Acute myocardial injury in new coronavirus infection: contribution of mast cells
https://doi.org/10.20538/1682-0363-2025-3-116-126
Abstract
The new coronavirus infection, COVID-19, led to a global pandemic in 2019–2023. The infection affects not only the lung tissue, but also other organs and systems, including the heart. This causes the frequent development of myocarditis, arrhythmia, and acute coronary syndrome in these patients, as well as worsening of coronary heart disease and chronic heart failure. One of the important mechanisms of heart damage in COVID-19 is the excessive activation of mast cells, which produce cytokines and chemokines with pro-inflammatory activity, thus causing a so-called “cytokine storm” – a special severe form of systemic inflammatory reaction that can be fatal.
The aim of the literature review was to analyze and summarize published data on cardiovascular complications in COVID-19, including the effect of mast cell proteases on myocardial damage.
About the Authors
A. V. BudnevskyRussian Federation
10 Studencheskaya St., 394036 Voronezh
Competing Interests:
The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article
S. N. Avdeev
Russian Federation
8-2 Trubetskaya St., 119048 Moscow
Competing Interests:
The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article
E. S. Ovsyannikov
Russian Federation
10 Studencheskaya St., 394036 Voronezh
Competing Interests:
The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article
R. E. Tokmachev
Russian Federation
10 Studencheskaya St., 394036 Voronezh
Competing Interests:
The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article
S. N. Feigelman
Russian Federation
10 Studencheskaya St., 394036 Voronezh
Competing Interests:
The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article
V. V. Shishkina
Russian Federation
10 Studencheskaya St., 394036 Voronezh
Competing Interests:
The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article
I. M. Perveeva
Russian Federation
151 Moskovsky Ave., 394066 Voronezh
Competing Interests:
The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article
T. A. Chernik
Russian Federation
10 Studencheskaya St., 394036 Voronezh
Competing Interests:
The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article
E. D. Arkhipova
Russian Federation
10 Studencheskaya St., 394036 Voronezh
Competing Interests:
The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article
S. A. Budnevskaya
Russian Federation
10 Studencheskaya St., 394036 Voronezh
Competing Interests:
The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article
References
1. Львов Д.К., Альховский С.В. Истоки пандемии COVID-19: экология и генетика коронавирусов (Betacoronavirus: Coronaviridae) SARS-CoV, SARS-CoV-2 (подрод Sarbecovirus), MERS-CoV (подрод Merbecovirus). Вопросы вирусологии. 2020;65(2):62–70.
2. Machhi J., Herskovitz J., Senan A.M., Dutta D., Nath B., Oleynikov M.D. et al. The natural history, pathobiology, and clinical manifestations of SARS-CoV-2 infections. J. Neuroimmune Pharmacol. 2020;15(3):359–386. DOI: 10.1007/s11481-020-09944-5.
3. Зарубин Е.А., Коган Е.А. Патогенез и морфологические изменения в легких при COVID-19. Архив патологии. 2021;83(6):54–59.
4. Zaki A.M., van Boheemen S., Bestebroer T.M., Osterhaus A.D., Fouchier R.A. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N. Engl. J. Med. 2012;367(19):1814–1820. DOI: 10.1056/NEJMoa1211721.
5. Rahman A, Sarkar A. Middle East respiratory syndrome coronavirus (MERS-CoV) infection: Analyses of risk factors and literature review of knowledge, attitude and practices. Zoonoses Public Health. 2022;69(6):635–642. DOI: 10.1111/zph.12952.
6. Apostolopoulos V., Chavda V., Alshahrani N.Z., Mehta R., Satapathy P., Rodriguez-Morales A.J. et al. MERS outbreak in Riyadh: A current concern in Saudi Arabia. Infez. Med. 2024;32(2):264–266. DOI: 10.53854/liim-3202-15.
7. Tian H., Liu Y., Li Y., Wu C.H., Chen B., Kraemer M.U.G. et al. An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China. Science. 2020;368(6491):638–642. DOI: 10.1126/science.abb6105.
