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COVID is here to stay:

Insights into new therapies targeting COVID induced mtROS overactivity, chronic inflammation, and endothelial dysfunction

Front Physiol 2021 Jan 15;11:605908.

SARS-CoV-2 Mediated Endothelial Dysfunction: The Potential Role of Chronic Oxidative Stress

Ryan Chang 1, Abrar Mamun 2, Abishai Dominic 3 4, Nhat-Tu Le 4


  • 1 College of Arts & Sciences, Washington University in St. Louis, St. Louis, MO, United States.

  • 2 Wiess School of Natural Sciences, Rice University, Houston, TX, United States.

  • 3 Department of Molecular and Cellular Medicine, College of Medicine, Texas A&M University, College Station, TX, United States.

  • 4 Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, United States.


Endothelial cells have emerged as key players in SARS-CoV-2 infection and COVID-19 inflammatory pathologies. Dysfunctional endothelial cells can promote chronic inflammation and disease processes like thrombosis, atherosclerosis, and lung injury. In endothelial cells, mitochondria regulate these inflammatory pathways via redox signaling, which is primarily achieved through mitochondrial reactive oxygen species (mtROS). Excess mtROS causes oxidative stress that can initiate and exacerbate senescence, a state that promotes inflammation and chronic endothelial dysfunction. Oxidative stress can also activate feedback loops that perpetuate mitochondrial dysfunction, mtROS overproduction, and inflammation. In this review, we provide an overview of phenotypes mediated by mtROS in endothelial cells – such as mitochondrial dysfunction, inflammation, and senescence – as well as how these chronic states may be initiated by SARS-CoV-2 infection of endothelial cells. We also propose that SARS-CoV-2 activates mtROS-mediated feedback loops that cause long-term changes in host redox status and endothelial function, promoting cardiovascular disease and lung injury after recovery from COVID-19. Finally, we discuss the implications of these proposed pathways on long-term vascular health and potential treatments to address these chronic conditions.

Keywords: Cardiovascular; EndMT; SARS-CoV-2; endothelial cells; inflammation; mitochondrial dysfunction; oxidative stress; senescence.


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