Rund 300 Millionen Alveolen sorgen in der menschlichen Lunge für den Gasaustausch. Eine essentielle Rolle spielen dabei die Alveolarepithelzellen, die die erste Barriere der Luft gegenüber dem Blut bilden. Man unterteilt diese in die kubisch förmigen Typ-II-Epithelzellen, die den wichtigen stabilisierenden Surfactant bilden und in die flacheren Typ-I-Zellen, die aufgrund von engen Zell-Zell Kontakten miteinander eine funktionelle Barriere zwischen Luft und Blut (Blut-Luft-Schranke) ermöglichen. In der Pathophysiologie von verschiedenen Lungenerkrankungen, wie z.B. dem ARDS, spielt die Störung dieser Barriere eine essentielle Rolle. Ziel der vorliegenden Promotionsarbeit war es, ein in vitro-Modell dieser Barriere, basierend auf der humanen Epithellzelllinie NCI H441, zu etablieren. Die Epithelzellen wurden hierzu erfolgreich auf Transwelleinsätzen gezüchtet. Um die Barriereeigenschaften zu überprüfen, wurden mit TER Messungen und Fluoreszenzpermeabilitätsmessungen zwei verschiedene Verfahren eingesetzt. Für die Bewahrung der Konfluenz wurden die Zellen mit Dexamethason – einem potenten Glukokortikoid – behandelt. Dexamethason wurde idealerweise bei jedem Medienwechsel ab Tag 5 apikal hinzugefügt und zeigte einen barrierefördernden Effekt. Die optimale hinzugefügte Dexamethason–konzentration erwies sich als 100 nM. Hierunter bildete die Zellschicht – sowohl mittels TER-Messung als auch mittels Fluoreszenzpermeabilitätsmessung überprüft – eine starke Barriere aus, die am Tag 14-15 nach Zellaussaat ihr Maximum erreichte. Auf mRNA Ebene konnten zu diesem Zeitpunkt unter 100 nM Dexamethason jeweils relevante Mengen zellspezifischer Proteine von Alveolarepithelzellen Typ-I und II nachgewiesen werden. Mittels Immunfluoreszenzmikroskopie konnte zusätzlich visualisiert werden, dass die zwei Zelltypen koexistieren. Mittels Immunfluoreszenzmikroskopie zeigte sich weiterhin ein ausgeprägtes Netz an Occludensjunktionsproteinen (Claudin -1,-3,-4, Occludin, ZO-1). In weiteren Versuchen wurde der Einfluß von Endothelzellfaktoren auf das epitheliale Lungenkulturmodell untersucht. Es zeigte sich ein stark ausgeprägter gewebsspezifischer Effekt: Die Faktoren der Lungenendothelzellen stärkten die Barriere des Modells, hingegen die Hirnendothelzellfaktoren sie stark schwächten. Dieser Effekt zeigte sich sowohl durch die gemessenen TER-Werte als auch durch die gemessenen Fluoreszeinpermeabelitätswerte. Erste Belastungsversuche des Modell durch Hypoxie und reaktive Sauerstoffspezies zeigten eine gewisse Widerstandsfähigkeit der Barriere gegenüber Noxen. Das vorliegende Zellkulturmodell des Lungenalveolarepithels, basierend auf der NCI H441 Zelllinie, kann folglich genutzt werden, um die Regulation der Barriere genauer zu erforschen und mögliche neue Therapiestrategien zu entwickeln. / The blood–air barrier in the lung consists of the alveolar epithelium, the underlying capillary endothelium, their basement membranes and the interstitial space between the cell layers. Within the framework of this thesis an in vitro-Transwell model of the alveolar epithelium based on human cell line H441 was established and the influence of conditioned medium obtained from human lung endothelial cell line HPMEC-ST1.6R on the barrier properties of the H441 layers were investigated. As control for tissue specificity H441 layers were exposed to conditioned medium from human brain endothelial cell line hCMEC/D3. Addition of dexamethasone was necessary to obtain stable H441 cell layers. Moreover, dexamethasone increased expression of cell type I marker caveolin-1, and cell type II marker SP-B, whereas decreased the transepithelial electrical resistance (TEER) in a concentration dependent manner. Soluble factors obtained from the lung endothelial cell line increased the barrier significantly proven by TEER values and fluorescein permeability on the functional level and by the differential expression of tight junctional proteins on the molecular level. In contrast to this, soluble factors derived from brain endothelial cells weakened the barrier significantly. In conclusion, soluble factors from lung endothelial cells can strengthen the alveolar epithelium barrier in vitro, which suggests communication between endothelial and epithelial cells regulating the integrity of the blood–air barrier. With regard to the clinical context, influencing the alveolar permeability may be a future target in the treatment of different lung diseases such as ARDS and this in-vitro model may be a helpful tool for it.

