The endothelium is part of your vascular system, and it plays an important role in maintaining your health. Here is a 🧵 about what the endothelium is, what it does, how SARS-CoV-2 harms it, and what that means for your health. (1/n) 
What is the endothelium and what does it do?
"The endothelium is a thin layer of flat epithelial cells that lines the heart, serous cavities, lymph vessels, and blood vessels. Endothelial cells form the barrier between vessels and tissue." (2/n)
en.wikipedia.org/wiki/Endotheli…
"The endothelium is a thin layer of flat epithelial cells that lines the heart, serous cavities, lymph vessels, and blood vessels. Endothelial cells form the barrier between vessels and tissue." (2/n)
en.wikipedia.org/wiki/Endotheli…
What is endotheliitis?
"Endotheliitis is an immune response within the endothelium in blood vessels, in which they become inflamed. The condition can cause swelling of the surrounding tissue, and can cause irritation and pain." (3/n)
en.wikipedia.org/wiki/Endotheli…
"Endotheliitis is an immune response within the endothelium in blood vessels, in which they become inflamed. The condition can cause swelling of the surrounding tissue, and can cause irritation and pain." (3/n)
en.wikipedia.org/wiki/Endotheli…
Why is endotheliitis bad?
"Endotheliitis as well as direct viral effects on vasculature would bring about endothelial injury and dysfunction, which could contribute to functional derangements of different internal organs in C19." (4/n)
ncbi.nlm.nih.gov/pmc/articles/P…
"Endotheliitis as well as direct viral effects on vasculature would bring about endothelial injury and dysfunction, which could contribute to functional derangements of different internal organs in C19." (4/n)
ncbi.nlm.nih.gov/pmc/articles/P…
How SARS-CoV-2 infects endothelial cells
"Although the virus uses ACE2 receptor expressed by pneumocytes in the epithelial alveolar lining to infect the host, the ACE2 receptor is also widely expressed on endothelial cells." (5/n)
thelancet.com/journals/lance…
"Although the virus uses ACE2 receptor expressed by pneumocytes in the epithelial alveolar lining to infect the host, the ACE2 receptor is also widely expressed on endothelial cells." (5/n)
thelancet.com/journals/lance…
SARS-CoV-2 causes endotheliitis (1)
"COVID-19 not only affects the lung parenchyma through the ACE2 receptors but can also result in generalized endothelial damage and inflammation in the entire body in the sense of so-called endotheliitis." (6/n)
ncbi.nlm.nih.gov/pmc/articles/P…
"COVID-19 not only affects the lung parenchyma through the ACE2 receptors but can also result in generalized endothelial damage and inflammation in the entire body in the sense of so-called endotheliitis." (6/n)
ncbi.nlm.nih.gov/pmc/articles/P…
SARS-CoV-2 causes endotheliitis (2)
"Impaired endothelial function can be documented in convalescent COVID-19 patients for up to 1 year after infection, especially when residual clinical manifestations persist." (7/n)
tandfonline.com/doi/full/10.10…
"Impaired endothelial function can be documented in convalescent COVID-19 patients for up to 1 year after infection, especially when residual clinical manifestations persist." (7/n)
tandfonline.com/doi/full/10.10…
SARS-CoV-2 impairs microvascular integrity
"In this cohort of patients with Post-COVID-19 syndrome, symptoms were associated with persistent impaired microvascular integrity, amplified by higher levels of pro-inflammatory cytokines." (8/n)
link.springer.com/article/10.100…
"In this cohort of patients with Post-COVID-19 syndrome, symptoms were associated with persistent impaired microvascular integrity, amplified by higher levels of pro-inflammatory cytokines." (8/n)
link.springer.com/article/10.100…
SARS-CoV-2 causes vascular endothelial cell turnover
Patients w severe C19 had a massive elevation of circulating cell-free DNA levels, which originated in lung epithelial cells, cardiomyocytes, vascular endothelial cells and erythroblasts." (9/n)
biorxiv.org/content/10.110…
Patients w severe C19 had a massive elevation of circulating cell-free DNA levels, which originated in lung epithelial cells, cardiomyocytes, vascular endothelial cells and erythroblasts." (9/n)
biorxiv.org/content/10.110…
Endotheliitis versus endotheliopathy
Endotheliitis specifically refers to inflammation of the endothelium, while endotheliopathy is a broader term that encompasses a range of pathological conditions affecting the endothelium's normal functions. (10/n)
Endotheliitis specifically refers to inflammation of the endothelium, while endotheliopathy is a broader term that encompasses a range of pathological conditions affecting the endothelium's normal functions. (10/n)
Endotheliitis leads to endotheliopathy
"Hypercoagulability, endotheliopathy, and inflammation extend well beyond acute SARS-CoV-2 infection, where recovered COVID-19 patients may develop long-term thrombotic and cardiovascular complications." (11/n)
onlinelibrary.wiley.com/doi/full/10.10…
"Hypercoagulability, endotheliopathy, and inflammation extend well beyond acute SARS-CoV-2 infection, where recovered COVID-19 patients may develop long-term thrombotic and cardiovascular complications." (11/n)
onlinelibrary.wiley.com/doi/full/10.10…
SARS-CoV-2 harms pulmonary veins and arteries
"Acute COVID-19 infection can result in widespread involvement of the pulmonary vasculature, myocardial injury, evidence of persistent lung disease, and venous thromboembolism." (12/n)
ncbi.nlm.nih.gov/pmc/articles/P…
"Acute COVID-19 infection can result in widespread involvement of the pulmonary vasculature, myocardial injury, evidence of persistent lung disease, and venous thromboembolism." (12/n)
ncbi.nlm.nih.gov/pmc/articles/P…
SARS-CoV-2 causes small vessel pulmonary blood clots
"Venous thromboembolism and small vessel pulmonary thromboses are both implicated in C19; these pulmonary vascular manifestations are a potential precursor to chronic thromboembolic disease." (13/n)
ncbi.nlm.nih.gov/pmc/articles/P…
"Venous thromboembolism and small vessel pulmonary thromboses are both implicated in C19; these pulmonary vascular manifestations are a potential precursor to chronic thromboembolic disease." (13/n)
ncbi.nlm.nih.gov/pmc/articles/P…
SARS-CoV-2 causes severe pulmonary endothelial injury
"Early autopsy studies reported severe endothelial injury, capillary thrombi, and extensive new vessel growth predominantly occurring through a mechanism of intussusceptive angiogenesis." (14/n)
link.springer.com/article/10.100…
"Early autopsy studies reported severe endothelial injury, capillary thrombi, and extensive new vessel growth predominantly occurring through a mechanism of intussusceptive angiogenesis." (14/n)
link.springer.com/article/10.100…
SARS-CoV-2 causes thrombotic endotheliitis
"Microclotting, together with relatively high levels of six inflammatory molecules known to be key drivers of endothelial and clotting pathology, points to thrombotic endotheliitis as a key..." (15/n)
medrxiv.org/content/10.110…
"Microclotting, together with relatively high levels of six inflammatory molecules known to be key drivers of endothelial and clotting pathology, points to thrombotic endotheliitis as a key..." (15/n)
medrxiv.org/content/10.110…
SARS-CoV-2 causes venous/arterial thrombosis
"Risks of venous thromboembolism and arterial thromboembolism were up to 1% among COVID-19 cases, and increased with age, among males, and in those who were hospitalized." (16/end)
thelancet.com/journals/lanin…
"Risks of venous thromboembolism and arterial thromboembolism were up to 1% among COVID-19 cases, and increased with age, among males, and in those who were hospitalized." (16/end)
thelancet.com/journals/lanin…
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