Pathophysiology of endothelial injury and coagulation alterations in patients with COVID-19

Authors

  • Mileidys León García Universidad de Ciencias Médicas de Pinar del Río. Facultad de Ciencias Médicas Dr. Ernesto Guevara de la Serna. Pinar del Río, Cuba https://orcid.org/0000-0001-9241-2042
  • Yunit Hernéndez Rodríguez Universidad de Ciencias Médicas de Pinar del Río. Facultad de Ciencias Médicas Dr. Ernesto Guevara de la Serna. Pinar del Río, Cuba https://orcid.org/0000-0002-1731-6816
  • Raúl Alexander Vento Pérez Universidad de Ciencias Médicas de Pinar del Río. Facultad de Ciencias Médicas Dr. Ernesto Guevara de la Serna. Pinar del Río, Cuba https://orcid.org/0000-0001-6102-571X

Keywords:

SARS-COV-2, COVID-19, CORONAVIRUS, ENDOTHELIAL, BLOOD COAGULATION DISORDERS, INFECTIOUS DISEASE INCUBATION PERIOD, COMMUNICABLE DISEASES.

Abstract

Introduction: SARS-CoV-2 infection can frequently induce endothelial injury and coagulation alterations, which has led experts to suggest that the signs and symptoms caused by this virus is comparable to the clinical phenotype of endothelial dysfunction.

Objective: to describe the pathophysiological mechanisms involved in endothelial injury and coagulation alterations in patients with COVID-19.

Methods: a literature review was conducted, using articles retrieved from SciELO, PubMed, EBSCO and Springer.

Development: different pathophysiological mechanisms are associated with endothelial injury and coagulation alterations in patients affected by SARS-CoV-2, either by direct action of the virus on endothelial cells and/or excessive inflammatory response induced by the virus.

Conclusions: the pathophysiological mechanisms involved in endothelial lesion and coagulation alterations in patients with COVID-19 are varied, sharing as a common factor the storm of pro-inflammatory cytokines and conditioning the endothelial lesion itself together with other factors, with the onset of thrombopathies that affects the evolution of the patient.

 

Downloads

Download data is not yet available.

Author Biographies

Mileidys León García, Universidad de Ciencias Médicas de Pinar del Río. Facultad de Ciencias Médicas Dr. Ernesto Guevara de la Serna. Pinar del Río, Cuba

Doctora en medicina. Especialista de primer grado en Madicina General Integral y Fisiología Normal y patológica. Profesora Auxiliar.

Yunit Hernéndez Rodríguez, Universidad de Ciencias Médicas de Pinar del Río. Facultad de Ciencias Médicas Dr. Ernesto Guevara de la Serna. Pinar del Río, Cuba

Doctora en medicina. Especialista de segundo grado en Fisiología Normal y patológica. Profesora Auxiliar.

Raúl Alexander Vento Pérez, Universidad de Ciencias Médicas de Pinar del Río. Facultad de Ciencias Médicas Dr. Ernesto Guevara de la Serna. Pinar del Río, Cuba

Doctor en medicina. Especialista de primer grado en Madicina General Integral y Fisiología Normal y patológica. Profesora Auxiliar.

References

1. Alves Cunha A, Quispe Cornejo A, Ávila Hilari A, Valdivia Cayoja A, Chino Mendoza J, Vera Carrasco O. Breve historia y fisiopatología del COVID-19. Revista "Cuadernos"[Internet]. 2020 [Citado: 10/12/2020]; 61(1): 130-143. Disponible en: http://www.scielo.org.bo/scielo.php?script=sci_arttext&pid=S1652-67762020000100011

2. Rozadoa J, Ayestaa A, Morísa C, Avanzas P. Fisiopatología de la enfermedad cardiovascular en pacientes con COVID-19. Isquemia, trombosis y disfunción cardiaca. Rev Esp Cardiol Supl [Internet]. 2020 [Citado: 10/12/2020]; 20(E):2-8. Disponible en: https://www.revespcardiol.org/es-fisiopatologia-enfermedad-cardiovascular-pacientes-con-articulo-S1131358720300285

3. OPS/OMS. Actualización epidemiológica: Enfermedad por Coronavirus (COVID-19) [Internet]. Washington, D.C:Organización Panamericana de la Salud / Organización Mundial de la Salud; 2021 [Citado: 11/03/2021]; Disponile en: https://www.paho.org/es/documentos/actualizacion-epidemiologica-enfermedad-por-coronavirus-covid-19-9-febrero-2021

