The Calroy scientific team continues to monitor the daily stream of new insights relating to COVID-19. Here's the big picture as we see it today, realizing that COVID-19 is a moving target in a fast-changing landscape...
In recent news stories, you may have noted growing concern about two phenomena in severe cases of COVID-19: the proliferation of small blood clots in multiple locations, (1)(2)(3) and the unexpected occurrence of stroke,(4)(5) which is particularly surprising in young patients.
It’s been known for some time that the virus can attach to ACE2 receptors on the endothelium. Clinicians and researchers are now reporting that cardiovascular comorbidities are among the highest risk factors for COVID-19 patients.(6)
What are the Clinical Implications?
While we know that the new coronavirus is attacking the vascular system, we have yet to learn how far pre-existing vascular problems increase patients’ vulnerability. It’s a chicken-and-egg question, and for many patients everything is at stake.
For clinicians, there’s one conclusion that needn’t be in doubt: do whatever you can to strengthen the health and resilience of your patients’ vascular system.
That calls for attention to the endothelial glycocalyx (EGX), the first line of defense for the entire vascular system.
The EGX is a selective permeability barrier that protects the endothelium and mediates its functions in every artery, vein and capillary.(7) Degeneration of the glycocalyx can take place rapidly, in response to excess glucose, smoking, aging, stress, inflammation, and a variety of disease conditions. Conversely, EGX dysfunction has been implicated in atherosclerosis, stroke, hypertension, renal disease, and sepsis, among others.(8) The health of the endothelium, on which the entire vascular system depends, is contingent on the health of the endothelial glycocalyx. You can’t have one without the other.
Simply put, when the EGX is compromised, the endothelium is exposed. And that’s a worst-case scenario in the presence of COVID-19.
- Columbia University Irving Medical Center. Thrombosis Emerges as Significant Risk for COVID-19 Patients. April 2020. https://www.cuimc.columbia.edu/news/thrombosis-emerges-significant-risk-covid-19-patients
- Oudkerk M, Büller HR, Kuijpers D, van Es N, Oudkerk SF, McLoud TC, Gommers D, van Dissel J, Ten Cate H, van Beek EJ. Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands. Radiology. 2020 Apr 23:201629. doi: 10.1148/radiol.2020201629. [Epub ahead of print]
- Marco Ranucci, Andrea Ballotta, Umberto Di Dedda,Ekaterina Bayshnikova, Marco Dei Poli, Marco Resta, Mara Falco, Giovanni Albano, Lorenzo Menicanti. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. Brief report: April 14, 2020DOI: 10.1111/jth.14854
- Morassi M, Bagatto D, Cobelli M, D’Agostini S, Gigli GL, Bnà C, Vogrig A. Cerebrovascular complications in patients with SARS-CoV-2 infection: Case series. Preprint from Research Square, 19 Apr 2020 DOI: 10.21203/rs.3.rs-23137/v1 PPR: PPR152878
- Thomas J. Oxley, M.D. J. Mocco, M.D. Shahram Majidi, M.D. Christopher P. Kellner, M.D. Hazem Shoirah, M.D. I. Paul Singh, M.D. Reade A. De Leacy, M.D. Tomoyoshi Shigematsu, M.D. Travis R. Ladner, M.D. Kurt A. Yaeger, M.D. Maryna Skliut, M.D. Jesse Weinberger, M.D. Neha S. Dangayach, M.D. Joshua B. Bederson, M.D. Stanley Tuhrim, M.D. Johanna T. Fifi, M.D. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. April 28, 2020.The New England Journal of Medicine (Correspondence)
- Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:458–464. DOI: http://dx.doi.org/10.15585/mmwr.mm6915e
- Weinbaum, S., J. M. Tarbell et al. (2007). "The structure and function of the endothelial glycocalyx layer." Annual review of biomedical engineering 9: 121-167.
- John M. Tarbell & Limary M. Cancel. The Glycocalyx and Its Significance in Human Medicine. J Intern Med. (2016) 280(1):97-113. doi: 10.1111/joim.12465. Epub 2016 Jan 8.