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Growth hormone (GH) action in the developing lung: changes in lung proteins after adenoviral GH overexpression.

Growth hormone (GH) recently has been shown to be expressed in the neonatal rat lung during alveolarization. The possible functional importance of lung GH in lung function, therefore, has been assessed by determining changes in GH-responsive proteins in the developing rat lung after the overexpression of the GH gene in this tissue. GH overexpression was achieved using an adenovirus that expressed the mouse GH gene. This adenovirus was effective in inducing mouse GH expression in cultured rat lung L2 epithelial cells. It was also shown to be strongly expressed in the alveoli of 14-day-old rat pup lungs 10 days after it was administered by intratracheal injection, during a period of rapid lung development. Expression of the transgene in these pups was accompanied by changes in lung protein concentrations determined by two-dimensional gel electrophoresis and mass spectrometry. The lung concentrations of specific enzymes (nucleotide diphosphate kinase B, Cu/Zn superoxide dismutase, glutathione-S-transferase, and aldehyde reductase-1) were increased by the adenoviral expression of mouse GH, as were the concentrations of beta subunit G-protein calponin 2, beta-5 tubulin, retinoblastoma binding protein 4, and fetuin A. In contrast, the lung concentrations of haptoglobin and major acute phase alpha-1 protein were reduced by adenoviral expression of mouse GH. Although most of these proteins have not previously been identified as GH-responsive proteins, these results demonstrate actions of GH in the rat lung and support the possibility that GH acts as an autocrine/paracrine during early lung development.

Adenoviridae↗

Lung-derived growth factor that stimulates the growth of lung-metastasizing tumor cells: identification as transferrin.

We have previously shown that culture medium conditioned by lung fragments contains mitogenic activity for lung-metastasizing tumor cells but not for their non-metastatic counterparts. The growth-promoting component from media conditioned by rat and porcine lungs has been purified and partially characterized as a Mr approximately 66,000 (unreduced) or Mr approximately 72,000 (reduced) glycoprotein [Cancer Res 49:3928, 1989; J Cell Biochem 43:127, 1990]. Here we report that this factor is the iron transport protein transferrin. Migration distances in sodium dodecyl sulfate and native gel polyacrylamide electrophoresis systems were similar, as were the specific activities and spectrum of mitogenic activities of the lung-derived growth factor and transferrin. Electrophoretically separated holo-rat transferrin and rat lung-derived growth factor displayed similar positive stains for iron. A polyclonal antibody generated against the lung-derived growth factor cross-reacted with human and rat transferrin in Western blots, and anti-human transferrin cross-reacted with rat lung-derived growth factor. All of the mitogenic activity contained in crude lung conditioned media could be removed by antibody-mediated transferrin depletion. The putative cell receptor molecular weights for the lung-derived growth factor and transferrin were similar as were the molecular weights of polypeptides produced by partial trypsin cleavage of the two. Finally, the amino acid sequence of certain regions of rat lung-derived growth factor demonstrated a high degree of homology to human transferrin. The physical and biochemical properties, antigenicity, and mitogenic activity of a previously unidentified lung-derived growth factor for lung-metastasizing tumor cells indicate that it is transferrin.

Amino Acid Sequence↗

When does the lung die? Time course of high energy phosphate depletion and relationship to lung viability after "death".

The shortage of lung donors for clinical transplantation could be significantly alleviated if lungs could be retrieved from cadavers hours after death. However, the time course of loss of lung viability after circulatory arrest and organism death remains unclear. To determine postmortem adenine nucleotide tissue levels in the lung and their relationship to lung viability, Sprague-Dawley rats were sacrificed and then ventilated with 100% oxygen (n = 50, O2) or 100% nitrogen (n = 40, N2) or left nonventilated (n = 50). Lungs from control rats (n = 20) were retrieved immediately after sacrifice. Lungs in the three study groups were retrieved at successive intervals postmortem. Adenine nucleotides (ATP, ADP, and AMP) and hypoxanthine and xanthine metabolites of adenosine were extracted from lung tissue and measured using high-performance liquid chromatography. Pulmonary parenchymal cell viability was quantified by pulmonary artery infusion of trypan blue vital dye in the contralateral lung of each animal. By 4 hr postmortem, viability was 85 +/- 1% in the O2-ventilated cadaver rat lungs, significantly higher than in the N2-ventilated (43 +/- 8%) and in the nonventilated (48 +/- 4%) lungs, where the percentage of viable cells was similar. All of the groups showed a time-dependent decrement in ATP levels and total adenine nucleotide (TAN) levels after death, but this was markedly attenuated in O2-ventilated cadaveric rat lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenine Nucleotides↗

