Activation of human neutrophils by tachykinins: effect on formyl-methionyl-leucyl-phenylalanine- and platelet-activating factor-stimulated superoxide anion production and antibody-dependent cell-mediated cytotoxicity

This study examines the contribution of tachykinins to the processes of inflammation. Neurokinin A (NKA), neurokinin B (NKB) and eledoisin (E) but not kassinin (K) have similar effects to substance P (SP) in priming neutrophils for increased superoxide anion (O2-) production in response to formyl-methionyl-leucyl-phenylalanine (FMLP). This similarity in activity may be due to the carboxy amino acid terminal end of these tachykinins being highly conserved. This was confirmed by demonstrating that SP fragment 7-11 (SP7-11) had the same priming effect as the whole molecule, whereas, the amino end fragment 1-4 (SP1-4) inhibited the response to FMLP. The priming effect of tachykinins was not confined to a single stimulus, such as FMLP, since NKA, NKB and SP also enhanced O2- production stimulated by platelet-activating factor (PAF), an important mediator of inflammation but a weak stimulus of O2- production on its own. In addition, all the tachykinins studied increased neutrophil antibody-dependent cell-mediated cytotoxicity (ADCC) towards opsonized target cells. In contrast to their effects on FMLP-induced O2- production, both SP fragments, SP1-4 and SP7-11, stimulated neutrophil ADCC and had a synergistic effect when used together.

Plasma elastin-derived peptide levels in normal adults, children, and emphysematous subjects. Physiologic and computed tomographic scan correlates

Pulmonary emphysema is likely to be the result of elastic tissue digestion by unrestrained elastase activity in the lung. Elastin breakdown by elastases results in the release of soluble elastin fragments (EDP), which may be measured in plasma by an ELISA. Plasma EDP levels measured using an ELISA were determined in the following groups: disease-free children (n = 24), 0.162 +/- 0.082 ng/ml; disease-free adult nonsmokers (n = 114), 1.74 +/- 0.8 ng/ml; smokers (n = 68), 2.76 +/- 4.59 ng/ml; reformed smokers (n = 43), 1.91 +/- 1.14 ng/ml. Adults with established pulmonary emphysema (n = 50), as defined by bullous formation on the chest radiograph, had levels of 50.83 +/- 24.8 ng/ml, significantly higher than the disease-free groups at p < 0.01. Pulmonary emphysema can be reflected by pulmonary function tests, especially those that measure the pulmonary elastic properties, and by computed tomographic (CT) scan percent emphysema score. We therefore examined the relationship of plasma EDP to these other indicators of pulmonary emphysema in a separate group of 26 subjects using elastic recoil measurements (K), and a further group of 30 subjects with CT scan percent emphysema score. A significant correlation of p < 0.001 was shown for plasma EDP and K and a significant correlation of p < 0.01 was shown for plasma EDP and CT scan percent emphysema score, these correlations suggesting that plasma EDP levels are indicators of the loss of pulmonary distensibility and of mild to moderate pulmonary emphysema. These findings suggest that pulmonary emphysema is characterized by active elastin breakdown.

A rapid procedure for the measurement of elastase inhibitory function of plasma and bronchoalveolar lavage fluid

We describe a method to measure human leukocyte elastase (HLE) inhibitory capacity and compared it with porcine pancreatic elastase (PPE) inhibitory capacity and with a turbidimetric method using a specific antibody to alpha-1 antitrypsin (AAT), all performed on a Cobas Bio centrifugal analyser. This assay used methoxysuccinyl-dialanine-proline-valine-p-nitroanilide as substrate in the presence of 0.01% Brij 35, an HLE enzyme activator. Samples containing commonly used anti-coagulants and serum could be used in the assay, except for those containing heparin which strongly inhibited HLE. This assay was used to determine the functional AAT concentrations in plasma from a number of normal volunteers and patient groups, and was compared to the immuno-turbidimetric AAT assay. No difference in the proportion of functional to immuno-turbidimetric AAT was noted between any of the groups studied except for the adult respiratory distress syndrome (ARDS), where this percentage was reduced (p less than 0.05). An increase in both immuno-turbidimetric and functional AAT was seen for children (both p less than 0.01), in emphysema (p less than 0.05 and p less than 0.01 respectively) and ARDS (both p less than 0.05) when compared to adult non-smokers. This assay was also used to determine the HLE inhibitory capacity of serum and bronchoalveolar lavage (BAL) fluid from normal volunteer smokers (n = 4) and non-smokers (n = 4), and in the serum and BAL fluid from patients with ARDS (n = 5). Serum AAT was 94% functional in non-smokers (91% with PPE functional assay) and 96% in smokers (97% with PPE assay).(ABSTRACT TRUNCATED AT 250 WORDS)

