Neutrophils are granular immune cells and the most abundant leukocyte in peripheral blood, constituting about 50%-70% of leukocytes on average. They develop in the bone marrow from granulocyte-monocyte precursors (GMPs), which in turn develop from hematopoietic progenitor cells (HPCs) in the presence of granulocyte colony-stimulating factor (G-CSF). At homeostasis, they have a lifespan of ~24 h, but studies have shown that their lifespan can be extended under specific physiological conditions and their associated microenvironments such as chronic immune activation1, inflammation1, and even tissue residency in steady state2. Neutrophils have long been considered the first line of defense against pathogens and elicit their anti-microbial effects through 3 major effector functions -- degranulation, phagocytosis, and neutrophil extracellular trap (NET) activation and release (NETosis).
Most studies on neutrophil function and biology examine outcomes for the total neutrophil population. However, from studies in cancer settings delineating N1 (anti-tumor)/ N2 (pro-tumor) subtypes to the classification of neutrophils based on maturity, disease, and physiological state, and even cellular density (low density and normal density neutrophils), it has become increasingly apparent that the human neutrophil population constitutes phenotypically diverse subtypes. Whether the existence of these neutrophil subtypes can be attributed to being completely distinct cell types or due to the complex nature of plasticity, there exists a growing body of literature on atypical neutrophils and presents a compelling opportunity to study low-density neutrophils separate from normal-density neutrophils3.
Described for the first time in SLE patients as a pro-inflammatory neutrophil subset4, LDNs have since been identified in chronic diseases, pregnancy, and even in healthy circulation, in pro-inflammatory as well as suppressive capacities5,6,7,8. LDNs are found concurrently with peripheral blood mononuclear cells (PBMCs) when whole blood is centrifuged over density gradient media. Their specific density corresponds to approximately 1.077 g/mL, compared to NDNs at 1.083 g/mL9. While there is still considerable debate on the subject, there exists speculation that LDNs resemble a more immature granulocyte phenotype (similar to promyelocytes and myelocytes, with a density below 1.080 g/mL)9,10. Others still speculate that there are both mature and immature LDN phenotypes depending on the presence or absence of disease11,12,13. Nevertheless, LDNs have also been detected in healthy individuals; however, their inclusion in some studies is limited due to the difficulty in isolating them in sufficient numbers5.
This study aimed to isolate these two populations in quantities that would allow us to perform downstream in situ metabolic experiments (minimum 0.5 × 106 cells/mL). In doing so, an existing protocol5 was optimized with commonly reported phenotypic markers13,14 that provide the best outcome for isolating and characterizing LDNs and NDNs from whole blood (Figure 1A).