Molecular and Cellular Mechanisms of Neutrophil Extracellular Traps in Cardiovascular Diseases: From NET Formation to Mechanistic Therapeutic Targeting

Neutrophil extracellular traps (NETs) have emerged as key mediators of cardiovascular diseases (CVDs), linking innate immune activation to vascular injury, thrombosis, and maladaptive remodeling. This review synthesizes recent insights into the molecular and cellular pathways driving NET formation, including post-translational modifications, metabolic reprogramming, inflammasome signaling, and autophagy. It highlights the role of NETs in atherosclerosis, thrombosis, myocardial ischemia-reperfusion injury, and hypertension, emphasizing common control points such as peptidylarginine deiminase 4 (PAD4)-dependent histone citrullination and nicotinamide adenine dinucleotide phosphate oxidases 2 (NOX2)-mediated oxidative stress. Mechanistic interpretation of circulating biomarkers, including myeloperoxidase (MPO)-DNA complexes, citrullinated histone H3, and cell-free DNA, provides a translational bridge between NET biology and patient stratification. Therapeutic strategies targeting NETs are examined through three main approaches: inhibition of NET initiation, enhancement of chromatin clearance, and neutralization of toxic extracellular components, with attention to both established and emerging interventions. In contrast to previous reviews, this study highlights the novelty of a mechano-therapeutic framework by providing a mechanistic roadmap linking NET formation pathways to therapeutic targeting in cardiovascular disease. Moving forward, integrating mechanistic information with biomarker discovery, precision profiling, and targeted therapies offers innovative strategies to reduce vascular inflammation and improve outcomes in cardiovascular disease.