Department of Hematology, The First Hospital, Harbin Medical University, 150001, Harbin, China.
Department of Research, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA.
Angiogenesis. 2024 Feb;27(1):5-22. doi: 10.1007/s10456-023-09878-5. Epub 2023 Apr 27.
The world continues to contend with COVID-19, fueled by the emergence of viral variants. At the same time, a subset of convalescent individuals continues to experience persistent and prolonged sequelae, known as long COVID. Clinical, autopsy, animal and in vitro studies all reveal endothelial injury in acute COVID-19 and convalescent patients. Endothelial dysfunction is now recognized as a central factor in COVID-19 progression and long COVID development. Different organs contain different types of endothelia, each with specific features, forming different endothelial barriers and executing different physiological functions. Endothelial injury results in contraction of cell margins (increased permeability), shedding of glycocalyx, extension of phosphatidylserine-rich filopods, and barrier damage. During acute SARS-CoV-2 infection, damaged endothelial cells promote diffuse microthrombi and destroy the endothelial (including blood-air, blood-brain, glomerular filtration and intestinal-blood) barriers, leading to multiple organ dysfunction. During the convalescence period, a subset of patients is unable to fully recover due to persistent endothelial dysfunction, contributing to long COVID. There is still an important knowledge gap between endothelial barrier damage in different organs and COVID-19 sequelae. In this article, we mainly focus on these endothelial barriers and their contribution to long COVID.
世界仍在与 COVID-19 作斗争,这是由病毒变体的出现所推动的。与此同时,一部分康复患者仍持续存在长期且迁延的后遗症,即长新冠。临床、尸检、动物和体外研究均显示急性 COVID-19 和康复患者存在内皮损伤。内皮功能障碍现已被认为是 COVID-19 进展和长新冠发展的核心因素。不同器官包含不同类型的内皮细胞,每种细胞都有其特定的特征,形成不同的内皮屏障并执行不同的生理功能。内皮损伤导致细胞边缘收缩(通透性增加)、糖萼脱落、富含磷酯酰丝氨酸的丝状伪足延伸以及屏障损伤。在急性 SARS-CoV-2 感染期间,受损的内皮细胞促进弥散性微血栓形成,并破坏内皮(包括血-气、血-脑、肾小球滤过和肠-血)屏障,导致多器官功能障碍。在康复期间,由于持续的内皮功能障碍,一部分患者无法完全康复,导致长新冠。不同器官的内皮屏障损伤与 COVID-19 后遗症之间仍存在重要的知识空白。在本文中,我们主要关注这些内皮屏障及其对长新冠的贡献。
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