# Vascular endothelial injury exacerbates coronavirus disease 2019: The role of endothelial glycocalyx protection

## TL;DR

This review explores how vascular endothelial injury, particularly involving the glycocalyx, may worsen the severity of COVID-19 and suggests it as a potential therapeutic target.

## Contribution

The paper highlights the glycocalyx as a novel therapeutic target for systemic complications in COVID-19.

## Key findings

- Vascular endothelial injury and glycocalyx damage may contribute to systemic complications in COVID-19.
- The glycocalyx plays a key role in capillary homeostasis and is particularly vulnerable in the lungs.
- Targeting the glycocalyx could offer new treatment strategies for severe COVID-19.

## Abstract

The potential for a rapid increase in severity is among the most frightening aspects of severe acute respiratory syndrome coronavirus 2 infection. Evidence increasingly suggests that the symptoms of coronavirus disease‐2019 (COVID‐19)‐related acute respiratory distress syndrome (ARDS) differ from those of classic ARDS. Recently, the severity of COVID‐19 has been attributed to a systemic, thrombotic, and inflammatory disease that damages not only the lungs but also multiple organs, including the heart, brain, toes, and liver. This systemic form of COVID‐19 may be due to inflammation and vascular endothelial cell injury. The vascular endothelial glycocalyx comprises glycoproteins and plays an important role in systemic capillary homeostasis maintenance. The glycocalyx covers the entire vascular endothelium, and its thickness varies among organs. The endothelial glycocalyx is very thin in the pulmonary capillaries, where it is affected by gaseous exchange with the alveoli and the low intravascular pressure in the pulmonary circulation. Despite the clearly important roles of the glycocalyx in vascular endothelial injury, thrombosis, vasculitis, and inflammation, the link between this structure and vascular endothelial cell dysfunction in COVID‐19 remains unclear. In this prospective review, we summarize the importance of the glycocalyx and its potential as a therapeutic target in cases of systemic COVID‐19.