COVID-19, microangiopathy, hemostatic activation, and complement

• Published in: The Journal of clinical investigation Vol. 130; no. 8; pp. 3950 - 3953
• Main Authors: Song, Wen-Chao, FitzGerald, Garret A
• Format: Journal Article
• Language: English
• Published: United States American Society for Clinical Investigation 01.08.2020
• Subjects: Adult respiratory distress syndrome; Anemia; Bacterial infections; Betacoronavirus; Biomedical research; Capillaries; Cardiomyopathy; Complement Activation; Complement System Proteins - immunology; Coronavirus Infections - complications; Coronavirus Infections - immunology; Coronaviruses; COVID-19; Cytokines; Degradation products; Drugs; Eculizumab; Fibrin; Health aspects; Health care; Hemostasis; Humans; Immune system; Infections; Medical schools; Mutation; Necrosis; Pandemics; Pathogens; Phenotype; Phenotypes; Pneumonia, Viral - complications; Pneumonia, Viral - immunology; Proteins; Renal failure; Respiratory diseases; Respiratory Distress Syndrome; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Stroke; Systemic vasculitis; Thrombocytopenia; Thrombosis; Thrombotic Microangiopathies - complications; Viewpoint; Viral infections; Pennsylvania
• ISSN: 0021-9738; 1558-8238
• DOI: 10.1172/JCI140183

The COVID-19 pandemic caused by the SARS-CoV-2 virus has swept the globe with devastating societal consequences and has placed tremendous stress on health care systems. Although severe respiratory disease is a dominant feature, strokes, venous thrombosis, renal failure, cardiomyopathy, and coronary and systemic vasculitis have complicated the clinical phenotype (1-5). Indeed, besides typical features of acute respiratory distress syndrome (ARDS), patients with COVID-19 exhibit a thrombotic necrotizing injury of the lung capillaries (6). This clinical pattern, together with a low blood platelet count (thrombocytopenia) and elevated plasma fibrin degradation products (D-dimers) (7, 8), is highly suggestive of complement activation.