8. Yu W.B., Tang G.D., Zhang L., Corlett R.T. Decoding the evolution and transmissions of the novel pneumonia coronavirus (SARS-CoV-2/HCoV-19) using whole genomic data. Zool. Res. 2020;41(3):247–257. DOI: 10.24272/j.issn.2095-8137.2020.022.
9. Magateshvaren Saras M.A., Patro L.P.P., Uttamrao P.P., Rathinavelan T. Geographical distribution of SARS-CoV-2 amino acids mutations and the concomitant evolution of seven distinct clades in non-human hosts. Zoonoses Public Health. 2022;69(7):816–825. DOI: 10.1111/zph.12971
10. Andersen K.G., Rambaut A., Lipkin W.I., Holmes E.C., Garry R.F. The proximal origin of SARS-CoV-2. Nat. Med. 2020;26(4):450–452. DOI: 10.1038/s41591-020-0820-9.
11. Bolze A., Luo S., White S., Cirulli E.T., Wyman D., Dei Rossi A. et al. SARS-CoV-2 variant Delta rapidly displaced variant Alpha in the United States and led to higher viral loads. Cell Rep. Med. 2022;3(3):100564. DOI: 10.1016/j.xcrm.
12. Министерство здравоохранения РФ. Временные методические рекомендации: Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID 19). Версия 14 (27.12.2021). URL: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/064/610/original/%D0%92%D0%9C%D0%A0_COVID-19_V18.pdf
13. Карпова Л.С., Комиссаров А.Б., Столяров К.А., Поповцева Н.М., Столярова Т.П., Пелих М.Ю. и др. Особенности эпидемического процесса COVID19 в каждую из пяти волн заболеваемости в России. Эпидемиология и вакцинопрофилактика. 2023;22(2):23–36. DOI: 10.31631/20733046-2023-22-2-23-36.
14. Bali Swain R., Lin X., Wallentin F.Y. COVID-19 pandemic waves: Identification and interpretation of global data. Heliyon. 2024;10(3):e25090. DOI: 10.1016/j.heliyon.2024.e25090.
15. Zhu N., Zhang D., Wang W., Li X., Yang B., Song J. et al. China novel coronavirus investigating and research team. a novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 2020;382(8):727–733. DOI: 10.1056/NEJMoa2001017.
16. Wang Q., Zhang Y., Wu L., Niu S., Song C., Zhang Z. et al. Structural and functional basis of SARS-CoV-2 entry by using human ACE2. Cell. 2020;181(4):894–904.e9. DOI: 10.1016/j.cell.2020.03.045.
17. Hofmann H., Pyrc K., van der Hoek L., Geier M., Berkhout B., Pöhlmann S. Human coronavirus NL63 employs the severe acute respiratory syndrome coronavirus receptor for cellular entry. Proc. Natl. Acad. Sci. USA. 2005;102(22):7988–7993. DOI: 10.1073/pnas.0409465102.
18. Donoghue M., Hsieh F., Baronas E., Godbout K., Gosselin M., Stagliano N. et al. A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1-9. Circ. Res. 2000;87(5):e1–9. DOI: 10.1161/01.res.87.5.e1.
19. Shang J., Wan Y., Luo C., Ye G., Geng Q., Auerbach A. et al. Cell entry mechanisms of SARS-CoV-2. Proc. Natl. Acad. Sci. USA. 2020;117(21):11727–11734. DOI: 10.1073/pnas.2003138117.
20. Баклаушев В.П., Кулемзин С.В., Горчаков А.А., Юсубалиева Г.М., Лесняк В.Н., Сотникова А.Г. COVID-19. Этиология, патогенез, диагностика и лечение. Клиническая практика. 2020;1:7–20. DOI: 10.17816/clinpract26339.
21. Huang I.C., Bosch B.J., Li F., Li W., Lee K.H., Ghiran S. et al. SARS coronavirus, but not human coronavirus NL63, utilizes cathepsin L to infect ACE2-expressing cells. J. Biol. Chem. 2006;281(6):3198–3203. DOI: 10.1074/jbc.M508381200.
