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Biomedical subjects

Joel N Kline

Publications and source records attributed to Joel N Kline.

At least 19 recordsLinked to original sources

Intestinal helminths protect in a murine model of asthma.

Underdeveloped nations are relatively protected from the worldwide asthma epidemic; the hygiene hypothesis suggests this is due to suppression of Th2-mediated inflammation by increased exposure to pathogens and their products. Although microbial exposures can promote Th2-suppressing Th1 responses, even Th2-skewing infections, such as helminths, appear to suppress atopy, suggesting an alternate explanation for these observations. To investigate whether induction of regulatory responses by helminths may counter allergic inflammation, we examined the effects of helminth infection in a murine model of atopic asthma. We chose Heligosomoides polygyrus, a gastrointestinal nematode, as the experimental helminth; this worm does not enter the lung in its life cycle. We found that H. polygyrus infection suppressed allergen-induced airway eosinophilia, bronchial hyperreactivity, and in vitro allergen-recall Th2 responses in an IL-10-dependent manner; total and OVA-specific IgE, however, were increased by worm infection. Finally, helminth-infected mice were protected against eosinophilic inflammation induced by adoptive transfer of OVA-stimulated CD4(+) cells, and transfer of cells from helminth-infected/OVA-exposed mice suppressed OVA-induced eosinophilic inflammation, suggesting a role for regulatory cells. Increased CD4(+)CD25(+)Foxp3(+) cells were found in thoracic lymph nodes of helminth-infected/OVA-exposed mice. Helminthic colonization appears to protect against asthma and atopic disorders; the regulatory cytokine, IL-10, may be a critical player.

Animals↗

Early exposure to a nonhygienic environment alters pulmonary immunity and allergic responses.

The hygiene hypothesis suggests that early life exposure to a nonhygienic environment that contains endotoxin reduces the risk of developing allergic diseases. The mechanisms underlying the hygiene hypothesis are unclear and may involve subtle immune system interactions that occur during maturation. Experimental objectives of this study were to use a novel animal model to test the hygiene hypothesis and to characterize early life immune system responses to a nonhygienic environment. Mice were reared in corn dust, a grain-processing byproduct with a high-endotoxin content and microbial products or in a low-endotoxin environment. The influence of early or later life exposure to corn dust on a subsequent allergen stimulus (ovalbumin) was assessed by bronchoalveolar lavage (BAL) cell analysis, lung histology, serum IgE, and BAL cytokine measurements. The influence of the corn dust environment on the developing pulmonary immune system was assessed by BAL cell analysis and immunostaining of lung tissue. The corn dust environment contained significantly more endotoxin (P < 0.001), and the dust exposures attenuated the cellular inflammatory response to ovalbumin in the adult mouse (P < 0.01) but did not reduce serum IgE levels or alter baseline BAL fluid proinflammatory cytokine levels. The corn dust environment did not induce significant neutrophilia in lavage fluid but significantly increased the number of antigen-presenting cells in alveolar walls early in life by approximately 37%. In conclusion, exposure to a nonhygienic environment did not induce significant airway neutrophilia, yet altered the population of immunologically active cells in the lung and reduced subsequent allergic inflammation.

Animals↗

Cysteinyl leukotriene 1 receptor expression in nasal polyps.

OBJECTIVES: The pathogenesis of nasal polyps, thought to involve complex interactions between different factors, is currently not fully understood. Recent studies have suggested the involvement of cysteinyl leukotrienes (CysLTs) in nasal polyp development. To further understand the role of CysLTs in polyp pathogenesis, we studied the expression of CysLT1 receptors in nasal polyps. METHODS: The study group comprised polyps removed endoscopically from 20 consecutive patients. Samples of ethmoid mucosa from 4 patients who underwent orbital decompression for Graves' ophthalmopathy were used as controls. The presence of CysLT1 receptors was determined with a rabbit anti-human anti-CysLT1 receptor polyclonal antibody. Cells with and without CysLT1 receptor expression were counted within the epithelial layer and stroma by means of light microscopy (40x magnification). RESULTS: There were significantly more cells expressing CysLT1 receptors in the stroma than in the epithelium in both nasal polyps and control specimens. The stroma of polyps also contained more CysLT1 receptor-expressing cells than did controls (29 x 10(3) +/- 7 x 10(3) versus 3 x 10(3) +/- 3 x 10(3) cells per square millimeter; p < .01). In the epithelium of polyps, there was significantly higher expression of CysLT1 receptors than in controls (7 x 10(3) + 3 x 10(3) versus 0 cells per square millimeter; p = .02). No significant differences in polyps were found between patients with and patients without Samter's triad and asthma. CONCLUSIONS: The significant up-regulation of CysLT1 receptors we found in both the stroma and the epithelium of nasal polyps suggests the presence of an inflammatory component in the pathogenesis of polyps, and possibly explains the efficacy of leukotriene modifiers in their treatment.

