04 January 2021

Irish researchers have reported a link between severe COVID-19 and high levels of a particular marker in the blood, resulting from activation of endothelial cells in the blood vessels of the lungs.

Researchers from the RCSI University of Medicine and Health Sciences in Dublin found that von Willebrand Factor propeptide is linked to more severe disease and poorer outcomes for hospitalised patients with the virus.

The findings provide more evidence as to why COVID-19 patients develop blood clotting abnormalities that can trigger micro-clot development in the lungs. Previous research has found that the development of these micro-clots can lead to a poorer prognosis for patients and increased risk of intensive care admission.

Writing in the British Journal of Haematology, they say their findings could help doctors to stratify patients at high risk of developing severe thrombotic and respiratory complications.

The study links the formation of these micro-clots to elevated blood levels of von Willebrand Factor propeptide, which is an established blood marker for damage to the endothelial cells. Acute damage of these cells results in the rapid release of von Willebrand Factor propeptide but also initiates clot formation and inflammation.

Researchers observed the highest levels of the blood marker in patients with most severe COVID-19 disease or those who died from the disease.

Professor James O’Donnell, director of the Irish Centre for Vascular Biology, RCSI, and consultant haematologist in the National Coagulation Centre in St James’s Hospital, said: “We have previously established that abnormal blood clotting and the development of micro-clots within the lungs contributes to a greater risk of a poorer prognosis and intensive care admission for Irish patients with COVID-19.

“The mechanisms through which COVID-19 triggers the formation of these micro-clots however has been puzzling doctors throughout the world. This research now critically helps us to more clearly understand these mechanisms.”


Ward SE, Curley GF, Lavin M, Fogarty H, Karampini E, McEvoy NL, Clarke J, Boylan M, Alalqam R, Worrall AP, Kelly C, de Barra E, Glavey S, Ni Cheallaigh C, Bergin C, Martin-Loeches I, Townsend L, Mallon PW, O'Sullivan JM, O'Donnell JS, on behalf of the Irish COVID-19 Vasculopathy Study (ICVS) Investigators. (2020) “Von Willebrand factor propeptide in severe coronavirus disease 2019 (COVID-19): evidence of acute and sustained endothelial cell activation.” British Journal of Haematology, doi: 10.1111/bjh.17273


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