Abundant neutrophil extracellular traps in thrombus of patient with microscopic polyangiitis.

Abundant neutrophil extracellular traps in thrombus of patient with microscopic polyangiitis.
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DOI:
10.3389/fimmu.2012.00333
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发表时间:
2012
影响因子:
7.3
通讯作者:
Ishizu A
Ishizu A
中科院分区:
医学2区
文献类型:
--
作者:
Nakazawa D;Tomaru U;Yamamoto C;Jodo S;Ishizu A

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这是一例诊断为显微镜下多血管炎(MPA)并并发深静脉血栓形成(DVT)的患者的病例研究,尽管接受了治疗,但患者仍死于呼吸衰竭。尸检发现严重的新月体肾小球肾炎和大量肺泡出血。血栓中含有大量中性粒细胞。尽管有报道称ANCA相关性血管炎(AAV)患者发生DVT的风险增加,但他们易于发生血栓形成的原因仍然难以理解。最近的一项研究表明,在MPA患者的肾小球新月体中存在中性粒细胞胞外陷阱(NETs),这是一种新认识到的中性粒细胞死亡模式。有趣的是,在本病例中,在血栓和肾小球新月体中均发现了NET。与其他与MPA无关的血栓相比,MPA患者的NET数量明显更大。另一方面,NET与血栓形成密切相关,因为NET中的组蛋白可以结合血小板和凝血剂。尽管这对于在NET内遏制微生物很重要,但过量的NET可能导致血栓形成。集体研究结果表明,血栓形成可能与MPA通过NET密切相关,NET可能是MPA患者的治疗靶点。
This is a case study of a patient diagnosed with microscopic polyangiitis (MPA) and complicated with deep vein thrombosis (DVT), who died of respiratory failure despite treatment. Autopsy revealed severe crescentic glomerulonephritis and massive alveolar hemorrhage. The thrombus contained abundant neutrophils. Although it is reported that patients with ANCA-associated vasculitis (AAV) have an increased risk of DVT, it remains elusive why they are prone to thrombosis. A recent study has demonstrated the presence of neutrophil extracellular traps (NETs), a newly recognized mode of neutrophil cell-death, in glomerular crescents of MPA patients. Interestingly, NETs were identified in the thrombus as well as in the glomerular crescents in the present case. When compared to other thrombi unrelated to MPA, the amount of NETs was significantly greater in the MPA patient. On the other hand, NETs are critically involved in thrombogenesis because histones within NETs can bind platelets and blood coagulants. Although this is important in regard to containment of microbes within NETs, excessive NETs could cause thrombosis. The collective findings suggest the possibility that thrombosis could be critically associated with MPA via NETs, and that NETs could be a therapeutic target in MPA patients.
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