Murine model of BCG lung infection: dynamics of lymphocyte subpopulations in lung interstitium and tracheal lymph nodes.

C57Bl/6 female mice were infected with an intrapulmonary dose of 2.5 x 10(4) BCG (Mycobacterium bovis Bacillus Calmette-Guerin). Lymphocyte populations in lung interstitium and lung-associated tracheal lymph nodes (LN) were examined at 1, 2, 4, 5, 6, 8 and 12 weeks after infection. BCG load in lungs peaked between 4-6 weeks post-infection and declined to very low levels by the 12th week of infection. Lung leukocytes were obtained over the course of infection by enzyme digestion of lung tissue followed by centrifugation over Percoll discontinuous density gradients. By 4 to 6 weeks after infection, numbers of lung leukocytes had more than doubled but the proportions of lymphocytes (about 70%), macrophages (about 18%) and granulocytes (about 12%) remained essentially unaltered. Flow cytometric studies indicated: (i) the total number of CD3+ T cells in lungs increased by 3-fold relative to uninfected controls at 5 to 6 weeks post-infection, but the relative proportions of CD4 and CD8 cells within the T cell compartment remained unaltered; (ii) relative proportion of NK cells in lungs declined by 30% but the total number of NK cells (NK1.1+) per lung increased by about 50%, 5-6 weeks post infection; (iii) tracheal LN underwent marked increase in size and cell recoveries (6-10-fold increase) beginning 4 weeks after infection. While both T and B cells contributed to the increase in cell recoveries from infected tracheal LNs, the T/B ratio declined significantly but CD4/CD8 ratio remained unaltered. In control mice, IFNgamma producing non-T cells outnumbered T cells producing IFNgamma. However, as the adaptive response to infection evolves, marked increase occur in the number of IFNgamma producing T cells, but not NK cells in the lungs. Thus, T cells are the primary cell type responsible for the adaptive IFNgamma response to pulmonary BCG infection. Few T cells in tracheal LN of BCG infected mice produce IFNgamma, suggesting that maturational changes associated with migration to the lungs or residence in the lungs enhance the capability of some T cells to produce this cytokine.

Animals↗

Sliding thin slab, minimum intensity projection of the lung in asymptomatic subjects: lower limits of lung attenuation, without airways.

PURPOSE: A sliding thin slab, minimum intensity projection (STS-MinIP) is considered to be useful for detecting diseases that decrease lung attenuation. For evaluating these diseases, it would be useful to ascertain the lower limits of normal lung attenuation, allowing a division between normal and subnormal attenuation. However, normal lung attenuation may vary depending on respiratory status, anatomical position, and patient background factors. Our aim was to determine whether the lower limits of lung attenuation, without airways, in asymptomatic subjects using STS-MinIP varies under different conditions. MATERIALS AND METHODS: The study subjects were 43 volunteers without pulmonary symptoms. STS-MinIP was performed at full inspiration and full expiration at three levels of the lung. The lower limits of lung attenuation were compared among the three lung levels and between full inspiration and full expiration, the sexes, age groups, smokers and nonsmokers, and the right and left lungs. RESULTS: The lower limits of lung attenuation had significantly different Hounsfield unit values among lung levels, between the sexes at full inspiration, and between age groups at full expiration. CONCLUSION: This study shows that the lower limits of lung attenuation are influenced by lung fields, sex, and, on expiration, age.

Adult↗

A method for isolating human lung macrophages and observations of fluorescent phagocytes from the lungs of habitual cigarette smokers.

