Genetic variants in hypoxia-inducible factor pathway are associated with colorectal cancer risk and immune infiltration.

Hypoxia-inducible factor (HIF) pathway genes influence tumorigenesis and immune status. However, the associations between genetic variants in hypoxia-related genes and colorectal cancer risk and the immune status of hypoxia-associated genes in colorectal cancer have not been systematically characterized. The associations between genetic variants and colorectal cancer risk were evaluated in Chinese, Japanese and European populations using logistic regression analysis. The relationships between target genes and tumour immune infiltration were predicted by Tumour Immune Estimation Resource (TIMER). We found that rs34533650 in EPAS1 was associated with colorectal cancer risk (OR = 1.43, 95% CI = 1.20-1.70, P(FDR) = 8.35 × 10-4 ), and this finding was validated in two independent populations (Japanese: OR = 1.07, 95% CI = 1.01-1.15, p = 3.38 × 10-2 ; European: OR = 1.11, 95% CI = 1.03-1.19, p = 6.04 × 10-3 ). EPAS1-associated genes were enriched in immune-related pathways. In addition, we found that EPAS1 copy number variation (CNV) was associated with the degree of infiltration of immune cells and observed correlations between EPAS1 expression and immune cell infiltration levels in colorectal cancer. These results highlight that genetic variants of hypoxia-related genes play roles in colorectal cancer risk and provide new insight that EPAS1 might be a promising predictor of colorectal cancer susceptibility and immune status.

Effects of nitrate- and ammonium- nitrogen on anatomical and physiological responses of Catalpa bungei under full and partial root-zone drought.

Catalpa bungei is a precious timber species distributed in North China where drought often occurs. To clarify adaptive responses of C. bungei to partial- and full- root-zone drought under the influence of nitrogen forms, a two-factor experiment was conducted in which well-watered (WW), partial root-zone drought in horizontal direction (H-PRD) and in vertical direction (V-PRD), and full root-zone drought (FRD) were combined with nitrate-nitrogen (NN) and ammonium-nitrogen (AN) treatments. C. bungei responded to FRD by sharply closing stomata, decreasing gas exchange rate and increasing leaf instantaneous water use efficiency (WUEi). Under FRD condition, the growth of seedlings was severely inhibited and the effect of N forms was covered up by the drastic drought effect. In comparison, stomata conductance and gas exchanges were moderately inhibited by PRDs. WUEi in V-PRD treatment was superior to H-PRD due to the active stomata regulation resulting from a higher ABA level and active transcription of genes in abscisic acid (ABA) signaling pathway under V-PRD. Under both PRDs and FRD, nitrate benefited antioxidant defense, stomata regulation and leaf WUEi. Under V-PRD, WUEi in nitrate treatment was superior to that in ammonium treatment due to active stomata regulation by signaling network of nitric oxide (NO), Ca2+ and ABA. Under FRD, WUEi was higher in nitrate treatment due to the favoring photosynthetic efficiency resulting from active NO signal and antioxidant defense. The interactive effect of water and N forms was significant on wood xylem development. Superoxide dismutase (SOD) and catalase (CAT) largely contributes to stress tolerance and xylem development.

Metal Exposure Promotes Colorectal Tumorigenesis via the Aberrant N6-Methyladenosine Modification of ATP13A3.

