Human airway trypsin-like protease (HAT) is released into saliva

We first discovered human airway trypsin-like protease (HAT) in human mucoid sputum. Precursor HAT (47 kDa), a cell surface type Ⅱ transmembrane serine protease, is proteolyzed to mature HAT (27 kDa). Hitherto, HAT has not been detected in other biological fluids except for human sputum. We aimed to clarify whether human saliva contains mature HAT. Trypsin-like protease was isolated from saliva of healthy volunteers by a method adopted for isolation of HAT from sputum using Boc-Phe-Ser-Arg-MCA as the substrate. Biochemical properties of purified protease were similar to those of recombinant HAT (rHAT). HAT concentration in saliva was measured by ELISA, and immunoreactive HAT:total protein ratio (ng/mg) in saliva samples from healthy subjects was similar to that in mucoid sputum. RT-PCR showed that HAT mRNA was expressed in human gingival epithelial cells but not in gingival fibroblasts. Both indirect immunofluorescence and western blotting using monoclonal antibody for α-smooth muscle actin (α-SMA;a myofibroblast marker) showed that HAT enhanced α-SMA fiber expression in gingival fibroblasts. These results indicate that both mucoid sputum and saliva from healthy subjects have similar concentrations of mature HAT, and HAT is related to certain physiological functions and pathological states of myofibroblasts in the oral cavity. J. Med. Invest. 65:258-267, August, 2018.

Human airway trypsin-like protease enhances interleukin-8 synthesis in bronchial epithelial cells by activating protease-activated receptor 2

Human airway trypsin-like protease (HAT) localizes at human bronchial epithelial cells (HBECs). HAT enhanced release of interleukin-8 (IL-8) from HBECs at 10-100 mU/mL and the enhanced release was almost completely abolished by 50 μM leupeptin, a serine protease inhibitor. Previous reports suggested that HAT displays its physiological functions via protease-activated receptor 2 (PAR2). In the present study, we examined the mechanism whereby HAT upregulates IL-8 synthesis in HBECs with a focus on PAR2. Northern blot analysis revealed that HAT enhanced IL-8 mRNA expression at concentrations of 10-100 mU/mL. PAR2 activating peptide (PAR2 AP) also enhanced IL-8 release and IL-8 mRNA expression in HBECs at 50-1,000 μM at similar levels as HAT. Knockdown of PAR2 mRNA by siRNA methods showed that PAR2 mRNA expression was significantly depressed in primary HBECs, and both HAT- and PAR2 AP-induced IL-8 mRNA elevation was significantly depressed in PAR2 siRNA-transfected HBECs. Additionally, HAT cleaved the PAR2 activating site (R³⁶-S³⁷ bond) of synthetic PAR2 N-terminal peptide. These results indicate that HAT stimulates IL-8 synthesis in airway epithelial cells via PAR2 and could help to amplify inflammation in chronic respiratory tract disease.

The human airway trypsin-like protease modulates the urokinase receptor (uPAR, CD87) structure and functions

The human airway trypsin-like protease (HAT) is a respiratory epithelium-associated, type II transmembrane serine protease, which is also detected as an extracellular enzyme in lung fluids during airway inflammatory disorders. We have evaluated its capacity to affect the urokinase-type plasminogen activator receptor (uPAR), a membrane glycolipid-anchored, three-domain (D1D2D3) glycoprotein that plays a crucial role in innate immunity and inflammation by supporting cell migration and matrix degradation, with structure and biological properties that can be regulated via limited endoproteolysis. With the use of immunoblotting, flow immunocytometry, and ELISA analyses applied to a recombinant uPAR protein and to uPAR-expressing monocytic and human bronchial epithelial cells, it was shown that exposure of uPAR to soluble HAT in the range of 10-500 nM resulted in the proteolytic processing of the full-length (D1D2D3) into the truncated (D2D3) species, with cleavage occurring in the D1 to D2 linker sequence after arginine residues at position 83 and 89. Using immunohistochemistry, we found that both HAT and uPAR were expressed in the human bronchial epithelium. Moreover, transient cotransfection in epithelial cells showed that membrane coexpression of the two partners produced a constitutive and extensive shedding of the D1 domain, occurring for membrane-associated HAT concentrations in the nanomolar range. Because the truncated receptor was found to be unable to bind two of the major uPAR ligands, the adhesive matrix protein vitronectin and the serine protease urokinase, it thus appears that proteolytic regulation of uPAR by HAT is likely to modulate cell adherence and motility, as well as tissue remodeling during the inflammatory response in the airways.

Distinct expression of mast cell tryptase and protease activated receptor-2 in synovia of rheumatoid arthritis and osteoarthritis

The objective of this study is to examine the differential expression of mast cell tryptase and its receptor, protease-activated receptor-2 (PAR-2), in the synovium and synovial fluid of patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Biochemical and immunohistochemical analyses were performed to determine whether the trypsin-like protease in the synovium is identical to mast cell tryptase. The effects of mast cell tryptase on the proliferation of synovial fibroblast-like cells (SFCs) and the release of IL-8 thereof were evaluated by the [3H]-thymidine incorporation and ELISA, respectively. The trypsin-like protease in the synovium of RA patients was identical to human mast cell tryptase, which was composed of two subunits: 33 and 34 kDa. The 33- and 34-kDa proteins are different glycosylated forms of the 31-kDa protein, which was unglycosylated. Mast cell tryptase activity in RA synovial fluid was significantly higher than that in OA synovial fluid, while their activities and expression in the synovium were similar. Expression of PAR-2 mRNA in the synovium was higher in RA than in OA. Mast cell tryptase containing the unglycosylated 31-kDa subunit was the predominant form in synovial fluid. RA patients had higher amounts of this subunit in their synovial fluid than OA patients. Mast cell tryptase and PAR-2 activating peptide stimulated the proliferation of SFCs and release of IL-8 from these cells. Mast cell tryptase secretion into RA synovial fluid is higher than OA synovial fluid. Mast cell tryptase in synovial fluid stimulates the proliferation of SFCs and the release of pro-inflammatory cytokines via PAR-2, which may contribute to exacerbation of synovitis in RA.

Human airway trypsin-like protease stimulates human bronchial fibroblast proliferation in a protease-activated receptor-2-dependent pathway

Human airway trypsin-like protease (HAT) was isolated from airway secretions and localized to bronchial epithelial cells by immunohistochemistry. In the present study, we examined whether HAT could stimulate DNA synthesis and proliferation of primary human bronchial fibroblasts (HBF). HAT significantly stimulated the proliferation of HBF by 20–55%, a level similar to that of the mitogenic activity of lung mast cell tryptase (MCT). HAT also stimulated the incorporation of [3H]thymidine in HBF, and this HAT-induced DNA synthesis was abolished by leupeptin. Protease-activated receptor-2 (PAR-2) mRNA was expressed and localized to the cell surface in HBF. PAR-2 activating peptide (AP) also enhanced DNA synthesis, and both HAT and PAR-2 AP induced receptor internalization, similar to the response to trypsin. Pretreatment of HBF with anti-PAR-2 antibody significantly suppressed both HAT and PAR-2 AP-induced DNA synthesis. In addition, HAT and PAR-2 AP induced intracellular Ca2+mobilization in HBF. The HAT-induced increase in Ca2+was desensitized by pretreatment with trypsin or PAR-2 AP. U0126, a specific MAPK inhibitor, completely inhibited HAT-induced DNA synthesis as well as HAT-induced phosphorylation of MAPK. The effect of HAT and MCT together was additive, whereas the effect of HAT and insulin together on HBF DNA synthesis was synergistic. These results indicate that HAT stimulates fibroblast proliferation in bronchial airways through a PAR-2-dependent MEK-MAPK mediated pathway and that HAT is linked to airway processes involving fibroblasts.

