Abstract
BackgroundPatients with sepsis may progress to acute respiratory distress syndrome (ARDS). Evidence of neutrophil extracellular traps (NETs) in sepsis-induced lung injury has been reported. However, the role of circulating NETs in the progression and thrombotic tendency of sepsis-induced lung injury remains elusive. The aim of this study was to investigate the role of tissue factor-enriched NETs in the progression and immunothrombosis of sepsis-induced lung injury.MethodsHuman blood samples and an animal model of sepsis-induced lung injury were used to detect and evaluate NET formation in ARDS patients. Immunofluorescence imaging, ELISA, Western blotting, and qPCR were performed to evaluate in vitro NET formation and tissue factor (TF) delivery ability. DNase, an anti-TF antibody, and thrombin inhibitors were applied to evaluate the contribution of thrombin to TF-enriched NET formation and the contribution of TF-enriched NETs to immunothrombosis in ARDS patients.ResultsSignificantly increased levels of TF-enriched NETs were observed in ARDS patients and mice. Blockade of NETs in ARDS mice alleviated disease progression, indicating a reduced lung wet/dry ratio and PaO2 level. In vitro data demonstrated that thrombin-activated platelets were responsible for increased NET formation and related TF exposure and subsequent immunothrombosis in ARDS patients.ConclusionThe interaction of thrombin-activated platelets with PMNs in ARDS patients results in local NET formation and delivery of active TF. The notion that NETs represent a mechanism by which PMNs release thrombogenic signals during thrombosis may offer novel therapeutic targets.
Highlights
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are leading causes of death (30% to 60%) in patients with sepsis (Cecconi et al, 2018; Fan et al, 2018; Matthay et al, 2019)
More severe lung damage was observed in patients with ARDS than in the healthy control and sepsis groups (Figure 1A), which was accompanied by higher neutrophil numbers and higher serum levels of the inflammatory cytokines IL-6 and IL-8 in ARDS patients (Table 1)
To explore whether neutrophil extracellular traps (NETs) were associated with lung damage in ARDS patients, we detected NET levels in peripheral blood by immunostaining neutrophils with MPO and CitH3, which are biomarkers of NET formation
Summary
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are leading causes of death (30% to 60%) in patients with sepsis (Cecconi et al, 2018; Fan et al, 2018; Matthay et al, 2019). Both ALI and ARDS are characterized by diffuse alveolar damage and increased alveolar capillary permeability (Herrington et al, 2019). The aim of this study was to investigate the role of tissue factor-enriched NETs in the progression and immunothrombosis of sepsis-induced lung injury
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