Element contamination, including that from heavy metals, is associated with gastrointestinal tumorigenesis, but the effects and mechanisms of crucial element exposure associated with colorectal cancer remain unclear. We profiled 56 elements by ICP-MS and used logistic regression, LASSO, BKMR, and GAM to identify colorectal cancer-relevant elements. A series of biochemical experiments were performed to demonstrate the cytotoxicity and the mechanisms of malignant transformation after metal exposure. Using an elementomics approach, we first found that the metal thallium (Tl) was positively correlated with many toxic metals and was associated with a significantly increased risk of colorectal cancer. Acute exposure to Tl induced cytotoxicity and cell death by accelerating the generation of reactive oxygen species and DNA damage. Chronic exposure to Tl led to the inhibition of cell death and thereby induced the malignant transformation of normal colon cells and xenograft tumor formation in nude mice. Furthermore, we describe the first identification of a significant metal quantitative trait locus for the novel colorectal cancer susceptibility locus rs1511625 near ATP13A3. Mechanistically, Tl increased the level of aberrant N6-methyladenosine (m6A) modification of ATP13A3 via the METLL3/METTL14/ALKBH5-ATP13A3 axis to promote colorectal tumorigenesis. This study provides a basis for the development of public health strategies for reducing metal exposure among populations at high risk for colorectal cancer.

High-Energy-Density and High Efficiency Polymer Dielectrics for High Temperature Electrostatic Energy Storage: A Review.

Polymer dielectrics are key components for electrostatic capacitors in energy, transportation, military, and aerospace fields, where their operation temperature can be boosted beyond 125 °C. While most polymers bear poor thermal stability and severe dielectric loss at elevated temperatures, numerous linear polymers with linear D-E loops and low dielectric permittivity exhibit low loss and high thermal stability. Therefore, the broad prospect of electrostatic capacitors under extreme conditions is anticipated for linear polymers, along with intensive efforts to enhance their energy density with high efficiency in recent years. In this article, an overview of recent progress in linear polymers and their composites for high-energy-density electrostatic capacitors at elevated temperatures is presented. Three key factors determining energy storage performance, including polarization, breakdown strength, and thermal stability, and their couplings are discussed. Strategies including chain modulation, filler selection, and design of topological structure are summarized. Key parameters for electrical and thermal evaluations of polymer dielectrics are also introduced. At the end of this review, research challenges and future opportunities for better performance and industrialization of dielectrics based on linear polymers are concluded.

Excellent Stability in Polyetherimide/SiO2 Nanocomposites with Ultrahigh Energy Density and Discharge Efficiency at High Temperature.

Polymer dielectrics with excellent thermal stability are the essential core material for thin film capacitors applied in a harsh-environment. However, the dielectric and mechanical properties of polymers are commonly deteriorated with temperature rising. Herein, polyetherimide (PEI)-based nanocomposites contained with SiO2 nanoparticles (SiO2 -NPs) are fabricated by a solution casting method. It is found that the introduction of SiO2 -NPs decreases the electric conductivity and significantly enhances the breakdown strength of the nanocomposites, especially under high temperatures. As a result, the 5 vol% PEI/SiO2 -NPs nanocomposite film displays a superior dielectric energy storage performance, e.g., a discharged energy density of 6.30 J cm-3 and a charge-discharge efficiency of 90.5% measured at 620 MV m-1 and 150 °C. In situ scanning Kelvin probe microscopy characterization indicates that the charge carriers can be trapped in the interfacial regions between the polymer matrix and the SiO2 -NPs till the temperature reaches as high as 150 °C. This work demonstrates an effective strategy to fabricate high-temperature dielectric polymer nanocomposites by embedding inorganic nanoparticles and provides a method for directly detecting charge behavior at the nanoscale inside the matrix.

[Immune function effect of F3 rats fed with genetically modified maize harboring Cry1Ab and epsps genes].

OBJECTIVE: To evaluate the effects of genetically modified maize with Cry1Ab and epsps genes on immune function in F3 rats. METHODS: A total of 180 weaning SD rats for F0 generation were randomly divided into three groups, which were treated with AIN-93 G feed control diet, parental maize diet and genetically modified maize diet respectively. After three generations of breeding, antibody producing cells determination, concanavalin A(ConA)-induced lymphocyte transformation test, natural killer(NK)cells activities assay, whole blood lymphocyte subtype detection, delayed type hypersensitivity test and immunity organ index were performed. RESULTS: There were no significant differences between parental maize diet and genetically modified maize diet in terms of the number of antibody-producing cells, ConA-induced spleen lymphocyte proliferation, NK cell activity, whole blood lymphocyte subsets, delayed type hypersensitivity and thymus index(P>0. 05). CONCLUSION: Under the conditions of this experiment, no significant effects were found on immune function of F3 SD rats through the three generation development study of genetically modified maize with CrylAb and epsps genes.

