[A case of Mycobacterium intracellulare infection complicated by immotile cilia syndrome].

A 25-year-old woman with a history of immotile cilia syndrome (ICS) was admitted to our hospital with dyspnea. Chest roentgenography revealed dense infiltrates in both lower lung fields in addition to bronchiectasis and small nodular opacities, which had been observed previously. Transbronchial lung biopsy demonstrated evidence of non-caseating epithelioid cell granuloma. Sputum specimens were examined, and isolates were identified as Mycobacterium intracellulare. The patient was given antituberculous therapy and clarithromycin, which induced clinical improvement. It is well known that bronchial mucociliary transport is severely impaired in patients with ICS. However, to our knowledge, cases of M. intracellulare infection complicated by ICS have not been reported in Japan. We must pay close attention to the concurrence of these diseases.

Heme oxygenase-1 (HO-1) protein induction in a mouse model of asthma.

BACKGROUND AND OBJECTIVE: Carbon monoxide (CO) is known to be present in measurable quantities in the exhalation of asthmatic patients. Corticosteroid treatment resulted in a decrease in exhaled CO levels in asthmatic patients, raising the possibility that an increase in exhaled CO concentration reflects inflammation of the asthmatic airway. Heme oxygenase-1 (HO-1) protein, also called HSP32, is the rate-limiting enzyme in the catabolism of heme to biliverdin, free iron and CO. However, it is unknown whether an expression of HO-1 within the lung tissue is related to allergic airway inflammation. We studied the expression of HO-1 in lung tissue and bronchoalveolar lavage cells in a mouse model of asthma. METHODS: Ovalbumin (OVA)-sensitized C57BL/6 mice were challenged with aerosolized OVA. HO-1 positive cells were identified by immunostaining in lung tissue and bronchoalveolar lavage fluid (BALF) after the challenge. RESULTS: HO-1 positive cell numbers increased in the subepithelium of the bronchi after OVA challenge. In cytospin preparations from BALF after OVA challenge, HO-1 was localized to alveolar macrophages. Inside the macrophages, HO-1 reactivity was expressed in the cytoplasm, and the perinuclear region in particular. CONCLUSION: The expression of HO-1 is increased within the lung tissue in allergic airway inflammation. Measurement of HO-1 activity may be clinically useful in the management of asthma.

In vivo expression of signal transducer and activator of transcription factor 6 (STAT6) in nasal mucosa from atopic allergic rhinitis: effect of topical corticosteroids.

BACKGROUND: The allergen-induced late nasal response is associated with a high local expression of interleukin (IL) -4, a TH2-type cytokine implicated in immunoglobulin (Ig) E production, tissue eosinophilia and other events considered to be relevant to allergic inflammation. Interaction of IL-4 with its receptor activates at least two distinct signalling pathways that culminate in the transcription of specific target genes. One pathway involves the activation of a transcription factor termed signal transducer and activator of transcription factor 6 (STAT6). OBJECTIVE: To investigate the expression of STAT6 in the allergen-induced late nasal response and to examine the effect of local steroid treatment on STAT6 expression. METHODS: Inferior turbinate biopsies were obtained from subjects with allergic rhinitis out of the allergen season. Subjects were then randomized into topical steroid- (n = 6) and placebo-treated (n = 6) groups in a double-blind fashion. After a 6-week treatment period, a second nasal biopsy was performed 24 h after local challenge with allergen. STAT6 immunoreactivity was examined in biopsy specimens by immunocytochemistry using a specific monoclonal antibody. Numbers of inflammatory cells (CD3+ T cells and MBP+ eosinophils) and IL-4 mRNA+ cells were investigated by immunocytochemistry and in situ hybridization, respectively. RESULTS: STAT6 immunoreactivity was detected in all biopsies studied and localized predominantly to inflammatory tissue of the nasal mucosa. After allergen challenge, expression of STAT6 was markedly increased in placebo-treated patients (P < 0.01). By confocal microscopy, STAT6 was localized to the cytoplasm and the nucleus of positively-staining cells. The allergen-induced increase in STAT6 immunoreactive cells was not observed in the steroid-treated patients. The change in STAT6 immunoreactivity after allergen challenge correlated significantly with the change in numbers IL-4 mRNA+ cells (r = 0.74, P = 0.006) and CD3+ T cells (r = 0.76, P = 0. 004), but not MBP+ eosinophils. CONCLUSION: This study provides the first evidence of increased STAT6 expression in vivo in human allergic inflammation. The results support a role for STAT6 and IL-4 in the pathogenesis of late nasal response and show that decreases in STAT6 expression parallel the reduction in IL-4 expression that occurs with topical steroid treatment.

