Abstract
Heart failure threatens the lives of patients and reduces their quality of life. Heart failure, especially heart failure with preserved ejection fraction, is closely related to systemic and local cardiac persistent chronic low-grade aseptic inflammation, microvascular damage characterized by endothelial dysfunction, oxidative stress, myocardial remodeling, and fibrosis. However, the initiation and development of persistent chronic low-grade aseptic inflammation is unexplored. Oxidative stress-mediated neutrophil extracellular traps (NETs) are the main immune defense mechanism against external bacterial infections. Furthermore, NETs play important roles in noninfectious diseases. After the onset of myocardial infarction, atrial fibrillation, or myocarditis, neutrophils infiltrate the damaged tissue and aggravate inflammation. In tissue injury, damage-related molecular patterns (DAMPs) may induce pattern recognition receptors (PRRs) to cause NETs, but whether NETs are directly involved in the pathogenesis and development of heart failure and the mechanism is still unclear. In this review, we analyzed the markers of heart failure and heart failure-related diseases and comorbidities, such as mitochondrial DNA, high mobility box group box 1, fibronectin extra domain A, and galectin-3, to explore their role in inducing NETs and to investigate the mechanism of PRRs, such as Toll-like receptors, receptor for advanced glycation end products, cGAS-STING, and C-X-C motif chemokine receptor 2, in activating NETosis. Furthermore, we discussed oxidative stress, especially the possibility that imbalance of thiol redox and MPO-derived HOCl promotes the production of 2-chlorofatty acid and induces NETosis, and analyzed the possibility of NETs triggering coronary microvascular thrombosis. In some heart diseases, the deletion or blocking of neutrophil-specific myeloperoxidase and peptidylarginine deiminase 4 has shown effectiveness. According to the results of current pharmacological studies, MPO and PAD4 inhibitors are effective at least for myocardial infarction, atherosclerosis, and certain autoimmune diseases, whose deterioration can lead to heart failure. This is essential for understanding NETosis as a therapeutic factor of heart failure and the related new pathophysiology and therapeutics of heart failure.
Highlights
Heart failure (HF) is a complex syndrome
This study revealed that neutrophils expressing JAK2V617F increased the protein expression of peptidylarginine deiminase 4 (PAD4) required for NETosis and that NETosis and thrombosis in vivo driven by JAK2V617F require PAD4 [55]
The above summarized references indicate that damage-related molecular patterns (DAMPs), soluble CD40L derived from platelets, and CRP in the adjacent tissues activate the formation of neutrophil extracellular traps (NETs)
Summary
Heart failure (HF) is a complex syndrome. Its typical symptoms are breathlessness, paroxysmal nocturnal dyspnea, reduced exercise tolerance, fatigue, tiredness, increased time to recover after exercise, and ankle swelling, resulting in decreased cardiac output and/or increased intracardiac pressure [1]. NETs can be activated through various disease-related stimuli, such as pathogens, antibodies and immune complexes, cytokines, microcrystals, and aging [16,17,18,19], and they mediate tissue damage [20,21,22]. The induction of NETosis depends on the form of reactive oxygen species (ROS) via oxidative burst, and its main source is NADPH oxidase [23]. The structure of these NETs comprises various neutrophil-derived proteins such as myeloperoxidase (MPO), peptidylarginine deiminase 4 (PAD4), neutrophil elastase (NE), histones, neutrophil gelatinase-associated lipocalin (NGAL), proteinase-3, and DNA chains. Understanding, preventing, and targeting NETosis may contribute to the prevention and treatment of heart failure and improve the survival rate of patients
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