2020 Jul 1;100(3):1065-1075.
doi: 10.1152/physrev.00013.2020. Epub 2020 Mar 27.
Elevated Plasmin(ogen) as a Common Risk Factor for COVID-19 Susceptibility
Patients with hypertension, diabetes, coronary heart disease, cerebrovascular illness, chronic obstructive pulmonary disease, and kidney dysfunction have worse clinical outcomes when infected with SARS-CoV-2, for unknown reasons. The purpose of this review is to summarize the evidence for the existence of elevated plasmin(ogen) in COVID-19 patients with these comorbid conditions. Plasmin, and other proteases, may cleave a newly inserted furin site in the S protein of SARS-CoV-2, extracellularly, which increases its infectivity and virulence. Hyperfibrinolysis associated with plasmin leads to elevated D-dimer in severe patients. The plasmin(ogen) system may prove a promising therapeutic target for combating COVID-19.
Keywords: COVID-19; SARS-CoV-2; comorbidity; fibrinolysis; plasmin(ogen).
Conflict of interest statement
No conflicts of interest, financial or otherwise, are declared by the authors.