Over the past several decades, the rate of pulmonary nontuberculous my- cobacterial (PNTM) disease has been increasing. PNTM patients gener- ally consist of lean and tall women presenting with symptoms in the sixth decade of life. They have a de nitive morphophenotype, but no consistent immunological abnormalities despite extensive investigation. I hypothesized that respiratory epithelial dysfunction might play a critical role in PNTM disease predisposition because diseases with defects of mucociliary transport have high rates of PNTM disease that increase with age, suggesting a direct connection between airway epithelial function and PNTM disease. I found that PNTM patients have a distinct respiratory epithelial phenotype ex vivo and decreased nasal nitric oxide levels in vivo. The PNTM ex vivo phenotype consists of an abnormally low resting ciliary beat frequency (CBF) and abnormal CBF response to toll-like receptor (TLR) agonists. The depressed baseline CBF response in PNTM patient cells can be normalized ex vivo by augmenting the nitric oxide-cyclic guanosine monophosphate pathway without appreciable e ect on CBF in healthy controls. In healthy controls, bacterial TLR agonists increase CBF and viral TLR agonists decrease CBF. In PNTM patients these responses are impaired and are not normalized with the normalization of the resting CBF rate. Inhibitor-induced disruption of signalling pathways associated with CBF regulation demonstrated that the majority of the CBF response to TLR agonists involves the PI-3K pathway and PKC. Inhibition of the PI-3K pathway (PI-3K , Akt1, and PDK1) closely mimicked the ex vivo phenotype seen in PNTM patient respiratory epithelia. These data identify a novel aspect of PNTM disease with in vivo and ex vivo correlates that suggest that PNTM infection is associated with abnormal function at both the CBF and TLR response levels. This phenotype is novel, reproducible, and provide a foundation with which to determine the genetic basis of PNTM infection.

No description available.

Radon gas may be a major air quality hazard issue inside the home. Radon (222Rn) comes from the natural breakdown of radioactive uranium (238U) via radium (226Ra) in soil, rocks, and water. Radon and its progeny contribute more than 50% of the total radiation dose to the human population due to inhalation; it can result in severe and fatal lung disease. This investigation has determined the radon concentrations in seventy-seven domestic houses in a mountainous area of Hamadan in Iran which were monitored using track-etch detectors of type CR-39 exposed for three month periods. The arithmetic mean radon concentration in Hamadan buildings was determined to be 80 Bqm-3 and also an average indoor annual effective dose equivalent for the Hamadan city population was calculated as 1.5 mSv. Maximum radon concentrations were noted during the winter and spring season. In addition to this, 28 water wells were monitored by utilizing a Sarad Doseman detector at hourly intervals over extended periods. Radon measurements were also carried out in the nearby Alisadr show cave, using Solid State Nuclear Track etch Detectors (SSNTDs) during the winter and the spring periods. In the cave, the average annual effective geometric and arithmetic mean dose for guides was 28.1 and 34.2 mSv respectively. The dose received by visitors was very low. Hamadan city is built on alluvial fan deposits which are the source of the local water supply. The data from the wells shows that the groundwater in these alluvial deposits influences the flux of radon. The atmospheric radon concentration measurement in wells above the water surface ranged from 1,000 Bqm-3 to 36,600 Bqm-3. There is evidence that radon-rich ground waters play a significant role in the transport of radon through the alluvial fan system. There is evidence that the radon concentrations in homes in Hamadan are greatly influenced by the porous nature of the underlying geology and the movement of groundwater within the alluvial fan. / The Ministry of Health and Education; the University of Hamadan in Iran: University of Bradford: University of Kingston

