Researchers from the Pontifical Catholic University of Paraná (PUCPR) proved that covid-19 is not only a lung disease, but it is also a vascular disease. A study carried out with post-mortem samples, authorized by the relatives of patients who died due to covid-19, showed that they had lesions in the cell that lines the blood vessel, with the possibility of causing thrombi and leading to death. Patients with a mean age of 75 years and with comorbidities such as arterial hypertension, diabetes and obesity were analyzed.
After publishing the results of the first analyzes in the international medical journal Arteriosclerosis, thrombosis and vascular biology (ATVB), of the American Heart Association, the researchers indicated that the early use of anticoagulants may help in the treatment of covid-19 and avoid thrombosis.
The professor at the PUCPR School of Medicine and one of those responsible for the research, Lucia de Noronha, told Agência Brasil today (30) that minimally invasive autopsies were performed through small incisions in the patients’ chest, shortly after death, where the researchers had access to the lungs. Biopsies are guided by images that help to distinguish the most injured areas of the lung. Lung biopsies have already been done in 25 patients and more than 20 kidney biopsies. The published study refers to the first six analyzes. Further research will be carried out to confirm the findings.
Lucia pointed out that, “even with six patients, we have already been able to see the degree of vascular damage that covid-19 causes”.
For comparison, the researchers used a control group of post-mortem biopsies from H1N1 patients, who had been studying it since 2009. “It already had a parameter. Although viruses are different, they are pandemic diseases ”.
Biopsies of ten other patients who died not from lung disease, but from other causes, such as acute myocardial infarction, for example, were also used. “We took a normal lung, to compare,” said the researcher.
With the study, it was observed that covid-19 causes a very important lesion in the endothelium, which is a thin layer of cells that protects the vessel to prevent thrombosis. “It has a barrier function, so that the blood stays inside the vessel, but it does not clot and continues to flow. It is like a protective and smooth layer. It also has a lubricant function, so that blood is not sticky and flows easily, ”explained Lucia.
In addition, according to the professor, the endothelium in the lung has an air exchange function. “Because the lung endothelium, in addition to having all these protective functions, a lubricating layer for the blood to flow and not to coagulate, it also makes the gas exchange. It is the endothelium that helps the air in the lung to pass into the blood ”.
Lucia de Noronha also explained that when there is damage to the endothelium, the situation tends to get worse. In a person with a lung damaged by the covid, the air is no longer passing properly. “In addition, the vessel is not allowing blood to flow properly because it is pumped. You cannot even do the breathing, that is, neither pass your air into the vessel, nor distribute the air to the whole body through the blood, because it does not flow. This greatly aggravates the patient’s situation ”, said the teacher.
The researchers then suggested that the use of anticoagulants early could help these patients with all the care that the anticoagulant needs and that includes medical advice and monitoring care. They also warned that it is still necessary to think about which patient would be most at risk for endothelial injury and which would benefit most from the anticoagulant, because it is exactly the patients at risk who should be treated more carefully and earlier.
The risk is intrinsic, that is, the patient already has it. This is the case of hypertensive people, with morbid obesity, diabetes and kidney damage.
Another study was done by researchers at PUCPR with a focus on the lung mast cell and found that patients with covid-19 had more mast cells than H1N1 patients. “As covid is new, we started looking at all types of cells and, by chance, saw that the mast cell had more in patients with covid”, said the professor.
According to Lucia de Noronha, people with covid-19 have ten times more mast cells than people with H1N1. “If there is more, it is because there is an injury there”. The mast cell is a cell that is involved in allergic processes, such as asthma.
The study showed that the mast cell causes edema, an increase in fluid in the lung, which makes it difficult for gas to exchange oxygen into the vessel. The researchers concluded, at the end of the research, that the mast cell can be treated. “There are some drugs that are mast cell stabilizers. They leave the mast cell stable and it stops loosening granules and making this edema ”, explained Lucia.
This study was published in the journal of basic science Frontiers in Immunology, of the International Union of Immunological Societies (IUIS).
Just as in research on endothelial injury, PUCPR researchers suggested that some mast cell stabilizers could be used early for patients with moderate or mild covid form, to prevent them from going into a severe form, because they would stabilize the mast cell, whose granules aggravate lung injury, causing edema in the lung. They also suggested that these drugs could be tested in patients with covid-19, because they have no side effects.
Clinical tests with mast cell modules have not yet started at the Marcelino Champagnat Hospital, of the Marist Group, where the research was carried out because, to test these drugs, many patients would be needed. Professor Lucia said that the idea is to join a pre-existing consortium, which brings together several cities around the world.
The two studies are part of a broader research program on the new coronavirus (covid-19) that has been carried out at Hospital Marcelino Champagnat on several lines of covid-19, in which professors from PUCPR, undergraduate and postgraduate students participate. undergraduate, nurses, intensivists, among other health professionals.
One of these groups studies with patients who survived the covid, through the collection of serum and blood that starts from the first day of hospitalization until they are discharged. The idea is, in the end, to marry this information from those who lived and those who died to know what is different about those who died from those who managed to overcome the disease.
“We will probably collect stickers by the end of the year,” said Lúcia de Noronha.
The group that studies surviving covid patients already has more than 100 samples for research.