We report the development of a simple, efficient, expedient, and inexpensive procedure for isolating a large and relatively pure population of macrophages (Mphi) from residual (i.e., non-tumor) lung tissue obtained from lung cancer patients undergoing either a lobectomy or pneumonectomy. The proposed technique was founded on observations by fluorescent microscopy of fresh, non-fixed, and non-stained human lung tissue. Examinations of 74 specimens from different patients revealed that most of the Mphi reside as non-adherent cells within the sponge-like lung stroma. Very few Mphi were observed in the lungs of nonsmokers. In contrast, many Mphi were visible in the lungs of habitual smokers. For most specimens from smokers, a few of the Mphi were present as randomly distributed single cells; the majority of the Mphi, however, were in clusters that ranged from a dozen to several hundred cells. The Mphi could be released readily by different mechanical techniques. In the procedure reported herein, pulmonary leukocytes (> 75% Mphi) were dislodged easily from lung tissue with the use of an inexpensive, hand-operated, tissue grinder. The grinder consisted of a glass mortar and Teflon pestle that provided sufficient clearance between the mortar and pestle so as to avert damaging the displaced leukocytes. The leukocytes were then segregated by centrifugation on a density gradient. Further purification was achieved by harvesting Mphi that had been allowed to adhere to serum-coated polystyrene culture dishes (> 90% Mphi). In most experiments, the Mphi yield (approximately 5 x 10(6) Mphi /gr of lung) and Mphi viability (> 85%) were good. A significant advantage of this technique is that it avoids jeopardizing the cells to the hazards associated with enzymes that have been used in techniques employed previously for isolating Mphi from the lung and other organs. Thus, the proposed method provides numerous lung Mphi for detailed studies of their morphology, phenotype, and function. Moreover, lung Mphi were cultured as non-adherent, single cells in a serum- and cytokine-free tissue culture medium for more than 6 weeks. Lung Mphi from habitual smokers displayed a high level of fluorescence that was readily apparent when viewed with a fluorescence microscope that had been configured with either a fluorescein or rhodamine filter. Serial sections of single, living Mphi obtained with the use of a confocal laser scanning microscope revealed that the fluorescence originated from cytoplasmic inclusions. Relative fluorescence intensity was measured by cytometry.(ABSTRACT TRUNCATED AT 400 WORDS)

Bronchoalveolar Lavage Fluid↗

The impact of central lung distance, maximal heart distance, and radiation technique on the volumetric dose of the lung and heart for intact breast radiation.

PURPOSE: To investigate the impact of radiographic parameter and radiation technique on the volumetric dose of lung and heart for intact breast radiation. METHODS AND MATERIALS: Forty patients with both two-dimensional (2D) and computed tomographic (CT) simulations were enrolled in the study. Central lung distance (CLD), maximal heart distance (MHD), and maximal heart length (MHL) were measured under virtual simulation. Four plans were compared for each patient. Plan A used a traditional 2D tangential setup. Plan B used clinical target volume (CTV) based three-dimensional (3D) planning. Both plans C and D used a combination of a medial breast field with shallow tangents. Plan D is a further modification of plan C. RESULTS: Under the traditional tangential setup, the mean ipsilateral lung dose and volume at 20, 30, and 40 Gy correlated linearly with CLD (R = 0.85 approximately 0.91). The mean ipsilateral lung dose (Gy) approximated 4 times the CLD value (cm), whereas the percentage volume (%) of ipsilateral lung at 20, 30, and 40 Gy was about 10 times the CLD (cm). The mean heart dose and percentage volume at 20, 30, and 40 Gy correlated with MHD (R = 0.76 approximately 0.80) and MHL (R = 0.65 approximately 0.75). The mean heart dose (Gy) approximated 3 times the MHD value (cm), and the percentage volume (%) of the heart at 10, 20, 30, and 40 Gy was about 6 times MHD (cm). Radiation technique impacted lung and heart dose. The 3D tangential plan (plan B) failed to reduce the volumetric dose of lung and heart from that of the 2D plan (plan A). The medial breast techniques (plans C and D) significantly decreased the volume of lung and heart receiving high doses (30 and 40 Gy). Plan D further decreased the 20 Gy volumes. By use of the medial breast technique, the lung and heart dose were not impacted by original CLD and MHD/MHL. Therefore, the improvement from the tangential technique was more remarkable for patients with CLD >or= 3.0 cm (p < 0.001). CONCLUSIONS: The CLD and MHD impact the volumetric dose of lung and heart. The application of 3D planning for tangential breast irradiation does not decrease heart and lung dose. Adding a medial breast port significantly decreases percentage volume (PV) of lung and heart receiving high doses, especially when the CLD is excessive.

