SARS-CoV-2 binds platelet ACE2 to enhance thrombosis in COVID-19

Authors: Si Zhang 1Yangyang Liu 2Xiaofang Wang 2Li Yang 3Haishan Li 4Yuyan Wang 5Mengduan Liu 2Xiaoyan Zhao 2Youhua Xie 5Yan Yang 6Shenghui Zhang 7Zhichao Fan 8Jianzeng Dong 2Zhenghong Yuan 5Zhongren Ding 2Yi Zhang 9Liang Hu 10


Background: Critically ill patients diagnosed with COVID-19 may develop a pro-thrombotic state that places them at a dramatically increased lethal risk. Although platelet activation is critical for thrombosis and is responsible for the thrombotic events and cardiovascular complications, the role of platelets in the pathogenesis of COVID-19 remains unclear.

Methods: Using platelets from healthy volunteers, non-COVID-19 and COVID-19 patients, as well as wild-type and hACE2 transgenic mice, we evaluated the changes in platelet and coagulation parameters in COVID-19 patients. We investigated ACE2 expression and direct effect of SARS-CoV-2 virus on platelets by RT-PCR, flow cytometry, Western blot, immunofluorescence, and platelet functional studies in vitro, FeCl3-induced thrombus formation in vivo, and thrombus formation under flow conditions ex vivo.

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