[Three-generation study on neuroethology and cognitive ability of genetically modified maize with Cry1Ab and epsps genes on the SD rats].

OBJECTIVE: To evaluate the neurotoxicity effects of the genetically modified maize with insect-resistant Cry1 Ab and herbicide-resistant epsps genes on the SD rats through three generation exposure. METHODS: 180 weaning SD rats for F0 generation were divided into three groups, which were treated with parental maize diet( YC group), genetically modified maize diet( T group) and AIN-93 G control diet( C group). After three generations of breeding, 20 litters of rats those from pre-weaning F3 generation were selected randomly to evaluate early postnatal developmental neurotoxicity. After weaning, 10 pups were randomly selected from each litter( 1 male or female per litter) for future experiments of motor activity, cognitive function and neuropathology assessment as adult. RESULTS: There were no statistically significant differences on early neurological development, neuroethology and cognitive ability. Only in the spatial probe test, the distance and time spent as well as their corresponding percentage in the target quadrant of YC group female rats were less compared with T group and C group( P < 0. 05). CONCLUSION: Under current experimental conditions, no adverse effects were found in neuroethology and cognitive ability on SD rats though the three generation study of genetically modified maize with Cry1Ab and epsps genes.

Genetic variants in C1GALT1 are associated with gastric cancer risk by influencing immune infiltration.

Core 1 synthase glycoprotein-N-acetylgalactosamine 3-ß-galactosyltransferase 1 (C1GALT1) is known to play a critical role in the development of gastric cancer, but few studies have elucidated associations between genetic variants in C1GALT1 and gastric cancer risk. By using the genome-wide association study data from the database of Genotype and Phenotype (dbGAP), we evaluated such associations with a multivariable logistic regression model and identified that the rs35999583 G>C in C1GALT1 was associated with gastric cancer risk (odds ratio, 0.83; 95% confidence interval [CI], 0.75-0.92; P = 3.95 × 10 -4). C1GALT1 mRNA expression levels were significantly higher in gastric tumor tissues than in normal tissues, and gastric cancer patients with higher C1GALT1 mRNA levels had worse overall survival rates (hazards ratio, 1.33; 95% CI, 1.05-1.68; P log-rank = 1.90 × 10 -2). Furthermore, we found that C1GALT1 copy number differed in various immune cells and that C1GALT1 mRNA expression levels were positively correlated with the infiltrating levels of CD4 + T cells and macrophages. These results suggest that genetic variants of C1GALT1 may play an important role in gastric cancer risk and provide a new insight for C1GALT1 into a promising predictor of gastric cancer susceptibility and immune status.

Genetic variants reduced POPs-related colorectal cancer risk via altering miRNA binding affinity and m6A modification.

Exposure to persistent organic pollutants (POPs) may contribute to colorectal cancer risk, but the underlying mechanisms of crucial POPs exposure remain unclear. Hence, we systematically investigated the associations among POPs exposure, genetics and epigenetics and their effects on colorectal cancer. A case-control study was conducted in the Chinese population for detecting POPs levels. We measured the concentrations of 24 POPs in the plasma using gas chromatography-tandem mass spectrometry (GC-MS/MS) and evaluated the clinical significance of POPs by calculating the area under the receiver operating characteristic curve (AUC). To assess the associations between candidate genetic variants and colorectal cancer risk, unconditional logistic regression was used. Compared with healthy control individuals, individuals with colorectal cancer exhibited higher concentrations of the majority of POPs. Exposure to PCB153 was positively associated with colorectal cancer risk, and PCB153 demonstrated superior accuracy (AUC=0.72) for predicting colorectal cancer compared to other analytes. On PCB153-related genes, the rs67734009 C allele was significantly associated with reduced colorectal cancer risk and lower plasma levels of PCB153. Moreover, rs67734009 exhibited an expression quantitative trait locus (eQTL) effect on ESR1, of which the expression level was negatively related to PCB153 concentration. Mechanistically, the risk allele of rs67734009 increased ESR1 expression via miR-3492 binding and m6A modification. Collectively, this study sheds light on potential genetic and epigenetic mechanisms linking PCB153 exposure and colorectal cancer risk, thereby providing insight into the accurate protection against POPs exposure.

