Developmental study of a lamellar body fraction isolated from human amniotic fluid

Human lung development: recent progress and new challenges

Recent studies have revealed biologically significant differences between human and mouse lung development, and have reported new in vitro systems that allow experimental manipulation of human lung models. At the same time, emerging clinical data suggest that the origins of some adult lung diseases are found in embryonic development and childhood. The convergence of these research themes has fuelled a resurgence of interest in human lung developmental biology. In this Review, we discuss our current understanding of human lung development, which has been profoundly influenced by studies in mice and, more recently, by experiments using in vitro human lung developmental models and RNA sequencing of human foetal lung tissue. Together, these approaches are helping to shed light on the mechanisms underlying human lung development and disease, and may help pave the way for new therapies.

Summary: This Review describes how recent technological advances have shed light on the mechanisms underlying human lung development and disease, and outlines the future challenges in this field.

Human embryonic lung epithelial tips are multipotent progenitors that can be expanded in vitro as long-term self-renewing organoids

The embryonic mouse lung is a widely used substitute for human lung development. For example, attempts to differentiate human pluripotent stem cells to lung epithelium rely on passing through progenitor states that have only been described in mouse. The tip epithelium of the branching mouse lung is a multipotent progenitor pool that self-renews and produces differentiating descendants. We hypothesized that the human distal tip epithelium is an analogous progenitor population and tested this by examining morphology, gene expression and in vitro self-renewal and differentiation capacity of human tips. These experiments confirm that human and mouse tips are analogous and identify signalling pathways that are sufficient for long-term self-renewal of human tips as differentiation-competent organoids. Moreover, we identify mouse-human differences, including markers that define progenitor states and signalling requirements for long-term self-renewal. Our organoid system provides a genetically-tractable tool that will allow these human-specific features of lung development to be investigated.

DOI:http://dx.doi.org/10.7554/eLife.26575.001

Degenerative lung disease occurs when the structure of the lungs breaks down, which makes it harder to get enough oxygen into the bloodstream. Most, but not all, cases occur in smokers and ex-smokers or people who have been exposed to a lot of air pollution. Currently, there is no way to reverse the damage, and even slowing the progress of the disease is extremely difficult. Some researchers are looking for ways to treat patients with degenerative lung diseases by regenerating the surface of their lungs. However, it is still not clear what the most effective route towards this long-term goal will be.

One approach to lung regeneration is to use findings from developmental biology to understand how embryos normally build the gas exchange surfaces in the lungs. This knowledge may allow scientists to trigger a similar process in an adult lung to renew or replace any diseased tissue. Alternatively, cells could be collected from patients, reprogrammed and then coaxed into becoming a gas exchange surface in the laboratory. Such a “lung-in-a-dish” could be used to understand how degenerative diseases develop, to discover and test new drugs, or even to treat the patient directly via a transplant.

To date, the embryonic development of lungs has mostly been studied using mouse lungs as a model system. However, it was not clear if human lungs actually develop in similar ways to mouse lungs, and whether using mice is a valid research strategy.

Nikolić et al. compared embryonic lungs from humans and mice and showed that they are indeed very similar in terms of the cell types that they contain and how they mature. However, some key differences were identified that can only be explored in human cells and tissue. Nikolić et al. went on to identify conditions that allowed them to grow cells from human embryonic lungs indefinitely in a dish. These cells can now be used to investigate the aspects of lung development that are specific to humans.

Together these findings provide a useful guide to allow scientists to coax human cells growing in a laboratory to become lung cells. Further improvements to this process will make the lungs-in-a-dish more true to the real organs, meaning that they could be used to better understand lung disease and identify new medicines. In the longer term, Nikolić et al. hope to gain enough insight from the human lung-in-a-dish model to eventually be able to regenerate the lungs of patients with degenerative lung disease. However, this possibility is still many years away.

DOI:http://dx.doi.org/10.7554/eLife.26575.002

Testing for fetal lung maturation: a biochemical "window" to the developing fetus

Fetal lung maturity testing represents a major milestone in perinatology. This article critically evaluates specific controversies regarding the methodologies used to measure pulmonary surfactant in AF and how well each of these techniques performs both in principle and application. The clinical utility of fetal lung maturity testing as it applies to particularly difficult complications of pregnancy is discussed. These technical and clinical issues are framed by the scientific and empiric evidence that is used as the rationale for such testing and its implementation in the effective management of preterm delivery.