Zugl.: Giessen, Univ., Diss., 2005

Universiẗat, Diss., 2005--Giessen.

Zugl.: Giessen, Universiẗat, Diss., 2008.

Zugl.: Giessen, Universiẗat, Diss., 2008.

Marburg, Univ., Diss., 2009

Neutrophils as key effector cells of the innate immune system migrate from the circulation into sites of inflammation and are essential for the containment, killing and clearance of invading pathogens through a variety of highly regulated cell functions. Despite this beneficial role their involvement can also be detrimental. In a number of diseases dysregulated neutrophil influx and activation results in significant tissue damage and worsening of the acute inflammatory event as well as long term tissue injury, scarring and fibrosis. One such pulmonary condition is acute respiratory distress syndrome (ARDS) which, despite decades of intensive research and multiple clinical trials, remains without a cure and has an associated mortality rate of approximately 40%. Delineating and understanding the key pathogenic mediators that drive neutrophil recruitment into the lung in the context of both bacterial and sterile injury is therefore vital in the development of novel therapies. Neutrophils migrate towards a variety of agents but amongst such factors a hierarchy exists with bacterial-derived products, including formylated peptides, dominant in this process. In sterile tissue injury where no bacterial factors are present the mediators involved change but a hierarchy still exists. Mitochondrial formylated peptides are released following necrotic cell death and bind to formyl peptide receptor 1 (FPR1) on the neutrophil surface inducing migration and activation. Like bacterial formylated peptides they are powerful chemoattractants and are therefore likely to be important in recruiting neutrophils to sites of injury and inflammation. Hypothesis: The central hypothesis of this thesis is that mitochondrial formylated peptides, as end-target chemoattractants, are elevated in patients with ARDS and drive neutrophil recruitment through binding to FPR1. Inhibition of FPR1 in models of acute lung injury will therefore result in attenuation of this inflammatory response through multiple FPR1-mediated effects implicating both formylated peptides and their cognate receptor in the pathogenesis of sterile ARDS. Results: Free mitochondrial DNA and formylated peptides were elevated in the circulation of patients with ARDS or severe paracetamol-induced hepatic failure relative to healthy controls. In addition, FPR1 receptor number was increased on the surface of neutrophils isolated from critically ill septic patients. Isolated mitochondrial formylated peptides induced FPR1- dependent chemotaxis in primary human neutrophils in vitro. Alongside this, FPR1 ligand binding resulted in increased cell surface β2-integrin expression [integrin alpha M beta 2 (ITGB2); also called CD11b/CD18, Mac-1 or CR3] through intracellular activation of PI-3Kand MAPK-dependent signalling pathways. Indeed, blockade of neutrophil cell-surface integrin alpha M (ITGAM; also known as CD11b)) resulted in a reduction in mitochondrial formylated peptide-induced chemotaxis. To determine the production of human neutrophil IL-1β, a pivotal chemokine within a sterile inflammatory environment, a novel method for the in vitro isolation of ultrapure neutrophils was developed. Neutrophils were isolated by autofluorescence-based flow sorting as determined by intrinsic differences in neutrophil and eosinophil autofluorescence and their size and granularity relative to circulating mononuclear cells. Analysis of this approach demonstrated the ability to rapidly collect a highly pure neutrophil population (99.95 ± 0.03%). Flow sorting did not alter the activation state or functional capacity of these cells relative to unsorted neutrophils with regards to several measures of neutrophil behaviour/function. Cells also remained fully responsive to a variety of neutrophil agonists with no evidence of neutrophil priming. The capacity of highly pure neutrophils to secrete IL-1β was determined to be approximately 160-fold lower than equivalent numbers of circulating peripheral blood mononuclear cells. In the context of an inflammatory environment however this is likely to be of biological significance given the large number of infiltrating neutrophils. In sterile hydrochloric acid-induced acute lung injury pharmacological inhibition of FPR1 with cyclosporin H (CsH), or use of transgenic FPR1-/- mice, resulted in inhibition of neutrophil migration into the alveolar space 24 hours after injury. This was associated with a reduction in pulmonary haemorrhage, extravascular protein leak and pro-inflammatory cytokine expression with improved histological appearances. Furthermore, the HCl acid-induced reduction in alveolar macrophage numbers was inhibited by CsH with interstitial macrophages displaying an alternatively activated phenotype. Importantly, delivery of CsH 12 hours after the onset of injury also reduced acute lung inflammation demonstrating its potential therapeutic relevance in the treatment of human disease. In non-sterile E. coli-mediated acute lung injury partial antagonism of FPR1 with CsH resulted in a reduction in neutrophil migration and vascular leak with no effect on pulmonary bacterial load. A narrow therapeutic window existed however as increased concentrations of CsH, or infection in FPR1-/- mice, resulted in a reduction in alveolar neutrophil number and increase in E. coli at 24 hours. Alongside effects on myeloid cells within the lung FPR1 was found to be expressed on mouse lung epithelial cells. A technique to isolate and culture mouse type 1 alveolar epithelial (AT1) cells was therefore developed. Flow sorting of anti-type 1 alpha (anti-T1α) stained single cell lung homogenates with subsequent culture on transwell membranes resulted in the development of confluent AT1 cell monolayers after 10 days. Formylated peptides appear to induce a reduction in transepithelial resistance and increase in permeability across a monolayer in vitro alongside an increase in release of the neutrophil chemo-attractant mouse CXCL8 (KC). Conclusions: Taken together, mitochondrial formylated peptides released following cell necrosis and FPR1 play a significant role in the pathogenesis of sterile acute lung injury. This is likely to be predominantly through neutrophil-dependent means but data presented here also suggests that their role in macrophage function and alveolar epithelial cell permeability may be important. Inhibition of FPR1 may therefore represent a novel and multi-cellular therapeutic target in the treatment of ARDS.

