University of Aberdeen team suggest results indicate that protein PAI-1 could be an early indicator of severe COVID-19

A protein that could be an early indicator of severe COVID-19 has been identified by scientists at the University of Aberdeen.

Patients who get seriously ill following a COVID-19 infection frequently show evidence of a severe form of lung disease and in around 30% of patients blood clots are evident. Blood clots arise due to deposits of fibrin within the lung contributing to pneumonia and respiratory distress. These fibrin deposits restrict the amount of oxygen absorbed into the lung.

Patients with severe disease require oxygen support, which in very severe cases requires mechanical ventilation. In addition, blood clots are found throughout the body of those that are severely ill in both small and large vessels, frequently leading to deep vein thrombosis, stroke and other thrombotic complications.

The study, published in Journal of Thrombosis and Haemostasis, analysed profiles of 113 patients hospitalised in Aberdeen with severe COVID-19, 24 patients with non-COVID-19 respiratory infection and a control group with no symptoms.

The research group found that patients with COVID-19 had significantly higher levels of a protein called PAI-1 – plasminogen activator inhibitor 1 – compared to those with non-COVID-19 respiratory infections and those with no infection at all.

The team suggest the study results indicate that PAI-1 could be a potential early indicator of severe COVID-19 outcome. Furthermore, the results from the group indicate that an existing clot-busting drug, Tenecteplase, could be used to treat the condition.

Lead researcher Professor Nicola Mutch, from the University of Aberdeen, explained: “Our challenge is to understand why patients with severe cases of COVID-19 are so prone to the development of these clots in big and small blood vessels throughout the body. In this study we have identified PAI-1 as a key protein involved in the persistence of blood clots in severe COVID-19 disease. PAI-1 is associated with a poorer outcome in patients.”

“There are existing drugs that could be utilised to promote breakdown and clearance of fibrin in the lung of those with severe COVID-19, our study shows that a PAI-1 resistant form of a clot busting agent, Tenecteplase, is superior over other drugs. Our data indicates a novel strategy to treat patients with severe COVID-19 and subsequent severe acute respiratory coronavirus infections,” she added.

The study was funded by NHS Grampian, Medical Research Scotland, The Development Trust and Friends of Anchor.