Function and composition of pulmonary surfactant and surfactant-derived fatty acid profiles are altered in young adults with cystic fibrosis.

STUDY OBJECTIVES: To determine whether chronic lung inflammation in young adult patients with cystic fibrosis (CF) alters the composition and function of surfactant and surfactant components in bronchoalveolar secretions. DESIGN: A prospective, descriptive study. SETTING: An adult CF center in a tertiary health-care center. PARTICIPANTS: Thirteen normal volunteer (NV) subjects recruited via local advertising and 15 CF patients recruited from the CF center. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: We performed BAL and measured surfactant-associated protein A (SP-A) via enzyme-linked immunosorbent assay in BAL fluid (BALF), and quantitated total phospholipid, phospholipid subclass, and fatty acid subclass content of extracted BALF. We also determined the protein and phospholipid content, SP-A content, and functional characteristics of surfactant isolated from BALF via high-speed centrifugation. The phospholipid-to-protein ratio (milligram/milligram) of surfactant isolated by centrifugation (mean +/- SEM) was 1.01 +/- 0.07 for NV subjects and 2.62 +/- 0.42 for CF patients (p = 0.0001). Minimal surface tension was < 1 dyne.s.cm(-5) in all samples from NV subjects, but 21.9 +/- 0.73 dyne.s.cm(-5) for surfactant from CF patients. Immunoblotting of isolated surfactant revealed a marked decrease in SP-A for CF patients, compared to NV subjects. However, mean concentrations of SP-A in BALF that had not been subjected to high-speed centrifugation to isolate surfactant were not significantly different for CF patients (4.7 +/- 0.8 microgram/mL) vs NV subjects (4.6 +/- 0.2 microgram/mL). Additionally, phospholipid-to-protein ratios (0.32 +/- 0.04 for NV subjects vs 0.10 +/- 0.02 for CF patients; p < 0.0001) in extracted uncentrifuged BALF, and SP-A-to-protein ratios (microgram/milligram) in BALF were significantly depressed (74 +/- 8 for NV subjects vs 16 +/- 3 for CF patients; p < 0.0001). The phospholipid and fatty acid subclass profiles of extracted CF BALF vs NV BALF revealed a decreased mean phosphatidylcholine-to-sphingomyelin ratio (20.7 +/- 10.0 vs 55.2 +/- 8.7; p = 0.002), increased oleic acid content (12.1 +/- 2.3 nmol/mL vs 3.2 +/- 0.9 nmol/mL; p < 0.01), and increased arachidonic acid content (2.2 +/- 0.5 nmol/mL vs 0.6 +/- 0.3 nmol/mL; p < 0.05) for CF patients. CONCLUSIONS: Altered phospholipid-to-protein ratios and phospholipid subclasses, altered surfactant-derived fatty acid profiles, high minimal surface tension, and decreased association of SP-A with lipid components of isolated surfactant indicate that surfactant components are considerably altered and dysfunctional in lower respiratory tract secretions of CF patients. Surfactant composition and function are altered in CF, and the pattern of phospholipid and surfactant-derived fatty acid subclass alterations in CF are characteristic of ongoing lung injury and may depress surfactant function.

Neutrophil-mediated phospholipid peroxidation assessed by gas chromatography-mass spectroscopy.

Disease pathophysiology frequently involves manifestations of the systemic inflammatory response syndrome. Oxyradicals represent key inflammatory mediators, and neutrophils are one important source of oxyradicals. This investigation examined neutrophil-mediated peroxidation of dilinoleoyl phosphatidyl-choline (DLPC) liposomes by monitoring the appearance of monohydroxyl linoleic acid with the use of gas chromatography-mass spectroscopy (GC-MS), compared with traditional assessment of thiobarbituric acid-reactive species (TBARS) and phosphatidylcholine-specific conjugated dienes. DLPC was peroxidized in a system using activated neutrophils in balanced salt solution containing chelated iron. 9-Monohydroxyl linoleic acid and 13-monohydroxyl linoleic acid were readily identified in neutrophil-mediated peroxidized DLPC with the use of GC-MS. Neutrophil NADPH oxidoreductase specific activity correlated highly with total ion current or specific ion monitoring of integrated peak areas for peroxidized linoleic acid but correlated poorly with DLPC-derived TBARS or conjugated dienes. These results ascertain that activated neutrophils mediate phosphatidylcholine lipid peroxidation to specific products, which may be precisely monitored with the use of GC-MS. The extent of this peroxidation is highly correlated with the magnitude of the neutrophil respiratory burst.

Bronchoalveolar oxyradical inflammatory elements herald bronchopulmonary dysplasia.