Biomarkers↗

Safety of incremental inhaled lipopolysaccharide challenge in humans.

BACKGROUND: Inhalation of environmental endotoxin is important in the pathogenesis of asthma and other environmental airway diseases. Inhaled airway challenge using lipopolysaccharide in humans has been performed for over 20 years to assess the airway response to endotoxin. However, there are no published data on the short-term safety of endotoxin inhalation protocols. OBJECTIVE: To characterize the safety and tolerability of incremental inhaled lipopolysaccharide challenge in humans. PATIENTS AND METHODS: We performed a retrospective analysis of data obtained from 119 subjects who underwent inhaled challenge with up to 41.5 mug of lipopolysaccharide. We measured pulmonary function, temperature, mean arterial pressure, heart rate, and systemic symptoms for 3 h after challenge. RESULTS: Fever occurred in 30% of subjects and was associated with a higher cumulative dose of lipopolysaccharide. Reduced mean arterial pressure occurred in 21% of subjects and was dose-related. There was no association between fever or decreased mean arterial pressure and airway responsiveness to inhaled lipopolysaccharide. Common symptoms reported by subjects included: chills (64%), malaise (56%), cough (56%), chest tightness (49%), headache (43%), and myalgias (27%). None of the subjects experienced delayed discharge or a serious adverse event. CONCLUSIONS: Inhaled lipopolysaccharide causes dose-related systemic responses that include fever, reduced blood pressure, and constitutional symptoms that are not associated with the airway response to inhaled lipopolysaccharide. Systemic responses to inhaled lipopolysaccharide should be expected and subjects undergoing inhaled lipopolysaccharide challenge in the research setting should be carefully monitored for non-pulmonary adverse events for several hours after challenge.

Administration, Inhalation↗

School proximity to concentrated animal feeding operations and prevalence of asthma in students.

STUDY OBJECTIVES: Asthma prevalence and severity are rising in industrialized nations. Studies supporting the hygiene hypothesis suggest that being raised on a farm protects against atopy and, often, asthma. In rural United States, however, an increased rate of asthma has been found among schoolchildren. We hypothesized that the rural US environment may not be protective against airway inflammation, perhaps due to environmental effluents from a relatively high number of concentrated animal feeding operations (CAFOs). We compared the prevalence of asthma in two Iowa elementary schools, one adjacent to a CAFO, and the other distant from any large-scale farming operations. DESIGN: Cross-sectional questionnaire-based study. SETTING: Two rural Iowa elementary schools: the study school is located one-half mile from a CAFO, and the control school is distant from any large-scale agricultural operation. PARTICIPANTS: Children, kindergarten through grade 5, who attended either the study school or the control school. RESULTS: Children in the study school had a significantly increased prevalence of physician-diagnosed asthma (adjusted odds ratio, 5.71; p = 0.004). Although this group was more likely to live on a farm and have parents who smoke, these potentially confounding variables did not account for increased prevalence in a multivariate model. No difference in measures of asthma severity was found between the two populations. Because different sets of physicians are responsible for the medical care of the groups of children, it is possible that physician bias is responsible for the different prevalence of asthma diagnoses. This was not explored in the study. CONCLUSIONS: This study supports a role for exposure to rural environmental toxicants in the etiology of asthma, and suggests a need for further study of this relationship.

Animal Feed↗

Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis.