Accuracy of asthma statistics from death certificates in South Australia

OBJECTIVE

To assess the accuracy of asthma statistics from death certificates in South Australia.

DESIGN

Comparison of death certificate coding with expert panel assessments of causes of death after interviews with certifying doctors, regular medical practitioners and close acquaintances of the deceased.

SUBJECTS

261 subjects for whom the term "asthma", "asthmatic" or "asthmaticus" was recorded in Part I or Part II of death certificates lodged in the 24-month period from May 1988.

MAIN OUTCOME MEASURES

Sensitivity, specificity and predictive value of death certificate coding, with expert panel assessments as the reference standard.

RESULTS

About 95% of deaths assessed as definitely due to asthma were so coded from death certificates, but only 69% of deaths assessed by the panel as not due to asthma were coded to a "non-asthmatic" cause. Of the 129 deaths coded to asthma, the percentage assessed as definitely or likely to be due to asthma was 56%. For ages under 65 years, this figure was 84% compared with only 38% for older subjects.

CONCLUSION

The accuracy of death certificate data on asthma for the age group 65 years and over would be too low at present for most epidemiological purposes.

Heparin and heparan sulphate are inhibitors of human leucocyte elastase

1. Heparin and heparan sulphate strongly inhibited human leucocyte elastase activity in an automated assay using the soluble substrate, n-succinyl-(L-alanine)3-p-nitroanilide (50% inhibition of 250 microliters of 10 micrograms of human leucocyte elastase/ml was obtained with 80 microliters of 2.8 micrograms of heparin/ml and 8 micrograms of heparan sulphate/ml). Less significant inhibition at the same concentrations was seen with the other glycosaminoglycans tested: hyaluronic acid and chondroitin sulphates A-C. 2. Heparin and heparan sulphate also strongly inhibited human leucocyte elastase activity towards insoluble human lung elastin, as determined by an e.l.i.s.a. for soluble elastin-derived peptides released by elastolytic activity on the elastin. This inhibition was shown not to be due to a direct interference of the glycosaminoglycans in the e.l.i.s.a. nor to the inhibition causing a change in the size of the elastin-derived peptides. However, unlike the chromogenic assay with n-succinyl-(L-alanine)3-p-nitroanilide as substrate, where heparin was the more effective inhibitor, in this assay system heparan sulphate was the more effective inhibitor (50% inhibition of 100 microliters of 50 ng of human leucocyte elastase/ml was obtained with 100 microliters of 4.5 micrograms of heparin/ml and 0.8 microgram of heparan sulphate/ml). These results suggest that heparin and heparan sulphate, as components of cellular and basement membranes, are likely to have a role in protecting structural proteins, such as elastin, from the proteolytic activity of human leucocyte elastase.(ABSTRACT TRUNCATED AT 250 WORDS)

Activation of human neutrophils by substance P: effect on FMLP-stimulated oxidative and arachidonic acid metabolism and on antibody-dependent cell-mediated cytotoxicity

