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Exp Neurobiol 2021; 30(1): 1-12

Published online February 28, 2021

© The Korean Society for Brain and Neural Sciences

Neutrophil Extracellular Traps in Coronavirus Disease-19-Associated Ischemic Stroke: A Novel Avenue in Neuroscience

Tjokorda Istri Pramitasuri1, Anak Agung Ayu Putri Laksmidewi2*, Ida Bagus Kusuma Putra2 and Felix Adrian Dalimartha3

1Doctoral Program of Medical Sciences, Faculty of Medicine Udayana University, Denpasar 80232,
2Department of Neurology, Faculty of Medicine Udayana University-Sanglah Academic General Hospital, Denpasar 80232,
3Department of Neurology, Abdi Waluyo Hospital, Jakarta 10310, Indonesia

Correspondence to: *To whom correspondence should be addressed.
TEL: 62-361-223-867, FAX: 62-361-246-082

Received: September 28, 2020; Revised: November 26, 2020; Accepted: December 25, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License
( which permits unrestricted non-commercial use, distribution, and
reproduction in any medium, provided the original work is properly cited.

Ischemic stroke is one of the catastrophic neurological events that are being increasingly recognized among Coronavirus Disease (COVID)-19 patients. The recent studies have revealed about a possible connection among COVID-19, ischemic stroke, and excessive Neutrophil Extracellular Traps (NETs) formation. This paper establishes an overview of coronaviruses and NETs, NETs in pathogenesis of COVID-19 induced-ischemic stroke, and future directions using related recent literatures. NETs are normally functioned for a defense against pathogens, but in immoderate amount, they can trigger series of destructive events. Vasculopathy and neuroinflammation are the pathological mechanisms of NETs suggested to link COVID-19 and ischemic stroke. Based on newly discovered possible mechanisms, the potential clinical implications that could be applied consists of inhibition of NET formation, disrupting cholesterol synthesis, and interfering inflammatory pathway. A considerable number of scientific works are needed in order to complete the current understanding of the emerging relationship among COVID-19, NETs, and ischemic stroke. Although the exact mechanism is still unknown, these novel findings are a worthwhile contribution in defining future studies, suitable future frameworks, and therapeutic strategies.

Graphical Abstract

Keywords: Stroke, Coronavirus, Neutrophil, Extracellular traps