Elevated Circulating Endothelin-1 as a Potential Biomarker for Highrisk Covid-19 Severity

Abstract

There is a disproportionately higher rate of adverse outcomes in coronavirus disease 2019 (COVID19) patients of the male sex, select ethnicities, and individuals with obesity and those that tend to have endothelial dysfunction (e.g., hypertensives, diabetics and individuals with coronary heart disease and respiratory system diseases). Endotheliitis across vascular beds of multiple organs, thrombosis and ischaemia, are among common pathological features of severe COVID-19 cases. Endothelin-1 (ET-1) is the most potent vasoconstrictor of the human cardiovascular system and a culprit of endothelial dysfunction. Elevated circulating ET-1 levels are a predictor of cardiovascular disease status and have been correlated with racial/ethnic differences in microvascular and macrovascular disease severity and prognosis as well as with older age-associated endothelial dysfunction. Here, we propose elevated circulating ET-1 levels as a plausible biomarker and prognostic tool in predicting individuals at high risk of developing severe COVID-19. In addition to this, we also propose ET-1 gene variants and expression patterns might also cause a predisposition for an increased risk of severe acute respiratory syndrome coronavirus- 2 infection severity in some individuals and/or populations.