ArticleMedical hypotheses2020
SARS-CoV-2 cell entry receptor ACE2 mediated endothelial dysfunction leads to vascular thrombosis in COVID-19 patients.
Article in Medical hypotheses, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 1 of them a synthesis that pooled it.
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Who cites it
52 citing papers in PubMed, 1 synthesis or guideline pooled it, 81 citations in OpenAlex.
- COVID-19 pandemic: insights into molecular mechanisms leading to sex-based differences in patient outcomes.Expert reviews in molecular medicine · 2021Pooled it
- Adipose Tissue in SARS-CoV-2 Viral Tropism, Viral Replication, and the Concept of a Viral Reservoir: An Update.Obesity (Silver Spring, Md.) · 2026Review
- Predictive Role of CX3CL1 and D-dimer Levels in Mortality Risk Stratification for COPD Patients With COVID-19.Cureus · 2025Article
- SARS-CoV-2 infection promotes lung thrombosis by inducing integrinβ3 expression in vascular endothelial cells.Scientific reports · 2025Article
- Convalescent plasma therapy for COVID-19 in patients with nasal catheter oxygen therapy.Journal of thoracic disease · 2025Article
- Immunomodulatory Mechanisms Underlying Neurological Manifestations in Long COVID: Implications for Immune-Mediated Neurodegeneration.International journal of molecular sciences · 2025Review
- Cognitive Sequelae of COVID-19: Mechanistic Insights and Therapeutic Approaches.CNS neuroscience & therapeutics · 2025Review
- TMPRSS2 as a Key Player in Viral Pathogenesis: Influenza and Coronaviruses.Biomolecules · 2025Review
- COVID-19 Is a Coronary Artery Disease Risk Equivalent and Exhibits a Genetic Interaction With ABO Blood Type.Arteriosclerosis, thrombosis, and vascular biology · 2024Article
- Synergy Between NK Cells and Monocytes in Potentiating Cardiovascular Disease Risk in Severe COVID-19.Arteriosclerosis, thrombosis, and vascular biology · 2024Article
- Severe pediatric COVID-19: a review from the clinical and immunopathophysiological perspectives.World journal of pediatrics : WJP · 2024Review
- In Situ Endothelial SARS-CoV-2 Presence and PROS1 Plasma Levels Alteration in SARS-CoV-2-Associated Coagulopathies.Life (Basel, Switzerland) · 2024Article
- Endovascular Intervention for Acute Superior Mesenteric Artery Occlusion Following COVID-19 Pneumonia: Two Case Reports.Interventional cardiology (London, England) · 2024Article
- A cross-sectional case-control study on the structural connectome in recovered hospitalized COVID-19 patients.Scientific reports · 2023Article
- The role of the endothelium in severe acute respiratory syndrome coronavirus 2 infection and pathogenesis.Current opinion in physiology · 2023Review
- Review
- Single-Cell Transcriptomics Reveals Evidence of Endothelial Dysfunction in the Brains of COVID-19 Patients with Implications for Glioblastoma Progression.Brain sciences · 2023Article
- Article
- Long Chain N3-PUFA Decreases ACE2 Protein Levels and Prevents SARS-CoV-2 Cell Entry.International journal of molecular sciences · 2022Article
- Characteristic patterns of SARS-CoV-2 on chest CT suggests a hematologic pathway for viral entry into the lung.Clinical imaging · 2022Article
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Authors and funding
7 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Several studies have described unusually high incidence of vascular thrombosis in coronavirus disease-2019 (COVID-19) patients. Pathogenesis of the vascular thrombosis in COVID-19 is least understood for now and presents a challenge to the treating physicians. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative pathogen for COVID-19, has been shown to bind to angiotensin converting enzyme 2 (ACE2) protein in human epithelial cells which facilitates its entry in the organ and mediate tissue specific pathogenesis. For ACE2 mediated cell entry of the SARS-CoV-2, co-expression of one more protein-Transmembrane protease serine 2 (TMPRSS2) is essential. Existing studies suggested significant expression of ACE2 and TMPRSS2 in human vascular endothelium. Vascular endothelial dysfunction can potentially activate coagulation cascade eventually resulting in thrombosis. ACE2 has proven role in the maintenance of endothelial integrity inside the vessels. Existing in situ evidence for SARS-CoV-1 (the causative agent for SARS pandemic of 2002, which shared ACE2 as cell entry receptor) suggested that virus binding can downregulate ACE2, thus can induce endothelial dysfunction. Recently, in situ evidence has been presented that SARS-CoV-2 can infect cells in engineered human vascular endothelium, which can be effectively blocked by using clinical-grade recombinant human ACE2. Based on the circumstantial evidence present in the literature, we propose a SARS-CoV-2 cell entry receptor ACE2 based mechanism for vascular thrombosis in COVID-19 patients.
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