Potential association of neutrophil extracellular traps with cognitive impairment in cerebral small vessel disease.

No acceptable biomarker can facilitate the early identification of cognitive impairment associated with cerebral small vessel disease (CSVD) in the older persons. The neutrophil extracellular traps (NETs) in the inflammation response of circulatory and central systems are essential in destroying the blood-brain barrier. The present study aims to explore the potential associations of plasma NETs with cognitive performance in CSVD. We recruited 146 CSVD patients and 66 healthy controls (HCs), and comprehensive neuropsychological assessments and multimodal magnetic resonance imaging were conducted. Three NETs markers, viz., citrullination of histone H3, neutrophil elastase-DNA, and myeloperoxidase (MPO)-DNA, and four oxidative stress-related indexes in plasma samples were measured. The plasma levels of three NETs markers were more significantly elevated in CSVD patients than in HCs. Significant correlations of the three NETs markers were observed with multiple cognitive domain scores. Furthermore, higher plasma MDA and NETs levels were significantly associated with the worse Montreal Cognitive Assessment scores among CSVD patients. Moreover, plasma MPO-DNA levels significantly mediated the effect of the amplitude of low-frequency fluctuation value within the bilateral caudate and the scores of global cognitive function, executive function, and information processing speed. Additionally, a panel of three NETs markers had the highest area under the curve value to distinguish the cognitively impaired CSVD patients from HCs and non-impaired ones. Therefore, plasma NETs may be potential biomarkers for early diagnosis of CSVD-related cognitive impairment. Activated lipid peroxidation in circulation and impaired caudate function support potential associations of plasma NETs in cognitively impaired CSVD patients.