Androgen regulation of lung lipids in the male rat

The aim of this study was to determine whether or not testosterone regulates the lipid concentration in rat lung tissue. Rats were either sham-operated controls, castrated, or castrated and injected with testosterone. Twenty-one days after castration, we observed in relation to the control: (i) Total lipids, phospholipids, and total cholesterol increased, while triglycerides decreased in whole lung. (ii) Phospholipid concentration increased in microsomes, lamellar bodies, and alveolar macrophages, but it decreased in extracellular surfactant. (iii) On a percentage basis, the concentration of phosphatidylcholine increased in microsomes, lamellar bodies, and alveolar macrophages, and it decreased in extracellular surfactant. (iv) Protein concentration decreased in extracellular surfactant and increased in microsomes, lamellar bodies, and alveolar macrophages. (v) The incorporation of [14C]glycerol into phospholipids of lung slices increased. (vi) The activity of CTP:phosphocholine cytidylytransferase bound to the microsomal fraction increased without any change in the activity of the soluble form of the enzyme in the lung. The results obtained when testosterone was administered to castrated rats were similar to those obtained in the control in all cases. These results suggest that the lipid concentration in the lung is regulated at least partly directly or indirectly by androgens.

Ca(+2)-phosphatidylserine-dependent protein kinase C activity in fetal, neonatal and adult rabbit lung and isolated lamellar bodies

Evidence indicates that Ca(+2)-phosphatidylserine-dependent protein kinase C (PKC) is involved in regulation of surfactant secretion. This study was done to examine PKC activity in lung as surfactant synthesis and secretion is initiated, and at birth and to compare these enzyme levels with those in the adult lung. NZW rabbits were used. Fetal and adult lungs were fractionated into subcellular compartments including a lamellar body fraction, which represents intracellular surfactant. The time course for microsomal enzyme activity was compared between 24th gestational day and adult rabbit lung. The reactivity appeared similar in both fractions. PKC specific activity displayed a prominent peak between the 27th and 30th gestational days in total homogenate and lamellar bodies. Specific activity was also high in nuclear, mitochondrial and microsomal fractions the day prior to birth. Adult levels were similar or higher. Total PKC activity was high during late gestation but declined sharply the day prior to birth. A marked increase was present on the first postnatal day. In contrast lamellar bodies displayed a peak in activity between the 27th and 30th gestational days followed by a decline to adult levels. Delipidation of lamellar body fraction indicated that the high enzyme activity in this fraction on the 27th gestational day was not artifactual. The changes observed in PKC in fetal, neonatal and adult lung indicate this enzyme activity changes in lung during the period of onset of surfactant synthesis and secretion during late gestation and may be associated with lamellar bodies, in 27th gestational day fetal lung.

Mouse alveolar surfactant: characterization of subtypes prepared by differential centrifugation

To characterize the properties of alveolar surfactant subfractions obtained from mouse lung by differential centrifugation, lavage fluid, following a preliminary centrifugation at 140 x g for 5 min to yield a cellular pellet (Pc), was sequentially centrifuged at 10,000 x g for 30 min, 60,000 x g for 60 min and 100,000 x g for 15 h; and the resultant pellets, respectively referred to as P10, P60 and P100, were harvested for electron microscopy, phospholipid analysis and surface tension measurements. Ultrastructural differences were observed, in that P10 contained large multilamellated structures which were typical of newly secreted surfactant, P100 contained small unilamellar vesicular structures, typical of catabolic end products of alveolar surfactant and P60 appeared to contain a mixture of structures present in P10 and P100 in addition to numerous, large unilamellar vesicles which were not present in either P10 or P100. Slight but significant differences were found in the phospholipid compositions of the three subfractions but not in the fatty acid composition of their phosphatidylcholine (PC) component. There were no significant differences in their disaturated PC/total PC ratios, but significant differences in their phospholipid/protein ratios. P60 had the highest proportion of phospholipid to protein. P10 and P60 demonstrated surface activity but P100 did not. Total alveolar surfactant phospholipid was evenly distributed among the three fractions. This pattern of distribution was significantly different from that observed in rabbit subfractions prepared by the same procedure. These data indicate that mouse alveolar surfactant consists of three distinct subfractions or subtypes which can be separately and quantitatively isolated by differential centrifugation.(ABSTRACT TRUNCATED AT 250 WORDS)

