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EBioMedicine . Beneficial non-anticoagulant mechanisms underlying heparin treatment of COVID-19 patients

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  • EBioMedicine . Beneficial non-anticoagulant mechanisms underlying heparin treatment of COVID-19 patients


    EBioMedicine


    . 2020 Aug 24;59:102969.
    doi: 10.1016/j.ebiom.2020.102969. Online ahead of print.
    Beneficial non-anticoagulant mechanisms underlying heparin treatment of COVID-19 patients


    Baranca Buijsers 1 , Cansu Yanginlar 1 , Marissa L Maciej-Hulme 1 , Quirijn de Mast 2 , Johan van der Vlag 1



    Affiliations

    Abstract

    Coronavirus disease-2019 (COVID-19) is associated with severe inflammation in mainly the lung, and kidney. Reports suggest a beneficial effect of the use of heparin/low molecular weight heparin (LMWH) on mortality in COVID-19. In part, this beneficial effect could be explained by the anticoagulant properties of heparin/LMWH. Here, we summarise potential beneficial, non-anticoagulant mechanisms underlying treatment of COVID-19 patients with heparin/LMWH, which include: (i) Inhibition of heparanase activity, responsible for endothelial leakage; (ii) Neutralisation of chemokines, and cytokines; (iii) Interference with leukocyte trafficking; (iv) Reducing viral cellular entry, and (v) Neutralisation of extracellular cytotoxic histones. Considering the multiple inflammatory and pathogenic mechanisms targeted by heparin/LMWH, it is warranted to conduct clinical studies that evaluate therapeutic doses of heparin/LMWH in COVID-19 patients. In addition, identification of specific heparin-derived sequences that are functional in targeting non-anticoagulant mechanisms may have even higher therapeutic potential for COVID-19 patients, and patients suffering from other inflammatory diseases.

    Keywords: COVID-19; Heparanase; Heparin; Inflammation; Low molecular weight heparin.

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