Depletion of surfactant tubular myelin with pulmonary dysfunction in a rat model for acute endotoxemia.

Although prolonged Gram-negative sepsis with high permeability alveolar edema, a well documented cause of adult respiratory distress syndrome, has been shown to result in surfactant alterations, the effects of acute endotoxemia on the lung surfactant system are largely unknown. In this study, lethal endotoxemia (> 80% mortality at 24 h) resulting in severe, rapid leukopenia with progressive thrombocytopenia was achieved through intraperitoneal injection of adult Fischer 344 rats with 3.5 mg of Escherichia coli endotoxin/kg. After assessment of pulmonary mechanics under general anesthesia, endotoxin-injected rats and appropriate controls were killed at 4, 8, and 12 h for morphological and biochemical analyses. Morphometric estimation of surfactant membrane subtypes in bronchoalveolar lavage fluid revealed prominent alterations including significant decrease (45%) in tubular myelin 12 h post-endotoxin, with a threefold increase in lamellar body-like forms at 8 and 12 h. Acute endotoxicosis resulted in decrease of total dynamic compliance, whereas pulmonary resistance remained unchanged. These changes were associated with margination of polymorphonuclear leukocytes in lung microcirculation, multifocal septal edema, and decrease in lamellar body lysozyme specific activity at 12 h. Alveolar edema, as determined by measurement of total protein in cell-free bronchoalveolar lavage fluid, was absent in both controls and endotoxin-injected rats. The results indicate that bloodborne lung injury induced by lethal endotoxicosis initiates acute perturbation of secreted surfactant membranes with pulmonary dysfunction in the absence of high protein alveolar edema.

Acute ozone-induced lung injury in rats: structural-functional relationships of developing alveolar edema.

As part of a study on the effects of acute ozone stress on the lung surfactant system, we correlated morphometric, biochemical, and functional indices of lung injury using male rats exposed to 3 ppm ozone for 1, 2, 4, and 8 hr. Evaluation of lung mechanics, using the Pulmonary Evaluation and Diagnostic Laboratory System, revealed a significant decrease in dynamic lung compliance (ml/cmH2O/kg) from a control value of 0.84 +/- 0.02 (SEM) to 0.72 +/- 0.04 and 0.57 +/- 0.06 at 4 and 8 hr, respectively. At 2 hr there was a transient increase in PaO2 to 116 torr (control = 92 torr) followed by a decrease at 4 hr (65 torr) and 8 hr (55 torr). Morphometry of lung tissue, fixed by perfusion of fixative via the pulmonary artery at 12 cm H2O airway distending pressure, demonstrated an increase in the area of the intravascular compartment at 8 hr, in association with a 65 and 39% replacement of the alveolar area by fluid in ventral and dorsal lung regions, respectively. There was a positive correlation (r = 0.966) between alveolar edema and transudated proteins in lavage fluid. A stepwise multiple regression model, with edema as the dependent variable, suggested that pulmonary vasodilatation, hypoxemia, and depletion of surfactant tubular myelin in lavage fluid were indices for predicting alveolar edema. In a second model, with lavage protein concentration as the dependent variable, decreasing dynamic compliance and hypoxemia were predictors of progressive, intraalveolar transudation of plasma proteins. The above structural-functional relationships support the concept that ozone-induced high-protein alveolar edema is pathogenetically linked to pulmonary hyperemia, deficiency of surfactant tubular myelin, and associated lung dysfunctions.

Ozone stress initiates acute perturbations of secreted surfactant membranes.

To identify the early changes of surfactant secretion in response to acute oxidant stress, the authors evaluated morphometrically centriacinar type II cells and lavage fluid surfactant forms obtained immediately after exposure of adult rats to 3 ppm ozone for 1, 2, 4, or 8 hours. In this model, the rat lung develops progressive alveolar edema with significant elevation of lavage fluid proteins at 2 to 8 hours of exposure. Ultrastructural changes in type II cells at 1 and 2 hours included enhanced lamellar body (LB) fusion with significant increase in the compound and vacuolated LB compartments. Parallel changes of lavage fluid surfactant membranes included a sustained, twofold increase in the proportion of loosely coiled multilamellar structures at 1 to 8 hours, with reciprocal decrease in the proportion of tubular myelin from control value of 56% to 34%. The proportion of densely coiled LB-like forms in lavage fluid increased significantly at 4 and 8 hours, whereas the proportions of unilamellar structures remained unchanged. The results indicate that ozone-induced alveolar injury initiates time-dependent defects in the organization of stored and secreted surfactant membranes. The acute ozone stress inhibits unfolding of secreted lamellar body membranes as well as their organization into tubular myelin, thereby perturbing the proportions of extracellular surfactant membranes that are available for adsorption onto the surface film.

