Calcitonin gene-related peptide in human fetal lung and in neonatal lung disease

Neuroendocrinology of the lung revealed by single-cell RNA sequencing

Pulmonary neuroendocrine cells (PNECs) are sensory epithelial cells that transmit airway status to the brain via sensory neurons and locally via calcitonin gene-related peptide (CGRP) and γ- aminobutyric acid (GABA). Several other neuropeptides and neurotransmitters have been detected in various species, but the number, targets, functions, and conservation of PNEC signals are largely unknown. We used scRNAseq to profile hundreds of the rare mouse and human PNECs. This revealed over 40 PNEC neuropeptide and peptide hormone genes, most cells expressing unique combinations of 5-18 genes. Peptides are packaged in separate vesicles, their release presumably regulated by the distinct, multimodal combinations of sensors we show are expressed by each PNEC. Expression of the peptide receptors predicts an array of local cell targets, and we show the new PNEC signal angiotensin directly activates one subtype of innervating sensory neuron. Many signals lack lung targets so may have endocrine activity like those of PNEC-derived carcinoid tumors. PNECs are an extraordinarily rich and diverse signaling hub rivaling the enteroendocrine system.

Hyperplasia of alveolar neuroendocrine cells in rat lung carcinogenesis by silica with selective expression of proadrenomedullin-derived peptides and amidating enzymes

Pulmonary neuroendocrine (NE) cells are found as clusters called neuroepithelial bodies (NEBs) or as single cells scattered in the respiratory epithelium. They express a variety of bioactive peptides, and they are thought to be the origin of NE lung tumors. Proadrenomedullin N-terminal 20 peptide (PAMP) is a peptide derived from the same precursor as adrenomedullin (AM). AM and PAMP are C-terminally amidated during their processing by a well-characterized amidating enzyme, peptidylglycine alpha-amidating monooxygenase (PAM). We explored AM, PAMP, and PAM expression as markers for NE hyperplasia in three rodent species (Fischer 344 rats, Syrian golden hamsters, and A/J mice) after a single intratracheal instillation of crystalline silica (quartz), which was previously found to induce different reactions in the three species. Rats developed a marked silicosis, with alveolar and bronchiolar hyperplasia and formation of peripheral lung epithelial tumors. Mice developed a moderate degree of silicosis, but not epithelial hyperplasia or tumors. Hamsters showed dust-storage lesions, but not silicosis or tumors. NE cells were immunolabeled for calcitonin gene-related peptide (CGRP), AM, PAMP, and PAM in serial sections of each lung. The numbers of positive NEBs per lung area and positive cells per NEB were quantified. A marked hyperplastic reaction in the NEBs of silica treated rats occurred only in alveolar NEBs, but not in bronchiolar NEBs. From Month 11 onwards, there were marked differences in the number of alveolar NEBs per section and in the number of cells per alveolar NEB immunoreactive for CGRP. No hyperplastic NE cell reaction was observed in silica-treated mice and hamsters. Significant PAMP and PAM expression was seen only in rat hyperplastic alveolar and in bronchiolar NEBs from Month 11 onwards. In E18, rat fetal lung NEBs were found to be strongly positive for PAMP and PAM.

Pulmonary neuroendocrine cell distribution in sudden infant death syndrome

The density of pulmonary neuroendocrine cells (PNECs) in 21 sudden infant death syndrome (SIDS) cases, 19 controls, and 25 fetuses was studied morphometrically. Formalin-fixed, paraffin-embedded lung samples were immunostained with antibody against chromogranin A (CGA). The percentage of PNEC-positive airways and the density of PNECs in each airway were calculated in all cases. The density of PNECs was expressed as the number of cells per millimeter of basement membrane. The percentage of PNEC-positive airways reached nearly 100% by term and did not change significantly until 12 months of age in both the SIDS cases and the controls. The density of PNECs also showed a rapid increase in the saccular stage fetus and had its peak of about 4 cells/mm around birth. The density of PNECs, including the standard deviation, was higher in SIDS cases than in controls. The uneven distribution of PNECs may affect respiratory control in SIDS victims.