OBJECTIVES: To quantify oxyradical inflammatory markers in serial endotracheal tube aspirates obtained from premature neonates at risk for developing bronchopulmonary dysplasia, and to correlate these parameters with clinical manifestations of the disease. DESIGN: Prospective cohort study. SETTING: Tertiary neonatal intensive care unit. PATIENTS: Twenty-eight intubated, premature infants, with 15 infants displaying simple respiratory distress syndrome and 13 infants eventually developing bronchopulmonary dysplasia. INTERVENTIONS: Endotracheal tube aspirates were collected and clinical severity scores were calculated longitudinally from an inception cohort during the first week of life. Diagnosis of bronchopulmonary dysplasia by standard criteria was recorded at 30 days of life. Various biochemical analyses related to pulmonary oxyradical stress were determined on endotracheal tube aspirates and were normalized according to the magnitude of serum/aspirate urea ratios. The demographic, illness severity, and biochemical characteristics of infants with simple respiratory distress syndrome and those characteristics of infants developing bronchopulmonary dysplasia were evaluated by masked comparison. MEASUREMENTS AND MAIN RESULTS: Populations of respiratory distress syndrome and bronchopulmonary dysplasia infants could be differentiated during the first week of life by means of the following parameters: gestational age; birth weight; Score of Neonatal Acute Physiology; Neonatal Therapeutic Intervention Scoring System; epithelial lining fluid leukocytes; elastase; myeloperoxidase; xanthine oxidase and catalase enzyme activities; and total sulfhydryls. CONCLUSIONS: Infants with simple respiratory distress syndrome could be segregated from those infants who developed bronchopulmonary dysplasia by the magnitude of the epithelial lining fluid oxyradical inflammation markers. While infants developing bronchopulmonary dysplasia typically exhibited increased concentrations of these markers during the first week of life, those infants with simple respiratory distress syndrome displayed low, uniform, or decreasing values of these markers over this interval. Infants developing bronchopulmonary dysplasia demonstrate an early pulmonary inflammatory response, and one key aspect of this response involves various oxyradical-generating systems.

Longitudinal analysis of neutrophil superoxide anion generation in patients with septic shock.

OBJECTIVE: To examine polymorphonuclear leukocyte respiratory burst function serially in patients with septic shock. DESIGN: Prospective, longitudinal, descriptive study. SETTING: Adult and pediatric (university hospital) intensive care units. PATIENTS: Eight critically ill patients, with septic shock and eight critically ill patients without evidence of infection or sepsis. MEASUREMENTS AND MAIN RESULTS: Severity of patient illness was estimated serially using the Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system. For each patient, neutrophil superoxide anion synthesis was assayed spectrophotometrically in multiple blood samples over a period of 7 to 12 days after clinical identification of septic shock. The initial sample was obtained < 12 hrs after admission. Reaction velocities initially, at 2 to 3 mins, and at 4 to 5 mins (nmol superoxide anion/min/10(6) neutrophils), and extent of reaction at 5 mins (nmol superoxide anion/5 mins/10(6) neutrophils) were determined for each assay. On the day of admission, the mean APACHE II score and initial velocity for the septic shock group were 21.5 +/- 10 and 4.6 +/- 2 nmol superoxide anion/min/10(6) neutrophils, respectively. Over the next 7 to 12 days, as the patients recovered, there was a significant (paired t-test) decrease in APACHE II scores (p < .005) and increase in initial velocity (p < .0005). The increase in initial velocity correlated with the accompanying decrease in APACHE II scores (r2 = .46). Neutrophil superoxide anion generation in the critically ill group was not suppressed compared with the septic shock group and remained normal throughout the evaluation period. CONCLUSIONS: In vitro neutrophil respiratory burst function is significantly depressed during early septic shock. As patients improve clinically, as quantitated by decreasing APACHE II scores, neutrophil respiratory burst function recovers, approaching normal values.

Human neutrophil elastase and elastase/alpha 1-antiprotease complex in cystic fibrosis. Comparison with interstitial lung disease and evaluation of the effect of intravenously administered antibiotic therapy.

