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1.  The Glutathione-S-Transferase null genotype and increased neutrophil response to low level ozone (0.06 ppm) 
doi:10.1016/j.jaci.2012.07.005
PMCID: PMC3509264  PMID: 22921799
GSTM1null genotype; PMN responsiveness; ozone; innate immune phenotypes
2.  Pulmonary responses in current smokers and ex-smokers following a two hour exposure at rest to clean air and fine ambient air particles 
Background
Increased susceptibility of smokers to ambient PM may potentially promote development of COPD and accelerate already present disease.
Objectives
To characterize the acute and subacute lung function response and inflammatory effects of controlled chamber exposure to concentrated ambient fine particles (CAFP) with MMAD ≤ 2.5 microns in ex-smokers and lifetime smokers.
Methods
Eleven subjects, aged 35–74 years, came to the laboratory 5 times; a training day and two exposure days separated by at least 3 weeks, each with a post-exposure visit 22 h later. Double-blind and counterbalanced exposures to “clean air” (mean 1.5 ± 0.6 μg/m3) or CAFP (mean 108.7 ± 24.8 μg/m3 ) lasted 2 h with subjects at rest.
Results
At 3 h post-exposure subjects’ DTPA clearance half-time significantly increased by 6.3 min per 100 μg/m3 of CAFP relative to “clean air”. At 22 h post-exposure they showed significant reduction of 4.3% per 100 μg/m3 in FEV1 and a significant DLCO decrease by 11.1% per 100 μg/m3 of CAFP relative to “clean air”. At both 3 h and 22 h the HDL cholesterol level significantly decreased by 4.5% and 4.1%, respectively. Other blood chemistries and markers of lung injury, inflammation and procoagulant activity were within the normal range of values at any condition.
Conclusions
The results suggest that an acute 2 h resting exposure of smokers and ex-smokers to fine ambient particulate matter may transiently affect pulmonary function (spirometry and DLCO) and increase DTPA clearance half-time. Except for a post exposure decrease in HDL no other markers of pulmonary inflammation, prothrombotic activity and lung injury were significantly affected under the conditions of exposure.
doi:10.1186/1743-8977-10-58
PMCID: PMC3842765  PMID: 24245863
CAFP; Chamber exposure; Spirometry; Older smokers; Ex-smokers; DTPA clearance half-time; Lung diffusing capacity; Blood chemistry
3.  Nasal PMN response to repeated challenge with endotoxin in healthy volunteers 
Inhalation toxicology  2011;23(3):10.3109/08958378.2011.553247.
Rationale
We have employed nasal challenge with lipopolysaccharide (LPS) followed by nasal lavage (NL) to experimentally induce and examine upper airway inflammation in human volunteers. It is unclear however whether adaptation within individuals occurs following repeated nasal challenge. This was a pilot study to determine if repeated nasal LPS challenge yields attenuation of markers of inflammation (primarily neutrophil response) in the NL fluid of healthy humans.
Methods
We employed a 3-day nasal LPS challenge protocol with NL using a “split nose” design. The control and LPS nares received two consecutive day saline (0.9% saline/day) and LPS (2 μg LPS/day) challenges, respectively followed by an LPS (2 μg/day) challenge to each nare on Day 3. NL was performed immediately pre Day 1 challenges and 6-h post nasal LPS challenges on both Days 1 and 3. Markers of inflammation (PMNs/mg, cytokines) were assessed in NL and the inflammatory response to LPS (measured as the difference between pre and post challenge) was evaluated in both nares on Day 3 and compared to Day 1.
Results
Significant (p < 0.05) blunting of the LPS-induced polymorphonuclear leukocyte (PMN) response was observed in the nare that received repeated LPS challenges as compared to the control nare (67.60 ± 22.39 vs. 157.8 ± 76.04 PMN/mg) and initial LPS challenge on Day 1 (121 ± 32 PMN/mg). Decreased soluble CD14 and significantly decreased interleukin-8 were also found in the repeat LPS-treated nare. In the LPS-treated nare, the blunted PMN response on Day 3 correlated well with the observed PMN response on Day1 (r = 0.58, p = 0.02).
Conclusions
We show attenuation of PMN response to repeated LPS in the nasal airways in healthy humans. Effect of repeat endotoxin exposure prior to allergen delivery on local airway inflammation in both healthy and atopic subjects can be studied.
doi:10.3109/08958378.2011.553247
PMCID: PMC3808958  PMID: 21391782
Airway inflammation; neutrophils; adaptation; lipopolysaccharide (LPS, endotoxin)
4.  Enhancement of systemic and sputum granulocyte response to inhaled endotoxin in people with the GSTM1 null genotype 
Occupational and environmental medicine  2011;68(10):10.1136/oem.2010.061747.
Objective
To determine if the GSTM1 null genotype is a risk factor for increased inflammatory response to inhaled endotoxin.
