Skip to main content
Log in

Clinical symptoms and neutropenia: the balance of neutrophil development, functional activity, and cell death

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Neutrophilic granulocytes form the major type of leukocytes with counts ranging from about 1500–5000 cells/μl of blood under normal conditions. Neutrophils protect our body against bacterial and fungal infections. For this purpose, these cells are equipped with a machinery to sense the site of an infection and, upon local extravasation, rapidly move towards the site with invading micro-organisms, to ingest and kill them. As will be described, for proper functioning of this line of defence, a number of prerequisites have to be fulfilled. The quantitative defects are diagnosed more often and easier than the mere qualitative phagocytic defects. Nonetheless, functional defects may accompany neutropenia. These functional defects are seen in severe congenital neutropenia of which the gene defect has recently been elucidated, as well as in the more complex and syndromal forms of neutropenia such as Shwachman syndrome or the metabolic disease glycogen storage disease type 1b (non-a). The background of functional neutrophil defects is briefly reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

BM :

bone marrow

CN :

cyclic neutropenia

G-CSF :

granulocyte colony-stimulating factor

G-CSFR :

granulocyte colony-stimulating factor receptor

GM-CSF :

granulocyte-monocyte colony-stimulating factor

MPO :

myeloperoxidase

SCN :

severe chronic neutropenia

References

  1. Adams JM, Cory S (1998) The Bcl-2 protein family; arbiters of cell survival. Science 281: 1322–1326

    Article  CAS  PubMed  Google Scholar 

  2. Ambruso DR, Knall C, Abell AN, Panepinto J, Kurkchubasche A, Thurman G, Gonzalez-Aller C, Hiester A, de Boer M, Harbeck RJ, Oyer R, Johnson GL, Roos D (2000) Human neutrophil immunodeficiency syndrome is associated with an inhibitory Rac2 mutation. Proc Natl Acad Sci U S A 97: 4654–4659

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Anderson KL, Smith KA, Pio F, Torbett BE, Maki RA (1998) Neutrophils deficient in PU. 1 do not terminally differentiate or become functionally competent. Blood 92: 1576–1585

    CAS  PubMed  Google Scholar 

  4. Aprikyan AA, Liles WC, Park JR, Jonas M, Chi EY, Dale DC (2000) Myelokathexis, a congenital disorder of severe neutropenia characterized by accelerated apoptosis and defective expression of bcl-x in neutrophil precursors. Blood 95: 320–327

    CAS  PubMed  Google Scholar 

  5. Baggiolini M, Walz, A, Kunkel SL (1989) Neutrophil-activating peptides/interleukin-8: a novel cytokine that activates neutrophils. J Clin Invest 84: 1045–1049

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Belaaouaj A, McCarthy R, Baumann M, et al (1998) Mice lacking neutrophil elastase reveal impaired host defense against gram negative bacterial sepsis. Nat Med 4: 615–618

    Article  CAS  PubMed  Google Scholar 

  7. Betsuyaki T, Liu F, Senior RM, Haug JS, Brown EJ, Jones SL, Matsushima K, Link DC (1999) A functional granulocyte colony-stimulating factor is required for normal chemoattractant-induced neutrophil activation. J Clin Invest 103: 825–832

    Article  Google Scholar 

  8. Bishop AL, Hall A (2000) Rho GTPases and their effector proteins. Biochem J 348: 241–255

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Bokoch GM (1996) Chemoattractant signalling and leukocyte activation. Blood 86: 1649–1660

    Google Scholar 

  10. Brach MA, de Vos S, Gruss HJ, Herrmann F (1992) Prolongation of survival of human polymorphonuclear neutrophils by granulocyte-macrophage colony-stimulating factor is caused by inhibition of programmed cell death. Blood 80: 2920–2924

    CAS  PubMed  Google Scholar 

  11. Bux J, Behrens G, Jaeger G, Welte K (1998) Diagnosis and clinical course of autoimmune neutropenia in infancy: analysis of 240 cases. Blood 91: 181–186

    CAS  PubMed  Google Scholar 

  12. Calderwood S, Kilpatrick L, Douglas SD, Freedman M, Smith-Whitley K, Rolland M, Kurtzberg J (2001) Recombinant human granulocyte colony-stimulating factor therapy for patients with neutropenia and/or neutrophil dysfunction secondary to glycogen storage disease type 1b. Blood 97: 376–382

    Article  CAS  PubMed  Google Scholar 

  13. Dale DC, Person RE, Boylard AA, Aprikan AG et al (2000) Mutations in the gene encoding neutrophil elastase in congenital and cyclic neutropenia. Blood 96: 2317–2322

