Vascular Endothelium Damage as a Leading Mechanismof COVID-19 Systemic Pathology
An analysis of the molecular and pathophysiological mechanisms of COVID-19 is presented. The endothelium of blood vessels, a kind of “endocrine tree” of the lungs and other organs, where important pathophysiological processes are concentrated, is considered as the target of the aggressive effects of the SARS-CoV-2 coronavirus. Since the main cellular target of viral aggression is the ACE2 enzyme, consideration of its role becomes the main line of discussion. Coronavirus blocks the activity of ACE2, as a natural producer of angiotensins peptides, disrupting the balance of hemovascular control. Under normal conditions this mission is performed by the ACE/ACE2 complex – enzymes that control the synthesis and physiological activity of angiotensins and bradykinin peptides. Changes in the ACE/ACE2 axis ratios and cytokine stress are associated with endothelial dysfunction and multiple vascular disorders. For the first time, the concept of “STORM-2” was proposed, when the cause of severe organs pathology is violations of hemostasis, transcellular diffusion, and maintenance of blood pressure.