Elevated P-Selectin in Severe Covid-19: Considerations for Therapeutic Options

Area of Science:

• Cardiovascular Medicine
• Hematology
• Infectious Diseases

Background:

• Coronavirus disease 2019 (COVID-19) primarily affects the respiratory system.
• Acute respiratory failure and pulmonary microvascular thrombosis are key factors in COVID-19 morbidity and mortality.

Purpose of the Study:

• To investigate plasma P-selectin concentration as a biomarker for endothelial dysfunction and platelet activation in severe COVID-19 patients.
• To assess P-selectin levels in hospitalized patients with severe or critical SARS-CoV-2 infection.

Main Methods:

• Included 46 patients with severe or critical SARS-CoV-2 infection, divided into ICU and non-ICU groups.
• Collected blood samples at hospital admission for soluble P-selectin quantification using ELISA.
• Compared P-selectin levels between COVID-19 patients and healthy donors (HD).

Main Results:

• COVID-19 patients exhibited significantly higher P-selectin plasma concentrations compared to healthy donors (COVID-19: 65.2 vs. HD: 40.3).
• P-selectin levels remained high in both ICU and non-ICU COVID-19 patients, irrespective of platelet presence.
• Healthy donors showed a reduction in P-selectin after platelet removal, unlike COVID-19 patients.

Conclusions:

• Elevated P-selectin suggests a critical role for platelet-endothelium interactions in COVID-19 pathogenesis.
• These interactions contribute to the activation of the hemostatic system and pulmonary thrombi formation.
• Further research is needed to evaluate antiplatelet agents and anti-P-selectin antibodies, such as Crizanlizumab, as potential therapies.