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

• Published in: eLife Vol. 10
• Main Authors: Chioh, Florence Wj, Fong, Siew-Wai, Young, Barnaby E, Wu, Kan-Xing, Siau, Anthony, Krishnan, Shuba, Chan, Yi-Hao, Carissimo, Guillaume, Teo, Louis Ly, Gao, Fei, Tan, Ru San, Zhong, Liang, Koh, Angela S, Tan, Seow-Yen, Tambyah, Paul A, Renia, Laurent, Ng, Lisa Fp, Lye, David C, Cheung, Christine
• Format: Journal Article
• Language: English
• Published: England eLife Science Publications, Ltd 23-03-2021; eLife Sciences Publications Ltd; eLife Sciences Publications, Ltd
• Subjects: Adult; Aged; Biomarkers; Bone marrow; Cardiac patients; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - immunology; Cardiovascular Diseases - pathology; CD8 antigen; Cell Biology; circulating endothelial cells; Clinical trials; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - immunology; COVID-19 - pathology; Cytokines; Cytokines - immunology; Cytotoxicity; Diabetes; Diabetes mellitus; Effector cells; endothelial activation; Endothelial cells; Endothelial Cells - immunology; Endothelial Cells - pathology; Endothelium; Endothelium, Vascular - immunology; Endothelium, Vascular - pathology; Ethnicity; Female; Gender; Health aspects; Heart attacks; Humans; Hypertension; Hypoxia; immune effector cells; Immunology and Inflammation; Infections; Inflammation; Lymphocyte Activation; Lymphocytes T; Male; Medicin och hälsovetenskap; Middle Aged; Patients; Pneumonia; Population; Risk Factors; Severe acute respiratory syndrome coronavirus 2; Stains & staining; T cells; Vein & artery diseases; COVID-19; cell biology; inflammation; immune effector cells; cytokines; human; immunology; circulating endothelial cells; endothelial activation
• ISSN: 2050-084X; 2050-084X
• DOI: 10.7554/eLife.64909

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.