A Disease of the Endothelium
Written by Dallas Vein Specialists on August 31, 2020
More and more it seems that COVID-19 is a disease of the ENDOTHELIUM, the thin single layer of cells lining the inside of our arteries and veins. While the lung findings are devastating in many patients, it may be that this is only the entry point for the virus. The virus attaches to the ACE 2 receptors, which are numerous in the lower respiratory tract. There the disease gets a foot hold and then begins to attack the endothelium binding to the abundant ACE 2 receptors in the endothelium causing endothelial cell dysfunction (ECD). Thrombosis, i.e. the formation of clots within the blood vessels, is the natural consequence of this ECD. When the virus attaches to the ACE 2 receptors of the endothelial cells the natural protective action mediated by the ACE 2 receptors is blocked. This leads to OXIDATIVE STRESS, the production of excess damaging radicals within the endothelial cells, a situation where the system is out of balance leading to more dysfunction and thrombosis. This may be the explanation for the many different presentations and varied complications that are being reported, symptoms such as loss of the sense of smell or taste, strokes, kidney dysfunction, formation of clots, etc., that may proceed to multiorgan failure and death. It may also explain why individuals with hypertension, coronary artery disease, congestive heart failure, diabetes, prediabetes and high BMIs are more at risk for complications and death from COVID-19. All of these pre-existing diseases have some underlying endothelial cell dysfunction from oxidative stress resulting from the normal protective system being out of balance.