BACKGROUND: Rush immunotherapy (RIT) presents an attractive alternative to standard immunotherapy. However, RIT carries a much greater risk of acute allergic reactions, including anaphylaxis. OBJECTIVES: We hypothesized that omalizumab, a humanized monoclonal anti-IgE antibody, would be effective in enhancing both safety and efficacy of RIT. METHODS: Adult patients with ragweed allergic rhinitis were enrolled in a 3-center, 4-arm, double-blind, parallel-group, placebo-controlled trial. Patients received either 9 weeks of omalizumab (0.016 mg/kg/IgE [IU/mL]/mo) or placebo, followed by 1-day rush (maximal dose 1.2-4.0 mug Amb a 1) or placebo immunotherapy, then 12 weeks of omalizumab or placebo plus immunotherapy. RESULTS: Of the 159 patients enrolled, 123 completed all treatments. Ragweed-specific IgG levels increased >11-fold in immunotherapy patients, and free IgE levels declined >10-fold in omalizumab patients. Patients receiving omalizumab plus immunotherapy had fewer adverse events than those receiving immunotherapy alone. Post hoc analysis of groups receiving immunotherapy demonstrated that addition of omalizumab resulted in a 5-fold decrease in risk of anaphylaxis caused by RIT (odds ratio, 0.17; P = .026). On an intent-to-treat basis, patients receiving both omalizumab and immunotherapy showed a significant improvement in severity scores during the ragweed season compared with those receiving immunotherapy alone (0.69 vs 0.86; P = .044). CONCLUSION: Omalizumab pretreatment enhances the safety of RIT for ragweed allergic rhinitis. Furthermore, combined therapy with omalizumab and allergen immunotherapy may be an effective strategy to permit more rapid and higher doses of allergen immunotherapy to be given more safely and with greater efficacy to patients with allergic diseases.

Adolescent↗

Perspectives in asthma: molecular use of microbial products in asthma prevention and treatment.

Asthma and atopy are characterized by T(H)2-type patterns of inflammation. The hygiene hypothesis suggests that early-life environmental exposure to microbes, other pathogens, and their products promotes innate immune responses that suppress atopy; the current epidemic of allergic disease may result from a dearth of such stimuli. Antiatopic responses engendered by these exposures include both T(H)1-type and regulatory-type patterns, the latter including mechanisms of antigen-presenting cells as well as those of lymphoid origin, and are characterized by prominent IL-10 and/or TGF-beta effects. The Toll-like receptors are an important family of innate immune response elements that have many similar structural and functional properties, but have evolved to recognize distinct ligands as well as to be expressed differentially on immune cells. An active and productive area of current research is investigating the utility of microbes and microbial products for modulation of inflammation in asthma and atopic disorders. Clinical trials have been conducted for some of these biologic compounds, such as cytosine-guanine dinucleotide DNA and Mycobacterium vaccae, whereas others remain in preclinical testing.

Anti-Asthmatic Agents↗

Safety assessment of inhaled xylitol in mice and healthy volunteers.

BACKGROUND: Xylitol is a 5-carbon sugar that can lower the airway surface salt concentration, thus enhancing innate immunity. We tested the safety and tolerability of aerosolized iso-osmotic xylitol in mice and human volunteers. METHODS: This was a prospective cohort study of C57Bl/6 mice in an animal laboratory and healthy human volunteers at the clinical research center of a university hospital. Mice underwent a baseline methacholine challenge, exposure to either aerosolized saline or xylitol (5% solution) for 150 minutes and then a follow-up methacholine challenge. The saline and xylitol exposures were repeated after eosinophilic airway inflammation was induced by sensitization and inhalational challenge to ovalbumin. Normal human volunteers underwent exposures to aerosolized saline (10 ml) and xylitol, with spirometry performed at baseline and after inhalation of 1, 5, and 10 ml. Serum osmolarity and electrolytes were measured at baseline and after the last exposure. A respiratory symptom questionnaire was administered at baseline, after the last exposure, and five days after exposure. In another group of normal volunteers, bronchoalveolar lavage (BAL) was done 20 minutes and 3 hours after aerosolized xylitol exposure for levels of inflammatory markers. RESULTS: In naive mice, methacholine responsiveness was unchanged after exposures to xylitol compared to inhaled saline (p = 0.49). There was no significant increase in Penh in antigen-challenged mice after xylitol exposure (p = 0.38). There was no change in airway cellular response after xylitol exposure in naive and antigen-challenged mice. In normal volunteers, there was no change in FEV1 after xylitol exposures compared with baseline as well as normal saline exposure (p = 0.19). Safety laboratory values were also unchanged. The only adverse effect reported was stuffy nose by half of the subjects during the 10 ml xylitol exposure, which promptly resolved after exposure completion. BAL cytokine levels were below the detection limits after xylitol exposure in normal volunteers. CONCLUSIONS: Inhalation of aerosolized iso-osmotic xylitol was well-tolerated by naive and atopic mice, and by healthy human volunteers.

