Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma, USA.
J Infect Dis. 2021 May 20;223(9):1503-1505. doi: 10.1093/infdis/jiab053.
SARS-CoV-2 induced lower respiratory tract (LRT) disease can deteriorate to acute respiratory distress syndrome (ARDS). Because the release of neutrophil extracellular traps (NETs) is implicated in ARDS pathogenesis, we investigated the presence of NETs and correlates of pathogenesis in blood and LRT samples of critically ill COVID-19 patients. Plasma NET levels peaked early after ICU admission and correlated with SARS-CoV-2 RNA load in sputum and levels of neutrophil-recruiting chemokines and inflammatory markers in plasma. Baseline plasma NET quantity correlated with disease severity, but was not associated with soluble markers of thrombosis nor with development of thrombosis. High NET levels were present in LRT samples and persisted during the course of COVID-19, consistent with the detection of NETs in bronchi and alveolar spaces in lung tissue from fatal COVID-19 patients. Thus, NETs are produced and retained in the LRT of critical COVID-19 patients and could contribute to SARS-CoV-2-induced ARDS pathology.
SARS-CoV-2 引起的下呼吸道 (LRT) 疾病可恶化为急性呼吸窘迫综合征 (ARDS)。由于中性粒细胞胞外诱捕网 (NETs) 的释放与 ARDS 的发病机制有关，我们研究了重症 COVID-19 患者的血液和 LRT 样本中 NETs 的存在及其与发病机制的相关性。血浆 NET 水平在 ICU 入院后早期达到峰值，并与痰液中 SARS-CoV-2 RNA 载量以及血浆中中性粒细胞募集趋化因子和炎症标志物的水平相关。基线时的血浆 NET 量与疾病严重程度相关，但与血栓形成的可溶性标志物无关，也与血栓形成的发生无关。LRT 样本中存在高 NET 水平，并且在 COVID-19 期间持续存在，这与从死于 COVID-19 的患者的肺组织中支气管和肺泡空间中检测到 NETs 一致。因此，NETs 在重症 COVID-19 患者的 LRT 中产生并保留，并可能导致 SARS-CoV-2 诱导的 ARDS 病理学。
