Fig. 8

Summary schemes illustrating SARS-CoV-2 activates platelets and enhances thrombosis in COVID-19. Global schema illustrating SARS-CoV-2 from alveolus binds and activates platelets, which enhances thrombosis formation and inflammatory reaction in capillaries, and subsequently contributes to development of disseminated intravascular coagulation and acute respiratory distress syndrome. SARS-CoV-2 Spike protein binds to ACE2 and phosphorylates ACE2, leading to MAPK signaling activation (phosphorylation of Erk, p-38, and JNK) and subsequent platelet activation, coagulation factors release, and inflammatory cytokines secretion. Interaction between SARS-CoV-2 Spike protein and platelet ACE2 confers the platelet activation, which is suppressed by the recombinant human ACE2 protein and anti-Spike monoclonal antibody (central illustration)