Elevated P-Selectin in Severe Covid-19: Considerations for therapeutic options

Elevated P-Selectin in Severe Covid-19: Considerations for therapeutic options

Michele Bibas, Chiara Agrati, Veronica Bordoni, alessandra sacchi, germana grassi, nicola petrosillo, emanuele nicastri, franca del nonno, giampiero d'offizi, fabrizio palmieri, luisa marchioni, maria rosaria capobianchi, andrea antinori, giuseppe ippolito

BACKGROUND: 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. PURPOSE: 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. METHODS: 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 ELISA assay. RESULTS: 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=0.0023). Moreover, results showed a significant reduction of P-selectin 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. CONCLUSION: 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.

2021

covid-19, platelets, P-selectin, endothelium

10.4084/mjhid.2021.016

Epidemiology and Health

Korean Society of Epidemiology

Diseases of the blood and blood-forming organs