Allergic asthma is a syndrome characterized by respiratory distress in response to environmental triggers. This atypical response to an allergen is an over reaction of the immune system causing an influx of inflammatory cells into the airway and concomitant airway smooth muscle constriction. Firstly, we demonstrate using whole house dust mite (HDM) extract as a sensitizing allergen produces an equivalent or more robust hyperresponsive and inflammatory reaction than can be achieved with the widely used ovalbumin (OVA) sensitization / challenge protocol. Secondly, we investigated the role of caveolin-1 in the pathophysiology of allergic asthma . Our data suggest an important role for cav-1 in down regulating allergic airway inflammation, leading to reduced airways hyperresponsiveness and mucus overproduction.

Aberrant phenotypes of airway smooth muscle cells are central to the pathophysiology of asthma. The hypercontractile nature of these cells and hypertrophy are the key reasons for the excessive narrowing of the airways observed in allergic asthma. Although previous studies have indicated a role of enhanced content of smMLCK in modulating the contractile reactivity, as well as an indication of hypertrophy of HASM cells in asthmatic conditions, the effect of IgE on the expression of smMLCK in HASM cells is not fully understood. In this study, we demonstrate that IgE augments the expression of smMLCK at the mRNA and protein level. Inhibition of IgE binding with anti-FcεRI blocking antibody, Syk silencing, pharmacological inhibitors to MAPK (ERK1/2, p38, and JNK) and PI3K significantly diminished the IgE-mediated smMLCK expression in HASM cells. Finally, we found that IgE, similar to metacholine induces the contraction of HASM cells grown on collagen gel matrix. Our data suggest that IgE stimulates the phosphorylation of ERK, P38, STAT3 and induces the dephosphorylation of smMLCK to phosphorylate myosin regulatory light chain in HASM cells. Taken together, our data suggest a modulatory role of IgE in regulating the contractile machinery and hypertrophic phenotype of HASM cells.

Allergic asthma is a syndrome characterized by respiratory distress in response to environmental triggers. This atypical response to an allergen is an over reaction of the immune system causing an influx of inflammatory cells into the airway and concomitant airway smooth muscle constriction. Firstly, we demonstrate using whole house dust mite (HDM) extract as a sensitizing allergen produces an equivalent or more robust hyperresponsive and inflammatory reaction than can be achieved with the widely used ovalbumin (OVA) sensitization / challenge protocol. Secondly, we investigated the role of caveolin-1 in the pathophysiology of allergic asthma . Our data suggest an important role for cav-1 in down regulating allergic airway inflammation, leading to reduced airways hyperresponsiveness and mucus overproduction.

Methacholine (MCh) and mannitol challenges are tests used to assess airway responsiveness. It has been shown that airway responsiveness to direct bronchoconstrictors like MCh tends to increase following exposure to allergen but the response to mannitol an indirect stimuli, is not known. Furthermore, the provocative concentration causing a 20% decrease in Forced Expiratory Volume in one second (FEV1) for adenosine 5’ monophosphate (AMP) correlates better to sputum eosinophilia than MCh PC 20. Hence, we hypothesized that airway responsiveness will be greater when measured with mannitol than MCh. We studied airway responsiveness to MCh and mannitol first at 3 hours and then later at 24 hours after allergen challenge. The 3-hour study yielded results contrary to our hypothesis therefore a twenty-four hour study was undertaken. Ten mild atopic asthmatics who had a positive MCh challenge and an allergic response to allergen extracts such as cat, horse, and house dust mite completed the 3-hour study. Eleven mild atopic asthmatics with the criteria above completed the 24-hour study. Both studies were non-blinded, randomized clinical trials. Airway responsiveness to MCh was quantitated by changes in PC20. Airway responsiveness to mannitol was quantitated as PD15 in the 3-hour study and dose response ratio (DRR) in the 24-hour study. In both studies, the allergen challenges were separated by 14 days. Fractional exhaled nitric oxide measurements (FENO) were collected in both studies at varying time points to track airway inflammation. In the 3-hour study, the geometric mean MCh PC20 decreased significantly after allergen exposure from 0.88 mg/ml to 0.50 mg/ml (p = 0.02) indicating airway responsiveness to MCh increased. Conversely, the geometric mean mannitol PD15 increased significantly from 174 mg to 284 mg (p =0.02) indicating a decrease in airway responsiveness to mannitol. In the 24-hour study, the geometric mean MCh PC20 again decreased significantly from 5.9 mg/ml to 2.2 mg/ml (p= 0.01) after allergen exposure. The mannitol DRR increased significantly from 63 mg/∆%FEV1 to 158 mg/∆%FEV1 (p = 0.03). FENO levels increased significantly in MCh arm but not mannitol arm. That is pre allergen challenge versus 24 hours after allergen challenge (for MCh arm: 26 ppb pre to 55 ppb post; for mannitol arm: 31 ppb pre to 39 ppb post). In conclusion, at three and twenty-four hours after allergen challenge, a time when the airways are more responsive to MCh, there is a significant decrease in airway responsiveness to mannitol.

