1. Fibrin drives thromboinflammation and neuropathology in COVID-19.
- Author
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Ryu JK, Yan Z, Montano M, Sozmen EG, Dixit K, Suryawanshi RK, Matsui Y, Helmy E, Kaushal P, Makanani SK, Deerinck TJ, Meyer-Franke A, Rios Coronado PE, Trevino TN, Shin MG, Tognatta R, Liu Y, Schuck R, Le L, Miyajima H, Mendiola AS, Arun N, Guo B, Taha TY, Agrawal A, MacDonald E, Aries O, Yan A, Weaver O, Petersen MA, Meza Acevedo R, Alzamora MDPS, Thomas R, Traglia M, Kouznetsova VL, Tsigelny IF, Pico AR, Red-Horse K, Ellisman MH, Krogan NJ, Bouhaddou M, Ott M, Greene WC, and Akassoglou K
- Subjects
- Animals, Female, Humans, Male, Mice, Fibrinogen metabolism, Immunity, Innate, Killer Cells, Natural immunology, Lung drug effects, Lung immunology, Lung pathology, Lung virology, Macrophage Activation drug effects, Microglia immunology, Microglia pathology, Neuroinflammatory Diseases complications, Neuroinflammatory Diseases immunology, Neuroinflammatory Diseases pathology, Neuroinflammatory Diseases virology, Neurons pathology, Neurons virology, Oxidative Stress, SARS-CoV-2 immunology, SARS-CoV-2 pathogenicity, Spike Glycoprotein, Coronavirus metabolism, Post-Acute COVID-19 Syndrome immunology, Post-Acute COVID-19 Syndrome virology, Antibodies, Monoclonal immunology, Antibodies, Monoclonal pharmacology, Brain drug effects, Brain immunology, Brain pathology, Brain virology, COVID-19 immunology, COVID-19 pathology, COVID-19 virology, COVID-19 complications, Fibrin antagonists & inhibitors, Fibrin metabolism, Inflammation complications, Inflammation immunology, Inflammation pathology, Inflammation virology, Thrombosis complications, Thrombosis immunology, Thrombosis pathology, Thrombosis virology
- Abstract
Life-threatening thrombotic events and neurological symptoms are prevalent in COVID-19 and are persistent in patients with long COVID experiencing post-acute sequelae of SARS-CoV-2 infection
1-4 . Despite the clinical evidence1,5-7 , the underlying mechanisms of coagulopathy in COVID-19 and its consequences in inflammation and neuropathology remain poorly understood and treatment options are insufficient. Fibrinogen, the central structural component of blood clots, is abundantly deposited in the lungs and brains of patients with COVID-19, correlates with disease severity and is a predictive biomarker for post-COVID-19 cognitive deficits1,5,8-10 . Here we show that fibrin binds to the SARS-CoV-2 spike protein, forming proinflammatory blood clots that drive systemic thromboinflammation and neuropathology in COVID-19. Fibrin, acting through its inflammatory domain, is required for oxidative stress and macrophage activation in the lungs, whereas it suppresses natural killer cells, after SARS-CoV-2 infection. Fibrin promotes neuroinflammation and neuronal loss after infection, as well as innate immune activation in the brain and lungs independently of active infection. A monoclonal antibody targeting the inflammatory fibrin domain provides protection from microglial activation and neuronal injury, as well as from thromboinflammation in the lung after infection. Thus, fibrin drives inflammation and neuropathology in SARS-CoV-2 infection, and fibrin-targeting immunotherapy may represent a therapeutic intervention for patients with acute COVID-19 and long COVID., (© 2024. The Author(s).)- Published
- 2024
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