Biomedical subjects
Publications and source records attributed to T J Gross.
Two heart transplant patients were referred on the same day for evaluation of new chest radiograph abnormalities. Each proved to have advanced stage bronchogenic carcinoma. Review of the recent medical literature reveals that the combination of profound immunosuppression and a heavy smoking history puts cardiac transplant recipients at increased risk for the development of aggressive lung cancers.
A large body of literature supports the role of interleukin-8 (IL-8) in inflammatory lung disease. Numerous factors induce the local synthesis and secretion of this potent chemokine leading to the recruitment and activation of polymorphonuclear leukocytes. However, little is currently known about the fate of IL-8 secreted at sites of inflammatory injury. We have found that incubation of recombinant human IL-8 with purified human neutrophil elastase (HNE) results in the loss of IL-8 chemotactic activity in a dose- and time-dependent fashion. This loss in bioactivity is accompanied by a similar loss of IL-8 immunoreactivity. Western blot analysis revealed that IL-8 chemotactic activity is lost by proteolysis of the parent molecule into undetectable small fragments. The terminal digestion of IL-8 was specific to HNE as no loss of bioactivity was observed with equimolar concentrations of the serine proteases urokinase, plasmin, thrombin, or cathepsin G. This effect on chemotactic activity is not limited to recombinant IL-8 because HNE also digested IL-8 secreted by human monocytes. HNE-mediated proteolysis offers a novel mechanism for down-regulating the inflammatory cascade initiated by IL-8.
Coagulation and fibrinolysis universally accompany tissue injury and repair. The accumulation of regionally generated fibrin degradation products (FDP) may modify the local inflammatory response. We have found FDP to be potent neutrophil chemotaxins. We separated plasmin FDP by chromatofocusing and found chemotactic activity limited to fractions containing the fibrinogen D domain (D-D dimer and D monomer). The bioactivity of the D-D dimer did not require an intact cross link site as removal of this sequence with puff adder venom or hypocalcemic plasmic digestion did not decrease chemotaxis. Peptide inhibition studies confirmed that the chemotactic region did not involve terminal gamma chain sequences or alpha chain RGD motifs. The internal gamma chain peptide KYGWTVFQKRLDGSV (P1), known to bind CD11b/CD18, exhibited concentration dependent chemotactic activity. Similarly, monoclonal antibodies directed against CD11b/CD18 blocked PMN migration to FDP without similar inhibition of chemotaxis to IL-8 or LTB4. Thus, neutrophil chemotaxis to FDP is mediated by interactions between the fibrinogen D domain and CD11b/CD18.
Respiratory syncytial virus (RSV) is an important respiratory pathogen in infants and children. RSV preferentially infects airway epithelium and causes local production of inflammatory cytokines. Ribavirin, the only specific agent available for treatment of RSV infection, has limited effectiveness. There are few data regarding the ability of drugs to modulate the inflammatory response of epithelium infected with RSV. This study evaluated the effect of amiloride and ribavirin on cytokine production by RSV-infected epithelium. We observed a dose-dependent reduction in interleukin (IL)-8 protein release with both amiloride and ribavirin in RSV-infected A549 epithelial cells. Peak effects were observed at concentrations of 200 microM amiloride and 60 microM ribavirin. Both amiloride and ribavirin inhibited IL-8 mRNA induction. Pretreatment with either agent was not required to inhibit IL-8 release. Both drugs also inhibited IL-6 release. However, unlike ribavirin, amiloride did not inhibit viral replication or infection. Amiloride also inhibited IL-8 release from A549 cells stimulated with IL-1 or tumor necrosis factor. Amiloride similarly inhibited IL-8 protein release from primary human airway epithelium infected with RSV. These data demonstrate that both amiloride and ribavirin inhibit cytokine production in RSV-infected airway epithelium. These results suggest amiloride, as well as ribavirin, may be useful as a therapeutic agent in RSV infections.
