Morphologic and physiologic response of lungs to steroid and cigarette smoke: an animal model

Disruption of iron homeostasis and lung disease

As a result of a direct exchange with the external environment, the lungs are exposed to both iron and agents with a capacity to disrupt the homeostasis of this metal (e.g. particles). An increased availability of catalytically reactive iron can result from these exposures and, by generating an oxidative stress, this metal can contribute to tissue injury. By importing this Fe(3+) into cells for storage in a chemically less reactive form, the lower respiratory tract demonstrates an ability to mitigate both the oxidative stress presented by iron and its potential for tissue injury. This means that detoxification is accomplished by chemical reduction to Fe(2+) (e.g. by duodenal cytochrome b and other ferrireductases), iron import (e.g. by divalent metal transporter 1 and other transporters), and storage in ferritin. The metal can subsequently be exported from the cell (e.g. by ferroportin 1) in a less reactive state relative to that initially imported. Iron is then transported out of the lung via the mucociliary pathway or blood and lymphatic pathways to the reticuloendothelial system for long term storage. This coordinated handling of iron in the lung appears to be disrupted in several acute diseases on the lung including infections, acute respiratory distress syndrome, transfusion-related acute lung injury, and ischemia-reperfusion. Exposures to bleomycin, dusts and fibers, and paraquat similarly alter iron homeostasis in the lung to affect an oxidative stress. Finally, iron homeostasis is disrupted in numerous chronic lung diseases including pulmonary alveolar proteinosis, transplantation, cigarette smoking, and cystic fibrosis.

Iron homeostasis and oxidative stress in idiopathic pulmonary alveolar proteinosis: a case-control study

BACKGROUND

Lung injury caused by both inhaled dusts and infectious agents depends on increased availability of iron and metal-catalyzed oxidative stress. Because inhaled particles, such as silica, and certain infections can cause secondary pulmonary alveolar proteinosis (PAP), we tested the hypothesis that idiopathic PAP is associated with an altered iron homeostasis in the human lung.

METHODS

Healthy volunteers (n = 20) and patients with idiopathic PAP (n = 20) underwent bronchoalveolar lavage and measurements were made of total protein, iron, tranferrin, transferrin receptor, lactoferrin, and ferritin. Histochemical staining for iron and ferritin was done in the cell pellets from control subjects and PAP patients, and in lung specimens of patients without cardiopulmonary disease and with PAP. Lavage concentrations of urate, glutathione, and ascorbate were also measured as indices of oxidative stress.

RESULTS

Lavage concentrations of iron, transferrin, transferrin receptor, lactoferrin, and ferritin were significantly elevated in PAP patients relative to healthy volunteers. The cells of PAP patients had accumulated significant iron and ferritin, as well as considerable amounts of extracellular ferritin. Immunohistochemistry for ferritin in lung tissue revealed comparable amounts of this metal-storage protein in the lower respiratory tract of PAP patients both intracellularly and extracellularly. Lavage concentrations of ascorbate, glutathione, and urate were significantly lower in the lavage fluid of the PAP patients.

CONCLUSION

Iron homeostasis is altered in the lungs of patients with idiopathic PAP, as large amounts of catalytically-active iron and low molecular weight anti-oxidant depletion are present. These findings suggest a metal-catalyzed oxidative stress in the maintenance of this disease.

Animal models of pulmonary infection in the compromised host: potential usefulness for studying health effects of inhaled particles

Pulmonary infection leading to pneumonia is a significant cause of morbidity and mortality worldwide. Airborne particles have been associated with pneumonia through epidemiological research, but the mechanisms by which particles affect the incidence of pneumonia are not well established. The purpose of this review is to examine the potential of animal models to improve our understanding of the mechanisms by which inhaled particles might affect the incidence and resolution of pulmonary infection. The pathogenesis of pneumonia in most animal models differs from that in humans because humans frequently have underlying diseases that predispose them to infection with relatively low doses of pathogens. Normal, healthy animals lack the underlying pathology often found in humans and clear bacteria and viruses rapidly from their lungs. To overcome this, animals are administered large inocula of pathogens, are treated with agents that cause mucosal lesions, or are treated with immunosuppressive drugs. Alternatively, pathogenic bacteria are protected from phagocytosis by encasing them in agar. No one animal model will replicate a human disease in its entirety, and the choice of model depends upon how well the animal infection mimics the particular human response being examined. The advantages and disadvantages of animal models in current use for bacterial and viral infections important in the etiology of human pneumonia are reviewed in detail. Considerable data indicate that prior exposure to particles compromises the ability of experimental animals to resolve a subsequent infection. In addition, information is available on the effects of particle exposure on various portions of respiratory defense including phagocytic function, ciliary movement, inflammation, and antibody response in the absence of infection. In contrast, little research to date has examined the consequences of particle exposure on the host defense mechanisms of animals already infected or on their ability to resolve their infection.