We show that the neuropeptide, substance P (SP), a putative mediator of neurogenic inflammation, is a potent regulator of mature, human neutrophil function. SP increased neutrophil cytotoxic activity against an antibody-coated target (P815 cells) in a dose-dependent manner. The maximal effect was noted at an SP concentration of 10(-4) M, when cytotoxicity increased from 4.7 +/- 0.9% to 33.4 +/- 10.3%. This effect was not due to toxicity of SP against the target cells and was antibody-dependent. The level of cytotoxic activity induced by SP was comparable to that described for a number of cytokines, such as GM-CSF, under identical assay conditions. SP-induced cytotoxicity was 73.1 +/- 5.8% of that produced by an optimum concentration of conditioned medium known to contain a number of cytokines which activate mature neutrophils. In addition, SP enhanced FMLP-stimulated superoxide anion production by neutrophils in a dose-dependent fashion. Neutrophils preincubated with medium or 7.5 x 10(-5) M SP and then stimulated with 10(-7) M FMLP produced 7.9 +/- 2.7 and 29.9 +/- 3.7 nmol superoxide anion/10(6) cells, respectively. This priming effect of SP was rapid in onset (less than 15 min) and was maximal from 15 to 60 min, after which it declined. It was not reversed by washing the cells and was temperature dependent. SP did not shift the dose-response curve to FMLP to the left, but it enhanced the response to FMLP in the concentration range 10(-8)-10(-6) M. Similarly SP enhanced LTB4 and 5-HETE production by FMLP-stimulated but not calcium ionophore-stimulated neutrophils. Therefore, these data provide evidence that SP regulates a number of neutrophil functions and suggests a mechanism whereby the nervous system may affect the immune response. Furthermore, the regulatory effects of SP on the neutrophil functions studied appear to be similar to those of a number of cytokines that have been previously implicated in inflammation.

A prospective hospital study of the aetiology of community-acquired pneumonia

In a one-year prospective study of 106 adults (mean age, 60 years) who were admitted to hospital with community-acquired pneumonia, an aetiological diagnosis was made in 82 (77%) patients. Streptococcus pneumoniae was considered to be responsible for 44 (42%) and respiratory viruses for 19 (18%) infections. Other aetiological agents that were found in a smaller number of patients included Haemophilus influenzae (9% of patients), enteric Gram-negative bacilli (8% of patients), Staphylococcus aureus (3% of patients), Legionella spp. (3% of patients), Mycobacterium tuberculosis (3% of patients), Mycoplasma pneumoniae (8% of patients) and Chlamydia psittaci (5% of patients). The mortality was 10% and was related significantly to increasing age and to coexisting heart and lung disease. Antibiotic treatment that was commenced before admission to hospital and investigations were undertaken reduced significantly the isolation rate of susceptible bacterial pathogens. The Gram-stained smear of sputum was valuable in establishing a tentative diagnosis of bacterial pneumonia. The most-useful tests in making an early diagnosis proved to be those which detected pneumococcal and mycoplasmal antigens, blood cultures and culture of sputum for appropriate bacterial pathogens.

The role of bronchoalveolar lavage in the assessment of diffuse lung diseases

Bronchoalveolar lavage is a safe and simple technique for sampling the inflammatory cells of the lung. However, while its use in the evaluation of pulmonary pathogenic mechanisms is both well accepted and described, its clinical utility is more controversial. Marked variation in results may occur through variation in the lavage procedure. Standardisation of the lavage technique and laboratory processing of the specimen are essential for reliable results. This review examines the current clinical role of bronchoalveolar lavage in the assessment of patients with diffuse lung diseases, and immunocompromised patients with pulmonary infiltrates. In this latter category, for patients with Acquired Immunodeficiency Syndrome, lavage is of equal efficacy to lung biopsy and can establish the cause of pulmonary infiltrates in over 90% of cases. Bronchoalveolar lavage can detect abnormalities in patients with diffuse lung diseases prior to the development of irreversible fibrosis. Lavage features have been described for sarcoidosis, cryptogenic fibrosing alveolitis, extrinsic allergic alveolitis, connective tissue diseases, and asbestosis. In cryptogenic fibrosing alveolitis lavage data may be used to indicate a subsequent deterioration in the patient's condition, or predict a favourable response to therapy.