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Upper airways are lined with a pseudostratified mucociliary epithelium maintained by basal cells. To investigate functional and phenotypic heterogeneity within the human basal cell compartment, we used a combination of limiting dilution assays and surface marker profiling on primary cultures of basal cells with verified progenitor activity. The limiting dilution assay suggested functional heterogeneity in the ability of basal cells to repopulate a filter and maintain a barrier at ALI. The frequency of cells with this activity varied between patient strains and ranged from 0.08%-1% of basal cells. Validation of large-scale comprehensive surface marker profiling on basal cells led to identification of 74 antigens demarking consistent subpopulations. Preliminary functional analyses suggest differences in differentiation potential of some subpopulations. This work supports the idea that the basal cell compartment may be functionally heterogeneous, and provides new molecular tools for interrogation of human basal cells.

Upper airways are lined with a pseudostratified mucociliary epithelium maintained by basal cells. To investigate functional and phenotypic heterogeneity within the human basal cell compartment, we used a combination of limiting dilution assays and surface marker profiling on primary cultures of basal cells with verified progenitor activity. The limiting dilution assay suggested functional heterogeneity in the ability of basal cells to repopulate a filter and maintain a barrier at ALI. The frequency of cells with this activity varied between patient strains and ranged from 0.08%-1% of basal cells. Validation of large-scale comprehensive surface marker profiling on basal cells led to identification of 74 antigens demarking consistent subpopulations. Preliminary functional analyses suggest differences in differentiation potential of some subpopulations. This work supports the idea that the basal cell compartment may be functionally heterogeneous, and provides new molecular tools for interrogation of human basal cells.

The human upper airway structure provides access of ambient air to the lower respiratory tract, and it as an efficient filter to cleanse inspired air of dust bacteria, and other environmental pollutants. When air passes through airway passages, it constantly changes direction, which may lead to flow separation, recirculation, secondary flow and shear stress variations along the airway surface. Therefore, it is essential to understanding the air transport processes within the upper airway system. The functions are respiratory defence mechanisms that protecting the delicate tissues of the lower airway from the often harsh conditions of the ambient air. While protecting the lower respiratory system, however, the upper airway itself becomes susceptible to various lesions and infections from filtration of environmental pollutants. Inhaled particle pollutants have been implicated as a potential cause of respiratory diseases. In contrast, inhalation of drug particles de posited directly to the lung periphery results in rapid absorption across bronchopulmonary mucosal membranes and reduction of the adverse reactions in the therapy of asthma and other respiratory disorders. For this purpose, it is desirable that the particles should not deposit in the upper airways before reaching the lung periphery. Therefore, accurate prediction of local and regional pattern of inhaled particle deposition in the human upper airway should provide useful information to clinical researchers in assessing the pathogenic potential and possibly lead to innovation in inhalation therapies. With the development of the increasing computer power and advancement of modeling software, computational fluid dynamics (CFD) technique to study dilute gas-particle flow problems is gradually becoming an attractive investigative tool. This research will provide a more complete picture of the detailed physical processes within the human upper airway system. Owing to the significant advancements in computer technologies, it will allow us to efficiently construct a full-scaled model integrating the various functional biological elements including the nasal, oral, laryngeal and more generations of the bifurcation of the human upper airway system through imagining methodologies. A significant advantage of this human model is that the differences in airway morphology and ventilation parameters that exist between healthy and diseased airways, and other factors, can be accommodated. This model will provide extensive experimental and numerical studies to probe significant insights to the particle deposition characte ristics within the complex airway passages and better understanding of any important phenomena associated with the fluid-particle flow. It will also lead to an improved understanding of fluid/particle transport under realistic physiological conditions. New concepts and numerical models to capture the main features observed in the experimental program and innovative techniques will be formulated. The ability to numerically model and a better physical understanding of the complex phenomena associated with the fluid dynamics and biological processes will be one of the major medical contributions especially targeting drug delivery and health risk analysis. Its biomedical engineering significance lies in the fact that this will enable us to accurately evaluate potential biological effects by the inhaled drug particles, facilitating new drug research and development.

