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. 2022 May 10;13:879157. doi: 10.3389/fimmu.2022.879157

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Copyright © 2022 de Buhr, Baumann, Werlein, Fingerhut, Imker, Meurer, Götz, Bronzlik, Kühnel, Jonigk, Ernst, Leotescu, Gabriel, Worthmann, Lichtinghagen, Tiede, von Köckritz-Blickwede, Falk, Weissenborn, Schuppner and Grosse

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Proposed immunothrombotic mechanisms during VITT. Proposed interplay between cytokines and NETosis in VITT, Vaccination against SARS-CoV-2 may trigger the immune system and in particular NETosis as well as platelet activation by antiPF4 antibodies. NETosis is counter regulated by DNases which however may be blocked e.g. by LL-37. As a result, and under conversion of fibrinogen to fibrin excessive thrombus formation may occur with embedded NET markers, complement factors, LL-37 and DNase. The thrombus formation induces a subsequent inflammatory response which further contributes to NETosis in terms of a vicious cycle. Thus, an impaired efficacy of endogenous NET-regulation may be an important contributor to severe thrombotic complications of VITT (created with BioRender.com.).