Pleural involvement in sarcoidosis.

Pleural sarcoidosis is no longer considered rare, as it occurs in about 3% of all cases of sarcoidosis. However, newer methods of detection may boost this level higher. High-resolution computed tomographic scanning has increased our detection of pleural nodules and pleural thickening. Other manifestations include pneumothorax, chylothorax, and hemothorax. Further studies of large numbers of patients are needed to determine the true prevalence of pleural involvement in sarcoidosis.

Quality control of spirometry testing in the registry for patients with severe alpha1-antitrypsin deficiency. alpha1-Antitrypsin Deficiency Registry Study Group.

As part of the multicenter National Heart, Lung, and Blood Institute registry of patients with severe deficiency of alpha1-antitrypsin with 1,129 enrollees, this report describes measures undertaken to achieve high-quality FEV1 measurements, the rates of satisfying reproducibility and acceptability criteria, and clinical features of participants unable to achieve reproducible FEV1 values at baseline. Spirograms were performed both before and after an inhaled bronchodilator in enrollees followed up at 37 participating clinical centers. Using a reproducibility criterion of < 100 mL or 5% (whichever greater), high reproducibility rates for FEV1 measurements at baseline were observed for both prebronchodilator (95.0% of 1,090 sessions) and postbronchodilator measurements (95.7% of 1,077 sessions). Using the more recently published reproducibility criterion of < or = 200 mL, reproducibility rates were even higher. Eighty-four percent of clinical centers submitted FEV1 values that satisfied reproducibility criteria for at least 90% of spirograms. Also, the mean coefficient of variation for prebronchodilator FEV1 values measured over serial visits separated by up to 9 months was 5.6% for participants with baseline FEV1 55 to 90% predicted. This degree of reproducibility is similar to that observed in the Lung Health Study. Rates of satisfying acceptability criteria for prebronchodilator spirograms were lower, almost universally (98% of tests) due to failure to achieve end-of-test criteria (which usually required 15 s of expiration in this population with mean FEV1 = 42.6+/-29.6% [SD] predicted). Multivariate logistic regression models show that clinical correlates of failure to achieve reproducible prebronchodilator FEV1 efforts include symptoms of chronic wheeze, chronic cough, and chronic phlegm, and the degree of airflow obstruction. We conclude that highly reproducible FEV1 measurements are achievable in a population with severe airflow obstruction despite the additional challenges posed by testing in multiple centers on a variety of spirometers. Furthermore, the difficulty of satisfying end-of-test criteria in a large cohort with severe airflow obstruction did not preclude achieving high rates of reproducibility for FEV1 measurements. Finally, our study confirms prior observations that failure to achieve reproducible efforts is associated with the presence of pulmonary symptoms and the degree of airflow obstruction. Thus, excluding patients with nonreproducible FEV1 efforts from epidemiologic studies would bias results by including only healthier participants.

High-performance liquid chromatographic quantitation of desmosine plus isodesmosine in elastin and whole tissue hydrolysates.

Quantitation of desmosine and isodesmosine, the major crosslinks in elastin, has been of interest because of their uniqueness and use as markers of that protein. Accurate measurement of these crosslinks may allow determination of elastin degradation in vivo and elastin content in tissues, obviating lengthy extraction procedures. We have developed a method of quantitating desmosine plus isodesmosine in hydrolysates of tissue and insoluble elastin using high-performance liquid chromatographic separation and absorbance detection that is rapid (21-35 min) and sensitive (accurate linearity from 100 pmol to 5 nmol). This method has been used to quantitate desmosines in elastin from bovine nuchal ligament and lung and in whole aorta from hamster. The ability to completely separate [3H]lysine from desmosine plus isodesmosine allows the method to be used to study incorporation of lysine into crosslinks in elastin.

A new peptide boronic acid inhibitor of elastase-induced lung injury in hamsters.

A highly effective, reversible elastase inhibitor, MeOSuc-Ala-Ala-Pro-boroVal-OH, was tested for its ability to prevent emphysema induced by intratracheally administered elastase in hamsters. Anesthetized hamsters were given elastase intratracheally with or without the inhibitor or were given elastase intratracheally and the inhibitor intraperitoneally. Two weeks after administration, lungs were removed, and static air pressure volume curves were performed followed by intratracheal fixation and morphometric determination of mean linear intercepts. The results indicate significant preservation of structure and function whether the inhibitor is given intratracheally or intraperitoneally and suggest that this inhibitor may be useful in controlling diseases arising from aberrant proteolysis by elastolytic enzymes.

Effects of dosage and timing of administration of a peptide boronic acid inhibitor on lung mechanics and morphometrics in elastase-induced emphysema in hamsters.

