Frontiers in Cellular and Infection Microbiology (Jun 2021)

COVID-19: Lung-Centric Immunothrombosis

  • Peter R. Kvietys,
  • Hana. M. A. Fakhoury,
  • Sana Kadan,
  • Ahmed Yaqinuddin,
  • Eid Al-Mutairy,
  • Khaled Al-Kattan

DOI
https://doi.org/10.3389/fcimb.2021.679878
Journal volume & issue
Vol. 11

Abstract

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The respiratory tract is the major site of infection by SARS-CoV-2, the virus causing COVID-19. The pulmonary infection can lead to acute respiratory distress syndrome (ARDS) and ultimately, death. An excessive innate immune response plays a major role in the development of ARDS in COVID-19 patients. In this scenario, activation of lung epithelia and resident macrophages by the virus results in local cytokine production and recruitment of neutrophils. Activated neutrophils extrude a web of DNA-based cytoplasmic material containing antimicrobials referred to as neutrophil extracellular traps (NETs). While NETs are a defensive strategy against invading microbes, they can also serve as a nidus for accumulation of activated platelets and coagulation factors, forming thrombi. This immunothrombosis can result in occlusion of blood vessels leading to ischemic damage. Herein we address evidence in favor of a lung-centric immunothrombosis and suggest a lung-centric therapeutic approach to the ARDS of COVID-19.

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