Recounting COVID-19 associated complement-mediated coagulopathies: Triggers and controls

Abstract

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to a global health crisis, prompting extensive research into its pathogenesis and potential therapeutic interventions. One area of increasing interest is the interaction between SARS-CoV-2 and the complement system, a crucial component of innate immunity. This review explores the intricate relationship between COVID-19 and the complement system, shedding light on how the virus exploits and manipulates the complement components to induce inflammatory responses leading to coagulopathies. The activation of the complement pathway simultaneously activates the coagulation cascade due to the presence of common substrates of mannan-binding serine proteases of the lectin complement system in the coagulation pathway. This cross-talk between the components of the complement and coagulation system further aggravates the dysregulation of immune responses, contributing to the cytokine storm observed in severe COVID-19 cases. A comprehensive understanding of this crosstalk is crucial for developing targeted therapeutic strategies to mitigate the hyperinflammatory state associated with severe disease. Understandings into the molecular mechanisms governing this interaction may pave the way for the development of novel antiviral diagnostics and therapies based on immunomodulatory interventions, offering better management for such cases.