Thrombosis in COVID-19:dysregulation of the tromboinflammatory VWF/ADAMTS13 axis?

Despite COVID-19 principally being a respiratory disease, there is an increasing amount of concern about the hypercoagulability and prothrombotic state of COVID-19 patients, especially in those who are critically ill. The infection initiates a potent inflammatory response that can stimulate thrombosis. Von Willebrand factor (VWF) is a large multimeric protein that is involved in both inflammatory and thrombotic processes. We hypothesize that the cytokine storm induced by the SARS-CoV-2 virus leads to massive endothelial activation, resulting in massive release of the VWF, leading to a prothrombotic state. The goal of this project therefore is to investigate the status of VWF in COVID-19 patients. We will investigate the quantity and activity of VWF as well as the activity of the VWF-cleaving enzyme ADAMTS13. Novel insights from this project can lead to new supporting treatment strategies that lead to improved patient recovery and survival.