Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Translational Research in Inflammation and Immunology Research Unit (TRIRU), Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Int J Mol Sci. 2022 Apr 27;23(9):4805. doi: 10.3390/ijms23094805.
Neutrophil Extracellular Traps (NETs) are a contributing factor of vascular thrombosis and alveolar damage in COVID-19 patients. As enoxaparin is currently used to inhibit vascular thrombosis, this study aimed to investigate whether enoxaparin also reduced inflammation and NETs in COVID-19 patients. Patients with COVID-19 infection were classified into three groups: mild, moderate, and severe (n = 10 for all groups). Plasma was collected from patients and healthy donors (n = 10). Neutrophils isolated from healthy controls were incubated with COVID-19 or healthy plasma, and with or without enoxaparin pretreatment in vitro. Neutrophils and plasma isolated from patients treated with enoxaparin were also investigated. The levels of inflammatory cytokines and NET products such as dsDNA, NE, MPO−DNA and Histone−DNA complexes in plasma and supernatants were measured using immunofluorescence staining and ELISA kits. The expression of inflammatory signaling genes by neutrophils (RELA, SYK, ERK and PKC) was measured using real-time qPCR. The levels of NET products were elevated in the plasma of COVID-19 patients, particularly in the severe group (p < 0.01). Moreover, plasma from the severe group enhanced NET formation (p < 0.01) from neutrophils in vitro. Enoxaparin pretreatment in vitro decreased plasma-induced NETs in a dose-dependent manner and down-regulated the expression of inflammatory genes (p < 0.05). Patients treated with prophylactic enoxaparin showed lower inflammatory cytokine levels and expression of inflammatory genes (p < 0.05). Increased NETs were associated with the severity of COVID-19 infection, particularly in patients with severe pneumonia, and could be used as biomarkers to assess disease severity. Enoxaparin pretreatment inhibited NETs and reduced the expression of inflammatory cytokines, and these effects mostly persisted in patients treated with prophylactic enoxaparin.
中性粒细胞胞外诱捕网(NETs)是 COVID-19 患者血管血栓形成和肺泡损伤的一个促成因素。由于依诺肝素目前被用于抑制血管血栓形成,本研究旨在探究依诺肝素是否也能减轻 COVID-19 患者的炎症和 NETs。将 COVID-19 感染患者分为三组:轻症、中度和重症(每组 10 例)。从患者和健康供者(每组 10 例)采集血浆。从健康对照者分离的中性粒细胞与 COVID-19 或健康血浆在体外孵育,并在有无依诺肝素预处理的情况下孵育。还研究了接受依诺肝素治疗的患者的中性粒细胞和血浆。使用免疫荧光染色和 ELISA 试剂盒测量血浆和上清液中炎症细胞因子和 NET 产物(如 dsDNA、NE、MPO-DNA 和组蛋白-DNA 复合物)的水平。使用实时 qPCR 测量中性粒细胞中炎症信号基因(RELA、SYK、ERK 和 PKC)的表达。COVID-19 患者的血浆中 NET 产物水平升高,尤其是重症组(p<0.01)。此外,来自重症组的血浆体外增强了中性粒细胞的 NET 形成(p<0.01)。体外依诺肝素预处理呈剂量依赖性降低血浆诱导的 NETs,并下调炎症基因的表达(p<0.05)。预防性依诺肝素治疗的患者表现出较低的炎症细胞因子水平和炎症基因的表达(p<0.05)。NETs 的增加与 COVID-19 感染的严重程度相关,尤其是在重症肺炎患者中,可作为评估疾病严重程度的生物标志物。依诺肝素预处理抑制 NETs 并减少炎症细胞因子的表达,这些作用在预防性依诺肝素治疗的患者中大多持续存在。