INTRODUÇÃO: Asma é uma doença inflamatória crônica das vias aéreas que envolve diversos tipos de células, especialmente eosinófilos, células T, macrófagos, células epiteliais e células dendríticas. Durante a exposição alérgica, células dendríticas migram para os linfonodos broncopulmonares e iniciam a resposta imune na asma. Em asma humana, poucas informações sobre células dendríticas, células B, células T, eosinófilos, VCAM em linfonodos broncopulmonares são conhecidas. Poucos estudos também descrevem a interação celular entre linfonodos e vias aéreas na asma durante exacerbações. MÉTODOS: Foram analisados por método histoquímico, imuno-histoquímico e análise de imagens as expressões de Vermelho Congo, FatorXIIIa+, CD83+, CD207+, CD1a+, CD23+, CD20+, CD4+, CD8+, VCAM, em vias aéreas grandes e linfonodos broncopulmonares de 11 indivíduosnão asmáticos falecidos por asma e 8 controles não asmáticos. A análise dos marcadores foi realizada na região cortical dos linfonodos e em três regiões das vias aéreas: camadas interna, muscular e externa. RESULTADOS: Os indivíduos asmáticos apresentaram maior expressão de eosinófilos nos lifonodos broncopulmonares e nas três camadas das vias aéreas. Os marcadores FatorXIIIa+, CD23+, CD20+, CD4+ e CD8+ apresentaram aumento na camada externa das vias aéreas dos indivíduos asmáticos. CONCLUSÕES: Os eosinófilos estão aumentados nos linfonodos broncopulmonares e nas vias aéreas dos asmáticos. Alguns marcadores como o FatorXIIIa+, CD20+, CD4+, CD8+ e CD23+ estão aumentados apenas na camada externa das vias aéreas dos asmáticos. VCAM, CD83+, CD207+, CD1a+ não apresentaram aumento nos asmáticos. Este resultado sugere que esses marcadores não estão relacionados ao evento da asma fatal nos indivíduos estudados. As correlações encontradas entre vias aéreas e linfonodos nos asmáticos sugerem que na asma fatal ocorra um fluxo celular direcionado. Nossos resultados fornecem novas evidências para a participação do linfonodo broncopulmonar na exacerbação da asma / INTRODUCTION: Asthma is a chronic inflammatory disease of the airways that involves many different cells, specially mast cells, eosinophils, T cells, macrophages, epithelial cells and dendritic cells (DCs). During allergen exposure, pulmonary DCs migrate to bronchopulmonary lymph nodes (LNs) and prime the immune cells that will characterize the immune response in asthma. In human asthma, there is no information about the composition of DCs, B cells, T cells, and vessels in the regional LNs involved in the immune responses to inhaled antigens. Also, there is little information about the lung - LN cells trafficking occurring in asthma during exacerbations. METHODS: Using histochemistry, immunohistochemistry and image analysis, we investigated the expression of Congo Red+ (eosinophil), factor XIIIa+, CD23+, CD4+, CD8+, CD20+, CD207+, CD83+, CD1a+ cells and VCAM-1+ in the large airways and bronchopulmonary lymph nodes of 11 non-smoker patients that died due to an asthma exacerbation and compared with 8 deceased non-asthmatic controls. The analysis of the markers was carried out in the cortical área of the lymph nodes and three layers of the airways: internal, airway smooth muscle and outer layer. RESULTS: The LNs of asthmatics had increased expression of eosinophils when compared to controls. The large airways of asthmatics had increased expression of eosinophils in all the layers and factor XIIIa+, CD4+, CD8+, CD20+ and CD23+ had increased in the outer layer. CONCLUSIONS: A fatal asthma episode is associated with an altered expression of eosinophils in LNs and large airways.Factor XIIIa+ monocyte dendritic cel, CD4+, CD8+, CD20+, CD23+ cells had increased in the large airways without a concomitant increase in the expression of these cells in bronchopulmonary LNs.However, some DC cell trafficking between the airway mucosa and LNs seems occurs in this severe fatal asthma exacerbation