Methods
35 volunteers who had undergone inhalation challenge with a 20 000 endotoxin unit dose of Clinical Center Reference Endotoxin (CCRE) were genotyped for the GSTM1 null polymorphism. Parameters of airway and systemic inflammation observed before and after challenge were compared in GSTM1 null (n=17) and GSTM1 (n=18) sufficient volunteers.
Results
GSTM1 null volunteers had significantly increased circulating white blood cells (WBCs), polymorphonuclear neutrophils (PMNs), platelets and sputum PMNs (% sputum PMNs and PMNs/mg sputum) after CCRE challenge. GSTM1 sufficient volunteers had significant, but lower increases in circulating WBCs, PMNs and % sputum PMNs, and no increase in platelets or PMNs/mg sputum. Linear regression analysis adjusted for baseline values of the entire cohort revealed that the GSTM1 null genotype significantly increased circulating WBCs, platelets and % sputum PMNs after challenge
Conclusion
These data support the hypothesis that the GSTM1 null genotype is a risk factor for increased acute respiratory and systemic inflammatory response to inhaled CCRE. These data are consistent with other observations that the GSTM1 null genotype is associated with increased respiratory, systemic and cardiovascular effects linked to ambient air particulate matter exposure and indicate that the GSTM1 null genotype should be considered a risk factor for adverse health effects associated with exposure to environmental endotoxin.
doi:10.1136/oem.2010.061747
PMCID: PMC3808962  PMID: 21441173
5.  Atopic asthmatic patients have reduced airway inflammatory cell recruitment after inhaled endotoxin challenge compared with healthy volunteers 
Background
Atopic asthmatic patients are reported to be more sensitive to the effects of environmental endotoxin (LPS) than healthy volunteers (HVs). It is unknown whether this sensitivity is due to dysregulated inflammatory responses after LPS exposure in atopic asthmatic patients.
Objective
We sought to test the hypothesis that atopic asthmatic patients respond differentially to inhaled LPS challenge compared with HVs.
Methods
Thirteen allergic asthmatic (AA) patients and 18 nonallergic nonasthmatic subjects (healthy volunteers [HVs]) underwent an inhalation challenge to 20,000 endotoxin units of Clinical Center Reference Endotoxin (LPS). Induced sputum and peripheral blood were obtained at baseline and 6 hours after inhaled LPS challenge. Sputum and blood samples were assayed for changes in inflammatory cell numbers and cytokine and cell-surface marker levels on monocytes and macrophages.
Results
The percentage of neutrophils in sputum (%PMN) in induced sputum similarly and significantly increased in both HVs and AA patients after inhaled LPS challenge. However, the absolute numbers of leukocytes and PMNs recruited to the airways were significantly lower in AA patients compared with those seen in HVs with inhaled LPS challenge. Sputum levels of IL-6 and TNF-α were significantly increased in both cohorts, but levels of IL-1β and IL-18 were only significantly increased in the HV group. Cell-surface expression of Toll-like receptors 4 and 2 were significantly enhanced only in the HV group.
Conclusions
The airway inflammatory response to inhaled LPS challenge is blunted in AA patients compared with that seen in HVs and accompanied by reductions in airway neutrophilia and inflammasome-dependent cytokine production. These factors might contribute to increased susceptibility to airway microbial infection or colonization in AA patients.
doi:10.1016/j.jaci.2012.05.026
PMCID: PMC3652253  PMID: 22770265
Asthma; LPS; induced sputum; inflammasome; innate immunity
6.  EFFECT OF INHALED DUST-MITE ALLERGEN ON REGIONAL PARTICLE DEPOSITION AND MUCOCILIARY CLEARANCE IN ALLERGIC ASTHMATICS 
Background
Acute exacerbations in allergic asthmatics may lead to impaired ability to clear mucus from the airways, a key factor in asthma morbidity.
Objective
The purpose of this study was to determine the effect of inhaled house dust mite challenge on regional deposition of inhaled particles and mucociliary clearance (MCC) in allergic asthmatics.
Methods
We used gamma scintigraphy (inhalation of 99mTc -sulfur colloid particles) to measure regional particle deposition and MCC in allergic asthmatics (n=12) 4hr following an inhaled dust mite allergen challenge (Dermatophagoides farinae extract; PDmax = fall in FEV1 of 10%) for comparison to baseline non-challenge measures.
Results
In responders (n=9 PDmax dose), lung function returned to pre-challenge values by 3 hours but was significantly decreased at 6 and 24 hours in 3 of the responders (i.e. late phase response) and induced sputum eosinophils were increased at 24 hours post-challenge (p < 0.05). Responders showed enhanced bronchial airway deposition of inhaled particles (p < 0.05) and slowed clearance from the central lung zone (p < 0.01) at 4 hrs post-challenge compared to baseline (no allergen challenge) that was predicted by the PDmax allergen concentration (r = − 0.70, p < 0.05). The fall in lung function at 24 hours post challenge correlated with reduced MCC from the central lung zone (r = − 0.78, p < 0.02) and PDmax. Non-responders (n=3) had no change in lung function, regional deposition or MCC post-challenge vs. baseline.