Administration, Inhalation↗

Endotoxin responsiveness of human airway epithelia is limited by low expression of MD-2.

The expression of inducible antimicrobial peptides, such as human beta-defensin-2 (HBD-2) by epithelia, comprises a component of innate pulmonary defenses. We hypothesized that HBD-2 induction in airway epithelia is linked to pattern recognition receptors such as the Toll-like receptors (TLRs). We found that primary cultures of well-differentiated human airway epithelia express the mRNA for TLR-4, but little or no MD-2 mRNA, and display little HBD-2 expression in response to treatment with purified endotoxin +/- LPS binding protein (LBP) and soluble CD14. Expression of endogenous MD-2 by transduction of airway epithelial cells with an adenoviral vector encoding MD-2 or extracellular addition of recombinant MD-2 both increased the responses of airway epithelia to endotoxin + LBP and sCD14 by >100-fold, as measured by NF-kappaB-luciferase activity and HBD-2 mRNA expression. MD-2 mRNA could be induced in airway epithelia by exposure of these cells to specific bacterial or host products (e.g., killed Haemophilus influenzae, the P6 outer membrane protein from H. influenzae, or TNF-alpha + IFN-gamma). These findings suggest that MD-2, either coexpressed with TLR-4 or secreted when produced in excess of TLR-4 from neighboring cells, is required for airway epithelia to respond sensitively to endotoxin. The regulation of MD-2 expression in airway epithelia and pulmonary macrophages may serve as a means to modify endotoxin responsiveness in the airway.

Antigens, Surface↗

Experimental human exposure to inhaled grain dust and ammonia: towards a model of concentrated animal feeding operations.

BACKGROUND: Ammonia and endotoxin-rich dust are present in high concentrations in swine confinement facilities; exposure to this environment is linked to workers' respiratory problems. We hypothesized that experimental exposure to ammonia and dust would impair pulmonary function, and that these exposures would be synergistic. METHODS: We exposed six normal subjects and eight subjects with mild asthma to ammonia (16-25 ppm) and/or endotoxin-rich grain dust (4 mg/m3). Pulmonary function and exhaled NOx were measured before and after exposure. RESULTS: There was no significant change in pulmonary function in the normal subjects following any of the exposure conditions. Among asthmatics, a significant transient decrease in FEV1 was induced by grain dust, but was not altered by ammonia; increased bronchial hyperreactivity was also noted in this group. CONCLUSION: In a vulnerable population, exposure to grain dust results in transient airflow obstruction. Short-term exposure to ammonia does not increase this response.

Adult↗

Working Group report 3: sensitivity to organic dusts--atopy and gene polymorphisms.

Working Group 3 (Sensitivity to Organic Dusts-Atopy and Gene Polymorphisms) was convened to review the current understanding of how effects of inhaled organic dust may be modified by genetic factors-both those that increase as well as those that may reduce susceptibility. Furthermore, the group was asked to suggest areas that require more investigation in this field. The discussion focused on individual sensitivity to inhaled agents as the most important determinant of inter-individual heterogeneiety in responses to exposures. Genetic modifiers are known for a number of pathologic conditions (including asthma, atopy, chronic obstructive pulmonary disease, and hypersensitivity pneumonitis) associated with inhalation of organic dusts; modifiers are likely to be identified for a number of other disease states. Further studies are required to delineate more precisely the contribution (and the role in inflammatory cascade modulation) of these known polymorphisms, as well as to identify novel genetic factors.