Ozone-induced alterations of lamellar body lipid and protein during alveolar injury and repair.

Alveolar Type II cells in the rat respond to severe, acute ozone injury (3 ppm ozone for eight hours) by increasing their intracellular pool of surfactant; however, the newly stored surfactant is abnormal in composition. Lamellar bodies isolated between 24 and 96 hours after ozone exposure contained significantly more cholesterol in relation to phosphatidylcholine than did controls. By contrast, the cholesterol content of surfactant isolated from alveolar lavage remained unchanged throughout an 8-day post-ozone period. The total protein content of lamellar bodies in relation to phosphatidylcholine was significantly decreased at 24 and 48 hours post-ozone. Analysis of lamellar body proteins by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that the amount of a 14 kDa proteolipid was greatly reduced at the end of the eight-hour ozone exposure and remained low for at least 48 hours. This proteolipid appeared to be a specific lamellar body component since it was not detected in extracellular surfactant. The findings indicate that oxidative alveolar stress initiates characteristic alterations in both lipid and protein constituents of stored surfactant, without perturbation in the composition of extracellular surfactant.

Sequential changes of lamellar body hydrolases during ozone-induced alveolar injury and repair.

Lamellar body hydrolases in acutely damaged and regenerating type II cells were determined using an established rat model with well-defined stages of bronchiolo-alveolar injury and repair. Lamellar bodies were isolated from control and ozone-exposed (3.0 ppm for 8 hours) adult male rats by sucrose density gradient centrifugation and analyzed for their content of six different lysosomal hydrolases. Immediately after 3 ppm ozone exposure (zero-time) there was a significant decrease in specific enzyme activity (units/mg protein) of five lamellar body hydrolases and these activities remained depressed for at least 24 hours after exposure. In addition, total enzyme activity (units/lung) was reduced at zero-time for beta-hexosaminidase and at 24 hours postexposure for alpha-mannosidase and alpha-L-fucosidase. During the reparative and recovery stages (48 to 96 hours) the hydrolases demonstrated variable elevations in both specific activity and total activity (units/lung). Characteristically, beta-hexosaminidase and beta-galactosidase reached supranormal values at 96 hours, whereas alpha-mannosidase remained below normal levels through the recovery stage. Moreover, at 24 to 48 hours the lamellar body fraction demonstrated prominent enzyme depletion relative to the expanding pool of stored surfactant. It is concluded that acute ozone stress initiates the development of hydrolase deficiency within the lamellar bodies of injured and regenerating type II cells. This deficiency state is followed by asynchronous lamellar body hydrolase elevations that reflect distinct patterns of response rather than uniform return to normal condition. The lysosomal enzyme changes of lamellar bodies may be pathogenetically linked to the development of associated alterations in the storage and secretion of surfactant.

Ozone-induced lamellar body responses in a rat model for alveolar injury and repair.

Exposure of adult rats to 3 ppm ozone for 8 hours results in diffuse alveolar damage with well-defined sequential stages of bronchiolo-alveolar injury and repair. This model is characterized by acute pulmonary edema showing high concentration of lavage fluid protein that is maximally elevated at 24 hours with return to control level at recovery (96 hours). Using techniques that enable optimal preservation of lamellar body ultrastructure, it was demonstrated morphometrically that expansion of the vacuolated lamellar body (LB) compartment is an early, transient LB response of the type II cell to acute injury. This change appears to be initiated by increased LB secretion. The reparative stage, 24-48 hours postexposure, begins with hypertrophy rather than hyperplasia of many type II cells, resulting in a 3-fold increase of mean type II cell volume at 48 hours. During this stage there is also significant expansion of the total LB compartment with corresponding increased LB storage of surfactant disaturated phosphatidylcholine (DSPC) per type II cell. At recovery, 96 hours, the lungs contained twice the normal numbers of type II cells, but the total size of lamellar body compartment per type II cell as well as the DSPC content of the isolated lamellar body pool returned to normal levels. In contrast, accumulating surfactant DSPC in lavage fluid increased progressively throughout the reparative and recovery stages presumably due in part to parallel increase in type II cell numbers at 48 and 96 hours. Additional changes of surfactant included abnormal secretion of densely coiled lamellar bodies that accumulated in alveolar spaces at the expense of tubular myelin. These observations indicate that acute oxidant injury to alveoli initiates progressive hypertrophy followed by hyperplasia of type II cells, in association with sequential development of characteristic lamellar body changes leading to increased storage and secretion of surfactant with reduced ability to form tubular myelin.