<p> Lung disease is the leading threat to human health worldwide. In particular, two threats are responsible for the majority of the pulmonary disease burden: infection and tobacco smoke exposure. Efforts to combat these diseases have been hampered by gaps in our understanding of the complex interactions between environmental threats and the host's own immune defences. Indeed, much of the pulmonary disease burden should be ascribed not to direct smoke-, virus-or bacteria-induced damage, but to maladaptive host defence responses against these threats. This is an understudied topic. Efforts to redress this deficiency have been hampered by the lack of available animal models. Thus, the present studies developed and examined models of Heterologous pulmonary infection, in which hosts must defend against two different infections, and of tobacco smoke exposure. In the first study, a critical role for MIP-2 driven pulmonary neutrophilia was elucidated in the pathology associated with bacterial superinfection of influenza virus infection. This study further demonstrated that the timing and sequence in which pathogens were encountered played important roles in determining the outcome of disease, and that viral and bacterial infections have different but long-lived impacts on alveolar macrophages. In the second study, it was determined that cigarette smoke exposure impacts host defence without exhausting T-or B-cells. Collectively, these studies have advanced our understanding of complex lung pathologies, and suggest an important role for the innate immune system in mediating such diseases. </p> / Thesis / Doctor of Philosophy (PhD)

Fibroproliferative disorders are the leading cause of morbidity and mortality worldwide, with one specific group of fibroproliferative disorders being interstitial lung diseases (ILD). Idiopathic pulmonary fibrosis is the most common ILD; however its pathogenesis is not entirely understood. What is known is that there is repetitive cellular injury preceding the fibrotic remodeling in the lungs that contributes to the irreversible deposition of extracellular matrix (ECM) proteins. Myofibroblasts that accumulate at the site of injury are thought to be the key drivers of ECM deposition and are often associated in the disease. Although it is poorly understood how these immune cells differentiate in the lung, one hypothesis suggests the role of alternatively activated profibrotic macrophages in this process. The data presented in this thesis suggest that there are a presence of UPR and macrophage proteins in the lungs of IPF patients and the UPR may be necessary in the polarization of alternatively activated macrophages. / Thesis / Master of Science (MSc)

Background – Feeding horses round bale hay (RBH) has been associated with airway inflammation. The purpose of this study was to determine if horses fed RBH for a 6-week period demonstrated more evidence of airway inflammation than horses fed square bale hay (SBH) of comparable quality. Hypothesis - The respiratory health of horses fed RBH will not differ from horses fed SBH of comparable quality. Animals – Two feeding groups of 15 healthy horses (mixed ages, breeds) from the University riding program. Methods – This was a prospective study performed during fall of 2009. At the beginning and end of a 6- week feeding trial, horses were examined (physical, upper airway endoscopic) and samples (tracheal aspirate (TA), bronchoalveolar lavage (BAL)) collected for cytology and/or bacterial/fungal culture. Hay was analyzed for nutritional value and bacterial/fungal content. Results – Horses fed RBH demonstrated an increase in pharyngeal lymphoid hyperplasia (p=0.0143) and percentage neutrophils (p=0.0078) in the TA samples post-feeding as compared to pre-feeding values. Nutritional analysis of hay and measurements of bacterial/fungal load did not differ over time and/or between hay types. Conclusions and clinical importance – The identification of airway inflammation in the horses fed RBH indicates that factors associated with the manner in which the hay is fed and consumed contribute to the development of subclinical airway inflammation. RBH affords horses continuous daily exposure to hay and as horses bury their muzzles in the bale, exposure to particulate matter is likely increased. These factors may partially explain the response in horses fed RBH. Further studies are required to confirm these predictions. / Master of Science