Nós investigamos o perfil inflamatório do lavado broncoalveolar (LBA) em crianças portadoras de asma de difícil controle apesar do tratamento com corticóide oral e sua relação com parâmetros clínicos e funcionais. O LBA foi realizado em 24 crianças com asma de difícil controle (13M/11F; idade média de 13 anos) e 5 controles. Houve aumento do número de neutrófilos em 15 das 24 crianças (60%) portadoras de asma de difícil controle (mediana 15%, 5-43%) e aumento de eosinófilos em 5 pacientes (mediana 9%, 6.5%-18.5%). Observou-se uma correlação entre a necessidade de corticóide oral e o número de internações e o percentual de eosinófilos no LBA. Ocorreu uma tendência de maiores números de neutrófilos no lavado e uma pior função pulmonar. Nós identificamos dois subgrupos de crianças portadoras de asma de difícil controle com características clínicas e funcionais distintas. Pacientes com aumento do percentual de neutrófilos tendem a apresentar uma pior função pulmonar. Um pequeno número de pacientes apresentou um padrão eosinofílico no lavado broncoalveolar com função pulmonar normal, porém sinais de instabilidade clínica. / Therapy resistant asthma is a major clinical problem in childhood. We investigated the inflammatory cell profile in the airways of children with severe asthma despite systemic steroid treatment and the relationship with clinical and functional severity. Bronchoalveolar lavage (BAL) was performed in 24 children with severe asthma (13M/11F; mean age 12.5 yrs, range 5-l4 yrs), and 5 controls. All received prednisolone prior to BAL. Neutrophils were the predominant inflammatory cell type in BAL in 15/24 (60%) children with asthma (median 15%, 5-43%).and only 5 patients had increases in eosinophils (median 9%, 6.5%-18,5%). There was a correlation between higher BAL eosinophils and more admissions Patients with higher BAL neutrophils showed a trend for lower pre-BAL lung function. We identified subgroups of children with severe asthma presenting different clinical and functional characteristics. Patients with increased percentages in BAL neutrophils showed a trend for lower lung function. A small number of patients presented eosinophilic airway inflammation in BAL with virtually normal lung function but showing signs of clinical instability.

<p>The eosinophil cationic protein (ECP) is usually associated with the eosinophil granulocyte. In this thesis the presence and production of this protein has been studied in two other cells. The circulating monocyte was found to contain ECP mRNA and small amounts of ECP, one thousand times less than that found in the eosinophil. The production decreased by differentiation of the myelomonoblastic cell line U937 into a macrophage phenotype. Submucosal lung macrophages did not stain for ECP and alveolar macrophages did not contain ECP mRNA. The circulating neutrophil contains ECP at a level hundred fold less than the eosinophil. We found that the protein is located to the primary granules of the neutrophil but could detect no ECP mRNA in the cell. It was shown in vitro that the protein was taken up by the cell and partly transported to the primary granules. The uptake did not seem to be receptor mediated. Upon stimulation of the neutrophils, ECP previously taken up, was re-secreted. </p><p>The ECP protein is heterogeneous both to molecular characteristics and to function. To evaluate if a genetic component is involved, the ECP gene was analysed in 70 individuals. Three single nucleotide polymorphisms (SNP´s) were found, denoted 277(C>T), 434(G>C) and 562(G>C). The two first were located to the mature peptide-coding region and would change the amino acids, arg45cys and arg97thr. The prevalence of the most common SNP, 434, was evaluated in two eosinophil-related diseases, allergy/asthma and Hodgkin Lymphoma (HL). Forty-three HL patients were evaluated and it was found that the 434GG was significantly more prevalent in patients having nodular sclerosis (NS) as compared to other histologies (p=0.03). Erythrocyte sedimentation rate was also related to the 434GG genotype (p=0.009). In 209 medical students 434GG was more common (p=0.002) in those who indicated allergy. The genotype was unrelated to the production of IgE antibodies to allergens. In analysis of 76 subjects with asthma it was found that the 434GG genotype was significantly more common among allergic asthmatics (p=0.04). Asthma and HL-NS are characterized by fibrosis and eosinophils and ECP has been suggested in fibrosis development. </p>

