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COVID-19 and immunothrombosis: emerging understanding and clinical management
Rebecca J Shaw1,2, Charlotte Bradbury3, Simon T Abrams1
1Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK.
Insights
The COVID-19 pandemic involves complex interactions between immunity, inflammation, and blood clotting. Understanding immunothrombosis is crucial for developing targeted treatments for severe COVID-19 and its long-term effects.
Area of Science:
- Immunology
- Hematology
- Infectious Diseases
Background:
- The COVID-19 pandemic has highlighted significant coagulopathy and mortality risks.
- Emerging evidence shows interplay between innate immunity, coagulation, and inflammation in severe COVID-19.
- Immunothrombosis, involving extracellular histones and neutrophil extracellular traps, is a key pathophysiological factor.
Purpose of the Study:
- To review the role of immunothrombosis in COVID-19 pathophysiology.
- To discuss current treatment strategies targeting immunothrombosis and inflammation.
- To emphasize the need for further research into COVID-19-associated coagulopathy.
Main Methods:
- Review of recent scientific literature on COVID-19, immunothrombosis, and coagulopathy.
- Analysis of studies on anticoagulation and immunomodulatory therapies in hospitalized COVID-19 patients.
- Synthesis of findings regarding the mechanisms of immunothrombosis in severe disease.
Main Results:
- Immunothrombosis plays a critical role in severe COVID-19, with specific markers found in patients.
- Anticoagulation therapies show varying outcomes and bleeding risks.
- Immunomodulatory treatments like corticosteroids and IL-6 inhibitors reduce mortality.
Conclusions:
- Targeting immunothrombosis components is vital for COVID-19 treatment.
- Further research is needed to elucidate upstream mechanisms of coagulopathy and immunothrombosis.
- Developing targeted therapies for acute and long-term COVID-19 symptoms is essential.
Abstract:
The COVID-19 pandemic has been the most significant health crisis in recent global history. Early studies from Wuhan highlighted COVID-19-associated coagulopathy and a significant association with mortality was soon recognised. As research continues across the world, more evidence is emerging of the cross-talk between the innate immune system, coagulation activation and inflammation. Immunothrombosis has been demonstrated to play a key role in the pathophysiology of severe COVID-19, with extracellular histones and neutrophil extracellular traps detected in the plasma and cardiopulmonary tissues of critically ill patients. Targeting the components of immunothrombosis is becoming an important factor in the treatment of patients with COVID-19 infection. Recent studies report outcomes of intermediate and therapeutic anticoagulation in hospitalised patients with varying severities of COVID-19 disease, including optimal dosing and associated bleeding risks. Immunomodulatory therapies, including corticosteroids and IL-6 receptor antagonists, have been demonstrated to significantly reduce mortality in COVID-19 patients. As the pandemic continues, more studies are required to understand the driving factors and upstream mechanisms for coagulopathy and immunothrombosis in COVID-19, and thus potentially develop more targeted therapies for SARS-CoV-2 infection, both in the acute phase and in those who develop longer-term symptom burden.
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