ACE2 and endothelial dysfunction: Moreover, the loss of pericytes increases EC sprouting and intussusceptive angiogenesis in SARS-CoV-2-infected lungs combined with disruption of intercellular junctions, cell swelling and a loss of contact with the basal membrane.5 Despite a lower expression of ACE2 on ECs, SARS-CoV-2 can also directly impair endothelial permeability by acting directly on ECs.46 The effect of spike protein-mediated endothelial dysfunction was further increased on diabetic ECs, supporting a role for chronic disease-induced vessel damage in the high susceptibility to cell damage.