Mannose-Binding Lectin is Associated with Thrombosis and Coagulopathy in Critically Ill COVID-19 Patients.

Abstract

The ongoing COVID-19 pandemic has caused significant morbidity and mortality worldwide, as well as profound effects on society. COVID-19 patients have an increased risk of thromboembolic (TE) complications, which develop despite pharmacological thromboprophylaxis. The mechanism behind COVID-19-associated coagulopathy remains unclear. Mannose-binding lectin (MBL), a pattern recognition molecule that initiates the lectin pathway of complement activation, has been suggested as a potential amplifier of blood coagulation during thromboinflammation. Here we describe data from a cohort of critically ill COVID-19 patients (n = 65) treated at a tertiary hospital center intensive care unit (ICU). A subset of patients had strongly elevated MBL plasma levels, and activity upon ICU admission, and patients who developed symptomatic TE (14%) had significantly higher MBL levels than patients without TE. MBL was strongly correlated to plasma D-dimer levels, a marker of COVID-19 coagulopathy, but showed no relationship to degree of inflammation or other organ dysfunction. In conclusion, we have identified complement activation through the MBL pathway as a novel amplification mechanism that contributes to pathological thrombosis in critically ill COVID-19 patients. Pharmacological targeting of the MBL pathway could be a novel treatment option for thrombosis in COVID-19. Laboratory testing of MBL levels could be of value for identifying COVID-19 patients at risk for TE events.

• Authors: Oskar Eriksson, Michael Hultström, Barbro Persson, Miklos Lipcsey, Kristina Nilsson Ekdahl, Bo Nilsson, Robert Frithiof
• Journal: Thrombosis and haemostasis (Thromb Haemost) Vol. 120 Issue 12 Pg. 1720-1724 (Dec 2020) ISSN: 2567-689X [Electronic] Germany
• PMID: 32871607 (Publication Type: Journal Article)
• Copyright: Thieme. All rights reserved.

Chemical References

• Biomarkers
• Fibrin Fibrinogen Degradation Products
• Mannose-Binding Lectin
• fibrin fragment D

Topics

• Adult
• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Blood Coagulation Disorders (diagnostic imaging)
• COVID-19 (diagnosis)
• Complement Activation
• Critical Illness
• Female
• Fibrin Fibrinogen Degradation Products (metabolism)
• Humans
• Intensive Care Units
• Male
• Mannose-Binding Lectin (blood)
• Middle Aged
• Pandemics
• Risk
• SARS-CoV-2 (physiology)
• Sweden
• Tertiary Care Centers
• Up-Regulation
• Venous Thromboembolism (diagnosis)
• Young Adult