Agrati Chiara, Bordoni Veronica, Sacchi Alessandra, Petrosillo Nicola, Nicastri Emanuele, Del Nonno Franca, D'Offizi Gianpiero, Palmieri Fabrizio, Marchioni Luisa, Capobianchi Maria Rosaria, Antinori Andrea, Ippolito Giuseppe, Bibas Michele
National Institute for Infectious Diseases, "Lazzaro Spallanzani" Rome, Italy.
Mediterr J Hematol Infect Dis. 2021 Mar 1;13(1):e2021016. doi: 10.4084/MJHID.2021.016. eCollection 2021.
Coronavirus disease 2019 (COVID-19) is mainly a respiratory tract disease and acute respiratory failure with diffuse microvascular pulmonary thrombosis are critical aspects of the morbidity and mortality of this new syndrome.
The aim of our study was to investigate, in severe COVID-19 hospitalized patients, the P-selectin plasma concentration as a biomarker of endothelial dysfunction and platelet activation.
46 patients with severe or critical SARS-CoV-2 infection were included in the study. Age-matched patients then were divided in those requiring admission to the intensive care unit (ICU, ICU cases) vs those not requiring ICU hospitalization (non-ICU cases). Blood samples of severe COVID-19 patients were collected at the time of hospital admission. The quantification of soluble P-selectin was performed by ELI, assay.
Our study showed a higher P-selectin plasma concentration in patients with Covid-19, regardless of ICU admission, compared to the normal reference values and compared to ten contextually sampled healthy donors (HD); (COVID-19): median 65.2 (IQRs: 45.1-81.1) vs. HD: 40.3 (IQRs: 24.3-48.7), p=0023. Moreover, results showed a significant reduction of P-sele din after platelets removal in HD, in contrast, both ICU and non-ICU COVID-19 patients showed similar high levels of P-selectin with and without platelets.
Elevation of P-selectin suggests a central role of platelet endothelium interaction as part of the multifaced pathogenic mechanism of COVID-19 leading to the local activation of hemostatic system forming pulmonary thrombi. Further work is necessary to determine the therapeutic role of antiplatelets agents or of the anti P-selectin antibody Crizanlizumab.
2019冠状病毒病（COVID-19）主要是一种呼吸道疾病，急性呼吸衰竭伴弥漫性微血管肺血栓形成是这种新综合征发病和死亡的关键方面。
我们研究的目的是调查重症COVID-19住院患者中，血浆P-选择素浓度作为内皮功能障碍和血小板活化生物标志物的情况。
46例重症或危重症严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染患者纳入研究。然后将年龄匹配的患者分为需要入住重症监护病房（ICU，ICU病例）和不需要入住ICU（非ICU病例）的患者。在入院时采集重症COVID-19患者的血样。可溶性P-选择素的定量通过酶联免疫吸附测定（ELISA）法进行。
我们的研究表明，与正常参考值以及与同时采集血样的10名健康供者（HD）相比，无论是否入住ICU，COVID-19患者的血浆P-选择素浓度更高；（COVID-19）：中位数65.2（四分位间距：45.1 - 81.1） vs. HD：40.3（四分位间距：24.3 - 48.7），p = 0.023。此外，结果显示HD去除血小板后P-选择素显著降低，相比之下，ICU和非ICU的COVID-19患者无论有无血小板，P-选择素水平均相似且较高。
P-选择素升高表明血小板与内皮相互作用在COVID-19多方面致病机制中起核心作用，导致止血系统局部激活形成肺血栓。有必要进一步开展工作以确定抗血小板药物或抗P-选择素抗体克赛妥珠单抗的治疗作用。