Safe and efficient swallowing requires integrity of both motor and sensory systems. Prior studies have established that motor impairment in individuals with PD frequently manifests as abnormalities in swallowing biomechanics. In contrast, very few studies have investigated the contribution of sensory impairment towards pharyngeal biomechanics and airway protection in this patient cohort. This area should be addressed in light of evidence that the severity of limb motor dysfunction in PD does not reliably predict severity of dysphagia. Emerging data suggests that dysphagia in PD cannot be solely attributed to motor impairment, but may also be influenced by deficits in sensory aspects of airway protection. As an example, silent aspiration in up to 100% has been reported in individuals with PD due to laryngopharyngeal sensory deficits have. Even so, current research lacks information on the integration of both motor and sensory components that make up the swallowing process. The aim of this study was to document changes in airway protection with age, in PD and across severity levels of PD. The project was comprised of two parts. In part one, three parallel studies were conducted to assess a series of both motor and sensory airway mechanism (Chapters 4 to 9). In the first study, 16 young (8 males, age range 21.3 - 32.4) and 16 elder adults (8 males, age range 61.5 - 84.7), were assessed to investigate changes in airway protection that accompany ageing. In the second study, data from individuals diagnosed with PD across severity levels (Hoehn-Yahr 1 - 4, age range 64.2 - 84.5) were age and gender-matched to 16 healthy elders in order to examine the effects of PD on airway protection. In the third, the impact of disease severity was studied with data from 16 individuals in the earlier stages (Hoehn-Yahr ≤ 2, 13 males, age range 51.3 - 82.5, ) compared to 16 individuals in the later stages (Hoehn-Yahr ≥ 2.5, 10 males, age range 61.5 - 78.9). In part two of this project, two smaller, pilot studies were completed to probe the influence of pharmacologic and behavioural treatments on airway protection mechanisms. In the first pilot study, the effect of pharmacotherapy on airway protection was investigated in 10 patients 'on' and 'off' levodopa (Chapter 10). In the second study, 5 patients were assessed before and after completing the Lee Silverman Voice Treatment (LSVT) to document effects of speech rehabilitation on airway protection (Chapter 11). Multimodality assessment elicited data from all participants on both motor and sensory components of airway protection (Chapter 3). Specifically, breathing-swallowing coordination (BSC) and swallowing apnoea (SA) were captured using simultaneous directional nasal airflow and surface electromyography (sEMG). Standard, closed-loop spirometry was used to assess pulmonary function. Swallowing biomechanics were screened using a validated timed test of swallowing efficiency and further evaluated using fibreoptic endoscopic evaluation of swallowing (FEES). Finally, chemo-sensation of the laryngopharynx was determined with the administration of the inhalation cough challenge while mechanosensation was examined using FEES. Results suggest that motor control for airway protection is reasonably robust in PD, although sensory response is impaired. The predominant pattern for swallowing respiratory coordination was mid-expiration for all participants regardless of age and disease severity (Chapter 4). Individuals with PD demonstrated a reduction in average time and volume per swallow, leading to an overall decrease in swallowing capacity (Chapter 5). No difference was found for swallowing efficiency between those in early and later stages of PD. Pulmonary function measures were not significantly different as a function of age, PD or PD severity (Chapter 6). In summary, results from motor assessments contributing to airway protection support the robustness of breathing-swallowing coordination (BSC) and pulmonary function across research groups, but identify a reduction in overall swallowing efficiency in PD. Results from sensory assessments contributing to airway protection revealed that chemosensation was not different between age groups but base of tongue mechano-sensation was diminished in individuals with PD. Natural cough thresholds did not differ between young adults and elders but when asked to stifle coughing, elders were less able to do so compared to young adults (Chapter 7). For the first time, a reduction in mechano-reception at the base of tongue was recorded in individuals with PD (Chapter 8). These patients also demonstrated increased post swallow residual (Chapter 5), which offers an explanation for the complaint of globus in this population. These assessments highlight some compromise to sensory aspects of airway protection in PD. Overall, dysphagia had a negative impact on the quality of life of individuals with PD and even more as disease severity progresses (Chapter 9). Results from part two of the study looking at the effects of therapeutic interventions on airway protection revealed some unexpected findings. In chapter 10, results showed a reduction in pulmonary function when 'on' levodopa, but no differences in swallowing efficiency, BSC, or laryngopharyngeal chemo- and mechano-reception were observed. These results suggested a reduction in pulmonary function with levodopa without any increase in risk of airway protection compromise1. Unexpectedly and documented for the first time, the percentage of post swallow inspiration increased after LSVT (Chapter 11) but as with the levodopa study, this was also not accompanied by any apparent increase in aspiration risk. An increase in submental surface electromyography (sEMG) amplitude across all 5 participants may serve as a proxy measure of improvement in hyolaryngeal excursion. Finally, participants reported an overall improvement in social functioning and communication after LSVT. In conclusion, this study provided evidence that mechano-sensory aspect of airway protection is diminished in individuals with PD, possibly compromising airway protection. Patients not only demonstrated increased residue but the lack of sensation may prevent clearing or spontaneous multiple swallows. Overall, airway protection is maintained in ageing but swallowing efficiency declines in the presence of PD. This study contributes significantly to current research efforts in PD by expanding on existing reports regarding motor aspects of airway protection. Specifically, BSC, swallowing efficiency and evaluation of biomechanics using FEES research have never before been investigated exclusively in the PD population. Finally, the chemo- and mechano-sensation evaluated in this study are an important addition to the limited evidence that sensory impairment in individuals with PD potentially compromises airway protection. Results of the present study will serve as a platform upon which future studies may compare and expand.