Effect of saliva collection method on the concentration of protein components in saliva

In order to clarify how we collect saliva for analyzing salivary protein in aged subjects who can not eat well, we compared the effects of suction, spitting and the swab saliva collection method on the yield of protein components in saliva samples from normal volunteers. The saliva collected by suction, spitting and the swab method were designated as, Saliva I, II and III, respectively. The saliva volume collected by Saliva I was about 2-fold greater than that by of Saliva II and III. This is mainly due to the fact that saliva secretion was stimulated by the suction itself. The content of total protein, S-IgA, trypsin-like activity and human airway trypsin-like protease (HAT) were almost the same in Saliva I and II, and significantly lower in Saliva III than in Saliva I and II. Kallikrein activity was almost the same in Saliva I, II and III. The concentration of each total protein, S-IgA, kallikrein activity, trypsin activity and HAT in Saliva I were significantly positively correlated with that in Saliva II. These results indicate that we can obtain information of change of salivary protein by analyzing saliva collected by suction method, although this method caused the stimulation of saliva to some extent.

Relationship between cathepsin B and thrombin in rheumatoid arthritis

OBJECTIVE

To investigate the pathophysiological significance of cathepsin B and thrombin in synovial fluid (SF) from patients with rheumatoid arthritis (RA).

METHODS

Thrombin and cathepsin B activities of samples from patients with RA and osteoarthritis (OA) were measured using fluorogenic synthetic substrates. The concentration of interleukin 8 (IL-8) in SF was measured by ELISA. The effect of thrombin on the proliferation of synovial fibroblast-like cells (SFC) was examined by measuring 3H-thymidine incorporation. The effect of thrombin on the release of IL-8 and cathepsin B from SFC was investigated. The expression of IL-8 mRNA in SFC after stimulation with thrombin was evaluated using real-time quantitative RT-PCR. The effect of recombinant IL-8 on the activation of cathepsin B was examined using the knee joints of rabbits.

RESULTS

In SF supernatants, cathepsin B and thrombin-like activity was significantly higher in RA than in OA, and there was a significant correlation between them. Cathepsin B activity was also significantly higher in SF cells and synovial tissue extracts from RA patients than in those from OA patients. There was a significant correlation between cathepsin B activity and the concentration of IL-8 in RA SF. Thrombin enhanced the proliferation of SFC in a dose-dependent manner. Thrombin significantly enhanced the release of IL-8 from SFC as well as the expression of IL-8 mRNA in SFC. IL-8 induced activation of cathepsin B in the knee joints of rabbits. However, thrombin did not directly increase cathepsin B activity in SFC.

CONCLUSION

In RA, thrombin was found to be related to the enhanced growth of SFC and the release of IL-8 from these cells; thus thrombin is probably related to worsening of inflammation through the recruitment of leukocytes (neutrophils), which release cathepsin B into the SF. Thrombin can induce activation of cathepsin B in SFC via increased expression of IL-8.

Human Airway Trypsin-Like Protease Induces PAR-2-Mediated IL-8 Release in Psoriasis Vulgaris

Human airway trypsin-like protease (HAT), a novel serine protease in the airways, enhances cell growth and IL-8 production. The expression and role of HAT in the skin however, is unknown. Immunofluorescence staining and reverse transcription (RT)-PCR were done to know HAT production in normal and psoriatic tissues and keratinocyte cell lines. Cell growth and/or IL-8 release analyses were made by bromo-deoxyuridine (BrdU) uptake and ELISA. Psoriatic epidermis showed more extensive immunofluorescence expression of HAT, and less extensive expression of protease-activated receptor (PAR)-2. RT-PCR demonstrated a higher HAT and a lesser PAR-2 mRNA expressions in psoriatic epidermis. Normal keratinocyte and epidermoid carcinoma cell lines expressed HAT and PAR-2 mRNA, and immortalized keratinocytes (HaCaT) expressed PAR-2, but not HAT mRNA. PAR-2 was detected along the keratinocyte surface in culture and became invisible upon HAT stimulation, suggesting a process of its internalization. HAT or PAR-2 activating peptide did not enhance BrdU uptake, but induced an IL-8 release. Treatment with HAT and IL-1beta synergistically increased the effect of IL-8 release. Inhibition of PAR-2 resulted in a decreased HAT-induced IL-8 release. Thus, HAT might promote PAR-2-mediated IL-8 production to accumulate inflammatory cells in the epidermal layer of psoriasis.

Human airway trypsin-like protease increases mucin gene expression in airway epithelial cells

Human airway trypsin-like protease (HAT) is a serine protease found in sputum of patients with chronic airway diseases and is an agonist of protease-activated receptor-2 (PAR-2). Results from this study show that HAT treatment also enhances mucus production by the airway epithelial cell line NCI-H292 in vitro. Histologic examination showed that HAT enhances mucous glycoconjugate synthesis, whereas the PAR-2 agonist peptide (PAR-2 AP) has no such effect. HAT, but not PAR-2 AP, enhances MUC2 and MUC5AC gene expression 23-fold and 32-fold, respectively. The proteolytic activity of HAT is required to enhance MUC5AC gene expression; the addition of the inhibitors of trypsin-like protease activity of HAT, aprotinin and leupeptin, abolishes its enhancing effect. AG1478, anti-epidermal growth factor receptor (anti-EGFR)-neutralizing antibody, and anti-amphiregulin (AR)-neutralizing antibody all inhibited the stimulatory effect of HAT. Furthermore, HAT increases AR gene expression and subsequent AR protein release, whereas PAR-2 AP shows no such effects. These results indicate that HAT enhances mucin gene expression through an AR-EGFR pathway, and PAR-2 is not sufficient for or does not directly cause HAT-induced mucin gene expression. Thus, HAT might be a possible therapeutic target to prevent excessive mucus production in patients with chronic airway diseases.

Effect of human airway trypsin-like protease on intracellular free Ca2+ concentration in human bronchial epithelial cells

It has been shown that human airway trypsin-like protease (HAT) is localized in human bronchial epithelial cells (HBEC), and trypsin activates protease-activated receptor-2 (PAR-2). Activation of PAR-2 activates G-protein followed by an increase of intracellular free Ca2+, [Ca2+]in. This study was undertaken to clarify whether HAT can activate PAR-2 in HBEC or not. RT-PCR showed that HAT mRNA is expressed in HBEC, and PAR-2 mRNA is the most strongly expressed of the known PARs in HBEC. Both PAR-2 agonist peptide (PAR-2 AP) and HAT increased [Ca2+]in in HBEC in a biphasic fashion; a prompt, sharp increase (peak I) and a sustained low plateau (peak II). PAR-2 AP over 100-200 microM and HAT over 200-300 mU/ml (0.08-0.12 microM) induced both peak I and II, and PAR-2 AP below 100 microM and HAT below 200 mU/ml induced only peak II. Both PAR-2 AP-induced and HAT-induced peak I were induced by Ca2+ mobilization from intracellular stores, because they appeared even in Ca2+-free medium. Both PAR-2 AP-induced and HAT-induced peak II were induced by an influx of extracellular Ca2+, because they were abolished in Ca2+-free medium. The Ca2+ response to HAT was desensitized by exposure of HBEC to PAR-2 AP. These results indicate that HBEC have a functional PAR-2, and HAT regulates cellular functions of HBEC via activation of PAR-2.

