Community respiratory virus infections following lung transplantation.

Respiratory infections remain a significant cause of morbidity and mortality after lung transplantation. In addition to cytomegalovirus, the community respiratory viruses such as respiratory syncytial virus (RSV), parainfluenza virus (PIV), influenza virus, and adenovirus, are important causes of infection in transplant recipients, often involve the lower respiratory tract, and may be associated with significant morbidity and mortality. In this review, we summarize the current state of knowledge regarding the epidemiology, clinical manifestations, diagnosis, treatment and outcomes associated with RSV, PIV, influenza virus, and adenovirus infections in lung transplant recipients.

Up-regulation of Na,K-ATPase beta 1 transcription by hyperoxia is mediated by SP1/SP3 binding.

The sodium pump, Na,K-ATPase, is an important protein for maintaining intracellular ion concentration, cellular volume, and ion transport and is regulated both transcriptionally and post-transcriptionally. We previously demonstrated that hyperoxia increased Na,K-ATPase beta(1) gene expression in Madin-Darby canine kidney (MDCK) cells. In this study, we identify a DNA element necessary for up-regulation of the Na,K-ATPase beta(1) transcription by hyperoxia and evaluate the nuclear proteins responsible for this up-regulation. Transient transfection experiments in MDCK cells using sequential 5'-deletions of the rat Na,K-ATPase beta(1) promoter-luciferase fusion gene demonstrated promoter activation by hyperoxia between -102 and +151. The hyperoxia response was localized to a 7-base pair region between -62 and -55, which contained a GC-rich region consistent with a consensus sequence for the SP1 family, that was sufficient for up-regulation by hyperoxia. This GC element exhibited both basal and hyperoxia-induced promoter activity and bound both transcription factors SP1 and SP3 in electrophoretic mobility shift assays. In addition, electrophoretic mobility shift assays demonstrated increased binding of SP1/SP3 in cells exposed to hyperoxia while mutation of this element eliminated protein binding. Other GC sites within the proximal promoter also demonstrated up-regulation of transcription by hyperoxia, however, the site at -55 had higher affinity for SP proteins.

Na(+)-K(+)-ATPase gene regulation by glucocorticoids in a fetal lung epithelial cell line.

The Na(+) pump, Na(+)-K(+)-ATPase, along with the Na(+) channel is essential for the removal of alveolar solute and fluid perinatally. Because Na(+)-pump mRNA and activity increase before birth and maternal glucocorticoids (GCs) influence Na(+)-K(+)-ATPase mRNA expression in fetal rat lung, we hypothesized that GCs increased Na(+)-K(+)-ATPase gene expression in a fetal lung epithelial cell line. After 24 h of exposure, dexamethasone increased the steady-state levels of Na(+)-K(+)-ATPase alpha(1) and beta(1) mRNA in a fetal rat lung epithelial cell line in a dose-dependent fashion (10(-7) to 10(-5) M). The maximal increase in mRNA levels was 3. 8-fold for alpha(1) and 2.8-fold for beta(1). The increase in mRNA was detected as early as 6 h for the beta(1)-subunit and 18 h for the alpha(1)-subunit, and both peaked at 24 h. This gene upregulation was not due to increased mRNA stability based on mRNA half-life determination after actinomycin D inhibition. Transfection experiments with alpha(1) and beta(1) promoter-reporter constructs demonstrated 3.2 +/- 0.5- and 2.6 +/- 0.4-fold increases, respectively, in promoter activity, consistent with transcriptional activation of the promoter-reporter construct. These findings, increased promoter activity with no change in stability, indicate that GCs increased Na(+)-K(+)-ATPase transcription in a fetal lung epithelial cell line.

Oxidant effects on epithelial Na,K-ATPase gene expression and promoter function.

The lung epithelium resorbs alveolar fluid through combined action of sodium channels and the sodium pump, Na,K-ATPase. The lung often is exposed to hyperoxia in disease states and hyperoxia generates a mixture of reactive oxygen species. In vivo and in vitro exposure of rat lung and alveolar type II cells, respectively, increases gene expression of both alpha-1 and beta-1 subunits of the sodium pump. In contrast to the primary type II cells, several type II cell lines did not increase sodium pump gene expression with hyperoxia, but the renal tubular epithelial MDCK cell line did. Using promoter-receptor constructs transfected into MDCK cells, hyperoxia did not markedly increase transcription of the alpha-1 subunit but doubled transcription of the beta-1 subunit gene. Using 5'-deletion constructs, the region required for the beta-1 increase was localized to a 40-base pair region from -44/-84. The hyperoxic responsiveness of this region was confirmed using constructs with one or two copies of this region placed in minimal promoter-luciferase reporters. This 5' promoter region contains a consensus binding sequence for SP-1, a basal transcription factor but not for binding of other known transcription factors. Thus, hyperoxia induces Na,K-ATPase beta-1 promoter transcription, likely acting through a novel mechanism.

