Airway mucosal permeability in chronic bronchitics and bronchial asthmatics with hypersecretion

Plasma protein leakage and local secretion of proteins assessed in sputum in asthma and COPD. The effect of inhaled corticosteroids

Asthma and chronic obstructive pulmonary disease (COPD) are characterized by chronic airway inflammation with cell infiltration, increased plasma exudation and abnormal local secretion of proteins. We have analysed whether sputum differs in this respect between asthma (n = 9) and COPD (n = 9), and whether inflammatory markers in sputum are affected by treatment. In non-smoking asthma patients there was more plasma protein leakage, based on the relative coefficient of excretion Q alpha 2macroglobulin/QIgG (P = 0.03). There was less local secretion of sIgA and lactoferrin than in COPD (P < 0.05). Tryptase was slightly higher in sputum from asthma than from COPD (P < 0.05), whereas eosinophil cationic protein and myeloperoxidase were similar. After treatment with glucocorticosteroids, there was a reduction in the Q alpha 2macroglobulin/Qalbumin (P < 0.015), but no effect was seen on the levels of products from local cells. We conclude that sputum analysis is useful to study the local inflammatory process in asthma and COPD.

Plasma exudation and solute absorption across the airway mucosa

The airway mucosa responds to inflammatory provocations with bulk exudation of plasma into the airway tissue (vascular exudation) and lumen (mucosal exudation). The intensity and time course of the exudative response can be relevantly examined by sampling and analysing airway surface liquids, because the luminal entry of plasma proteins/tracers promptly and quantitatively reflects the exudative response of the airways. The process of mucosal exudation of plasma is a prominent feature of airway inflammation and has been demonstrated in rhinitis, asthma, and bronchitis. Inflammatory mediators and allergen produce mucosal exudation of plasma into the airway lumen (outward permeability) whereas the solute absorption across the mucosa (inward permeability) is unaffected. Hence, in contrast to current views, we have demonstrated that in airway inflammation the solute absorption across the airway mucosa is not increased. The findings suggest the plasma exudation response also as a first line respiratory mucosal defence, allowing potent plasma protein systems to appear on an airway mucosa functionally intact as a barrier toward undue luminal material. Our data on plasma exudation and solute absorption across the mucosa of upper and lower airways further suggest the human nasal airways as a model relevant also for the tracheobronchial airways.

Regulation of T84 cell monolayer permeability by insulin-like growth factors

When grown on permeable supports, the T84 human colonic epithelial cell line forms polarized monolayer cultures with high-resistance tight junctions between adjacent cells. Addition of either insulin-like growth factor (IGF) I or II to the basolateral but not the apical membrane side of established monolayers caused a dose-dependent decrease in transepithelial resistance over a 4-day period. IGF-I was more potent than IGF-II, with half-maximally effective concentrations of 0.7 and 2.2 nM, respectively. Both IGF-I and -II caused a parallel increase in the transepithelial flux rates for Na+ and the extracellular space marker, mannitol, demonstrating that the decrease in electrical resistance was due to increased permeability through the tight junction-regulated paracellular pathway. Simultaneous addition of cycloheximide prevented the decline in electrical resistance, implying that protein synthesis is necessary for the effect of IGF on paracellular permeability. Treatment of monolayers with IGF produced a subtle condensation of the perijunctional actin ring as visualized using rhodamine-labeled phalloidin. These results demonstrate that IGF-I and -II regulate the paracellular permeability of T84 cell monolayers through a receptor-mediated process that probably involves changes in protein synthesis and cytoskeletal structure.

Role of chronic Pseudomonas aeruginosa infection in airway mucosal permeability

The role of Pseudomonas aeruginosa infection in airway mucosal permeability was studied in 16 patients with chronic bronchitis by measuring the amounts of radiolabeled albumin in sputum. One group (A) consisted of six patients (two female, four male, 53 +/- 6 years, SEM) with chronic P aeruginosa infection for 5 +/- 0.9 years. Another group (B) consisted of ten patients (five female, five male, 67 +/- 4 years) without P aeruginosa infection for at least two years. No significant differences between groups A and B were found in the volume of sputum (63 +/- 21 ml/day in group A and 45 +/- 8 ml/day in group B, p = 0.44), the obstructive changes (FEV1 of 57 +/- 6 percent in group A and 51 +/- 4 percent in group B), or the duration of disease (19 +/- 4 years in group A and 14 +/- 4 years in group B). Saliva, sputum, and serum samples were collected at intervals of 2 h over an 8-h period, and at 24 h after intravenous administration of 131I-labeled human albumin. For counting, free 131I was removed by dialysis. Radiocounts (cpm) of saliva were significantly smaller than those of sputum or serum. The cpm from each sputum sample was divided by serum cpm at the time of each sampling. Group A showed significantly higher values in the ratio of sputum- to serum-cpm than did group B at all sampling times. Furthermore, the ratios at 2 and 4 h after 131I-albumin injection significantly correlated with sputum volume per day, whereas they did not correlate with any other factors (age, obstructive impairment, and duration of disease). These findings suggest that chronic P aeruginosa infection produces an increase in airway mucosal permeability to albumin.

Exudative indices in airways inflammation

Airways inflammation has come to be equated with the presence of inflammatory cells and their products in airway lumen and tissue. However, the inflammatory condition must also, or rather, be determined by indices which show to what degree the tissue itself is affected by the process. Plasma exudation from abundant subepithelial microvessels is a specific defence/inflammatory tissue response to mucosal provocations; promptly after extravasation, the plasma exudate reversibly and non-injuriously creates intercellular pathways across the mucosa; the exudate enters the airway lumen without compromising the epithelial lining as a barrier to luminal solutes; there is a good correlation between surface and tissue plasma exudates. I propose that plasma tracers on the mucosal surface can identify the ongoing airway inflammation, its intensity and time-course in great detail.