Estimation of fetal lung maturity by assessment of lamellar body particle concentration

The concentration of lamellar bodies expressed as the optical density at 700 nm in amniotic fluid samples was calculated after centrifugation of the samples to obtain the lamellar bodies in a relatively pure form. The lamellar body concentrations obtained were compared with lecithin-sphingomyelin (L/S) ratios from the same samples. The advantages of the method compared with the L/S ratio are discussed as is the dependence on total volume that the method shares with all other procedures which depend on the measurement of a single concentration.

Hormonal and developmental regulation of pulmonary surfactant synthesis in fetal lung

Pulmonary surfactant, a unique developmentally regulated, phospholipid-rich lipoprotein, is synthesized by the type II cells of the pulmonary alveolus, where it is stored in organelles termed lamellar bodies. The principal surface-active component of surfactant, dipalmitoylphosphatidylcholine, a disaturated form of phosphatidylcholine, acts in concert with the surfactant-associated proteins to reduce alveolar surface tension. Relatively large amounts of phosphatidylglycerol also are present in lung surfactants of a number of species, including man. The role of phosphatidylglycerol in surfactant function has not been elucidated; however, its presence in increased amounts in pulmonary surfactant is correlated with enhanced fetal lung maturity. Surfactant glycerophospholipid synthesis in fetal lung tissue is regulated by a number of hormones and factors, including glucocorticoids, prolactin, insulin, oestrogens, androgens, thyroid hormones, and catecholamines acting through cyclic AMP. In studies with human fetal lung in organ culture, we have observed that glucocorticoids, in combination with prolactin and/or insulin, increase the rate of lamellar body phosphatidylcholine synthesis and alter lamellar body glycerophospholipid composition to one reflective of surfactant secreted by the human fetal lung at term. Four surfactant-associated proteins, SP-A, SP-B, SP-C and SP-D, have recently been characterized. Recognition of their potential importance in the reduction of alveolar surface tension and in endocytosis and reutilization of secreted surfactant by type II cells has stimulated rapid advancement of knowledge concerning the structures of the surfactant proteins and their genes, as well as their developmental and hormonal regulation in fetal lung tissue. The genes encoding SP-A, SP-B and SP-C are expressed in a cell-specific manner and are independently regulated in fetal lung tissue during development. SP-A gene expression occurs exclusively in the type II cell and is initiated after 75% of gestation is complete. In the human fetus, expression of the SP-B and SP-C genes is detectable much earlier in development than SP-A, before the time of appearance of differentiated type II cells. It is apparent from studies using human and rabbit fetal lung in culture that cyclic AMP and glucocorticoids serve important roles in the regulation of SP-A gene expression. While the effects of cyclic AMP are exerted primarily at the level of gene transcription in human fetal lung tissue, glucocorticoids have stimulatory effects on SP-A gene transcription and inhibitory effects on SP-A mRNA stability. In addition, cyclic AMP and glucocorticoids act synergistically to increase SP-A gene transcription in human fetal lung in vitro.(ABSTRACT TRUNCATED AT 400 WORDS)

Pulmonary toxicity of trichloroethylene: induction of changes in surfactant phospholipids and phospholipase A2 activity in the mouse lung