Asthma↗

Acute toxic pneumonitis complicating chronic obstructive pulmonary disease (COPD) in a farmer.

BACKGROUND: Toxic pneumonitis or Organic Dust Toxic Syndrome (ODTS) is a common, usually self-limiting condition among agricultural workers, occurring after high level exposure to agricultural dust. CASE REPORT: We describe the case of a 68-year-old smoker and farmer who became ill with dyspnea, flu-like symptoms, and hypoxia after cleaning out a grain bin. RESULTS: Chest radiograph was normal. He was treated with steroids, antibiotics, and oxygen supplementation and recovered over 3 months, but continues with lingering exercise intolerance after 2 years. DISCUSSION: Although toxic pneumonitis usually follows a relatively benign course with spontaneous recovery and no permanent sequale it can lead to the exacerbation of underlying lung conditions, resulting in incomplete or delayed recovery. Prevention is aimed at limiting exposure by avoidance, by increasing ventilation in closed spaces and by appropriate use of personal protective equipment.

Acute Disease↗

Characterization of a hooded human exposure apparatus for inhalation of gases and aerosols.

A human exposure apparatus was designed to administer a gas and/or aerosol directly to the subject's face. This apparatus utilized a hood associated with a powered air-purifying respirator. The design criteria included the need to maximize subject comfort, maintain consistent atmospheres of a gas or dust within the hood, and the accurate use of direct-reading instruments to monitor exposure levels. An 83-L drum was used to pre-mix the gas or aerosol with the main dilution air prior to entering the hood worn by the subject. A clear plastic oxygen tent, ventilated with room exhaust air, was used to contain contaminants exiting the hood. Bypass valves were added to allow for a startup period during which contaminant concentration levels were allowed to stabilize prior to exposing the human subject. Results from characterization studies demonstrated that the system adequately contained contaminants within the oxygen tent, provided adequate mixing of contaminant and dilution air, produced stable contaminant concentrations over time, and was responsive to sudden changes in contaminant generation rate.

Aerosols↗

DNA, the immune system, and atopic disease.

The prevalence and severity of atopic diseases (atopic dermatitis, asthma, and allergic rhinitis) have increased over recent decades, particularly in industrialized nations. Atopic dermatitis, like asthma, is more common in older siblings and in less crowded houses and with late entry to day care, increased maternal education, and higher socio-economic status. The inverse relationship between the incidence of atopy and childhood infections has led to the "hygiene hypothesis," which suggests that diminished exposure to childhood infections in modern society has led to decreased TH1-type responses. Reduced TH1 may lead to enhanced TH2-type inflammation, which is important in promoting asthma and allergic disease. Corticosteroids, commonly used to treat these conditions, inhibit the function of inflammatory cells, but they are ineffective in altering the initial TH2-type response to allergens in a sensitized individual. Treatment with TH1 cytokines not only has failed to make any significant impact on the outcome of these diseases, but it also has caused significant adverse reactions. A novel therapeutic approach, recently reported in the preclinical setting, is the use of oligodeoxynucleotides, which contain unmethylated motifs centered on CG dinucleotides. These CpG oligodeoxynucleotides potently induce TH1 cytokines and suppress TH2 cytokines, and can prevent manifestations of asthma and other allergic diseases in animal models. They have the potential to reverse TH2-type responses to allergens and thus restore balance to the immune system without the adverse effects of TH1 cytokines.

Animals↗

CpG DNA: immunomodulation and remodelling of the asthmatic airway.