Localization of human airway trypsin-like protease in the airway: an immunohistochemical study

Human airway trypsin-like protease (HAT) has been isolated from mucoid sputum of patients with chronic airway diseases. In order to clarify the cellular source of this novel protease in the human airway, we examined the localization of immunoreactive HAT in bronchial tissues obtained at surgery and fixed in 4% paraformaldehyde using an extremely sensitive immunohistochemical technique called a catalyzed signal amplification method and a monoclonal antibody against recombinant HAT. HAT immunoreactivity was demonstrated in cytoplasm of ciliated cells of bronchial epithelium and/or at the basal part of cilia. No positive reaction was found in submucosal glands or mast cells. The heterogeneous distribution of HAT immunoreactivity within the bronchial epithelium indicates that its expression might be changeable and that it might be closely related to the physiological status of the airway epithelium. Non-specific but intense reaction caused by endogenous avidin-binding activity (EABA) was selectively detected in submucosal glands, but was effectively blocked by successive treatments with avidin and biotin. These results indicate that HAT may be synthesized in the ciliated cells and that it may play some physiological roles within the epithelial layer and on the airway surface. It is necessary to keep in mind that some cells show strong EABA, especially when a highly sensitive immunohistochemical technique is applied.

Laser's effect on bone and cartilage change induced by joint immobilization: an experiment with animal model

OBJECTIVE

Influence of low-level (810 nm, Ga-Al-As semiconductor) laser on bone and cartilage during joint immobilization was examined with rats' knee model.

MATERIALS AND METHODS

The hind limbs of 42 young Wistar rats were operated on in order to immobilize the knee joint. One week after operation they were assigned to three groups; irradiance 3.9 W/cm2, 5.8 W/cm2, and sham treatment. After 6 times of treatment for another 2 weeks both hind legs were prepared for 1) indentation of the articular surface of the knee (stiffness and loss tangent), and for 2) dual energy X-ray absorptiometry (bone mineral density) of the focused regions.

RESULTS AND CONCLUSIONS

The indentation test revealed preservation of articular cartilage stiffness with 3.9 and 5.8 W/cm2 therapy. Soft laser treatment has a possibility for prevention of biomechanical changes by immobilization.

Cathepsins B and L in synovial fluids from patients with rheumatoid arthritis and the effect of cathepsin B on the activation of pro-urokinase

To clarify the pathophysiological role of cathepsins in rheumatoid arthritis (RA), we investigated whether cathepsin B or cathepsin L was increased in synovial fluid (SF) of RA joints, and whether the cathepsin isolated from SF of RA patients activated pro-urokinase or not. Thus, we estimated the content of cathepsins in SF of RA patients by measuring their activities by fluorospectrometry, using Z-Phe-Arg-MCA as the substrate. Cathepsin activity was approximately 4-fold higher in the SF of RA patients than in those of patients with osteoarthritis. Cathepsin B and cathepsin L were separated by cation-exchange column chromatography. As a result, a large peak corresponding to cathepsin B and a very small peak corresponding to cathepsin L were detected. Biochemical sequential fractionation of the cathepsin purified from the SF showed that the large peak was mainly composed of cathepsin B. This purified enzyme induced conversion of pro-urokinase to urokinase, and the Km for pro-urokinase was approximately 8.27 microM. These findings indicated that an imbalance between cathepsin B and its inhibitors occurred due to increased concentrations of active cathepsin B in RA articular lesions, and that cathepsin B might be related to the degradation of cartilage in RA by activating the fibrinolytic cascade.

Effect of biochemical components on rheologic properties of nasal mucus in chronic sinusitis

The effect of biochemical components on the viscoelasticity of nasal mucus from 24 patients with chronic sinusitis (CS) was investigated by multiple stepwise regression analysis. The dynamic viscosity (eta') and the elastic modulus (G') of nasal mucus were determined with an oscillating sphere magnetic rheometer at oscillatory frequencies of 1 and 10 Hz. The eta' and G' values of mucus determined at 1 Hz were 1.6 +/- 1.5 Pa/s and 31.8 +/- 31.0 Pa, respectively, and these values were much higher than optimal viscoelasticity for mucociliary transport. The concentrations of fucose, N-acetyl neuraminic acid, albumin, IgG, secretory-IgA, and lysozyme were measured in the same mucus samples. The multiple regression analysis showed that the concentration of fucose, a marker of mucous glycoproteins, was the most important determinant of eta' and G'. The analysis also revealed that the level of IgG was the next important determinant. The coefficients of multiple determination for fucose and IgG were 0.732 and 0.733 when the response variables were eta' and G', respectively. The results indicate that locally produced mucous glycoproteins may largely contribute to the high viscoelasticity of nasal mucus in CS.

Influenza virus overcomes apoptosis by rapid multiplication

The kinetics of apoptotic fragmentation of the chromosomal DNA was determined in the influenza virus-infected MDCK, HeLa and KB cells, respectively. Comparison of these kinetics with the kinetics of virus multiplication revealed that the multiplication of influenza virus was observed only when apoptosis was induced after the production of progeny virus in the infected cells. The extent of apoptotic response was reversely correlated with the permissiveness of the cells.

Characteristics of the protease activity in synovial fluid from patients with rheumatoid arthritis and osteoarthritis

OBJECTIVE

To clarify which proteases are specifically activated in the lesions of rheumatoid arthritis (RA) and osteoarthritis (OA).

METHODS

The activity levels of the serine proteases of the coagulation and fibrinolytic systems, and of elastase and collagenase as controls, in synovial fluid from 27 RA patients and 28 OA patients were measured using fluorogenic synthetic substrates which had methylcoumarylamide (MCA) at their COOH-termini. The thrombin-antithrombin III complex (TAT) content was also measured by ELISA.

RESULTS

Among the proteases, thrombin-like activity was the highest in both RA and OA. The profiles of protease activity were similar in RA and OA, but their activities were in general significantly higher in RA than in OA (p < 0.01). The levels of both thrombin-like activity and TAT were about 7.5-fold higher in RA than in OA, while the levels of CRP and fibrinogen were only about 2-fold higher. Biochemical characterization of the thrombin-like activity in the synovial fluid of RA patients showed that this activity was due to thrombin. Thrombin-like activity positively correlated with the TAT concentration in RA (r = 0.750, p < 0.0001), but not in OA.

CONCLUSION

Activation of the coagulation system was more marked in RA than in OA, strongly suggesting that in RA there is an imbalance between thrombin and its inhibitors, and that thrombin is more closely linked to the pathogenesis of RA than to that of OA. Our results also show that analysis of the synovial fluid may be useful to estimate the activation of the coagulation system in RA, but not that of the fibrinolytic system.

Relationships between activity of daily living, and oral cavity care and the number of oral cavity microorganisms in patients with cerebrovascular diseases

We examined the relationships among the activity of daily living (ADL), oral cavity care, and the number of oral cavity microorganisms in 40 patients with cerebrovascular diseases (CVD). The CVD patients were classified into 4 groups, I, II, III and IV based on their ADL and the method used for oral cavity care. The ADL was highest in group I and lowest in group III. Only the patients of only group III could not eat by themselves and were receiving naso-esophageal feeding. Oral cavity care was performed by the patients themselves in groups I and IV, but was performed by caregivers in groups II and III. The group IV patients had no teeth, but could eat by themselves using full dentures. The numbers of microorganisms in the pharyngeal swabs from the 4 groups were measured and expressed as colony-forming units (cfu). The numbers of both Staphylococci spp. and Candida spp. were significantly higher in group III than in the other groups. Moreover, Pseudomonas aeruginosa was isolated only from patients of group III (in about 66%). The oral cavity care by caregivers was almost the same in groups II and III, but the numbers of oral cavity microorganisms were significantly higher in group III than in group II. These results indicated that microorganisms grow more easily in the oral cavities of CVD patients with low ADL compared with CVD patients with higher ADL, and that eating is thought to be important for the prevention of an increase of microorganisms in the oral cavity.

