Platelets Promote Thromboinflammation in SARS-CoV-2 Pneumonia

Objective: Pulmonary thrombosis is observed in severe acute respiratory syndrome coronavirus 2 pneumonia. Aim was to investigate whether subpopulations of platelets were programmed to procoagulant and inflammatory activities in coronavirus disease 2019 (COVID-19) patients with pneumonia, without comorbidities predisposing to thromboembolism. Approach and Results: Overall, 37 patients and 28 healthy subjects were studied. Platelet-leukocyte aggregates, platelet-derived microvesicles, the expression of P-selectin, and active fibrinogen receptor on platelets were quantified by flow cytometry. The profile of 45 cytokines, chemokines, and growth factors released by platelets was defined by immunoassay. The contribution of platelets to coagulation factor activity was selectively measured. Numerous platelet-monocyte (mean +/- SE, 67.9 +/- 4.9%, n=17 versus 19.4 +/- 3.0%, n=22; P<0.0001) and platelet-granulocyte conjugates (34.2 +/- 4.04% versus 8.6 +/- 0.7%; P<0.0001) were detected in patients. Resting patient platelets had similar levels of P-selectin (10.9 +/- 2.6%, n=12) to collagen-activated control platelets (8.7 +/- 1.5%), which was not further increased by collagen activation on patient platelets (12.4 +/- 2.5%, P=nonsignificant). The agonist-stimulated expression of the active fibrinogen receptor was reduced by 60% in patients (P<0.0001 versus controls). Cytokines (IL [interleukin]-1 alpha, IL-1 beta, IL-1RA, IL-4, IL-10, IL-13, IL, 17, IL-27, IFN [interferon]-alpha, and IFN-gamma), chemokines (MCP-1/CCL2 [monocyte chemoattractant protein 1]), and growth factors (VEGF [vascular endothelial growth factor]-A/D) were released in significantly larger amounts upon stimulation of COVID-19 platelets. Platelets contributed to increased fibrinogen, VWF (von Willebrand factor), and factor XII in COVID-19 patients. Patients (28.5 +/- 0.7 s, n=32), unlike controls (31.6 +/- 0.5 s, n=28; P<0.001), showed accelerated factor XII-dependent coagulation. Conclusions: Platelets in COVID-19 pneumonia are primed to spread proinflammatory and procoagulant activities in systemic circulation.