Secretion of von Willebrand Factor and Suppression of ADAMTS-13 Activity by Markedly High Concentration of Ferritin

Clin Appl Thromb Hemost. 2021 Jan-Dec:27:1076029621992128. doi: 10.1177/1076029621992128.


Hyperferritinemia is associated with poor outcomes in critically ill patients with sepsis, hemophagocytic lymphohistiocytosis (HLH), macrophage activation syndromes (MAS) and coronavirus disease 19 (COVID-19). Autopsies of hyperferritinemic patients that succumbed to either sepsis, HLH, MAS or COVID-19 have revealed disseminated microvascular thromboses with von Willebrand factor (VWF)-, platelets-, and/or fibrin-rich microthrombi. It is unknown whether high plasma ferritin concentration actively promotes microvascular thrombosis, or merely serves as a prognostic biomarker in these patients. Here, we show that secretion of VWF from human umbilical vein endothelial cells (HUVEC) is significantly enhanced by 100,000 ng/ml of recombinant ferritin heavy chain protein (FHC). Ferritin fraction that was isolated by size exclusion chromatography from the plasma of critically ill HLH patients promoted VWF secretion from HUVEC, compared to similar fraction from non-critically ill control plasma. Furthermore, recombinant FHC moderately suppressed the activity of VWF cleaving metalloprotease ADAMTS-13. These observations suggest that a state of marked hyperferritinemia could promote thrombosis and organ injury by inducing endothelial VWF secretion and reducing the ADAMTS-13 activity.

Keywords: disseminated intravascular thrombosis; endothelial dysfunction; sepsis; von Willebrand factor.

MeSH terms

  • ADAMTS13 Protein / antagonists & inhibitors
  • ADAMTS13 Protein / metabolism*
  • COVID-19 / blood*
  • COVID-19 / complications*
  • COVID-19 / immunology
  • Critical Illness
  • Ferritins / blood
  • Ferritins / metabolism*
  • Human Umbilical Vein Endothelial Cells
  • Humans
  • Hyperferritinemia / blood*
  • Hyperferritinemia / complications*
  • Lymphohistiocytosis, Hemophagocytic / blood
  • Lymphohistiocytosis, Hemophagocytic / complications
  • Oxidoreductases / blood
  • Oxidoreductases / metabolism
  • Recombinant Proteins / blood
  • Recombinant Proteins / metabolism
  • SARS-CoV-2
  • Thrombosis / blood
  • Thrombosis / etiology
  • von Willebrand Factor / metabolism*


  • Recombinant Proteins
  • von Willebrand Factor
  • Ferritins
  • FTH1 protein, human
  • Oxidoreductases
  • ADAMTS13 Protein
  • ADAMTS13 protein, human