Evolving information has identified disease mechanisms and dysregulation of host biology that might be targeted therapeutically in
coronavirus disease 2019 (COVID-19).
Thrombosis and coagulopathy, associated with
pulmonary injury and
inflammation, are emerging clinical features of
COVID-19. We present a framework for mechanisms of
thrombosis in
COVID-19 that initially derive from interaction of SARS-CoV-2 with ACE2, resulting in dysregulation of
angiotensin signaling and subsequent
inflammation and tissue injury. These responses result in increased signaling by
thrombin (
proteinase-activated) and
purinergic receptors, which promote platelet activation and exert pathological effects on other cell types (e.g., endothelial cells, epithelial cells, and fibroblasts), further enhancing
inflammation and injury. Inhibitors of
thrombin and
purinergic receptors may, thus, have
therapeutic effects by blunting platelet-mediated
thromboinflammation and dysfunction in other cell types. Such inhibitors include agents (e.g., anti-platelet drugs) approved for other indications, and that could be repurposed to treat, and potentially improve the outcome of,
COVID-19 patients.
COVID-19, caused by the SARS-CoV-2 virus, drives dysregulation of
angiotensin signaling, which, in turn, increases
thrombin-mediated and purinergic-mediated activation of platelets and increase in
inflammation. This
thromboinflammation impacts the lungs and can also have systemic effects. Inhibitors of receptors that drive platelet activation or inhibitors of the coagulation cascade provide opportunities to treat
COVID-19 thromboinflammation.