Fibrinogenolytic activity of a novel trypsin-like enzyme found in human airway

Previously we isolated a new trypsin-like enzyme designated human airway trypsin-like protease (HAT) from human sputum. In this study, we examined in vitro whether HAT was related to the prevention of fibrin deposition in the airway lumen by cleaving fibrinogen. In mucoid sputum samples from patients with chronic airway diseases, the concentration of fibrinogen, as measured by ELISA, was in the range of 2-20 micrograms/ml, and trypsin-like activity, as measured by spectrofluorometry was in the range of 10-50 milliunits (mU)/ml. We showed by gel filtration that the trypsin-like activity of mucoid sputum was mainly due to HAT. We examined the effects of HAT on human fibrinogen at pH 7.4 and 8.6. Fibrinogen was used at concentrations of 4-2,000 micrograms/ml and HAT purified from sputum at concentrations of 0.6-10 mU/ml. As shown by SDS-polyacrylamide gel electrophoresis, HAT cleaved fibrinogen, especially its alpha-chain, regardless of the concentration of fibrinogen. Pretreatment of fibrinogen with HAT resulted in a decrease or complete loss of its thrombin-induced clotting capacity, depending on the duration of pretreatment with HAT and the concentration of HAT. From these results we postulated that HAT may participate in the anticoagulation process within the airway, especially at the level of the mucous membrane, by cleaving fibrinogen transported from the blood stream.

Cloning and characterization of the cDNA for human airway trypsin-like protease

Previously we isolated a trypsin-like enzyme designated human airway trypsin-like protease from the sputum of patients with chronic airway diseases. This paper describes the cDNA cloning, characterization of the primary protein structure deduced from the cDNA, and gene expression of this enzyme in various human tissues. We obtained an entire 1517-base pair sequence of cDNA with an open reading frame encoding a polypeptide with 418-amino acid residues. The polypeptide consisted of a 232-residue catalytic region and a 186-residue noncatalytic region with a hydrophobic putative transmembrane domain near the NH2 terminus. The polypeptide was suggested to be a type II integral membrane protein in which the COOH-terminal catalytic region is extracellular. Therefore, this protein is thought to be synthesized as a membrane-bound precursor and to mature to a soluble and active protease by limited proteolysis. It showed 29-38% identity in the sequence of the catalytic region with human hepsin, enteropeptidase, acrosin, and mast cell tryptase. The noncatalytic region had little similarity to other known proteins. In Northern blot analysis a transcript of 1.9 kilobases was detectable most prominently in the trachea among 17 human tissues examined.

Purification, characterization, and localization of a novel trypsin-like protease found in the human airway

A novel trypsin-like protease was purified to homogeneity from the sputum of patients with chronic airway diseases, by sequential chromatographic procedures. The enzyme migrated on SDS-polyacrylamide gel electrophoresis to a position corresponding to a molecular weight of 28 kDa under both reducing and non-reducing conditions, and showed an apparent molecular weight of 27 kDa by gel filtration, indicating that it exists as a monomer. It had an NH2-terminal sequence of Ile-Leu-Gly-Gly-Thr-Glu-Ala-Glu-Glu-Gly-Ser-Trp-Pro-Trp-Gln-Val-Ser-Leu- Arg-Leu, which differed from that of any known protease. Studies with model peptide substrates showed that the enzyme preferentially cleaves the COOH-terminal side of arginine residues at the P1 position of certain peptides, cleaving Boc-Phe-Ser-Arg-4-methylcoumaryl-7-amide most efficiently and having an optimum pH of 8.6 with this substrate. The enzyme was strongly inhibited by diisopropyl fluorophosphate, leupeptin, antipain, aprotinin, and soybean trypsin inhibitor, but hardly inhibited by secretory leukocyte protease inhibitor at 10 microM. An immunohistochemical study indicated that the enzyme is located in the cells of the submucosal serous glands of the bronchi and trachea. These results suggest that the enzyme is secreted from submucosal serous glands onto the mucous membrane in patients with chronic airway diseases.

Localized osteoarticular change due to joint immobilization; biomechanical test and bone densitometry in rat's hind limb model

Bone change induced by knee immobilization was assessed on dissected femurs and tibias to clarify the influences upon the mechanical properties and their demands. Fifty-eight Wistar-Imamichi male rats (11-12 weeks old, body weight 350-450 g) were subjected to knee joint immobilization (150 degrees flexed position) on one side while the opposite side served as a control. Animals were killed in seven groups at time intervals of 1, 2, 3, 4, 5, 7, and 10 weeks. The hind leg was extirpated and prepared for (1) biomechanical analysis by the indentation method at the articular surfaces of the femoral condyle and head and at the subchondral bone of the proximal tibia, and for (2) dual-energy X-ray absorptiometry of the distal metaphysis of the femur. The biomechanical parameters measured induced dynamic stiffness and phase lag derived from forced oscillation (preload 3 N, cyclic load 2 N and 11 Hz, 35 Hz), and bone mineral density was analyzed. These were compared between the immobilized side and control side, and among the seven time groups. The biomechanical results showed an early change of osteocartilaginous properties at the femoral condyle, a late response at the tibial subchondral bone, and no change at the femoral head. The measurement of bone mineral density revealed that a very sensitive reaction started within 1-2 weeks. This study provides objective data demonstrating that disuse or lack of mechanical stress greatly affects the remodeling activity for homeostasis of joints, and dramatically impairs normal bone mineral density next to the immobilized joint in young animals.

[Fibrinogenolytic activity of a novel trypsin-like enzyme found in human airways]

We previously reported finding a novel trypsin-like enzyme in sputum samples from patients with chronic airway diseases, and named it human airway tryptase (HAT). We also obtained data suggesting that HAT is secreted from submucosal serous glands onto the mucous membrane of the airway, and that fibrinogen is cleaved by HAT. We studied whether HAT can act as an anticoagulant in the airway by breaking down fibrinogen. The concentration of fibrinogen in sputum samples was measured by enzyme-linked immunosorbent assay. The concentration was higher in mucoid sputum from patients with bronchial asthma (6.3 +/- 5.5) than in mucoid sputum from patients with chronic bronchitis (1.9 +/- 1.1), and it was higher in purulent sputum from patients with bronchiectasis (18.8 +/- 8.8) than in mucoid sputum from patients with asthma. The trypsin-like activity in sputum (milliunit/ml) was 23.4 +/- 18.0 in mucoid sputum from patients with chronic bronchitis, 46.9 +/- 43.9 in mucoid sputum from patients with asthma, and 14.9 +/- 8.23 in purulent sputum from patients with bronchiectasis. The effect of HAT on human fibrinogen at concentrations from 4 to 2000 micrograms/ml was examined at pH 7.4 and 8.6, with purified HAT at concentrations from 0.5 to 10 milliunit/ml. SDS-polyacrylamide gel electrophoresis showed that HAT can cleave fibrinogen. especially the alpha-chain, at low concentrations (4 to 16 micrograms/ml) and at a high concentration (2000 micrograms/ml) of fibrinogen. Exposure of fibrinogen to HAT resulted in the loss of thrombin-induced clotting capacity; the strength of that effect depended on the duration of exposure to HAT and on the concentration of HAT. From these results we postulate that HAT acts at an anticoagulant in the airways, especially on the mucous membrane, by cleaving fibrinogen transported from blood.

Biochemical analysis of airway aspirates of newborns

We measured contents of tracheobronchial and alveolar components contained in the newborn airway aspirates (NAA) obtained from 54 healthy newborns, with bronchoalveolar lavage fluid (BALF) and bronchial lavage fluid (BLF) from healthy adults, and with mucoid sputum from adults with chronic bronchitis as controls. Fucose (a parameter of tracheobronchial mucus mucoprotein) and tryptase activity were used as tracheobronchial components, and pulmonary surfactant apoprotein A (SP-A) as an alveolar component. The ratio of the content of each component to that of total protein (TP) was compared among NAA, BLF, BALF, and the mucoid sputum. The SP-A/TP ratio in the NAA was similar to that in BLF but 1/24 of that in BALF. The fucose/TP ratio in NAA was about 1/2 of that in BLF and about 6 times higher than that in BALF. The tryptase/TP ratio in NAA was about twice that in BLF and about 80 times that in BALF. The ratios of the above components to TP in the mucoid sputum were closer to those in NAA and BLF than those in BALF. These results suggest that NAA contain both tracheobronchial and alveolar components, and their contents of the formers are larger than those of the latters, and that NAA may be useful for diagnosing pathologic conditions in the airway of newborns, and for comparing the biological defence mechanism between newborns and adults.