22. Bayati A., Kumar R., Francis V., McPherson P.S. SARSCoV-2 infects cells after viral entry via clathrin-mediated endocytosis. J. Biol. Chem. 2021;296:100306. DOI: 10.1016/j.jbc.2021.100306.
23. Hou Y.J., Okuda K., Edwards C.E., Martinez D.R., Asakura T., Dinnon K.H. 3rd et al. SARS-CoV-2 reverse genetics reveals a variable infection gradient in the respiratory tract. Cell. 2020;182(2):429–446.e14. DOI: 10.1016/j.cell.2020.05.042.
24. Wang Y., Wang Y., Luo W., Huang L., Xiao J., Li F. et al. A comprehensive investigation of the mRNA and protein level of ACE2, the putative receptor of SARS-CoV-2, in human tissues and blood cells. Int. J. Med. Sci. 2020;17(11):1522–1531. DOI: 10.7150/ijms.46695.
25. Lindner D., Fitzek A., Bräuninger H., Aleshcheva G., Edler C., Meissner K. et al. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. JAMA Cardiol. 2020;5(11):1281–1285. DOI: 10.1001/jamacardio.2020.3551.
26. Jackson C.B., Farzan M., Chen B., Choe H. Mechanisms of SARS-CoV-2 entry into cells. Nat. Rev. Mol. Cell Biol. 2022;23(1):3–20. DOI: 10.1038/s41580-021-00418-x.
27. Zhuang M.W., Cheng Y., Zhang J., Jiang X.M., Wang L., Deng J. et al. Increasing host cellular receptor-angiotensin-converting enzyme 2 expression by coronavirus may facilitate 2019-nCoV (or SARS-CoV-2) infection. J. Med. Virol. 2020;92(11):2693–2701. DOI: 10.1002/jmv.26139.
28. Jacobs M., Van Eeckhoutte H.P., Wijnant S.R.A., Janssens W., Joos G.F., Brusselle G.G. et al. Increased expression of ACE2, the SARS-CoV-2 entry receptor, in alveolar and bronchial epithelium of smokers and COPD subjects. Eur. Respir. J. 2020;56(2):2002378. DOI: 10.1183/13993003.02378-2020.
29. Leung J.M.., Yang CX., Tam A., Shaipanich T., Hackett T.L., Singhera G.K. et al. ACE-2 expression in the small airway epithelia of smokers and COPD patients: implications for COVID-19. Eur. Respir. J. 2020;55(5):2000688. DOI: 10.1183/13993003.00688-2020.
30. Колесникова Н.В. Тучные клетки при аллергическом и инфекционном воспалении. РМЖ. Медицинское обозрение. 2022;6(2):79–84. DOI: 10.32364/2587-6821-2022-6-279-84.
31. Будневский А.В., Авдеев С.Н., Овсянников Е.С., Шишкина В.В., Есауленко Д.И., Филин А.А. и др. Роль тучных клеток и их протеаз в поражении легких у пациентов с COVID-19. Пульмонология. 2023;33(1):17–26. DOI: 10.18093/0869-0189-2023-33-1-17-26.
32. Будневский А.В., Авдеев С.Н., Овсянников Е.С., Алексеева Н.Г., Шишкина В.В., Савушкина И.А. и др. Некоторые аспекты участия карбоксипептидазы а3 тучных клеток в патогенезе COVID-19. Туберкулез и болезни легких. 2024;102(1):26–33. DOI: 10.58838/2075-1230-2024-102-126-33.
33. Ellison-Hughes G.M., Colley L., O’Brien K.A., Roberts K.A., Agbaedeng T.A., Ross M.D. The role of MSC therapy in attenuating the damaging effects of the cytokine storm induced by COVID-19 on the heart and cardiovascular system. Front. Cardiovasc. Med. 2020;7:602183. DOI: 10.3389/fcvm.2020.602183.
34. Будневский А.В., Авдеев С.Н., Овсянников Е.С., Савушкина И.А., Чопоров О.Н., Шишкина В.В. и др. К вопросу о роли тучных клеток и их протеаз в тяжелом течении новой коронавирусной инфекции COVID-19. Архивъ внутренней медицины. 2024;14(3):181–189. DOI: 10.20514/22266704-2024-14-3-181-189.
