Background

Inflamed environments are typically hypercellular, rich in pro‐inflammatory cytokines, and profoundly hypoxic. While the effects of hypoxia on neutrophil longevity and function have been widely studied, little is known about the consequences of this stimulus on eosinophils.
Objective

We sought to investigate the effects of hypoxia on several key aspects of eosinophil biology, namely secretion, survival, and their sensitivity to glucocorticosteroids (GCS), agents that normally induce eosinophil apoptosis.
Methods

Eosinophils derived from patients with asthma/atopy or healthy controls were incubated under normoxia and hypoxia, with or without glucocorticoids. Activation was measured by flow cytometry, ELISA of cultured supernatants, and F‐actin staining; apoptosis and efferocytosis by morphology and flow cytometry; and GCS efficacy by apoptosis assays and qPCR.
Results

Hypoxic incubation (3 kPa) caused (i) stabilization of HIF‐2α and up‐regulation of hypoxia‐regulated genes including BNIP3 (BCL2/adenovirus E1B 19‐kDa protein‐interacting protein 3) and GLUT1 (glucose transporter 1); (ii) secretion of pre‐formed IL‐8, and Charcot Leyden crystal (CLC) formation, which was most evident in eosinophils derived from atopic and asthmatic donors; (iii) enhanced F‐actin formation; (iv) marked prolongation of eosinophil lifespan (via a NF‐κB and Class I PI3‐kinase‐dependent mechanism); and (v) complete abrogation of the normal pro‐apoptotic effect of dexamethasone and fluticasone furoate. This latter effect was evident despite preservation of GCS‐mediated gene transactivation under hypoxia.
Conclusion and Clinical Relevance

These data indicate that hypoxia promotes an eosinophil pro‐inflammatory phenotype by enhancing eosinophil secretory function, delaying constitutive apoptosis, and importantly, antagonizing the normal pro‐apoptotic effect of GCS. As eosinophils typically accumulate at sites that are relatively hypoxic, particularly during periods of inflammation, these findings may have important implications to understanding the behaviour of these cells in vivo.