Breast Neoplasms↗

The role of cryotherapy for airway complications after lung and heart-lung transplantation.

OBJECTIVE: Although airway problems after lung and heart-lung transplantation have been greatly reduced due to changes in surgical technique, excessive granulation tissue at the anastomosis may threaten airway patency. Treatment options include electrocautery, dilation, laser coagulation and stent placement however, recurrence remains a problem. Cryotherapy, the controlled application of extreme cold, is effective at causing cell lysis in granulation tissue and may therefore be effective after lung transplantation for airway problems arising from granulation stenosis. Our objective was to review our experience with cryotherapy as a first-line treatment for airways compromised by granulation tissue after lung and heart-lung transplantation. METHODS: A retrospective analysis of patient records after lung and heart-lung transplantation was performed. A total of 696 patients were identified who received lung or heart-lung transplants, 64 of whom were found to have granulation tissue at the site of airway anastomosis (8.9% of 721 airways at risk). When the granulation tissue was found to narrow the lumen by > or = 50% and affect lung function. RESULTS: The trachea was involved in 5 patients and the main stem bronchus in 16. Each patient required a mean of 2.6 +/- 2.0 cryoapplications. Anatomical results of cryotherapy were judged excellent to good in 15 patients and fair in 6 patients. Eight patients required endobronchial stenting as part of a multimodality treatment. Overall, the post-treatment FEV1 and FVC increased by 34 +/- 36% and 25 +/- 27% from pre-treatment values respectively (P < 0.001). In 13 patients in whom cryotherapy and dilation alone were effective, the FEV1 increased by 41 +/- 43% (range -11 +/- 138%) and the FVC by 28 +/- 29% (range -4 +/- 96%). These changes were also significant (P < 0.001). Changes in these two parameters were positively and significantly correlated (P < 0.01). Acturial survival at 3 and at 5 years were 57 and 43%, respectively (NS compared to total cohort), and median survival was 978 days (range 365-1862). Six patients are alive at a median follow-up of 5.75 years (range 0.6-8.3). CONCLUSIONS: We conclude that cryotherapy is a safe, effective treatment for excessive granulation tissue after lung and heart lung transplantation and may reduce the need for endobronchial stenting and limit recurrence.

Adult↗

Effect of ventilator-induced lung injury on the development of reperfusion injury in a rat lung transplant model.

OBJECTIVE: Although mechanical ventilation can potentially worsen preexisting lung injury, its importance in the setting of lung transplantation has not been explored. This study was undertaken to examine the effect of 2 ventilatory strategies on the development of ischemia-reperfusion injury after lung transplantation. METHODS: In a rat lung transplant model animals were randomized into 2 groups defined by the ventilatory strategy during the early reperfusion period. In conventional mechanical ventilation the transplanted lung was ventilated with a tidal volume equal to 50% of the inspiratory capacity of the left lung and a low positive end-expiratory pressure. In minimal mechanical stress ventilation the transplanted lung was ventilated with a tidal volume equal to 20% of the inspiratory capacity of the left lung, and positive end-expiratory pressure was adjusted according to the shape of the pressure-time curve to minimize pulmonary stress. RESULTS: After 3 hours of reperfusion, oxygenation from the transplanted lung was significantly higher with minimal mechanical stress ventilation than with conventional ventilation. In addition, elastance, cytokine levels, and morphologic signs of injury were significantly lower in the group with minimal mechanical stress ventilation. CONCLUSIONS: This study demonstrates that the mode of mechanical ventilation used in the early phase of reperfusion of the transplanted lung can influence ischemia-reperfusion injury, and a protective ventilatory strategy on the basis of minimizing pulmonary mechanical stress can lead to improved lung function after lung transplantation.

