More than a key—the pathological roles of SARS-CoV-2 spike protein in COVID-19 related cardiac injury

Cardiac injury is common in hospitalized coronavirus disease 2019(COVID-19)patients and cardiac abnormalities have been observed in a significant number of recovered COVID-19 patients,portending long-term health issues for millions of infected individuals.To better understand how Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2,CoV-2 for short)damages the heart,it is critical to fully comprehend the biology of CoV-2 encoded proteins,each of which may play multiple pathological roles.For example,CoV-2 spike glycoprotein(CoV-2-S)not only engages angiotensin converting enzyme II(ACE2)to mediate virus infection but also directly activates immune responses.In this work,the goal is to review the known pathological roles of CoV-2-S in the cardiovascular system,thereby shedding lights on the pathogenesis of COVID-19 related cardiac injury.