4.4 Article

Association of heme-oxygenase 1, hemopexin, and heme levels with markers of disease severity in COVID-19

Journal

EXPERIMENTAL BIOLOGY AND MEDICINE
Volume 248, Issue 4, Pages 309-316

Publisher

SAGE PUBLICATIONS LTD
DOI: 10.1177/15353702221139185

Keywords

Heme-oxygenase 1; hemopexin; heme; COVID-19; inflammation; coagulation

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Heme-oxygenase 1 (HO-1) is an enzyme with anti-inflammatory and antioxidant properties, and its levels have been associated with disease severity in various diseases. The heme/HO-1 pathway has also been linked to prothrombotic changes. This study aimed to investigate the association between HO-1, heme, and hemopexin (HPX) levels with COVID-19 severity and markers of inflammation and coagulation activation.
Heme-oxygenase 1 (HO-1) is an enzyme with well-known anti-inflammatory and antioxidant properties, whose levels have been previously associated with disease severity in the context of sterile and infectious diseases. Moreover, the heme/HO-1 pathway has been associated with prothrombotic changes in other diseases. Accordingly, the potential of modulating HO-1 levels for the treatment of COVID-19 was extensively speculated during the COVID-19 pandemic, but very few actual data were generated. The aim of our study was to explore the association of HO-1, heme, and hemopexin (HPX) levels with COVID-19 severity and with markers of inflammation and coagulation activation. The study was conducted in 30 consecutive patients with COVID-19 admitted due to hypoxemia, and 30 healthy volunteers matched by sex, age, and geographic region. HO-1 and HPX levels were measured by enzyme immunoassay (ELISA) and heme levels were measured by a colorimetric method. A comprehensive panel of coagulation and fibrinolysis activation was also used. Patients with COVID-19 presented increased levels of HO-1 when compared to controls (5741 +/- 2696 vs 1953 +/- 612 pg/mL, respectively, P < 0.0001), as well as a trend toward increased levels of HPX (3.724 +/- 0.880 vs 3.254 +/- 1.022 mg/mL, respectively; P = 0.06). In addition, HO-1 and HPX levels reduced from admission to day + 4. HO-1 levels were associated with duration of intensive care unit stay and with several markers of coagulation activation. In conclusion, modulation of HO-1 could be associated with the prothrombotic state observed in COVID-19, and HO-1 could also represent a relevant biomarker for COVID-19. New independent studies are warranted to explore and expand these findings.

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