<p>Apoptosis or programmed cell death is crucial for the resolution of inflammation, and phagocytosis of apoptotic cells initiates the release of actively anti-inflammatory responses from the phagocytes. Eosinophils are one of the most potent inflammatory cells in the body and is involved in a number of diseases, most commonly associated with parasitic infections and allergic diseases. Apoptosis in eosinophils is therefore one of the most important systems to avoid inflammation. This aim of the present investigation was to examine the mechanisms behind, and the consequences of this process in eosinophils. Apoptotic eosinophils have a unique surface receptor expression that indicates abilities to communicate with T-, B- and antigen presenting cells. They have a novel expression of CD49f, indicating an importance for binding to laminin or unknown functions of the VLA-6 receptor, possibly in the concept of phagocytosis of the apoptotic cell. </p><p>In apoptotic eosinophils the granules are translocated to the periphery of the cell, probably through a disruption of the cytoskeleton. This translocation makes the granules easily accessible and the apoptotic eosinophil can release considerable amounts of granule proteins in response to specific stimuli. The spontaneous release however, is decreased as compared with living cells. </p><p>Furthermore, the survival of eosinophils in response to an allergen challenge is increased in healthy subjects, but not in allergic patients. Mechanistically, this needs further investigation, but one theory is that it is due to the presence of specific IgE in patients in combination with differences in the response from the epithelial cells.</p>

<p>In this thesis the oxidative metabolism by blood eosinophils from birch pollen allergic subjects was studied and compared to that by eosinophils from healthy controls, during and out of the pollen season. The effects and mechanisms of <i>in vitro</i> IL-5 priming on blood eosinophils were investigated and compared to the effects of <i>in vivo</i> priming during pollen exposure.</p><p>The main findings of this work were that the oxidative metabolism by blood eosinophils taken from pollen allergic subjects is reduced during the pollen season. The eosinophils taken from asymptomatic allergics have a reduced capacity to produce oxygen free radicals as compared to non-allergic controls. The oxidative metabolism by blood eosinophils from allergic subjects is primed <i>in vivo</i> during the pollen season, as compared to the healthy controls and as compared to out of season. IL-5 primed the oxidative metabolism by eosinophils from allergic subjects in a similar way as eosinophils from healthy controls, both during and out of pollen exposure. The total and tyrosine phosphorylation patterns obtained were identical in eosinophils from allergic subjects and non-allergic controls during the pollen season. Spontaneous phosphorylation was the same in both groups and different from that after IL-5 priming. The oxidative metabolism of blood eosinophils is composed of different stages. The initial stage, measured as the t_½rises of the CL curves, is an indication of the state of priming of the cell, while the end stage, measured as the peaks of the CL curves, is an estimate of the total radical production by the cells. IL-5 priming affected these two stages differently and the two stages are regulated by different signal transduction pathways and IL-5 priming causes a by-passing of MEK.</p><p>In conclusion, in this thesis it is shown that blood eosinophils from allergic subjects are primed <i>in vivo</i> during exposure to their allergen. This <i>in vivo</i> priming leads on one hand to a reduced oxidative metabolism during the pollen season, but also to a faster onset of radical production as a response to certain stimuli. Our data do not provide any evidence of IL-5 involvement in the <i>in vivo</i> priming of blood eosinophils from allergic patients during pollen exposure.</p>