Animals↗

Multiple markers for lung cancer diagnosis: validation of models for localized lung cancer.

Sera from 71 patients with localized lung cancer, from 70 normal controls, and from 73 patients with benign lung diseases were analyzed for 10 substances to detect lung cancer: ferritin, lipid-bound sialic acid, total sialic acid, beta 2-microglobulin, lipotropin, the alpha and beta subunits of human chorionic gonadotropin, calcitonin (two assays), parathyroid hormone, and carcinoembryonic antigen (CEA). Individual markers were studied, and optimal combinations of markers were sought for discriminating patients with localized lung cancer from normal controls and from patients with benign lung disease. Both logistic regression and recursive partitioning methods for discrimination were tried. The best rules involved only CEA and ferritin for discriminating patients with lung cancer from normal controls, and CEA and age for discriminating patients with lung cancer from those with benign lung diseases. The performance of these rules was validated on an independent serum panel containing sera from 56 patients with localized lung cancer, 75 normal controls, and 75 patients with benign lung diseases. Three rules designed to achieve 95% specificity against normal controls attained 14%-36% sensitivity for localized lung cancer in the validation panels, whereas three rules designed to achieve 95% specificity against benign lung diseases attained 30%-39% sensitivity. Some aspects of potential clinical applications are discussed.

Age Factors↗

Spontaneous breathing improves lung aeration in oleic acid-induced lung injury.

BACKGROUND: Experimental and clinical studies have shown reduction in intrapulmonary shunt with improved oxygenation by spontaneous breathing with airway pressure release ventilation (APRV) in acute lung injury. The mechanisms of these findings are not clear. The authors hypothesized that spontaneous breathing results in better aeration of lung tissue and that improvement in oxygenation can be explained by these changes. This hypothesis was studied in a porcine model of oleic acid-induced lung injury. METHODS: Two hours after induction of lung injury, 24 pigs were randomly assigned to APRV with or without spontaneous breathing at a positive end-expiratory pressure of 5 cm H(2)O. Hemodynamics, spirometry, and end-expiratory lung volume by nitrogen washout were measured at baseline, after 2 h of lung injury, and after 2 and 4 h of mechanical ventilation in the specific mode. Finally, spiral computed tomography of the chest was performed at end-expiratory lung volume in 22 pigs. RESULTS: Arterial carbon dioxide tension and mean and end-inspiratory airway pressures were comparable between settings. Four hours of APRV with spontaneous breathing resulted in improved oxygenation compared with APRV without spontaneous breathing (arterial oxygen tension, 144 +/- 65 vs. 91 +/- 50 mmHg, P < 0.01 for interaction time x mode), higher end-expiratory lung volume (786 +/- 320 vs. 384 +/- 148 ml, P < 0.001), and better aeration. End-expiratory lung volume and venous admixture were both correlated with the amount of lung reaeration (r(2) = 0.62 and r(2) = 0.61, respectively). CONCLUSIONS: The results support the hypothesis that spontaneous breathing during APRV improves oxygenation mainly by recruitment of nonaerated lung and improved aeration of the lungs.

Anesthesia↗

High-frequency oscillatory ventilation of the perfluorocarbon-filled lung: preliminary results in an animal model of acute lung injury.