Montelukast, a leukotriene receptor antagonist, inhibits the late airway response to antigen, airway eosinophilia, and IL-5-expressing cells in Brown Norway rats.

BACKGROUND: Asthma is characterized by airflow obstruction, inflammatory cell infiltration, and the synthesis of mediators, such as T(H2) cytokines and leukotrienes, in the airways. Cysteinyl leukotriene (cysLT) receptor antagonists have recently been associated with clinical improvement of asthma and reduced airway inflammation. Whether the beneficial effects of cysLT antagonists are mediated through the modulation of cytokine expression has not been determined. OBJECTIVE: The aim of the study was to determine the presence of eosinophils and IL-5 messenger (m)RNA(+) cells within the lungs of antigen-challenged Brown Norway rats after treatment with the cysLT(1) receptor antagonist montelukast (MK). METHODS: Ovalbumin-sensitized Brown Norway rats were treated with either MK or saline before ovalbumin challenge. Pulmonary mechanics were monitored for 8 hours. Subsequently, immunocytochemistry and in situ hybridization were used to examine bronchoalveolar lavage (BAL) fluid and lung tissue for cells expressing major basic protein (eosinophils) and IL-5 mRNA, respectively. Simultaneous in situ hybridization and immunocytochemistry was used to phenotype the cells expressing mRNA encoding IL-5. RESULTS: Animals treated with MK had significantly lower lung resistance and fewer eosinophils and IL-5 mRNA(+) cells within BAL fluid and lung tissue compared with that found in saline-treated animals. Colocalizaton studies revealed that the majority of IL-5 mRNA(+) cells were T cells and that the number of IL-5 mRNA(+)/CD3(+) or IL-5 mRNA(+)/major basic protein(+) cells were significantly less within BAL from animals treated with MK than from those treated with saline. CONCLUSIONS: These results indicate that the cysLT(1) receptor antagonist MK can diminish the pulmonary response to antigen, tissue eosinophilia, and the number of cells expressing IL-5 mRNA, suggesting that leukotrienes may also regulate the allergic response through the modulation of inflammation and cytokine synthesis.

CD8+ T cells modulate late allergic airway responses in Brown Norway rats.

To test the hypothesis that CD8+ T cells may suppress the allergen-induced late airway response (LAR) and airway eosinophilia, we examined the effect of administration of Ag-primed CD8+ T cells on allergic airway responses, bronchoalveolar lavage (BAL) leukocytes, and mRNA expression for cytokines (IL-4, IL-5, and IFN-gamma) in OVA-sensitized Brown Norway rats. On day 12 postsensitization to OVA, test rats were administered 2 million CD8+ T cells i.p. isolated from either the cervical lymph nodes (LN group; n = 8) or the spleen (Spl group; n = 6) of sensitized donors. On day 14, test rats were challenged with aerosolized OVA. Control rats were administered PBS i.p. on day 12, and challenged with OVA (n = 10) or BSA (n = 6) on day 14. The lung resistance was measured for 8 h after challenge. BAL was performed at 8 h. Cytospin slides of BAL were analyzed for major basic protein by immunostaining and for cytokine mRNA by in situ hybridization. The LAR was significantly less in the LN group (1.8 +/- 0.5 U; p < 0.01) and BSA controls (1.4 +/- 0.7; p < 0.01), but not in the Spl group (6.7 +/- 2.2), compared with that in OVA controls (8.1 +/- 1.8). In BAL, the number of major basic protein-positive cells was lower in the LN and Spl groups compared with OVA controls (p < 0.05 and p < 0.01). IL-4- and IL-5-positive cells were decreased in the LN group compared with the OVA controls (p < 0.01). INF-gamma-positive cells were increased in the LN and Spl groups compared with the OVA controls (p < 0.01). Serum OVA-specific IgE levels were unaffected by CD8+ T cell transfers. These results indicate that Ag-primed CD8+ T cells have a potent suppressive effect on LAR.

Increased expression of IL-12 receptor mRNA in active pulmonary tuberculosis and sarcoidosis.