Differentiation and proliferation of pulmonary neuroendocrine cells

In this review article the morphological profiles of pulmonary neuroendocrine cells (PNEC) in experimental animals and humans are described. Although the mechanisms of differentiation and proliferation of neuroendocrine cells in the airway epithelium remain to be solved, several experimental studies using explant culture and cell culture systems of fetal animal lungs have been performed to clarify fundamental phenomena associated with neuroendocrine differentiation and proliferation. Experimental animal studies using chronic hypoxia, toxic substances and carcinogens have succeeded in inducing alterations in PNEC systems, and these studies have elucidated the reactions of PNEC in cell injury and inflammation, and functional aspects of PNEC in disease conditions. Human pulmonary neuroendocrine tumors include various histological subtypes, and show divergent morphological and biological varieties. Molecular abnormalities of small cell carcinoma, the most aggressive subtype of pulmonary neuroendocrine tumors, have been extensively studied, but the mechanism of neuroendocrine differentiation of this tumor is still largely unknown. PNEC share common phenotypes with neuronal cells, and developmental studies have begun contributed evidence that similar transcriptional networks, including active and repressive basic helix-loop-helix (bHLH) factors, function in the differentiation of both PNEC and neuronal cells. Such a bHLH network may also play a central role in determining cell differentiation in lung carcinomas. Further studies of the neuronal bHLH network, its regulatory system and related signal transduction pathways, will be required for understanding the mechanisms of neuroendocrine differentiation and proliferation in normal and pathological lung conditions.

Tumor necrosis factor induces neuroendocrine differentiation in small cell lung cancer cell lines

We studied tumor necrosis factor (TNF)-alpha as a candidate cytokine to promote neuroendocrine cell differentiation in a nitrosamine-hyperoxia hamster lung injury model. Differential screening identified expression of the genes modulated by TNF-alpha preceding neuroendocrine cell differentiation. Undifferentiated small cell lung carcinoma (SCLC) cell lines NCI-H82 and NCI-H526 were treated with TNF-alpha for up to 2 wk. Both cell lines demonstrated rapid induction of gastrin-releasing peptide (GRP) mRNA; H82 cells also expressed aromatic-L-amino acid decarboxylase mRNA within 5 min after TNF-alpha was added. Nuclear translocation of nuclear factor-kappaB immunostaining occurred with TNF-alpha treatment, suggesting nuclear factor-kappaB involvement in the induction of GRP and/or aromatic-L-amino acid decarboxylase gene expression. We also demonstrated dense core neurosecretory granules and immunostaining for proGRP and neural cell adhesion molecule in H82 cells after 7-14 days of TNF-alpha treatment. We conclude that TNF-alpha can induce phenotypic features of neuroendocrine cell differentiation in SCLC cell lines. Similar effects of TNF-alpha in vivo may contribute to the neuroendocrine cell differentiation/hyperplasia associated with many chronic inflammatory pulmonary diseases.

Immunoreactivity for the alpha-subunit of the pituitary glycoprotein hormones in pulmonary neuroendocrine cells of developing human lung and various perinatal diseases

Infant lung tissue, obtained at autopsy, was studied by immunohistochemistry for the presence of pituitary glycoprotein hormones (PGHs) in the lung. The infants, born at term or preterm, died of various causes. The results provide the first immunological evidence of the presence of the common a-subunit of the pituitary glycoprotein hormones (alphaPGH) in the lung. The immunoreactivity is located in the pulmonary neuroendocrine cells and neuroepithelial bodies. In addition, the cells labelled by alphaPGH antisera (alphaPGH cells) form a subpopulation of the neuroendocrine cells detected by anti-calcitonin immunohistochemistry (CT cells). Moreover, the number of alphaPGH cells appears to increase after neonatal pneumonia or when the number of CT cells is elevated following the development of disease. Also, the weak staining of one of the monoclonal antibodies against the specific b-subunit of thyrotropin (TSH) might, in combination with the increased detectability of a-subunits, indicate that TSH can be endogenously produced in the lung.

Quantitative microscopical methods for the identification and localisation of nerves and neuroendocrine cell markers in mammalian lung

The lung contains a dense innervation and a population of endocrinelike cells both of which are believed to have a role in pulmonary function and to be involved in disease processes. They contain a number of regulatory peptides that affect vascular and bronchial tone, growth and repair. They can be detected and localised by immunocytochemistry, thereby allowing investigation of the normal distribution and changes in disease processes. The application of image analysis has added greatly to the amount of information that can be obtained from such morphological studies. Data can be obtained on either the overall distribution and amount of the antigen in a tissue, thereby allowing comparisons between normal and disease states, or following experimental manipulation. Furthermore, the actual intracellular level can be assessed, which adds the previously unattained dimension of comparisons between cells. Thus the density of innervation in the specific regions of the lung tissue, either total nerves or specific peptide-containing cells, may be estimated and used to show release of a peptide or to determine changes in the nerve density in disease. Image processing and image analysis have reduced the labour-intensive manual input required to perform such studies. The continuing development of digital image processing and computer technology will increase the application of these methods in lung research of normal and pathological material.