OBJECTIVE: To examine the efficiency of gas exchange, hemodynamic function, and histopathologic evidence of lung protection using high-frequency oscillation of the perfluorocarbon-filled lung in a model of acute lung injury. SETTING: An animal research laboratory. DESIGN: A prospective, randomized animal study comparing animals randomized to high-frequency oscillation or high-frequency oscillation and perfluorocarbon administration (perfluoro-octyl bromide, perfubron, or LiquiVent). SUBJECTS: Ten healthy swine (mean weight, 24.6 kg) with saline lavage-induced acute lung injury. INTERVENTIONS: Animals were treated with repetitive saline lavage to achieve a uniform degree of acute lung injury (Pao2 of <90 torr [11.9 kPa] on a Fio2 of 1.0). After lung injury, subjects were changed to high-frequency oscillatory ventilation and stabilized for 1 hr. High-frequency oscillation of the perfiuorocarbon-filled lung was initiated in five animals with the instillation of 30 mUkg perflubron and five animals continued receiving high-frequency oscillation for a total duration of 2 hrs after the dosing period. Histopathologic evidence of lung injury was quantified by a pathologist using an eight-variable lung injury scoring system to generate a lung injury score. MEASUREMENTS AND MAIN RESULTS: Administration of perflubron did not produce acute alterations of gas exchange. After the dosing period, there were no differences in gas exchange, hemodynamic function, or pulmonary vascular resistance between the two groups. The perfluorocarbon-treated animals had a significantly lower histopathologic total lung injury score, primarily manifested by significantly less atelectasis. CONCLUSIONS: The combination of high-frequency oscillatory ventilation and partial liquid ventilation with perfiubron was well tolerated hemodynamically, was not associated with deterioration of gas exchange during dosing, and did not produce significant differences in either gas exchange or hemodynamic variables over a 2-hr period. There was histopathologic evidence that the combination of high-frequency oscillation and perfiubron administration produces improved recruitment in both dependent and nondependent lung regions.

Animals↗

Lung deflation impairs alveolar epithelial fluid transport in ischemic rabbit and rat lungs.

BACKGROUND: Because the fluid transport capacity of the alveolar epithelium after lung ischemia with and without lung deflation has not been well studied, we carried out experimental studies to determine the effect of lung deflation on alveolar fluid clearance. METHODS: After 1 or 2 hr of ischemia, we measured alveolar fluid clearance using 125I-albumin and Evans blue-labeled albumin concentrations in in vivo rabbit lungs in the presence of pulmonary blood flow and in ex vivo rat lungs in the absence of any pulmonary perfusion, respectively. RESULTS: The principal results were: (1) lung deflation decreased alveolar fluid clearance while inflation of the lungs during ischemia preserved alveolar fluid clearance in both in vivo and ex vivo studies; (2) alveolar fluid clearance was normal in the rat lungs inflated with nitrogen (thus, alveolar gas composition did not affect alveolar fluid clearance); (3) amiloride-dependent alveolar fluid clearance was preserved when the lungs were inflated during ischemia; (4) terbutaline-simulated alveolar fluid clearance was preserved in the hypoxic rat lungs inflated with nitrogen; (5) lecithinized superoxide dismutase, a scavenger of superoxide anion, and N(omega)-nitro-L-arginine methyl ester, an inhibitor of nitric oxide, preserved normal alveolar fluid clearance in the deflated rat lungs. CONCLUSION: Lung deflation decreases alveolar fluid clearance by superoxide anion- and nitric oxide-dependent mechanisms.

Amiloride↗

Improvement of arterial oxygenation by selective infusion of prostaglandin E1 to ventilated lung during one-lung ventilation.

BACKGROUND: One-lung anesthesia provides a better surgical field for thoracic procedures but also impairs the arterial oxygenation and venous admixture. During one-lung ventilation, pulmonary vasoconstriction is assumed to be present within both ventilated and collapsed lungs. We propose that arterial oxygenation could be optimized by offsetting the vasoconstriction within the microcirculation of ventilated lung. METHOD: In an anesthetized dog model, incremental doses of prostaglandin E1 (PGE1) were selectively infused into the main trunk of the pulmonary artery of the ventilated lung after one-lung ventilation for 60 min (PGE1 group, n = 9). Arterial oxygenation and calculated venous admixture (Qs/Qt) was also assessed in a time-course control group (Control group, n = 5). During two-lung ventilation (FIO2: 0.66), arterial PO2 and venous admixture was 44.2 +/- 3.5 kPa and 10.7 +/- 2.3%, respectively. One-lung ventilation (FIO2: 0.66) with left lung collapsed reduced arterial PO2 to 11.6 +/- 1.7 kPa and increased venous admixture to 40.7 +/- 5.8% (P<0.001). Venous O2 tension also decreased from 6.3 +/- 0.7 kPa to 5.0 +/- 0.6 kPa with a slight increase in mean pulmonary artery pressure and pulmonary vascular resistance (P<0.05). RESULTS: During selective infusion of PGE1 at a dose of 0.04 to 0.2 mu g kg-1 min-1, there was a dose-dependent improvement in arterial PO2 with a parallel reduction of venous admixture during one-lung ventilation. Arterial PO2 increased to a maximum of 23.0 +/- 4.3 kPa, and the venous admixture decreased significantly to a minimum of 27.4 +/- 4.2% by PGE1 at a dose of 0.04-0.4 mu g kg-1 min-1 (P<0.01). PGE1 resulted in a small increase in cardiac output and decreases of pulmonary pressure and pulmonary vascular resistance at a relatively high dose of 0.4 mu g kg-1 min-1 during selective infusion (P<0.05). CONCLUSIONS: These results suggest that a selective pulmonary artery infusion of PGE1 to the ventilated lung within the dose range of 0.04-0.4 mu g kg-1 min-1 is practical and effective to improve arterial oxygenation and reduce venous admixture during one-lung ventilation.

