Health
Immune thrombotic dysregulation is an important marker of COVID-19 disease severity
In severe cases of COVID-19, the infection can block the blood vessels in the lungs, heart, and kidneys. Ludwig-Maximilians-Universitaet (LMU), a Munich researcher, has shown that activated immune cells and platelets play a major role in these pathologies.
The novel coronavirus SARS-CoV-2 infects the respiratory tract and, in severe cases, infection can lead to lung failure, necessitating the use of mechanical ventilation.
In addition, these patients develop further complications such as pulmonary embolism and venous thrombosis (thrombus). It remains unclear whether virus-related respiratory failure is functionally associated with a systemic increase in the incidence of intravascular clot formation.
However, a new study led by the LMU clinician, led by Liru Nicolai and Konstantin Stark, is published in Circulation, identifying an association between virally altered pulmonary vascularity and an increased risk of thrombosis. ..
After a post-mortem examination of the lungs of a COVID-19 patient who died of illness, Nicolai and colleagues found many microclots in the thinnest branches of the pulmonary vasculature. Similar observations were made in the heart and kidneys.
These clots were composed primarily of platelets and activated immune cells, especially neutrophils. A detailed analysis of thrombi suggested that the activating interaction between platelets and neutrophils was involved in promoting intravascular coagulation.
Neutrophils belong to the innate immune system, whose main role is to fight invading pathogens. The involvement in abnormal coagulation calls this process immune thrombosis.
In COVID-19 patients, the stimulation of blood clot formation eventually impairs the blood supply to nearby tissues. This eventually causes respiratory failure, but the tendency to cause coagulation becomes systemic.
LMU researchers use multidimensional flow cytometric assay to significantly increase circulating activated neutrophils and platelets in COVID-19 patients with lung failure and requiring mechanical ventilation I showed that I did.
As the two cell types activate each other, their interaction creates an occlusive thrombus in the lung. In addition, activated neutrophils extrude a mesh-like complex of DNA and cytoplasmic proteins known as the neutrophil extracellular trap (NET).
They normally act to trap and destroy bacterial and viral pathogens, but they also play an important role in immune thrombosis by stabilizing the thrombus. This process, initially confined to the lungs, exacerbates respiratory failure and results in a systemic thrombotic condition.
These findings contribute to a better understanding of the pathophysiology underlying COVID-19 disease progression. This study also identifies immune thrombosis as a promising target for the prevention and treatment of lung failure and thrombotic complications that occur in COVID-19 cases“
Ludwig Maximilian University, Munich, clinician, Constantine Stark
Source:
See journal:
Nikolai, L. , other.. (2020) Immune thrombotic dysregulation in COVID-19 pneumonia is associated with respiratory failure and coagulopathy. circulation.. doi.org/10.1161/CIRCULATIONAHA.120.048488..
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