35. Budnevsky A.V., Avdeev S.N., Kosanovic D., Shishkina V.V., Filin A.A., Esaulenko D.I. et al. Role of mast cells in the pathogenesis of severe lung damage in COVID-19 patients. Respiratory Research. 2022;23(1):1–10. DOI: 10.1186/s12931-022-02284-3.
36. Azkur A.K., Akdis M., Azkur D., Sokolowska M., van de Veen W., Brüggen M.C. et al. Immune response to SARS-CoV-2 and mechanisms of immunopathological changes in COVID-19. Allergy. 2020;75(7):1564–1581. DOI: 10.1111/all.14364.
37. Manjili R.H., Zarei M., Habibi M., Manjili M.H. COVID-19 as an acute inflammatory disease. J. Immunol. 2020;205(1):12– 19. DOI: 10.4049/jimmunol.2000413.
38. Vardhana S.A., Wolchok J.D. The many faces of the anti-COVID immune response. J. Exp. Med. 2020;217(6):e20200678. DOI: 10.1084/jem.20200678.
39. Ravindran M., Khan M.A., Palaniyar N. Neutrophil extracellular trap formation: physiology, pathology, and pharmacology. Biomolecules. 2019;9(8):365. DOI: 10.3390/biom9080365.
40. Tinsley J.H., Hunter F.A., Childs E.W. PKC and MLCK-dependent, cytokine-induced rat coronary endothelial dysfunction. J. Surg. Res. 2009;152(1):76–83. DOI: 10.1016/j.jss.2008.02.022.
41. Budnevsky A.V., Avdeev S.N., Kosanovic D., Ovsyannikov E.S., Savushkina I.A., Alekseeva N.G. et al. Involvement of mast cells in the pathology of COVID-19: clinical and laboratory parallels. Cells. 2024;13(8):711. DOI: 10.3390/cells13080711.
42. Poto R., Marone G., Galli S.J., Varricchi G. Mast cells: a novel therapeutic avenue for cardiovascular diseases? Cardiovasc. Res. 2024;120(7):681–698. DOI: 10.1093/cvr/cvae066.
43. Patella V., Marino I., Arbustini E., Lamparter-Schummert B., Verga L., Adt M. et al. Stem cell factor in mast cells and increased mast cell density in idiopathic and ischemic cardiomyopathy. Circulation. 1998;97(10):971–978. DOI: 10.1161/01.cir.97.10.971.
44. Daugherty S.E., Guo Y., Heath K., Dasmariñas M.C., Jubilo K.G., Samranvedhya J. et al. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study. BMJ. 2021;373:n1098. DOI: 10.1136/bmj.n1098.
45. Xie Y., Xu E., Bowe B., Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat. Med. 2022;28(3):583–590. DOI: 10.1038/s41591-022-01689-3.
46. Tomasoni D., Inciardi R.M., Lombardi C.M., Tedino C., Agostoni P., Ameri P. et al. Impact of heart failure on the clinical course and outcomes of patients hospitalized for COVID-19. Results of the Cardio-COVID-Italy multicentre study. Eur. J. Heart Fail. 2020;22(12):2238–2247. DOI: 10.1002/ejhf.2052.
47. Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. DOI: 10.1016/S0140-6736(20)30566-3.
48. Guo T., Fan Y., Chen M., Wu X., Zhang L., He T. et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811–818. DOI: 10.1001/jamacardio.2020.1017.
49. Shi S., Qin M., Shen B., Cai Y., Liu T., Yang F. et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802–810. DOI: 10.1001/jamacardio.2020.0950.
50. Falasca L., Nardacci R., Colombo D., Lalle E., Di Caro A., Nicastri E. et al. Postmortem findings in Italian patients with COVID-19: a descriptive full autopsy study of cases with and without comorbidities. J. Infect. Dis. 2020;222(11):1807– 1815. DOI: 10.1093/infdis/jiaa578.
