Title:Clinical Evidence and Therapeutic Treatments at the Time of the Coronaviruses Responsible for SARS: A Perspective and Points of view with a Focus on Vascular Endothelium
Volume: 2
Issue: 11
Author(s): Gerardo Tricarico, Barbara Zavan and Valter Travagli*
Affiliation:
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena,Italy
Keywords:
Coronavirus, SARS-CoV-2, COVID-19, lymphocytopenia, endothelial cells, endotheliitis, prescriptive appropriateness,
personalized medicine.
Abstract: The clinical outcomes of COVID-19 patients highlight a significant minority of subjects
with very rapid lethal outcomes subsequent to the almost complete healing after coronavirus infections
for most of the subjects involved. In addition, the reckless use of some drugs and therapeutic
protocols that have not shown any efficacy in reducing mortality in those patients where the progression
of the disease was unstoppable suggests a different interpretative model in the pathogenesis
of severe cases. Starting from the clinical data already known for almost twenty years on the behavior
of human SARS coronaviruses, it is possible to develop a new hypothesis. The reference
points taken into consideration are: i) the comparison of the histological evidence of the autoptic
material; ii) the poor pharmacological response in subjects with severe phenotypes of the pathology;
iii) the common element of endotheliitis in a subgroup of the population characterized by harmful
clinical outcomes during the evolution of the pathology. The tendency to develop widespread,
massive endothelial lesions not responding to any drug therapy or other interventions necessarily
plays a crucial role in the onset of the systemic and severe stage of the disease. The present perspective
opens the door to a different therapeutic approach both to the full-blown phase of COVID-19
and to the preventive phase or the very first manifestations of the disease. It is imperative to pay
more attention to the protection of the vascular endothelium in subjects who already have a predisposition
to the development of a severe evolution of this ailment rather than to give a simple antiviral
therapy together with symptomatic drugs.
