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Rockefeller University Press, Journal of Experimental Medicine, 12(217), 2020

DOI: 10.1084/jem.20201129

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SARS-CoV-2–triggered neutrophil extracellular traps mediate COVID-19 pathology

Journal article published in 2020 by Flavio Protasio Veras ORCID, Marjorie Cornejo Pontelli ORCID, Camila Meirelles Silva ORCID, Juliana E. Toller-Kawahisa ORCID, Mikhael de Lima ORCID, Daniele Carvalho Nascimento ORCID, Ayda Henriques Schneider ORCID, Diego Caetité ORCID, Lucas Alves Tavares ORCID, Isadora M. Paiva ORCID, Roberta Rosales ORCID, David Colón ORCID, Ronaldo Martins ORCID, Italo Araujo Castro ORCID, Maria Isabel Fernandes Lopes and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

Severe COVID-19 patients develop acute respiratory distress syndrome that may progress to cytokine storm syndrome, organ dysfunction, and death. Considering that neutrophil extracellular traps (NETs) have been described as important mediators of tissue damage in inflammatory diseases, we investigated whether NETs would be involved in COVID-19 pathophysiology. A cohort of 32 hospitalized patients with a confirmed diagnosis of COVID-19 and healthy controls were enrolled. The concentration of NETs was augmented in plasma, tracheal aspirate, and lung autopsies tissues from COVID-19 patients, and their neutrophils released higher levels of NETs. Notably, we found that viable SARS-CoV-2 can directly induce the release of NETs by healthy neutrophils. Mechanistically, NETs triggered by SARS-CoV-2 depend on angiotensin-converting enzyme 2, serine protease, virus replication, and PAD-4. Finally, NETs released by SARS-CoV-2–activated neutrophils promote lung epithelial cell death in vitro. These results unravel a possible detrimental role of NETs in the pathophysiology of COVID-19. Therefore, the inhibition of NETs represents a potential therapeutic target for COVID-19.