Lung cancer in Australia

Lung cancer is the leading cause of death of cancer in Australian men and the third leading cause in Australian women. Efforts are being made to reduce the incidence of this disease by smoking-cessation programmes and improved industrial hygiene, and these measures need to be encouraged strongly by all sectors of the community. On a population basis, insufficient evidence is available to justify screening procedures for the early detection of lung cancer in "at-risk" groups. Cure is possible by surgical resection in early cases. Improvements in therapeutic results with traditional cancer treatments largely have reached a plateau, but a number of newer therapies, and combinations of standard therapies, currently are being evaluated. Of particular interest is concurrent radiotherapy and chemotherapy in localized non-small-cell lung cancer; laser "debulking" in conjunction with radiotherapy in non-small-cell lung cancer, and biological response-modifying agents in non-small-cell and small-cell lung cancer. It is important that data be collected adequately to define epidemiological changes and to evaluate treatment results (including repeat bronchoscopy, to assess local control of tumour), and that the quality of life is recorded and reported in the evaluation process. Finally, phase-III studies in lung-cancer treatments require adequate numbers of subjects to enable meaningful conclusions to be achieve objectives within a reasonable study period.

The immunogold staining technique for the measurement of lymphocyte subpopulations in bronchoalveolar lavage fluid

The immunogold staining technique was evaluated for use in the identification of lymphocyte subsets in bronchoalveolar lavage fluid. The results obtained compared favorably to the identification of lymphocytes by the E-rosette method, the acid alpha-naphthyl-acetate esterase (ANAE) stain and immunofluorescence microscopy. The main advantages of the immunogold staining method include improved cellular detail and the attainment of permanent preparations, allowing for reassessment, intralaboratory comparison and the performance of further histochemical techniques if desired.

Bronchoalveolar lavage

Bronchoalveolar lavage (BAL) is a relatively new technique for assessment of the alveolar compartment of the lung. Its current clinical applications are the initial assessment of acute and chronic diffuse interstitial lung disease and the diagnosis of pulmonary infections, especially in the immunocompromised host. In addition, BAL provides information on the pathophysiology of diffuse interstitial lung disease. Future studies of BAL fluids should confirm its use in the prognostic assessment of diffuse interstitial lung diseases and in the assessment of effects of therapy.

Antibody-dependent cellular cytotoxicity in blood monocytes and alveolar macrophages in patients with lung cancer

Antibody-dependent cellular cytotoxicity (ADCC), mediated by blood monocytes (MNC) and pulmonary alveolar macrophages (PAM) obtained from 31 patients with lung cancer and 13 control subjects, was determined. The ADCC of the PAM obtained from patients with lung cancer was significantly less (40% reduction) than that of the control group. This finding was demonstrated over the range of effector-to-target cell ratios. The ADCC of blood MNC from the cancer patients was not different from that of control subjects and in both groups the ADCC of blood MNC was significantly greater than that of lung macrophages. Comparison of PAM ADCC in smokers and nonsmokers within the control group suggested that the lower activity in cancer patients was not simply an effect of smoking.

The pulmonary alveolar macrophage

The pulmonary alveolar macrophage (PAM) occupies a unique environment, with exposure to both the atmosphere and the blood stream. This position enables the PAM to perform its primary role of protecting the lung from inhaled, potentially damaging, agents. The effects of long term cigarette smoking on the human PAM appear to be functionally minimal when the cells are studied as a group, but the marked recruitment of PAM's which occurs in smokers leads to a greater potential for PAM helpful and/or damaging activity within the lung. The traditional role of phagocytosis is not a global function of the unstimulated human PAM. Of increasing importance for the understanding of pulmonary disease is the ability of the PAM to modulate lymphocyte, polymorphonuclear leukocyte and fibroblast activity. These functions are primarily for the defence of the lung but often produce temporary or permanent lung damage. Subclassification of the human PAM based upon functional heterogeneity may lead to a better understanding of the role of this cell.

