Skip to main content
Oxford University Press - PMC COVID-19 Collection logoLink to Oxford University Press - PMC COVID-19 Collection
. 2021 Jan 27:jiab053. doi: 10.1093/infdis/jiab053

Neutrophil extracellular traps persist at high levels in the lower respiratory tract of critically ill COVID-19 patients

Werner J D Ouwendijk 1,, Matthijs P Raadsen 1, Jeroen J A van Kampen 1, Robert M Verdijk 2, Jan H von der Thusen 2, Lihui Guo 3,4, Rogier A S Hoek 5, Johannes P C van den Akker 6, Henrik Endeman 6, Thomas Langerak 1, Richard Molenkamp 1, Diederik Gommers 6, Marion P G Koopmans 1, Eric C M van Gorp 1, Georges M G M Verjans 1, Bart L Haagmans 1
PMCID: PMC7928807  PMID: 33503244

Abstract

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.  

Keywords: COVID-19, SARS-CoV-2, neutrophil extracellular traps, acute respiratory distress syndrome, neutrophils


Articles from The Journal of Infectious Diseases are provided here courtesy of Oxford University Press

RESOURCES