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CC BY-NC-ND 4.0 · Semin Thromb Hemost
DOI: 10.1055/s-0044-1790603
Review Article

Vascular Pathogenesis in Acute and Long COVID: Current Insights and Therapeutic Outlook

Arneaux Kruger 
1   Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
,
David Joffe
2   Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
3   World Health Network, Cambridge, Massachusetts
,
Graham Lloyd-Jones 
4   Department of Radiology, Salisbury District Hospital, Salisbury NHS Foundation Trust, United Kingdom
,
Muhammed Asad Khan
3   World Health Network, Cambridge, Massachusetts
5   Directorate of Respiratory Medicine, Manchester University Hospitals, Wythenshawe Hospital, Manchester, United Kingdom
,
Špela Šalamon
3   World Health Network, Cambridge, Massachusetts
,
Gert J. Laubscher
6   Mediclinic Stellenbosch, Stellenbosch, South Africa
,
David Putrino
2   Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
7   Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York
,
Douglas B. Kell 
1   Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
8   Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
9   The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kongens Lyngby, Denmark
,
Etheresia Pretorius 
1   Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
3   World Health Network, Cambridge, Massachusetts
8   Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
› Author Affiliations Funding E.P.: Funding was provided by National Research Foundation of South Africa (grant number: 142142) and South African Medical Research Council (self-initiated research [SIR] grant), and Balvi Foundation (grant number: B31).
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Abstract

Long coronavirus disease 2019 (COVID-19)—a postacute consequence of severe acute respiratory syndrome coronavirus 2 infection—manifests with a broad spectrum of relapsing and remitting or persistent symptoms as well as varied levels of organ damage, which may be asymptomatic or present as acute events such as heart attacks or strokes and recurrent infections, hinting at complex underlying pathogenic mechanisms. Central to these symptoms is vascular dysfunction rooted in thrombotic endothelialitis. We review the scientific evidence that widespread endothelial dysfunction (ED) leads to chronic symptomatology. We briefly examine the molecular pathways contributing to endothelial pathology and provide a detailed analysis of how these cellular processes underpin the clinical picture. Noninvasive diagnostic techniques, such as flow-mediated dilation and peripheral arterial tonometry, are evaluated for their utility in identifying ED. We then explore mechanistic, cellular-targeted therapeutic interventions for their potential in treating ED. Overall, we emphasize the critical role of cellular health in managing Long COVID and highlight the need for early intervention to prevent long-term vascular and cellular dysfunction.

Keywords

postacute COVID-19 syndrome - SARS-CoV-2 - reinfection - endothelium - vascular - thrombosis

Supplementary Material



Publication History

Article published online:
30 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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