Neutrophil modulation in alpha-1 antitrypsin deficiency

Research output: Contribution to journalReview articlepeer-review

Colleges, School and Institutes


Neutrophils have been implicated in the pathogenesis of alpha-1 antitrypsin deficiency (AATD) since the first descriptions of the disease. Neutrophil proteinases can cause all lung manifestations of AATD, from small airways destruction, to emphysema, to chronic bronchitis and airflow obstruction. Initially, it was proposed that neutrophil functions were normal in AATD, responding in an initially physiological manner to a high burden of pulmonary inflammation. More recent studies have shed new light on this, describing changes in neutrophil responses (a modulation of usual cellular functions) in the presence of inflammation or infection which might enhance tissue damage while impeding bacterial clearance, providing some evidence to support there being an AATD neutrophil phenotype. Many facets of neutrophil function in AATD can be explained by the loss of alpha-1 antitrypsin (AAT) in diverse biological processes. If this were the only reason for altered neutrophil functions, one would predict similar disease presentation across affected people. However, this is not the case. Despite similar (low) levels of AAT, lung disease is extremely variable in AATD, with some patients suffering a significant burden of lung disease and some much less, irrespective of smoking habits and, in some cases, despite augmentation therapy. This review will explore how complex neutrophil responses are and how they are altered with age, inflammation and AATD. Further, it will discuss the need to understand more completely which aspects of AATD-associated disease are driven by neutrophils and how patients more susceptible to neutrophil dysfunction could be identified to potentially stratify treatment approaches.

Bibliographic note

Funding Information: Abbreviations: alpha-1 antitrypsin deficiency, AATD; alpha-1 antitrypsin, AAT; neutrophil elastase, NE; proteinase 3, PR3; chronic obstructive pulmonary disease, COPD; leukotriene B4, LTB4; C-X-C chemokine receptor type 4, CXCR4; C-X-C motif chemokine 12, CXCL12; lymphocyte function-associated antigen 1, LFA-1; macrophage 1 antigen, MAC-1; nicotinamide adenine dinucleotide phosphate, NADPH; reactive oxygen species, ROS; neutrophil extracellular traps, NETs; 18-fluorodeoxyglucose, 18FDG; positron emission tomography-computed tomography, PET-CT; tumor necrosis factor alpha, TNFα; TNF receptor 1, TNF-R1 Funding Support: This article was supported by an unrestricted grant from the Alpha-1 Foundation. Date of Acceptance: January 28, 2020 Citation: Sapey E. Neutrophil modulation in alpha-1 antitrypsin deficiency. Chronic Obstr Pulm Dis. 2020;7(3):247-259. doi: https://doi. org/10.15326/jcopdf.7.3.2019.0164 Funding Information: Dr Sapey reports grants from the Alpha-1 Foundation, Wellcome Trust, Medical Research Council, British Lung Foundation and the National Institute of Health Research. She has no other conflicts of interest. Publisher Copyright: © 2020. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.


Original languageEnglish
Pages (from-to)247-259
Number of pages13
JournalChronic Obstructive Pulmonary Diseases
Issue number3
Publication statusPublished - Sep 2020


  • Alpha-1 antitrypsin deficiency, Bronchitis, Chronic obstructive pulmonary disease, COPD, Emphysema, Exacerbations, Proteinases

ASJC Scopus subject areas