Effects of mainstream and environmental tobacco smoke on the immune system in animals and humans: a review

This review evaluates the available information on the effects of mainstream and environmental tobacco smoke on the immune system in animals and humans. The primary emphasis is on mainstream smoke since little information is available on the effects of environmental smoke. The effects of mainstream tobacco smoke on the immune system in humans and animals are similar. Animals exposed to mainstream tobacco smoke for periods of a few weeks generally exhibit a slight immunostimulation. However, subchronic and chronic exposure studies indicate that immunosuppressive changes develop. Lymphocyte proliferation in response to the mitogens PHA and LPS is decreased, suggesting compromise of cell function. Antibody production can be suppressed. Smoke-exposed animals that are challenged with metastasizing tumors or viruses have been shown to exhibit a higher incidence of tumorigenic and infectious diseases, respectively. Localized immunological changes in the lung can include reduction of bronchus-associated lymphoid tissue and immunoglobulin levels. Smoking-related changes in the peripheral immune system of humans have included elevated WBC counts, increased cytotoxic/suppressor and decreased inducer/helper T-cell numbers, slightly suppressed T-lymphocyte activity, significantly decreased natural killer cell activity, lowered circulating immunoglobin titers, except for IgE which is elevated, and increased susceptibility to infection. The effects of environmental tobacco smoke on the immune system, in contrast to mainstream tobacco smoke, have just begun to be investigated and information available in the literature, to date, is limited. Immunoreactive substances are known to be present in environmental tobacco smoke, but to date, environmental tobacco smoke has been more closely associated with irritation than sensitization. A few studies have indicated a potential for environmental smoke-induced hypersensitivity and suppression of immunoregulatory substances. In contrast, other investigators have failed to detect immunological or other biological changes associated with environmental smoke. Clearly, more research is needed to resolve these differences.

Murine lung response to kaolin conveyed by cigarette smoke

The effects of chronic (3 to 8.5 months) smoke inhalation from cigarettes laced with 0.1, 1.0 and 10.0 mg kaolin (hydrated aluminum silicate) per gram of tobacco on the morphological integrity of lungs and the pulmonary macrophage population were evaluated in young and old male C57BL/6 mice. Lacing procedures, monitored by determining aluminum content in acid-digested aliquots of tobacco via atomic absorption spectrometry (AAS), proved to be uniform. Amounts of aluminum in right lungs of young mice evaluated by AAS and of kaolin assessed by electron diffraction and polarizing light microscopy were larger in mice which inhaled smoke from cigarettes laced with more kaolin. A more pronounced increase in lung parenchymal tissue and decrease of alveolar space was observed in old mice subjected to smoke from cigarettes containing higher doses of kaolin than in similarly treated young animals. Concomitant with the above, the lung macrophage population did not increase as markedly in response to smoke inhalation in old mice nor did it increase in as clear a dose-response fashion to kaolin as it did in young animals. Further, the degree of ultrastructural alteration of the phagocytes in the old mice suggested impaired cell function. Plate-like material resembling kaolin crystals was most conspicuous in lung macrophages of mice which inhaled largest amounts of kaolin. Manifestations of abnormal aggregates of lymphocytes and macrophages correlated with kaolin dose inhaled in old mice but not in young animals. The reported observations indicate that 1) kaolin gains access to lungs via cigarette smoke inhalation, 2) macrophages are important in maintaining pulmonary homeostasis and 3) the inorganic compound kaolin appears to impede macrophage function, resulting in potentiation of lung abnormalities.

Lung deformation and macrophage displacement in smoke-exposed and normal mice (Mus musculus) following different fixation procedures

Lung deformation (shrinkage or inflation) and displacement of pulmonary parenchymal macrophages were evaluated after immersion fixation, intratracheal instillation of fixative and lung lavage followed by intratracheal fixative instillation in cigarette smoke-exposed, sham-treated and control pallid male mice. Lung volume displacement and lung section and alveolar area analysis revealed that degree of deformation was uniform in lungs from all treatment groups fixed by immersion but not by instillation of fixative and fixative instillation following lavage. In situ pulmonary parenchymal macrophage number per lung section area of fixative-instilled lungs and lavaged lungs followed by fixative instillation was significantly greater than in those following immersion fixation in all corresponding treatment groups. A paucity of macrophages was noted in airways of fixative-instilled and lavaged followed by instillation of fixative lungs. Pulmonary macrophages were uniformly distributed throughout lung parenchyma following immersion fixation, while in fixative-instilled and lavaged prior to instillation of fixative lungs these cells tended to be concentrated in alveoli near terminal bronchioles. Lavage procedures removed an unknown portion of lung macrophages and appeared to ineffectively sample the pulmonary parenchymal macrophage population. Intratracheal instillation of fixative with or without prior lavage apparently alters the distribution of pulmonary macrophages by displacing airway phagocytes into the alveoli. Data reported suggest that fractional estimates of in situ lung parenchymal macrophage population can be obtained by counting the number of these cells per area of tissue from lungs fixed by immersion.