Conclusions and clinical relevance
These data suggest that regional deposition and clearance of inhaled particles may be sensitive for detecting mild airway obstruction associated with early and late-phase allergen-induced effects on mucus secretions. The study was listed on clinicaltrials.gov (NCT00448851).
doi:10.1111/j.1365-2222.2011.03814.x
PMCID: PMC3750994  PMID: 21729182
dust-mite allergen; particle inhalation; airway deposition; mucus
7.  Flow cytometry of sputum: assessing inflammation and immune response elements in the bronchial airways 
Inhalation toxicology  2011;23(7):392-406.
Background
The evaluation of sputum leukocytes by flow cytometry is an opportunity to assess characteristics of cells residing in the central airways, yet it is hampered by certain inherent properties of sputum including mucus and large amounts of contaminating cells and debris.
Objective
To develop a gating strategy based on specific antibody panels in combination with light scatter properties for flow cytometric evaluation of sputum cells.
Methods
Healthy and mild asthmatic volunteers underwent sputum induction. Manually selected mucus “plug” material was treated with dithiothrietol, filtered and total leukocytes acquired. Multicolor flow cytometry was performed using specific gating strategies based on light scatter properties, differential expression of CD45 and cell lineage markers to discriminate leukocytes from squamous epithelial cells and debris.
Results
The combination of forward scatter and CD45 expression reliably segregated sputum leukocytes from contaminating squamous epithelial cells and debris. Overlap of major leukocyte populations (neutrophils, macrophages/monocytes) required the use of specific antibodies (e.g. CD16, CD64, CD14, HLA-DR) that differentiated granulocytes from monocytes and macrophages. These gating strategies allowed identification of small populations of eosinophils, CD11c+ myeloid dendritic cells, B cells and NK cells.
Conclusions
Multicolor flow cytometry can be successfully applied to sputum samples to identify and characterize leukocyte populations residing on the surfaces of the central airways.
doi:10.3109/08958378.2011.575568
PMCID: PMC3677049  PMID: 21639708
induced sputum; flow cytometry; immunophenotype; methods; human
8.  Climate Change and Our Environment: The Effect on Respiratory and Allergic Disease 
Climate change is a constant and ongoing process. It is postulated that human activities have reached a point at which we are producing global climate change. This article provides suggestions to help the allergist/environmental physician integrate recommendations about improvements in outdoor and indoor air quality and the likely response to predicted alterations in the earth’s environment into their patient’s treatment plan. Many changes that affect respiratory disease are anticipated. Examples of responses to climate change include energy reduction retrofits in homes that could potentially affect exposure to allergens and irritants, more hot sunny days that increase ozone-related difficulties, and rises in sea level or altered rainfall patterns that increase exposure to damp indoor environments. Climate changes can also affect ecosystems, manifested as the appearance of stinging and biting arthropods in new areas. Higher ambient carbon dioxide concentrations, warmer temperatures, and changes in floristic zones could potentially increase exposure to ragweed and other outdoor allergens, whereas green practices such as composting can increase allergen and irritant exposure. Finally, increased energy costs may result in urban crowding and human source pollution, leading to changes in patterns of infectious respiratory illnesses. Improved governmental controls on airborne pollutants could lead to cleaner air and reduced respiratory diseases but will meet strong opposition because of their effect on business productivity. The allergy community must therefore adapt, as physician and research scientists always have, by anticipating the needs of patients and by adopting practices and research methods to meet changing environmental conditions.
doi:10.1016/j.jaip.2012.07.002
PMCID: PMC3654689  PMID: 23687635
9.  Sputum Inflammatory Cells from Persons with Allergic Rhinitis and Asthma Have Decreased Inflammasome Gene Expression 
Capsule Summary
Deficits in inflammasomes, a key element of innate immunity, confer increased susceptibility to infection. We report that sputum cells from asthmatics have decreased expression of inflammasome factors, consistent with reports of increased infection risk in asthmatics.
doi:10.1016/j.jaci.2011.08.012
PMCID: PMC3185200  PMID: 21868073
Innate Immunity; Asthma; Atopy; Inflammasome; IL-1β
10.  Lung Function and Inflammatory Responses in Healthy Young Adults Exposed to 0.06 ppm Ozone for 6.6 Hours 
Rationale: Exposure to ozone causes a decrease in spirometric lung function and an increase in airway inflammation in healthy young adults at concentrations as low as 0.08 ppm, close to the National Ambient Air Quality Standard for ground level ozone.