Pulmonary epithelial injury leads to increased permeability and plasma exudation. Plasma rapidly forms an insoluble fibrin clot in the distal airspace because of the potent procoagulant activity expressed there. Because these airspaces also express potent fibrinolytic activity, digestion of fibrin results in high local concentrations of fibrin degradation products (FDP), which are biologically important molecules with numerous proinflammatory actions. Inflammatory lung injury is associated with neutrophil accumulation, and other matrix proteins affect inflammatory cell traffic. In this study we examined the potential role of FDP in neutrophil recruitment to the lung. Using a chemotaxis assay, we found that FDP are potent chemotactic proteins when neutrophils are prestimulated with lipopolysaccharide (LPS) or formylmethionylleucylphenylalanine (fMLP). Although FDP are high molecular weight proteins, we found that these potent chemoattractants induce polymorphonuclear leukocyte (PMN) migration across epithelial monolayers. The magnitude of response is dependent upon the monolayers' ability to form and maintain tight junctions. Human neutrophil elastase (HNE), another fibrinolytic enzyme released from neutrophils, digests fibrin into chemotactic peptides which are more potent on a weight basis than plasmin-generated FDP. Furthermore, HNE secondarily digests plasmin FDP, producing molecules which are more potent chemoattractants than native plasmin FDP. These observations suggest a potential mechanism whereby FDP may contribute to the neutrophil accumulation which characterizes many inflammatory lung diseases.
Middle lobe syndrome is defined as recurrent or chronic collapse of the middle lobe of the right lung. It occurs in all age groups and is divided into an obstructive type, with a demonstrable airway occlusion, and a nonobstructive type, with a patent right middle lobe bronchus apparent on bronchoscopy. Middle lobe collapse has specific radiographic findings. Malignancy is the most common cause of the obstructive type, and infections are the second leading etiology. The nonobstructive type is associated with inflammatory conditions and bronchiectasis. In all cases, treatment is directed at the underlying cause.
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OBJECTIVE: Our aim was to determine the effect of lung resection on spirometric lung function and to evaluate the accuracy of simple calculation in predicting postoperative pulmonary function in patients undergoing lung resection. DESIGN: We reviewed preoperative and postoperative pulmonary function test results on patients who were followed in the multidisciplinary lung cancer clinic between July 1991 and March 1994 and who underwent lung resection. The predicted postoperative FEV1 and FVC were calculated based on the number of segments resected and were compared with the actual postoperative FEV1 and FVC. SETTING: This study was conducted at a university, tertiary referral hospital. PATIENTS: All patients were evaluated at a multidisciplinary lung cancer clinic and underwent lung resection by one surgeon (L.A.L.). MEASUREMENTS AND MAIN RESULTS: Sixty patients undergoing 62 pulmonary resections were reviewed. The predicted postoperative FEV1 and FVC were calculated using the following formula: predicted postoperative FEV1 (or FVC) = preoperative FEV1 (or FVC) x (1-(S x 0.0526)); where S = number of segments resected. The actual postoperative FEV1 and FVC correlated well with the predicted postoperative FEV1 and FVC for patients undergoing lobectomy (r = 0.867 and r = 0.832, respectively); however, the predicted postoperative FEV1 consistently underestimated the actual postoperative FEV1 by approximately 250 mL. For patients undergoing pneumonectomy, the actual postoperative FEV1 and FVC did not correlate as well with the predicted postoperative FEV1 and FVC (r = 0.677 and r = 0.741, respectively). Although there was considerable variability, the predicted postoperative FEV1 consistently underestimated the actual postoperative FEV1 by nearly 500 mL. Of the patients undergoing lobectomy, eight also received postoperative radiation therapy. When analyzed separately, patients receiving combined therapy lost an average of 5.47% of FEV1 per segment resected. This contrasts with a 2.84% per segment reduction in FEV1 for patients who did not receive radiation therapy. CONCLUSIONS: This simple calculation of predicted postoperative FEV1 and FVC correlates well with the actual postoperative FEV1 and FVC in patients undergoing lobectomy. The predicted postoperative FEV1 consistently underestimated the actual postoperative FEV1 by approximately 250 mL. The postoperative FEV1 and FVC for patients undergoing pneumonectomy is not accurately predicted using this equation. The predicted postoperative FEV1 for patients undergoing pneumonectomy was underestimated by an average of 500 mL and by greater than 250 mL in 12 of our 13 patients. Thus, by adding 250 mL to the above calculation of predicted postoperative FEV1, we improve our ability to we identify a minimal postoperative FEV1 for patients undergoing pneumonectomy. Finally, combined modality treatment with surgery followed by radiation therapy may result in additive lung function loss.
