Kondashevskaya M V
А.Р. Avtsyn Research Institute of Human Morphology, Moscow, Russia.
J Evol Biochem Physiol. 2022;58(2):523-534. doi: 10.1134/S002209302202020X. Epub 2022 May 16.
The disease caused by the coronavirus SARS-CoV-2, named COVID-19, has been spread around the world at a high transmission rate. It was initially considered to be an acute respiratory distress syndrome. Recent clinical data has highlighted that COVID-19 is characterized by a vascular dysfunction and thrombosis, which are not typical for many other acute respiratory diseases. Thrombotic complications are markers of severe COVID-19 and are associated with multiple organ failure and increased mortality. The application of unfractionated and/or low-molecular-weight heparins as anticoagulant medications, significantly reduced the severity of the disease and COVID-19-induced mortality, since heparin is a multifunctional agent. The goal of this review is to summarize the literature data on the pathogenic mechanisms of SARS-CoV-2 and to characterize the properties of heparin, which allow inhibiting these mechanisms at any stage of pathogenesis. We proposed a vicious circle hypothesis of SARS-CoV-2 pathogenesis, as well as an original approach to low-dose heparin therapy beyond its anticoagulant properties. The analysis of a wide range of effects and mechanisms of action of heparin will help create an idea of current possibilities and future potential of applying this drug.
由冠状病毒SARS-CoV-2引起的疾病，命名为COVID-19，已以高传播率在全球传播。它最初被认为是一种急性呼吸窘迫综合征。最近的临床数据突出表明，COVID-19的特征是血管功能障碍和血栓形成，而这在许多其他急性呼吸道疾病中并不典型。血栓形成并发症是重症COVID-19的标志，与多器官功能衰竭和死亡率增加相关。应用普通肝素和/或低分子量肝素作为抗凝药物，可显著降低疾病的严重程度和COVID-19所致的死亡率，因为肝素是一种多功能药物。本综述的目的是总结关于SARS-CoV-2致病机制的文献数据，并描述肝素的特性，这些特性使其能够在发病机制的任何阶段抑制这些机制。我们提出了SARS-CoV-2发病机制的恶性循环假说，以及一种超越其抗凝特性的低剂量肝素治疗的原始方法。对肝素广泛的作用效果和作用机制的分析将有助于了解应用这种药物的当前可能性和未来潜力。
