# A Narrative Review: The Role of NETs in Acute Respiratory Distress Syndrome/Acute Lung Injury

## TL;DR

This review explores how neutrophil extracellular traps (NETs) contribute to acute respiratory distress syndrome (ARDS) and suggests potential treatments.

## Contribution

The paper highlights the role of NETs in ARDS progression and proposes DNase I as a potential therapeutic approach.

## Key findings

- NETs contribute to inflammation and tissue damage in ARDS through DNA, histones, and granuloproteins.
- NETs can form a self-sustaining cycle that worsens ARDS progression.
- DNase I is suggested as a viable treatment to break down NETs and mitigate ARDS.

## Abstract

Nowadays, acute respiratory distress syndrome (ARDS) still has a high mortality rate, and the alleviation and treatment of ARDS remains a major research focus. There are various causes of ARDS, among which pneumonia and non-pulmonary sepsis are the most common. Trauma and blood transfusion can also cause ARDS. In ARDS, the aggregation and infiltration of neutrophils in the lungs have a great influence on the development of the disease. Neutrophils regulate inflammatory responses through various pathways, and the release of neutrophils through neutrophil extracellular traps (NETs) is considered to be one of the most important mechanisms. NETs are mainly composed of DNA, histones, and granuloproteins, all of which can mediate downstream signaling pathways that can activate inflammatory responses, generate immune clots, and cause damage to surrounding tissues. At the same time, the components of NETs can also promote the formation and release of NETs, thus forming a vicious cycle that continuously aggravates the progression of the disease. NETs are also associated with cytokine storms and immune balance. Since DNA is the main component of NETs, DNase I is considered a viable drug for removing NETs. Other therapeutic methods to inhibit the formation of NETs are also worthy of further exploration. This review discusses the formation and mechanism of NETs in ARDS. Understanding the association between NETs and ARDS may help to develop new perspectives on the treatment of ARDS.