Trichloroethylene (TCE) is a common organic solvent in use as a dry cleaning agent as well as an inhalant anesthetic. Nevertheless the effects of this material on the pulmonary surfactant which prevents alveolar collapse at maximal expiration is not known. Therefore, we have examined the effect of TCE on the intra- and extracellular surfactant pools and the activity of phospholipase A2, an enzyme which controls the remodeling of phosphatidylcholine to dipalmitoylphosphatidylcholine, the primary constituent of the pulmonary surfactant. Male CD-1 mice were treated ip with 2500 or 3000 mg/kg TCE. Twenty-four hours later mice were anesthetized and the lungs lavaged. Mice were then killed, the lungs perfused and excised, and subcellular fractions including lamellar bodies prepared. Some lungs were prepared for ultrastructural examination. Phospholipase A2 was assayed in all subcellular fractions. Phospholipid was assayed in the lavage (extracellular surfactant) and the lamellar bodies (intracellular surfactant). TCE (2500 mg/kg) caused selective exfoliation of Clara cells. However, only the dose of 3000 mg/kg TCE produced a significant decrease in the intracellular surfactant phospholipid. Minimal changes occurred in the phospholipid profiles. Phospholipase A2 specific activity was significantly decreased at both dosages within the lung microsomal fraction. In addition after treatment with 3000 mg/kg TCE the enzyme activity in the lamellar body fraction was significantly increased. These data suggest that inhalation of TCE may damage the enzymes which are responsible for synthesizing the pulmonary surfactant resulting in lower amounts of surfactant being stored and available for secretion into the alveolus.

Characterization and comparison of the role of beta-agonists on in vivo and in vitro surfactant-related phospholipid synthesis and secretion by fetal rabbit lung and isolated type II alveolar cells

The role of beta-adrenergic stimulation in surfactant synthesis and secretion was investigated in the fetal lung. Fetuses were treated with isoxsuprine or saline on gestational day 24 by ip injection. Three days later the fetal lungs were lavaged and intracellular surfactant was isolated on a sucrose gradient. Concurrently undifferentiated type II alveolar cells were isolated from 24-day fetal rabbit lung and grown in vitro. In the in vivo portion of the study, examination of surfactant pool sizes revealed that only saline treatment produced a significant elevation in tissue-stored or secreted surfactant compared to untreated controls. Isoxsuprine appeared to inhibit the saline-induced increase. In the case of the intracellular surfactant, the phosphatidylcholine content per gram of lung was significantly increased after saline treatment. In vitro response of isolated type II alveolar cells to isoxsuprine was dependent on prior incubation of the cells for 24 h with conditioned medium. Isoxsuprine stimulated a dose-dependent decrease in the intracellular stores of radioactively labeled DSPC after 24 h of exposure to the drug. A corresponding increase in labeled DSPC in the culture medium was observed. Forth-eight hours after exposure to the drug, those cells that had secreted the highest level of DSPC displayed the highest levels of renewed synthesis of DSPC. This study indicates that the immature fetal lung can be induced to synthesize surfactant-related phospholipid by the stress of laparotomy and/or drug administration. Short-term exposure to beta-agonists is insufficient to stimulate secretion of surfactant stores. In contrast, isolated type II alveolar cells exposed to isoxsuprine respond by secreting DSPC.

An improved procedure for the isolation of lamellar bodies from human lung. Lamellar bodies free of lysosomes contain a spectrum of lysosomal-type hydrolases

We have recently shown that lamellar body fractions purified from human lung contain a distinct acid alpha-glucosidase distinguishable from lysosomal acid alpha-glucosidase in that it does not cross-react with antibodies raised against the lysosomal enzyme and does not bind to concanavalin A (De Vries, A.C.J., Schram, A.W., Tager, J.M., Batenburg, J.J. and Van Golde, L.M.G. (1985) Biochim. Biophys. Acta 837, 230-238). In order to study the relationship between the non-concanavalin A-binding alpha-glucosidase and lamellar bodies more closely a method was developed for the further purification of the organelles. A purified lamellar body preparation isolated from human lung homogenate by discontinuous sucrose density centrifugation was subjected to gel filtration with Sepharose 4B followed by Percoll density gradient centrifugation, which yielded a lamellar body preparation with a phospholipid phosphorus/protein ratio of 12.57 +/- 0.38 (mumol/mg) (n = 3) as compared to a ratio of 3.34 +/- 0.16 (mumol/mg) (n = 3) in the sucrose density gradient preparation. Concomitantly there was a 3.3 +/- 0.1 (n = 3)-fold enrichment in the content of total acid alpha-glucosidase and a 3.2 +/- 0.1 (n = 3) -fold enrichment of non-concanavalin A-binding acid alpha-glucosidase. The new purification method removes adhering proteins without changing the phospholipid composition. During the successive purification steps the concanavalin A-sensitive and -insensitive alpha-glucosidases remained fully lamellar body fraction associated. Differences between a lysosome-enriched fraction and a lamellar body preparation at varying stages of purification with respect to the ratio between soluble acid hydrolases and the membrane-associated lysosomal enzyme glucocerebrosidase indicate that the purified lamellar bodies were not contaminated with lysosomes. The absence of lysosomes in the purified lamellar body fraction was confirmed by experiments with the weak base glycyl-L-phenylalanine-beta-naphthylamide, which is an artificial substrate for the lysosomal enzyme cathepsin C and brings about lysis of lysosomes. Morphological examination by electron microscopy endorses the absence of contaminating vesicles and organelles and showed a structural integrity of the lamellar bodies in the final preparation. The improved isolation procedure strongly suggests that the concanavalin A-insensitive acid alpha-glucosidase is endogenous to lamellar bodies and supports our earlier idea that it can be used as a lamellar body-specific marker enzyme. In addition, the experiments show that lamellar bodies free of lysosomes contain a spectrum of lysosomal-type enzymes.