[Comparison of biochemical properties of human airway tryptase isolated from mucoid sputum with those of lung mast cell tryptase]

We found a novel trypsin-like enzyme (tryptase) in sputum from patients with chronic airway diseases, and named this enzyme human airway tryptase (HAT). To clarify its physiological significance in the airway, we compared biochemical properties of purified HAT with those of purified lung mast cell tryptase (MCT). Studies with model peptide substrates showed that both the HAT and MCT preferentially cleaved the COOH-terminal side of arginine residues of certain peptides, but substrate specificities to nine synthetic model substrates of HAT differed from those of MCT. Effects of protease inhibitors on the two enzymes were examined at a concentration of 10 microM. Both the HAT and MCT were strongly inhibited by the trypsin inhibitors leupeptin, antipain, and aprotinin. An alpha-1-protease inhibitor inhibited HAT by 50%, but it did not inhibit MCT. In contrast, a secretory leukocyte protease inhibitor strongly inhibited MCT, but not HAT. Mucoid sputum from patients with chronic bronchitis contained much more HAT than MCT. These differences in biochemical properties between HAT and MCT indicate that they play different physiological roles in the airways.

[Lung fibroblast growth-stimulating activity of serine protease]

We compared lung fibroblast growth-stimulating activity (FGA) of several serine proteases including thrombin in vitro, and examined the mechanism of FGA. FGA was measured by incorporation of 3H-thymidine into lung fibroblasts (IMR-90). The activities of the enzymes were measured by spectrofluorometric method with synthetic peptides specific for each enzyme, and these enzymes were added to the assay system for FGA at concentrations of 7 x 10(0)-7 x 10(5) unit/ml. Human thrombin, bovine trypsin and bovine alpha-chymotrypsin showed clear FGA, but that of alpha-chymotrypsin was lower than those of thrombin and trypsin. On the other hand, porcine pancreatic elastase and human neutrophil elastase did not show any FGA, and had a cytotoxic effect on fibroblasts. A specific low molecular-weight thrombin inhibitor, argatroban (MW. 562), inhibited not only the enzyme (peptidolytic) activity of thrombin, but also its FGA at the same concentration. These results suggest that serine proteases can be classified into at least two groups, showing FGA and cytotoxic activity, respectively, and that the FGA of the former group is mediated by their catalytic (enzymatic) action.

[Cell-associated interleukin 1 production of alveolar macrophages from bleomycin-induced pulmonary fibrosis in rats]

In order to clarify the mechanisms of pulmonary fibrosis, we produced bleomycin (BLM)-induced pulmonary fibrosis in rats and examined the ability of alveolar macrophages (AM) to produce interleukin-1 (IL-1). BLM (0.9 mg) was administered once via the trachea to male Wistar rats weighing about 200 g. Bronchoalveolar lavage was performed at 1, 3, 6, 9 and 12 days after administration. AM were incubated for 24 hours, then extracellular IL-1 in the supernatants and cell-associated IL-1 of AM were measured by proliferation assay of mouse thymocytes. Cell-associated IL-1 activity was measured after fixation by paraformaldehyde (PFA). Extracellular IL-1 was detected in the culture media of AM at only day 1 after administration. On the other hand, cell-associated IL-1 was detected in AM fixed by PFA on days 1, 3, 6 and 9 after administration. AM from BLM-induced pulmonary fibrosis in rats were fixed by PFA and then were treated with anti-IL-1 alpha antibody or anti-IL-1 beta antibody. Cell-associated IL-1 activity was neutralized by treatment with anti-IL-1 alpha antibody and was not neutralized by treatment with anti-IL-1 beta antibody. Following this, the effect of cell-associated IL-1 on pulmonary fibroblasts was examined. This was estimated by the proliferation of pulmonary fibroblasts using incorporation of 3H-thymidine. When pulmonary fibroblasts were incubated with AM fixed by PFA from BLM-induced pulmonary fibrosis in rats, proliferation of pulmonary fibroblasts was inhibited.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors that stimulate the proliferation and survival of eosinophils in eosinophilic pleural effusion: relationship to granulocyte/macrophage colony-stimulating factor, interleukin-5, and interleukin-3

To investigate the mechanism of eosinophilia in patients with eosinophilic pleural effusions, we measured the activities of eosinophil colony-stimulating factor (Eo-CSF) and stimulating factor for eosinophil survival in the eosinophilic pleural fluids of six patients (two with tuberculous pleuritis, two with drug allergy, and one each with chronic eosinophilic pneumonia and pleuritis associated with rheumatoid arthritis). The number of eosinophil colonies formed by the pleural fluid of patients with eosinophilic pleural effusions significantly exceeded that of control patients with noneosinophilic pleural effusions (7.5 +/- 1.9 colonies/10(5) bone marrow cells, n = 6, versus 0.3 +/- 0.1 colonies/10(5) bone marrow cells, n = 6, P < 0.01). Similarly, eosinophil survival evaluated on day 4 of culture with pleural fluid of patients with eosinophilic pleural effusions significantly exceeded that of patients with noneosinophilic pleural effusions (83.9 +/- 9.8% versus 46.1 +/- 11.2%, P < 0.001). Both activities were inhibited mainly by anti-IL-5 antibody and partially by anti-GM-CSF antibody and anti-IL-3 antibody. Mononuclear cells obtained from eosinophilic pleural fluid released the activities of Eo-CSF and stimulating factor for eosinophil survival in vitro. These findings suggest that GM-CSF, IL-5, and IL-3 are important to eosinophil accumulation in pleural cavity as stimulators of proliferation and survival of eosinophils.

Analysis of secretory leukocyte protease inhibitor (SLPI) in bronchial secretions from patients with hypersecretory respiratory diseases

Changes in the content and molecular state of secretory leukocyte protease inhibitor (SLPI) in the airways in chronic airway diseases were studied. SLPI in bronchoalveolar and bronchial lavage fluids (BALF and BLF) from normal subjects and patients with diffuse panbronchiolitis (DPB), and in mucoid sputa from patients with emphysema and in purulent sputa from DPB patients were examined by ELISA and Western blotting. Results showed that in the BALF and BLF of normal subjects, the SLPI/alpha 1-protease inhibitor (alpha 1-PI) ratios (M/M) are about 0.6 and 6, respectively and the neutrophil elastase inhibitory capacity of BLF is mainly due to SLPI. In the BALF and BLF of DPB patients, both the elastase activity and alpha 1-PI level are increased, but the SLPI level is decreased. In purulent sputa, the elastase activity was found to be 430-fold that in mucoid sputa and the alpha 1-PI level to be 3.5-fold that in mucoid sputa, but the SLPI level was slightly lower in the mucoid sputa. Analysis by Western blotting showed that in BLF from normal subjects and mucoid sputa, SLPI is present in an intact form and in complexes with other substances, whereas in BLF and purulent sputa from DPB patients, SLPI is present in a degraded form and in complexes with other substances, but not in the intact form. These results indicate that SLPI is the main protease inhibitor in the airways of both normal subjects and patients with hypersecretory respiratory diseases without infection, but that its level is insufficient to overcome the increased protease burden in the airways of DPB patients.