Polymer nanocomposite dielectrics for capacitive energy storage.

Owing to their excellent discharged energy density over a broad temperature range, polymer nanocomposites offer immense potential as dielectric materials in advanced electrical and electronic systems, such as intelligent electric vehicles, smart grids and renewable energy generation. In recent years, various nanoscale approaches have been developed to induce appreciable enhancement in discharged energy density. In this Review, we discuss the state-of-the-art polymer nanocomposites with improved energy density from three key aspects: dipole activity, breakdown resistance and heat tolerance. We also describe the physical properties of polymer nanocomposite interfaces, showing how the electrical, mechanical and thermal characteristics impact energy storage performances and how they are interrelated. Further, we discuss multi-level nanotechnologies including monomer design, crosslinking, polymer blending, nanofiller incorporation and multilayer fabrication. We conclude by presenting the current challenges and future opportunities in this field.

Generative learning facilitated discovery of high-entropy ceramic dielectrics for capacitive energy storage.

Dielectric capacitors offer great potential for advanced electronics due to their high power densities, but their energy density still needs to be further improved. High-entropy strategy has emerged as an effective method for improving energy storage performance, however, discovering new high-entropy systems within a high-dimensional composition space is a daunting challenge for traditional trial-and-error experiments. Here, based on phase-field simulations and limited experimental data, we propose a generative learning approach to accelerate the discovery of high-entropy dielectrics in a practically infinite exploration space of over 1011 combinations. By encoding-decoding latent space regularities to facilitate data sampling and forward inference, we employ inverse design to screen out the most promising combinations via a ranking strategy. Through only 5 sets of targeted experiments, we successfully obtain a Bi(Mg0.5Ti0.5)O3-based high-entropy dielectric film with a significantly improved energy density of 156 J cm-3 at an electric field of 5104 kV cm-1, surpassing the pristine film by more than eight-fold. This work introduces an effective and innovative avenue for designing high-entropy dielectrics with drastically reduced experimental cycles, which could be also extended to expedite the design of other multicomponent material systems with desired properties.

Electrically and mechanically driven rotation of polar spirals in a relaxor ferroelectric polymer.

Topology created by quasi-continuous spatial variations of a local polarization direction represents an exotic state of matter, but field-driven manipulation has been hitherto limited to creation and destruction. Here we report that relatively small electric or mechanical fields can drive the non-volatile rotation of polar spirals in discretized microregions of the relaxor ferroelectric polymer poly(vinylidene fluoride-ran-trifluoroethylene). These polar spirals arise from the asymmetric Coulomb interaction between vertically aligned helical polymer chains, and can be rotated in-plane through various angles with robust retention. Given also that our manipulation of topological order can be detected via infrared absorption, our work suggests a new direction for the application of complex materials.

Compressible Polymer Composites with Enhanced Dielectric Temperature Stability.