Relationship between amniotic fluid optical density and L/S ratio

Determination of the lecithin-sphingomyelin (L/S) ratio to predict fetal lung maturation requires rather complicated laboratory techniques which are not always available on a 24-hour basis in all hospitals. For that reason more simple tests have been developed. One of these tests, the determination of amniotic fluid optical density at 650 nm (OD 650), was initially reported to correlate well with the L/S ratio, but later studies gave varying and conflicting results. To assess the possible usefulness of measurement of amniotic fluid OD 650 we determined the correlation between L/S ratio and OD 650 in 90 amniotic fluid samples from 90 pregnant women. All samples were obtained by transabdominal amniocentesis between 26 and 39 weeks' gestation. Indications for amniocentesis were threatened premature labor (n = 49), fetal growth retardation (n = 25), and rhesus sensitization (n = 16). The OD 650 and the L/S ratio were determined in the same amniotic fluid sample using standard techniques. A statistically significant positive correlation was found between the OD 650 and the L/S ratio. Considering an OD 650 reading of 0.15 or greater and an L/S ratio of 2.0 or higher as indicative of fetal lung maturation, 25.5% of the OD 650 readings appeared to be false positive, and 28% were false negative as compared with the L/S ratio. It is concluded that the low predictive values of positive and negative optical density readings preclude the clinical application of this simple test.

Lack of change in the composition of fetal lamb lung surfactant during gestation

Fetal surfactant from lamb lung fluids collected daily from day 114 to day 146 of gestation, was isolated by centrifugation (pellet material) and further purified by sucrose density gradient centrifugation. The concentration of the pellet material from lung fluid (crude surfactant) increased from day 125 till day 135 and fluctuated strongly from that period onwards, whereas lung fluid secretion increased linearly until a few days before parturition. The pellet phospholipid composition changed with gestational age, suggesting biochemical maturation of the surfactant-producing system. The purified surfactant fraction, of which approximately 85% was phosphatidylcholine, did not change however from day 122 onwards except for a small increase in the percentage of phosphatidylglycerol. Alveolar wash surfactant or the lamellar body material, isolated from fetal lungs at different gestational ages had the same composition as surfactant from lung fluids. Only the composition of lamellar bodies of '125 day' lungs differed slightly from that of the lung fluid surfactant. The similar characteristics of all purified surfactant fractions throughout gestation indicate that, in the fetal lamb, lung maturation is associated with an increase in surfactant production no significant changes in phospholipid composition.

A semi-automated and standardized method of determining the lamellar body content of amniotic fluid

We have simplified and standardized the method of determining the lamellar bodies (LB) in amniotic fluid as a measure of fetal lung maturity. For this purpose we have first diluted the amniotic fluid and then concentrated its LB by low-speed centrifugation at the interface of a 10% Nycodenz solution. As a standard we use liposomes which consist of phospholipids enclosing a Nycodenz solution with a density similar to that of the LB. The phosphorus content of the LB and liposome standard is then determined by an automated fluorimetric method. There is an excellent correlation between the newly described procedure and the lecithin/sphingomyelin ratio. One technician can easily analyse 40 samples in a working day.