[Neutrophil chemotactic factor in supernatant from pulmonary fibroblasts stimulated with cytokines]

Fibroblasts are important for maintenance of the structural frame network for most tissues, and they also play an important role in the inflammatory process via production of various mediators. In this study, we demonstrated that pulmonary fibroblasts may participate in pulmonary inflammation by production of neutrophil chemotactic factor (NCF). Pulmonary fibroblasts were stimulated with various cytokines (IGF-1, PDGF, IL-1 alpha, IL-1 beta, IL-2, IL-6, TNF, IFNr). Fibroblasts stimulated with either TNF, IL-1 alpha or IL-beta but not IGF, PDGF, IL-2 or IL-6 demonstrated a kinetic and dose-dependent increase in NCF activity. The NCF activity of crude supernatant was heat-stable and was not changed by anti-C5 antibody treatment or ether extraction. Characterization of the NCF activity by gel-filtration using high pressure liquid chromatography showed two active fractions, one with MW greater than 100 kD and the other with MW less than 10 kD. NCF activity in the small molecular weight fraction was demonstrated by inhibition of chemotaxis by addition of anti-IL-8 antibody. These data suggest that cytokine-treated fibroblast-derived NCF may be important in the pathogenesis and expression of a variety of pulmonary disease processes associated with neutrophil accumulation and activation.

Increased granulocyte/macrophage colony-stimulating factor production by mononuclear cells from peripheral blood of patients with bronchial asthma

The in vitro production of granulocyte/macrophage colony-stimulating factor (GM-CSF) by mononuclear cells (MNC) from the peripheral blood of patients with bronchial asthma (BA) was examined by enzyme-linked immunosorbent assay (ELISA). GM-CSF concentrations in the media of MNC from patients with BA cultured with interleukin-2 (IL-2) was 80.2 +/- 52.0 pg/ml (mean +/- SE, n = 12), and that in cultures without a stimulant was 12.1 +/- 11.3 pg/ml. The GM-CSF concentrations in the media of MNC from patients with other diseases (n = 13) and from healthy volunteers (n = 6) cultured with or without IL-2 were less than 7.5 pg/ml (the minimum detectable value). The culture media of MNC from patients with BA demonstrated activities for stimulating the proliferation and survival of eosinophils, and these activities were partially inhibited by anti-GM-CSF antibodies. GM-CSF production by MNC of patients with BA treated with glucocorticoids was lower than that of MNC from untreated patients with BA, and it was inhibited by coculture with glucocorticoids in vitro. These results suggest that GM-CSF production by MNC is increased in patients with BA, is modulated by glucocorticoids, and may play an important role in the pathogenesis of BA.

[Increased granulocyte/macrophage colony stimulating factor production by mononuclear cells from patients with bronchial asthma]

The in vitro production of granulocyte/macrophage colony stimulating factor (GM-CSF) by mononuclear cells from the peripheral blood of patients with bronchial asthma (BA) was examined by enzyme-linked immunosorbent assay (ELISA). In 3 of 12 cases studied, mononuclear cells from BA patients produced GM-CSF without stimulation. And in 5 of 12 cases studied, mononuclear cells from BA patients produced GM-CSF in response to IL-2. Mononuclear cells from patients with other diseases (n = 13) and healthy volunteers (n = 6) did not release any detectable (> or = 7.5 pg/ml) GM-CSF. The culture media of mononuclear cells from BA patients showed activities for stimulating the proliferation and survival of eosinophils, and these activities were partially inhibited by anti-GM-CSF antibodies. GM-CSF production by mononuclear cells from BA patients treated with prednisolone was lower than that of mononuclear cells from untreated BA patients. And prednisolone showed a reduction in the GM-CSF production from mononuclear cells in response to IL-2. These results suggest that GM-CSF production by mononuclear cells may play a role in the pathogenesis of BA.

[Measurement of CA19-9 in bronchial lavage fluid from patients with lung cancer]

Carbohydrate antigen 19-9 (CA19-9) was measured in bronchial lavage fluid in 21 patients with lung cancer and 4 patients with benign lung diseases (2 patients with DPB, 2 patients with BE). Bronchial lavage of the tumor-related bronchus was performed. In normal subjects, levels of CA19-9 in lavage fluid were less than 1000 IU/ml. On the other hand, in 6 patients with lung cancer, levels of CA19-9 were higher than 1000 IU/ml, and in 3 of these cases, CA19-9 levels were higher than 8000 IU/ml. All six three cases were histologically diagnosed as adenocarcinoma. Tumor resected at operation was then stained by antibody recognizing CA19-9. Tumor in cases with high levels of CA19-9 was stained immunohistochemically. These results indicate that measurement of CA19-9 in bronchial lavage fluid of the tumor-related bronchus is a useful auxiliary method in the diagnosis of lung cancer.

Differential cell analysis in bronchoalveolar lavage fluid from pulmonary lesions of patients with tuberculosis

To obtain information on the cellular reactions to Mycobacterium (M) tuberculosis in the lung, we analyzed the cells in bronchoalveolar lavage (BAL) fluid from pulmonary lesions in comparison with those in BAL fluid from nonaffected regions of the lungs, and control lungs, and in peripheral blood of patients with tuberculosis. Neutrophils and lymphocytes were increased in number in BAL fluid from affected lesions of the lungs of patients with miliary tuberculosis and patients with active pulmonary tuberculosis compared with those in BAL fluid from control patients, but the number of alveolar macrophages was decreased in BAL fluid from tuberculous lesions. However, the numbers of these cells were not changed in the BAL fluid from nonaffected regions of the lungs of patients with active or inactive pulmonary tuberculosis. The numbers of lymphocytes were decreased and the numbers of monocytes were increased in peripheral blood from patients with miliary tuberculosis and with active tuberculosis, indicating inverse changes in the numbers of lymphocytes and monocytes in the peripheral blood to those in the BAL fluid of patients with tuberculosis. These results indicate characteristic redistributions of immune or inflammatory cells in response to infection with M tuberculosis and suggest that these changes are important for understanding the pathophysiology of pulmonary tuberculosis.

Analysis of IgA antibody to Pseudomonas aeruginosa in sera and sputa of patients with chronic airway diseases

The change of IgA system for Pseudomonas infection was examined by enzyme-linked immunosorbent assay of the system in sera and sputa of patients with chronic airway diseases. The anti-Pseudomonas total IgA antibody titers in both sera and sputa were not elevated in group I with no infection (mainly chronic bronchitis) and group II infected with bacteria other than Pseudomonas, but were elevated in group III colonized transiently with Pseudomonas [diffuse panbronchiolitis (DPB) and bronchiectasis] and group IV colonized persistently with Pseudomonas (mainly DPB). The elevation in the sera and sputa were mainly due to monomeric IgA and polymeric IgA (S-IgA), respectively, and values were significantly higher in group III than in group IV only in the sera. These results indicate that the IgA system is enhanced in advanced DPB and bronchiectasis complicated by Pseudomonas infection, and that the anti-Pseudomonas IgA antibody titer in serum is more useful than that in sputum for the diagnosis of respiratory Pseudomonas infection.

Cell profile and elastase activity in diffuse panbronchiolitis investigated by bronchoalveolar and bronchial lavage

To examine the mechanism of tissue damage which causes bronchiolectasis in diffuse panbronchiolitis (DPB), the cellular components, elastase and its main inhibitor, alpha 1-protease inhibitor (alpha 1-PI) were measured in bronchoalveolar and bronchial lavage fluid (BALF and BLF) from 14 DPB patients. A predominant increase in the neutrophil count was observed in DPB. Elastase activity in BALF and BLF was about 1,000-fold higher in the DPB group than in the control group. An inhibitor study and a positive correlation between elastase activity and the neutrophil count in both lavage fluids from the DPB group indicated that the activity was mainly that of neutrophil elastase. Western blot analysis of alpha 1-PI showed that most of the alpha 1-PI in the lavage fluids from DPB group was degraded. These results indicated that neutrophil infiltration increases the level of elastase in the DPB lesions; this increase seems to be closely related to tissue damage.