In this thesis the oxidative metabolism by blood eosinophils from birch pollen allergic subjects was studied and compared to that by eosinophils from healthy controls, during and out of the pollen season. The effects and mechanisms of in vitro IL-5 priming on blood eosinophils were investigated and compared to the effects of in vivo priming during pollen exposure. The main findings of this work were that the oxidative metabolism by blood eosinophils taken from pollen allergic subjects is reduced during the pollen season. The eosinophils taken from asymptomatic allergics have a reduced capacity to produce oxygen free radicals as compared to non-allergic controls. The oxidative metabolism by blood eosinophils from allergic subjects is primed in vivo during the pollen season, as compared to the healthy controls and as compared to out of season. IL-5 primed the oxidative metabolism by eosinophils from allergic subjects in a similar way as eosinophils from healthy controls, both during and out of pollen exposure. The total and tyrosine phosphorylation patterns obtained were identical in eosinophils from allergic subjects and non-allergic controls during the pollen season. Spontaneous phosphorylation was the same in both groups and different from that after IL-5 priming. The oxidative metabolism of blood eosinophils is composed of different stages. The initial stage, measured as the t½rises of the CL curves, is an indication of the state of priming of the cell, while the end stage, measured as the peaks of the CL curves, is an estimate of the total radical production by the cells. IL-5 priming affected these two stages differently and the two stages are regulated by different signal transduction pathways and IL-5 priming causes a by-passing of MEK. In conclusion, in this thesis it is shown that blood eosinophils from allergic subjects are primed in vivo during exposure to their allergen. This in vivo priming leads on one hand to a reduced oxidative metabolism during the pollen season, but also to a faster onset of radical production as a response to certain stimuli. Our data do not provide any evidence of IL-5 involvement in the in vivo priming of blood eosinophils from allergic patients during pollen exposure.

The eosinophil cationic protein (ECP) is usually associated with the eosinophil granulocyte. In this thesis the presence and production of this protein has been studied in two other cells. The circulating monocyte was found to contain ECP mRNA and small amounts of ECP, one thousand times less than that found in the eosinophil. The production decreased by differentiation of the myelomonoblastic cell line U937 into a macrophage phenotype. Submucosal lung macrophages did not stain for ECP and alveolar macrophages did not contain ECP mRNA. The circulating neutrophil contains ECP at a level hundred fold less than the eosinophil. We found that the protein is located to the primary granules of the neutrophil but could detect no ECP mRNA in the cell. It was shown in vitro that the protein was taken up by the cell and partly transported to the primary granules. The uptake did not seem to be receptor mediated. Upon stimulation of the neutrophils, ECP previously taken up, was re-secreted. The ECP protein is heterogeneous both to molecular characteristics and to function. To evaluate if a genetic component is involved, the ECP gene was analysed in 70 individuals. Three single nucleotide polymorphisms (SNP´s) were found, denoted 277(C&gt;T), 434(G&gt;C) and 562(G&gt;C). The two first were located to the mature peptide-coding region and would change the amino acids, arg45cys and arg97thr. The prevalence of the most common SNP, 434, was evaluated in two eosinophil-related diseases, allergy/asthma and Hodgkin Lymphoma (HL). Forty-three HL patients were evaluated and it was found that the 434GG was significantly more prevalent in patients having nodular sclerosis (NS) as compared to other histologies (p=0.03). Erythrocyte sedimentation rate was also related to the 434GG genotype (p=0.009). In 209 medical students 434GG was more common (p=0.002) in those who indicated allergy. The genotype was unrelated to the production of IgE antibodies to allergens. In analysis of 76 subjects with asthma it was found that the 434GG genotype was significantly more common among allergic asthmatics (p=0.04). Asthma and HL-NS are characterized by fibrosis and eosinophils and ECP has been suggested in fibrosis development.

Apoptosis or programmed cell death is crucial for the resolution of inflammation, and phagocytosis of apoptotic cells initiates the release of actively anti-inflammatory responses from the phagocytes. Eosinophils are one of the most potent inflammatory cells in the body and is involved in a number of diseases, most commonly associated with parasitic infections and allergic diseases. Apoptosis in eosinophils is therefore one of the most important systems to avoid inflammation. This aim of the present investigation was to examine the mechanisms behind, and the consequences of this process in eosinophils. Apoptotic eosinophils have a unique surface receptor expression that indicates abilities to communicate with T-, B- and antigen presenting cells. They have a novel expression of CD49f, indicating an importance for binding to laminin or unknown functions of the VLA-6 receptor, possibly in the concept of phagocytosis of the apoptotic cell. In apoptotic eosinophils the granules are translocated to the periphery of the cell, probably through a disruption of the cytoskeleton. This translocation makes the granules easily accessible and the apoptotic eosinophil can release considerable amounts of granule proteins in response to specific stimuli. The spontaneous release however, is decreased as compared with living cells. Furthermore, the survival of eosinophils in response to an allergen challenge is increased in healthy subjects, but not in allergic patients. Mechanistically, this needs further investigation, but one theory is that it is due to the presence of specific IgE in patients in combination with differences in the response from the epithelial cells.