Purification of lamellar bodies from human amniotic fluid

Lamellar bodies were purified from human amniotic fluid obtained from pregnancies at 17, 31, and 40 weeks' gestation by means of Sephacryl S-300 column chromatography. Fractions were labeled with diphenylhexatriene and two peaks of phospholipid were identified at each gestational age. The size of peak I increased relative to that of peak II with advancing gestational age. Further study of the two peaks from 40-week pregnancies showed that peak I contained lamellar bodies that could be identified by electron microscopy. The ratio of the concentration of protein to phospholipid for peak I varied from 0.2 to 1.1. There were four proteins which could be identified by sodium dodecyl sulfate polyacrylamide gel electrophoresis (130K, 80K, 50K, and 20K), and there was 90-degree scattering of 400 nm light. Peak II also contained phospholipid. However, bilayer structures could not be visualized by electron microscopy, and there was no 90-degree scattering of 400 nm light. Peak II had a much higher ratio of protein to phospholipid (approximately 100) and two broad bands of protein on sodium dodecyl sulfate electrophoresis (80K, 50K). The anisotropy of diphenylhexatriene in both peaks decreased with advancing gestational age. The anisotropy in peak I was always lower than that in peak II, indicating that the microenvironment in peak I was more fluid. Peak I may represent mature surfactant and peak II, precursors of surfactant.

Amniotic fluid absorbance at 650 nm: its relationship to the lecithin/sphingomyelin ratio and neonatal pulmonary sufficiency

In the present study, we sought to assess the clinical efficacy of the optical density of amniotic fluid at 650 nm (A650) to predict lung maturity in the human fetus. The A650 of 113 samples of amniotic fluid obtained from 16 to 45 weeks' gestation was determined. Mature values (A650 greater than or equal to 0.11) were not observed until 35 weeks' gestation but were always present after 39 weeks' gestation. In those infants delivered within 48 hours of amniocentesis, the absence rates of respiratory distress syndrome were the same with a mature lecithin/sphingomyelin (L/S) ratio (97.9%) and a mature A650 (97.3%). However, immature values in both tests were poor prognosticators of respiratory distress syndrome, with a rate of 37.5% with the immature L/S ratio and 15.8% with the immature A650. A mature A650 may be substituted for the L/S ratio, but an immature A650 is less reliable. In addition, we found that differences in centrifugation altered the A650 value, whereas exposure to light and cold storage did not.

Changes in phospholipid composition of lung surfactant during development in the fetal lamb

The lung surfactant isolated from pulmonary fluid of fetal sheep changes both in amount and composition during gestation. Total phosphatidylcholine (PC) and its most surface-active components, disaturated PC, are present at very low levels 3-4 weeks prior to term and rise to adult levels 3-4 days before birth. The acidic phospholipids appear with a different time course. Phosphatidylserine reaches elevated levels about 21 days before birth. Phosphatidylinositol begins to increase at about 130 days of gestation. Phosphatidylglycerol is not a component (less than 1%) of the surfactant in this fetal lung fluid. At term, phosphatidylinositol is the major acidic phospholipid found in these fluids.

Bovine pulmonary surfactant: chemical composition and physical properties

Bovine pulmonary surfactant was obtained by endotracheal lavage of lungs from newly slaughtered cows followed by differential centrifugation. Lipid extracts of bovine surfactant contained 3% neutral lipid, mainly as cholesterol and diacylglycerol and 97% phospholipid. Phosphatidylcholine (79%) and phosphatidylglycerol (11%) accounted for most of the phospholipids with smaller amounts of phosphatidylethanolamine, phosphatidylinositol, lyso-bis-phosphatidic acid and sphingomyelin. Fatty acid analysis revealed high levels of palmitate in phosphatidylcholine and to a lesser extent phosphatidylglycerol, but not in the other diacylphospholipids. Phosphatidylcholine was 53% disaturated and phosphatidylglycerol was 23% disaturated. Monoenoic species accounted for the major proportion of the remaining lipid. The protein content was 10% as estimated by the Lowry procedure and 5% when determined by amino acid analysis. Extraction with chloroform/methanol removed ca. 90% of the protein but had no effect on the surfactant properties as evaluated by a pulsating bubble technique.

