Do Circulating Histones Represent the Missing Link among COVID-19 Infection and Multiorgan Injuries, Microvascular Coagulopathy and Systemic Hyperinflammation?

Daniela Ligi; Rosanna Maniscalco; Mario Plebani; Giuseppe Lippi; Ferdinando Mannello

doi:10.3390/jcm11071800

Do Circulating Histones Represent the Missing Link among COVID-19 Infection and Multiorgan Injuries, Microvascular Coagulopathy and Systemic Hyperinflammation?

J Clin Med. 2022 Mar 24;11(7):1800. doi: 10.3390/jcm11071800.

Authors

Daniela Ligi¹, Rosanna Maniscalco¹, Mario Plebani², Giuseppe Lippi³, Ferdinando Mannello¹

Affiliations

¹ Unit of Clinical Biochemistry, Department of Biomolecular Sciences-DISB, University of Urbino Carlo Bo, 61029 Urbino, Italy.
² Department of Medicine-DIMED, University of Padua, 35128 Padua, Italy.
³ Section of Clinical Biochemistry, University Hospital of Verona, 37134 Verona, Italy.

Abstract

Several studies shed light on the interplay among inflammation, thrombosis, multi-organ failures and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Increasing levels of both free and/or circulating histones have been associated to coronavirus disease 2019 (COVID-19), enhancing the risk of heart attack and stroke with coagulopathy and systemic hyperinflammation. In this view, by considering both the biological and clinical rationale, circulating histones may be relevant as diagnostic biomarkers for stratifying COVID-19 patients at higher risk for viral sepsis, and as predictive laboratory medicine tool for targeted therapies.

Keywords: COVID-19; coagulopathy; cytokine storm; heparin; heparinoids; histone; inflammation; laboratory medicine; multiorgan injury; neutrophil extracellular trap.