51. Schurink B., Roos E., Radonic T., Barbe E., Bouman C.S.C., de Boer H.H. et al. Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study. Lancet Microbe. 2020;1(7):e290–e299. DOI: 10.1016/S2666-5247(20)30144-0.
52. Halushka M.K., Vander Heide R.S. Myocarditis is rare in COVID-19 autopsies: cardiovascular findings across 277 postmortem examinations. Cardiovasc. Pathol. 2021;50:107300. DOI: 10.1016/j.carpath.2020.107300.
53. Aretz H.T., Billingham M.E., Edwards W.D., Factor S.M., Fallon J.T., Fenoglio J.J. Jr. et al. Myocarditis. A histopathologic definition and classification. Am. J. Cardiovasc. Pathol. 1987;1(1):3–14.
54. Richardson P., McKenna W., Bristow M., Maisch B., Mautner B., O’Connell J. et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies. Circulation. 1996;93:841–842. DOI: 10.1161/01.cir.93.5.841.
55. Tsai E.J., Cˇiháková D., Tucker N.R. Cell-specific mechanisms in the heart of COVID-19 patients. Circ. Res. 2023;132(10):1290– 1301. DOI: 10.1161/CIRCRESAHA.123.321876.
56. Pellegrini D., Kawakami R., Guagliumi G. et al. Microthrombi as a Major Cause of Cardiac Injury in COVID-19: A Pathologic Study. Circulation. 2021;143(10):1031–1042. DOI: 10.1161/CIRCULATIONAHA.120.051828.
57. Sewanan L.R., Clerkin K.J., Tucker N.R., Tsai E.J. How does COVID-19 affect the heart? Curr. Cardiol. Rep. 2023;25(3):171–184. DOI: 10.1007/s11886-023-01841-6.
58. Basso C., Leone O., Rizzo S., De Gaspari M., van der Wal A.C., Aubry M.C. et al. Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study. Eur. Heart J. 2020;41(39):3827–3835. DOI: 10.1093/eurheartj/ehaa664.
59. Bearse M., Hung Y.P., Krauson A.J., Bonanno L., Boyraz B., Harris C.K. et al. Factors associated with myocardial SARSCoV-2 infection, myocarditis, and cardiac inflammation in patients with COVID-19. Mod. Pathol. 2021;34(7):1345–1357. DOI: 10.1038/s41379-021-00790-1.
60. Chen S.T., Park M.D., Del Valle D.M., Buckup M., Tabachnikova A., Simons N.W. et al. A shift in lung macrophage composition is associated with COVID-19 severity and recovery. Sci. Transl. Med. 2022;14(662):eabn5168. DOI: 10.1126/scitranslmed.abn5168.
61. Shao H.H., Yin R.X. Pathogenic mechanisms of cardiovascular damage in COVID-19. Mol. Med. 2024;30(1):92. DOI: 10.1186/s10020-024-00855-2.
62. Brener M.I., Hulke M.L., Fukuma N., Golob S., Zilinyi R.S., Zhou Z. et al. Clinico-histopathologic and single-nuclei RNA-sequencing insights into cardiac injury and microthrombi in critical COVID-19. JCI Insight. 2022;7(2):e154633. DOI: 10.1172/jci.insight.154633.
63. Dmytrenko O., Lavine K.J. Cardiovascular tropism and sequelae of SARS-CoV-2 infection. Viruses. 2022;14(6):1137. DOI: 10.3390/v14061137.
Review
For citations:
Budnevsky A.V., Avdeev S.N., Ovsyannikov E.S., Tokmachev R.E., Feigelman S.N., Shishkina V.V., Perveeva I.M., Chernik T.A., Arkhipova E.D., Budnevskaya S.A. Acute myocardial injury in new coronavirus infection: contribution of mast cells. Bulletin of Siberian Medicine. 2025;24(3):116-126. https://doi.org/10.20538/1682-0363-2025-3-116-126
JATS XML








































