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https://www.arca.fiocruz.br/handle/icict/46941
SHOULD COVID-19 BE BRANDED TO VIRAL THROMBOTIC FEVER?
SARS-CoV-2
Febre
SARS COV Mpro
Endotélio
Inflamação
Coagulação
Trombose
Hipercoagulabilidade
COVID-19
SARS-CoV-2
Fever
NETs
Inflammation
Coagulation
roTEM
Hypercoagulability
Thrombosis
Author
Affilliation
Hospital Pró-Cardíaco. Founder and coordinator of Department of Critical Care. Americas Medical Services. United Health Group. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunofarmacologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunologia Clínica. Rio de Janeiro, RJ, Brasil / UNIFASE. Faculdade de Medicina. Petrópolis, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Patologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inflamação. Rio de Janeiro, RJ, Brasil.
Instituto Nacional do Câncer. Rio de Janeiro, RJ, Brasil.
Políticas de Saúde – UHG (UnitedHealth Group). Brasil
Fundação Oswaldo Cruz. Instituto Carlos Chagas. Laboratório de Proteômica Estrutural e Computacional. Curitiba, PR, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS & Imunologia Molecular. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratorio de Virologia Comparada e Ambiental. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunofarmacologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunologia Clínica. Rio de Janeiro, RJ, Brasil / UNIFASE. Faculdade de Medicina. Petrópolis, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Patologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inflamação. Rio de Janeiro, RJ, Brasil.
Instituto Nacional do Câncer. Rio de Janeiro, RJ, Brasil.
Políticas de Saúde – UHG (UnitedHealth Group). Brasil
Fundação Oswaldo Cruz. Instituto Carlos Chagas. Laboratório de Proteômica Estrutural e Computacional. Curitiba, PR, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS & Imunologia Molecular. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratorio de Virologia Comparada e Ambiental. Rio de Janeiro, RJ, Brasil.
Abstract
Coronaviruses can cause a diverse array of clinical manifestations, from fever with symptoms of the common cold to highly lethal Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). SARS-CoV-2, the coronavirus discovered in Hubei province, China, at the end of 2019, became known worldwide for causing COVID-19. Over one time-period, the scientific community has produced a large bulk of knowledge about this disease and countless reports about its immune-pathological aspects. This knowledge, including data obtained in postmortem studies, points unequivocally to a hypercoagulability state. However, the name COVID 19 tells us very little about the true meaning of the disease. Our proposal is more comprehensive; it intends to frame COVID-19 in more clinical terminology, making an analogy to Viral Hemorrhagic Fever (VHF). Thus, we found irrefutable evidence in the current literature that COVID-19 is the first viral disease that can be branded as a Viral Thrombotic Fever. This manuscript points out that SARS CoV-2 goes far beyond pneumonia or SARS. COVID-19 infections promote remarkable interactions among the endothelium, coagulation, and immune response, building up a background capable of promoting a “thrombotic storm,” much more than a “cytokine storm.” The importance of a viral protease called main protease (Mpro) is highlighted as a key component for SARS-CoV-2 replication in the host cell. A deeper analysis of this protease and its importance on the coagulation system is also discussed for the first time, mainly because of its similarity with the thrombin and factor Xa molecules, as recently pointed out by structural comparison of crystallographic structures.
Keywords in Portuguese
COVID-19SARS-CoV-2
Febre
SARS COV Mpro
Endotélio
Inflamação
Coagulação
Trombose
Hipercoagulabilidade
Keywords
EndotheliumCOVID-19
SARS-CoV-2
Fever
NETs
Inflammation
Coagulation
roTEM
Hypercoagulability
Thrombosis
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