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Review
. 2022 Aug:169:105658.
doi: 10.1016/j.micpath.2022.105658. Epub 2022 Jun 25.

ABO blood group and link to COVID-19: A comprehensive review of the reported associations and their possible underlying mechanisms

Eric Pereira  1 , Stela Felipe  1 , Raquel de Freitas  1 , Valdevane Araújo  1 , Paula Soares  1 , Jannison Ribeiro  2 , Luiz Henrique Dos Santos  1 , Juliana Osório Alves  1 , Natália Canabrava  3 , Mauricio van Tilburg  3 , Maria Izabel Guedes  3 , Vânia Ceccatto  4
Affiliations
Review

ABO blood group and link to COVID-19: A comprehensive review of the reported associations and their possible underlying mechanisms

Eric Pereira et al. Microb Pathog. 2022 Aug.

Abstract

ABO blood group is long known to be an influencing factor for the susceptibility to infectious diseases, and many studies have been describing associations between ABO blood types and COVID-19 infection and severity, with conflicting findings. This narrative review aims to summarize the literature regarding associations between the ABO blood group and COVID-19. Blood type O is mostly associated with lower rates of SARS-CoV-2 infection, while blood type A is frequently described as a risk factor. Although results regarding the risk of severe outcomes are more variable, blood type A is the most associated with COVID-19 severity and mortality, while many studies describe O blood type as a protective factor for the disease progression. Furthermore, genetic associations with both the risk of infection and disease severity have been reported for the ABO locus. Some underlying mechanisms have been hypothesized to explain the reported associations, with incipient experimental data. Three major hypotheses emerge: SARS-CoV-2 could carry ABO(H)-like structures in its envelope glycoproteins and would be asymmetrically transmitted due to a protective effect of the ABO antibodies, ABH antigens could facilitate SARS-CoV-2 interaction with the host' cells, and the association of non-O blood types with higher risks of thromboembolic events could confer COVID-19 patients with blood type O a lower risk of severe outcomes. The hypothesized mechanisms would affect distinct aspects of the COVID-19 natural history, with distinct potential implications to the disease transmission and its management.

Keywords: ABO antibodies; ABO blood Group system; ABO blood Types; COVID-19; Glycobiology; SARS-CoV-2.

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Conflict of interest statement

The authors have no financial or non-financial competing interests to disclose.

Figures

Fig. 1
Fig. 1
- Sequential synthesis the ABO antigens. Gal: d-Galactose, GlcNAc: N-Acetylglucosamine, GalNAc: N-Acetyl-galactosamine, Fuc: l-fucose, R: Radical group, GTA: Glucosyltransferase A, GTB: Glucosyltransferase B, β1,3: Type 1 chain, β1,4: Type 2 chain. (Two-column fitting image).
Fig. 2
Fig. 2
- Structural representations of the ABO blood group antigens. (1.5-column fitting image).
See this image and copyright information in PMC

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