Objectives: To test whether airway effects occur below the current ozone standard and if they are more pronounced in potentially susceptible individuals, such as those deficient in the antioxidant gene glutathione S-transferase mu 1 (GSTM1).
Methods: Pulmonary function and subjective symptoms were measured in 59 healthy young adults (19–35 yr) immediately before and after exposure to 0.0 (clean air, CA) and 0.06 ppm ozone for 6.6 hours in a chamber while undergoing intermittent moderate exercise. The polymorphonuclear neutrophil (PMN) influx was measured in 24 subjects 16 to 18 hours postexposure.
Measurements and Main Results: Subjects experienced a significantly greater (P = 0.008) change in FEV1 (± SE) immediately after exposure to 0.06 ppm ozone compared with CA (−1.71 ± 0.50% vs. −0.002 ± 0.46%). The decrement in FVC was also greater (P = 0.02) after ozone versus CA (−2.32 ± 0.41% vs. −1.13 ± 0.34%). Similarly, changes in %PMN were greater after ozone (54.0 ± 4.6%) than CA (38.3 ± 3.7%) exposure (P < 0.001). Symptom scores were not different between ozone versus CA. There were no significant differences in changes in FEV1, FVC, and %PMN between subjects with GSTM1-positive and GSTM1-null genotypes.
Conclusions: Exposure of healthy young adults to 0.06 ppm ozone for 6.6 hours causes a significant decrement of FEV1 and an increase in neutrophilic inflammation in the airways. GSTM1 genotype alone appears to have no significant role in modifying the effects.
doi:10.1164/rccm.201011-1813OC
PMCID: PMC3114053  PMID: 21216881
pulmonary function; airway inflammation; polymorphism; ozone exposure; exercise
11.  Airway purinergic responses in healthy, atopic non-asthmatic, and atopic asthmatic subjects exposed to ozone 
Inhalation toxicology  2011;23(6):324-330.
Context
Ozone exposure triggers airway inflammatory responses that may be influenced by biologically active purine metabolites.
Objective
Examine the relationships between airway purine metabolites and established inflammatory markers of ozone exposure, and determine if these relationships are altered in individuals with atopy or asthma.
Materials and Methods
Mass spectrometry was utilized to measure concentrations of purine metabolites (AMP, adenosine, hypoxanthine, uric acid) and non-purine metabolites (taurine, urea, phenylalanine, tyrosine) in induced sputum obtained from 31 subjects with normal lung function (13 healthy controls, 8 atopic non-asthmatics, and 10 atopic asthmatic) before and four hours after ozone exposure.
Results
At baseline, the purines AMP and hypoxanthine correlated with multiple inflammatory markers including neutrophil counts and the cytokines IL-6, IL-8, TNF-α, and IL-1β (r ranged from 0.41–0.66, all p<0.05). Following ozone exposure, these purines remained correlated with IL-6, IL-8, and TNF-α (r=0.37-0.68). However, AMP and hypoxanthine increased significantly post ozone exposure in atopic nonasthmatics but not atopic asthmatics. In contrast, the non-purine metabolite taurine correlated with baseline neutrophil counts (r=0.56) and IL-6 (r=0.53) and was elevated post exposure in both atopic cohorts.
Discussion and Conclusions
The purine metabolites AMP and hypoxanthine are correlated with multiple inflammatory markers at baseline and after ozone exposure. However, changes in these purine metabolites after ozone appear to differ from other inflammatory markers, with less response in atopic asthmatics relative to atopic nonasthmatics. Purine metabolites may play a role in the signaling responses to ozone, but these responses may be altered in subjects with asthma.
doi:10.3109/08958378.2011.572096
PMCID: PMC3175355  PMID: 21605007
Induced sputum; adenosine; adenosine monophosphate; hypoxanthine; taurine
12.  Influence of C-159T SNP of the CD14 gene promoter on lung function in smokers with chronic bronchitis 
Respiratory medicine  2009;103(9):1358-1365.
CD14, a co-receptor for endotoxin, plays a significant role in the inflammatory response to this environmentally important pollutant. The C-159T single nucleotide polymorphism (SNP) in the CD14 gene promoter is reported to affect expression of CD14, with TT homozygous persons having higher CD14 expression. This SNP has been linked to pathogenesis of asthma and with cardiovascular diseases in smokers. We hypothesize that CD14 also plays a role in development of COPD in smokers who are exposed to inhaled endotoxin by cigarette smoking and to endotoxin released from Gram-negative microbes colonizing their airways. To assess the effect of the C-159T SNP of the CD14 gene promoter on lung function and GOLD score in smokers with COPD, we recruited 246 smokers with COPD with a range of 10–156 pack-year smoking exposures. We found that the C-159T single gene polymorphism of the CD14 gene promoter may play a role in modulating severity of obstructive impairment in smokers with COPD: The TT genotype was associated with lower lung function in smokers with a moderate smoking history. However, the CC genotype was associated with decreased lung function in heavy smokers (>56 pack-years). The result on CC genotype in risk for COPD is analogous with the effect of this genotype in risk for asthma. CD14 may be a factor in the pathophysiology of COPD, as it is in asthma and smoking-related cardiovascular diseases.
doi:10.1016/j.rmed.2009.03.007
PMCID: PMC3178042  PMID: 19361972
13.  Atopic Asthmatics but not atopics without asthma have enhanced inflammatory response to ozone 
Background
Asthma is a known risk factor for acute ozone-associated respiratory disease. Ozone (O3) causes an immediate decrease in lung function and increased airway inflammation. The role of atopy and asthma in modulation of O3-induced inflammation has not been determined.