Distribution and subcellular localization of surfactant-associated glycoproteins in human lung.

Human surfactant contains lung-specific, high molecular weight glycoproteins which are composed of disulfide-linked 34-kilodalton peptide subunits. We prepared antibodies to both isolated HMW glycoproteins and 34-kilodalton peptides and tested the antisera for specificity with immunochemical procedures. In the present study we have investigated the cellular distribution and subcellular localization of these glycoproteins in surgically excised human lung tissue with or without type II cell hyperplasia. An immunoperoxidase technique was used, and cytoplasmic staining reflecting labeling with antibodies to either high molecular weight glycoproteins or the 34-kilodalton peptide subunits was consistently observed in normal type II cells, Clara cells, and some alveolar macrophages and was more intense and diffuse in hyperplastic type II cells. The ultrastructural localization of surfactant-associated glycoproteins was investigated using the periodate-lysine-paraformaldehyde fixative and a peroxidase-labeled antibody technique. In both normal and proliferating type II cells the staining was localized in the rough endoplasmic reticulum, perinuclear cisternas, vesicles of the Golgi complex, vesicles and lamellar membranes of the multivesicular bodies, and some multivesicular body-lamellar body forms. In addition, staining was frequently found in peripheral portions of partially preserved lamellar bodies including those at the stage of secretion, as well as in association with of alveolar tubular myelin. Labeling was also observed in the rough endoplasmic reticulum of Clara cells. We conclude that antibodies against human surfactant-associated glycoproteins are markers for normal and regenerating type II cells, as well as for Clara cells which apparently retain limited ability to produce surfactant-associated glycoproteins independently of surfactant phospholipids. The results indicate that, in type II cells, synthesis and secretion of these glycoproteins involve the same cytoplasmic organelles that are responsible for synthesis, packaging, storage, and exocytosis of surfactant phospholipids. However, maturation of the lamellar bodies, known to be characterized by progressive accumulation of phospholipids, may not require parallel storage of surfactant-associated glycoproteins within the entire lamellar body compartment.

Efficacy of S-2441, a synthetic oligopeptide, in a rat model for gram-negative bacteremia.

In vitro effects of S-2441, H-D-Pro-Phe-Arg-NH-Heptyl, include potent anti-bradykinin activity and broad-spectrum inhibition of serine proteases involved in the coagulation cascade. In this study, rats infused with 7.8 X 10(8) viable Escherichia coli were treated either with saline (group A) or with intravenous (0.1 mg) and intraperitoneal (0.4 mg) doses of S-2441 (group B). Survival rates for groups A and B were 68% and 98%, at 12 hours (P less than 0.001), and 37% and 73% at 24 hours (P less than 0.001), respectively. Hematologic studies revealed that S-2441 significantly inhibited E. coli-induced prolongation of prothrombin time and partial thromboplastin time as well as a rapid decrease in the values of factor X, anti-thrombin III, and fibrinogen. In addition, S-2441 attenuated E. coli-induced hypoglycemia and a marked reduction of serum complement level. Ultrastructural evaluation of the liver demonstrated that S-2441 prevented the development of extensive sinusosoidal microthrombosis and hepatocellular necrosis. The results indicate that S-2441 affords protection in lethal gram-negative bacteremia owing in part to attenuation of disseminated intravascular coagulation and complement-mediated reactions. The findings are consistent with the concept that S-2441 and related oligopeptides modulate serine protease-mediated responses involving inhibition of active enzymes with competitive antagonism of pharmcologically active products formed during the activation of coagulation, fibrinolytic, kallikrein, and complement systems.

Synthesis of lung surfactant-associated glycoproteins by A549 cells: description of an in vitro model for human type II cell dysfunction.