Alprostadil↗

Pharmacological and histological examinations of regional differences of guinea-pig lung: a role of pleural surface smooth muscle in lung strip contraction.

1. Parenchymal lung strip preparations have been widely used as an in vitro model of peripheral airway smooth muscle. The present study examined functional responses of 4 consecutive guinea-pig lung parenchymal strips isolated from the central region (segment 1) to the distal edge (segment 4) of the lower lung lobe. The middle two segments were designated as segments 2 and 3. 2. Lung segments 1 and 4 exhibited significantly greater contraction than the other 2 segments to KCl when responses were expressed as mg force per mg tissue weight. Contractile responses to bronchospastic agents including histamine, carbachol, endothelin-1, leukotrienes (LT) B4 and D4, and the thromboxane A2-mimetic U46619 demonstrated no significant difference in EC50 values among the 4 lung segments. 3. Contractile responses of segments 1 and 4 to antigen-challenge (ovalbumin), ionophore A23187 and substance P were significantly greater than the other 2 segments with respect to either sensitivity or maximum responsiveness. 4. U46619-induced contractions of the 4 lung segments were relaxed in similar manner by papaverine and theophylline up to 100%, salbutamol up to 80%, and sodium nitroprusside by only 20%. In contrast, sodium nitroprusside markedly reversed U46619-induced contraction of pulmonary arterial rings and bronchial rings. 5. Histological studies identified 2-4 layers of smooth muscle cells underlying the lung pleural surface. Mast cells were prominent in this area. Moreover, morphometric studies showed that segment 4 possessed the least amount of smooth muscle structures from bronchial/bronchiolar wall and vasculatures as compared to the other 3 segments, and a significant difference in this respect was evident between segment 1 and segment 4.6. Since lung segments 1 and 4 are covered with larger surface area of lung pleura, the present results suggest that the significantly greater intrinsic contractile responses of segments 1 and 4 are associated with the presence of increased lung pleural surface possibly together with more mast cells. Thus, a primary contribution to the net contraction of the lung parenchymal strips may be smooth muscle from the lung pleura, alveolar ducts and interstitial contractile cells rather than from bronchi/bronchioles and microvasculatures.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗

Acute lung injury: effects of prone positioning on cephalocaudal distribution of lung inflation--CT assessment in dogs.

