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Author Spotlight: Modeling an Aspect of Preeclampsia in Female Mice Using Hypoxic Human Placenta-Derived Small Extracellular Vesicles
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Author Spotlight: Modeling an Aspect of Preeclampsia in Female Mice Using Hypoxic Human Placenta-Derived Small Extracellular Vesicles

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COVID-19, Pre-Eclampsia, and Complement System

Chiara Agostinis1, Alessandro Mangogna1, Andrea Balduit2

  • 1Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy.

Frontiers in Immunology
|December 6, 2021
PubMed

Insights

COVID-19 infection in pregnant women can lead to pre-eclampsia by damaging endothelial cells and activating the complement system. Complement inhibitors show promise for treating both COVID-19 and pre-eclampsia.

Area of Science:

  • Immunology
  • Obstetrics
  • Virology

Background:

  • COVID-19 causes multi-organ failure, endothelial cell injury, and thrombotic events.
  • The complement system interacts with contact and coagulation systems, worsening SARS-CoV-2 infection outcomes.
  • Overlapping immunopathological mechanisms exist between COVID-19 and pre-eclampsia (PE).

Purpose of the Study:

  • To review the role of the complement, contact, and coagulation systems in SARS-CoV-2 infection during pregnancy.
  • To explore the link between COVID-19 infection and the development of pre-eclampsia.
  • To examine potential therapeutic strategies targeting these systems.

Main Methods:

  • Review of existing literature on COVID-19, pre-eclampsia, and related immune/coagulation pathways.
  • Analysis of the cross-talk between complement, contact, coagulation, and endothelial cell activation in SARS-CoV-2 infection.
  • Examination of the impact of SARS-CoV-2 on endothelial cells via ACE2 and TMPRSS2.

Main Results:

  • SARS-CoV-2 infection can dysregulate endothelial cells, leading to dysfunction, vascular damage, hyperinflammation, and hypercoagulability.
  • Increased bradykinin levels due to ACE2 inhibition by SARS-CoV-2 exacerbate endothelial dysfunction.
  • Complement system dysregulation in pregnancy can result in PE-like syndromes following SARS-CoV-2 infection.

Conclusions:

  • Pregnant women with COVID-19 are at increased risk for pre-eclampsia due to overlapping pathological pathways.
  • Complement inhibitors, particularly those targeting C3 or MASP-2, represent promising therapeutic options for COVID-19 and associated pre-eclampsia.
  • Understanding these interconnected systems is crucial for managing pregnant patients with COVID-19.

Keywords:
COVID-19SARS-CoV-2complement systempre-eclampsiapregnancy

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