Cytokines have been implicated in the pathophysiology and development of pulmonary diseases such as tuberculosis and sarcoidosis. In particular, the numbers of cells expressing Th1-type cytokines such as IFN-gamma and IL-12 are increased within the lungs of patients with these granulomatous diseases. As a factor promoting the commitment of naive lymphocytes to a Th1-type profile of cytokine expression, IL-12 may be pivotal in the cascade of proinflammatory events within the airways. In this study, we examined the expression of the IL-12 receptor (IL-12R) mRNA in bronchoalveolar lavage (BAL) fluid from patients with active pulmonary tuberculosis (n = 6) and active pulmonary sarcoidosis (n = 6), and from allergic asthmatics (n = 6) and normal control subjects (n = 6). Bronchoscopy with BAL was undertaken, and cell cytospins were examined using the technique of in situ hybridization. There was a significant increase in the numbers of cells expressing mRNA for both beta(1) and beta(2) subunits of the IL-12R in active pulmonary sarcoidosis (p < 0.02, p < 0.01, respectively) and active pulmonary tuberculosis (p < 0.01, p < 0.005, respectively) compared with normal control subjects. In contrast, the allergic asthmatic patients exhibited a significant decrease in the number of IL-12R mRNA-positive cells (both beta(1) and beta(2) subunits (p < 0.01, p < 0.005, respectively), compared with the normal control subjects. These patients did, however, exhibit a significant increase in IL-4R mRNA, which was not evident in those with either tuberculosis or sarcoidosis when compared with normal subjects (p < 0.05). Colocalization studies demonstrated that CD8+ve cells are a principal site for the expression of IL-12R in tuberculosis. In sarcoidosis, IL-12R was expressed both on CD4+ve and CD8+ve cells. The increased expression of receptors for IL-12 in granulomatous diseases such as pulmonary tuberculosis and sarcoidosis provides evidence supporting the commitment of lymphocytes to a Th1-type cytokine profile in vivo.

[Pleural malignant mesothelioma complicated by multiple myeloma].

A 79-year-old woman was admitted because of dyspnea. Chest X-ray films and computed tomographic scans disclosed left pleural effusion and diffuse pleural thickening. A diagnosis of multiple myeloma was made on the basis of blood tests and bone marrow aspiration biopsy findings. Multiple myeloma was the suspected cause of the pleural lesions. However, a postmortem diagnosis of malignant mesothelioma of the pleura was made on the basis of histological and immunohistological studies of autopsy specimens.

Two cases of eosinophilic gastroenteritis associated with analgesic-induced bronchial asthma.

Two patients (one male and one female) with bronchial asthma were diagnosed as having eosinophilic gastroenteritis (EG). The condition was revealed by biopsies through fibrescopic endoscopy. According to the Klein classification, they had mucosal disease. The symptoms were abdominal pain and nausea. The symptoms subsided with corticosteroid administration in one patient and with palliative treatment in the other patient. It was suggested that fibrescopic endoscopy biopsy is needed to identify coexisting EG if a bronchial asthma patient complains of severe gastrointestinal symptoms.

[Role of adhesion molecules (VLA-4) in the asthmatic response to allergens].

We evaluated the role of very late antigen-4 (VLA-4) in asthmatic responses. Brown-Norway rats were sensitized with ovalbumin and then challenged with ovalbumin. Respiratory impedance, and the influx of eosinophils and of VLA-4-positive cells were measured. Eosinophils were stained with Giemsa's solution and VLA-4-positive cells were detected by an immunocytochemical method with a monoclonal antibody against rat VLA-4 (MR alpha 4-1). The numbers of eosinophils and of VLA-4-positive cells in sections of lung tissue from the rats were counted. The effect of MR alpha 4-1 and of a new anti-allergic drug, TYB-2285, on late asthmatic responses was also studied. Respiratory impedance had increased in all the rats by 6-7 hours after the challenge, which indicated that these animals had a late asthmatic response. These rats had more eosinophils and more VLA-4-positive cells than did sensitized animals that were not challenged. The rats given MR alpha 4-1 had significantly smaller increases in respiratory impedance and less eosinophil influx than did those given only phosphate-buffered saline. The rats given TYB-2285 had significantly smaller increases in impedance and less influx of eosinophils and of VLA-4-positive cells. These results show that infiltration of eosinophils and of VLA-4-positive cells corresponds closely with the late asthmatic response, and they suggest that the VLA-4/VCAM-1 pathway plays an important role in this response. These data also suggest that the infiltration of VLA-4-positive cells can be used to evaluate the effect of anti-allergic drugs on the late asthmatic response.

Role of eosinophils and cell adhesion molecules in the allergen-induced asthmatic response of rats.