High-dielectric-constant polymer composites have broad application prospects in flexible electronics and electrostatic energy storage capacitors. Substantial enhancement in dielectric constants (εr ) of polymer composites so far can only be obtained at a high loading of nanofillers, resulting in high dielectric loss and high elastic modulus of polymer composites. Addressing the polarization shielding and the consequent polarization discontinuity at polymer/filler interfaces has been a long-standing challenge to achieve flexible polymer composite with high εr . Herein, a polymer composite with interconnected BaTiO3 (BT) ceramic scaffold is proposed and demonstrated, which exhibits a high εr of ≈210 at a low BT volume fraction of ≈18 vol%, approaching the upper limit predicted by the parallel model. By incorporating relaxor Ba(Zrx Ti1-x )O3 phase in BT scaffold, dielectric temperature stability is further achieved with Δεr below ±10% within a broad temperature range (25-140 °C). Moreover, the dielectric performances remain stable under a compressive strain of up to 80%. This work provides a facile approach to construct large-scale polymer composites with robust dielectric performance against changes in thermal and mechanical conditions, which are promising for high-temperature applications in flexible electronics.

Loss of RPA1 Impairs Peripheral T Cell Homeostasis and Exacerbates Inflammatory Damage through Triggering T Cell Necroptosis.

The peripheral T cell pool is maintained at dynamic homeostasis through fine-tuning of thymic output and self-renewal of naïve T cells. Lymphopenia or reduced lymphocyte number is implicated in autoimmune diseases, yet little is known about the homeostatic mechanisms. Here, it is reported that the replication protein A1 (RPA1) plays a critical role in T cell homeostasis. Utilizing T cell-specific Rpa1-deficient (Rpa1fl/fl Cd4-cre) mice, loss of Rpa1 results in lymphopenia through restraining peripheral T cell population and limiting TCR repertoire diversity. Moreover, Rpa1fl/fl Cd4-cre mice exhibit increased susceptibility to inflammatory diseases, including colitis and hepatitis. Clinical analysis reveals that the expression of RPA1 is reduced in patients with ulcerative colitis or other autoinflammatory diseases. Mechanistically, depletion of RPA1 activates ZBP1-RIPK3 signaling through triggering the genomic DNA leakage into cytosol, consequently resulting in T cell necroptosis. This necroptotic T cell death induced by RPA1 deficiency allows the release of damage-associated molecular patterns (DAMPs), which in turn recruits leukocytes and exacerbates inflammatory response. Reciprocally, chemical or genetic inhibition of necroptosis signaling can ameliorate the Rpa1 deficiency-induced inflammatory damage. The studies thus uncover the importance of RPA1-ZBP1-RIPK3 axis in T cell homeostasis and provide a promising strategy for autoinflammatory disease treatment.

Genetic Modulation of BET1L Confers Colorectal Cancer Susceptibility by Reducing miRNA Binding and m6A Modification.

Genetic variants in regions encoding 3' untranslated regions (UTR) of mRNA potentially alter miRNA binding affinity and N6-methyladenosine (m6A) levels to affect gene expression. A better understanding of the association of these variants with colorectal cancer susceptibility could facilitate development of cancer prevention and treatment approaches. Here, we analyzed miRNA expression profiles and integrated genetic analyses from 8,533 individuals to evaluate the effects of altered miRNA-binding sites on colorectal cancer risk. The single-nucleotide polymorphism rs11245997 in the BET1L 3'UTR was significantly associated with colorectal cancer risk. The rs11245997 A allele facilitated BET1L expression by disrupting miR-140-3p binding. It also reduced BET1L m6A modification, which upregulated BET1L expression levels through a mechanism mediated by the m6A methyltransferases (METTL14 and WTAP) and the m6A demethylase ALKBH5. Moreover, higher expression of BET1L was associated with advanced tumor stages and poor patient prognosis. Increased BET1L expression promoted growth of colorectal cancer cells in vitro and in vivo, which could be partially rescued with miR-140-3p overexpression. RNA sequencing and pathway analyses indicated that BET1L is associated with the steroid biosynthesis pathway through regulation of HSD17B7, CYP27B1, and COMT. These findings provide insights into the involvement of genetic variants of BET1L in the development and progression of colorectal cancer. SIGNIFICANCE: The integration of miRNA expression profiles and genetic variants identified rs11245997 as a colorectal cancer risk-related variant that reduces miR-140-3p binding and m6A modification, leading to BET1L upregulation to promote colorectal tumorigenesis.

