06-Jan-2023 - Medizinische Hochschule Hannover

How COVID-19 permanently damages the heart

Research team shows for the first time how the inflammation in COVID 19 alters the smallest vessels in the heart

Severe courses of COVID-19 infection not only impair lung function, but can also cause life-threatening consequences for the heart. The spectrum ranges from acute inflammation of the heart muscle (myocarditis) to chronic restriction of the heart's pumping function. The basic patterns of damage have not yet been completely proven. An interdisciplinary research team led by Professor Dr. Danny Jonigk, Christopher Werlein and Private Lecturer (PD) Dr. Mark Kühnel from the Institute of Pathology at the Hannover Medical School (MHH) has now used innovative molecular methods and a high-resolution microscopy technique to show how the ongoing inflammation in COVID-19 attacks the heart tissue and, in the long term, remodels the smallest coronary vessels by directing special precursor cells of the immune system from the blood into the heart. The study was published in the journal Angiogenesis.

False-activated inflammatory cells

About one in three people complain of discomfort and functional impairment of the heart after severe COVID-19 disease. In order to elucidate the mechanisms of this long-lasting myocardial damage, the researchers examined heart tissue from patients with severe COVID 19 and compared it with tissue samples taken after severe influenza infections caused by the influenza virus and after severe myocarditis caused by other viruses. Although in the COVID 19 heart injury - unlike the comparison samples - there was no classic inflammation of the heart tissue on the outside, the research team did find a large accumulation of false-activated inflammatory cells: so-called macrophages and their precursor cells, the monocytes. "These monocytes have an outstanding importance as precursor cells of new blood vessel formation and can remodel the blood vessel system in a very short time," explains Christopher Werlein, first author of the study.

COVID-19 attacks all vessels in the body

Triggered by the infection with the coronavirus SARS-CoV-2, tiny blockages accumulate in the heart vessels, which are only a few millimetres thick. "These ultra-thrombi change the blood flow considerably and thus also the oxygen supply", emphasises PD Dr. Kühnel. This calls the monocytes into action, which attach themselves to the inner vessel walls and form new branches there. This vascular remodelling - known as intussusceptive angiogenesis - has already been described by the team as a characteristic pattern of damage in other organs of COVID 19 patients. What may be intended as a short-term rescue response by the body to compensate for reduced blood flow and undersupply of oxygen could lead to chronic damage to the heart and long covid, the researchers suspect. "In any case, the latest investigations confirm our earlier assumption that SARS-CoV-2 systemically attacks all vessels in the body and remodels them in the long term," Professor Jonigk emphasises.

Facts, background information, dossiers
More about Medizinische Hochschule Hannover
  • News

    How well does the adapted Covid-19 vaccine protect?

    These questions are asked by many citizens who have received the basic immunization consisting of usually three individual vaccine doses. A team of researchers from the German Primate Center – Leibniz Institute for Primate Research in Göttingen and Hannover Medical School studied antibody-m ... more

    New gene taxis to combat liver disease

    There are numerous severe, hardly treatable monogenetic diseases that are caused by a defect in a single gene - also in the liver. These include the blood coagulation disorders haemophilia A or B or the metabolic disease phenylketonuria. Gene therapies could help here, in which intact genes ... more

    Botox influences the control of emotions in the brain

    The bacterial toxin botulinum toxin (BTX) - colloquially known as Botox - is probably known to most people as a remedy for wrinkles. But botulinum toxin can do even more: if it is injected into the forehead, for example, it can alleviate depression. It also dampens negative emotions in peop ... more