From Cold to Killer: How SARS-CoV-2 Evolved without Hemagglutinin Esterase to Agglutinate, Then Clot Blood Cells in Pulmonary and Systemic Microvasculature
PhD David E Scheim
The role of vascular occlusion in the morbidities, pulmonary and systemic, of COVID-19 has received increasing focus. Histological studies of lung tissue from COVID-19 patients have found extensively damaged endothelium of capillaries adjoining relatively intact alveoli, corresponding to hypoxemia accompanying normal breathing mechanics in such patients. Essential to the study of vascular occlusion in COVID-19 are viral properties dating back to studies of Jonas Salk in the 1940s that have been positively established for SARS-CoV-2. First, SARS-CoV-2 binds to red blood cells (RBCs) in vitro and also clinically in COVID-19 patients. Second, although fusion and replication of SARS-CoV-2 occur via ACE2, such hemagglutinating viruses initially attach to infective targets and clump with blood cells via much more abundantly distributed glycoconjugate binding sites, notably those tipped with sialic acid (SA). SARS-CoV-2, in particular, attaches to these glycan binding sites. Third, certain enveloped viruses express an enzyme, hemagglutinin esterase (HE), that counteracts viral-RBC clumping. Notably, among betacoronaviruses, the common cold strains express HE while SARS-CoV-2, SARS-CoV-1 and MERS, the virulent strains, do not. The hemagglutinating properties of SARS-COV-2 establish a framework for "catch and clump" induction of microvascular occlusion proposed here. Ultramicroscopic studies of tissues from COVID-19 patients indicate a key role for hemagglutination early and mid-course in COVID-19, before such clumps develop into clots via the coagulation cascade.
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'abstract': '<p>The role of vascular occlusion in the morbidities, pulmonary and systemic, of COVID-19 has '
'received increasing focus. Histological studies of lung tissue from COVID-19 patients have '
'found extensively damaged endothelium of capillaries adjoining relatively intact alveoli, '
'corresponding to hypoxemia accompanying normal breathing mechanics in such patients.Essential '
'to the study of vascular occlusion in COVID-19 are viral properties dating back to studies of '
'Jonas Salk in the 1940s that have been positively established for SARS-CoV-2. First, '
'SARS-CoV-2 binds to red blood cells (RBCs) in vitro and also clinically in COVID-19 patients. '
'Second, although fusion and replication of SARS-CoV-2 occur via ACE2, such hemagglutinating '
'viruses initially attach to infective targets and clump with blood cells via much more '
'abundantly distributed glycoconjugate binding sites, notably those tipped with sialic acid '
'(SA). SARS-CoV-2, in particular, attaches to these glycan binding sites. Third, certain '
'enveloped viruses express an enzyme, hemagglutinin esterase (HE), that counteracts viral-RBC '
'clumping. Notably, among betacoronaviruses, the common cold strains express HE while '
'SARS-CoV-2, SARS-CoV-1 and MERS, the virulent strains, do not. The hemagglutinating '
'properties of SARS-COV-2 establish a framework for “catch and clump” induction of '
'microvascular occlusion proposed here. Ultramicroscopic studies of tissues from COVID-19 '
'patients indicate a key role for hemagglutination early and mid-course in COVID-19, before '
'such clumps develop into clots via the coagulation cascade.</p>',
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'title': 'From Cold to Killer: How SARS-CoV-2 Evolved without Hemagglutinin Esterase to Agglutinate and '
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