Abstract
Objective: Behçet’s syndrome (BS) is a systemic vasculitis with several
clinical manifestations. Neutrophils hyperactivation mediates vascular
BS involvement, via a massive production of reactive oxygen species
(ROS) and the release of neutrophil extracellular traps (NETs). We
investigated neutrophil-mediated mechanisms of damage in non-vascular BS
manifestations and explored in vitro the effects of colchicine in
counteracting these mechanisms. Methods: NETs and intracellular ROS
production was assessed in blood samples from 80 BS patients (46 with
active non-vascular BS, 34 with inactive disease) and 80 healthy
controls. Moreover, isolated neutrophils were incubated for 1 hour with
an oxidating agent (2,2′-azobis (2-amidinopropane) dihydrochloride;
250nM), and the ability of pure colchicine pre-treatment (100ng/ml) to
counteract oxidation-induced damage was assessed. Results: Patients with
active non-vascular BS had remarkably increased NET levels [21.2 (IQR
18.3-25.9) mU/ml] compared to patients with inactive disease [16.8
(13.3-20.2) mU/ml] and to controls [7.1 (5.1-8.7) mU/ml],
p<0.001]. Also, intracellular ROS tended to be increased in
active BS, although not significantly. In active non-vascular BS, NETs
correlated with neutrophils ROS production (p<0.001) and were
particularly increased in patients with active mucosal
(p<0.001), articular (p=0.004), and gastrointestinal symptoms
(p=0.006). On isolated neutrophils, colchicine significantly reduced
oxidation-induced NET production and cell apoptosis, though not via an
antioxidant activity. Conclusion: Neutrophil-mediated mechanisms might
be directly involved in non-vascular BS, and NETs, more than ROS, might
drive the pathogenesis of mucosal, articular and intestinal
manifestations. Colchicine might be effective to counteract
neutrophils-mediated damage in BS, although further studies are needed.