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Clinical Manifestation of Endotheliitis in COVID-19 along with Flow-Mediated Vasodilation Study

Kazumi Fujioka

The emerging Coronavirus Disease 2019 (COVID-19) by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused a worldwide outbreak and still has spread relentlessly and recrudescence due to the new mutant’s occurrence. The respiratory failure from Acute Respiratory Distress Syndrome (ARDS) presents the major cause of mortality and multi-organ failure represents other causes of mortality in patients with COVID-19. The author previously described a link between endothelial dysfunction and SARS-CoV-2 infection in patients with COVID-19 and cutaneous manifestation and vasculitis of COVID-19 in dermatology, suggesting that COVID-19 may be a systemic endothelial disease or a multi-organ disease especially in the severe stage. In this review, the author emphasizes that COVID-19 represents a systemic endothelial disease and/or a multi-organ disease based on the current evidences. The author also suggests that Flow Mediated Vasodilation (FMD) test should be assessed for the risk stratification and therapy effects in follow up study in COVID-19. As COVID-19 is a pathophysiological systemic and complex disease including the endothliitis, hypercoagulability, and cytokine storm, thereby therapeutic strategy is complicated especially in severe stage. Based on the current evidences therapeutic strategy to improve endothelial dysfunction such as Renin Angiotensin System (RAS) inhibitors or statins might be helpful to prevent and control systemic complications in patients with SARS-CoV-2 infection. In addition to antiviral and anti-inflammatory drugs, a novel therapeutic of Nitric Oxide (NO) use may be a potential prevention and treatment in COVID-19.