Ontogeny of neuroepithelial bodies: correlations with mitogenesis and innervation

This paper summarizes current knowledge and advances speculation about the formation of the neuroendocrine system of mammalian lungs (comprising uninnervated solitary and clustered small-granule cells and innervated neuroepithelial bodies). It relates the initial appearance of neuroendocrine cells to regulation of mitotic activity in the epithelium during the development of the lung and pays special attention to the later in growth of nerves that converts some of them into neuroepithelial bodies, structures considered ideally adapted to function as chemoreceptors. A few original observations from ongoing immunohistochemical, electron microscopic, and analytical studies have been included here and there to point the discussion. The neuroendocrine cells are derived from undifferentiated precursors present in the endodermal pulmonary epithelium. At an early pseudoglandular stage of lung development these precursors begin to differentiate into neuroendocrine small-granule cells, commencing in the larynx and upper trachea, and expanding centrifugally into pulmonary airways almost as rapidly as these are laid down. Subsequently many of the intrapulmonary small-granule cell clusters become innervated. This event, the delayed appearance of small-granule cells synthesizing other than the dominant peptides and amines (calcitonin gene-related peptide and serotonin in rodents, gastrin-releasing peptide and serotonin in human beings), and other regional adjustments yield the population distribution present in the lungs of adults. Neuroendocrine cell precursors normally differentiate into typical serotonin- or peptide-synthesizing small-granule cells without requiring direct contact by nerves, and dissociated cells from a previously innervated population continue to exhibit physiological characteristics of oxygen sensors despite the loss of contact with nerves. Development of the innervation occurs in stages. Small-granule cell clusters are reached first by ganglion cells derived from pulmonary neuroblasts and later on by processes of extrinsic sensory nerves. The latter not only convey information to the central nervous system but also serve in a variety of ways to extend the neuroepithelial bodies' sphere of influence within the lung itself.

Pulmonary Neuroendocrine Cells and Lung Development

Pulmonary neuroendocrine cells produce bioactive peptides such as gastrin-releasing peptide (GRP) at high levels in developing fetal lung. The role of GRP and other peptides in promoting branching morphogenesis, cell proliferation, and cell differentiation during lung organogenesis is reviewed. Possible roles for bioactive peptides derived from these cells in the pathophysiology of perinatal lung disorders are discussed.

Hamster pulmonary endocrine cells with neural cell adhesion molecule (NCAM) immunostaining

Pulmonary endocrine cells of Syrian golden hamster were stained for neural cell adhesion molecule (NCAM) with indirect fluorescent immunostaining and observed with a confocal laser scanning microscope equipped with an argon laser. Sections 100 microns thick of hamster lung fixed with phosphate-buffered 4% paraformaldehyde were prepared. The sections were incubated with rat monoclonal antibody against NCAM, followed by fluorescence-labeled antibody against rat immunoglobulin. Some were doubly immunostained for NCAM and one of the following endocrine markers: neuron-specific enolase, calcitonin gene-related peptide and serotonin. Expression of NCAM in the hamster airway epithelium was seen in cell nests resembling neuroepithelial bodies (NEBs). NCAM immunostaining was positive at the lateral cell borders between the cells composing the nest, but negative at the border with the adjacent, presumably non-endocrine cells. Double immunostaining confirmed that the grouped cells with NCAM immunoreactivity were of an endocrine nature, but that single endocrine cells did not show NCAM immunoreactivity. An electron microscopic study with NCAM immunostaining confirmed the light microscopic study. These suggest that NCAM expression could be important for the morphogenesis of NEBs. A confocal laser microscope was used to make three-dimensional images of NEBs after NCAM immunostaining and the spatial interaction between NEBs and the surrounding microenvironment was studied.

