Elastase and myeloperoxidase participate in neutrophil extracellular trap release stimulated by SARS-CoV-2

J Juliana da Costa Silva (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) C Cícero Almeida (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) B Bruna M Souza Silva (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) B Beatriz de S Bonfim (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) A Ayda H Schneider (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) A Anderson dos Santos Ramos (Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo) I Isadora Marques Paiva (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) L Letícia S Galant (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) R Ronaldo Martins D Daniel Macedo de Melo Jorge (Virology Research Center, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) V Victor Ferreira Costa (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) G Guilherme C Martelossi Cebinelli (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) J Juliana E Toller-Kawahisa (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) G Giovanni F Gomes (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) G Gabriel Victor Lucena da Silva (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) R Robertha M R Lemes (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) G Gabriel Azevedo Publio (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) F Fernanda M de Souza (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) P Paulo Sérgio de A Augusto (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) E Eurico Arruda P Paulo Louzada-Junior (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) P Pérsio da Costa Roxo-Júnior (Division of Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) L Larissa Cunha (Department of Cell and Molecular Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) L Letícia Bonjorno (Division of Clinical Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) R Renê de Oliveira (Division of Clinical Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) A Ana Paula Carlotti (Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,) T Thiago Mattar Cunha J Jose Carlos Alves-Filho F Fernando Queiroz Cunha (Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo)

Abstract

Abstract COVID-19 is a disease triggered by SARS-CoV-2 and some individuals develop a severe form that can progress to multiple organ failure. Neutrophils have been described as responsible for the release of neutrophil extracellular traps (NETs). The role of the elastase and myeloperoxidase (MPO) in NET release by neutrophils stimulated by SARS-CoV-2 infection was not addressed, and it was the aim of the present study. The NET release by human neutrophils infected with SARS-CoV-2 depends on elastase/MPO migration to the nucleus. Moreover, elastase/MPO migration is a consequence of PKC and PI3K kinase activation, leading to reactive oxygen species generation by the neutrophil mitochondria and NOX-2. We also reanalyzed the single-cell RNA sequencing data available in a database and demonstrated that neutrophils from bronchoalveolar lavage (BAL) fluid of patients with COVID-19 present increased expression of genes involved in the formation of the NOX2 complex, PKC delta and members of the PI3K family. In summary, the release of NETs by neutrophils in response to SARS-CoV-2 infection depends on the sequential activation of the PKC/PI3K/ROS pathway, inducing elastase/MPO migration to the nucleus triggering the NET formation. Thus, our study demonstrates new insights into the signaling pathways that induce NETs in response to SARS-CoV-2, highlighting new targets for studies and therapies for COVID-19.

Article Details

Volume / Issue Vol. 215, Issue 8
Published August 04, 2026
ISSN 0022-1767
Publisher American Association of Immunologists

Authors (29)

J

Juliana da Costa Silva

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

C

Cícero Almeida

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

B

Bruna M Souza Silva

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

B

Beatriz de S Bonfim

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

A

Ayda H Schneider

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

A

Anderson dos Santos Ramos

Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo

I

Isadora Marques Paiva

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

L

Letícia S Galant

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

R

Ronaldo Martins

D

Daniel Macedo de Melo Jorge

Virology Research Center, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

V

Victor Ferreira Costa

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

G

Guilherme C Martelossi Cebinelli

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

J

Juliana E Toller-Kawahisa

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

G

Giovanni F Gomes

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

G

Gabriel Victor Lucena da Silva

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

R

Robertha M R Lemes

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

G

Gabriel Azevedo Publio

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

F

Fernanda M de Souza

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

P

Paulo Sérgio de A Augusto

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

E

Eurico Arruda

P

Paulo Louzada-Junior

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

P

Pérsio da Costa Roxo-Júnior

Division of Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

L

Larissa Cunha

Department of Cell and Molecular Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

L

Letícia Bonjorno

Division of Clinical Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

R

Renê de Oliveira

Division of Clinical Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

A

Ana Paula Carlotti

Center of Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto , São Paulo,

T

Thiago Mattar Cunha

J

Jose Carlos Alves-Filho

F

Fernando Queiroz Cunha

Center for Research in Inflammatory Diseases, Ribeirão Preto Medical School, University of São Paulo