Regulation of Na-K-ATPase gene expression by hyperoxia in MDCK cells.

Na-K-ATPase plays a central role in a variety of physiological processes, including ion transport and regulation of cell volume. Our previous data showed that hyperoxia increased the expression of Na-K-ATPase alpha 1 and beta 1 mRNA in lung type II cells. We similarly show that hyperoxia (> or = 95% O2 for 24-48 h) increased steady-state mRNA levels in both Na-K-ATPase subunits in Madin-Darby canine kidney (MDCK) cells. The mechanism of gene regulation by hyperoxia was assessed. Stability of the Na-K-ATPase mRNA levels of both subunits was unchanged in hyperoxia-exposed MDCK cells. To determine whether gene transcription was augmented by hyperoxia, MDCK cells were transfected with a beta 1-subunit promoter-reporter construct. Transfection with the wild-type promoter (beta 1-817) revealed a 1.9 +/- 0.2-fold increase in promoter activity. Transfection with 5' deletion constructs identified a 61-base pair (bp) region between -102 and -41 that was necessary for this increase in promoter activity by hyperoxia. Incorporation of this 61-bp region into a minimal promoter (mouse mammary tumor virus) similarly increased promoter activity 2.3-fold in the presence of hyperoxia. This increase in promoter activity was not seen when MDCK cells were incubated with various concentrations of hydrogen peroxide. In summary, hyperoxia increased Na-K-ATPase beta 1-subunit mRNA steady-state level due to increased transcription in MDCK cells. A region necessary for this hyperoxic effect on beta 1 transcription is located between base pairs -102 and -41 on the promoter.

Community respiratory viruses: organ transplant recipients.

Respiratory infections are common after solid organ transplantation, but the significance of community respiratory viral infections in this patient population has not been determined. Review of the literature indicates that infection of organ transplant recipients by community respiratory viruses can result in significant morbidity with some associated mortality. These viruses include respiratory syncytial virus (RSV), parainfluenza virus (PIV), influenza virus, and adenovirus. As in normal hosts, infection of organ transplant recipients by these viruses can result in limited upper respiratory tract symptoms, such as rhinorrhea, cough, and fever. Immunocompromised patients can also have lower respiratory tract infection, resulting in bronchiolitis, pneumonitis, respiratory failure, and death. The highest incidence of infection with these viruses is reported in lung transplant recipients, with an incidence up to 21%. In addition to the effects of the usual immunosuppressant regimen, lung transplant recipients have altered lung immunity due to impaired ciliary clearance, poor cough reflex, and abnormal lymphatic drainage, predisposing these patients to lower respiratory tract infections. Of additional importance to organ transplant recipients is the correlation of organ rejection to recent viral infections with these agents. Influenza A and B, PIV, and adenovirus have been reported to be associated with acute rejection in renal transplant recipients. Diagnosis of these infections is often made by positive respiratory cultures, often with a delay between symptom onset and diagnosis. Clinical trials of antiviral agents in this patient population have not been carried out, and treatment has often been limited to severe, life-threatening cases.

Respiratory syncytial virus and parainfluenza virus infections in the immunocompromised host.

Respiratory syncytial virus (RSV) and parainfluenza virus (PIV) are common causes of respiratory infections in immunocompetent children under the age of 6 years. These viruses belong to a family of enveloped single-stranded RNA viruses, the paramyxoviruses. The clinical manifestations in the normal host range from mild illness to severe croup, bronchiolitis, and pneumonia. After the age of 6 years, reinfections occur, but are characterized by diminishing frequency and severity. In contrast to the normal adult host, severe lower respiratory tract infection can occur in immunocompromised adults as well as children, with significant morbidity and mortality. Similar to the normal host, infection with RSV occurs in epidemics in the winter and spring, while PIV occurs throughout the year. Immunocompromised hosts often have upper respiratory tract symptoms similar to those experienced by normal hosts, as well as a higher incidence of lower respiratory tract symptoms and sinusitis. Lower respiratory tract infection can lead to respiratory failure and death, especially in bone marrow transplant recipients. The diagnosis of RSV and PIV depends on the analysis of specimens obtained from the respiratory tract. Rapid diagnostic tests are readily available for RSV and are less widely used for some of the PIV serotypes. Primary cultures are used for both viruses, but take several days to yield a positive result. Ribavirin, a broad-spectrum antiviral agent, is effective against RSV and PIV in vitro. Clinical trials have shown ribavirin to be of benefit in treating infants infected with RSV. However, clinical trials in immunocompromised patients infected with RSV or PIV have not been carried out. Since infection with RSV and PIV can be severe and life-threatening and treatment with ribavirin is relatively benign, it seems warranted to treat immunocompromised patients infected with RSV or PIV with ribavirin until otherwise proven unwarranted.

