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Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had spread from China and, within 2 months, became a global pandemic. The infection from this disease can cause a diversity of symptoms ranging from asymptomatic to severe acute respiratory distress syndrome with an increased risk of vascular hyperpermeability, pulmonary inflammation, extensive lung damage, and thrombosis. One of the host defense systems against coronavirus disease 2019 (COVID-19) is the formation of neutrophil extracellular traps (NETs). Numerous studies on this disease have revealed the presence of elevated levels of NET components, such as cell-free DNA, extracellular histones, neutrophil elastase, and myeloperoxidase, in plasma, serum, and tracheal aspirates of severe COVID-19 patients. Extracellular histones, a major component of NETs, are clinically very relevant as they represent promising biomarkers and drug targets, given that several studies have identified histones as key mediators in the onset and progression of various diseases, including COVID-19. However, the role of extracellular histones in COVID-19 per se remains relatively underexplored. Histones are nuclear proteins that can be released into the extracellular space via apoptosis, necrosis, or NET formation and are then regarded as cytotoxic damage-associated molecular patterns that have the potential to damage tissues and impair organ function. This review will highlight the mechanisms of extracellular histone-mediated cytotoxicity and focus on the role that histones play in COVID-19. Thereby, this paper facilitates a bench-to-bedside view of extracellular histone-mediated cytotoxicity, its role in COVID-19, and histones as potential drug targets and biomarkers for future theranostics in the clinical treatment of COVID-19 patients.
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Affiliation(s)
- Femke de Vries
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Joram Huckriede
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Kanin Wichapong
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Chris Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Gerry A F Nicolaes
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Huckriede J, de Vries F, Hultström M, Wichapong K, Reutelingsperger C, Lipcsey M, Garcia de Frutos P, Frithiof R, Nicolaes GAF. Histone H3 Cleavage in Severe COVID-19 ICU Patients. Front Cell Infect Microbiol 2021; 11:694186. [PMID: 34568088 PMCID: PMC8461091 DOI: 10.3389/fcimb.2021.694186] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 12/26/2022] Open
Abstract
The severity of coronavirus disease 19 (COVID-19) is associated with neutrophil extracellular trap (NET) formation. During NET formation, cytotoxic extracellular histones are released, the presence of which is linked to the initiation and progression of several acute inflammatory diseases. Here we study the presence and evolution of extracellular histone H3 and several other neutrophil-related molecules and damage-associated molecular patterns (DAMPs) in the plasma of 117 COVID-19-positive ICU patients. We demonstrate that at ICU admission the levels of histone H3, MPO, and DNA-MPO complex were all significantly increased in COVID-19-positive patients compared to control samples. Furthermore, in a subset of 54 patients, the levels of each marker remained increased after 4+ days compared to admission. Histone H3 was found in 28% of the patients on admission to the ICU and in 50% of the patients during their stay at the ICU. Notably, in 47% of histone-positive patients, we observed proteolysis of histone in their plasma. The overall presence of histone H3 during ICU stay was associated with thromboembolic events and secondary infection, and non-cleaved histone H3 was associated with the need for vasoactive treatment, invasive ventilation, and the development of acute kidney injury. Our data support the validity of treatments that aim to reduce NET formation and additionally underscore that more targeted therapies focused on the neutralization of histones should be considered as treatment options for severe COVID-19 patients.
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Affiliation(s)
- Joram Huckriede
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Femke de Vries
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Michael Hultström
- Department of Surgical Sciences, Section for Anaesthesia & Intensive Care, Uppsala University, Uppsala, Sweden.,Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden
| | - Kanin Wichapong
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Chris Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Miklos Lipcsey
- Department of Surgical Sciences, Section for Anaesthesia & Intensive Care, Uppsala University, Uppsala, Sweden.,Hedenstierna Laboratory, Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Pablo Garcia de Frutos
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS and CIBERCV, Barcelona, Spain
| | - Robert Frithiof
- Department of Surgical Sciences, Section for Anaesthesia & Intensive Care, Uppsala University, Uppsala, Sweden
| | - Gerry A F Nicolaes
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
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3
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Huckriede J, Anderberg SB, Morales A, de Vries F, Hultström M, Bergqvist A, Ortiz-Pérez JT, Sels JW, Wichapong K, Lipcsey M, van de Poll M, Larsson A, Luther T, Reutelingsperger C, de Frutos PG, Frithiof R, Nicolaes GAF. Evolution of NETosis markers and DAMPs have prognostic value in critically ill COVID-19 patients. Sci Rep 2021; 11:15701. [PMID: 34344929 PMCID: PMC8333321 DOI: 10.1038/s41598-021-95209-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/13/2021] [Indexed: 12/22/2022] Open
Abstract
Coronavirus disease 19 (COVID-19) presents with disease severities of varying degree. In its most severe form, infection may lead to respiratory failure and multi-organ dysfunction. Here we study the levels and evolution of the damage associated molecular patterns (DAMPS) cell free DNA (cfDNA), extracellular histone H3 (H3) and neutrophil elastase (NE), and the immune modulators GAS6 and AXL in relation to clinical parameters, ICU scoring systems and mortality in patients (n = 100) with severe COVID-19. cfDNA, H3, NE, GAS6 and AXL were increased in COVID-19 patients compared to controls. These measures associated with occurrence of clinical events and intensive care unit acquired weakness (ICUAW). cfDNA and GAS6 decreased in time in patients surviving to 30 days post ICU admission. A decrease of 27.2 ng/mL cfDNA during ICU stay associated with patient survival, whereas levels of GAS6 decreasing more than 4.0 ng/mL associated with survival. The presence of H3 in plasma was a common feature of COVID-19 patients, detected in 38% of the patients at ICU admission. NETosis markers cfDNA, H3 and NE correlated well with parameters of tissue damage and neutrophil counts. Furthermore, cfDNA correlated with lowest p/f ratio and a lowering in cfDNA was observed in patients with ventilator-free days.
