Von Willebrand Factor and ADAMTS-13 Are Associated with the Severity of COVID-19 Disease.

Coagulopathy in COVID-19 patients is presumably based on systemic hypercoagulation with the inflammatory response. As a result of endothelial dysfunction, tissue factor and von Willebrand factor (vWF) are released into the blood stream, which leads to prothrombinase activation. The vWF/ADAMTS-13 ratio can be used for monitoring the severity of the disease. This observational prospective study included 141 patients with COVID-19. In patients with mild COVID-19 (group 1), the assessment was performed on the 3rd-7th day of illness (point 1) and 14-28 days after recovery (point 2). In patients with moderate (groups 2) and severe (group 3) COVID-19, the assessment was performed during hospitalization (point 1) and after 14 days (point 2). The vWF:RCo/ADAMTS-13:activity (point 1), vWF/ADAMTS-13 (point 2) and vWF:RCo/ADAMTS-13:activity (point 2) ratios were significantly higher in patients with moderate and severe COVID-19. Moreover, in these patients, both ratios increased after recovery (point 2), which is a negative prognostic factor of thrombotic complications. Thus, COVID-19 is characterized by a decrease in the concentration and activity of ADAMTS-13 metalloproteinase, especially in patients with the severe form of COVID-19. A decrease in ADAMTS-13 activity results in an increase in vWF concentration and activity so the ratio of vWF to ADAMTS-13 changes significantly.

Effects of SARS-CoV-2 on human reproduction

The available information on the clinical features of COVID-19, the effects of the infection on various organs and systems, and the prevention and treatment is very limited and contradictory. There is especially little evidence for the effects of SARS-CoV-2 on the human reproductive system. The authors carried out a systematic analysis of the data available in modern literature about the effects of the SARS-CoV-2 and COVID-19 on the female and male reproductive system and fertility. The literature review includes data from the publications available at https://pubmed.ncbi.nlm.nih.gov/ on this topic. The paper provides data on the etiology and pathogenesis of COVID-19, the ways of penetration into the human body, the possible mechanisms of damage to the gonads in males and females, and the available evidence of the effect of SARS-CoV-2 on human reproduction. Currently, there are no data proving the presence of infection of ovarian or endometrial tissues in women, which would affect oogenesis, embryo implantation, early embryogenesis, and the occurrence of pregnancy in natural cycles or in ART programs. It can be assumed that there may be the following disorders of the female reproductive system: ovarian tissue damage caused by SARS-CoV-2, which may contribute to ovulatory dysfunction;oocyte damage, which can facilitate the production of aneuploid oocytes;and endometrial cell damages, which can lead to impaired embryo implantation. The data on the effect of SARS- CoV-2 on spermatogenesis and testicular tissue damage are scanty and contradictory. Conclusion. Further investigations are needed to study the effects of SARS-CoV-2 on human reproductive function. Имеющиеся сведения о клинических особенностях COVID-19, влиянии инфекции на различные органы и системы, профилактике и лечении весьма ограничены и противоречивы. Особенно мало данных о влиянии SARS- CoV-2 на репродуктивную систему человека. Проведен систематический анализ данных, имеющихся в современной литературе, о влиянии вирусов SARS-CoV-2 и COVID-19 на репродуктивную систему и фертильность женщин и мужчин. В обзор литературы включены данные публикаций, представленных в https://pubmed.ncbi.nlm.nih.gov/ по данной теме. Приведены данные об этиологии и патогенезе COVID-19, о путях проникновения в организм человека, о возможных механизмах поражения гонад у мужчин и женщин и имеющиеся доказательства влияния SARS-CoV-2 на репродукцию у человека. В настоящее время отсутствуют данные, доказывающие наличие инфицирования тканей яичника или эндометрия у женщин, которые бы повлияли на оогенез, имплантацию эмбриона, ранний эмбриогенез, наступление беременности в естественных циклах или в программах ВРТ. Можно предположить вероятность следующих нарушений женской репродуктивной системы: поражение SARS-CoV-2 тканей яичников, что может способствовать нарушению овуляторной функции;поражение ооцитов, что может способствовать получению анеуплоидных ооцитов;поражение клеток эндометрия, что может приводить к нарушению имплантации эмбрионов. Данные по влиянию SARS- CoV-2 на сперматогенез и поражение тканей яичек немногочисленны и противоречивы. Заключение. Необходимо проведение дальнейших исследований по изучению влияния SARS-CoV-2 на репродуктивную функцию человека.