In cystic fibrosis (CF), extracellular lung matrix is progressively damaged, neutrophils invade the air spaces, and activated neutrophils may release large amounts of neutrophil elastase (NE). Although alpha 1-antiprotease (alpha 1-AP) binds and inactivates NE and is the major antielastase of the lower respiratory tract, antielastase defenses may be overwhelmed in CF, leading to progressive lung damage. To determine whether the ability of alpha 1-AP to neutralize NE is impaired in CF, we compared NE activity in bronchoalveolar lavage (BAL) fluid and human neutrophil elastase/alpha 1-antiprotease (NE/alpha 1-AP) complex in both BAL fluid and peripheral blood serum from patients with CF, normal volunteers, and patients with interstitial lung disease. We detected a considerable amount of NE activity in BAL fluid from all but one patient with CF but none in that from normal volunteers or from patients with interstitial lung disease. Although in interstitial lung disease there was a significant correlation between increased NE/alpha 1-AP complex in BAL or peripheral blood and the degree of neutrophil influx, NE/alpha 1-AP complex was disproportionately low in CF BAL compared with significantly elevated values in serum. These data suggest that in CF, alpha 1-AP-mediated defense against free NE in the lower respiratory tract is significantly impaired, and high levels of uncomplexed, enzymatically active, NE are present in CF respiratory secretions. To determine whether intravenously administered antipseudomonal antibiotic therapy for exacerbations of CF lung disease diminished the amount of free NE in respiratory secretions, we used BAL to investigate the effect of such therapy on neutrophils and NE in patients with CF colonized with pseudomonads.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro phosphatidylcholine peroxidation mediated by activated human neutrophils.

Activated human polymorphonuclear leukocytes (PMNs) mediated peroxidation of dilinoleoyl phosphatidylcholine (DPLC) liposomes. Concentration-response effects were demonstrated for both PMNs and DLPC in the system studied. Chelated iron facilitated peroxidation threefold. Superoxide dismutase variably inhibited peroxidation, but never completely. Although O2-. synthesis ceased 30-40 min after PMN stimulation, lipid peroxidation continued for an additional 30-60 min, suggesting that PMNs may initiate peroxidation which subsequently becomes autocatalytic. Enhanced PMN-mediated DLPC peroxidation was noted in acidic media. Separation of DLPC reaction products by high pressure liquid chromatography demonstrated the de novo appearance of conjugated diene species. Preliminary specific ion monitoring mass spectroscopy analysis of gas chromatography fractions of reaction products (derivatized to fatty acid methyl esters/trimethylsilane hydroxyl ethers) indicated that PMN-generated oxyradicals resulted in production of conjugated 9- and 13-hydroperoxy DLPC derivatives. These results illustrate directly how activated PMNs may participate in host autoinjury by mediating phospholipid peroxidation.

Activated polymorphonuclear leukocytes inhibit phosphatidylcholine synthesis in cultured type II alveolar cells.

Activated human neutrophils (PMNs) were demonstrated to inhibit total de novo phosphatidylcholine (PC) synthesis in monolayered rat alveolar type II cells (T2C). Non-activated PMNs had no effect on PC synthesis in this system. The magnitude of inhibition T2C PC synthesis by phorbol myristate acetate-activated PMNs in six experiments averaged 59.0 +/- 13%. Exogenous chelated iron (ferric pyrophosphate) did not appear to augment the PMN-mediated inhibition of T2C PC production in this model. Alpha-1-antiprotease usually provided no protection relative to the PMN insult towards the T2C. However, superoxide dismutase and catalase alone or in combination generally provided a significant, protective effect. Although activated PMNs consistently decreased T2C PC synthesis, this effect did not appear to involve generalized T2C cytotoxicity, as assessed by lack of release of cytosolic lactate dehydrogenase. These results indicate that PMNs can inhibit T2C PC synthesis in vitro, probably via oxyradical injury. This type of pulmonary host autoinjury may be operative in a variety of acute lung injury syndromes involving pulmonary sequestration of activated PMNs.

Retinol inhibition of in vitro human neutrophil superoxide anion release.

Retinol deficiency has been clinically associated with visual impairment as well as altered growth and differentiation of various epithelial cell populations. An additional factor that may be operative in the setting of retinol deficiency is impaired immunomodulation of the neutrophil inflammatory response. Our study demonstrated a concentration-dependent inhibition by retinol of activated neutrophil superoxide anion (O2.-) release. Concentration of drug (retinol) causing 50% inhibition of initial velocity O2.- production (IC50) was 42.6 +/- 10.9 microM. Latter phases of the O2.- release reaction displayed significantly lower IC50 values. Similarly, as time of retinol-neutrophil incubation was increased, IC50 decreased. Retinol inhibition of neutrophil O2.- did not appear to involve activation/desensitization, cytotoxicity, or free-radical scavenging mechanisms. Retinol was shown to inhibit intact PMN O2.- release even after addition of the respiratory burst stimulus. Moreover, retinol inhibited O2.- release in membranes isolated from activated neutrophils. In addition to promoting proper organization and differentiation of epithelial cells, appropriate plasma/tissue retinol levels may also modulate the neutrophil tissue inflammatory response.