High Level of Neutrophil Extracellular Traps Correlates with Poor Prognosis of Severe Influenza A Infection

Liuluan Zhu, Lu Liu, Yue Zhang, Lin Pu, Jingyuan Liu, Xingwang Li, Zhihai Chen, Yu Hao, Beibei Wang, Junyan Han, Guoli Li, Shuntao Liang, Haofeng Xiong, Hong Zheng, Ang Li, Jianqing Xu, Hui Zeng

Research output: Contribution to journalArticlepeer-review

135 Scopus citations


Background. Most patients with severe infection with influenza A virus (IAV) progress to acute respiratory distress syndrome and even multiple organ dysfunction syndrome (MODS). Neutrophil extracellular traps (NETs) can be induced by pathogens and are responsible for immune tissue damage. We conducted a prospective study on the production and effects of NETs in H7N9 and H1N1 patients. Methods. We investigated NET production in plasma and supernatant of cultured neutrophils by measuring cell-free deoxyribonucleic acid (DNA) and myeloperoxidase (MPO)-DNA complexes with PicoGreen dye and enzyme-linked immunosorbent assay methods, respectively. We also observed NET structure by immunofluorescence staining. Results. We found that patients with severe influenza showed elevated plasma NET level on the day of admission. Neutrophils from these patients showed higher capacity to release MPO-DNA complex in response to interleukin-8 or lipopolysaccharide stimulation. We also found that NETs from H7N9 and H1N1 patients increased the permeability of alveolar epithelial cells, and, consequently, NET production was positively correlated with acute physiology and chronic health evaluation (APACHE) II score and MODS. Conclusions. These data indicate that high level of NETs contributes to lung injury and is correlated with severity of disease. Thus, NETs might be a key factor to predict the poor prognosis in IAV patients.

Original languageEnglish (US)
Pages (from-to)428-437
Number of pages10
JournalJournal of Infectious Diseases
Issue number3
StatePublished - Jan 17 2018

All Science Journal Classification (ASJC) codes

  • General Medicine


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