Serum citrullinated histone H3 concentrations differentiate patients with septic verses non-septic shock and correlate with disease severity

Yuzi Tian, Rachel M. Russo, Yongqing Li, Monita Karmakar, Baoling Liu, Michael A. Puskarich, Alan E. Jones, Kathleen A. Stringer, Theodore J. Standiford, Hasan B. Alam

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1 Scopus citations


Purpose: Microbial infection stimulates neutrophil/macrophage/monocyte extracellular trap formation, which leads to the release of citrullinated histone H3 (CitH3) catalyzed by peptidylarginine deiminase (PAD) 2 and 4. Understanding these molecular mechanisms in the pathogenesis of septic shock will be an important next step for developing novel diagnostic and treatment modalities. We sought to determine the expression of CitH3 in patients with septic shock, and to correlate CitH3 levels with PAD2/PAD4 and clinically relevant outcomes. Methods: Levels of CitH3 were measured in serum samples of 160 critically ill patients with septic and non-septic shock, and healthy volunteers. Analyses of clinical and laboratory characteristics of patients were conducted. Results: Levels of circulating CitH3 at enrollment were significantly increased in septic shock patients (n = 102) compared to patients hospitalized with non-infectious shock (NIC) (n = 32, p < 0.0001). The area under the curve (95% CI) for distinguishing septic shock from NIC using CitH3 was 0.76 (0.65–0.86). CitH3 was positively correlated with PAD2 and PAD4 concentrations and Sequential Organ Failure Assessment Scores [total score (r = 0.36, p < 0.0001)]. The serum levels of CitH3 at 24 h (p < 0.01) and 48 h (p < 0.05) were significantly higher in the septic patients that did not survive. Conclusion: CitH3 is increased in patients with septic shock. Its serum concentrations correlate with disease severity and prognosis, which may yield vital insights into the pathophysiology of sepsis.

Original languageEnglish (US)
Pages (from-to)83-93
Number of pages11
Issue number1
StatePublished - Feb 2021

Bibliographical note

Funding Information:
This work was funded by the Norman W. Thompson Endowed Professorship to Dr. Hasan B. Alam, Kickstart N022142, and Mcube U049657 to Dr. Yongqing Li. This work was also supported, in part, by grants from the National Institute of General Medical Sciences (NIGMS), the National Institutes of Health (NIH), GM069438-07 (to J.G.Y.) and GM111400 (to K.A.S). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIGMS or the NIH. Acknowledgments

Publisher Copyright:
© 2020, The Author(s).


  • Citrullinated histone H3
  • Diagnosis
  • Outcomes
  • Peptidylarginine deiminase
  • Sepsis

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