PURPOSE: To quantify cephalocaudal gradient of lung inflation in acute lung injury in a dog model in prone versus supine position. MATERIALS AND METHODS: Experiments were performed in accordance with Guide for the Care and Use of Laboratory Animals, as approved by National Research Council (National Institutes of Health), and were approved by committee on care and use of animals in research at Seoul National University Hospital. After induction of acute lung injury with intravenous injection of oleic acid, dogs were randomized to be ventilated in either prone (n = 6) or supine (n = 6) position. Spiral computed tomography (CT) and hemodynamic measurement were performed sequentially on an hourly basis. Volume and mean attenuation of lung were measured quantitatively by using software to evaluate each CT section. Cephalocaudal gradient of mean lung attenuation, distribution of gas and tissue, and alveolar expansion were assessed. Functional residual capacity and net alveolar expansion of entire lung were measured. Statistical analysis was performed with Friedman, sign, and Mann-Whitney tests. RESULTS: Mean lung attenuation increased gradually from apex to base of lung in supine position. Thus, inflation gradient along cephalocaudal axis was found. Gas was located predominantly in upper lung, whereas tissue was dominant in lower lung in supine position. In supine group, cephalocaudal inflation gradient showed no significant change from baseline up to 4 hours. After prone positioning, cephalocaudal inflation gradient was reduced, and gas and tissue proportions became more uniform along cephalocaudal axis. In prone group, absolute values of cephalocaudal inflation gradient at time points of prone positioning for 1, 2, and 3 hours were significantly lower than baseline values (P < .05) and those in supine group (P < .05). Alveolar expansion occurred in caudal regions, and alveolar contraction occurred in cephalic regions; accordingly, net alveolar volume of entire lung was not altered significantly. Functional residual capacity was unchanged by prone positioning. CONCLUSION: In acute lung injury, prone positioning induced more uniform distribution of gas and tissue along cephalocaudal axis by reducing cephalocaudal inflation gradient.

Animals↗

Elevated levels of interleukin-8 in donor lungs is associated with early graft failure after lung transplantation.

Increased levels of the neutrophil chemokine interleukin (IL)-8 in the lungs of severe trauma patients can predict subsequent development of acute respiratory distress syndrome. Because the lungs of brain-dead organ donors can contain high levels of IL-8, we hypothesized that this may predispose to early graft failure in the recipient after lung transplantation. Twenty-six organ donors prospectively satisfying clinical criteria for lung donation underwent bronchoalveolar lavage and lung biopsy to determine the effect of neutrophil infiltration and IL-8 expression in the donor lung on graft function and survival in 26 respective recipients after lung transplantation. Nine recipients developed severe graft dysfunction, of whom six subsequently died (median survival: 24 d [range: 5 to 39 d]); all others survived beyond 6 mo. The IL-8 signal in the donor lung correlated with the percent neutrophils in bronchoalveolar lavage fluid (BALF) before implantation (42.4 +/- 7.24 [mean +/- SE]%, p = 0.03) and with the degree of impairment in graft oxygenation after implantation (p = 0.01). An increased level of IL-8 in the donor BALF was associated with the development of severe early graft dysfunction (p = 0.027) and with early recipient mortality (p = 0.0034). Use of donor lungs with high IL-8 levels is associated with a poor prognosis after lung transplantation. Attenuating the donor's inflammatory response before organ retrieval may improve early outcome after lung transplantation, and help maximize lung use from the existing donor pool.

Bronchoalveolar Lavage Fluid↗

Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits.

Controversy exists whether high frequency oscillatory ventilation with an active expiratory phase (HFO-A) should be used at low ventilator pressures or high alveolar volumes to minimize lung injury in the atelectasis-prone lung. We therefore ventilated 20 anesthetized, tracheostomized rabbits made surfactant-deficient by lung lavage in 1 of 3 ways: HFO-A at a high lung volume (HFO-A/HI), HFO-A at a low lung volume (HFO-A/LO), or conventional mechanical ventilation (CMV); all received 100% oxygen for 7 h. We examined oxygenation, lung mechanics, and lung pathology. Arterial oxygenation in the HFO-A/HI rabbits was kept greater than 350 mm Hg. Mean lung volume above FRC in these animals was 23.4 ml/kg. In rabbits ventilated with HFO-A/LO and CMV, arterial oxygen tensions were 70 to 100 mm Hg. Mean lung volumes were 7.8 and 4.3 ml/kg, respectively. Total respiratory system pressure-volume curves (P-V curves) showed no change from baseline in the HFO-A/HI group after 7 h of ventilation. The low lung volume groups (HFO-A/LO and CMV) showed a diminution in hysteresis of their P-V curves, lower total respiratory system compliance, more hyaline membranes and severe airway epithelial damage. (All changes significant with p less than 0.05). We conclude that maintenance of alveolar volume is a key mechanism in the prevention of lung injury during mechanical ventilation of the atelectasis-prone lung. For optimal outcome using high frequency oscillatory ventilation, alveoli must be actively reexpanded and then kept expanded using appropriate mean airway pressures.

Airway Resistance↗