Targeting potential drivers of COVID-19: Neutrophil extracellular traps

TLDR

COVID‑19 can progress to ARDS in about 10–15 % of patients due to a cytokine storm, and aberrant neutrophil extracellular trap (NET) formation has been linked to pulmonary disease, thrombosis, mucus secretion, and cytokine production. The authors hypothesize that NETs contribute to organ damage and mortality in COVID‑19. They review autopsy findings and literature to support the role of NETs in COVID‑19 pathogenesis. Autopsy revealed neutrophil infiltration in the lungs of a deceased COVID‑19 patient, and the authors suggest that targeting NETs could lessen disease severity.

Abstract

Coronavirus disease 2019 (COVID-19) is a novel, viral-induced respiratory disease that in ∼10-15% of patients progresses to acute respiratory distress syndrome (ARDS) triggered by a cytokine storm. In this Perspective, autopsy results and literature are presented supporting the hypothesis that a little known yet powerful function of neutrophils-the ability to form neutrophil extracellular traps (NETs)-may contribute to organ damage and mortality in COVID-19. We show lung infiltration of neutrophils in an autopsy specimen from a patient who succumbed to COVID-19. We discuss prior reports linking aberrant NET formation to pulmonary diseases, thrombosis, mucous secretions in the airways, and cytokine production. If our hypothesis is correct, targeting NETs directly and/or indirectly with existing drugs may reduce the clinical severity of COVID-19.