Ontogeny of endocrine cells in the respiratory system of Syrian golden hamsters. I. Larynx and trachea

The ontogeny of protein gene product 9.5 (PGP 9.5), serotonin (5-HT), calcitonin gene-related peptide (CGRP), and calcitonin (CT) immunoreactivity was evaluated in small-granule endocrine cells of hamster laryngotracheal epithelium from fetal day 11 to adulthood. Two centrifugal (proximal-to-distal) patterns of differentiation occur. The first pattern begins during fetal life. Endocrine cells, single and clustered in groups (presumptive- or protoneuroepithelial bodies, pNEBs), initially colocalize immunostaining for PGP 9.5, 5-HT, and CGRP in the larynx and proximal 2/3 of the trachea on day 12 and spread to the caudal trachea on day 13. 5-HT disappears fleetingly during the 24 h preceding birth; otherwise immunoreactivity for all three substances persists into adulthood. The clusters of endocrine cells survive beyond birth but are so diluted by expansion of the nonendocrine epithelium as to become inconspicuous. Since innervation was not actually observed, these clusters may persist as pNEBs, without developing connections to afferent or efferent nerve fibers. The second pattern concerns single small-granule cells stainable for CGRP but not for 5-HT. These cells first appear in the larynx and cartilaginous part of the cranial trachea on postnatal day 3, and in the middle and caudal trachea, on day 5. The cells increase in number on day 7. In adults, they predominate among endocrine cells of the cartilaginous region. A subset of these cells begins to co-express CT proximally on postnatal day 10, reaching the caudal end of the trachea by 3 weeks. A few elements of the older 5-HT-positive population may also become immunoreactive for CT in juvenile hamsters.

Ontogeny of endocrine cells in the respiratory system of Syrian golden hamsters. II. Intrapulmonary airways and alveoli

Results of this and the preceding study reveal 3 patterns of endocrine cell development in hamster airway. The first, a prenatal wave, begins in the larynx and sweeps down the extra- and intrapulmonary conducting airway to the bronchioloalveolar portals. Cells differentiate singly and in groups (presumptive neuroepithelial bodies, pNEBs), colocalize immunoreactivity for serotonin (5-HT) and calcitonin gene-related peptide (CGRP), and persist throughout adulthood. Postnatally a few cells also express calcitonin (CT). Appearance of 5-HT and CGRP staining correlates with the onset of local, NEB-associated mitogenesis in fetal hamster airway epithelium. The second pattern begins after birth and is unique to the larynx and cartilaginous trachea. It involves differentiation of single cells which stain for CGRP but not 5-HT. Later, a proportion also stain for CT. This pattern seemingly accounts for the predominance of single cells in laryngotracheal epithelium of adult animals. In the third pattern, cells immunoreactive for peptide YY (PYY) differentiate, singly at first and later among cells of tiny pNEBs. This begins postnatally in alveoli, spreading centripetally with retrograde differentiation of alveolar epithelium back into the bronchiolar terminations. Restricted distribution and lack of immunoreactivity for 5-HT, CGRP, or CT suggest that the PYY-positive endocrine cells form a regional subset performing special roles in pulmonary homeostasis.

Colocalization of peptide hormones in neuroendocrine cells of human fetal and newborn lungs: an electron microscopic study

This study investigated the colocalization of the peptide hormones bombesin or calcitonin with calcitonin gene related peptide (CGRP) in neuroendocrine cells (NE) in the lungs of human fetuses of varying gestational ages and in the lungs of newborn infants who died with acute or chronic lung disease in the first weeks or months after birth. Double immunolabeling of dense core granules for these peptides was also studied in this same patient population. On-grid double gold immunolabeling was carried out on 29 subjects using anti-bombesin and anti-CGRP and on 22 subjects using anti-calcitonin and anti-CGRP as primary antibodies, the secondary antibodies being labeled with different-size gold spheres. Colocalization of both bombesin and calcitonin with CGRP was demonstrated, not only in the same NE cell, but also on the same dense core granule. Colocalization was rarely found in normal fetuses, and most frequently found in newborn infants with acute lung disease, usually hyaline membrane disease (HMD), or with the development of chronic lung disease in the first weeks or months after birth. Double labeling of the same dense core granules might imply action of peptides in concert, or perhaps one peptide acting in a paracrine role (e.g., on bronchial or bronchiolar smooth muscle) and the second peptide acting in an autocrine fashion on the parent cell (e.g., in the regulation of granule production or release).

Immunocytochemical study of the diffuse neuroendocrine system cells in equine lungs

This study was undertaken to investigate the presence of neuroendocrine cells (N.E.C.) by immunocytochemical means in equine lungs during three distinct evolutionary periods: fetal, neonatal and adult. The authors identified bombesin, somatostatin and calcitonin secretory cells. In the fetal lungs the N.E.C. were located in the interstitial tissue and exhibited greater immunoreactivity to bombesin than to the other two neuropeptides studied. A large number of calcitonin-producing cells and a smaller number of bombesin-positive cells were seen in the bronchial and bronchiolar epithelium of newborn Equidae. In the adult equine lungs far fewer N.E.C. were observed than in the earlier stages. Somatostatin-producing cells were not seen in neonatal or adult lung tissue.