Mononuclear phagocytes concentrate urokinase-type plasminogen activator (uPA) at the cell surface by expressing membrane uPA receptors (uPAR). This study examines the ability of exogenous cytokines to alter expression of membrane-associated uPA and uPAR in U937 mononuclear phagocytes. Cells were stimulated with recombinant interferon gamma (IFN gamma) or tumor necrosis factor alpha (TNF alpha), followed by immunolabeling for uPA or uPAR and flow cytometry. IFN gamma increased surface uPA 2.2-fold relative to unstimulated controls (P < .001), whereas TNF alpha had no significant effect. Likewise, maximal uPA binding capacity was increased 2.8-fold by IFN gamma (P < .02), but was not affected by TNF alpha. In unstimulated cells, 50% of receptors were occupied by endogenously generated uPA, and this proportion was not affected by either cytokine. IFN gamma upregulated uPAR 2.1-fold relative to unstimulated controls (P < .001), whereas TNF alpha had no effect. In contrast to effects on surface protein, TNF alpha induced a substantial increase in uPAR mRNA, equaling the effect of IFN gamma. In addition, both cytokines doubled the intracellular uPAR pool (P < .01). By contrast, TNF alpha induced a 2.5-fold increase in the level of uPAR protein released into conditioned medium (compared with unstimulated cells), whereas IFN gamma had no effect. These results indicate that uPAR expression is regulated in a cytokine-specific fashion. Some stimuli, such as TNF alpha, may increase uPAR synthetic activity without a corresponding change in membrane expression, because of enhanced release of uPAR from the cell. Cytokine-specific modulation of uPAR may be important in regulating the function of mononuclear phagocytes in inflammation and tissue repair.
The inflammatory response to asbestos fiber inhalation suggests that the distal respiratory epithelium is an important early target of asbestos-induced injury. We have previously found that asbestos exposure increases the fibrinolytic activity and mannitol permeability of human airway epithelial cell monolayers. Because fibrin degradation products (FDP) are potent inflammatory mediators, we asked whether asbestos fiber exposure would increase the transepithelial flux of FDP into the interstitial space. To stimulate the pericellular environment following fiber deposition, asbestos-exposed epithelial monolayers grown on permeable filters were covered with human plasma containing fluorescein isothiocyanate (FITC)-labeled human fibrinogen. After 24 h, nearly twice as much FITC-FDP appeared in the abluminal chamber of asbestos-exposed monolayers compared with unexposed controls. This did not result solely from increased degradation product production because asbestos-exposed epithelium was more permeable at all apical FDP concentrations. The proteins that crossed asbestos-exposed monolayers included biologically relevant high-molecular-weight FDP, as demonstrated by streptavidin blotting of biotin-labeled FDP. We also found that FDP flux was not vectorial, was not saturable, did not involve proteolytic processing of FDP, and did not require active transport. Thus asbestos exposure increases the paracellular flux of intact FDP across human airway epithelium. This represents a novel mechanism whereby fiber-induced epithelial dysfunction may initiate and sustain inflammation in the distal airspace.
Chronic exposure to asbestos fibers results in fibrotic lung disease. The distal pulmonary epithelium is an early target of asbestos-mediated injury. Local plasmin activity may be important in modulating endoluminal inflammatory responses in the lung. We studied the effects of asbestos exposure on cell-mediated plasma clot lysis as a marker of pericellular plasminogen activation. Exposing human bronchial epithelial (HBE) cells to 100 micrograms/ml of asbestos fibers for 24 h resulted in increased plasma clot lysis. Fibrinolytic activity was augmented in a dose-dependent fashion, was not due to secreted protease, and occurred only when there was direct contact between the plasma clot and the epithelial monolayer. Further analysis showed that asbestos exposure increased HBE cell-associated urokinase-type plasminogen activator (uPA) activity in a time-dependent manner. The increased cell-associated PA activity could be removed by acid washing. The increase in PA activity following asbestos exposure required new protein synthesis because it was abrogated by treatment with either cycloheximide or actinomycin D. Therefore, asbestos exposure increases epithelial-mediated fibrinolysis by augmenting expression of uPA activity at the cell surface by mechanisms that require new RNA and protein synthesis. These observations suggest a novel mechanism whereby exposure of the distal epithelium to inhaled particulates may result in a chronic inflammatory response that culminates in the development of fibrotic lung disease.
