Clinical relevance of cell‐free <scp>DNA</scp> during venovenous extracorporeal membrane oxygenation

Lingel, Maximilian P.; Haus, Moritz; Paschke, Lukas; Foltan, Maik; Lubnow, Matthias; Gruber, Michael; Krenkel, Lars; Lehle, Karla

doi:10.1111/aor.14616

Cited by 1 publication

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References 46 publications

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“…As expected, the blood smears from critically ill patients that required VV ECMO (n=10) showed significantly increased rates of NETs and NET precursors as well as a higher proportion of neutrophils in all nucleated cells compared to healthy controls (n=13) as a correlate of the severe generalized inflammation. Blood samples of the same patient population also contained significantly higher plasma levels of cell free DNA (cfDNA) compared to healthy controls ( 58 ). The results of our present study are consistent with a comparable immunofluorescence microscopic analysis of blood smears from critically ill patients with systemic inflammatory response syndrome (SIRS) and healthy volunteers, in which NETs were detected frequently in the patient’s blood ( 31 , 32 ).…”

Section: Discussionmentioning

confidence: 99%

Neutrophil extracellular traps - a potential trigger for the development of thrombocytopenia during extracorporeal membrane oxygenation

Haus,

Foltan,

Philipp

et al. 2024

Front. Immunol.

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Neutrophil extracellular traps (NETs) have recently emerged as a potential link between inflammation, immunity, and thrombosis, as well as other coagulation disorders which present a major challenge in the context of extracorporeal membrane oxygenation (ECMO). By examining blood from ECMO patients for NETs and their precursors and correlating them with clinical and laboratory biomarkers of coagulation and inflammation, this study aims to evaluate the association between the presence of NETs in the bloodstream of ECMO patients and the development of potentially severe coagulation disorders during ECMO therapy. Therefore, blood samples were collected from healthy volunteers (n=13) and patients receiving veno-venous (VV) ECMO therapy (n=10). To identify NETs and their precursors, DNA and myeloperoxidase as well as granulocyte marker CD66b were visualized simultaneously by immunofluorescence staining in serial blood smears. Differentiation of DNA-containing objects and identification of NETs and their precursors was performed semiautomatically by a specific algorithm using the shape and size of DNA staining and the intensity of MPO and CD66b signal. Neutrophil extracellular traps and their precursors could be detected in blood smears from patients requiring VV ECMO. Compared to volunteers, ECMO patients presented significantly higher rates of NETs and NET precursors as well as an increased proportion of neutrophil granulocytes in all detected nucleated cells. A high NET rate prior to the initiation of ECMO therapy was associated with both increased IL-6 and TNF-α levels as an expression of a high cytokine burden. These patients with increased NET release also presented an earlier and significantly more pronounced decrease in platelet counts and ATIII activity following initiation of therapy compared with patients with less elevated NETs. These findings provide further indications for the development of immune-mediated acquired thrombocytopenia in ECMO patients.

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Section: Discussionmentioning

confidence: 99%