COVID-19 is characterized by virus-induced injury leading to multi-organ failure, together with inflammatory reaction, endothelial cell (EC) injury, and prothrombotic coagulopathy with thrombotic events. Complement system (C) via its cross-talk with the contact and coagulation systems contributes significantly to the severity and pathological consequences due to SARS-CoV-2 infection. These immunopathological mechanisms overlap in COVID-19 and pre-eclampsia (PE). Thus, mothers contracting SARS-CoV-2 infection during pregnancy are more vulnerable to developing PE. SARS-CoV-2 infection of ECs, via its receptor ACE2 and co-receptor TMPRSS2, can provoke endothelial dysfunction and disruption of vascular integrity, causing hyperinflammation and hypercoagulability. This is aggravated by bradykinin increase due to inhibition of ACE2 activity by the virus. C is important for the progression of normal pregnancy, and its dysregulation can impact in the form of PE-like syndrome as a consequence of SARS-CoV-2 infection. Thus, there is also an overlap between treatment regimens of COVID-19 and PE. C inhibitors, especially those targeting C3 or MASP-2, are exciting options for treating COVID-19 and consequent PE. In this review, we examine the role of C, contact and coagulation systems as well as endothelial hyperactivation with respect to SARS-CoV-2 infection during pregnancy and likely development of PE.
【저자키워드】 COVID-19, SARS-CoV-2, complement system, Pregnancy, pre-eclampsia, 【초록키워드】 ACE2, TMPRSS2, SARS-COV-2 infection, severity, progression, virus, inhibitors, Endothelial dysfunction, Coagulopathy, hyperinflammation, Coagulation system, Thrombotic events, mechanism, hypercoagulability, mother, MASP-2, Endothelial cell, Injury, Contact, dysregulation, endothelial, Vascular, overlap, syndrome, treatment regimen, multi-organ failure, inflammatory reaction, treating COVID-19, receptor ACE2, Hyperactivation, consequence, prothrombotic, normal pregnancy, significantly, characterized, contribute, immunopathological, cross-talk, provoke, 【제목키워드】 System,