Isolation and culture of neuroendocrine cells from fetal rabbit lung using immunomagnetic techniques

We describe a novel method for the isolation and subsequent culture of pulmonary neuroendocrine cells (PNEC) from normal fetal rabbit lung using immunomagnetic techniques with a monoclonal antibody, MOC-1. This surface antigen has originally been identified on small cell carcinoma of the lung. Our immunohistochemical studies have shown that MOC-1 cross-reacts with PNEC of human and rabbit fetal lungs on frozen sections, and in fixed cultures of rabbit fetal lung. Using a combination of mechanical and enzymatic disaggregation, a single-cell suspension of fetal rabbit lung was obtained. These cells were incubated with MOC-1 conjugated to magnetic beads. PNEC were selectively removed from the heterogeneous mixture using a magnet, giving up to 2-fold enrichment compared with our previously reported method. These cells were maintained in culture in a functional state for up to 7 days. The ability to prepare PNEC from rabbit fetal lung offers an opportunity to develop in vitro models to investigate the physiologic and biochemical properties of these cells, and ultimately it may lead to a better understanding of their function in health and disease.

Gastrin-releasing peptide gene products in midtrimester human fetal lung with and without maternal smoking history during pregnancy

A preliminary morphological study on human fetal lungs with positive maternal smoking history demonstrated alterations of the neuroepithelial bodies (NEBs). We studied human fetal lung tissue between the gestational ages of 12 weeks and 19 weeks, comprising 12 cases with a smoking history during pregnancy (Group 1) and eight cases without a smoking history during pregnancy (Group 2). We demonstrated, by immunocytochemistry, the presence of gastrin-releasing peptide (GRP) gene products: GRP 14-27 in all 20 cases, and C terminal peptide of pro-GRP (C-flanking peptide) in 17 cases. Quantification of the neuroepithelial cells (NECs) was made by computer-enhanced image analysis using the Context Vision system, expressing 1) the total stained areas of the NECs per unit area of section and 2) the total staining areas of the NECs per unit area of airway epithelium, measured as the area of cytokeratin immunoreactivity in an adjacent section. The results show no statistically significant difference between groups 1 and 2 for either GRP 14-27 or C-flanking peptides. The apparent lack of influence of maternal smoking during pregnancy on the expression of GRP gene products in the NECs could be a reflection of inherently reduced reactivity of the cells during the gestation period studied. However, a larger series is needed before any conclusions can be made. Alternatively, the adverse effects of smoking might be reflected during the canalicular phase of lung development; an increased immunoreactivity appears to be present during that period. The expression of pro-GRP gene products in the pulmonary NECs of older fetuses and neonates with maternal smoking history during pregnancy requires further study.

Pulmonary endocrine cells in infancy and childhood

Lung sections from 22 infants and children who died of noncardiopulmonary diseases (control) and from 12 infants with hyaline membrane disease/bronchopulmonary dysplasia (HMD/BPD) were immunostained for bombesin (BOM), calcitonin (CT), calcitonin gene-related peptide (CGRP), leu-enkephalin (ENK), and serotonin (5HT). The numbers of immunoreactive cells per millimeter airway epithelial length were counted and determined by morphometry. In lungs from the control group, BOM-immunoreactive (IR) solitary cells (SCs) were numerous at the bronchiolar level, and remained so for 4 to 7 months after birth. The number of CT-IR SCs increased markedly around term. At the bronchial level these cells continued to increase postnatally apparently in inverse proportion to the number of BOM-IR SCs in later childhood. The number of CGRP-IR SCs was high only during the neonatal period. 5HT-IR SCs were relatively few and showed no clear developmental change in number. No unequivocal ENK-IR SCs were observed in any case. BOM-IR neuroepithelial bodies (NEBs) were observed more frequently than any other type of NEBs and remained relatively numerous throughout childhood. In lungs of infants with HMD/BPD, endocrine cells of all types except for ENK-IR cells were markedly increased in number during periods of regeneration, to the chronic stage. It is concluded that each of these types of pulmonary endocrine cell demonstrates a characteristic developmental pattern in distribution and frequency during infancy and childhood, probably reflecting the various functional roles of these cells in early life. In HMD/BPD, there is alteration in the number and/or peptide and serotonin content of pulmonary endocrine cells, possibly a result of acute hypoxia, oxygen administration, and epithelial regenerative activity.