Role of the extracellular matrix in COVID-19

Abstract

An outbreak of coronavirus disease 2019 (COVID-19) has spread globally, with over 500 million cases and 6 million deaths to date. COVID-19 is associated with a systemic inflammatory response and abnormalities of the extracellular matrix (ECM), which is also involved in inflammatory storms. Upon viral infection, ECM proteins are involved in the recruitment of inflammatory cells and interference with target organ metabolism, including in the lungs. Additionally, serum biomarkers of ECM turnover are associated with the severity of COVID-19 and may serve as potential targets. Consequently, understanding the expression and function of ECM, particularly of the lung, during severe acute respiratory syndrome of the coronavirus 2 infection would provide valuable insights into the mechanisms of COVID-19 progression. In this review, we summarize the current findings on ECM, such as hyaluronic acid, matrix metalloproteinases, and collagen, which are linked to the severity and inflammation of COVID-19. Some drugs targeting the extracellular surface have been effective. In the future, these ECM findings could provide novel perspectives on the pathogenesis and treatment of COVID-19.

Keywords: COVID-19; SARS-CoV-2; Extracellular Matrix; Inflammation

Core Tip: Coronavirus disease 2019 (COVID-19) shows abnormal expression of the extracellular matrix (ECM). The ECM is a type of macromolecular network secreted by cells into the extracellular stroma, which is also the major component of connective tissue. It can trigger various activities biologically essential for tissue homeostasis and normal organ development. Upon severe acute respiratory syndrome coronavirus 2 infection, ECM proteins are involved in the recruitment of inflammatory cells and interference with target organ metabolism, including that of the lung. The manuscript addresses the current findings of ECM, which are linked to the severity and inflammation of COVID-19, and the roles of ECM in COVID-19.