Objective
To determine if atopic status modulates O3 response phenotypes in humans.
Methods
Fifty volunteers (25 normal volunteers, 14 atopic non-asthmatics, 11 atopic asthmatics not requiring maintenance therapy) underwent a 0.4 ppm O3 exposure protocol. Ozone response was determined by changes in lung function and induced sputum composition, including airway inflammatory cell concentration, cell surface markers, cytokine and hyaluronic acid concentration.
Results
All cohorts experienced similar decreases in lung function post O3. Atopics and atopic asthmatics had increased sputum neutrophils and IL-8 after O3 exposure; levels did not significantly change in normal volunteers. Following O3 exposure, atopic asthmatics had significantly increased sputum IL-6 and IL-1 β, and airway macrophage TLR4, FceRI, and CD23 expression; levels in normal volunteers and atopic non-asthmatics showed no significant change. Atopic asthmatics had significantly decreased IL-10 at baseline compared to normal volunteers: IL-10 did not significantly change in any group with O3. All groups had similar levels of hyaluronic acid at baseline, with increased levels after O3 exposure in atopics and atopic asthmatics.
Conclusion
Atopic asthmatics have increased airway inflammatory responses to O3. Elevated TLR4 expression suggests a potential pathway through which O3 generates the inflammatory response in allergic asthmatics but not in atopics without asthma.
Clinical Implications
These observations suggest that mild atopic asthma confers increased risk for exacerbation of O3-induced lung disease through promoting an enhanced innate immune inflammatory response to O3.
doi:10.1016/j.jaci.2010.06.043
PMCID: PMC2949284  PMID: 20816188
ozone; innate immunity; asthma; atopy; hyaluronic acid; environmental airways disease; interleukin-1 beta; interleukin-10
14.  Low-level ozone exposure induces airways inflammation and modifies cell surface phenotypes in healthy humans 
Inhalation toxicology  2010;22(7):593-600.
The effects of low-level ozone exposure (0.08 ppm) on pulmonary function in healthy young adults are well known; however, much less is known about the inflammatory and immunomodulatory effects of low-level ozone in the airways. Techniques such as induced sputum and flow cytometry make it possible to examine airways inflammatory responses and changes in immune cell surface phenotypes following low-level ozone exposure. The purpose of this study was to determine if exposure to 0.08 parts per million ozone for 6.6 h induces inflammation and modifies immune cell surface phenotypes in the airways of healthy adult subjects. Fifteen normal volunteers underwent an established 0.08 part per million ozone exposure protocol to characterize the effect of ozone on airways inflammation and immune cell surface phenotypes. Induced sputum and flow cytometry were used to assess these endpoints 24 h before and 18 h after exposure. The results showed that exposure to 0.08 ppm ozone for 6.6 h induced increased airway neutrophils, monocytes, and dendritic cells and modified the expression of CD14, HLA-DR, CD80, and CD86 on monocytes 18 h following exposure. Exposure to 0.08 parts per million ozone is associated with increased airways inflammation and promotion of antigen-presenting cell phenotypes 18 hours following exposure. These findings need to be replicated in a similar experiment that includes a control air exposure.
doi:10.3109/08958371003596587
PMCID: PMC3162473  PMID: 20384440
Antigen-presenting cells; dendritic cell; inflammation; macrophage; ozone; pollution; polymorphonu-clear neutrophil
15.  Comparative airway inflammatory response of normal volunteers to ozone and lipopolysaccharide challenge 
Inhalation toxicology  2010;22(8):648-656.
