{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T11:18:28Z","timestamp":1756898308463,"version":"3.40.5"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T00:00:00Z","timestamp":1689206400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Extracorporeal photopheresis (ECP) is considered an effective treatment for patients with chronic graft vs host disease (cGVHD) and demonstrates efficacy in ameliorating GVHD. The mechanism by which ECP acts against cGVHD is not fully understood. Preliminary observations have hinted at the potential involvement of neutrophil extracellular traps (NETs) formation in the pathogenesis of cGVHD. We aimed to assess the influence of ECP on the formation of NETs in patients with cGVHD as a potential mechanism in this setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients treated with ECP for cGVHD at the Rabin Medical Center were included in this study. Blood samples were obtained at three different time points: before starting an ECP cycle, at the end of the first day of treatment, and 24\u2009h following the initiation of the ECP treatment cycle. Neutrophils were harvested from all blood samples. NET formation was assessed by measurement of NET\u2010bound specific neutrophil elastase activity and by immunofluorescence staining.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six patients (two females and four males) with cGVHD were included in the study. We observed a significant increase in NET formation among all six patients following ECP. Net\u2010bound specific neutrophil elastase activity was elevated from a median value of 2.23\u2009mU\/mL (interquartile range [IQR] 2.06\u20102.47\u2009mU\/mL) at baseline to a median value of 13.06\u2009mU\/mL (IQR 10.27\u201015.97\u2009mU\/mL) immediately after the treatment and to a peak median value of 14.73\u2009mU\/mL (IQR 9.6\u201022.38\u2009mU\/mL) 24\u2009h following the initiation of the ECP cycle. A qualitative assessment of NET formation using immunofluorescence staining has demonstrated markedly increased expression of citrullinated histone H3, a marker of NET formation, following ECP treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our preliminary data indicate that ECP induces NET formation among patients with cGVHD. The contribution of increased NET formation to the therapeutic effect of cGVHD should be further investigated.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jca.22073","type":"journal-article","created":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T10:01:24Z","timestamp":1689242484000},"page":"615-621","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Extracorporeal photopheresis induces <scp>NETosis<\/scp> in neutrophils derived from patients with chronic <scp>graft\u2010vs\u2010host<\/scp> disease"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1953-4163","authenticated-orcid":false,"given":"Idan","family":"Goldberg","sequence":"first","affiliation":[{"name":"Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital Rabin Medical Center  Petah Tikva Israel"},{"name":"Sackler School Medicine Tel Aviv University  Tel Aviv Israel"},{"name":"Department of Internal Medicine 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