Title:Tissue Factor and COVID-19: An Update
Volume: 23
Issue: 17
Author(s): Ana Teresa Azevedo Sachetto and Nigel Mackman*
Affiliation:
- Department of Medicine, UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Keywords:
Coagulation, COVID-19, extracellular vesicles, SARS-CoV-2, tissue factor, thrombosis.
Abstract: The coronavirus 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) virus. Infection with SARS-CoV-2 is associated with acute
respiratory distress syndrome, thrombosis and a high rate of mortality. Thrombotic events increase
with severity. Tissue factor (TF) expression is increased during viral and bacterial infections. This
review summarizes studies that have examined TF expression in response to SARS-CoV-2 infection.
SARS-CoV-2 virus and its proteins upregulate TF mRNA, protein and activity in a variety of
cells, including bronchial epithelial cells, neutrophils, monocytes, macrophages, endothelial cells
and adventitial fibroblasts. COVID-19 patients have increased TF expression in lungs, bronchoalveolar
lavage fluid and circulating extracellular vesicles. The increase in TF was associated
with coagulation activation markers, thrombosis, inflammatory markers, severity of disease and
mortality. Taken together, the studies suggest that TF plays a central role in thrombosis in COVID-
19. TF may be a useful prognostic marker and therapeutic target to reduce thrombosis and inflammation.
