Olfactomedin 4 Positive Neutrophils are Upregulated Following Hemorrhagic Shock.

Neutrophils are vital to both the inflammatory cascade and tissue repair following injury. Neutrophil heterogeneity is well established, but there is less evidence for significant different functional roles for neutrophil subsets. Olfactomedin 4 (OLFM4) is expressed by a subset of neutrophils and high expression of OLFM4 is associated with worse outcomes in patients with sepsis and acute respiratory distress syndrome. We hypothesized that increased number of OLFM4+ neutrophils would occur in trauma patients with worse clinical outcomes. To test this, we prospectively enrolled patients who suffered blunt traumatic injury. Blood was collected at the time of admission, day three, and day seven and analyzed for percentage of neutrophils expressing OLFM4. We found that a subset of patients who suffered blunt traumatic injury upregulated their percentage of OLFM4 positive neutrophils. Those who upregulated their OLFM4 had increased length of stay, days in the intensive care unit, and ventilator days. A majority of these patients also suffered from hemorrhagic shock. To establish a potential role for OLFM4+ neutrophils we used a murine model of hemorrhagic shock because mice also express OLFM4 in a subset of neutrophils. These studies demonstrated that wild-type mice had higher levels of cytokines in the plasma and myeloperoxidase in the lungs compared to OLFM4 null mice. Additionally, we used anti-OLFM4 antibody, which when given to wild-type mice, led to the reduction of myeloperoxidase in the lungs of mice. These findings suggest that OLFM4+ neutrophils are a unique subset of neutrophils that affect the inflammatory response following tissue injury.