Increased circulating platelet-derived extracellular vesicles in severe COVID-19 disease.

ABSTRACT

Coagulation disturbances are major contributors to COVID-19 pathogenicity, but limited data exist on the involvement of extracellular vesicles (EVs) and residual cells (RCs). Fifty hospitalized COVID-19 patients stratified by their D-dimer levels into high (>1.5 mg/L, n = 15) or low (≤1.5 mg/l, n = 35) and 10 healthy controls were assessed for medium-sized EVs (mEVs; 200-1000 nm) and large EVs/RCs (1000-4000 nm) by high sensitivity flow cytometry. EVs were analyzed for CD61, CD235a, CD45, and CD31, commonly used to detect platelets, red blood cells, leukocytes or endothelial cells, respectively, whilst phosphatidyl serine EVs/RCs were detected by lactadherin-binding implicating procoagulant catalytic surface. Small EV detection (sEVs; 50-200 nm) and CD41a (platelet integrin) colocalization with general EV markers CD9, CD63, and CD81 were performed by single particle interferometric reflectance imaging sensor. Patients with increased D-dimer exhibited the highest number of RCs and sEVs irrespective of cell origin (p < .05). Platelet activation, reflected by increased CD61+ and lactadherin+ mEV and RC levels, associated with coagulation disturbances. Patients with low D-dimer could be discriminated from controls by tetraspanin signatures of the CD41a+ sEVs, suggesting the changes in the circulating platelet sEV subpopulations may offer added prognostic value during COVID progression.

What is the context? Coronavirus disease 19 (COVID-19) frequently leads to blood clotting disturbances, including thromboses.Particles smaller than cells, extracellular vesicles (EVs), and residual cells (RCs) affect blood clotting, but data on their role and diagnostic utility in COVID-19 are sparse.What is new? In this study, we assessed 50 hospitalized COVID-19 patients and 10 healthy controls for their different EV subpopulations and residual cells (50­4000 nm).Blood clotting marker D-dimer, which is elevated in severe COVID-19 infection, was used to characterize disease severity and stratify the patient subgroups. Fifteen patients (30%) with high D-dimer (>1.5 mg/L) were compared to controls, and 35 patients with lower D-dimer (≤1.5 mg/mL).The most topical state-of-the-art methods for detection of EV subpopulations, that is, high sensitivity flow cytometry (hsFCM) and single particle interferometric reflectance imaging sensor (SP-IRIS), were used with markers indicative of platelet, red blood cell, leukocyte or endothelial cells. The subpopulations differentiated by platelet and tetraspanin signatures by hsFCM and SP-IRIS, respectively.The main findings are Patients with high D-dimer systematically exhibited the highest number of platelet EVs in all subpopulations (p < .05).Small EVs subpopulations (differentiated by the tetraspanin signatures) could discriminate patients with low D-dimer (p < .001) from healthy controls.Differences between the two D-dimer groups were seen in the platelet-derived (large and medium EVs and RCs), RBC-derived mEVs and l EVs and RCs, and lactadherin-positive large EVs and RCs (p < .05).What is the impact? Platelet activation, reflected by increased EVs was associated with blood clotting disturbances. Small EVs signatures revealed changes in the EV subpopulations in association with blood clotting during COVID-19. Such signatures may enable identification of severely ill patients before the increase in coagulation is evident by coagulation parameters, for example, by high D-dimer.