Monocyte antibody-dependent cellular cytotoxicity in splenectomized subjects

Monocyte antibody-dependent cellular cytotoxicity (ADCC) was determined in normal subjects by using human A1 erythrocytes and immune human anti-A1 antiserum. The experimental data were fitted to a mathematical model and the values for maximal cytotoxicity and monocyte numbers required to produce 15% specific cytotoxicity (MD15) were subsequently computed and compared with the values for these two parameters estimated from the dose response curves. The values for both were significantly associated, and the mathematical model permitted precise quantitation of cytotoxicity in instances where this was impossible by standard methods. Maximal monocyte ADCC was significantly reduced in a group of splenectomized subjects, whereas the MD15 was increased. These findings emphasize the possible influences of the method of quantitation of ADCC and provide one explanation for the apparent conflict of published data.

Monocyte antibody-dependent cellular cytotoxicity in splenectomized subjects

Monocyte antibody-dependent cellular cytotoxicity (ADCC) was determined in normal subjects by using human A1 erythrocytes and immune human anti-A1 antiserum. The experimental data were fitted to a mathematical model and the values for maximal cytotoxicity and monocyte numbers required to produce 15% specific cytotoxicity (MD15) were subsequently computed and compared with the values for these two parameters estimated from the dose response curves. The values for both were significantly associated, and the mathematical model permitted precise quantitation of cytotoxicity in instances where this was impossible by standard methods. Maximal monocyte ADCC was significantly reduced in a group of splenectomized subjects, whereas the MD15 was increased. These findings emphasize the possible influences of the method of quantitation of ADCC and provide one explanation for the apparent conflict of published data.

Primary veloplasty or primary palatoplasty: some preliminary findings

Staged palatal closure was carried out in 30 children. The soft palate was closed at 9 months and the hard palate at 5 years. These patients were followed up for 7 years, and it was found that although the incidence of lateral crossbite was reduced in both unilateral and bilateral cases, the speech results were less satisfactory than those obtained with total palatal closure. In this series, there were two fistulae at the junction of the hard and soft palate. This was related to difficulty in closing this area in some patients at the time of the second operation. As a result, the procedure is not advised. An alternative palatal closure technique is described. This technique consists of nasal layer closure, careful dissection and reconstruction of the levator musculature, transverse division of the nasal layer, insertion of a buccal flap for lengthening, and closure of the oral layer with Veau flaps without dissection behind the tuberosities and with almost total closure of the lateral donor sites on the palatal shelves. In this way there is minimal scarring, particularly in the retrotuberosity area. This is felt to be important since it would seem from studies of facial growth that this is a much more significant area than the palatal shelves.

Plasma proteins of the bronchoalveolar surface of the lungs of smokers and nonsmokers

Plasma proteins were measured in bronchoalveolar lavage effluents and serums from normal healthy nonsmokers and smokers, and their concentrations in the 2 fluids were compared. Two-dimensional polyacrylamide gel electropherograms suggested, and radial immunodiffusion assays confirmed, that the soluble proteins of the bronchoalveolar surface resemble serum in kind and amount with the following significant exceptions. Two immunoglobulins, IgG and IgA, were present in amounts that exceeded their concentrations in serum; of the 2, IgG was more abundant. Large nonimmunoglobulin proteins (greater than 300,000 daltons) were absent or present at very low concentrations compared with the amounts found in serum. Transferrin was the only nonimmunoglobulin with a concentration significantly higher at the bronchoalveolar surface than in serum. Smoking did not cause a significant change in the concentration of any protein in serum, but did cause an increase in IgG, C4, and C3 and a decrease in alpha 2-thioglycoprotein, alpha 1-acid glycoprotein, and Gc-globulin in lavage effluents from females.

Pneumocystis carinii pneumonitis successfully treated with trimethoprim-sulphamethoxazole

Pneumocystis carinii pneumonitis was diagnosed on lung biopsy in an immunosuppressed patient. Therapy with trimethoprim-sulphamethoxazole led to a rapid clinical recovery with no side-effects being observed.