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10.1172/jci.insight.209641
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Published August 10, 2026 - More info
Despite the high morbidity and mortality among patients with extensive cutaneous burns in the intensive care unit due to the development of acute respiratory distress syndrome, effective therapeutics remain to be determined. This is primarily because the mechanisms leading to acute lung injury (ALI) in these patients remain unknown. We test the hypothesis that cutaneous chemical burns promote lung injury due to systemic activation of neutrophils, in particular, toxicity mediated by the deployment of neutrophil extracellular traps (NETs). We also demonstrate the potential benefit of a peptidyl arginine deiminase 4 (PAD4) inhibitor to prevent NETosis and to preserve microvascular endothelial barrier function, thus reducing the severity of ALI in mice. Our data demonstrated that phenylarsine oxide (PAO) treatment of neutrophils caused increased intracellular Ca2+-associated PAD4 activity. A dermal chemical burn by lewisite or PAO resulted in PAD4 activation, NETosis, and ALI. NETs disrupted the barrier function of endothelial cells in human lung microvascular endothelial cell spheroids. Citrullinated histone 3 alone caused ALI in mice. Pharmacologic or genetic abrogation of PAD4 inhibited lung injury following cutaneous chemical burns. Cutaneous burns by lewisite and PAO caused ALI by PAD4-mediated NETosis. PAD4 inhibitors may have potential as countermeasures to suppress detrimental lung injury after chemical burns.
Ranu Surolia, Fu Jun Li, Zheng Wang, Mahendra Kashyap, Ritesh Kumar Srivastava, Amie M. Traylor, Pooja Singh, Kevin G. Dsouza, Harrison Kim, Jean-Francois Pittet, Jaroslaw W. Zmijewski, Anupam Agarwal, Mohammad Athar, Aftab Ahmad, Veena B. Antony
Original citation: JCI Insight. 2026;11(14):e209641. https://doi.org/10.1172/jci.insight.209641
Citation for this research: JCI Insight. 2021;6(10):e147564. https://doi.org/10.1172/jci.insight.147564
After publication, the authors became aware of an error in Figure 8A.The representative higher-magnification GSK484 + PAO panel was inadvertently duplicated from the control panel during figure preparation. The correct figure is shown below, and the HTML and PDF versions have been updated.
The authors regret the error.
See the related article at NETosis in the pathogenesis of acute lung injury following cutaneous chemical burns.