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CC BY-NC-ND 4.0 · Journal of Health and Allied Sciences NU 2022; 12(03): 235-242
DOI: 10.1055/s-0041-1741418
Review Article

NET-Mediated Pathogenesis of COVID-19: The Role of NETs in Hepatic Manifestations

Wael Alkattan
1   College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
,
Ahmed Yaqinuddin
1   College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
,
Areez Shafqat 
1   College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
,
Junaid Kashir
1   College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
2   Department of Comparative Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
› Author Affiliations Funding None.
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Abstract

Some coronavirus disease-2019 (COVID-19) patients exhibit multi-organ failure, which often includes the liver. Indeed, liver disease appears to be an emerging feature of COVID-19 infections. However, the exact mechanism behind this remains unknown. Neutrophil extracellular traps (NETs) have increasingly been attributed as major contributors to various liver pathologies, including sepsis, ischemic-reperfusion (I/R) injury, and portal hypertension in the setting of chronic liver disease. Although vital in normal immunity, excessive NET formation can drive inflammation, particularly of the endothelium. Collectively, we propose that NETs observed to be elevated in severe COVID-19 infection play principal roles in liver injury in addition to acute lung injury. Herein, we discuss the potential mechanisms underlying COVID-induced liver injury including cytopathic effects from direct liver infection, systemic inflammatory response syndrome, and hypoxic injury, encompassing I/R injury and coagulopathy. Further research is required to further elucidate the role of NETs in COVID. This holds potential therapeutic significance, as inhibition of NETosis could alleviate the symptoms of acute respiratory distress syndrome and liver injury, as well as other organs.

Keywords

COVID-19 - SARS-CoV2 - NETs - liver disease - ACE2 receptor - multi-organ failure


Publication History

Article published online:
18 January 2022

© 2022. Nitte (Deemed to be University). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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