Alternative polyadenylation-related genetic variants contribute to bladder cancer risk.

Aberrant alternative polyadenylation (APA) events play an important role in cancers, but little is known about whether APA-related genetic variants contribute to the susceptibility to bladder cancer. Previous genome-wide association study performed APA quantitative trait loci (apaQTL) analyses in bladder cancer, and identified 17 955 single nucleotide polymorphisms (SNPs). We found that gene symbols of APA affected by apaQTL-associated SNPs were closely correlated with cancer signaling pathways, high mutational burden, and immune infiltration. Association analysis showed that apaQTL-associated SNPs rs34402449 C>A, rs2683524 C>T, and rs11540872 C>G were significantly associated with susceptibility to bladder cancer (rs34402449: OR = 1.355, 95% confidence interval [CI]: 1.159-1.583, P = 1.33 × 10 -4; rs2683524: OR = 1.378, 95% CI: 1.164-1.632, P = 2.03 × 10 -4; rs11540872: OR = 1.472, 95% CI: 1.193-1.815, P = 3.06 × 10 -4). Cumulative effect analysis showed that the number of risk genotypes and smoking status were significantly associated with an increased risk of bladder cancer ( P trend = 2.87 × 10 -12). We found that PRR13, being demonstrated the most significant effect on cell proliferation in bladder cancer cell lines, was more highly expressed in bladder cancer tissues than in adjacent normal tissues. Moreover, the rs2683524 T allele was correlated with shorter 3' untranslated regions of PRR13 and increased PRR13 expression levels. Collectively, our findings have provided informative apaQTL resources and insights into the regulatory mechanisms linking apaQTL-associated variants to bladder cancer risk.

Stretchable polymer composites with ultrahigh piezoelectric performance.

Flexible piezoelectric materials capable of withstanding large deformation play key roles in flexible electronics. Ferroelectric ceramics with a high piezoelectric coefficient are inherently brittle, whereas polar polymers exhibit a low piezoelectric coefficient. Here we report a highly stretchable/compressible piezoelectric composite composed of ferroelectric ceramic skeleton, elastomer matrix and relaxor ferroelectric-based hybrid at the ceramic/matrix interface as dielectric transition layers, exhibiting a giant piezoelectric coefficient of 250 picometers per volt, high electromechanical coupling factor keff of 65%, ultralow acoustic impedance of 3MRyl and high cyclic stability under 50% compression strain. The superior flexibility and piezoelectric properties are attributed to the electric polarization and mechanical load transfer paths formed by the ceramic skeleton, and dielectric mismatch mitigation between ceramic fillers and elastomer matrix by the dielectric transition layer. The synergistic fusion of ultrahigh piezoelectric properties and superior flexibility in these polymer composites is expected to drive emerging applications in flexible smart electronics.

An Optical/Ferroelectric Multiplexing Multidimensional Nonvolatile Memory from Ferroelectric Polymer.

Multiplexing physical dimensions to realize multidimensional storage in a single material has been a goal to increase storage density and data security. Multidimensional storage is only achieved in optical storage material (OSM) by far. Poly(vinylidene fluoride) (PVDF), a semicrystalline polymer, is widely studied as a candidate for ferroelectric random access (FeRAM). Herein, the atomic force microscopy (AFM)-based infrared spectroscopy techniqueis used to induce multilevel phase transformations in PVDF ultrathin film on nanometric scales and for writing/readout of IR signals. An optical/ferroelectric multiplexing PVDF memory, where information can be coded with independent four-level optical IR and bilevel ferroelectric signals, is demonstrated. High data security and a storage density up to 180 GBit in.-2 are achieved simultaneously. Owing to the different critical temperature for phase transformation (optical data, <167 °C) and polarization switching (ferroelectric data, <100 °C), the multiplexing memory can function both as optical read-only memory and FeRAM. This work expands material supporting physical dimensions multiplexing beyond OSM for the first time, opening up new opportunities for future high-capacity, multifunctional nano-memory. The strategy proposed here enables on-demand and tunable programming on IR waves, offering prospects for fabrication of active nano-optical devices.

