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Costa-Filho RC, Castro-Faria HC, Mengel J, Pelajo-Machado M, Martins MA, Leite ÉT, Mendonça-Filho HT, de Souza TDACB, Bello GB, Leite JPG. Should COVID-19 be branded to viral thrombotic fever? Mem Inst Oswaldo Cruz 2021; 116:e200552. [PMID: 33950107 PMCID: PMC8103775 DOI: 10.1590/0074-02760200552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/01/2021] [Indexed: 12/17/2022] Open
Abstract
Coronaviruses can cause a diverse array of clinical manifestations, from fever with symptoms of the common cold to highly lethal severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS). SARS-CoV-2, the coronavirus discovered in Hubei province, China, at the end of 2019, became known worldwide for causing coronavirus disease 2019 (COVID-19). Over one year's time period, the scientific community has produced a large bulk of knowledge about this disease and countless reports about its immune-pathological aspects. This knowledge, including data obtained in postmortem studies, points unequivocally to a hypercoagulability state. However, the name COVID-19 tells us very little about the true meaning of the disease. Our proposal is more comprehensive; it intends to frame COVID-19 in more clinical terminology, making an analogy to viral haemorrhagic fever (VHF). Thus, we found irrefutable evidence in the current literature that COVID-19 is the first viral disease that can be branded as a viral thrombotic fever. This manuscript points out that SARS-CoV-2 goes far beyond pneumonia or SARS. COVID-19 infections promote remarkable interactions among the endothelium, coagulation, and immune response, building up a background capable of promoting a "thrombotic storm," much more than a "cytokine storm." The importance of a viral protease called main protease (Mpro) is highlighted as a critical component for its replication in the host cell. A deeper analysis of this protease and its importance on the coagulation system is also discussed for the first time, mainly because of its similarity with the thrombin and factor Xa molecules, as recently pointed out by structural comparison crystallographic structures.
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Affiliation(s)
- Rubens Carmo Costa-Filho
- Hospital Pró-Cardíaco, Américas Serviços Médicos, United-Health Group, Rio de Janeiro, RJ, Brasil
| | - Hugo Caire Castro-Faria
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Imunofarmacologia, Rio de Janeiro, RJ, Brasil
| | - José Mengel
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Imunologia Clínica, Rio de Janeiro, RJ, Brasil
- Centro Universitário Arthur Sá Earp Neto, Faculdade de Medicina de Petrópolis, Petrópolis, RJ, Brasil
| | - Marcelo Pelajo-Machado
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Patologia, Rio de Janeiro, RJ, Brasil
| | - Marco Aurélio Martins
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Inflamação, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Gonzalo Bentacor Bello
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de AIDS e Imunologia Molecular, Rio de Janeiro, RJ, Brasil
| | - José Paulo Gagliardi Leite
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Virologia Comparada e Ambiental, Rio de Janeiro, RJ, Brasil
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López Reboiro ML, Suárez Fuentetaja R, Gutiérrez López R, Ares Castro-Conde B, Sardiña González C, Navarro Menéndez I, Pereyra Barrionuevo MF, Alves Pérez MT, López Castro J. Role of lupus anticoagulant and von Willebrand factor in chronic reactive endotheliitis in COVID-19. J Infect 2021; 82:e27-e28. [PMID: 33737115 PMCID: PMC7959681 DOI: 10.1016/j.jinf.2021.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/27/2022]
Affiliation(s)
| | | | | | | | | | - Inés Navarro Menéndez
- Hematology Section, Department of Internal Medicine, Hospital Público de Monforte, Lugo,Spain
| | | | | | - José López Castro
- Department of Internal Medicine, Hospital Público de Monforte, Lugo, Spain.
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