COVID-19: Coronavirus causes systemic vascular inflammation

COVID-19: Coronavirus causes systemic vascular inflammation

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COVID-19 also includes systemic inflammation

Infections with the new coronavirus SARS-CoV-2 are known to cause severe pneumonia. However, according to a recent study, the virus also causes systemic inflammation of the so-called endothelium (inner lining of the blood vessels). This could possibly explain why a relatively large number of those affected develop cardiovascular problems and even fatal multi-organ failure.

It has so far been unclear why those affected by COVID-19 also experience life-threatening failure of other organs, reports the University Hospital Zurich (USZ). However, the interdisciplinary research team led by Prof. Zsuzsanna Varga from the USZ has now succeeded in proving that SARS-CoV-2 triggers inflammation in the vessels and can lead to organ failure and even death. The study results were published in the specialist magazine "The Lancet".

Cardiovascular problems and multi-organ failure

In the COVID-19 cases, severe disease courses were initially associated with viral pneumonia, which is difficult to treat, which is a very typical disease for coronaviruses. "However, doctors found that increasing numbers of patients also showed cardiovascular problems or multi-organ failure," reports the research team.

Connection so far unclear

It remained unclear whether there is a connection with pneumonia in multi-organ failure. For example, older people infected with the disease could develop cardiovascular problems that are typical for this age group. The Zurich research group pursued a different thesis here. They suspected that the viruses directly harm the vascular system.

Inflammation in the endothelium

Examinations of the tissue samples from COVID-19 deceased after an autopsy showed that the patients not only suffered from inflammation of the lungs, but that the inflammation affected the entire endothelium of various organs, reports the USZ. The endothelium forms a cell layer that serves as a kind of protective shield in the vessels and regulates and balances various processes in the microvessels.

Detection of coronaviruses in the endothelium

If the function of the endothelium is disturbed, this can trigger, for example, circulatory disorders in the organs or in body tissues, which lead to cell death and thus to the death of these organs or tissues, reports the USZ. The pathologist Prof. Zsuzsanna Varga has now succeeded for the first time with the electron microscope to detect SARS-CoV-2 directly in the endothelium and to document the cell death triggered there by the virus.

Not only spread through the lungs

The new corona virus does not spread through the lungs as previously suspected, but attacks the body's defenses directly via the ACE2 receptors found in the endothelium, the researchers report. The virus caused generalized inflammation in the endothelium, which brought its protective function to a standstill.

Systemic inflammation in all blood vessels

According to the researchers, systemic endotheliitis (inflammation of the entire endothelium in the body) records all blood vessels - heart, brain, lung and kidney vessels as well as vessels in the intestinal tract. The consequences are fatal. "There are severe microcirculation disorders that damage the heart, trigger pulmonary embolism and vascular occlusion in the brain and intestinal tract and can lead to multi-organ failure until death," reports the research team.

Increased risk with certain previous illnesses

Although the endothelium of younger patients usually copes well with the virus attack, patients who have already suffered from endothelial function impairment, such as high blood pressure, diabetes, heart failure or coronary artery disease, are said to be infected with SARS, according to the researchers -CoV-2 more at risk. Because with them, especially in the phase in which the virus multiplies the most, the already weakened endothelial function decreases even further.

COVID endotheliitis as a clinical picture

"With our investigation we were able to prove our hypothesis that COVID-19 can affect not only the lungs but the vessels of all organs," reports Prof. Frank Ruschitzka from the USZ. The virus could trigger systemic vascular inflammation, which from now on should be described as a clinical picture under the term "COVID endotheliitis", says Prof. Ruschitzka.

Inhibit virus multiplication, protect vascular system

According to the researchers, the new findings should also be used in COVID-19 treatment. "We have to inhibit the multiplication of viruses in their most proliferating phase and at the same time protect and stabilize the patient's vascular system," emphasizes Prof. Ruschitzka. This particularly affects patients "with cardiovascular diseases and a known restricted endothelial function as well as the known risk factors for a severe course of COVID-19." (Fp)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters


  • University Hospital Zurich (USZ): COVID-19: Also a systemic vascular inflammation (published April 20, 2020),
  • Zsuzsanna Varga, Andreas J. Flammer, Peter Steiger, Martina Haberecker, Rea Andermatt, Annelies S. Zinkernagel, et al .: Endothelial cell infection and endotheliitis in COVID-19; in The Lancet (published April 20, 2020),

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