Identification of phospholipid platelet-activating factor (1-0-alkyl-2-acetyl-sn-glycero-3-phosphocholine) in human amniotic fluid and urine

Human amniotic fluid and fetal urine were examined for the presence of phospholipid platelet-activating factor (PAF). PAF was detected in lipid extracts of some samples of amniotic fluid obtained from women in labor but it was undetectable in samples of amniotic fluid obtained before the onset of labor. PAF was identified by chromatographic mobility, platelet aggregation and chemical modifications. LysoPAF was also present in amniotic fluid at higher concentrations than those of PAF. Both PAF and lysoPAF were identified also in newborn and adult urine.

On the suitability of organotypic cultures of fetal rat lung type II cells for biochemical studies concerning development

When organotypic cultures of fetal rat lung epithelial cells are initiated with undifferentiated cells, the cells differentiate into type II cells (Douglas, W.H.J., McAteer, J. A., Smith, J.R. and Braunschweiger, W.R. (1979) Int. Rev. Cytol., Suppl. 10, 45-65). This conclusion was based only on morphologic studies. The present study was undertaken to investigate whether such maturation in culture could also be demonstrated biochemically. In organotypic cultures initiated with epithelial cells from fetal rat lungs at 17-days gestation, the amount of phospholipids increased for at least 10 days. However, no change took place in the percentage of phosphatidylglycerol nor in the ratio of disaturated to total phosphatidylcholine. In cultures initiated with cells obtained at day 17 of gestation the specific activity of cholinephosphate cytidylyltransferase reached a maximum after approximately 3 days, followed by a decrease. A similar profile was obtained, however, if the culture was started at day 20 of gestation. This indicates that the activity profiles obtained in the organotypic cultures reflect changes caused by the culture conditions rather than changes caused by maturation. From these investigations it is concluded that biochemical studies on type II cell development using organotypic cultures as model should be interpreted with caution.

Cytodifferentiation of human fetal lung tissue following transplantation into "nude" mice

Lung fragments from 10 human fetuses aged 10 to 14 weeks of gestation were implanted into athymic "nude" mice. Cytodifferentiation of the transplants was studied by both scanning and transmission electron microscopy. Two weeks after implantation mitotic figures of epithelial and stroma cells were observed. In five week old transplants ciliated as well as endocrine cells were found dispersed among undifferentiated bronchial epithelium. During further experimental period epithelial differentiation in the transplants proceeded. Thus, eight week old implants assumed the morphologic appearance of fetal lungs in the canalicular stage displaying prospective type I and II pneumocytes. In addition stroma cells also differentiated forming mature fibroblasts and myofibroblasts. Our study indicates that human fetal lung tissue transplanted into "nude" mice not only grow but even differentiate. Xenogeneic transplantation of human fetal cells and tissues, therefore, offers additional opportunities to investigate the prenatal development of human tissues.

Assessment of fetal lung maturity: relationship of gestational age and pregnancy complications to phosphatidylglycerol levels

Phosphatidylglycerol (PG) was measured in the pellet fraction of 863 amniotic fluid samples, and charts were reviewed for maternal disease, duration of gestation at collection, and outcome of pregnancy. PG was present at 32 to 34 weeks' gestation in 24.1% of samples; at 35 to 36 weeks, in 52.3%; and at 37 weeks, in 85.4%. Pre-eclamptic toxemia/hypertension, diabetes, premature rupture of membranes, and preterm labor all had earlier appearance of PG than a comparison group. There was no delay in lung maturity in gestational diabetics or Rh isoimmunization. Infants of patients with overt diabetes with PG greater than or equal to 0.5% did not develop respiratory distress syndrome. This value appeared in 30% of diabetic patients by 35 to 36 weeks and in 76.9% by 37 weeks' gestation.

