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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Thromb+Thrombolysis
2021 ; 51
(2
): 313-329
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COVID-19: the role of excessive cytokine release and potential ACE2
down-regulation in promoting hypercoagulable state associated with severe
illness
#MMPMID32676883
Du F
; Liu B
; Zhang S
J Thromb Thrombolysis
2021[Feb]; 51
(2
): 313-329
PMID32676883
show ga
The novel coronavirus disease (COVID-19) has become a universally prevalent
infectious disease. The causative virus of COVID-19 is severe acute respiratory
syndrome coronavirus type 2. Recent retrospective clinical studies have
established a significant association between the incidence of vascular
thrombotic events and the severity of COVID-19. The enhancement in serum levels
of markers that reflect a hypercoagulable state has been suggested to indicate a
poor prognosis. Therefore, at present, it is crucial to understand the mechanisms
that foster the hypercoagulable state in COVID-19. Over-activated inflammatory
response, which is manifested as excessive cytokine release in COVID-19 patients,
is also associated with COVID-19 severity. This review discusses the
immuno-pathological basis of the excessive cytokine release in COVID-19. Besides,
this article reviews the role of pro-inflammatory or anti-inflammatory cytokines,
whose significant elevations in their serum levels have been consistently
detected in multiple different clinical studies, in promoting the hypercoagulable
state. Since the expression of angiotensin-converting enzyme 2 (ACE2) is
potentially down-regulated in COVID-19, as proposed by a recent bio-informatic
analysis, mechanisms through which reduced ACE2 expressions promote vascular
thrombosis are summarized. In addition, the reciprocal-enhancing effects of the
excessive cytokine release and the downregulated ACE2 expression on their
pro-thrombotic activities are further discussed. Here, based on currently
available evidence, we review the pathogenic mechanisms of the hypercoagulable
state associated with severe cases of COVID-19 to give insights into prevention
and treatment of the vascular thrombotic events in COVID-19.