Asbestos causes the fibrotic lung disease asbestosis, but the biologic basis for this is unknown. Lung epithelial dysfunction including increased permeability is hypothesized to contribute to lung scarring in other forms of pulmonary fibrosis. Lung epithelial permeability is increased in both animals and humans exposed to asbestos. It is not known whether the increased epithelial permeability results from direct effects of asbestos or occurs as a result of the inflammatory reaction to asbestos fibers. To address this question we used a cultured human lung epithelial model, and we measured the direct effect of asbestos on lung epithelial barrier integrity as measured by mannitol permeability. We exposed the monolayer to chryogenically ground, respirable-sized chrysotile asbestos particles. This chrysotile asbestos caused a dose- and time-dependent increase in mannitol permeability across the epithelial monolayer. Increased mannitol permeability occurred both in the presence and in the absence of serum, was not due to cytotoxicity as measured by lactate dehydrogenase release, and was not associated with altered actin cytoskeleton at the light microscopic level. Permeability to 70 kDa neutral dextran also increased after asbestos exposure; however, the absolute permeability to dextran was less than mannitol permeability. Neither latex beads nor tantalum caused any change in permeability, suggesting that our findings are not explained by nonspecific effects of particles. Increased permeability did not reverse in the continued presence of asbestos and persisted even after removing the asbestos. Finally, surface-bound iron did not appear to be necessary for this effect because neither chelating iron with deferoxamine nor iron-loading the asbestos altered the effect on mannitol permeability. These results show that asbestos has direct effects on lung epithelial permeability. Together with the recent observation that asbestos directly increases epithelial fibrinolytic activity, our results suggest a novel mechanism for asbestos-induced lung injury.
The persistence of intra-alveolar fibrin during acute and chronic inflammatory lung diseases indicates that the normally profibrinolytic environment of the alveolar space has been altered as part of the disease process. We have recently shown that alveolar epithelial cells may control fibrinolysis by expressing both urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1. In this study, monolayers of rat alveolar epithelial cells were used as a model of the alveolar surface and were found to lyse plasma-derived fibrin matrices by a process that was plasminogen and uPA dependent. Fibrinolysis was not achieved by fluid-phase epithelial products but required the presence of epithelial cells, optimally in close contact with the clot surface. Epithelial cell-mediated fibrinolytic activity was augmented 99% by endotoxin and suppressed 66% by dexamethasone. Fibrinolysis also increased 84% as cells aged in culture from day 1 to day 4, during which time the cells lose many type II cell characteristics and assume a type I cell-like phenotype. We conclude that alveolar epithelial cells actively participate in fibrin clearance through mechanisms that require close proximity between epithelial cell and clot surfaces. Alterations in these mechanisms may be partly responsible for the persistence of intraalveolar fibrin during lung inflammation.
Fibrin deposition in the alveolar space is characteristic of inflammatory lung injury. The formation of fibrin in the alveolus results from the coagulation of extravasated plasma. The cellular elements that promote intra-alveolar clotting have not been completely defined. We have investigated the capacity of alveolar epithelial cells (AEC) to promote coagulation through the expression of procoagulant activity (PCA) in tissue culture. Using a single-stage coagulation assay, rat AEC monolayers were found to contain 20,750 +/- 4,035 procoagulant units (PCU)/10(6) cells; 10- to 20-fold greater activity than that found in concomitantly isolated alveolar macrophages. The epithelial-derived procoagulant was shown to be tissue factor by a series of assays using clotting factor-deficient human plasmas. Freshly isolated AEC also possessed PCA (2,500 +/- 1,000 PCU/10(6) cells) and expressed a 2.1-kb mRNA that hybridized with a cDNA for murine tissue factor. Using a kinetic turbidometric assay of clot acceleration, PCA was found on the surface of unstimulated epithelial monolayers and could be increased to 170% of control by incubation with phorbol myristate acetate (PMA). This response to PMA was accompanied by a parallel increase in the relative abundance of tissue factor mRNA. AEC shed particulate PCA into the culture media that displayed a specific activity similar to that recovered from alveolar lining fluid. Therefore, by expressing both cell surface and particulate PCA, the alveolar epithelium likely contributes significantly to the modulation of intra-alveolar coagulation.
There is considerable evidence to suggest that intra-alveolar plasminogen activation is instrumental in many aspects of inflammatory lung injury and subsequent tissue repair. Rat alveolar epithelial cells produce large quantities of urokinase-type plasminogen activator (uPA) in vitro, and uPA expression is modulated in association with cellular differentiation and exposure to inflammatory mediators. We now report that these cells also secrete heat-stable PA inhibitory activity having the characteristics of PA inhibitor type 1 (PAI-1). In particular, immunoreactive PAI-1 was demonstrable in conditioned media, cell lysates, and extracellular matrix from epithelial cell cultures. As alveolar epithelial cells differentiated in vitro, secreted PA inhibitor activity increased significantly from 104 +/- PAI U/ml (n = 5, mean +/- SE) on day 2 to 442 +/- 150 on day 7 in parallel with increases in secreted and matrix-associated immunoreactive PAI-1. PAI-1 mRNA expression decreased over this same period suggesting posttranscriptional regulation. The levels of both newly synthesized antigen and PAI-1 mRNA were increased by exposure to lipopolysaccharide and tumor necrosis factor-alpha. Thus, by the coexpression of uPA and PAI-1, the alveolar epithelium may actively regulate the generation of plasmin in both the normal and injured alveolus.