Background: With the COVID-19 pandemic, there has been an influx of patients with acute respiratory distress syndrome (ARDS), an inflammatory lung condition. ARDS survivors are at high risk for developing post-traumatic stress disorder (PTSD) due to intensive care unit (ICU) medical treatments/procedures. They are known to have traumatic memories triggered by their sensorium months to years after being discharged from the ICU. One study found that 23% of ARDS survivors experienced long-term PTSD symptoms 2-3 years after hospital discharge (Bienvenu et al., 2018). Unknown is whether there are similarities in the memories and sensory triggers of PTSD amongst ARDS and COVID ARDS survivors. Purpose: The purpose of this study was to 1) identify the most common vivid ICU memories and sensory triggers for PTSD symptoms in survivors of ARDS and COVID positive ARDS; 2) to analyze the frequency of sensory triggers and determine whether differences exist between ARDS and COVID ARDS survivors. Method: A multi-step, thematic analysis of qualitative data from 27 patients was completed (20 COVID ARDS patients and 7 ARDS patients) by a team of 7 researchers. Patients were asked a series of open-ended questions regarding vivid memories and sensory triggers for them. Major themes were generated from their responses. Results: Major themes identified were prevalent in both COVID ARDS and ARDS groups. Prominent vivid memories included medical treatment/procedures, emergence delirium, illusions/hallucinations, vivid nonsense dreams and sensory to dream conversion. Common sensory triggers included seeing medical equipment, hearing beeping/alarms, seeing media depictions of the hospital setting, hospital smells and seeing doctors, nurses, hospitals. Differences between COVID-ARDS and ARDS groups were not notable. Conclusion: The data collected in this study revealed ARDS and COVID ARDS patients experience sensory inputs during their ICU stay that contribute to the development of vivid, long-lasting memories and subsequent PTSD symptoms. Survivors' everyday lives are altered by these symptoms, impacting their ability to work, familial relationships, and likelihood to seek out healthcare. Data from this study is being used in a compressed exposure therapy trial and should be incorporated into future PTSD preventative and treatment interventions.

No description available.

The cardiopulmonary effects of endotoxin administration (1 microgram/kg) were evaluated in 8-10 week old SPF-derived Yorkshire pigs, both because endotoxemia is a common and important swine problem, and because the pig is a good model for human adult respiratory distress syndrome. Physiological changes included sustained increases in mean pulmonary artery pressure, pulmonary vascular resistance, pulmonary arterial wedge pressure, heart rate, hematocrit, and the arterial partial pressure of carbon dioxide. Transient increases were also observed in central venous pressure and airway pressure. Transient increases, followed by decreases, were observed in mean systemic arterial pressures and systemic vascular resistance. Decreases were seen in cardiac output, cardiac index, arterial partial pressure of oxygen and oxygen saturation. The number of circulating leukocytes, lymphocytes and segmented neutrophils decreased with endotoxin infusion. To investigate the role of airway smooth muscle, bronchial rings were isolated and exposed to contractile agents in tissue baths. A hyperresponsiveness of the third generation bronchi to substance P, carbachol, bradykinin and electric field stimulation was observed. However the increase in response to bradykinin and electric field stimulation were not statistically significant. Histopathology of the lungs demonstrated congestion, hemorrhage and neutrophilic infiltration. / Master of Science