To evaluate the airway infiltration of eosinophils in the asthmatic responses of Brown-Norway rats, which were sensitized with ovalbumin, the time course of eosinophil infiltration and respiratory resistance (Rrs) after ovalbumin challenge was measured. The effect of treatment with monoclonal antibody against ICAM-1 and CD18 was studied. Finally, the expression of ICAM-1 and CD18 in the airway was investigated. All rats showed Rrs increase 6-7 hours after ovalbumin challenge, indicating a late asthmatic response (LAR). Animals with LAR had higher eosinophil counts than those with an immediate asthmatic response (IAR) and in the sensitized but nonchallenged animals. Rats treated with the antibodies showed significantly smaller increases in Rrs and lower eosinophil counts than the control animals. Immunohistochemical staining in airway was performed. ICAM-1 immunoreactivity was positive on both the epithelium and the vascular endothelium of a trachea section, and on the pulmonary vascular endothelium. ICAM-1 expression was upregulated after challenge. The number of CD18-positive cells in sections of trachea and lung increased after challenge. Our results show that eosinophil infiltration is important in LAR development and the treatment with antagonists of ICAM-1 and CD18 may provide a therapeutic approach to reducing asthmatic symptoms.

[Role of eosinophils and cell adhesion molecules in the asthmatic response to allergen].

To evaluate the eosinophil infiltration in lung tissues in asthmatic responses of Brown-Norway rats and guinea pigs, both of which were sensitized with ovalbumin (OA), the time course of changes in respiratory impedance (Zrs) and eosinophil influx after aerosol challenge with OA were measured. The effect of treatment with monoclonal antibody (MoAb) 1A29 against rat intercellular adhesion molecule-1 (ICAM-1) alone and a mixture of MoAb 1A29 and MoAb WT-3 against rat CD18 on asthmatic responses of the rats was studied. Finally, these expressions in lung tissues of the rats were recognized. The number of eosinophils in the subepithelial area was counted in sections of lung tissue stained with Giemsa's solution, using an Interaktive Build-Analyse System (IBAS). All of the rats and 80% of the guinea pigs developed an increase in Zrs 6-7 hours after challenge, indicating that these animals showed a late asthmatic response (LAR). The rats and the guinea pigs with a LAR had higher eosinophil counts than those with an immediate asthmatic response and sensitized, non-challenged animals (p < 0.01). The rats treated with MoAb 1A29 alone (n = 5) and a mixture of MoAb 1A29 and MoAb WT-3 (n = 8) developed significantly smaller increases in Zrs and a smaller eosinophil influx than the control animals treated with phosphate buffered saline (n = 15): 147.3 +/- 3.5, 134.8 +/- 11.6 versus 158.8 +/- 6.3% of baseline; 734 +/- 21, 545 +/- 108 versus 1006 +/- 147 cells/mm2 (p < 0.01). Immunoperoxidase staining of rat lung tissues using MoAb 1A29 or MoAb WT-3 was performed ICAM-1 immunoreactivity was positive in the basilar portion of the epithelium, in the vascular endothelium of the trachea and in the pulmonary vascular endothelium. ICAM-1 immunoreactivity was revealed to be upregulated after challenge. The number of CD18-positive cells in the trachea and in the subepithelial area increased after challenge. These results show that eosinophil infiltration corresponds closely to bronchoconstriction in LAR and that treatment with MoAbs to ICAM-1 and CD18 may be effective in reducing asthmatic symptoms.

[Superoxide dismutase suppressed asthmatic response with inhibition of manganese superoxide induction in rat lung].

To investigate the involvement of oxygen radicals in the development of asthma, we examined the time course of changes in the expression of superoxide dismutases (SODs) both at mRNA and protein levels in the rat model of allergic asthma. We then examined the effects of recombinant-human SOD (r-hSOD) on these expressions and on the late asthmatic response (LAR). 1) In situ hybridization histochemistry and immunocytochemistry revealed that non-sensitized and sensitized rats before challenge had a very low level of manganese SOD (MnDOS) in the bronchial epithelial cells, although they showed a significant level of copper-zinc SOD (CuZnSOD). 2) All of the animals displayed LAR within 7 hours after the challenge, when they showed dramatic induction of MnSOD, but not of CuZnSOD, in the epithelial cells. 3) Treatment with r-hSOD almost completely suppressed LAR, with abolishment of MnSOD induction. This study suggests that the oxygen radical plays an important role in the inflammatory state of bronchial asthma, during which some cytokines induce the expression of MnSOD in the lung.