Emerging role of nucleic acid aptamers in sepsis-induced coagulopathy: Future perspectives in diagnostics and therapeutics

Sepsis-induced coagulopathy is a severe complication of sepsis and septic shock, contributing significantly to organ dysfunction and increased mortality. Currently, there is no effective treatment for coagulopathy, highlighting a critical need for new therapeutic options to improve patient outcomes. This review explores the potential use of nucleic acid aptamers for septic-induced coagulopathy. Aptamers are short single-stranded oligonucleotides, known for their high affinity and specificity towards targets. They offer several advantages over antibodies, including smaller size, synthetic production, lower immunogenicity, and greater flexibility in targeting a wide range of molecules and cells. Due to these properties, aptamers have emerged as promising tools for the diagnosis and treatment of various diseases, with several currently ongoing clinical trials and others already available on the pharmaceutical market. This illustrated and thoroughly documented review provides a comprehensive overview of the key aspects of sepsis pathophysiology, emphasizing the significant roles aptamers can play, including: the targeting of endothelial dysfunction where aptamers could protect vascular integrity and inhibit leukocyte adhesion to the endothelium thereby limiting local inflammation; the targeting of dysregulated coagulation pathways by preventing platelet adhesion and aggregation, as well as blocking coagulation factors, helping to limit thrombus formation; the restoration of fibrinolytic function by targeting direct inhibitors of plasmin generation; the targeting of neutrophil extracellular traps to decrease excessive coagulation activation and restore fibrinolysis; the inhibition of complement system in sepsis-induced disseminated intravascular coagulation. This review also includes a chapter on the use of aptamers as diagnostic and prognostic tools for sepsis-induced coagulopathy.