Von Willebrand factor is elevated in individuals infected with Sudan virus and is associated with adverse clinical outcomes.

Sudan virus (SUDV) is a member of the Filoviridae family that has been associated with sporadic outbreaks of human disease in sub-Saharan Africa. The filoviruses are notable for the high frequencies with which they cause both hemorrhagic manifestations and death in infected individuals. Recently, we reported an extensive biomarker analysis of patient specimens from the Gulu SUDV outbreak. In that study, we found evidence of endothelial dysfunction and alterations of factors important to the coagulation pathways. The complex intersection between the endothelium, coagulation, and immunity is further explored in this study where we examine several additional biomarkers using the same patient specimens. We report that von Willebrand factor (vWF), a protein that promotes platelet adhesion to the injured endothelium, is elevated in SUDV-infected individuals compared to normally reported values in healthy individuals. Furthermore, vWF is associated with a fatal outcome in SUDV-infected pediatric patients. In addition, we find that vWF is elevated in individuals who have hemorrhagic manifestations of disease, suggesting excessive thrombosis in these patients.