Convalescent COVID-19 patients are susceptible to endothelial dysfunction due to persistent immune activation.

Florence Wj Chioh,Siew-Wai Fong,Ru San Tan,Shuba Krishnan,Guillaume Carissimo,Fei Gao,Lisa Fp Ng,Yi-Hao Chan,Kan-Xing Wu,Seow-Yen Tan,Barnaby E Young,Liang Zhong,David C Lye,Angela S Koh,Anthony Siau,Louis Ly Teo,Paul A Tambyah,Laurent Renia,Christine Cheung

doi:10.7554/elife.64909

Abstract

Numerous reports of vascular events after an initial recovery from COVID-19 form our impetus to investigate the impact of COVID-19 on vascular health of recovered patients. We found elevated levels of circulating endothelial cells (CECs), a biomarker of vascular injury, in COVID-19 convalescents compared to healthy controls. In particular, those with pre-existing conditions (e.g., hypertension, diabetes) had more pronounced endothelial activation hallmarks than non-COVID-19 patients with matched cardiovascular risk. Several proinflammatory and activated T lymphocyte-associated cytokines sustained from acute infection to recovery phase, which correlated positively with CEC measures, implicating cytokine-driven endothelial dysfunction. Notably, we found higher frequency of effector T cells in our COVID-19 convalescents compared to healthy controls. The activation markers detected on CECs mapped to counter receptors found primarily on cytotoxic CD8+ T cells, raising the possibility of cytotoxic effector cells targeting activated endothelial cells. Clinical trials in preventive therapy for post-COVID-19 vascular complications may be needed.

Highlights

As of February 21, 2021, there have been more than 110 million confirmed cases and 2.4 million deaths from coronavirus disease 2019 (COVID-19)
To ascertain the consequence of COVID-19 on endothelial dysfunction, we regrouped the convalescent COVID-19 patients by their disease severity during acute infection (Figure 1c). We found that both convalescent COVID-19 patients who recovered from moderate symptoms (p=0.0009) and non-COVID-19 patients with cardiovascular risks (p
We found a significant relationship between the number of endothelial activation markers expressed by CECs and the disease status of patients, Χ2 (9, N = 64)=19.83, p=0.019 where convalescent COVID-19 patients compounded with cardiovascular risk had the most pronounced endothelial activation hallmarks (Figure 1f), more than those having either a history of COVID-19 alone or cardiovascular risk without COVID-19

Summary

Introduction

As of February 21, 2021, there have been more than 110 million confirmed cases and 2.4 million deaths from coronavirus disease 2019 (COVID-19). Many countries are facing multiple waves of resurgence upon reopening their economy, prompting new lockdown. Intensive ongoing research has shed light on the pathogenesis of COVID-19 and the extent of damages caused directly or. Cell Biology Immunology and Inflammation indirectly by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The intermediate and long-term complications of COVID-19 remains unclear (del Rio et al, 2020). While most infected people recover completely within a few weeks, a considerable proportion continue to experience symptoms after their initial recovery (Yelin et al, 2020), similar to SARS survivors (Ngai et al, 2010)

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