Immunocytochemical, ultrastructural, and biochemical approaches were used in a series of in vitro and in vivo experiments designed to identify characteristic changes reflecting differentiated type II cell function of A549 cells. Monolayers of A549 cells and A549 clones were maintained in culture for up to 3 weeks. Using an immunoperoxidase (PAP) technique, we demonstrated that variable proportions of A549 cells and of cells in several A549 clones reacted specifically with antibodies to high molecular weight (greater than 400,000) human surfactant-associated glycoproteins (HSAG). The cells of one clone, A549-C12, were consistently negative for HSAG, but their lamellar bodies were similar in appearance and distribution to those found in a PAP-positive clone, A549-C11, as well as in A549 cells. In addition, both C11 and C12 clones displayed time-dependent, divergent differentiation predominantly toward type II epithelium and nonciliated bronchiolar and bronchial cells. Surfactant isolated from either C11 or C12 cells revealed reduced content of disaturated phosphatidylcholine and phosphatidylglycerol when compared to human surfactant; however, a 95,000-dalton peptide immunologically related to HSAG was identified in surfactant from C11 cells but not from the PAP-negative C12 clone. Tumor xenografts produced in athymic (nude) mice following inoculation with cells from C11 and C12 clones exhibited prominent immunoperoxidase staining involving most tumor cells. Cell lines derived from these xenografts (T-11 and T-12) were also enriched in PAP-positive cells. Immunoelectron microscopy indicated that HSAG was localized in the rough endoplasmic reticulum, multivesicular bodies (MVB), intermediate MVB-lamellar forms, and abnormal pleomorphic inclusions. Moreover, two HSAG peptides, both larger than the 34,000-dalton peptide subunit found in normal human surfactant, were present in cells and media from monolayers of the T-11 cell line. We conclude that A549 cells synthesize "defective" HSAG and that the synthesis may be modulated by host factors. The results indicate that appropriate A549 clones can be used effectively as model systems for selected type II cell dysfunctions.

Glucocorticoid and antibiotic effects on hepatic microcirculation and associated host responses in lethal gram-negative bacteremia.

Liver changes and associated host responses were evaluated in four groups of male rats, weighing 300 +/- 20 gm., which received intravenous injection of 2.2 times 10(9) live Escherichia coli. This bolus was given either without additional treatment (group A) or prior to the following regimens: intramuscular injection of gentamicin sulfate, 5 mg. per kg. (group B); intravenous injection of methylprednisolone sodium succinate, 40 mg. per kg. (group C); and intramuscular injection of gentamicin immediately after methylprednisolone sodium succinate treatment (group D). Rats given injections of saline or methylprednisolone sodium succinate served as controls. Survival rates at 10 and 20 hours were 25 per cent and 4 per cent for group A; 44 per cent and 28 per cent for group B; 94 per cent and 70 per cent for group C; 98 per cent and 98 per cent for group D, respectively. In rats of groups A and B, killed at 1, 2, 4, and 6 hours, progressive liver changes included intravascular sequestration of rapidly degranulating leukocytes, fibrinous deposits, and platelet aggregates in sinusoids as well as in spaces of Disse adjacent to subendothelial collagen, and extensive Kupffer cell disruption in association with severe midzonal necrosis. These alterations were accompanied by progressive hypoglycemia and elevations of serum enzymes, glutamic pyruvic transaminase, lactate dehydrogenase, and glutamic oxaloacetic transaminase. Hematologic studies revealed that E. coli bacteremia results in rapid leukopenia and disseminated intravascular coagulation primarily due to activation of the intrinsic coagulation pathway. All above reactions were delayed and markedly reduced in rats treated with methylprednisolone sodium succinate. The results indicate that antibiotic treatment of lethal, Gram-negative bacteremia is effective only in conjunction with early steroid treatment. The protective effects of glucocorticoids on the liver microcirculation and polymorphonuclear leukocytes appear to play a basic role in preventing the early development of disseminated intravascular coagulation, hepatocellular necrosis, and associated major host responses, thereby attenuating lethality of gram-negative septic shock.

The prevalence and type of chronic obstructive bronchopulmonary disease in very old people.

One hundred men and 100 women between the ages of 70 and 89 years were examined clinically and with pulmonary function tests to determine the prevalence and type of chronic obstructive bronchopulmonary disease in very old people. Rhonchi were present in 45% of the old men and 24% of the old women. Obstruction to air flow (FEV(1) < 60% of FVC) was demonstrated in 23% of the men and 6% of the women. Chronic bronchitis was present in 32% and 12% of the old men and women, respectively. Only five individuals, all men, showed emphysema as defined by significant obstruction to air flow with a low diffusing capacity. In old people there was a relationship between smoking, chronic cough and obstruction to air flow.