One of the major mysteries in treating patients with Covid-19 is the frequent development of blood clots that can subsequently damage their organs and sometimes be fatal.
In a new study, researchers found a leading mechanism behind the pathophysiology of Covid-19 and pinpoint a biological marker for the mechanism that may aid in treating these patients.
They found while many forms of illness can generate blood clots, the endothelial cells that line the inside of blood vessels play a surprisingly large role in Covid-19 clotting.
Endothelial cells line the interior surface of blood vessels and lymphatic vessels.
Endothelial damage is a central component in the entire spectrum of Covid-19 disease.
This study is the first to demonstrate that this process of endothelial damage is present in a wide range of Covid-19 patients, particularly as people become critically ill.
The research was led by Yale Cancer Center (YCC) experts.
The clinical study examined the blood of 68 patients with Covid-19, 48 of them critically ill in an intensive care unit (ICU), and 20 receiving care on a non-ICU hospital unit, along with 13 disease-free volunteers who acted as a control arm.
The team found several markers of endothelial cell and blood platelet activation were about twice as high in the ICU group than in the non-ICU group and also higher in the non-ICU group than in the control group.
One of the biomarkers, a soluble form of a protein on the surface of endothelial cells called thrombomodulin, was highly correlated with survival among all Covid-19 patients.
This finding suggests that measuring thrombomodulin levels might aid in managing patients.
The team is now exploring opportunities to develop a diagnostic test based on thrombomodulin, which is also elevated in other life-threatening diseases.
One early candidate among approved therapies is an oral drug called dipyridamole, long used to prevent stroke and other conditions.
The research began with a Yale Covid-19 initiative that brought together medical experts charged with making recommendations on standard treatments for the Yale New Haven Health System.
One author of the study is Alfred Lee, M.D., Ph.D., Associate Professor of Medicine (Hematology).
The study is published in The Lancet Haematology.
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