Representative images of immunofluorescence staining to detect citrullinated histone H3 (Cit-H3).

<p>Citrullination of histone H3, which is a critical enzymatic process to produce NETs through decondensation of chromatin, was visualized in the blood smear samples using anti-citrullinated histone H3 antibody by immunohistochemistry. Cit-H3 was present in the bloodstream of critically ill patients. The inset in the merged image is the magnified image of a representative cell (white rectangle) expressing citrullinated histone H3 in the nucleus. Neutrophil extracellular traps are not recognized here. In the blood smears surveyed in this study, we identified Cit-H3 in 11 patients (11/49, 22.4%). Blue, 4′,6-diamidino-2-phenylindole (DAPI); red, histone H3; green, citrullinated histone H3 (Magnification ×400). Scale bar; 50 µm.