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On-line Access: 2024-01-25

Received: 2023-07-21

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Journal of Zhejiang University SCIENCE B

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COVID-19 and acute limb ischemia: latest hypotheses of pathophysiology and molecular mechanisms


Author(s):  Chengjun YAO, Yanzhao DONG, Haiying ZHOU, Xiaodi ZOU, AHMAD ALHASKAWI, Sohaib Hasan Abdullah EZZI, Zewei WANG, Jingtian LAI, Vishnu Goutham KOTA, Mohamed Hasan Abdulla Hasan ABDULLA, Zhenfeng LIU, Sahar Ahmed ABDALBARY, Olga ALENIKOVA, Hui LU

Affiliation(s):  Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, P. R. China, 310003; more

Corresponding email(s):  huilu@zju.edu.cn

Key Words:  Acute limb ischemia; COVID-19 infection complication; Hypercoagulability; Thrombosis; Vasospasm; Hypoxia-inducible factor 1α; ACE2; IFN-I; Tocilizumab


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Chengjun YAO, Yanzhao DONG, Haiying ZHOU, Xiaodi ZOU, AHMAD ALHASKAWI, Sohaib Hasan Abdullah EZZI, Zewei WANG, Jingtian LAI, Vishnu Goutham KOTA, Mohamed Hasan Abdulla Hasan ABDULLA, Zhenfeng LIU, Sahar Ahmed ABDALBARY, Olga ALENIKOVA, Hui LU. COVID-19 and acute limb ischemia: latest hypotheses of pathophysiology and molecular mechanisms[J]. Journal of Zhejiang University Science B,in press.Frontiers of Information Technology & Electronic Engineering,in press.https://doi.org/10.1631/jzus.B2300512

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author="Chengjun YAO, Yanzhao DONG, Haiying ZHOU, Xiaodi ZOU, AHMAD ALHASKAWI, Sohaib Hasan Abdullah EZZI, Zewei WANG, Jingtian LAI, Vishnu Goutham KOTA, Mohamed Hasan Abdulla Hasan ABDULLA, Zhenfeng LIU, Sahar Ahmed ABDALBARY, Olga ALENIKOVA, Hui LU",
journal="Journal of Zhejiang University Science B",
year="in press",
publisher="Zhejiang University Press & Springer",
doi="https://doi.org/10.1631/jzus.B2300512"
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%A Chengjun YAO
%A Yanzhao DONG
%A Haiying ZHOU
%A Xiaodi ZOU
%A AHMAD ALHASKAWI
%A Sohaib Hasan Abdullah EZZI
%A Zewei WANG
%A Jingtian LAI
%A Vishnu Goutham KOTA
%A Mohamed Hasan Abdulla Hasan ABDULLA
%A Zhenfeng LIU
%A Sahar Ahmed ABDALBARY
%A Olga ALENIKOVA
%A Hui LU
%J Journal of Zhejiang University SCIENCE B
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A1 - Chengjun YAO
A1 - Yanzhao DONG
A1 - Haiying ZHOU
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A1 - AHMAD ALHASKAWI
A1 - Sohaib Hasan Abdullah EZZI
A1 - Zewei WANG
A1 - Jingtian LAI
A1 - Vishnu Goutham KOTA
A1 - Mohamed Hasan Abdulla Hasan ABDULLA
A1 - Zhenfeng LIU
A1 - Sahar Ahmed ABDALBARY
A1 - Olga ALENIKOVA
A1 - Hui LU
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doi="https://doi.org/10.1631/jzus.B2300512"


Abstract: 
Coronavirus disease 2019 (COVID-19) is a multi-system disease which can lead to various severe complications. Acute limb ischemia (ALI) has been increasingly recognized as a COVID-19-associated complication that often predicts a poor prognosis. However, the pathophysiology and molecular mechanisms underlying COVID-19-associated ALI remain poorly understood. Hypercoagulability and thrombosis are considered important mechanisms, while we also emphasize the roles of vasospasm, hypoxia, and acidosis in the pathogenesis of the disease. The angiotensin-converting enzyme 2 (ACE2) pathway, inflammation, and platelet activation may be important molecular mechanisms underlying these pathological changes induced by COVID-19. Furthermore, we discuss the hypotheses of risk factors for COVID-19-associated ALI from genetic, age, and gender perspectives based on our analysis of molecular mechanisms. Additionally, we summarize therapeutic approaches such as use of the interleukin-6 (IL-6) blocker tocilizumab, calcium channel blockers, and angiotensin-converting enzyme inhibitors, providing insights for the future treatment of coronavirus-associated limb ischemic diseases.

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