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Advancing the knowledge on COVID-19


COVID-19 and the endothelium

The primary target of SARS-CoV-2 is the epithelial cells of the lung (1), through the Angiotensin Converting Enzyme-2 (ACE-II) receptor, which is also expressed on endothelial cells (ECs) (2). Recent evidence suggest SARS-CoV-2 directly infect endothelial cells and cause diffuse endothelial inflammation (3).

SARS-CoV-2 is thus directly targeting both components of the ephitelial-endothelial barrier.

Ephitelial-endothelial barrier


The damaged and/or activated endothelium could contribute to a pro-inflammatory cascade, which perpetuates and amplifies lung damage and respiratory distress and could lead to the most severe complication represented by Acute Respiratory Distress Syndrome (ARDS).

COVID-19 and cardiovascular complications

Although the major clinical manifestations of COVID-19 are respiratory symptoms, publications are reporting that, in a number of patients there are associated cardiovascular complications (4, 5) and these can lead to acute myocardial injury and chronic damage to the cardiovascular system .

Endothelial damage and consequent clotting is reported to be common in severe COVID-19 by Chinese Clinicians (6) and it is suggested that COVID-19- endotheliitis could explain the systemic impaired microcirculatory function in different vascular beds (3) and may have implications for treatment.

Circulating Endothelial Cells as a potential Biomarker of endothelial damage and COVID-19-induced cardiovascular complications

Circulating Endothelial Cells (CECs) are a specific and sensitive marker of endothelial damage in a variety of pathological conditions and an increase in the CEC count has been reported to be linked to cardio-vascular events (7-14).


The CEC count may resemble the pulmonary and systemic endothelial damage and an increase in the CEC count may predict the extent of pro-inflammatory cascade activation.

Hence, the CEC count could become a potential biomarker for the risk of activation of the coagulation cascade, cardio vascular events and the onset of severe respiratory distress during SARS-CoV-2 infection.

The CELLSEARCH platform to study Circulating Endothelial Cells 

The CELLSEARCH system enables the enrichment and enumeration of rare cell types — from circulating tumor cells (CTCs) to circulating  endothelial cells from blood. The system is based on ferrofluid technology which allows the immune-magnetic capture of rare cells in the whole blood.

The CELLSEARCH platform, in combination with the CELLSEARCH Circulating Endothelial Cell Kit*, is able to  enumerate CECs by immuno-magnetically capturing CD146-positive cells. The technology has been extensively validated in different settings, such as cardiovascular, neoplastic and autoimmune diseases (10-14).

CELLSEARCH  CEC count* and its dynamic changes during the course of COVID-19 could potentially be used as a biomarker in research studies evaluating the risk of  cardiovascular events and the onset of a severe respiratory distress.
*For Research use Only. Not for use in diagnostic procedures. The performance characteristics and safety and effectiveness have not been established and are not cleared or approved by the FDA.


  1. Wan Y. et al J Virol 2020
  2. Hamming I. et al, J Pathol 2004
  3. Varga Z. et al, Lancet 2020
  4. Huang C. et al, Lancet 2020
  5. Zheng Y. et al, Nat Rev Cardiol 2020
  6. Webinar co-sponsored by Chinese Cardiovascular Association and American College of Cardiology
  7. Dignat-Gearge F. et al Eur J Hematology, 2000
  8. Rowand L. et al Cytometry 105-113;2007
  9. Erdbruegger U et al Curr Stem cells Therapy and Research 5, 294-300;2010
  10. Almici et al. Transplantation 98, 706-12;2014
  11. Almici et al. Bone Marrow Transplantation 56, 1637-42; 2017
  12. Almici et al. Scientific Report 9:87; 2019
  13. De Simone C et al. J Eur Acad Dermatol Venerol 28 (5) 590-6;2014
  14. Damani et al. Sci Trans Med, 2012

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