Respiratory distress after intratracheal bleomycin: selective deficiency of surfactant proteins B and C.

Intratracheal bleomycin in rats is associated with respiratory distress of uncertain etiology. We investigated the expression of surfactant components in this model of lung injury. Maximum respiratory distress, determined by respiratory rate, occurred at 7 days, and surfactant dysfunction was confirmed by increased surface tension of the large-aggregate fraction of bronchoalveolar lavage (BAL). In injured animals, phospholipid content and composition were similar to those of controls, mature surfactant protein (SP) B was decreased 90%, and SP-A and SP-D contents were increased. In lung tissue, SP-B and SP-C mRNAs were decreased by 2 days and maximally at 4--7 days and recovered between 14 and 21 days after injury. Immunostaining of SP-B and proSP-C was decreased in type II epithelial cells but strong in macrophages. By electron microscopy, injured lungs had type II cells lacking lamellar bodies and macrophages with phagocytosed lamellar bodies. Surface activity of BAL phospholipids of injured animals was restored by addition of exogenous SP-B. We conclude that respiratory distress after bleomycin in rats results from surfactant dysfunction in part secondary to selective downregulation of SP-B and SP-C.

Inspired oxygen concentration alters the phospholipids and protein content in the bronchoalveolar lavage-accessible space.

OBJECTIVE: To examine the effect of FIO2 on the contents of total protein, total phospholipids, phosphatidylcholine, and phosphatidylglycerol in the bronchoalveolar lavage-accessible space in male and female rats in vivo. DESIGN: Prospective, controlled trial. SETTING: Research laboratory. SUBJECTS: Adult male and female Sprague-Dawley rats. INTERVENTIONS: After animals were anesthetized with an intraperitoneal injection of pentobarbitol (50 mg/kg), a 24-gauge catheter was placed in the femoral artery. Determinations of arterial pH and PaO2 and PaCO2 were performed before tracheostomy, and all animals were then ventilated for 3 mins with an FIO2 of 0.21, followed by a reduction bronchoalveolar lavage. The animals were randomly divided equally by gender and given either an FIO2 of 0.21, 0.50, or 1.00. All subjects were ventilated in the same manner. Sampling bronchoalveolar lavage was performed 80 and 160 mins after institution of the variable FIO2. Bronchoalveolar lavage samples were analyzed for protein and phospholipid content. Arterial blood was obtained for determination of arterial pH and the PaO2 and PaCO2 immediately and 40 mins after each sampling bronchoalveolar lavage. MEASUREMENTS AND MAIN RESULTS: At the times of bronchoalveolar sampling lavage, the PaCO2 increased and the PaO2 decreased, as did the pH. In the 40-min samples obtained between sampling lavages, the arterial pH and PaCO2 and PaO2 returned to pretracheostomy values (animals ventilated with an FIO2 of 0.21) and/or higher pO2 values (animals ventilated with an FIO2 of 0.5 or 1.0). No differences were found between genders in amounts of total protein and phospholipid content in reduction and zero time bronchoalveolar lavage fluid. Males and females ventilated with an FIO2 of 0.21 differed in the amounts of total protein, total phospholipids, phosphatidylcholine, and phosphatidylglycerol found in sampling bronchoalveolar lavage at 80 and 160 mins. Amounts of total protein and total phospholipids also demonstrated gender differences with the administration of an FIO2 of 1.0, but no differences with the administration of and FIO2 of 0.5. In terms of the phospholipids, males had greater amounts in the sampling bronchoalveolar lavage at 80 mins, and females at 160 mins. Administration of an FIO2 of 0.5 or 1.0 resulted in decreased amounts of total phospholipids in both males and females when compared with and FIO2 of 0.21. In males, administration of both FIO2 of 0.5 and 1.0 resulted in decreased amounts of phosphtidylcholine found in the bronchoalveolar lavage-accessible space; in females, amounts of phosphatidylcholine were only decreased when and FIO2 of 1.0 was administered. In males, administration of and FIO2 of 1.0 also resulted in decreased amounts of phosphatidylglycerol. The decreased amount of phosphatidylglycerol occurred in females given an FIO2 of 0.5. Amounts of total protein in males and females given an FIO2 of 0.5 and in females given an FIO2 of 1.0 were found to be increased. CONCLUSIONS: Our findings support the hypothesis that hyperoxia alters surfactant composition. Further investigation is warranted to determine the mechanisms affecting secretion of phosphatidylcholine and phosphatidylglycerol into the bronchoalveolar space and to explore the gender difference in secretion.

