Affiliation:
1. Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR72079, United States
Abstract
A pericyte-centered theory suggesting that embolisms occurring within the microvasculature
of a neurovascular unit that can result in either parenchymal hemorrhage or intravascular congestion
is presented here. Dysfunctional microvascular pericytes are characterized by their location
in the neurovascular unit, either on the arteriole or venule side. Pathophysiological and pathological
changes caused by coronavirus disease 2019 (COVID-19) include pulmonary hypertension, edema,
focal hemorrhage, microvascular congestion, and thrombosis. In this paper, the application of
the pericytes-centered hypothesis to COVID-19 has been presented by proposing the concept of a
pulmonary neurovascular unit (pNVU). The application of this concept implies that human lungs
contain approximately 300 million pNVUs. This concept of existing local regulation of microvascular
blood flow is supported by the observation of pathophysiology in pulmonary embolism and in
acute high-altitude illness. The autonomic control seen in these three disease states matches blood
flow with oxygen supply in each pNVU to maintain physiological blood oxygen saturation level.
This paper illustrates how the malfunction of microvascular pericytes may cause focal hemorrhage,
edema or microvascular congestion and thrombosis. A bypass existing in each pNVU would autonomically
deviate blood flow from a COVID-19-affected pNVU to other healthy pNVUs. This action
would prevent systemically applied medicines from reaching the therapeutic threshold in
COVID-19-affected pNVUs. While testing this hypothesis with experimental evidence is urgently
needed, supporting therapy aimed at improving microcirculation or rebuilding the physiological
function of microvascular pericytes is recommended as a potentially effective treatment of COVID
19.
Publisher
Bentham Science Publishers Ltd.
Subject
Cellular and Molecular Neuroscience,Developmental Neuroscience,Neurology
Cited by
2 articles.
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