Allergic diseases are chronic inflammatory conditions, characterised by eosinophil inflammation systemically and in target organs, where cytotoxic granule proteins are responsible for tissue injury. Allergic rhinitis is known to be a risk factor for the development of asthma, yet not all with rhinitis develop asthma. The overall aim was to investigate the involvement of eosinophils in allergic rhinitis and allergic asthma in vivo and in experimental settings, with a focus on differences between rhinitis and asthma. Birch pollen allergy was used as a model and patients were studied during pollen season and after nasal and bronchial allergen challenge. During pollen season and at baseline, allergic rhinitis and allergic asthma had the same degree of systemic eosinophil inflammation. Despite this, impairment in lung function during season and increased bronchial responsiveness at baseline were more common in the asthmatics. Systemic inflammation was more pronounced after seasonal exposure than after experimental challenge. Allergic rhinitis and allergic asthma had the same degree of eosinophil airway inflammation after bronchial challenge, but only the asthmatics had increased bronchial responsiveness measured as PD20 for birch allergen. Allergen primed eosinophils were investigated in vitro for C3b-induced degranulation after seasonal and experimental challenge. The released amount of eosinophil granule proteins was within the same range for all three allergen challenge models with just minor differences in propensity for degranulation between rhinitics and asthmatics. Signalling through PI3K for degranulation was studied with the specific inhibitor Wortmannin. PI3K signalling for eosinophil degranulation was clearly involved in allergic rhinitis and allergic asthma irrespective of the model for allergen exposure. Asthmatics demonstrated less inhibition of degranulation through PI3K during pollen season, indicating that other pathways contribute to eosinophil degranulation in allergic asthmatics. Conclusion: Allergic rhinitis and allergic asthma present with the same degree of systemic and local eosinophil inflammation. The eosinophils are primed for degranulation equally and follow the same pathway through PI3K for degranulation. Our data indicates that eosinophil inflammation per se is not sufficient for the development of asthma.

<p><italic>Cryptococcus neoformans</italic> is an opportunistic fungal pathogen that initiates infection following inhalation. As a result, the pulmonary immune response provides a first line of defense against <italic>C. neoformans</italic>. Surfactant protein D (SP-D) is an important regulator of pulmonary immune responses and is typically host protective against bacterial and viral respiratory infections. However, SP-D is not protective against <italic>C. neoformans</italic>. This is evidenced by previous work from our laboratory demonstrating that SP-D-deficient mice infected with a highly virulent <italic>C. neoformans</italic> strain (H99 Stud) have a lower fungal burden and live longer compared to wild-type (WT) control animals. We hypothesized that SP-D alters susceptibility to <italic>C. neoformans</italic> by dysregulating the innate pulmonary immune response following infection. For this reason, inflammatory cells and cytokines were compared in the bronchoalveolar lavage fluid from WT and SP-D<super>-/-</super> mice after <italic>C. neoformans</italic> infection. Post-infection, mice lacking SP-D had reduced eosinophil infiltration and IL-5 in lung lavage fluid. To further explore the interplay of SP-D, eosinophils, and IL-5, mice expressing altered levels of eosinophils and/or IL-5 were used to assess the role these innate immune mediators play during the host response to <italic>C. neoformans</italic>. IL-5 overexpressing mice had increased pulmonary eosinophilia and were more susceptible to <italic>C. neoformans</italic> infection as compared to WT mice. Furthermore, the response to <italic>C. neoformans</italic> infection in SP-D<super>-/-</super> mice could be restored to that of WT mice by increasing IL-5 and eosinophils, via crossing the IL-5 transgene onto the SP-D<super>-/-</super> background. Together, these studies support the conclusion that SP-D increases susceptibility to <italic>C. neoformans</italic> infection by promoting <italic>C. neoformans</italic>-driven pulmonary IL-5 and eosinophil infiltration.</p> / Dissertation