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Peptidylarginine deiminase 4 promotes age-related organ fibrosis
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Aging promotes inflammation, a process contributing to fibrosis and decline in organ function. The release of neutrophil extracellular traps (NETs [NETosis]), orchestrated by peptidylarginine deiminase 4 (PAD4), damages organs in acute inflammatory models. We determined that NETosis is more prevalent in aged mice and investigated the role of PAD4/NETs in age-related organ fibrosis. Reduction in fibrosis was seen in the hearts and lungs of aged PAD4−/− mice compared with wild-type (WT) mice. An increase in left ventricular interstitial collagen deposition and a decline in systolic and diastolic function were present only in WT mice, and not in PAD4−/− mice. In an experimental model of cardiac fibrosis, cardiac pressure overload induced NETosis and significant platelet recruitment in WT but not PAD4−/− myocardium. DNase 1 was given to assess the effects of extracellular chromatin. PAD4 deficiency or DNase 1 similarly protected hearts from fibrosis. We propose a role for NETs in cardiac fibrosis and conclude that PAD4 regulates age-related organ fibrosis and dysfunction.
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![Figure 1. Increased neutrophil and platelet count, formation of platelet–neutrophil complexes, and neutrophil susceptibility to produce NETs in aged C57BL/6NIA mice. (A) Neutrophil counts in peripheral blood of young (2 mo) versus old (20–24 mo) WT mice; n = 16–18. (B) Platelet counts in young (2 mo) versus old (20–24 mo) WT mice; n = 16–18. (C) Quantification by flow cytometry of platelet–neutrophil complexes (CD41+Ly6G+) in whole blood collected from young (2–3 mo) and old (20–24 mo) mice; n = 7–12. (D) Quantification of Ly6G-positive neutrophils in cytospins of the total leukocyte population; n = 6–8. (E) Quantification of the percentage of H3Cit-positive neutrophils by thresholding analysis of immunostained cytospins of RBC-depleted blood cells; n = 6–8. In D and E, young mice were 6–8 wk old and old mice were 15–20 mo old. (F) Percentage of NET-forming peripheral blood neutrophils after incubation with vehicle (unstimulated [US]), 4 µM ionomycin (Iono), or 100 nM PMA for 3.5 h. Neutrophils from old (24–27 mo) mice formed significantly more NETs under all conditions than neutrophils from young (2–5 mo) mice; n = 5. *, P < 0.05; **, P < 0.01; ***, P < 0.001 by Student’s t test. The graphs show mean and SEM from 16–18 (A and B), 7–12 (C), 6–8 (D and E), and 5 (F) mice per group from five (A and B), three (C), or two (D–F) independent experiments.](/paper-figures/06511405369d4dd385f117cdad0142d5/peptidylarginine-deiminase-4-promotes-age-related-organ-fibrosis-figure-1.jpg)








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“A previous study found that aged mice exhibited an increased propensity for NETosis compared to younger mice.”
From Inflammation and aging: signaling pathways and intervention therapies (2023) · cites this paper as [270]
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“This heightened NETosis activity was associated with the activation of peptidylarginine deiminase 4 (PAD4), an enzyme involved in the formation of NETs.”
From Inflammation and aging: signaling pathways and intervention therapies (2023) · cites this paper as [270]
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“The excessive formation of NETs, in turn, was implicated in the development of age-related organ fibrosis.270”
From Inflammation and aging: signaling pathways and intervention therapies (2023) · cites this paper as [270]
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Metadata
- Authors
- Martinod, K., Witsch, T., Erpenbeck, L., Savchenko, A., Hayashi, H., Cherpokova, D., Gallant, M., Mauler, M., Cifuni, S. M., & Wagner, D. D.
- Affiliations
- Boston Children's Hospital (US)
- University of Freiburg (DE)
- Corresponding author
- Wagner, Denisa D.
- ORCID
- Venue
- Journal of Experimental Medicine
- Publisher
- Rockefeller University Press
- Published
- 2016-12-28
- Volume
- 214
- Issue
- 2
- Pages
- 439-458
- ISSN
- 0022-1007 (ISSN-L)
- 1540-9538
- PMC
- PMC5294849
- OpenAlex
- W2562661149
- Cited by
- 218
- References
- 91
- Citations by year
- 2026: 14 · 2025: 23 · 2024: 36 · 2023: 28 · 2022: 20 · 2021: 25 · 2020: 22 · 2019: 21 · 2018: 19 · 2017: 10
- FWCI
- 10.11
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Journal of Experimental Medicine (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- GRO (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL102101, R01HL125501, 5T32HL066987-13)
- Boston Children’s Hospital
- Deutsche Forschungsgemeinschaft (CH 1734/1-1)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Neutrophil, Myeloperoxidase and Oxidative Mechanisms
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
- Keywords
- PAD4, neutrophil extracellular traps, NETosis, myocardial fibrosis, pulmonary fibrosis, aging, inflammation, DNase1, platelet recruitment, pressure overload, collagen deposition, cardiac function
- MeSH terms
- Protein-Arginine Deiminase Type 4, Age Factors, Animals, Collagen, Fibrosis, Hydrolases, Mice, Inbred C57BL, Myocardium, Pulmonary Fibrosis, Ventricular Function, Left, Reactive Oxygen Species, Mice, Extracellular Traps
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