A wide spectrum of pulmonary disorders may manifest clinical and radiographic features consistent with infectious pneumonitis. Bronchiolitis obliterans, eosinophilic pneumonia, hypersensitivity pneumonitis, pulmonary vasculitis, alveolar hemorrhage, and alveolar proteinosis all may be difficult to distinguish from community-acquired pneumonia. The salient clinical features of these disorders are reviewed in this article. In addition, specific diagnostic and therapeutic approaches that may aid in differentiating these unusual diseases from the pulmonary infections they mimic are outlined.
Mononuclear phagocytes regulate the generation of plasmin by secreting urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-2 (PAI-2). We investigated the production of plasminogen activator (PA) and PA inhibitor by the human monocytic leukemia cell line, THP-1. Similar to U937 monoblast-like cells and peripheral blood monocytes (PBM), THP-1 cells produce a PA that is specifically neutralized by anti-uPA antibody and comigrates with human high molecular mass uPA (54 kDa) on casein-plasminogen zymogaphy. PA activity could be dissociated from intact THP-1 cells by brief treatment with a weak acid-glycine buffer, indicating that the uPA is secreted and bound to receptors on the plasma membrane. Regulation of uPA proceeds normally in THP-1 cells, with cell-associated PA activity increasing from 77 +/- 20 to 163 +/- 26 and 325 +/- 30 mPU/10(6) cells in response to PMA and LPS, respectively; parallel increases in steady state levels of uPA mRNA were observed. In contrast to normal expression of uPA activity, functional PAI-2 could not be demonstrated in either the conditioned media or cell lysates of THP-1 under basal or stimulated conditions. Both U937 and PBM secrete low levels of PA inhibitor activity that increase substantially in response to stimulation with PMA and LPS. Immunoreactive PAI-2, measured by ELISA, was undetectable in THP-1 lysates or conditioned medium, but was consistently present in U937 and PBM, paralleling the presence of PA inhibitor activity. THP-1 cells express low levels of an abnormally sized mRNA for PAI-2 and demonstrate a regulatory defect whereby steady state levels of PAI-2 mRNA are markedly reduced upon stimulation with PMA or LPS. By contrast, U937 and PBM respond to identical stimulation with increases in PAI-2 mRNA. We conclude that THP-1 cells express a structurally abnormal species of PAI-2 mRNA, with complete loss of inhibitory activity as well as altered function of PMA- and LPS-responsive regulatory elements.
Intra-alveolar fibrin deposition accompanies many forms of inflammatory lung injury. Appropriate clearance of this fibrin matrix is important for normal healing and remodeling. The local generation of plasmin by the action of plasminogen activators (PAs) represents a pivotal step in the fibrinolytic process. To investigate whether the alveolar epithelium plays a role in the modulation of intra-alveolar fibrinolysis, we have studied PA regulation by rat pulmonary alveolar epithelial cells. We have found large quantities of PA activity both in conditioned media and cell lysates from epithelial monolayers in culture. Casein-plasminogen zymography reveals that this PA activity migrates as a tight doublet with an apparent mol wt of 45 kD, clearly distinct from rat tissue-type PA (tPA, greater than 68 kD). Analysis of freshly isolated type II alveolar epithelial cells demonstrates readily measurable PA activity in cell lysates, as well as expression of urokinase-type PA (uPA) mRNA on Northern blot analysis. Upregulation of PA activity occurs progressively with time in culture as the alveolar epithelial cells lose type II cell characteristics and become more flattened. Stimulation of alveolar epithelial cell monolayers with lipopolysaccharide or tumor necrosis factor increases levels of secreted PA activity. The relative abundance of uPA mRNA was shown to change in parallel with PA activity during in vitro differentiation or after exposure to inflammatory mediators. Thus, alveolar epithelial cells are likely an important source of uPA in the lung, the expression of which is influenced by the state of cellular differentiation as well as the presence of inflammatory mediators.(ABSTRACT TRUNCATED AT 250 WORDS)