Journal
EBIOMEDICINE
Volume 58, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.ebiom.2020.102925
Keywords
SARS-CoV-2; Endothelialitis; Immunothrombosis; Aggregated neutrophil extracellular traps; Coagulopathy
Funding
- Deutsche Forschungsgemeinschaft (DFG)
- Friedrich-Alexander Universitat Erlangen-Nurnberg (FAU)
- German Research Foundation (DFG) [SCHA 2040/1-1, SCHE1583714-1, TRR241, CRC1181, SFB 1350, FOR 2886, FOR 2438]
- EU (H2020-MSCE-RISE2015) [690836 PANG]
- EU (ERC-Synergy grant 4D Nanoscope)
- Volkswagen-Stiftung [97744]
- Interdisciplinary Center for Clinical Research (IZKF)
- ELAN of the FAU
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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. (c) 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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