# Neutrophil extracellular traps in COVID-19

“Neutrophil extracellular traps in COVID-19” (2020), by Yu Zuo et al. Immunology and Microbiology research paper. Original abstract below, unchanged. No free PDF was found.

- Authors: Yu Zuo, Srilakshmi Yalavarthi, Hui Shi, Kelsey Gockman, Melanie Zuo, Jacqueline A. Madison, Christopher Blair, Andrew G. Weber, Betsy Jo Barnes, Mikala Egeblad et al.
- Published: April 24, 2020
- Field: Immunology and Microbiology
- DOI: https://doi.org/10.1172/jci.insight.138999
- Source: https://doi.org/10.1172/jci.insight.138999

## Abstract

BACKGROUND: Early studies of patients with COVID-19 have demonstrated markedly dysregulated coagulation and a high risk of morbid arterial and venous thrombotic events. While elevated levels of blood neutrophils and neutrophil extracellular traps (NETs) have been described in patients with COVID-19, their potential role in COVID-19-associated thrombosis remains unknown. OBJECTIVES: To elucidate the potential role of hyperactive neutrophils and NET release in COVID-19-associated thrombosis. PATIENTS/METHODS: This is a retrospective, case-control study of patients hospitalized with COVID-19 who developed thrombosis (n=11), as compared with gender- and age-matched COVID-19 patients without clinical thrombosis (n=33). In addition to capturing clinical data, we measured remnants of NETs (cell-free DNA, myeloperoxidase-DNA complexes, and citrullinated histone H3) and neutrophil-derived S100A8/A9 (calprotectin) in patient sera. RESULTS: The majority of patients (9/11) were receiving at least prophylactic doses of heparinoids at the time thrombosis was diagnosed. As compared with controls, patients with COVID-19-associated thrombosis had significantly higher blood levels of markers of NETs (cell-free DNA, myeloperoxidase-DNA complexes, citrullinated histone H3) and neutrophil activation (calprotectin). The thrombosis group also had higher levels of D-dimer, CRP, ferritin, and platelets, but not troponin or neutrophils. Finally, there were strong associations between markers of hyperactive neutrophils (calprotectin and cell-free DNA) and D-dimer. CONCLUSION: Elevated levels of neutrophil activation and NET formation in patients hospitalized with COVID-19 are associated with higher risk of morbid thrombotic complications. These observations underscore the need for urgent investigation into the potential relationship between NETs and unrelenting thrombosis in COVID-19.

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