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Updated: Sep 16, 2025

Comprehensive Analysis of Procoagulant Platelets Exhibiting Features of Necrosis, Apoptosis and Platelet Activation
Published on: May 23, 2025
Platelet-Induced NET in Liver Cirrhosis: Mitochondrial ROS-Mediated NETosis and Its Contribution to the
Xiaoming Wu1,2,3, Haijiao Jing1,2, Tao Jiang4
1Department of Hematology, The First Hospital, Harbin Medical University, Harbin, China.
Platelets in liver cirrhosis trigger neutrophil extracellular traps (NETs) via mitochondrial ROS and autophagy. This elevates clotting and impairs anticoagulant function, impacting the cirrhotic coagulation system.
Area of Science:
- Hematology
- Immunology
- Pathophysiology
Background:
- Mitochondrial reactive oxygen species (mtROS)-mediated neutrophil extracellular traps (NETs) release is poorly understood.
- Liver cirrhosis is associated with elevated NETs, but the underlying mechanisms and consequences remain unclear.
Purpose of the Study:
- To investigate if platelets induce NETs in liver cirrhosis via mtROS.
- To determine the effects of platelet-induced NETs on the cirrhotic coagulation system.
Main Methods:
- Studied 103 cirrhosis patients and 19 healthy controls.
- Assessed platelet-induced NETosis using immunofluorescence, confocal microscopy, flow cytometry, and microplate assays.
- Evaluated NETs' procoagulant activity via coagulation complex assays and thrombin generation.
Main Results:
- Elevated NETs and mtROS were observed in Child-Pugh B and C cirrhosis patients.
- Platelets and high mobility group box 1 (HMGB1) enhanced NETs and neutrophil autophagy, mediated by mtROS.
- Mito TEMPO, anti-HMGB1, anti-RAGE antibodies, and wortmannin inhibited NETs and autophagy.
- Elevated NETs increased thrombin and fibrin formation, shortened coagulation time, and impaired thrombomodulin activity.
Conclusions:
- Cirrhotic platelets induce NETs via mtROS and autophagy.
- These NETs enhance procoagulant activity and impair anticoagulant function, contributing to coagulation system abnormalities in cirrhosis.
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