Das Sjögren-Syndrom (SjS) stellt eine mögliche autoimmune Ursache einer interstitiellen Lungenerkrankung dar. Die Abklärung in Richtung SjS ist aber im Vergleich zu anderen systemischen Autoimmunerkrankungen bisher kaum standardisiert. Die subjektive Sicca-Symptomatik, die Anti-SS-A/Ro-Antikörper und selbst die ANA-Diagnostik als Suchtest haben alle relevante Einschränkungen in ihrer Sensitivität und/oder Spezifität. Vor diesem Hintergrund haben wir in einer interdisziplinären Diskussion einen Konsens für die SjS-Abklärung entwickelt, den wir hier für die breitere Diskussion vorstellen. Neben ANA sollten sowohl Anti-SS-A/Ro-Antikörper als auch Antikörper gegen α‑Fodrin bestimmt werden. Wichtig ist die Objektivierung der Trockenheit mittels Schirmer- und Saxon-Test und bei fehlenden typischen Autoantikörpern die Speicheldrüsenbiopsie. / Sjögren’s syndrome (SjS) is a possible autoimmune cause of interstitial lung disease. The diagnostic pathway for SjS, however, is largely undefined in comparison to other systemic autoimmune diseases. Subjective sicca symptoms, anti-SS-A/Ro antibodies and even ANA as screening tests all have relevant limitations in sensitivity and/or specificity. Against this background, in an interdisciplinary discussion we have developed a consensus for the clarification of SjS, which is presented here for broader discussion. In addition to ANA and anti-SS-A/Ro antibodies, antibodies against alpha-fodrin should be included. Objective measures of dryness, such a Schirmer and Saxon tests are important, as is a salivary gland biopsy in the absence of typical autoantibodies.

No / We report patients, family members and health professionals' experiences of Chronic Obstructive Pulmonary Disease (COPD) in Barnsley, northern England. A widespread belief that having "bad lungs" is part of normal ageing shapes everyday experience in this former mining town. People with COPD, and their families, link its cause to the areas industrial past and are sceptical of a medical orthodoxy that attributes cause to smoking. They doubt doctors' objectivity. Encouraging uptake of care, promoting smoking cessation, and developing care planning would be enhanced by engaging with the significance of place in the social narrative of health evident in this town.