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Affiliation(s)
- Joram Huckriede
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Sara Bülow Anderberg
- Department of Surgical Sciences, Section for Anaesthesia & Intensive Care, Uppsala University, Uppsala, Sweden
| | - Albert Morales
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS, and BCLC, CIBEREHD, Barcelona, Spain
| | - Femke de Vries
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Michael Hultström
- Department of Surgical Sciences, Section for Anaesthesia & Intensive Care, Uppsala University, Uppsala, Sweden
- Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden
| | - Anders Bergqvist
- Department of Medical Sciences, Clinical Microbiology, Uppsala University, Uppsala, Sweden
| | - José T Ortiz-Pérez
- Cardiology Department, Hospital Clinic Barcelona and CIBERCV, Barcelona, Spain
| | - Jan Willem Sels
- Department of Intensive Care Medicine, Maastricht University Medical Centre MUMC+), Maastricht, the Netherlands
- Department of Cardiology, Maastricht University Medical Centre, MUMC+), Maastricht, the Netherlands
| | - Kanin Wichapong
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Miklos Lipcsey
- Department of Surgical Sciences, Section for Anaesthesia & Intensive Care, Uppsala University, Uppsala, Sweden
- Hedenstierna Laboratory, Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Marcel van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Centre MUMC+), Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre (MUMC+), School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Tomas Luther
- Department of Surgical Sciences, Section for Anaesthesia & Intensive Care, Uppsala University, Uppsala, Sweden
| | - Chris Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Pablo Garcia de Frutos
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS and CIBERCV, Barcelona, Spain
| | - Robert Frithiof
- Department of Surgical Sciences, Section for Anaesthesia & Intensive Care, Uppsala University, Uppsala, Sweden
| | - Gerry A F Nicolaes
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
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Busch MH, Timmermans SAMEG, Nagy M, Visser M, Huckriede J, Aendekerk JP, de Vries F, Potjewijd J, Jallah B, Ysermans R, Oude Lashof AML, Breedveld PH, van de Poll MCG, van de Horst ICC, van Bussel BCT, Theunissen ROMFIH, Spronk HMH, Damoiseaux JGMC, Ten Cate H, Nicolaes GAF, Reutelingsperger CP, van Paassen P. Neutrophils and Contact Activation of Coagulation as Potential Drivers of COVID-19. Circulation 2020; 142:1787-1790. [PMID: 32946302 PMCID: PMC7594534 DOI: 10.1161/circulationaha.120.050656] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthias H Busch
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Sjoerd A M E G Timmermans
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Magdolna Nagy
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Mayken Visser
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Joram Huckriede
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Joop P Aendekerk
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Femke de Vries
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Judith Potjewijd
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands
| | - Borefore Jallah
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands
| | - Renée Ysermans
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands
| | - Astrid M L Oude Lashof
- Department of Medical Microbiology (A.M.L.O.L.), Maastricht University Medical Center, The Netherlands
| | - Paul H Breedveld
- Department of Surgery (P.H.B.), Maastricht University Medical Center, The Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care Medicine (M.C.G.v.d.P., I.C.C.v.d.H., B.C.T.v.B.), Maastricht University Medical Center, The Netherlands
| | - Iwan C C van de Horst
- Department of Intensive Care Medicine (M.C.G.v.d.P., I.C.C.v.d.H., B.C.T.v.B.), Maastricht University Medical Center, The Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine (M.C.G.v.d.P., I.C.C.v.d.H., B.C.T.v.B.), Maastricht University Medical Center, The Netherlands
| | - Ruud O M F I H Theunissen
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Henri M H Spronk
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Jan G M C Damoiseaux
- Central Diagnostic Laboratory (J.G.M.C.D.), Maastricht University Medical Center, The Netherlands
| | - Hugo Ten Cate
- Thrombosis Expertise Center (H.t.C.), Maastricht University Medical Center, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Gerry A F Nicolaes
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Chris P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology (M.H.B., S.A.M.E.G.T., J.P., B.J., R.Y., P.v.P.), Maastricht University Medical Center, The Netherlands.,Department of Biochemistry, Cardiovascular Research Institute, Maastricht, The Netherlands (M.H.B., S.A.M.E.G.T., M.N., M.V., J.H., J.P.A., F.d.V., R.O.M.F.I.H.T., H.M.H.S., H.t.C., G.A.F.N., C.P.R., P.v.P.)
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