May 21, 2020
COVID-19 Shown to Cause Severe Vascular Damage by Invading Endothelial Cells
May 21, 2020—The Angiogenesis Foundation announced the publication of new research showing that the respiratory virus SARS-CoV-2, which causes COVID-19, causes severe damage to blood vessels, leading to widespread thrombosis in the lung.
“Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in COVID-19” by Maximilian Ackermann, MD, et al is available online ahead of print in The New England Journal of Medicine (NEJM).
According to the Angiogenesis Foundation, an international team of investigators compared the lungs of patients who died from COVID-19 with the lungs of patients who died from influenza and with healthy lungs donated for transplantation. They found an unexpected disease pattern in COVID-19 lungs: The virus invaded the endothelial cells, and this was accompanied by blood clots. Compared with the flu, COVID-19 lungs had ninefold more blood clots, and the blood vessels were injured by the virus, causing an unusual reaction of blood vessel growth.
“One of the great mysteries of COVID-19 has been why blood clots, or thrombosis, form in some patients who are infected,” commented William Li, MD, in the announcement. Dr. Li, who is President and Medical Director of the Angiogenesis Foundation and one of the investigators of the study, continued, “These clots can become lethal because they severely compromise blood flow not only in the lungs but also in other organs such as the brain and heart, among other tissues. Our research is the first to show that these clots are associated with damaged blood vessels. The damage causes a unique healing reaction called intussusceptive angiogenesis that was found in COVID-19 at levels 30 times above normal.”
In the NEJM study, the investigators found an association between the more intussusceptive angiogenesis present, the longer the hospital stay of the patient, suggesting that the severity of COVID-19 disease is linked to blood vessel damage. Intense inflammation was also found in all COVID-19 lungs. Dr. Li stated, “Although SARS-Cov-2 is a respiratory virus, we now see it can cause a vascular disease in COVID-19. The intussusceptive angiogenesis is how the body compensates when faced with thrombosis and blood vessel damage.”
According to the Angiogenesis Foundation, the injured blood vessel lining helps explain the serious blood clotting observed in patients. This damage may also underlie other problems seen with COVID-19, such as stroke, deep vein thrombosis, COVID toe, and damage to the heart, and also explain why anticoagulation may be helpful in preventing serious complications.
The Angiogenesis Foundation also noted that in a report on May 6, investigators at Mount Sinai Hospital in New York, New York, described how using blood thinners in patients hospitalized with COVID-19 appeared to be protective and associated with better outcomes The research letter was published by Ishan Paranjpe, BS, et al online in the Journal of the American College of Cardiology.
The Angiogenesis Foundation stated that the current study highlights the need for additional research on angiogenesis and the vascular effects of COVID-19. Dr. Li concluded, “Our blood vessels are the lifelines for all of our organs. If COVID-19 damages our vessels, the long-term effects could be devastating even after the virus is cleared. Finding ways to protect our blood vessels and helping them heal could be an important dimension to COVID-19 treatment. These interventions could involve not only medications but importantly, dietary factors and lifestyle.”