    CAS  PubMed  Google Scholar 

  14. Dibbert B, Weber M, Nikolaizik WH, Vogt P, Schoni MH, Blaser K, Simon HU (1999) Cytokine-mediated Bax deficiency and consequent delayed neutrophil apoptosis: a general mechanism to accumulate effector cells in inflammation. Proc Natl Acad Sci U S A 96: 13330–13335

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Dong F, Dale DC, Bonilla MA, Freedman M et al (1997) Mutations in the granulocyte colony-stimulating factor receptor gene in patients with severe congenital neutropenia. Leukemia 11: 120–125

    Article  CAS  PubMed  Google Scholar 

  16. Dror Y, Freedman M (1999) Shwachman-Diamond syndrome: an inherited preleukemic bone marrow failure syndrome with aberrant hematopoietic progenitors and faulty marrow microenvironment. Blood 94: 3048–3054

    CAS  PubMed  Google Scholar 

  17. Giles KM, Hart SP, Haslett C, Rossi AG, Dransfield I (2000) An appetite for apoptotic cells? Controversies and challenges. Br J Haematol 109: 1–12

    Article  CAS  PubMed  Google Scholar 

  18. Ginzberg H, Shin J, Ellis L, Morrison J, Ip W, Doror Y, Freedman M, Heitlinger LA, Belt MA, Corey M, Rommens JM, Durie PR (1999) Shwachman syndrome: phenotypic manifestations of sibling sets and isolated cases in a large patient cohort are similar. J Pediatr 135: 81–88

    Article  CAS  PubMed  Google Scholar 

  19. Gorlin RJ, Gelb B, Diaz GA, Lofsness KG, Pittelkow MR, Fenyk JR Jr (2000) WHIM syndrome, an autosomal dominant disorder: clinical, hematological, and molecular studies. Am J Med Genet 91: 368–376

    Article  CAS  PubMed  Google Scholar 

  20. Gross A, McDonnell JA, Korsmeyer SJ (1999) Bcl-2 family members and the mitochondria in apoptosis. Genes Dev 13: 1899–1911

    Article  CAS  PubMed  Google Scholar 

  21. Horwitz, M, Benson KF, Person RE, Aprikyan AG, Dale DC (1999) Mutations in ELA2, encoding neutrophil elastase, define a 21-day biological clock in cyclic haematopoiesis. Nat Genet 23: 433–436

    Article  CAS  PubMed  Google Scholar 

  22. Kasper B, Tidow N, Grothues D, Welte K (2000) Differential expression and regulation of GTPases (RhoA and Rac2) and GDIs (LyGDI and RhoGDI) in neutrophils from patients with severe congenital neutropenia. Blood 95: 2947–2953

    CAS  PubMed  Google Scholar 

  23. Kothakota S, Azuma T, Reinhard C, Klippel A, Tang J, Chu K, McGarry TJ, Kirschner KW, Koths K, Kwiatkowski DJ, Williams LT (1997) Caspase-3-generated fragment of gelsolin: effector of morphological change in apoptosis. Science 278: 294–298

    Article  CAS  PubMed  Google Scholar 

  24. Kuijpers TW, Hakkert BC, Hart MHL, Roos D (1992) Neutrophil migration across monolayers of cytokine-prestimulated endothelial cells: a role for platelet-activating factor and IL-8. J Cell Biol 117: 565–572

    Article  CAS  PubMed  Google Scholar 

  25. Kuijpers TW, de Haas M, de Groot CJ, von dem Borne AE, Weening RS (1996) The use of rhG-CSF in chronic autoimmune neutropenia: reversal of autoimmune phenomena, a case history. Br J Haematol 94: 464–469

    Article  CAS  PubMed  Google Scholar 

  26. Kuijpers TW, Weening RS, Roos D (1999) Laboratory workup for neutrophil dysfunctions: numerical and functional defects. J Immunol Methods 232: 211–229

    Article  CAS  PubMed  Google Scholar 

  27. Leavey PJ, Sellins KS, Thurman G, Elzi D, Hiester A, Silliman CC, Zerbe G, Cohen JJ, Ambruso DR (1998) In vivo treatment with granulocyte colony-stimulating factor results in divergent effects on neutrophil functions measured in vitro. Blood 92: 4366–4374

    CAS  PubMed  Google Scholar 

  28. Lekstrom-Himes JA, Dorman SE, Kopar P, Holland SM, Gallin JI (1999) Neutrophil-specific granule deficiency results from a novel mutation with loss of function of the transcription factor CCAAT/enhancer binding protein epsilon. J Exp Med 189: 1847–1852

