Spikeopathy exerts its effects, as summarised by Cosentino and Marino [86] through ACE-2 binding related platelet aggregation, thrombosis and inflammation; disruption of CD147 transmembrane glycoproteins that interfere with cardiac pericyte and erythrocyte function; binding to TLR2 and TLR4 igniting inflammatory cascades; binding to ER alpha possibly responsible for menstrual irregularities and increasing cancer risk via interactions with p53BP1 and BRCA1. The gene discussed is ESR1; the disease is cancer.