Doctor of Philosophy (PhD) / Asthma is an inflammatory disease characterised by tissue remodelling. A prominent feature of this remodelling is an increase in the number and size of the blood vessels- formed from pre-existing capillaries – angiogenesis (Siddiqui et al., 2007; Wilson, 2003). This is triggered by many different endogenous angiogenic stimulators such as vascular endothelial growth factor (VEGF), and inhibited by endogenous angiogenic inhibitors such as tumstatin. Tumstatin is the non-collagenous domain (NC1) of the collagen IV α3 chain which, when cleaved, inhibits endothelial cell proliferation and induces apoptosis. Experiments described in this thesis have for the first time demonstrated the absence of tumstatin in the airways of individuals with asthma and lymphangioleiomyomatosis (LAM) as well as the functional responses to tumstatin as an angiogenic inhibitor, both in vitro and in vivo, in the airway. Although tumstatin was absent from the airways of asthmatic and LAM individuals it was present in the airways of individuals with no airways disease, chronic obstructive pulmonary disease, bronchiectasis and cystic fibrosis. No significant difference was seen in the levels of the Goodpasture Binding Protein (GPBP), a phosphorylating protein responsible for the alternate folding of tumstatin, between asthmatic, LAM and individuals with no airways disease. The αvβ3 integrin, reported to be necessary for the activity of tumstatin, as well as the individual αv and β3 sub-units were shown to be equally expressed in the airways of all patient groups. Co-localisation of tumstatin, VEGF and the αvβ3 integrin was seen in the disease free airways, however, a different pattern of VEGF and the αvβ3 integrin expression was observed in asthmatic and LAM airways with minimal co-localisation. Tumstatin was detected in serum and bronchoalveolar lavage fluid (BAL-f) samples from asthmatics and individuals with no airway disease, however there was no significant difference in the level of expression between the two groups. It was demonstrated that the tumstatin detected in the serum and BAL-f samples from asthmatics and individuals with no airway disease was part of the whole collagen IV α3 chain and not in its free and potentially active form. The ability of recombinant tumstatin to inhibit tube formation and proliferation of primary pulmonary endothelial cells was demonstrated for the first time. Further, the functional response of tumstatin was demonstrated in vivo in a mouse model of allergic airway disease. Tumstatin inhibited angiogenesis in the airway and decreased airway hyperresponsiveness. Whether there is potential for tumstatin, or a derivative thereof, to be of therapeutic value in airways diseases in which angiogenesis is a component should be the subject of future studies.