tetano
Editor, Senior Moderator
Thromb Haemost
. 2022 Jan 21.
doi: 10.1055/s-0041-1740182. Online ahead of print.
Associations between the von Willebrand Factor-ADAMTS13 Axis, Complement Activation, and COVID-19 Severity and Mortality
György Sinkovits[SUP] 1 [/SUP], Marienn Réti[SUP] 2 [/SUP], Veronika Müller[SUP] 3 [/SUP], Zsolt Iványi[SUP] 4 [/SUP], János Gál[SUP] 4 [/SUP], László Gopcsa[SUP] 2 [/SUP], Péter Reményi[SUP] 2 [/SUP], Beáta Szathmáry[SUP] 5 [/SUP], Botond Lakatos[SUP] 5 [/SUP], János Szlávik[SUP] 5 [/SUP], Ilona Bobek[SUP] 6 [/SUP], Zita Z Prohászka[SUP] 1 [/SUP], Zsolt Förhécz[SUP] 1 [/SUP], Blanka Mező[SUP] 1 7 [/SUP], Dorottya Csuka[SUP] 1 [/SUP], Lisa Hurler[SUP] 1 [/SUP], Erika Kajdácsi[SUP] 1 [/SUP], László Cervenak[SUP] 1 [/SUP], Petra Kiszel[SUP] 7 [/SUP], Tamás Masszi[SUP] 1 [/SUP], István Vályi-Nagy[SUP] 2 [/SUP], Zoltán Prohászka[SUP] 1 7 [/SUP]
Affiliations
Abstract
Background: Endothelial and complement activation were both associated with immunothrombosis, a key determinant of COVID-19 severity, but their interrelation has not yet been investigated.
Objectives: We aimed to determine von Willebrand factor (VWF) antigen (VWF:Ag) concentration, VWF collagen binding activity (VWF:CBA), a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) activity (ADAMTS13:Ac), and their ratios in hospitalized COVID-19 patients, and to investigate how these parameters and their constellation with complement activation relate to disease severity and in-hospital mortality in COVID-19.
Methods: Samples of 102 hospitalized patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 positivity were included in our observational cohort study. Patients were stratified according to the peak severity of COVID-19 disease in agreement with the World Health Organization ordinal scale. Twenty-six convalescent plasma donors with previous COVID-19 disease formed the control group. VWF:Ag concentration and VWF:CBA were determined by enzyme-linked immunosorbent assay (ELISA); ADAMTS13:Ac was determined by fluorescence resonance energy transfer. Complement C3 and C3a were measured by turbidimetry and ELISA, respectively. Clinical covariates and markers of inflammation were extracted from hospital records.
Results: VWF:Ag and VWF:CBA were elevated in all groups of hospitalized COVID-19 patients and increased in parallel with disease severity. ADAMTS13:Ac was decreased in patients with severe COVID-19, with the lowest values in nonsurvivors. High (> 300%) VWF:Ag concentrations or decreased (< 67%) ADAMTS13:Ac were associated with higher risk of severe COVID-19 disease or in-hospital mortality. The concomitant presence of decreased ADAMTS13:Ac and increased C3a/C3 ratio-indicating complement overactivation and consumption-was a strong independent predictor of in-hospital mortality.
Conclusion: Our results suggest that an interaction between the VWF-ADAMTS13 axis and complement overactivation and consumption plays an important role in the pathogenesis of COVID-19.
. 2022 Jan 21.
doi: 10.1055/s-0041-1740182. Online ahead of print.
Associations between the von Willebrand Factor-ADAMTS13 Axis, Complement Activation, and COVID-19 Severity and Mortality
György Sinkovits[SUP] 1 [/SUP], Marienn Réti[SUP] 2 [/SUP], Veronika Müller[SUP] 3 [/SUP], Zsolt Iványi[SUP] 4 [/SUP], János Gál[SUP] 4 [/SUP], László Gopcsa[SUP] 2 [/SUP], Péter Reményi[SUP] 2 [/SUP], Beáta Szathmáry[SUP] 5 [/SUP], Botond Lakatos[SUP] 5 [/SUP], János Szlávik[SUP] 5 [/SUP], Ilona Bobek[SUP] 6 [/SUP], Zita Z Prohászka[SUP] 1 [/SUP], Zsolt Förhécz[SUP] 1 [/SUP], Blanka Mező[SUP] 1 7 [/SUP], Dorottya Csuka[SUP] 1 [/SUP], Lisa Hurler[SUP] 1 [/SUP], Erika Kajdácsi[SUP] 1 [/SUP], László Cervenak[SUP] 1 [/SUP], Petra Kiszel[SUP] 7 [/SUP], Tamás Masszi[SUP] 1 [/SUP], István Vályi-Nagy[SUP] 2 [/SUP], Zoltán Prohászka[SUP] 1 7 [/SUP]
Affiliations
- PMID: 35062036
- DOI: 10.1055/s-0041-1740182
Abstract
Background: Endothelial and complement activation were both associated with immunothrombosis, a key determinant of COVID-19 severity, but their interrelation has not yet been investigated.
Objectives: We aimed to determine von Willebrand factor (VWF) antigen (VWF:Ag) concentration, VWF collagen binding activity (VWF:CBA), a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) activity (ADAMTS13:Ac), and their ratios in hospitalized COVID-19 patients, and to investigate how these parameters and their constellation with complement activation relate to disease severity and in-hospital mortality in COVID-19.
Methods: Samples of 102 hospitalized patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 positivity were included in our observational cohort study. Patients were stratified according to the peak severity of COVID-19 disease in agreement with the World Health Organization ordinal scale. Twenty-six convalescent plasma donors with previous COVID-19 disease formed the control group. VWF:Ag concentration and VWF:CBA were determined by enzyme-linked immunosorbent assay (ELISA); ADAMTS13:Ac was determined by fluorescence resonance energy transfer. Complement C3 and C3a were measured by turbidimetry and ELISA, respectively. Clinical covariates and markers of inflammation were extracted from hospital records.
Results: VWF:Ag and VWF:CBA were elevated in all groups of hospitalized COVID-19 patients and increased in parallel with disease severity. ADAMTS13:Ac was decreased in patients with severe COVID-19, with the lowest values in nonsurvivors. High (> 300%) VWF:Ag concentrations or decreased (< 67%) ADAMTS13:Ac were associated with higher risk of severe COVID-19 disease or in-hospital mortality. The concomitant presence of decreased ADAMTS13:Ac and increased C3a/C3 ratio-indicating complement overactivation and consumption-was a strong independent predictor of in-hospital mortality.
Conclusion: Our results suggest that an interaction between the VWF-ADAMTS13 axis and complement overactivation and consumption plays an important role in the pathogenesis of COVID-19.