Profiling peripheral blood neutrophils in patients with bronchiectasis: an EMBARC study

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Introduction: Neutrophilic inflammation is implicated in the pathogenesis of bronchiectasis. Whether peripheral blood neutrophil function is altered in bronchiectasis patients is controversial. Methods: Single-centre observational study of patients with stable bronchiectasis enrolled in Dundee, UK. Peripheral blood was collected from bronchiectasis patients and a control group. Following neutrophil isolation, activation and functional surface markers were measured by flow cytometry. The neutrophil extracellular trap marker, CitH3 was measured in serum by ELISA. Results: 30 patients with bronchiectasis were included (age 68.1±12.1(mean±SD); 59.1% female) and 15 controls with no known respiratory disease. The activation marker CD11b was significantly lower (p=0.03) while the migration marker CXCR2 was significantly higher (p=0.04) in bronchiectasis patients compared to controls. CD11b positively correlated with FEV1% predicted (r=0.44; p=0.02) and FVC% predicted (r=0.52; p=0.007) scores. Consistent with neutrophil activation being greater in milder disease, CD11b was significantly higher in bronchiectasis patients with an MRC dyspnoea score 0-1 (mild-to-no breathlessness) compared to those with higher scores of 2-4 (p=0.02). Serum CitH3 levels were significantly elevated in bronchiectasis patients in the lower quartile for FEV1% predicted compared to those in quartiles 2-4 (p=0.009). A non-significant trend towards increased CitH3 in those with more severe disease was observed. Conclusion: Changes in systemic neutrophil markers associated with clinical characteristics in bronchiectasis patients. Surprisingly, patients with less severe lung disease had more neutrophil activation.

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