Tumor necrosis factor-alpha alters phospholipid content in the bronchoalveolar lavage-accessible space of isolated perfused rat lungs.

OBJECTIVES: To examine the effect of tumor necrosis factor-alpha (TNF-alpha) on pulmonary artery pressure and on total protein, phospholipid, lysophosphatidylcholine, phosphatidylcholine, phosphatidylinositol, and phosphatidylglycerol content in the bronchoalveolar lavage-accessible space of the isolated perfused rat lung, and to evaluate the role of the lung in the clearance of TNF-alpha from the perfusion medium in this model. DESIGN: Prospective, controlled trial. SETTING: Research laboratory. SUBJECTS: Adult male Sprague-Dawley rats. INTERVENTIONS: The lungs from all subjects were isolated, perfused, and ventilated in the same manner. After a baseline sampling bronchoalveolar lavage, a reduction bronchoalveolar lavage was performed to establish a uniform amount of phospholipid in all lungs. This procedure was followed by the zero time sampling bronchoalveolar lavage, which verified the efficacy of the reduction lavage. After 5 mins, isoproterenol was added to the perfusion medium to promote surfactant secretion. Five minutes later, TNF-alpha (experimental group) and/or its carrier solution (control group) was added to the perfusion medium. Sampling bronchoalveolar lavages were repeated at 1 and 2 hrs after the zero time. Bronchoalveolar lavage samples were subsequently analyzed for protein and phospholipid content. After each sampling bronchoalveolar lavage, perfusion medium was obtained for immediate determinations of pH and the partial pressures of oxygen and carbon dioxide and the subsequent determination of TNF-alpha content. Pulmonary arterial pressures were continuously measured. MEASUREMENTS AND MAIN RESULTS: The pH and PCO2 in the perfusion medium remained in the physiologic range for all lungs, while the PO2 remained consistently increased. Mean pulmonary arterial pressures did not differ between groups. TNF-alpha levels were constant throughout the 2-hr period in the experimental group, and no TNF-alpha was detected in the perfusion medium of the control group. Amounts of total protein, total phospholipid, and lysophosphatidylcholine did not differ between the two groups. Although not statistically significant, phosphatidylglycerol was lower in the experimental group (p < .07). An increase in phosphatidylinositol content in the experimental group with a concomitant decrease in the control group between 60 and 120 mins was noted (p < .01). Amounts of phosphatidylcholine were found to be lower in the experimental group throughout the 2-hr period (p < .02). CONCLUSIONS: a) TNF-alpha alters the amounts of phosphatidylcholine, phosphatidylinositol, and possibly phosphatidylglycerol present in the lavage-accessible space of the isolated perfused rat lung. Possible mechanisms might include a direct effect of TNF-alpha on phospholipid secretion and/or reuptake, or an indirect effect via alteration of the type II pneumocytes' response to beta-adrenergic receptor stimulation. b) Increases in pulmonary arterial pressures seen in vivo with TNF-alpha administration are not due to a direct effect. Alterations in cardiac function or the interaction of other agents may be necessary to develop changes in pulmonary arterial pressure. c) This in vitro model does not demonstrate the rapid clearance of TNF-alpha from the circulation that is seen in vivo, suggesting that TNF-alpha metabolism does not occur primarily in the lung. Our findings support the hypothesis that TNF-alpha may alter surfactant composition, which may in turn contribute to the development of the adult respiratory distress syndrome.