Asthma is a disorder of increasing severity and prevalence. Present understanding of the pathogenesis of asthma emphasises its inflammatory nature. Unbridled inflammation appears to induce irreversible changes, collectively known as airway remodelling. CpG oligonucleotides are a class of compounds that have been developed from studies of prokaryotic DNA. Bacterial DNA, for example, contains sequence motifs based on the dinucleotides cytosine-guanine (CpG); these motifs are suppressed in mammalian DNA and induce (as part of the innate immune system) inflammation, characterised by the induction of T helper type 1 and regulatory responses. The pattern of inflammation promoted by CpG DNA tends to suppress the cytokine and cellular responses characteristic of asthma and atopic disorders. This has led to the investigation and development of CpG DNA as a novel therapeutic approach for the treatment and prevention of these disorders. In addition to suppressing acute and persistent airway inflammation, CpG DNA also reduces the development of subepithelial collagen deposition, goblet cell hyperplasia/metaplasia, and other aspects of airway remodelling. In this paper, the effects of CpG DNA on asthma inflammation and remodelling are reviewed.

Animals↗

Mucosal immunotherapy with CpG oligodeoxynucleotides reverses a murine model of chronic asthma induced by repeated antigen exposure.

Murine models of acute atopic asthma may be inadequate to study the effects of recurrent exposure to inhaled allergens, such as the epithelial changes seen in asthmatic patients. We developed a murine model in which chronic airway inflammation is maintained by repeated allergen [ovalbumin (OVA)] inhalation; using this model, we examined the response to mucosal administration of CpG DNA (oligonucleotides) and specific antigen immunotherapy. Mice repeatedly exposed to OVA developed significantly greater airway hyperresponsiveness and goblet cell hyperplasia, but not airway eosinophilia, compared with those exposed only twice. CpG-based immunotherapy significantly reversed both acute and chronic markers of inflammation as well as airway hyperresponsiveness. We further examined the effect of mucosal immunotherapy on the response to a second, unrelated antigen. Mice sensitized to both OVA and schistosome eggs, challenged with inhaled OVA, and then treated with OVA-directed immunotherapy demonstrated significant reduction of airway hyperresponsiveness and a moderate reduction in eosinophilia, after inhalation challenge with schistosome egg antigens. In this model, immunotherapy treatment reduced bronchoalveolar lavage (BAL) levels of Th2 cytokines (IL-4, IL-5, IL-13, and IL-10) without changing BAL IFN-gamma. Antigen recall responses of splenocytes from these mice demonstrated an antigen-specific (OVA) enhanced release of IL-10 from splenocytes of treated mice. These results suggest that CpG DNA may provide the basis for a novel form of immunotherapy of allergic asthma. Both antigen-specific and, to a lesser extent, antigen-nonspecific responses to mucosal administration of CpG DNA are seen.

Administration, Inhalation↗

CpG oligodeoxynucleotides: a novel therapeutic approach for atopic disorders.

Atopic disorders such as allergic rhinitis, asthma and atopic dermatitis are associated with skewing of immune responses towards a TH2 phenotype, resulting in eosinophilic inflammation. TH2 cytokines promote eosinophil growth, migration and activation, mast cell differentiation, and IgE production, and are candidate mediators of pathologic abnormalities in asthma and other atopic diseases. There has been a significant increase in the prevalence of allergic disorders over the past several decades. Recent epidemiological studies suggest that reduced early-life exposure to strong TH1 stimuli in industrialized counties has skewed the TH1/TH2 balance towards TH2 responses. Improved hygiene, vaccination, and use of antibiotics may contribute to this imbalance. In the last half of the twentieth century we have seen the use of multiple agents to treat atopic disorders, ranging from antihistamines, steroids and leukotriene modifiers to anti-IgE antibodies. All these agents can block symptoms but do not significantly modify the course of the disease. Recent attempts to restore TH1/TH2 balance by blocking TH2 cytokines or inducing TH1 cytokines, have not only failed to alter the outcome of atopic diseases but, in some cases, have caused significant adverse effects. An alternate method of suppressing TH2 responses takes advantage of the innate immune response to bacterial DNA. Oligodeoxynucleotides (ODN) containing sequence motifs centered on unmethylated CG dinucleotides (CpG ODN) resemble bacterial DNA, and like bacterial DNA are immunostimulatory; we and others have shown that CpG ODN can suppress TH2-mediated atopic inflammation without requiring the induction of TH1-type cytokines. These agents may represent a novel therapeutic approach toward restoring immune tolerance in atopic individuals.

Anti-Allergic Agents↗