Paramyxovirus infection in lung transplant recipients.

BACKGROUND: Respiratory infections are common after lung transplantation. The significance of respiratory paramyxoviruses, respiratory syncytial virus, and parainfluenza virus in lung transplant recipients has not been determined. METHODS: In a retrospective fashion, we examined the incidence and clinical characteristics of paramyxovirus infection in 84 consecutive lung transplant recipients at the University of Minnesota Hospital and Clinics from 1986 through 1993. RESULTS: We identified 19 cases of paramyxovirus infection in 18 patients (21% of all transplant recipients). All patients had symptoms with lower respiratory tract involvement, and nine (47%) had coexisting upper respiratory involvement. Symptom onset was 24 to 2056 days after transplantation (median = 260 days). Respiratory syncytial virus infection was seasonal (January through June), but parainfluenza virus infection occurred throughout the year. Six patients showed a decline in spirometry (26% +/- 2.8% decrease in forced expiratory volume in 1 second); four returned to baseline. Diagnosis was made by bronchoalveolar lavage in 15 cases, nasopharyngeal swab in three cases, and sputum in one case. Most patients (74%) were treated with ribavirin, and all but one treated patient recovered fully. In untreated patients, respiratory syncytial virus contributed to one death and one parainfluenza virus infection resulted in a persistent reduction in spirometry. Age was the strongest predictor of infection, with a higher incidence in patients under 18 years old (57%, p < 0.05). Preexisting obliterative bronchiolitis did not correlate with an increased incidence of paramyxovirus infection (20% with obliterative bronchiolitis, 22% without obliterative bronchiolitis; p > 0.05). CONCLUSIONS: Lower respiratory tract infection with paramyxovirus is common in lung transplant recipients and capable of causing death or a permanent reduction in pulmonary function.

Alveolar epithelial cells regulate the induction of endothelial cell apoptosis.

Mesenchymal cell apoptosis is important during development, tissue homeostasis, and repair. We sought to determine whether type II alveolar epithelial cells influence mesenchymal cell apoptosis, using the model of tumor necrosis factor-alpha (TNF-alpha)-induced apoptosis of endothelial cells. Apoptosis was quantified by morphology and confirmed by electrophoretic DNA size analysis. Endothelial cells exposed to 20 ng/ml of TNF-alpha for 16 h exhibited apoptosis in 14.4 +/- 1.4% (SE) of the cells, whereas serum-free conditioned media (CM) from primary cultures of rat type II cells reduced TNF-alpha-induced apoptosis by 52% to 7.5 +/- 0.9% (P < 0.01). Flow cytometric analysis of subdiploid DNA content per cell also showed that CM reduced the percentage of cells with TNF-alpha-induced DNA degradation by 48 +/- 1.7%. The protective effect of CM was concentration dependent and also was effective across a range of TNF concentrations. This CM factor was trypsin sensitive and stable at 65 degrees C for 1 h. It bound to a Mono-Q anion-exchange resin, eluting in a discrete peak at 1.18 M NaCl and pH 8.5. Therefore alveolar type II cells release a heat-stable peptide(s) that protects endothelial cells against apoptosis induced by TNF. Our results suggest that alveolar epithelial cells regulate the response of mesenchymal cells to factors that induce apoptosis during injury and repair.

Induction of endothelial cell apoptosis by TNF alpha: modulation by inhibitors of protein synthesis.

Our objective was to examine the induction of endothelial cell apoptosis by the proinflammatory ligand, TNF alpha. We hypothesized that TNF alpha influences endothelial cell viability by altering the balance of regulatory molecules that either induce or suppress apoptosis. Since the identity of these regulators is unknown, our approach was to examine induction of endothelial cell apoptosis by TNF alpha alone and in the context of an inhibitor of transcription or translation. TNF alpha was able to induce bovine pulmonary artery endothelial cell apoptosis in a dose-dependent fashion. Inhibition of transcription with actinomycin D or translation with cycloheximide also resulted in apoptosis, which reached a maximum value of approximately 35 to 40% of cells after 24 h. TNF alpha induction of apoptosis was either potentiated or abrogated by cycloheximide, depending on the timing of TNF alpha exposure in relation to inhibition of protein synthesis. When cycloheximide was added concomitantly with midrange concentrations of TNF alpha, there was both a dramatic acceleration and a synergistic increase in the observed apoptotic response, with all endothelial cells dying within 24 h. When cycloheximide was added as a function of time after termination of TNF alpha exposure, the synergistic induction of apoptosis was maintained at > 70% of its maximum value for 1 h, declining monotonically in a time-dependent fashion to baseline values after 6 h. In contrast, when TNF alpha was added after protein synthesis was inhibited, no additional increase in apoptosis above that observed with inhibition of protein synthesis alone was observed. Our results are consistent with the concept that endothelial cell viability depends on an interaction of inducers and suppressors of apoptosis, which are susceptible to modulation by TNF alpha.