Ozone and lipopolysaccharide (LPS) are environmental pollutants with adverse health effects noted in both healthy and asthmatic individuals. The authors and others have shown that inhalation of ozone and LPS both induce airway neutrophilia. Based on these similarities, the authors tested the hypothesis that common biological factors determine response to these two different agents. Fifteen healthy, nonasthmatic volunteers underwent a 0.4 part per million ozone exposure for 2 h while performing intermittent moderate exercise. These same subjects underwent an inhaled LPS challenge with 20,000 LPS units of Clinical Center Reference LPS, with a minimum of 1 month separating these two challenge sessions. Induced sputum was obtained 24 h before and 4–6 h after each exposure session. Sputum was assessed for total and differential cell counts and expression of cell surface proteins as measured by flow cytometry. Sputum supernatants were assayed for cytokine concentration. Both ozone and LPS challenge augmented sputum neutrophils and subjects’ responses were significantly correlated (R = .73) with each other. Ozone had greater overall influence on cell surface proteins by modifying both monocytes (CD14, human leukocyte antigen [HLA]-DR, CD11b) and macrophages (CD11b, HLA-DR) versus LPS where CD14 and HLA-DR were modified only on monocytes. However, LPS significantly increased interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, with no significant increases seen after ozone challenge. Ozone and LPS exposure in healthy volunteers induce similar neutrophil responses in the airways; however, downstream activation of innate immune responses differ, suggesting that oxidant versus bacterial air pollutants may be mediated by different mechanisms.
doi:10.3109/08958371003610966
PMCID: PMC3162474  PMID: 20540623
16.  Ambient PM2.5 Exposure Up-regulates the Expression of Costimulatory Receptors on Circulating Monocytes in Diabetic Individuals 
Environmental Health Perspectives  2010;119(6):778-783.
Background
Exposure of humans to air pollutants such as ozone and particulate matter (PM) may result in airway and systemic inflammation and altered immune function. One putative mechanism may be through modification of cell-surface costimulatory molecules.
Objectives
We examined whether changes in expression of costimulatory molecules on circulating cells are associated with ambient levels of fine PM [aerodynamic diameter ≤ 2.5 μm (PM2.5)] in a susceptible population of diabetic individuals.
Methods
Twenty subjects were studied for 4 consecutive days. Daily measurements of PM2.5 and meteorologic data were acquired on the rooftop of the exam site. Circulating cell-surface markers that mediate innate immune and inflammatory responses were assessed by flow cytometry on each day. Sensitivity analysis was conducted on glutathione S-transferase M1 (GSTM1) genotype, body mass index, and glycosylated hemoglobin A1c (HbA1c) levels to determine their role as effect modifiers. Data were analyzed using random effects models adjusting for season, weekday, and meteorology.
Results
We found significantly increased monocyte expression (mean fluorescent intensity) of CD80, CD40, CD86, HLA-DR, and CD23 per 10-μg/m3 increase in PM2.5 at 2- to 4-day lag times after exposure. These findings were significantly higher in obese individuals, in individuals with HbA1c > 7%, and in participants who were GSTM1 null.
Conclusions
Exposure to PM2.5 can enhance antigen-presenting cell phenotypes on circulating cells, which may have consequences in the development of allergic or autoimmune diseases. These effects are amplified in diabetic individuals with characteristics that are associated with insulin resistance or with oxidative stress.
doi:10.1289/ehp.1002543
PMCID: PMC3114811  PMID: 21169129
air pollution; costimulatory receptors; diabetes; inflammation; flow cytometry; particulate matter
17.  The Glutathione-S-Transferase Mu 1 null genotype modulates ozone-induced airway inflammation in humans 
Background
The Glutathione-S-Transferase Mu 1 null genotype has been reported to be a risk factor for acute respiratory disease associated with increases in ambient air ozone. Ozone is known to cause an immediate decrease in lung function and increased airway inflammation. However, it is not known if GSTM1 modulates these ozone responses in vivo in humans
Objective
The purpose of this study was to determine if the GSTM1 null genotype modulates ozone responses in humans.
Methods
Thirty-five normal volunteers were genotyped for the GSTM1 null mutation and underwent a standard ozone exposure protocol to determine if lung function and inflammatory responses to ozone were different between the 19 GSTM1 normal and 16 GSTM1 null volunteers.
Results
GSTM1 did not modulate lung function responses to acute ozone. Granulocyte influx 4 hours after challenge was similar between GSTM1 normal and null volunteers. However, GSTM1 null volunteers had significantly increased airway neutrophils 24 hours after challenge, as well as increased expression of HLA-DR on airway macrophages and dendritic cells.
Conclusion
The GSTM1 null genotype is associated with increased airways inflammation 24 hours following ozone exposure, consistent with the lag time observed between increased ambient air ozone exposure and exacerbations of lung disease.
Clinical Implications
These observations suggest that the GSTM1 null genotype likely confers increased risk for exacerbation of ozone-induced lung disease through promoting an enhanced neutrophilic and monocytic inflammatory response to ozone.
