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10.1007/s12185-022-03324-w

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suck abstract from ncbi


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pmid35316498      Int+J+Hematol 2022 ; 115 (4): 457-469
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  • COVID-19 microthrombosis: unusually large VWF multimers are a platform for activation of the alternative complement pathway under cytokine storm #MMPMID35316498
  • Fujimura Y; Holland LZ
  • Int J Hematol 2022[Apr]; 115 (4): 457-469 PMID35316498show ga
  • ADAMTS13, a metalloproteinase, specifically cleaves unusually large multimers of von Willebrand factor (VWF), newly released from vascular endothelial cells. The ratio of ADAMTS13 activity to VWF antigen (ADAMTS13/VWF) and indicators of the alternative complement pathway (C3a and sC5b-9) are both related to the severity of COVID-19. The ADAMTS13/VWF ratio is generally moderately decreased (0.18-0.35) in patients with severe COVID-19. When these patients experience cytokine storms, both interleukin-8 and TNFalpha stimulate VWF release from vascular endothelial cells, while interleukin-6 inhibits both production of ADAMTS13 and its interaction with VWF, resulting in localized severe deficiency of ADAMTS13 activity. Platelet factor 4 and thrombospondin-1, both released upon platelet activation, bind to the VWF-A2 domain and enhance the blockade of ADAMTS13 function. Thus, the released unusually-large VWF multimers remain associated with the vascular endothelial cell surface, via anchoring with syndecan-1 in the glycocalyx. Unfolding of the VWF-A2 domain, which has high sequence homology with complement factor B, allows the domain to bind to activated complement C3b, providing a platform for complement activation of the alternative pathway. The resultant C3a and C5a generate tissue factor-rich neutrophil extracellular traps (NETs), which induce the mixed immunothrombosis, fibrin clots and platelet aggregates typically seen in patients with severe COVID-19.
  • |*ADAMTS13 Protein/metabolism[MESH]
  • |*COVID-19/immunology[MESH]
  • |*Cytokine Release Syndrome[MESH]
  • |*von Willebrand Factor/metabolism[MESH]
  • |Complement Pathway, Alternative[MESH]
  • |Endothelial Cells/metabolism[MESH]


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