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.
The Journal of experimental medicine. 2020 Jun 01 [Epub]
Betsy J Barnes, Jose M Adrover, Amelia Baxter-Stoltzfus, Alain Borczuk, Jonathan Cools-Lartigue, James M Crawford, Juliane Daßler-Plenker, Philippe Guerci, Caroline Huynh, Jason S Knight, Massimo Loda, Mark R Looney, Florencia McAllister, Roni Rayes, Stephane Renaud, Simon Rousseau, Steven Salvatore, Robert E Schwartz, Jonathan D Spicer, Christian C Yost, Andrew Weber, Yu Zuo, Mikala Egeblad
Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, The Feinstein Institutes for Medical Research & Departments of Molecular Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY., Cold Spring Harbor Laboratory, Cold Spring Harbor, NY., Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY., Division of Thoracic and Upper GI Surgery, Department of Surgery, Montreal, Canada., Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, East Garden City, NY., Centre Hospitalier Universitaire de Nancy, Nancy, France., Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI., Department of Medicine, University of California, San Francisco, San Francisco, CA., Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, TX., Department of Medicine, McGill University & The Research Institute of the McGill University Health Centre, Montreal, Canada., Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY., Department of Pediatrics, Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, UT., Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Northwell Health, Manhasset, NY.