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Leppkes M, Knopf J, Naschberger E, Lindemann A, Singh J, Herrmann I, Stürzl M, Staats L, Mahajan A, Schauer C, Kremer AN, Völkl S, Amann K, Evert K, Falkeis C, Wehrfritz A, Rieker RJ, Hartmann A, Kremer AE, Neurath MF, Muñoz LE, Schett G, Herrmann M. Vascular occlusion by neutrophil extracellular traps in COVID-19. EBioMedicine 2020; 58:102925. [PMID: 32745993 PMCID: PMC7397705 DOI: 10.1016/j.ebiom.2020.102925] [Citation(s) in RCA: 310] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Coronavirus induced disease 2019 (COVID-19) can be complicated by severe organ damage leading to dysfunction of the lungs and other organs. The processes that trigger organ damage in COVID-19 are incompletely understood. METHODS Samples were donated from hospitalized patients. Sera, plasma, and autopsy-derived tissue sections were examined employing flow cytometry, enzyme-linked immunosorbent assays, and immunohistochemistry. PATIENT FINDINGS Here, we show that severe COVID-19 is characterized by a highly pronounced formation of neutrophil extracellular traps (NETs) inside the micro-vessels. Intravascular aggregation of NETs leads to rapid occlusion of the affected vessels, disturbed microcirculation, and organ damage. In severe COVID-19, neutrophil granulocytes are strongly activated and adopt a so-called low-density phenotype, prone to spontaneously form NETs. In accordance, markers indicating NET turnover are consistently increased in COVID-19 and linked to disease severity. Histopathology of the lungs and other organs from COVID-19 patients showed congestions of numerous micro-vessels by aggregated NETs associated with endothelial damage. INTERPRETATION These data suggest that organ dysfunction in severe COVID-19 is associated with excessive NET formation and vascular damage. FUNDING Deutsche Forschungsgemeinschaft (DFG), EU, Volkswagen-Stiftung.
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Affiliation(s)
- Moritz Leppkes
- Department of Internal Medicine 1, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany.
| | - Jasmin Knopf
- Department of Internal Medicine 3, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Elisabeth Naschberger
- Division of Molecular and Experimental Surgery, Translational Research Center, Department of Surgery, University Medical Center Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Aylin Lindemann
- Department of Internal Medicine 1, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Jeeshan Singh
- Department of Internal Medicine 3, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Irmgard Herrmann
- Department of Internal Medicine 3, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Stürzl
- Division of Molecular and Experimental Surgery, Translational Research Center, Department of Surgery, University Medical Center Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Léonie Staats
- Department of Internal Medicine 1, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Aparna Mahajan
- Department of Internal Medicine 3, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Christine Schauer
- Department of Internal Medicine 3, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Anita N Kremer
- Department of Internal Medicine 5, Hematology and Oncology, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Simon Völkl
- Department of Internal Medicine 5, Hematology and Oncology, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kerstin Amann
- Department of Nephropathology, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Katja Evert
- Institute of Pathology, University Medical Center Regensburg, Germany
| | | | - Andreas Wehrfritz
- Department of Anaesthesiology, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf J Rieker
- Institute of Pathology, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas E Kremer
- Department of Internal Medicine 1, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Markus F Neurath
- Department of Internal Medicine 1, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Luis E Muñoz
- Department of Internal Medicine 3, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Martin Herrmann
- Department of Internal Medicine 3, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
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Zwahlen RD, Holden WJ, Wyder-Walther M, Holub M, Moiola F. Influence of anti-inflammatory drugs on adhesion of neutrophils to endothelial cells cultured on microcarriers: a novel in vitro system as an alternative to animal experimentation. ZENTRALBLATT FUR VETERINARMEDIZIN. REIHE A 1994; 41:671-82. [PMID: 7732745 DOI: 10.1111/j.1439-0442.1994.tb00135.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pharmacological control of inflammation by steroidal (SAIDs) and nonsteroidal (NSAIDs) antiinflammatory drugs is of substantial clinical importance. To reduce the number of animals used in pharmacological and toxicological evaluation of these drugs we developed a novel assay to determine adhesion of bovine neutrophils (PMN) to bovine aortic endothelial cells (BAEC) cultured on microcarriers in a flow-through system. Pretreatment of BAEC with thrombin (10(-7)-10(-4) M) led to a dose-dependent increase of PMN-adhesion (10(-6)-10(-4) M:P < 0.05); platelet-activating factor (10(-9) M) and 1:200 diluted zymosan-activated serum (ZAS) had similar effects (P < 0.001). Pretreatment of PMN with SAIDs (50.9 and 509 microM dexamethasone, 12.2 and 24.4 microM flumethasone) did inhibit adhesion to ZAS-treated BAEC dose-dependently. Pretreatment of PMN with NSAIDs had a less consistent influence on adhesion to ZAS-stimulated BAEC. While phenylbutazone (0.33 and 3.3 mM), diclofenac (0.392 and 0.574 mM), indomethacine (0.436 and 0.872 mM), and acetylsalicylic acid (3.47 and 16.94 mM) induced dose-dependent inhibition of PMN-adhesion to ZAS-treated BAEC, piroxicam (0.377 and 0.754 mM) inhibited PMN-adhesion strongly (P < 0.001) but not dose-dependently, and ketoprofene (0.614 and 1.228 mM) had no effect on PMN-adhesion. The method presented here is efficient for evaluating the pharmacological modulation of PMN interaction with endothelial cells, and useful for studying further aspects of endothelial cell biology.
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Affiliation(s)
- R D Zwahlen
- Institute of Veterinary Pathology, University of Bern, Switzerland
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Moiola F, Spycher M, Wyder-Walther M, Zwahlen RD. Comparative in vitro phagocytosis and F-actin polymerization of bovine neonatal neutrophils. ZENTRALBLATT FUR VETERINARMEDIZIN. REIHE A 1994; 41:202-14. [PMID: 7941837 DOI: 10.1111/j.1439-0442.1994.tb00087.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Analysis of neonatal neutrophil (PMN) functions should help to reveal factors which could contribute to the impaired host defense system of neonates. We analysed functional parameters of PMN from newborn calves (N-PMN) and adult bovines (A-PMN): cellular volume and F-actin content upon stimulation with complement factors, by cytofluorometry and phagocytosis of E. coli 78:80B with a colorimetric assay. Polymerization of F-actin was rapid in both N- and A-PMN, but reached higher levels in N-PMN. N-PMN are significantly smaller than A-PMN throughout the whole activation time. Percentage of phagocytosing PMN, the rate of phagocytosis, and the rate of killing are similar between A- and N-PMN after opsonization of bacteria with adult serum (AS). Opsonization with newborn serum (NS) reduced all three examined parameters: in A-PMN more (P < 0.001) than in N-PMN (P < 0.05). However, when phagocytosis was compared following age-matched opsonization (N-PMN and NS; A-PMN and AS), N-PMN phagocytosed less (P < 0.001) bacteria per PMN than A-PMN. Additionally, steroidal (dexamethasone) and non-steroidal (phenylbutazone) anti-inflammatory drugs inhibited phagocytosis by N-PMN less than by A-PMN. Higher relative F-actin content of N-PMN can be correlated with the documented functional hyperactivity of bovine N-PMN. However, the exaggerated impairment of phagocytosis in calves observed after age-matched opsonization of bacteria could potentially indicate a specific host defence defect.
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Affiliation(s)
- F Moiola
- Institute of Veterinary Pathology, University of Bern, Switzerland
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