Die Rationale für immuntherapeutische Ansätze zur Behandlung maligner Neoplasien geht davon aus, daß Tumore über spezifische Tumorantigene verfügen. Dendritische Zellen als die wichtigsten antigenpräsentierenden Zellen sind in der Lage, Tumorantigene naiven T-Zellen zu präsentieren und spezifische zytotoxische T-Zellen zu stimulieren. In der vorliegenden Arbeit wurden dendritische Zellen durch Stimulation mit Interleukin-4 (IL-4) und Granulozyten/ Makrophagen Koloniestimulierender Faktor (GM-CSF) aus peripheren mononukleären Blutzellen gesunder Spender und an Tumoren des gastroenteropankreatischen Systems erkrankter Patienten generiert. Mit den dendritischen Zellen cokultivierte immunologische Effektorzellen (Zytokin- induzierte Killerzellen, CIK-Zellen) wurden im Zytotoxizitätstest gegen kolorektale und pankreatische Karzinomzellen eingesetzt. CIK-Zellen sind zytototoxische Zellen, die durch Stimulation mit Zytokinen aus peripheren Blutlymphozyten erzeugt werden. Durch die Cokultivierung der Effektorzellen mit dendritischen Zellen konnte eine signifikante Steigerung der unspezifischen zytotoxischen Wirkung der CIK-Zellen bewirkt werden. Zur Steigerung der spezifischen Zytotoxizität wurden dendritische Zellen mit dem Gesamtprotein der tumor- assoziierten Antigene cancer associated antigen (CA 19-9) und carcinoembryonic antigen (CEA) gepulst. Effektorzellen zeigten nach der Cokultur mit gepulsten dendritischen Zellen zytotoxische Wirkung gegen Targetzellen, die das zum Pulsen verwendete Tumorantigen auf der Zelloberfläche exprimieren. Die Antigenspezifität der zytotoxischen Wirkung konnte durch eine signifikant verminderte Zellyse nach Blockade des Tumorantigens auf den Targetzellen belegt werden. Erstmals beschrieben ist hier das Pulsen dendritischer Zellen mit sowohl autologen als auch allogenen Seren von Patienten mit erhöhten Tumormarkerspiegeln. Eine Kultivierung dendritischer Zellen in tumormarkerhaltigem Serum bewirkte dosisabhängig eine verstärkte zytotoxische Wirkung cokultivierter Effektorzellen gegen Tumorzellen. Die verstärkte Zellyse zeigte sich unabhängig vom allogenem oder autologem Charakter des Serums. Der immunstimulierende Effekt des Patientenserums konnte durch eine vorhergehende Hitzeinaktivierung des Serums neutralisiert werden. Die höchsten Zellysen wurden durch eine Kultivierung dendritischer Zellen in tumormarkerhaltigem Serum und zusätzlichem Pulsen mit exogenem Tumorantigen erreicht. Untersuchungen an komplett autologen Systemen reproduzierten die an Zellkulturen erhobenen Befunde. Hierfür wurden erfolgreich Primärkulturen kolorektaler Tumore etabliert.Aus dem Blut von Tumorpatienten wurden dendritische Zellen generiert, die mit autologem Serum kultiviert wurden. Die cokultivierten autologen Effektorzellen erwiesen sich im Zytotoxizitätstest gegen autologe Tumorzellen als zytotoxisch. Die Cokultivierung der Effektorzellen mit den dendritischen Zellen bewirkte bei beiden Zellpopulationen Veränderungen. Dendritische Zellen zeigten nach der Cokultur eine verstärkte Expression antigenpräsentierender und costimulatorischer Moleküle. Bei den CIK-Zellen kam es zu einem Anstieg der Proliferationsrate. Bei Untersuchungen zur Antigenspezifität von T-Zellrezeptoren konnte vermehrt antigenspezifischer T-Zellrezeptor nachgewiesen werden. Des weiteren stieg das Verhältnis zwischen zytotoxischen T-Zellen und T-Helferzellen zugunsten der zytotoxischen T-Zellen. In ELISpot-Untersuchungen wurde eine Zunahme Interferon-gamma sezernierender CIK-Zellen nachgewiesen. Dendritische Zellen ließen sich erfolgreich mit inaktiviertem Adenovirus, an das kovalent Poly-L-Lysin gekoppelt ist, transfizieren. Die für den adenoviralen Gentransfer benötigten Oberflächenstrukturen konnten auf dendritischen Zellen nachgewiesen werden. Zur Verbesserung der Zytotoxizität wurden dendritische Zellen erfolgreich mit dem Gen für den Transaktivator CIITA transfiziert. CIITA- transfizierte dendritische Zellen exprimierten vermehrt MHC Klasse II-Moleküle. Die transduzierten dendritischen Zellen induzierten bei cokultivierten Effektorzellen eine erhöhte unspezifische Zytotoxizität. Mit Tumorantigen gepulste dendritische Zellen können bei der Entwicklung immuntherapeutischer Protokolle bei malignen Neoplasien von Bedeutung sein. / The immunotherapeutic approach against malignant neoplasias appreciates that tumours encode tumour rejection antigens, that enable them to induce protective immunity. Dendritic cells are major antigen-presenting cells and are able to present tumour antigens to naive T-cells and stimulate cytotoxic T-cells in a specific manner. In the present graduation-manuscript dendritic cells were generated in the presence of Interleukin-4 and granulocyte/macrophage colony-stimulating factor (GM-CSF) from peripheral mononuclear blood cells of healthy donors and tumour-patients. Immunological effector cells termed cytokine-induced killer cells (CIK cells) were co-cultured with dendritic cells and tested for their cytotoxic capacity against colorectal and pancreatic cancer cell-lines in a LDH-release assay. CIK cells are cytotoxic lymphocytes generated by incubation of peripheral blood lymphocytes with different cytokines. Co-culture of effector cells with dendritic cells led to a significant increase of the cytotoxic effect of CIK cells. For a further increase of specific cytotoxicity dendritic cells were pulsed with total protein of the tumour-associated antigens cancer associated antigen CA 19-9 and carcinoembryonic antigen (CEA). Co-cultured effector cells showed an increase in cytotoxicity against tumour-antigen expressing target cells, after co-culture with pulsed dendritic cells. The specificity of the cytotoxic effect could be shown by blocking the tumour-antigens with a monoclonal antibody. Autologous and allogenec untreated serums from patients with elevated tumour-marker levels were also used for pulsing of dendritic cells. Similar to the results when using total protein for pulsing, a cultivation in serum of patients with elevated tumour marker levels caused an intensified cytotoxic effect of effector cells against tumour cells in a dose-dependent manner. The intensified cytotoxicity was seen independent of the allogenec or autologous character of the serum. The immuno-stimulating effect of the patient serum could be neutralized by preceding heat inactivating. The highest cytotoxicity was achieved by a cultivation of dendritic cells in serum from patients with elevated tumour marker levels and additional pulsing with exogenous tumour antigen. Experiments with completely autologous systems reproduced the results made with cell-lines. Primary cultures of colorectal tumours were established. Dendritic cells were generated from the blood of tumour patients and were cultivated in autologous serum. Co-cultured autologous effector cells showed cytotoxicity when used against autologous tumour cells. Co-culturing of effector cells with dendritic cells caused modifications at both cell populations. Dendritic cells showed an increase expression of antigen-presenting and co-stimulatory molecules. CIK cells showed a higher proliferation-rate when co-cultured. They express more antigen-specific T-cell receptor, and the cytotoxic T-cells to T-helper cells ratio increased. ELISpot-assays showed an increase of interferon gamma producing cells. Dendritic cells were successfully transduced by using an inactivated adenovirus, which covalently binds poly-L-lysine. Dendritic cells express the molecules that enables adenoviral gene delivery on their surface. For the improvement of cytotoxicity dendritic cells were transduced with the gene encoding for the transactivator CIITA. CIITA transduced dendritic cells increases expression of MHC class II molecules. Cytotoxicity experiments with transduced dendritic cells resulted in an increased induction of non-specific cytolysis from co-cultured effector cells. DC pulsed with tumour-antigens may have a major impact on immunotherapeutic protocols for cancer patients.

