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The four horsemen of a viral Apocalypse: The pathogenesis of SARS-CoV-2 infection (COVID-19).
Domingo, Pere; Mur, Isabel; Pomar, Virginia; Corominas, Héctor; Casademont, Jordi; de Benito, Natividad.
  • Domingo P; Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret, 167, 08025 Barcelona, Spain. Electronic address: pdomingo@santpau.cat.
  • Mur I; Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret, 167, 08025 Barcelona, Spain.
  • Pomar V; Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret, 167, 08025 Barcelona, Spain.
  • Corominas H; Departments of Rheumatology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
  • Casademont J; Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
  • de Benito N; Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret, 167, 08025 Barcelona, Spain.
EBioMedicine ; 58: 102887, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-684307
Semantic information from SemMedBD (by NLM)
1. Thrombophilia COEXISTS_WITH Inflammation
Subject
Thrombophilia
Predicate
COEXISTS_WITH
Object
Inflammation
2. Thrombophilia COEXISTS_WITH Inflammation
Subject
Thrombophilia
Predicate
COEXISTS_WITH
Object
Inflammation
ABSTRACT
The pathogenesis of coronavirus disease 2019 (COVID-19) may be envisaged as the dynamic interaction between four vicious feedback loops chained or happening at once. These are the viral loop, the hyperinflammatory loop, the non-canonical renin-angiotensin system (RAS) axis loop, and the hypercoagulation loop. Severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 lights the wick by infecting alveolar epithelial cells (AECs) and downregulating the angiotensin converting enzyme-2 (ACE2)/angiotensin (Ang-1-7)/Mas1R axis. The viral feedback loop includes evading the host's innate response, uncontrolled viral replication, and turning on a hyperactive adaptative immune response. The inflammatory loop is composed of the exuberant inflammatory response feeding back until exploding in an actual cytokine storm. Downregulation of the ACE2/Ang-(1-7)/Mas1R axis leaves the lung without a critical defense mechanism and turns the scale to the inflammatory side of the RAS. The coagulation loop is a hypercoagulable state caused by the interplay between inflammation and coagulation in an endless feedback loop. The result is a hyperinflammatory and hypercoagulable state producing acute immune-mediated lung injury and eventually, adult respiratory distress syndrome.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pneumonia, Viral / Renin-Angiotensin System / Blood Coagulation / Cytokines / Coronavirus Infections / Betacoronavirus Subject: Pneumonia, Viral / Renin-Angiotensin System / Blood Coagulation / Cytokines / Coronavirus Infections / Betacoronavirus Type of study: Etiology study Language: English Journal: EBioMedicine Clinical aspect: Etiology Year: 2020

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pneumonia, Viral / Renin-Angiotensin System / Blood Coagulation / Cytokines / Coronavirus Infections / Betacoronavirus Subject: Pneumonia, Viral / Renin-Angiotensin System / Blood Coagulation / Cytokines / Coronavirus Infections / Betacoronavirus Type of study: Etiology study Language: English Journal: EBioMedicine Clinical aspect: Etiology Year: 2020
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