[Eosinophil colony stimulating factor production by lymphocytes from patients with bronchial asthma]

To investigate the eosinophilia in patients with bronchial asthma (BA), we examined the release of eosinophil colony stimulating factor (Eo-CSF) from blood mononuclear cells (MNC) and lymphocytes from BA. We also investigated the effect of specific antigens on the release of Eo-CSF to determine its relation to other known Eo-CSFs. 1) Phytohaemagglutinin (PHA) and interleukin (IL)-2 at optimal concentrations stimulated mononuclear cells from BA, and induced Eo-CSF release. In contrast, MNC from normal volunteers released Eo-CSF with only PHA, but did not release Eo-CSF with IL-2. 2) Lymphocytes from BA who were sensitive to house dust mite and Dermatophagoides farinae (D. farinae) antigens responded to specific antigens with Eo-CSF production, but those from normal volunteers did not. 3) The anti-IL-3, anti-IL-5, and anti-granulocyte-macrophage (GM)-CSF antibody inhibited Eo-CSF activity in culture media of lymphocytes from BA. These results indicate that the increase in responsiveness of lymphocytes from BA to specific antigens and cytokines produced by T cells play an important role in the induction of eosinophilia in BA.

Neutrophil chemotactic factors in the respiratory tract of patients with chronic airway diseases or idiopathic pulmonary fibrosis

This study was designed to clarify the contributions of specific neutrophil chemotactic factors (NCF) in neutrophil accumulation in the human respiratory tract associated with various diseases. The activity and characteristics of the NCF in the bronchoalveolar lavage (BAL) fluid and culture media of alveolar macrophages obtained from normal volunteers, control patients, patients with chronic airway diseases (CAD) and patients with idiopathic pulmonary fibrosis (IPF) were examined. The BAL fluid from normal volunteers contained NCF comparable with the chemotactic factors interleukin-8 (IL-8) and leukotriene B4 (LTB4). Analysis of the biochemical characteristics of NCF released from alveolar macrophages suggests that they are derived from alveolar macrophages. The NCF activities in BAL fluids from patients with CAD and IPF were higher than those in BAL fluids from normal volunteers and control patients. Biochemical analysis demonstrated that several kinds of NCF, including those derived from the complement component C5 and alveolar macrophages, were present in the BAL fluid from patients with CAD and respiratory infections. The especially marked increase of C5-derived NCF indicate their importance in neutrophil accumulation in the respiratory tract of patients with CAD. Alveolar macrophages released different types of NCF after different lengths of culture periods (4 h and 24 h). Alveolar macrophages from patients with IPF released larger amounts of NCF than alveolar macrophages from normal volunteers, indicating the importance of alveolar-macrophage-derived NCF as well as C5-derived NCF in neutrophil accumulation in the respiratory tract of patients with IPF. These results suggest that various types of NCF increase in response to different disease states of the respiratory tract and serve to regulate the accumulation of neutrophils.

Relationship between dynamic viscoelasticity and biochemical parameters in whole sputum from patients with hypersecretory respiratory diseases

To obtain suitable biochemical parameters for measuring the dynamic viscoelasticity of sputum, we examined the relationships of the dynamic viscoelasticity with the dry weight (DW) and the contents of fucose, a parameter of airway mucous glycoprotein (AMG), and total protein (TP) and major proteins in whole sputum. The DW and TP, albumin and IgG concentrations and elastase activity were higher in purulent sputum than in mucoid-mucopurulent sputum, but there was no significant difference in the concentrations of airway wall-derived substances, such as fucose and S-IgA in the two. In mucoid-mucopurulent sputum, the dynamic viscosity (eta') and elastic modulus (G'), an indicator of dynamic elasticity, were most closely correlated with the fucose concentration (r = +0.75, and +0.74, p < 0.005 at 1 Hz) and slightly correlated with the DW, TP and S-IgA, but not with the other parameters tested. In the purulent sputum, the eta' and G' correlated with the DW and concentration of TP (r = +0.70-0.80, p < 0.005), but not with any concentrations of fucose, S-IgA or albumin. The results indicate that as parameters for estimating the dynamic viscosity and elasticity of whole sputum, fucose is useful for mucoid-mucopurulent sputum whereas DW and TP are useful for purulent sputum.

[A case of small cell lung cancer associated with pulmonary sarcoidosis]

A 63-year-old man with pulmonary sarcoidosis, diagnosed by mediastinal lymph node biopsy in 1977, was admitted in Feb. 1987 because of shortness of breath and cough. Chest X-ray showed bilateral hilar lymphadenopathy and a tumor shadow in the right lung field. Histological examination of specimens biopsied from the right lung revealed small cell carcinoma (S.C.C.). Bronchoalveolar lavage was performed to evaluate the disease activity of sarcoidosis, and the total number of cells and T-lymphocytes; the ratio of CD4+ cells to CD8+ cells was not increased. He was treated with combination chemotherapy, however, he died of respiratory failure after 7 months. An autopsy was performed, and the lesions were examined histologically. The sarcoid lesion in a lymph node obtained at autopsy was not active, in contrast to that obtained by mediastinal lymph node biopsy. Lung cancer and sarcoidosis are both common diseases, but their coexistence in the same patient is not common, and autopsied cases are rare. In this case, an autopsy was performed, and BAL had been performed prior to his death. The relationship between the BAL findings and the histology of sarcoidosis was examined. Based on the results of autopsy and BAL, the sarcoidosis was inactive prior to death, but had been histologically active 10 years previously. Therefore, this is a very interesting case, since we can examine the relationship between the two diseases, and the progression of each disease. This case also provides an interesting example of differentiation of sarcoidosis from S.C.C. Metastatic invasion of the hilar lymph nodes without bronchial stenosis and changes secondary to stenosis may often occur in patients with small cell lung cancer. Such metastatic invasion closely resembles the bilateral hilar lymphadenopathy of sarcoidosis; therefore, in some cases, it may be extremely difficult to differentiate the two diseases.

[A case of pathological dilation of seminal vesicle with high level of serum CA-19-9]

A case of pathological dilation of seminal vesicle is presented. A 18-year-old male was admitted to our hospital with the complaints of gross hematuria and discomfort of the scrotum. IVP and abdominal CT scan revealed the left aplastic kidney, and ultrasound, vesiculography, and pelvic CT scan revealed markedly dilated bilateral seminal vesicles without filling defects. The level of serum CA19-9 was 390 u/ml, which was extremely high. After resection of dilated seminal vesicles, it returned to the normal range (37 u/ml). Sixty six cases of pathological dilation of seminal vesicle were collected from the Japanese literature. No cases showing a high level of serum CA19-9 have been reported in Japan.

Thrombin enhances lung fibroblast proliferation in bleomycin-induced pulmonary fibrosis

To clarify the role of thrombin in fibroblast growth and the development of pulmonary fibrosis in bleomycin-induced interstitial lung disease, we examined the relationship of thrombin activity to fibroblast growth-stimulating activity (FGA) in bronchoalveolar lavage (BAL) fluid from bleomycin-treated rats. Male Wistar rats were given a single intratracheal injection of bleomycin, BAL was performed 2, 6, and 15 days later, and the BAL fluid was assayed for thrombin activity and FGA. Higher FGA than the control value was detected in the BAL fluid from rats on day 6 after bleomycin administration. In bleomycin-treated rats, thrombin activity in the BAL fluid was significantly elevated on day 2 and maximal on day 6. The FGA of the BAL fluid from bleomycin-treated rats on day 6 was significantly decreased by its treatment with various thrombin inhibitors, such as alpha 1-protease inhibitor, antithrombin III, hirudin, and MD-805. In our assay, purified rat thrombin also showed FGA in vitro, and its FGA was inhibited by the same concentrations of these thrombin inhibitors as those inhibiting the activity in the BAL fluid. On ammonium sulfate fractionation, most of the thrombin activity was recovered in the fraction of 35 to 50% saturation in which most of the FGA was detected. These results suggest that the FGA of the BAL fluid from bleomycin-treated rats was at least partly due to thrombin is responsible, at least in part, for fibroblast growth and pulmonary fibrosis in bleomycin-induced interstitial lung disease.

