Vascular Endothelium


  • It regulates the vascular tone, the adhesion of inflammatory cells, it participates in hemostasis and in angiogenesis, among other functions.
  • It has the ability to adapt to the different stimuli present in circulation. When this ability is lost due to a persistent stimulus, it may become dysfunctional.

Normal Endothelium

Endothelial injury repair

Monocytes on dysfunctional Endothelium

Endothelial dysfunction

  • Dysregulation of the physiological functions of the vascular endothelium, resulting in reduced vasodilating capacity, enhanced proinflammatory and prothrombotic properties, and abnormal modulation of vascular smooth muscle cell growth and migration.
  • Common characteristic in many diseases, such as chronic kidney disease, obesity, diabetes, major depression, septic syndromes, and COVID-19, and also certain treatments, such as hematopoietic stem cell transplantation.

Chronic Kidney Disease (CKD)

  • Accelerated atherosclerosis, increased risk of thrombotic-ischemic complications, and excessive mortality rates when compared with the general population.
  • Different factors causing endothelial damage: accumulation of toxins, due to reduced renal clearance, activation of cells through the dialysis filters, activation of the innate immunity.

Hematopoietic stem cell transplantation (HCT)

  • Hematopoietic stem cell transplantation (HCT) is the only curative treatment option for many patients suffering from hematological malignancies.
  • There are complications that appear early after HCT, which have the endothelial damage and activation as the main pathophysiological substrate.
  • Endothelial cells develop a pro-inflammatory and prothrombotic phenotype, due to the effect of conditioning treatment, the engraftment and allogenicity.


  • Patients with COVID-19 present a wide spectrum of disease severity, from asymptomatic cases to serious disease leading to critical care and even death.
  • Levels of some markers of endothelial activation and damage are associated with the disease severity.

Micrographs showing immunofluorescence detection of ICAM-1 (left image) and VCAM-1 (right image) on the surface of endothelial cells after being exposed to a damaging condition.


Aznar-Salatti J, Escolar G, Cases A, Gomez-Ortiz G, Anton P, Castillo R, Revert L, Ordinas A. Uraemic medium causes endothelial cell dysfunction characterized by an alteration of the properties of its subendothelial matrix. Nephrol Dial Transplant. 1995; 10: 2199-204. 10.1093/ndt/10.12.2199.

Escolar G, Diaz-Ricart M, Cases A. Uremic platelet dysfunction: past and present. Curr Hematol Rep. 2005; 4: 359-67.

Diaz-Ricart M, Carmona A, Palomo M, Rovira M, Escolar G, Carreras E. Impact of Different Immunosuppresive Drugs on the Endothelium. Protective Effect of Defibrotide. ASH Annual Meeting Abstracts. 2011; 118: 5319.

Palomo M, Mir E, Rovira M, Escolar G, Carreras E, Diaz-Ricart M. What is going on between defibrotide and endothelial cells? Snapshots reveal the hot spots of their romance. Blood. 2016; 127: 1719-27. 10.1182/blood-2015-10-676114.

Martinez-Sanchez J, Palomo M, Torramade-Moix S, Moreno-Castano AB, Rovira M, Gutierrez-Garcia G, Fernandez-Aviles F, Escolar G, Penack O, Rosinol L, Carreras E, Diaz-Ricart M. The induction strategies administered in the treatment of multiple myeloma exhibit a deleterious effect on the endothelium. Bone Marrow Transplant. 2020; 55: 2270-8. 10.1038/s41409-020-0947-9.

Palomo M, Diaz-Ricart M, Carbo C, Rovira M, Fernandez-Aviles F, Martine C, Ghita G, Escolar G, Carreras E. Endothelial dysfunction after hematopoietic stem cell transplantation: role of the conditioning regimen and the type of transplantation. Biol Blood Marrow Transplant. 2010; 16: 985-93. 10.1016/j.bbmt.2010.02.008.

Palomo M, Youssef L, Ramos A, Torramade-Moix S, Moreno-Castano AB, Martinez-Sanchez J, Bonastre L, Pino M, Gomez-Ramirez P, Martin L, Garcia Mateos E, Sanchez P, Fernandez S, Crovetto F, Escolar G, Carreras E, Castro P, Gratacos E, Crispi F, Diaz-Ricart M. Differences and similarities in endothelial and angiogenic profiles of preeclampsia and COVID-19 in pregnancy. Am J Obstet Gynecol. 2022. 10.1016/j.ajog.2022.03.048.

Torramade-Moix S, Palomo M, Vera M, Jerez D, Moreno-Castano AB, Zafar MU, Rovira J, Diekmann F, Garcia-Pagan JC, Escolar G, Cases A, Diaz-Ricart M. Apixaban Downregulates Endothelial Inflammatory and Prothrombotic Phenotype in an In Vitro Model of Endothelial Dysfunction in Uremia. Cardiovasc Drugs Ther. 2021; 35: 521-32. 10.1007/s10557-020-07010-z.

Hanzu FA, Palomo M, Kalko SG, Parrizas M, Garaulet M, Escolar G, Gomis R, Diaz-Ricart M. Translational evidence of endothelial damage in obese individuals: inflammatory and prothrombotic responses. J Thromb Haemost. 2011; 9: 1236-45. 10.1111/j.1538-7836.2011.04285.x.

Castro P, Palomo M, Moreno-Castano AB, Fernandez S, Torramade-Moix S, Pascual G, Martinez-Sanchez J, Richardson E, Tellez A, Nicolas JM, Carreras E, Richardson PG, Badimon JJ, Escolar G, Diaz-Ricart M. Is the Endothelium the Missing Link in the Pathophysiology and Treatment of COVID-19 Complications? Cardiovasc Drugs Ther. 2021. 10.1007/s10557-021-07207-w.

Fernandez S, Moreno-Castano AB, Palomo M, Martinez-Sanchez J, Torramade-Moix S, Tellez A, Ventosa H, Segui F, Escolar G, Carreras E, Nicolas JM, Richardson E, Garcia-Bernal D, Carlo-Stella C, Moraleda JM, Richardson PG, Diaz-Ricart M, Castro P. Distinctive Biomarker Features in the Endotheliopathy of COVID-19 and Septic Syndromes. Shock. 2022; 57: 95-105. 10.1097/SHK.0000000000001823.