Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19

Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with severe disease show hyperactivation of the immune system, which can affect multiple organs besides the lungs. Here, we propose that SARS-CoV...

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Vydáno v:Nature reviews. Immunology Ročník 21; číslo 5; s. 319 - 329
Hlavní autoři: Bonaventura, Aldo, Vecchié, Alessandra, Dagna, Lorenzo, Martinod, Kimberly, Dixon, Dave L, Van Tassell, Benjamin W, Dentali, Francesco, Montecucco, Fabrizio, Massberg, Steffen, Levi, Marcel, Abbate, Antonio
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Nature Publishing Group 01.05.2021
Témata:
Blood Coagulation - immunology
Blood Platelets - immunology
Coronaviruses
COVID-19
COVID-19 - immunology
COVID-19 - pathology
Critical Illness - therapy
Cytokine Release Syndrome - immunology
Cytokine Release Syndrome - pathology
Drug development
Endothelium, Vascular - pathology
Fibrinolytic Agents - therapeutic use
Humans
Immune system
Immunity, Innate - immunology
Immunosuppressive agents
Infections
Leukocytes (neutrophilic)
Lung - blood supply
Lung - pathology
Lung - virology
Monocytes
Monocytes - immunology
Neutrophils - immunology
Patients
Respiratory distress syndrome
SARS-CoV-2 - immunology
SARS-CoV-2 - pathogenicity
Severe acute respiratory syndrome coronavirus 2
Venous Thrombosis - immunology
Venous Thrombosis - pathology
Venous Thrombosis - prevention & control
ISSN:1474-1733, 1474-1741, 1474-1741
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Shrnutí:Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with severe disease show hyperactivation of the immune system, which can affect multiple organs besides the lungs. Here, we propose that SARS-CoV-2 infection induces a process known as immunothrombosis, in which activated neutrophils and monocytes interact with platelets and the coagulation cascade, leading to intravascular clot formation in small and larger vessels. Microthrombotic complications may contribute to acute respiratory distress syndrome (ARDS) and other organ dysfunctions. Therapeutic strategies aimed at reducing immunothrombosis may therefore be useful. Several antithrombotic and immunomodulating drugs have been proposed as candidates to treat patients with SARS-CoV-2 infection. The growing understanding of SARS-CoV-2 infection pathogenesis and how it contributes to critical illness and its complications may help to improve risk stratification and develop targeted therapies to reduce the acute and long-term consequences of this disease.
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ISSN:1474-1733
1474-1741
1474-1741
DOI:10.1038/s41577-021-00536-9