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Objective  Different studies have demonstrated that neutrophil extracellular traps ( NET s) may be involved in the pathophysiology of both antineutrophil cytoplasmic antibody ( ANCA )–associated vasculitis ( AAV ) and systemic lupus erythematosus ( SLE ).  AAV  and  SLE  are clinically and pathologically divergent autoimmune diseases with different autoantibodies. However, the respective autoantigens recognized in  AAV  and  SLE  have been shown to be an intricate part of  NET s. This study aimed to examine whether the mechanisms of  NET  formation and the composition of  NET s are distinct between  AAV  and  SLE .    Methods  To investigate this hypothesis, healthy neutrophils were stimulated with serum from patients with  AAV  (n = 80) and patients with  SLE  (n = 59), and the mechanisms of  NET  formation and  NET  composition were compared.    Results  Both patients with  AAV  and patients with  SLE  had excessive  NET  formation, which correlated with the extent of disease activity (in  AAV  r = 0.5,  P  < 0.0001; in  SLE  r = 0.35,  P  < 0.01). Lytic  NET  formation over several hours was observed in patients with  AAV , as compared to rapid (within minutes), non‐lytic  NET  formation coinciding with clustering of neutrophils in patients with  SLE .  AAV ‐induced  NET  formation was triggered independent of IgG  ANCA s, whereas  SLE  immune complexes ( IC x) induced  NET  formation through Fcγ receptor signaling.  AAV ‐induced  NET  formation was dependent on reactive oxygen species and peptidyl arginine deaminases, and  AAV ‐induced  NET s were enriched for citrullinated histones (mean ±  SEM  23 ± 2%). In contrast,  SLE ‐induced  NET s had immunogenic properties, including binding with high mobility group box chromosomal protein 1 (mean ±  SEM  30 ± 3%) and enrichment for oxidized mitochondrial  DNA , and were involved in  IC x formation.    Conclusion  The morphologic features, kinetics, induction pathways, and composition of excessive  NET  formation are all intrinsically distinct in  AAV  compared to  SLE . Recognizing the diversity of  NET  formation between  AAV  and  SLE  provides a better understanding of the pathophysiologic role of  NET s in these different autoimmune diseases.

arthritis and rheumatology

Intrinsically Distinct Role of Neutrophil Extracellular Trap Formation in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis Compared to Systemic Lupus Erythematosus