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Lenny N, Westendorf JJ, Hiebert SW (1997) Transcriptional regulation during myelopoiesis. Mol Biol Rep 24: 157–168

    Article  CAS  PubMed  Google Scholar 

  30. Liu F, Wu HF, Wesselschmidt R, Kornaga T, Link DC (1996) Impaired production and increased apoptosis of neutrophils in granulocyte colony-stimulating factor receptor-deficient mice. Immunity 5: 491–501

    Article  CAS  PubMed  Google Scholar 

  31. Maianski NA, Mul FPJ, van Buul JD, Roos D, Kuijpers TW (2002) Granulocyte Colony-Stimulating factor (G-CSF) inhibits in neutrophils the mitochondria-dependent activation of Caspase-3. Blood 99: 672–679

    Article  CAS  PubMed  Google Scholar 

  32. Malech HL, Nauseef WM (1997) Primary inherited defects in neutrophil function: etiology and treatment. Semin Hematol 34: 279–290

    CAS  PubMed  Google Scholar 

  33. McCawley LJ, Korchak HM, Douglas SD, Campbell DE, Thornton PS, Stanley CA, Baker L, Kilpatrick L (1994) In vitro and in vivo effects of granulocyte colony-stimulating factor on neutrophils in glycogen storage disease type 1B: granulocyte colony-stimulating factor therapy corrects the neutropenia and the defects in respiratory burst activity and Ca2+ mobilization. Pediatr Res 35: 84–90

    Article  CAS  PubMed  Google Scholar 

  34. Murdoch C, Finn A (2000). Chemokine receptors and their role in inflammation and infectious diseases. Blood 95: 3032–3043

    CAS  PubMed  Google Scholar 

  35. Roos D, Kuijpers TW, Mascart-Lemone F, Koenderman L, de Boer M, van Zwieten R, Verhoeven AJ (1993) Severe neutrophil dysfunction caused by a defect in signal transduction. Blood 81: 2735–2740

    CAS  PubMed  Google Scholar 

  36. Sallusto F, mackay CR, Lanzavecchia A (2000) The role of chemokine receptors in primary, effector, and memory immune responses. Annu Rev Immunol 18: 593–620

    Article  CAS  PubMed  Google Scholar 

  37. Springer TA (1994) Traffic signals for lymphocyte recirculation and leukocyte emigration: the multistep paradigm. Cell 76: 301–314

    Article  CAS  PubMed  Google Scholar 

  38. Thornberry NA, Lazebnik Y (1998) Caspases: enemies within. Science 281: 1312–1316

    Article  CAS  PubMed  Google Scholar 

  39. Van de Winkel JGJ, Capel PJA (1996) Human IgG Fc receptors. Landes, Austin

    Google Scholar 

  40. Van den Berg JM, Weyer S, Weening JJ, Roos D, Kuijpers TW (2001) Divergent effects of tumor necrosis factor-alpha on apoptosis of human neutrophils. J Leukoc Biol 69: 467–473

    PubMed  Google Scholar 

  41. Veiga-da-Cunha M, Gerin I, Van Schaftingen E (2000) How many forms of glycogen storage disease type I? Eur J Pediatr 159: 314–318

    Article  CAS  PubMed  Google Scholar 

  42. Ward AC, van Aesch YM, Gits J, Schelen AM, de Koning JP, van Leeuwen D, Freedman MH, Touw IP (1999) Novel point mutation in the extracellular domain of the granulocyte colony-stimulating factor (G-CSF) receptor in a case of severe congenital neutropenia hyporesponsive to G-CSF treatment. J Exp Med 190: 497–507

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Weinmann P, Gaehtgens P, Walzog B (1999) Bcl-XL- and Bax-α-mediated regulation of apoptosis of human neutrophils via caspase-3. Blood 99: 3106–3115

    Google Scholar 

  44. Zeidler C, Boxer L, Dale DC, Freedman M, Kinsey S, Welte K (2000) Management of Kostmann syndrome in the G-CSF era. Br J Haematol 109: 490–495

    Article  CAS  PubMed  Google Scholar 

  45. Zhang P, Iwama A, Datta MW, Darlington GJ, Link DC, Tenen DG (1998) Upregulation of interleukin 6 and granulocyte colony-stimulating factor receptors by transcription factor CCAAT enhancer binding protein alpha (C/EBP alpha) is critical for granulopoiesis. J Exp Med 188: 1173–1184

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Published online: 13 September 2002

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kuijpers, T.W. Clinical symptoms and neutropenia: the balance of neutrophil development, functional activity, and cell death. Eur J Pediatr 161, S75–S82 (2002). https://doi.org/10.1007/BF02680000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02680000

Keywords

Navigation