Bakgrund: Rökning står för mer än vart tionde dödsfall i Sverige och hälften av alla långsiktiga rökare avlider av rökrelaterade sjukdomar. Lungcancer är den femte vanligaste cancersjukdomen i Sverige och orsakas i första hand av rökning. Kronisk obstruktiv lungsjukdom (KOL) orsakas också i första hand av rökning och är den tredje vanligaste dödsorsaken i världen. Fler kvinnor än män dör av KOL i Sverige men förklaringen till detta är oklar. Den komplexa kemiska blandningen som inhaleras vid förbränning av tobak orsakar negativa hälsoresultat, särskilt cancer och lungsjukdomar. Risken för och svårighetsgraden av många negativa hälsoeffekter orsakade av rökning kan variera beroende på om man själv är rökare eller bara exponeras för tobaksrök. Rökavvänjningen är potentiellt den mest effektiva av alla förbyggande åtgärder. Rökning påverkar också metabolisering av olika läkemedel. Nikotin är den beroendeframkallande substansen i tobak som orsakar abstinensbesvär. Rökfri tobak t.ex. snustobak orsakar också sjukdomar men i mycket mindre utsträckning än cigaretter. Syfte: Syftet med detta examensarbete var att ytterligare belysa kända hälsoproblem med rökning samt att beskriva eventuella ytterligare, tidigare okända, hälsoproblem. Metod: Detta arbete är en litteraturstudie baserat på 6 vetenskapliga artiklar. Resultat: Rökning ökar mortalitet och förkortar därmed livslängd. En stor del av dessa dödsfall orsakas av hjärt-kärl sjukdomar, kronisk obstruktiv lungsjukdom och många olika cancersjukdomar. Det finns ingen riskfri nivå av exponering för tobaksrök. Slutsats: Rökning ökar risken för alla typer av hjärt-kärl sjukdomar, låg födelsevikt för barn och många olika typer av cancer. Risken för pankreascancer i samband med rökning är relaterat till mängden av tobak som rökts dagligen. Minskning av antal rökta cigaretter per dag eller förpackningar per år har annars ingen större effekt på att minska risken för sjukdomar eller minska mortaliteten.