Capsule summary
The GSTM1 null genotype is associated with increased risk for ozone-induced lung disease. We report the GSTM1 genotype modulates ozone-induced inflammation but not lung function, and may predict persons at risk for environmental lung disease.
doi:10.1016/j.jaci.2009.07.036
PMCID: PMC3038610  PMID: 19796798
Glutathione-S-Transferase Mu 1; Ozone; Pollution; Inflammation; Polymorphonuclear Neutrophil; Macrophage; Dendritic cell
20.  Macrophage enrichment from induced sputum 
Thorax  2007;62(6):558-559.
doi:10.1136/thx.2006.073544
PMCID: PMC2117218  PMID: 17536036
21.  Mechanisms of LPS-induced CD40 Expression in Human Peripheral Blood Monocytic Cells 
CD40 plays important roles in cell-mediated and humoral immune responses. In this study, we explored mechanisms underlying lipopolysaccharide (LPS)-induced CD40 expression in purified human peripheral blood monocytic cells (PBMCs) from healthy volunteers. Exposure to LPS induced increases in CD40 mRNA and protein expression on PBMCs. LPS stimulation caused IκBα degradation. Inhibition of NFκB activation abrogated LPS-induced CD40 expression. LPS stimulation also resulted in phosphorylation of mitogen-activated protein kinases, however, only Jun N-terminal kinase (JNK) was partially involved in LPS-induced CD40 expression. In addition, LPS exposure resulted in elevated interferon γ (IFNγ) levels in the medium of PBMCs. Neutralization of IFNγ and IFNγ receptor using specific antibodies blocked LPS-induced CD40 expression by 44% and 37%, respectively. In summary, LPS induced CD40 expression on human PBMCs through activation of NFκB and JNK, and partially through the induction of IFNγproduction.
doi:10.1016/j.bbrc.2008.12.082
PMCID: PMC2649752  PMID: 19118532
CD40; interferon γ; LPS; mitogen-activated protein kinase; NFκB
22.  Tracheobronchial air-liquid interface cell culture: a model for innate mucosal defense of the upper airways? 
Human tracheobronchial epithelial cells grown in air-liquid interface culture have emerged as a powerful tool for the study of airway biology. In this study, we have investigated whether this culture system produces “mucus” with a protein composition similar to that of in vivo, induced airway secretions. Previous compositional studies of mucous secretions have greatly underrepresented the contribution of mucins, which are major structural components of normal mucus. To overcome this limitation, we have used a mass spectrometry-based approach centered on prior separation of the mucins from the majority of the other proteins. Using this approach, we have compared the protein composition of apical secretions (AS) from well-differentiated primary human tracheobronchial cells grown at air-liquid interface and human tracheobronchial normal induced sputum (IS). A total of 186 proteins were identified, 134 from AS and 136 from IS; 84 proteins were common to both secretions, with host defense proteins being predominant. The epithelial mucins MUC1, MUC4, and MUC16 and the gel-forming mucins MUC5B and MUC5AC were identified in both secretions. Refractometry showed that the gel-forming mucins were the major contributors by mass to both secretions. When the composition of the IS was corrected for proteins that were most likely derived from saliva, serum, and migratory cells, there was considerable similarity between the two secretions, in particular, in the category of host defense proteins, which includes the mucins. This shows that the primary cell culture system is an important model for study of aspects of innate defense of the upper airways related specifically to mucus consisting solely of airway cell products.
doi:10.1152/ajplung.90388.2008
PMCID: PMC2636953  PMID: 18931053
mucus; mucin; innate immunity; proteomics; human tracheobronchial epithelial cell culture
23.  Repetitive Organic Dust Exposure in vitro Impairs Macrophage Differentiation and Function 
Background
Organic dust exposure in the agricultural industry results in significant airway disease and lung function decline. Mononuclear phagocytes are key cells that mediate the inflammatory and innate immune response following dust exposure.
Objective
To investigate the effect of organic dust extract (ODE) from modern swine operations on monocyte-derived macrophage (MDM) phenotype and function.
Methods
Peripheral blood monocytes were obtained by elutriation methodology (>99% mCD14+) and differentiated into macrophages in the presence of GM-CSF (1 week) with and without ODE (0.1%). At one week, cells were analyzed by flow cytometry for cell surface marker expression (HLA-DR, CD80, CD86, TLR2, TLR4, mCD14, CD16), phagocytosis (IgG-opsonized zymosan particles), and intracellular killing of Streptococcus pneumoniae. At one week, MDMs were re-challenged with high dose ODE (1%), lipopolysaccharide (LPS), and peptidoglycan (PGN), and cytokines (TNFα, IL-6, IL-10, CXCL8/IL-8) were measured. To elucidate ODE-associated factors, comparisons were made to MDMs conditioned with heat-inactivated dust, endotoxin-depleted dust, LPS, and PGN.
Results
Expression of HLA-DR, CD80, CD86, phagocytosis and intracellular bacterial killing were significantly decreased with ODE- versus control-MDMs. Responses were retained after marked depletion of endotoxin. PGN, LPS and PGN + LPS significantly reduced MDM surface marker expression, and except for LPS alone, also reduced phagocytosis. ODE-MDMs had significantly diminished cytokine responses (TNFα, IL-6, IL-10) following repeat challenge with high dose ODE. Cross-tolerant cytokine responses were also observed.
