Pre-clinical and autopsy studies have fueled the hypothesis that a dysregulated vascular endothelium might play a central role in the pathogenesis of acute respiratory distress syndrome (ARDS) and multi-organ failure in COVID-19.
Using a comprehensive analysis approach, comprising novel functional imaging and biomarker data severe alterations of the microcirculation and the endothelial glycocalyx (a protective inner lining of the vascular endothelium) were found in patients with COVID-19. Several of those markers were closely related to disease severity and predicted ARDS development. Of note, sublingual glycocalyx thickness and circulating endothelial markers, but not initially proposed (inflammatory) markers such as ferritin, CRP, IL-6 or hs-troponin, predicted 60-day in-hospital mortality.
The data clearly provide further evidence for the importance of systemic microvascular dysfunction and glycocalyx damage in COVID-19. Future therapeutic approaches should thus consider the importance of systemic vascular involvement in COVID-19.
Dr. Alexandros Rovas receives the Award for the MYSTIC study, that has been performed and published together with Irina Osiaevi (shared first authorship) and group leader Prof. Philipp Kümpers.