The peptide boronic acid, MeOSuc-Ala-Ala-Pro-boroVal-pinacol (AAPbV), is an effective inhibitor of both pancreatic and leukocyte elastase. Initial work showed that AAPbV diminishes the effect of emphysema induced by pancreatic elastase. This initial work has been expanded to show that AAPbV provides a high degree of protection against elastase-induced increases in lung volume and mean linear intercept when given intratracheally at 200 mg/kg either 15 min before, simultaneous with, or 15 min after instilling elastase. Intraperitoneal administration, although less effective, is dose dependent and dependent on the time of treatment. We conclude that a reversible protease inhibitor can be used to prevent aberrant proteolysis in vivo.

Lysyl oxidase activity in lungs of copper-deficient hamsters.

Lysyl oxidase, the enzyme responsible for mediating crosslink formation in collagen and elastin, requires copper for its activity. In this study, lysyl oxidase activity and insoluble elastin content were unchanged in lungs from copper-deficient hamsters compared to controls. The lack of dramatic diminution in lysyl oxidase activity in animals who demonstrate significant structural alterations in the lung suggests that other mechanisms in addition to inhibition of crosslink formation are operative in this model.

A comparison of six methods of extracting elastin residue from hamster lungs.

Elastin was extracted from homogenized lungs by six commonly used methods. Results were expressed as micrograms of elastin per milligrams of fat-free dry weight of lung tissue. Relative purity of extracted elastin residue was assessed by amino acid analysis. Relative intactness of extracted residue was assessed by a degradation index utilizing a combination of N-terminal analysis and amino acid analysis. Results indicate that of the six methods compared, none is ideal in terms of purity and intactness of the resultant product extracted from lung tissue. In general, harsher methods produce a pure but degraded product, whereas milder methods produce a product that is intact but contaminated. In conclusion, most currently available methods of extracting elastin from tissues appear poorly suited to extracting it from lung tissue. However, the Starcher method yields a product as pure as that obtained by the Lansing procedure and one almost as intact as that obtained by the least degradative methods.

A copper-deficient, zinc-supplemented diet produces emphysema in pigs.

A mild form of emphysema was produced in pigs raised on a copper-deficient, zinc-supplemented diet. The copper-requiring enzyme, lysyl oxidase, catalyzes the cross-linking of tropoelastin into mature elastin. Zinc further inhibits the activity of lysyl oxidase. Lungs from animals raised on copper-deficient, zinc-supplemented diets of demonstrate perforations in alveolar walls and diminished amounts of elastin bronchi and pulmonary arteries. Mean linear intercepts are greater and alveolar internal surface areas are less than those in control animals, fulfilling the generally accepted definition of emphysema. Physiologic confirmation is provided by a leftward shift of the saline volume-pressure curves when compared with those in control animals. Ultrastructurally, the alveolar walls are effaced and pores of Kohn are enlarged. There are areas in which elastin is absent leaving remnant microfibrils, and there are other changes consistent with active elastin synthesis. Biochemical data demonstrate no difference in elastin content as micrograms/ml of fat-free dry weight but do demonstrate increased collagen content in experimental animal lungs compared with that in control lungs. Ultrastructural similarities to enzyme-induced models of emphysema suggest the presence of elastin degradation in our model. We speculate that although the copper-deficient, zinc-supplemented state may stimulate protein synthesis in general, elastin is being degraded by endogenous means, but collagen is not.

Structure of the elastic fiber: an overview.

Intense research efforts over the past 18 yr have probed deeply into the structure of the elastic fiber. This began with the elucidation of the demosine crosslinks in elastin and the description of the elastin precursor, tropoelastin, derived from copper-deficient animals. Characterization of the precursor material indicates that it is a single polypeptide chain of approximately 800 amino acid residues containing lysine residues in clusters destined to form the desmosine crosslinks. The molecule contains large areas of hydrophobic sequence interspersed with shorter stretches of polyalanine and the lysines. The shorter structures may be folded into alpha-helices. The larger hydrophobic areas appear to form a unique structure known as the beta spiral which possesses elastometric properties. Inside the hydrophobic areas repeating sequences such as the pentapeptide pro-gly-val-gly-val have been observed the exact significance of which is not appreciated, but it appears to be well-conserved between species. Recent studies in the molecular biology of this protein have indicated that it is synthesized on the rough ER with a short leader sequence of about 25 residues. This is lost before the tropoelastin is exported. Diversity in sequence studies in these leaders suggest that there may be two elastins, type A and B, which vary with the maturation of the animal.

A steady-state kinetic analysis of the prolyl-4-hydroxylase mechanism.

Published kinetic data by Kivirikko, et al. on the prolyl-4-hydroxylase reaction have been re-evaluated using the overall steady-state velocity equation in the forward and reverse directions for an ordered ter ter kinetic mechanism. Qualitatively, the published data for prolyl-4-hydroxylase appear to fit the predicted patterns for this kinetic mechanism. More kinetic data are needed to confirm these results and to quantitate the kinetic parameters but, tentatively, the order of substrate addition would appear to be alpha-ketoglutarate, oxygen, and peptide; and the order of product release would be hydroxylated peptide (or collagen), carbon dioxide, and succinate.