Lamellar bodies isolated from adult human lung tissue

Lamellar bodies, the intracellular storage form of pulmonary surfactant, were isolated from adult human lung tissue. As shown by electron microscopy, the isolated human lamellar bodies resembled the lamellar bodies isolated from experimental animals. Chemical analysis revealed that the lamellar bodies consisted largely of lipids, particularly phospholipids (85%). The major phospholipid was phosphatidylcholine, which accounted for 71% of the total phospholipids. Phosphatidylglycerol and phosphatidylethanolamine were 10 and 8%, respectively, of the lamellar body phospholipid. Phosphatidylserine, phosphatidylinositol, lysophosphatidylcholine, and sphingomyelin were minor components. Cholesterol was found to represent 60% of the neutral lipids or 9% of the total lipids. Phosphatidylcholine contained largely saturated fatty acids, of which palmitic acid was the most abundant. Disaturated phosphatidylcholines comprised 67% of the total phosphatidylcholines. Phosphatidylglycerol and phosphatidylethanolamine contained considerably less saturated fatty acids. Only 24% of phosphatidylglycerol was disaturated. The chemical composition of adult human lamellar bodies was very similar to that of lamellar bodies derived from experimental animals. The similarities in morphology and chemical composition of lamellar bodies suggest that surfactant metabolism in human lung may be similar to that of other mammals.

Methods of evaluating fetal lung maturity

Respiratory distress syndrome occurs in infants born with immature lungs. The immature fetal lung lacks an adequate supply of surfactant, a phospholipid-rich substance which is produced in the type II cells of the alveolar epithelium. In the fetus, surfactant is secreted into the potential air spaces of the lung and passes into the amniotic fluid as gestation proceeds. It is now clear that most methods currently in use for assessing fetal lung maturity depend on the detection of a sudden release of surfactant into the amniotic fluid as the lung reaches a critical stage of maturity. These methods, which include the lecithin/sphingomyelin ratio, the lung profile, total phospholipid or lecithin concentration, fluorescence depolarization, lamellar body phospholipid concentration, and the "shake" test, are reviewed in the light of recent understanding of the nature of surfactant. In assessing each method, we have examined possible sources of error in performing the test in the laboratory, factors which could theoretically limit its ability to reflect the state of fetal lung maturity and current information regarding its reliability, in terms of clinical performance. Guidelines for future research in this area are also suggested.

Differentiation of type II cells of human fetal lung in vitro

Lung tissue explants from mid-trimester human abortuses were maintained for 8 days in organ culture in medium with or without serum. Before the start of culture the cells lining the pre-alveolar ducts were undifferentiated and contained no lamellar bodies, the intracellular organelle that contains surfactant. After 4 days in organ culture, the epithelium lining the pre-alveolar ducts was composed of differentiated type II cells containing numerous lamellar bodies. During the 8-day culture period there was increased incorporation of [3H]choline into phosphatidylcholine and disaturated phosphatidylcholine. In addition, the specific activity of phosphatidate phosphohydrolase, a regulatory enzyme in lung phospholipid synthesis, increased 4-fold during the culture period. Lamellar bodies isolated by differential centrifugation from explants maintained in culture for 7 days had the characteristic ultrastructure described for this organelle. Lamellar bodies were isolated from explants which had been incubated with [14C]glycerol. When the glycerophospholipid composition of lamellar bodies was analyzed it was found that the majority of the radiolabeled glycerol (74%) was incorporated into phosphatidylcholine and into the anionic phospholipids, phosphatidylglycerol (5%) and phosphatidylinositol (6%). Thus, human fetal lung explants maintained in organ culture contain differentiated type II cells which synthesize surfactant characteristic of human fetal lung at 36 to 38 weeks of gestation.

Phosphatidylglycerol determination on amniotic fluid 10,000 x g pellet in the prediction of fetal lung maturity

Phosphatidylglycerol and the lecithin/sphingomyelin (L/S) ratio were determined, and the shake test was performed, as indicators of fetal lung maturity, in more than 600 patients. A clinical review of the outcome was made in all patients who underwent delivery within 2 days after collection of amniotic fluid. Correlation was made phosphatidylglycerol, shake test, and L/S ratio results. L/S ratio had a false positive rate of 5%, and a false negative rate of 58.1%. The shake test had a false positive rate of 1.1%, and a false negative rate of 63.5%. Phosphatidylglycerol determination had a false positive rate of 1.8%, and a false negative rate of 26.9%. Phosphatidylglycerol determination is an accurate predictor of fetal lung maturity, and predicts lung immaturity more correctly than do the L/S ratio and shake test.