ABSTRACT
Background: There is emerging evidence of microvascular thrombosis and thrombotic microangiopathy (TMA) induced by COVID-19, presumably from endothelial injury or endotheliopathy . Thrombomodulin (TM) is an endothelial glycoprotein that plays a crucial role as a natural anticoagulant, binding thrombin to activate protein C (PC). TM is shed from endothelial surface during injury. We hypothesize SARS-CoV-2 spike proteins cause direct microvascular endothelial injury, leading to TM shedding, decreased activation of PC, and consequently, microvascular thrombosis in COVID-19. Aim(s): To assess: 1) endothelial injury (by soluble TM [sTM] levels) in a cohort of critically-ill COVID-19 pediatric patients;2) endothelial injury (TM shedding) in vitro by SARS-CoV-2 spike proteins and the subsequent functional consequence in activated PC (APC) levels. Method(s): STM in plasma samples from SARS-CoV-2 positive patients admitted to Texas Children's Hospital Pediatric Intensive Care Unit (n = 34) and healthy controls (n = 38) were measured by ELISA. IRB approval and waiver of informed consent were obtained. In vitro, confluent glomerular microvascular endothelial cells (GMVECs) were incubated for 24 hours in the presence or absence (control) of purified SARS-CoV-2 spike proteins, S1 and S2. In some experiments, cell lysates were collected, and TM was measured by ELISA;in others, GMVECs were further supplemented with PC and thrombin for 1 hour, followed by supernatant collection for APC measurement by ELISA. Result(s): STM levels were significantly higher in the COVID-19 pediatric patients (p < 0.01) (Fig. 1). In vitro, surface bound TM (Fig 2a) and soluble APC (Fig 2b) were significantly lower in GMVECs after addition of spike proteins (p < 0.05). Conclusion(s): We provide evidence of endothelial injury in COVID-19 patients and demonstrate a potential pathway of SARS-CoV-2 induced thrombosis. Decreased surface-bound TM results in lower amount of thrombin-TM complex, hence lesser activation of PC, likely leading to a pro-thrombotic state. These findings in GMVECs could explain the vulnerability of kidneys to COVID-19-induced TMA.
ABSTRACT
This paper discusses water security and wellbeing within a public health perspective and focuses on urban areas with high population density. It analyses access to safe water and the multiple challenges to water security in two megacities: S..o Paulo and London, comparing differences and similarities. It illustrates how water security and health are related to Agenda 2030 Sustainable Development Goal 6 (SDG6): universal and equitable access to safe drinking water, sanitation, and hygiene, and SDG3: healthy lives and well-being for all, focusing on the problem exacerbated by the context of the COVID-19 pandemic, during 2020.
ABSTRACT
The rapid degradation of the environment has reached a new level, even more worrying, with the outbreak of the Covid-19 pandemic. It is increasingly evident that the new coronavirus has sounded a warning that calls attention to the indirect effects of deforestation, especially in tropical forests such as the Amazon rainforest. The concept of the so-called risk society, proposed by the German sociologist Ulrich Beck, represents an opportunity to broaden the discussion on possible intersections between the environmental and health crises, reinforcing the urgency of articulated measures to contain epidemics and the deforestation supported by public policies based on science. However, it is observed that the dissemination of this understanding in public management collides with the Brazilian federal government's obstacles. Such barriers are supported by historical and scientific denial, considered a guiding principle for decisions that favour the dissemination of Covid-19 and the aggravation of environmental crises in Brazil. To face this challenge, it is necessary to strengthen democratic and participatory governance structures, strengthening the relationship between science and society to search for solutions to combat increasingly complex socio-environmental problems. Copyright: © 2021 by the authors. Submitted for open access publication under the terms and conditions of Fronteiras: Journal of Social, Technological and Environmental Science .