4. MINSAP. Actualización de la situación de la Covid-19 en Cuba [Internet]. MINSAP; 2021 [Citado: 11/03/2021]. Disponile en: https://salud.msp.gob.cu/parte-de-cierre-del-dia-27-de-marzo-a-las-12-de-la-noche/

5. Lukassen S, Chua R, Trefzer T, Kahn N, Schneider M, Muley T. SARS-CoV-2 receptor ACE2 and TMPRSS2 are primarily expressed in bronchial transient secretory cells. EMBO J[Internet]. 2020 [Citado: 11/03/2021]; 39(10): e105114. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32246845/

6. Pastrian Soto G. Presencia y Expresión del Receptor ACE2 (Target de SARS-CoV-2) en Tejidos Humanos y Cavidad Oral. Posibles Rutas de Infección en Órganos Orales. Int. J. Odontostomat [Internet]. 2020 [Citado: 11/03/2021]; 14(4): 501-507. Disponible en: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-381X2020000400501

7. Cano F, Gajardo M, Freundlich M. Eje Renina Angiotensina, Enzima Convertidora de Angiotensina 2 y Coronavirus. Rev. chil. Pediatr [Internet]. 2020 [Citado: 11/03/2021]; 91(3): 330-338. Disponible en: https://www.revistachilenadepediatria.cl/index.php/rchped/article/view/2548

8. Abarca Rozas B, Vargas Urra J, García Garzón J. Caracterización patogénica, clínica y diagnóstica de la pandemia por SARS-CoV-2. Rev. chil. Infectol [Internet]. 2020 [Citado: 11/03/2021]; 37(3): 265-275. Disponile en: https://scielo.conicyt.cl/scielo.php?script=sci_abstract&pid=S0716-10182020000300265&lng=es&nrm=iso

9. Cao W, Li T. COVID-19: towards understanding of pathogenesis. Cell Res[Internet]. 2020 [Citado: 11/03/2021]; 30(5): 367–369. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32346073/

10. Iwasaki M, Saito J, Zhao H, Sakamoto A, Hirota K. Inflammation Triggered by SARS-CoV-2 and ACE2 Augment Drives Multiple Organ Failure of Severe COVID-19: Molecular Mechanisms and Implications. Review [internet]. 2021 [Citado: 11/03/2021]; 44(1): 13-34. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33029758/

11. Fu Y, Cheng Y, Wu Y. Understanding SARS-CoV-2-mediated inflammatory responses: from mechanisms to potential therapeutic tools. Virol Sin [Internet]. 2020 [Citado: 11/03/2021]; 35: 266–271. Disponible en: https://link.springer.com/article/10.1007/s12250-020-00207-4

12. Carvajal Carvajal C. El endotelio: estructura, función y disfunción endotelial / The endothelium: structure, function and endothelial dysfunction. Med. leg. Costa Rica [Internet]. 2017 [Citado: 11/03/2021]; 34(2): 90-100. Disponible en: https://www.scielo.sa.cr/scielo.php?script=sci_arttext&pid=S1409-00152017000200090

13. Becker R. COVID 19 update: Covid 19 associated coagulopathy. Journal of Thrombosis and Thrombolysis [Internet]. 2020 [Citado: 11/03/2021]; 50: 54–67. Disponible en: https://link.springer.com/article/10.1007/s11239-020-02134-3

14. Contreras Domínguez V. Función y disfunción endotelial. Revista Mexicana de Anestesiología [Internet]. 2004 [Citado: 11/03/2021]; 27(1): 124-125. Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2004/cmas041z.pdf

15. Gavriilaki E, Anyfanti P, Gavriilaki M, Lazaridis A. Endothelial Dysfunction in COVID-19: Lessons Learned from Coronaviruses. Curr Hypertens Rep [Internet]. 2020 [Citado: 11/03/2021]; 22(63). Disponible en: https://link.springer.com/article/10.1007/s11906-020-01078-6

16. Bérangère J, Siguret V, Veyradier A. Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID-19. Intensive Care Med [Internet]. 2020 [Citado: 04/02/2021]; 46(8): 1603–1606. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32415314/

17. Sharma A, Garcia G, Arumugaswami V, Svendsen C. Human iPSC-derived cardiomyocytes are sus-ceptible to SARS–CoV-2 infection. BioRxiv [Internet]. 2020 [Citado: 04/02/2021]; Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263549/

18. Chatterjee V, Yang X, Ma Y, Cha B, Meegan J, Wu M, et al. Endothelial microvesicles carrying Src-rich cargo impair adherens junction integrity and cytoskeleton homeostasis. Cardio-vasc Res[Internet]. 2020 [Citado: 04/02/2021]; 116(8): 1525–1538. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31504252/