Parainfluenza virus respiratory infection after bone marrow transplantation.

BACKGROUND: Pneumonia complicates about half of all bone marrow transplantations, and in about a third of the cases no specific cause is identified. Although parainfluenza virus is a common cause of respiratory infection in normal children, its role in transplant recipients is unknown. METHODS: We describe the incidence and clinical course of parainfluenza infection among the 1253 recipients of bone marrow transplants at our center from 1974 through 1990. We performed viral cultures on all such recipients who had manifestations of a viral infection or fever without apparent cause. RESULTS: Among the 1253 patients, we found 27 (2.2 percent) who had parainfluenza virus infection as demonstrated by culture (12 of 580 adults and 15 of 673 children). Eight of these patients had only upper respiratory tract involvement, all of whom had positive nasopharyngeal cultures. Of the remaining 19, 8 had symptoms of both upper and lower respiratory tract involvement, and 11 had only lower respiratory involvement, of whom only 6 had positive nasopharyngeal cultures. Four required bronchoalveolar lavage for diagnosis. A median of nine days elapsed from the onset of symptoms until the culture became positive, and overall only 33 of 118 cultures obtained were positive. Respiratory failure developed in 6 of the 19 patients with lower respiratory tract involvement, and all died. CONCLUSIONS: Parainfluenza virus is a cause of serious lower respiratory tract involvement in both adults and children who undergo bone marrow transplantation. Given the insensitivity of current culturing techniques, it may be underdiagnosed.

Muscle cross-bridges: do they rotate?

We have used electron paramagnetic resonance (EPR) spectroscopy to monitor the orientation of spin labels attached specifically to a reactive sulfhydryl on the myosin heads in glycerinated rabbit psoas skeletal muscle. Previous work has shown that the paramagnetic probes are highly ordered in rigor muscle and display a random angular distribution in relaxed muscle (Thomas and Cooke , 1980). Addition of ADP to rigor fibers caused no spectral changes, while addition of AMPPNP or PPi increased the fraction of disordered probes. We show here that the application of stress to fibers in the presence of ADP, AMPPNP or PPi causes no change in their spectra. During the generation of isometric tension approximately 80% of the probes display a random angular distribution as in relaxed muscle while the remaining 20% are highly oriented at the same angle as found in rigor muscle. In each of the above cases the spectrum consists of two components, one highly ordered as in rigor and one highly disordered. Saturation transfer EPR has shown that the ordered component is rigid while the disordered component is mobile on the microsecond time scale (Thomas, Ishiwata , Seidel and Gergely , 1980). These data lead to the conclusion that the disordered spectral component arises from myosin heads that are detached from actin while the ordered component comes from heads that are attached to actin. The observation that the ordered component displays an identical angular distribution under all conditions indicates that its orientation is not linked to force generation.

Saturation transfer EPR spectroscopy on spin-labeled muscle fibers using a loop-gap resonator.

Previously, saturation transfer (ST-EPR) studies of biomolecular dynamics have involved the use of a resonant cavity and the V'2 display (absorption, second harmonic, out of phase). In the present study, we replaced the resonant cavity with a loop-gap resonator and used the U'1 display (dispersion, first harmonic, out of phase) to study spin-labeled muscle fibers. The new resonator and display showed several advantages over those previously used. It produced virtually noiseless U'1 spectra on a 0.4 microliter sample using a 4 min scan; previous U'1 experiments on spin-labeled muscle, using a conventional rectangular cavity, resulted in an unacceptably low signal-to-noise ratio. The high filling factor of the resonator facilitated the study of these extremely small fiber bundles and permitted high microwave field intensities to be achieved at much lower incident microwave power levels, thus greatly enhancing the signal-to-noise ratio in U'1 experiments. This reduction in the noise level made it possible to benefit from the other advantages of U'1 over V'2, such as stronger signals, simpler line shapes, and simpler data analysis. For these muscle fiber samples, the resulting sensitivity (signal/noise/sample volume) of the U'1 signals was greater than 100 times that of V'2 signals obtained in a conventional cavity. Another advantage of the U'1 display is that signals from weakly immobilized probes, i.e., probes that have nanosecond rotational mobility relative to the labeled protein (myosin), are greatly suppressed relative to strongly immobilized probes. This reduces the ambiguity of spectral analysis, and eliminates the need for chemical treatments [e.g., using K3Fe(CN)6] that were previously required in muscle fibers and other systems. Further suppression of this weakly immobilized component was achieved in U'1 spectra by increasing the microwave power and decreasing the field modulation frequency.