[A case of a large invasive thymoma successfully treated by using a combination of artery infusion of CDDP and operation]

A 21-year-old male was admitted with SVC syndrome. Chest X-ray film showed an abnormal density on the upper mediastinum, that was recognized thymoma on the needle aspiration specimen. The large tumor, which extensively infiltrated the surrounding tissues (SVC, the right brachiocephalic vein, bilateral lungs and the pericardium) led us to choose preoperative chemotherapy. CDDP (cisdiammin-edichloroplatinum) was infused through the right IMA (internal mammary artery). After obtaining the major response the tumor mass was resected with adjacent structure accompised vessels reconstructions. Histological examination revealed totally necrosed tissue. Three years after initiation of therapy, the patient is doing well. The therapy with CDDP injection into selective IMA for invasive thymoma before operation was considered to be very useful utilized.

[C5 contents and neutrophil chemotactic activities in bronchiolar and alveolar regions]

To clarify the localization and mechanism of neutrophil infiltration in the lower respiratory tract, we measured neutrophil number, neutrophil chemotactic factor (NCF) activity and content of C5 in bronchial lavage (BL) fluid and bronchoalveolar lavage (BAL) fluid. Numbers of neutrophils, NCF activity and C5 content were higher in the BL fluid from normal volunteers (NV) and control patients (CP) than those in the BAL fluid from the same subjects. The NCF activity in the BL fluid was inhibited approximately 40% by anti-C5 antiserum, and correlated with C5 content in the BL fluid. In the BAL fluids of patients with chronic airway diseases (CAD) and patients with idiopathic interstitial pneumonia (IIP), neutrophil number, NCF activity and C5 content were increased compared to those in BAL fluid from NV or CP. These results indicated that neutrophils are predominant in the bronchial region compared to the alveolar region, and that C5-derived NCF play important roles in the accumulation of neutrophils in the bronchial region. Also C5-derived NCF are thought to be related to, at least, a part of the neutrophil infiltration in the respiratory tract of patients with CAD and IIP.

Elevated level of soluble interleukin-2 receptor in bronchoalveolar lavage fluid from sarcoidosis patients

Pulmonary sarcoidosis is a granulomatous disorder of unknown cause, characterized by an accumulation of active T lymphocytes in the lung. We measured the levels of soluble interleukin-2 receptor (IL-2R) in bronchoalveolar lavage fluid (BALF) of patients with active pulmonary sarcoidosis and normal subjects by a sensitive enzyme-linked immunosorbent assay. Soluble IL-2R was detectable in BALF from 6 of 11 patients with sarcoidosis but in only 1 of 8 normal control subjects, the mean levels of IL-2R in BALF of the two groups being 2.8 +/- 0.9 U/ml and 0.1 +/- 0.1 U/ml, respectively (p less than 0.01). A slight correlation was found between the soluble IL-2R level and the number of CD4-positive cells. Sarcoidosis patients were classified by radiographical staging. Soluble IL-2R was not detectable in the BALF of any stage I patients, but was found in the BALF of 6 of the 7 stage II and stage III patients. These results suggest that in the clinical management of patients with sarcoidosis, measurement of soluble IL-2R in BALF is useful for evaluating the activity of the lung disease is sarcoidosis.

[The role of thrombin on lung fibroblast growth and fibrosis in bleomycin-induced lung disorder]

In order to clarify the role of thrombin on the development of pulmonary fibrosis in diffuse interstitial lung diseases, we examined the relationship between fibroblast growth-stimulating activity (FGA) and thrombin activity in bronchoalveolar lavage fluid (BALF) from rats with bleomycin-induced interstitial lung disorders. Male Wistar strain rats (body weight about 200 g) were given a single intratracheal injection of 0.9 mg bleomycin, and bronchoalveolar lavage was performed on days 2, 6 and 15. The BALF was centrifuged at 250 X g for 10 min to remove cells, and then the supernatant was recentrifugation at 27,000 X g for 40 min to remove pulmonary surfactants. The supernatant (10 ml) was dialyzed overnight against distilled water, frozen at -70 degrees C, freeze-dried, and resuspended in 2 ml of Dulbecco's modified Eagle medium (concentrated 5-fold). The 5-fold concentrated BALF was added to rat lung fibroblast culture media, and assayed for cytotoxic activity and FGA. Thrombin activity in 250 X g supernatant was measured by using fluorescence assay with the synthetic peptide substrate, Boc-Val-Pro-Arg-4-methylcoumaryl-7-amide. Histological examination showed a prominent increase in fibroblast number in the pulmonary interstitium on day 6, and transformation of fibroblasts into mature forms, fibrocytes, on day 15. On day 2 after bleomycin administration, no FGA was seen but cytotoxic activity was detected in the BALF. On day 6, the cytotoxic activity was not found, whereas FGA showed a significantly higher level than the control value. On day 15, the FGA decreased to the control value.(ABSTRACT TRUNCATED AT 250 WORDS)

Fibroblast growth-stimulating activity in bronchoalveolar lavage fluid of patients with pulmonary sarcoidosis

Increased fibroblast growth-stimulating activity (FGA) was found in bronchoalveolar lavage fluid (BALF) from sarcoidosis patients. For evaluation of the significance of FGA in disease activity and the pathophysiology of sarcoidosis, the FGA levels were compared with data on cellular analysis of BALF, serum angiotensin-converting enzyme (S-ACE) activity and chest radiograms. The FGA level was significantly higher in sarcoidosis patients with parenchymal involvement (radiological stages II and III) than in those without parenchymal involvement (radiological stage I). The FGA was positively correlated with albumin and fibronectin concentrations in BALF. However, it was not significantly correlated with the ratio of CD-4 + to CD-8 + T-lymphocytes in BALF or the S-ACE level, which are known to be useful in evaluating the disease activity of sarcoidosis. These results indicate that the diagnostic value of FGA is different from that of the lymphocyte subpopulations in BALF and S-ACE, and is useful in estimating the extent of parenchymal involvement in sarcoidosis.

Eosinophil colony-stimulating factor induced by administration of interleukin-2 into the pleural cavity of patients with malignant pleurisy

Systemic administration of interleukin (IL)-2 to patients with malignant diseases induces peripheral eosinophilia. In the present study, to clarify the mechanism of eosinophilia induced by IL-2, we examined the changes in the number of eosinophils and eosinophil colony-stimulating factor (Eo-CSF) activity in the pleural fluids of six patients with malignant pleurisy caused by lung cancer or malignant mesothelioma during and after intrapleural administration of IL-2. Results showed that intrapleural administration of IL-2 induced marked eosinophilia in the pleural fluid and moderate eosinophilia in the peripheral blood, and that during IL-2 administration, marked Eo-CSF activity appeared in the pleural fluid before increase in the number of eosinophils, but that this activity did not appear in the peripheral blood. This Eo-CSF activity was inhibited by a combination of anti-IL-5 antibody, anti-IL-3 antibody, and anti-granulocyte/macrophage colony-stimulating factor (anti-GM-CSF) antibody, but not by each antibody alone. Chemotactic activity for eosinophils was also detected in the pleural fluid during IL-2 treatment. These results suggest that eosinophilia in the pleural fluid induced by IL-2 injection into the pleural cavity of patients with malignant pleurisy is due to the Eo-CSF activities of various components, including IL-5, IL-3, and GM-CSF, and chemotactic factors for eosinophils induced locally in the pleural cavity by IL-2.