Challenging role of neutrophil extracellular traps in vascular complications of diabetes mellitus

Diabetes mellitus (DM) is a global metabolic disease with prevalence rates which have reached pandemic levels. This disease is strongly associated with vascular complications, even when the hyperglycemia is kept under control. The main complications of DM are stroke, myocardial infarction, and peripheral artery disease, and they often increase the risk of developing atherosclerosis, inflammatory angiopathy, and thrombosis. Angiopathy is commonly initiated by microvascular inflammation characterized by neutrophil extracellular traps (NETs) and metabolic abnormalities, and is controlled by (epi)-genetic events and immune / antigen-presenting cells. NETs play an important role in blood coagulation, activation of the innate and adaptive immune system, as well as vascular integrity and endothelial dysfunction. The aim of the review is to summarize the current knowledge about the role of NETs in the pathogenesis of vascular complications in DM.