Research Center-Montreal Heart Institute, 5000 Belanger St., Montreal, QC H1T 1C8, Canada.
Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis St, Montreal, QC H2X 0A9, Canada.
Cells. 2022 Oct 29;11(21):3420. doi: 10.3390/cells11213420.
Primary graft dysfunction (PGD) is characterized by alveolar epithelial and vascular endothelial damage and inflammation, lung edema and hypoxemia. Up to one-third of recipients develop the most severe form of PGD (Grade 3; PGD3). Animal studies suggest that neutrophils contribute to the inflammatory process through neutrophil extracellular traps (NETs) release (NETosis). NETs are composed of DNA filaments decorated with granular proteins contributing to vascular occlusion associated with PGD. The main objective was to correlate NETosis in PGD3 (n = 9) versus non-PGD3 (n = 27) recipients in an exploratory study. Clinical data and blood samples were collected from donors and recipients pre-, intra- and postoperatively (up to 72 h). Inflammatory inducers of NETs' release (IL-8, IL-6 and C-reactive protein [CRP]) and components (myeloperoxidase [MPO], MPO-DNA complexes and cell-free DNA [cfDNA]) were quantified by ELISA. When available, histology, immunohistochemistry and immunofluorescence techniques were performed on lung biopsies from donor grafts collected during the surgery to evaluate the presence of activated neutrophils and NETs. Lung biopsies from donor grafts collected during transplantation presented various degrees of vascular occlusion including neutrophils undergoing NETosis. Additionally, in recipients intra- and postoperatively, circulating inflammatory (IL-6, IL-8) and NETosis biomarkers (MPO-DNA, MPO, cfDNA) were up to 4-fold higher in PGD3 recipients compared to non-PGD3 ( = 0.041 to 0.001). In summary, perioperative elevation of NETosis biomarkers is associated with PGD3 following human lung transplantation and these biomarkers might serve to identify recipients at risk of PGD3 and initiate preventive therapies.
原发性移植物功能障碍(PGD)的特征是肺泡上皮和血管内皮损伤和炎症、肺水肿和低氧血症。多达三分之一的受者会发展为最严重的 PGD 形式(3 级;PGD3)。动物研究表明,中性粒细胞通过中性粒细胞细胞外陷阱(NETs)的释放(NETosis)有助于炎症过程。NETs 由带有颗粒蛋白的 DNA 丝组成,有助于与 PGD 相关的血管阻塞。主要目的是在一项探索性研究中比较 PGD3(n=9)与非 PGD3(n=27)受者的 NETosis。从供体和受者术前、术中及术后(最长 72 小时)采集临床数据和血液样本。通过 ELISA 定量测定 NETs 释放(IL-8、IL-6 和 C 反应蛋白[CRP])和成分(髓过氧化物酶[MPO]、MPO-DNA 复合物和无细胞 DNA [cfDNA])的炎症诱导剂。在供体移植物的肺活检中,如有可用的组织学、免疫组织化学和免疫荧光技术,评估手术中采集的激活中性粒细胞和 NETs 的存在。在移植过程中,供体移植物的肺活检显示出不同程度的血管阻塞,包括正在进行 NETosis 的中性粒细胞。此外,在受者术中及术后,PGD3 受者的循环炎症(IL-6、IL-8)和 NETosis 生物标志物(MPO-DNA、MPO、cfDNA)升高了 4 倍以上(=0.041 至 0.001)。综上所述,人类肺移植后围手术期 NETosis 生物标志物的升高与 PGD3 相关,这些生物标志物可能有助于识别发生 PGD3 的风险受者并启动预防性治疗。