Conclusion
Repetitive organic dust exposure significantly decreases markers of antigen presentation and host defense function in monocyte-derived macrophages. Bacterial cell components appear to be driving these impaired responses.
Key Messages
Repetitive organic dust exposure impairs monocyte-derived macrophage host defense functions.
Gram positive bacterial cell components may be driving this impaired response.
Clinical implications: Organic dust-induced macrophage dysfunction may be important in respiratory disease development.
Capsule Summary
Repetitive organic dust exposure in vitro impairs host defense function in monocyte-derived macrophages, which appear to be driven by gram positive bacterial cell components. Organic dust-induced macrophage dysfunction may be important in respiratory disease development.
doi:10.1016/j.jaci.2008.05.023
PMCID: PMC2685162  PMID: 18585769
Monocyte; Macrophage; Organic dust; Phagocytosis; Intracellular killing; Cell surface molecules; Cytokines; Inflammation; Lipopolysaccharide; Peptidoglycan
24.  In vivo gamma tocopherol supplementation decreases systemic oxidative stress and cytokine responses of human monocytes in normal and asthmatic subjects 
We have recently reported that gamma tocopherol (γT) reduces allergen and zymosan-induced inflammation using rodent models. As an initial step in extending these observations to humans, we conducted an open-label, Phase I dosing study of two doses (one or two capsules/daily for one week) of a gamma tocopherol rich preparation containing 623mg of γ tocopherol, 61.1mg of d-α-tocopherol, 11.1 mg of d-β-tocopherol (11.1mg), and 231 mg of d-σ-tocopherol per capsule. Endpoints for this study include serum levels of 5-nitro-gamma tocopherol, as a marker of oxidative stress, and changes in serum gamma, alpha and delta tocopherol and γ-2′-carboxyethyl-6-hydroxychroman (CEHC) six and 24 hours after the first dose and after 1 week of treatment. To assess biological activity of this treatment, we obtained peripheral blood mononuclear cells at baseline and after 1 week of treatment with 2 capsules of a gamma tocopherol rich preparation/day, and examined the inflammatory cytokine response of these cells in culture to ex-vivo endotoxin/LPS (0.01 ng/ml) challenge. We also monitored a number of safety endpoints to examine how well this preparation is tolerated in 8 normal volunteers (4 allergic and 4 non-allergic) and 8 allergic asthmatics. We further obtained human monocytes from a subset of these volunteers and treated them ex vivo with γT, αT,γ-CEHC and α-CEHC and assessed their actions on LPS induced degradation of IkBα, and JNK signaling and ROS generation. As detailed herein, this open label study demonstrates that gamma tocopherol enriched supplementation decreased systemic oxidative stress, increased serum levels of gamma tocopherol, and inhibited monocyte responses to LPS without any adverse health effects. Further,in vitro treatment of human monocytes with γ-CEHC and α-CEHC inhibits ROS generation and LPS-induced degradation of IκB and JNK activation.
doi:10.1016/j.freeradbiomed.2008.03.002
PMCID: PMC2492672  PMID: 18405673
gamma tocopherol; gamma CEHC; asthma
25.  Involvement of Mitogen-activated Protein Kinases and NFκB in LPS-induced CD40 Expression on Human Monocytic Cells 
Toxicology and applied pharmacology  2007;228(2):135-143.
CD40 is a costimulatory molecule linking innate and adaptive immune responses to bacterial stimuli, as well as a critical regulator of functions of other costimulatory molecules. The mechanisms regulating lipopolysaccharide (LPS)-induced CD40 expression have not been adequately characterized in human monocytic cells. In this study we used a human monocytic cell line, THP-1, to investigate the possible mechanisms of CD40 expression following LPS exposure. Exposure to LPS resulted in a dose- and time-dependent increase in CD40 expression. Further studies using immunoblotting and pharmacological inhibitors revealed that mitogen-activated protein kinases (MAPKs) and NFκB were activated by LPS exposure and involved in LPS-induced CD40 expression. Activation of MAPKs was not responsible for LPS-induced NFκB activation. TLR4 was expressed on THP-1 cells and pretreatment of cells with a Toll-like receptor 4 (TLR4) neutralizing antibody (HTA125) significantly blunted LPS-induced MAPK and NFκB activation and ensuing CD40 expression. Additional studies with murine macrophages expressing wild type and mutated TLR4 showed that TLR4 was implicated in LPS-induced ERK and NFκB activation, and CD40 expression. Moreover, blockage of MAPK and NFκB activation inhibited LPS-induced TLR4 expression. In summary, LPS-induced CD40 expression in monocytic cells involves MAPKs and NFκB.
doi:10.1016/j.taap.2007.12.002
PMCID: PMC2430028  PMID: 18187173
Lipopolysaccharide; CD40; Toll-like receptor; Mitogen-activated protein kinase

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