NETosis, complement, and coagulation: a triangular relationship

NETosis is a regulated form of neutrophil cell death that contributes to the host defense against pathogens and was linked to various diseases soon after its first description in 2004. During NETosis, neutrophils release neutrophil extracellular traps (NETs), which can capture and kill bacteria and other pathogens to prevent them from spreading. Although substantial progress has been made in our understanding of NETosis, the precise mechanism underlying NETosis is still a matter of debate. Research continues to elucidate the molecular pathways involved in NETosis. In recent years, interactions with the complement and coagulation systems have become increasingly apparent. Activated complement proteins can stimulate NET formation, and NETs, in turn, can serve as a platform for complement activation. In addition, NETs can act as a scaffold for thrombus formation during coagulation. While crosstalk between the coagulation and complement systems has been previously described, NETosis appears to be a third important player in this consortium to protect the host against pathogens. This review summarizes our current knowledge on the mutual interactions between NETosis, the complement system and the coagulation system, with an emerging description of their complex triangular relationship.