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There is little doubt that neutrophils, while vital in host defence, have the potential to cause significant tissue damage implicated both in lung and systemic diseases as well as systemic organ failure. Following pathogen recognition receptor activation by agents including formyl-methionyl-leucyl-phenylalanine (fMLP), cigarette smoke, cytokines or complement factor C5a, neutrophils are activated, recruited and participate in tissue breakdown and bacterial clearance via an array of mechanisms including phagocytosis, superoxide burst, extrusion of neutrophil extracellular traps (de-condensed chromatin and antimicrobial protein coated web-like structures), secretion of reactive oxygen and nitrogen species, and extrusion of a range of granule-derived proteases and antimicrobial peptides. These proteases, hydrolases and antimicrobial peptides are thought to contribute to many cellular functions including neutrophil migration, adherence and apoptosis, but their extra-cellular release is also associated with obligate tissue damage (as described in studies of quantum proteolysis1) and inflammation, and neutrophil proteinases in particular have been found to have a myriad of pro-inflammatory effects on bystander tissue to amplify inflammation, favouring further cell recruitment and degranulation.

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