Low Density Granulocytes in ANCA Vasculitis Are Heterogenous and Hypo-Responsive to Anti-Myeloperoxidase Antibodies

Front Immunol. 2019 Nov 7:10:2603. doi: 10.3389/fimmu.2019.02603. eCollection 2019.


Low Density Granulocytes (LDGs), which appear in the peripheral blood mononuclear cell layer of density-separated blood, are seen in cancer, sepsis, autoimmunity, and pregnancy. Their significance in ANCA vasculitis (AAV) is little understood. As these cells bear the autoantigens associated with this condition and have been found to undergo spontaneous NETosis in other diseases, we hypothesized that they were key drivers of vascular inflammation. We found that LDGs comprise a 3-fold higher fraction of total granulocytes in active vs. remission AAV and disease controls. They are heterogeneous, split between cells displaying mature (75%), and immature (25%) phenotypes. Surprisingly, LDGs (unlike normal density granulocytes) are hyporesponsive to anti-myeloperoxidase antibody stimulation, despite expressing myeloperoxidase on their surface. They are characterized by reduced CD16, CD88, and CD10 expression, higher LOX-1 expression and immature nuclear morphology. Reduced CD16 expression is like that observed in the LDG population in umbilical cord blood and in granulocytes of humanized mice treated with G-CSF. LDGs in AAV are thus a mixed population of mature and immature neutrophils. Their poor response to anti-MPO stimulation suggests that, rather than being a primary driver of AAV pathogenesis, LDGs display characteristics consistent with generic emergency granulopoiesis responders in the context of acute inflammation.

Keywords: ANCA associated vasculitis; anti-MPO; low density granulocytes; neutrophil heterogeneity; reactive oxygen species.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / enzymology
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / immunology*
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / pathology
  • Antigens, Surface / metabolism
  • Autoantibodies / immunology*
  • Cell Count
  • Female
  • Flow Cytometry
  • GPI-Linked Proteins / metabolism
  • Granulocytes / immunology
  • Granulocytes / physiology*
  • Humans
  • Male
  • Mice
  • Middle Aged
  • Myelopoiesis
  • Peroxidase / immunology*
  • Phenotype
  • Receptors, IgG / metabolism


  • Antigens, Surface
  • Autoantibodies
  • FCGR3B protein, human
  • GPI-Linked Proteins
  • Receptors, IgG
  • Peroxidase