Recombinant human ADAMTS13 treatment and anti-NET strategies enhance skin allograft survival in mice

Am J Transplant. 2020 Apr;20(4):1162-1169. doi: 10.1111/ajt.15703. Epub 2019 Dec 12.


Enhancing skin allograft longevity lessens the need for new allografts before optimal intervention is available. Reduced activity of ADAMTS13 (an enzyme that cleaves the pro-thrombotic and proinflammatory von Willebrand factor) and presence of neutrophil extracellular traps (NETs) have been implicated in liver and lung allograft failures. The effect of ADAMTS13 treatment and the impact of NETs on skin allografts, however, remain unexplored. Here, we adopted a murine model of complete mismatch full-thickness skin transplant by grafting dorsal skin from BALB/c mice to C57BL/6J background mice. Recombinant human ADAMTS13 (rhADAMTS13) treatment of graft recipients increased allograft survival. Western blot and immunofluorescence microscopy revealed the presence of NETs in allografts of vehicle, but surprisingly, not in rhADAMTS13-treated mice, 3 days after surgery. Recapitulating the observations in mice, NETs were also observed in all the examined allografts from burn patients. Intriguingly, knocking out peptidylarginine deiminase 4 (PAD4, a key enzyme for NET formation) or DNase 1 treatment (which cleaves NETs) also prolonged allograft survival. In summary, rhADAMTS13 lessens inflammation in allografts by reducing NET burden, resulting in enhanced allograft survival. RhADAMTS13 and anti-NET treatments could be new therapeutic strategies to promote skin allograft longevity and, hence, the survival of patients with severe burns.

Keywords: adhesion molecules/integrins; animal models: murine; basic (laboratory) research/science; immunobiology; organ transplantation in general; rejection; thrombolytic therapy/thrombolysis; tissue (nonvascularized) transplantation; translational research/science.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • ADAMTS13 Protein
  • Allografts
  • Animals
  • Graft Rejection / drug therapy
  • Graft Rejection / prevention & control
  • Graft Survival*
  • Humans
  • Mice
  • Mice, Inbred BALB C
  • Mice, Inbred C57BL
  • Transplantation, Homologous
  • von Willebrand Factor*


  • von Willebrand Factor
  • ADAMTS13 protein, mouse
  • ADAMTS13 Protein
  • ADAMTS13 protein, human