reproductive capacity and millions of new viral particles are produced. The epithelial cells burst and die, releasing these millions of virus particles to both bind to more epithelial cells and to be exhaled by the patient - possibly infecting other humans.
Why is this relevant? ACE is a control mechanism for one of the key activation factors of that little understood system - the Kinin- Kalikrein, bradykinin. Bradykinin receptors are also found on lung epithelial cells adjacent to the ACE receptors, thus - under normal conditions - ACE bound to lung receptors markedly inhibits the effect of Bradykinin, with the ACE receptor either bound to a SARS Cov-2 virus or destroyed. Patients with COVID-19 have a markedly reduced system for controlling the effects of Bradykinin. This has a major impact on the patient and pushes them into the second condition seen in COVID- 19 patients.
How does this create the second COVID-19 condition? The majority of patients, who die from COVID-19 infection, do so because of multiple blood clots in various organs including the lung, brain and liver. These patients have been shown to have levels of the coagulation factor fibrinogen ten times normal. They
Patients who develop symptoms again divide in to two groups, those who, after nine or ten days, start to get better, and those who, after nine to ten days, get markedly worse
have also been found to have increased levels of the clotting marker D-Dimer, which is only raised when a clot has occurred within the body. Bradykinin is produced by the initial activation of the clotting system, which can be activated by the release of a substance-caused tissue factor, which is found in high concentrations in lung tissue. Release of tissue factor can be expected when lungs are damaged, for example when a virus destroys the cells. Coagulation is also activated when neutrophils are activated to defend against infections because they contain a procoagulant, which is released both upon
activation and their destruction. Another interesting fact is that fibrinogen production is stimulated by activated monocytes, which are found in the liver tissue where fibrinogen is produced.
The chemicals that control all of these processes are called cytokines, they are potent activators or inhibitors that are released from various cells when the cell is activated. In Covid19 patients the balance of cytokine activity is pushed towards activation and the inhibition loops appear either not to be working or overwhelmed by the activation loop.
inherited disorder where the coagulation factor (factor 8 (FVIII)) is either missing or severely reduced - illustrates this point. FVIII is one of more than 20 identified components involved in the control of blood clotting, yet untreated haemophiliacs have severe life-shortening problems.
What does this mean for COVID-19 patients? Scientists are convinced that SARS Cov-2 infects humans by being pulled into the epithelial cells which line the airways into and including the lungs. This happens because the protein coat of the virus happens to have either the same or a similar sequence of amino acids to human Angiotensin Converting Enzyme (ACE). The epithelial cells have a sequence of amino acids, which causes ACE to stick to it. These are called ACE receptors. When the virus is inhaled, if it comes in contact with a free ACE receptor, it binds and enters the cell. Once inside the cell, the virus takes over the cell’s
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