ArticleEBioMedicine2021
SARS-CoV-2 leads to a small vessel endotheliitis in the heart.
Article in EBioMedicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 76 papers, 1 of them a synthesis that pooled it.
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Who cites it
76 citing papers in PubMed, 1 synthesis or guideline pooled it, 119 citations in OpenAlex.
- Findings and inferences from full autopsies, minimally invasive autopsies and biopsy studies in patients who died as a result of COVID19 - A systematic review.Forensic science, medicine, and pathology · 2022Pooled it
- Efficacy and safety of baricitinib or ravulizumab in adult patients with severe COVID-19 (TACTIC-R): a randomised, parallel-arm, open-label, phase 4 trial.The Lancet. Respiratory medicine · 2023Trial
- Longitudinal trajectories of hematological indices and serum metalloproteinases-2 and 9 over 1 year after moderate and severe COVID-19.Frontiers in medicine · 2026Article
- Decoding long COVID-associated cardiovascular dysfunction: Mechanisms, models, and new approach methodologies.Journal of molecular and cellular cardiology · 2025Review
- SARS-CoV-2 enhances complement-mediated endothelial injury via the suppression of membrane complement regulatory proteins.Emerging microbes & infections · 2025Article
- The influence of SARS-CoV-2 spike protein exposure on retinal development in the human retinal organoids.Cell & bioscience · 2025Article
- Endocan as a marker of endotheliitis in COVID-19 patients: modulation by veno-venous extracorporeal membrane oxygenation, arterial hypertension and previous treatment with renin-angiotensin-aldosterone system inhibitors.Inflammation research : official journal of the European Histamine Research Society ... [et al.] · 2025Article
- TMPRSS2 as a Key Player in Viral Pathogenesis: Influenza and Coronaviruses.Biomolecules · 2025Review
- Bitter taste receptors in the gut-vascular axis: a novel target for immune and metabolic regulation of hypertension.Frontiers in immunology · 2025Review
- Coronary Implications of COVID-19.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2025Review
- Factors Influencing COVID-19 Viral Clearance: Implications for Vaccination and Antiviral Therapy.Infection and drug resistance · 2025Article
- The COVID-19 thrombus: distinguishing pathological, mechanistic, and phenotypic features and management.Journal of thrombosis and thrombolysis · 2025Review
- CCL2-mediated endothelial injury drives cardiac dysfunction in long COVID.Nature cardiovascular research · 2024Article
- Endothelial dysfunction and cardiovascular risk in post-COVID-19 patients after 6- and 12-months SARS-CoV-2 infection.Infection · 2024Article
- Cardiovascular pathology in vasculitis.Pathologica · 2024Review
- Oxidative Stress in Sepsis: A Focus on Cardiac Pathology.International journal of molecular sciences · 2024Article
- Red Blood Cell Adenylate Energetics Is Related to Endothelial and Microvascular Function in Long COVID.Biomedicines · 2024Article
- Immunologic and inflammatory consequences of SARS-CoV-2 infection and its implications in renal disease.Frontiers in immunology · 2024Review
- Vascular Dysfunctions Contribute to the Long-Term Cognitive Deficits Following COVID-19.Biology · 2023Review
- Intravital imaging of three different microvascular beds in SARS-CoV-2-infected mice.Blood advances · 2023Article
16 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSARS-CoV-2 infection (COVID-19 disease) can induce systemic vascular involvement contributing to morbidity and mortality. SARS-CoV-2 targets epithelial and endothelial cells through the ACE2 receptor. The anatomical involvement of the coronary tree is not explored yet.
methodsCardiac autopsy tissue of the entire coronary tree (main coronary arteries, epicardial arterioles/venules, epicardial capillaries) and epicardial nerves were analyzed in COVID-19 patients (n = 6). All anatomical regions were immunohistochemically tested for ACE2, TMPRSS2, CD147, CD45, CD3, CD4, CD8, CD68 and IL-6. COVID-19 negative patients with cardiovascular disease (n = 3) and influenza A (n = 6) served as controls.
findingsCOVID-19 positive patients showed strong ACE2 / TMPRSS2 expression in capillaries and less in arterioles/venules. The main coronary arteries were virtually devoid of ACE2 receptor and had only mild intimal inflammation. Epicardial capillaries had a prominent lympho-monocytic endotheliitis, which was less pronounced in arterioles/venules. The lymphocytic-monocytic infiltrate strongly expressed CD4, CD45, CD68. Peri/epicardial nerves had strong ACE2 expression and lympho-monocytic inflammation. COVID-19 negative patients showed minimal vascular ACE2 expression and lacked endotheliitis or inflammatory reaction.
interpretationACE2 / TMPRSS2 expression and lymphomonocytic inflammation in COVID-19 disease increases crescentically towards the small vessels suggesting that COVID-19-induced endotheliitis is a small vessel vasculitis not involving the main coronaries. The inflammatory neuropathy of epicardial nerves in COVID-19 disease provides further evidence of an angio- and neurotrophic affinity of SARS-COV2 and might potentially contribute to the understanding of the high prevalence of cardiac complications such as myocardial injury and arrhythmias in COVID-19.
fundingNo external funding was necessary for this study.
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