rapezzi Claudio, Rizzo Paola, Ferrari Roberto
Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy.
Laboratory for Technologies of Advanced Therapies (LTTA), Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy.
Biomedicines. 2021 Aug 11;9(8):997. doi: 10.3390/biomedicines9080997.
Endothelial dysfunction characterizes every aspect of the so-called cardiovascular continuum, a series of events ranging from hypertension to the development of atherosclerosis and, finally, to coronary heart disease, thrombus formation, myocardial infarction, and heart failure. Endothelial dysfunction is the main prognostic factor for the progression of vascular disorders, which responds to drug intervention and lifestyle changes. Virtually all of the drugs used to prevent cardiovascular disorders, such as long-used and new antilipidemic agents and inhibitors of angiotensin enzyme (ACEi), exert an important effect on the endothelium. Endothelial dysfunction is a central feature of coronavirus disease -19 (COVID-19), and it is now clear that life-risk complications of the disease are prompted by alterations of the endothelium induced by viral infection. As a consequence, the progression of COVID-19 is worse in the subjects in whom endothelial dysfunction is already present, such as elderly, diabetic, obese, and hypertensive patients. Importantly, circulating biomarkers of endothelial activation and injury predict the severity and mortality of the disease and can be used to evaluate the efficacy of treatments. The purpose of this review is to provide updates on endothelial function by discussing its clinical relevance in the cardiovascular continuum, the latest insights from molecular and cellular biology, and their implications for clinical practice, with a focus on new actors, such as the Notch signaling and emerging therapies for cardiovascular disease.
内皮功能障碍是所谓心血管连续体各个方面的特征，这一系列事件包括从高血压到动脉粥样硬化的发展，最终到冠心病、血栓形成、心肌梗死和心力衰竭。内皮功能障碍是血管疾病进展的主要预后因素，它对药物干预和生活方式改变有反应。几乎所有用于预防心血管疾病的药物，如长期使用的和新型的抗血脂药物以及血管紧张素酶抑制剂（ACEi），都对内皮产生重要影响。内皮功能障碍是冠状病毒病-19（COVID-19）的一个核心特征，现在很清楚，该疾病的危及生命的并发症是由病毒感染引起的内皮改变所引发的。因此，在已经存在内皮功能障碍的患者中，如老年人、糖尿病患者、肥胖患者和高血压患者，COVID-19的进展更差。重要的是，内皮激活和损伤的循环生物标志物可预测该疾病的严重程度和死亡率，并可用于评估治疗效果。本综述的目的是通过讨论内皮功能在心血管连续体中的临床相关性、分子和细胞生物学的最新见解及其对临床实践的影响，提供内皮功能的最新信息，重点关注新的因素，如Notch信号通路和心血管疾病的新兴疗法。