Effect of food on orally-ingested titanium dioxide and zinc oxide nanoparticle behaviors in simulated digestive tract.

Nanomaterials have been widely utilized in human daily life. The interaction between nanoparticles (NPs) and food matrices through oral ingestion is important for fate and potential toxicity of NPs. In this study, the interaction between NPs (i.e., titanium dioxide (TiO2) and zinc oxide (ZnO)) and food matrices (namely sucrose, protein powder, and corn oil) was investigated by use of an in vitro physiological model. Measurement using asymmetrical flow field-flow fractionation (AF4) showed that particle size of TiO2 NPs in saliva fluid decreased from 102 ± 6.21 nm (control) to 69.2 ± 6.90 and 81.9 ± 4.30 nm in protein powder and corn oil. Similar trend was also observed for ZnO. Compared with gastric fluid, micelles formed by corn oil in intestinal fluid further dispersed NPs, as indicated by approximately 11.1% and 13.2% decrease in particle size of TiO2 and ZnO NPs, respectively. Characterization of TEM, FTIR and AFM showed that a layer of biological corona was attached on surface of NPs in protein and oil. The XPS demonstrated that oil bound with NPs through forming covalent bonds, while protein bound with NPs through van der Waals force and electrostatic force for TiO2 and ZnO NPs, respectively. The result here demonstrated the importance of considering food effect when investigating the morphology and behavior of NPs after oral ingestion. This understanding was valuable in assessment of environmental fate and biological effects of NPs.

Neutrophil extracellular traps induce thrombogenicity in severe carotid stenosis.

BACKGROUND: Severe carotid stenosis is a common cause of stroke. In addition, previous clinical studies revealed that patients symptomatic of carotid stenosis suffer from increased episodes of stroke compared with their asymptomatic counterparts. However, the mechanism underlying these differences in the recurrence of stroke remains unclear. OBJECTIVE: The present study aimed to evaluate the levels of neutrophil extracellular traps (NETs) in the plasma of patients with severe carotid stenosis and investigate whether NETs induced procoagulant activity (PCA) in severe carotid stenosis. The study also sought to investigate the interactions between platelets or endothelial cells (ECs) and NETs. METHODS: The levels of NETs in plasma were quantified using enzyme-linked immunosorbent assay (ELISA). In addition, NETting neutrophils and neutrophil-platelet aggregates were detected through flow cytometry. On the other hand, the morphology of NETs formation and endothelial cells were analyzed through confocal microscopy. Finally, the procoagulant activity (PCA) of NETs and endothelial cells were assessed through ELISA and fibrin formation. RESULTS: Patients with symptomatic carotid stenosis patients had significantly higher levels of NETs markers compared with their asymptomatic counterparts and healthy subjects. In addition, increased levels of neutrophil-platelet aggregates induced the generation of NETs in patients with symptomatic carotid stenosis. Moreover, NETs contributed to PCA through tissue factor (TF), in patients with carotid stenosis. Furthermore, NETs disrupted the endothelial barrier and converted endothelial cells (ECs) into PCA to enhance the PCA in patients with carotid stenosis. CONCLUSIONS: The current study revealed differences in the levels of NETs in the plasma of symptomatic and asymptomatic patients suffering from carotid stenosis. The study also uncovered the interaction between NETs and thrombogenicity in carotid stenosis. Therefore, inhibiting NETs may be a potential biomarker and therapeutic target for recurring stroke in severe carotid stenosis.