19. Silk E, Zhao H, Weng H, Ma D. The role of extracellular histone in organ injury. Cell Death Dis [Internet]. 2017 [Citado: 04/02/2021]; 8. Disponible en: https://www.nature.com/articles/cddis201752

20. Magro C, Mulvey J, Berlin D, Nuovo G, Salvatore S, Harp J. Complement associated mi-crovascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res [Internet]. 2020 [Citado: 04/02/2021]; 220: 1–13. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32299776/

21. Wen W, Su W, Tang H, Le W, Zhang X, Zheng Y, et al. Immune cell profling of COVID-19 patients in the recovery stageby single-cell sequencing. Cell Discov [Internet]. 2020 [Citado: 04/02/2021]; 6(31). Disponible en: https://www.nature.com/articles/s41421-020-0168-9

22. Helms J, Tacquard C, Severac F. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med [Internet]. 2020 [Citado: 04/02/2021]; 46(6): 1089-1098. Disponible en: https://europepmc.org/article/med/32367170

23. Gavriilaki E, Sakellari I, Gavriilaki M, Anagnostopoulos A. Thrombocytopenia in COVID-19: pathophysiology matters. Annals of Hematology [Internet]. 2020 [Citado: 04/02/2021]: 1-2. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368623/

24. Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patien tsinfected with SA RS- CoV- 2. Cardiovasc Res[Internet]. 2020 [Citado: 04/02/2021]; 116(6): 1097-1100. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32227090/

25. Ikewaki N, Sharaf Rao K, Durant Archibold A, Iwasaki M, Senthilkumar R. Coagulopathy associated with COVID-19 – Perspectives & Preventive strategies using a biological response modifier Glucan. Thrombosis Journal [Internet]. 2020 [Citado: 04/02/2021]; 18(27). Disponible en: https://pubmed.ncbi.nlm.nih.gov/33082714/

26. Carrillo Esper R, González Salazar J. Inflamación-endotelio-coagulación en sepsis.Conceptos actuales. Cir Ciruj[Internet]. 2002 [Citado: 04/02/2021]; 70(6): 433-441. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=3251

27. Asakura H, Ogawa H. COVID 19 associated coagulopathy and disseminated intravascular. International Journal of Hematology [Internet]. 2020 [Citado: 04/02/2021]; 113: 45–57. Dispoinible en: https://www.x-mol.com/paper/1325953303421620224

28. Whyte C, Morrow G. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series. J Thromb Haemost [Internet]. 2020 [Citado: 04/02/2021]; 18(7): 1548-1555. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262152/

29. Duboscq C. El sistema plasminógeno plasmina. Hematología [Internet]. 2017 [Citado: 04/02/2021]; 21: 48-55. Disponible en: www.sah.org.ar/revista/numeros/vol21/extra/10-Vol%2021-extra.pdf

Downloads

Published

2022-01-24

How to Cite

1.
León García M, Hernéndez Rodríguez Y, Vento Pérez RA. Pathophysiology of endothelial injury and coagulation alterations in patients with COVID-19. Rev Ciencias Médicas [Internet]. 2022 Jan. 24 [cited 2025 Aug. 1];26(1):e5037. Available from: https://revcmpinar.sld.cu/index.php/publicaciones/article/view/5037

Issue

Vol. 26 No. 1 (2022)

Section

REVIEW ARTICLES

License

Authors who have publications with this journal agree to the following terms: Authors will retain their copyrights and grant the journal the right of first publication of their work, which will be publication of their work, which will be simultaneously subject to the Creative Commons Attribution License (CC-BY-NC 4.0) that allows third parties to share the work as long as its author and first publication in this journal are indicated.

Authors may adopt other non-exclusive license agreements for distribution of the published version of the work (e.g.: deposit it in an institutional telematic archive or publish it in a volume). Likewise, and according to the recommendations of the Medical Sciences Editorial (ECIMED), authors must declare in each article their contribution according to the CRediT taxonomy (contributor roles). This taxonomy includes 14 roles, which can be used to represent the tasks typically performed by contributors in scientific academic production. It should be consulted in monograph) whenever initial publication in this journal is indicated. Authors are allowed and encouraged to disseminate their work through the Internet (e.g., in institutional telematic archives or on their web page) before and during the submission process, which may produce interesting exchanges and increase citations of the published work. (See The effect of open access). https://casrai.org/credit/