Rationale: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of deaths worldwide. Patients with COPD have episodes of aggravated symptoms called exacerbations caused by pathogens or pollution. Respiratory viruses are associated with a significant number of COPD exacerbations with the most common virus being the rhinovirus (RV). The mechanisms by which RVs trigger COPD exacerbations are still unclear. Using human whole lung tissue explants (WTE), a novel model of RV-induced COPD exacerbations is proposed. Methods: WTE from COPD patients and smokers were initially stimulated with TLR ligands that are known to activate the same receptors as RV: poly(I:C) for TLR3 and R848 for TLR7/8 activation. Pro-inflammatory cytokines and type I and III IFN gene expression was measured by ELISA and qRT-PCR, respectively. A neutralising antibody against TNFα, a corticosteroid, and a panel of inhibitors targeting TLR pathway (p38 MAPK, IKK-2 and IRAK1/4) was applied to the tissue from COPD patients to establish which signalling pathways are responsible for the inflammatory response and IFN release. Explants from COPD patients and smokers was also exposed to two RV serotypes, RV-16 and RV-1B, in order to compare findings with a clinically relevant stimulant. Results: Poly(I:C) and R848 caused a significant increase of protein and gene expression of pro-inflammatory cytokines (TNFα, CCL5 and IL-6). Type I and III IFN gene expression was also significantly increased. Using the two ligands together caused a synergistic release of TNFα and CCL5. Tissue from COPD patients released more pro-inflammatory cytokines and expressed less IFNβ when compared to smokers. TNFα neutralisation inhibited subsequent release of CCL5 and IL-6. Dexamethasone and p38 MAPK inhibitor decreased TLR3- and TLR7/8-induced pro-inflammatory response whereas IKK-2 and IRAK1/4 inhibition had little effect on cytokine release. Dexamethasone and IKK-2 showed limited effect on IFN gene expression whereas p38 MAPK inhibitor significantly decreased and IRAK1/4 inhibition enhanced IFN expression. RV-16 induced modest but significant pro-inflammatory response in lung tissue, whereas RV-1B did not induce cytokine release. Both serotypes induced type I and III IFN gene expression. Tissue from COPD patients showed a lower expression of IFNβ and IFNλ when compared to smokers. Conclusion: This tissue explant was responsive to both synthetic TLR ligands and RV. The release of pro-inflammatory cytokines in response to TLR stimulation was partially inhibited by steroid. p38 MAPK is involved in TLR-induced inflammation but it also further decreases the already impaired IFN gene expression in COPD tissue. The role of IKK-2 and IRAK1/4 in TLR-induced innate immune response remains unclear. This model is a valuable system to study the mechanisms underlying RV-induced COPD exacerbations and also to test new inhibitors in the whole tissue environment.

Lung segmentation is an important first step for quantitative lung CT image analysis and computer aided diagnosis. However, accurate and automated lung CT image segmentation may be made difficult by the presence of the abnormalities. Since many lung diseases change tissue density, resulting in intensity changes in CT image data, intensity-only segmentation algorithms will not work for most pathological lung cases. This thesis presents two automatic algorithms for pathological lung segmentation. One is based on the geodesic active contour, another method uses graph search driven by a cost function combining the intensity, gradient, boundary smoothness, and the rib information. The methods were tested on several 3D thorax CT data sets with lung disease. Given the manual segmentation result as gold standard, we validate our methods by comparing our automatic segmentation results with Hu's method. Sensitivity, specificity, and Hausdorff distance were calculated to evaluate the methods.

There is no rapid diagnostic technique at medical examiners' offices to determine if a decedent is infected with Mycobacterium tuberculosis. Present diagnostic testing requires at least one month for results. A biosensor-based sandwich immunoassay for the detection of M. tuberculosis was developed in this study. M. tuberculosis polyclonal antibody was used for target antigen capture and detection in the immunoassay. Live attenuated M. tuberculosis (ATCC 25177) suspended in phosphate-buffered saline with 0.1% Tween 20 was used as the antigen in the detection assay. The Analyte 2000 was the initial biosensor platform. Initial testing was of Freund's adjuvant complete. M. tuberculosis was detected 50% of the time at 1,000,000 CFU/ml and 100% of the time at 10,000,000 CFU/ml and 100,000,000 CFU/ml. Live attenuated M. tuberculosis was also tested using the Analyte 2000 biosensor. Detection was obtained 87.5% of the time at 1,000,000 CFU/ml and 100% of the time at 10,00 0,000 CFU/ml and 100,000,000 CFU/ml. The RAPTOR, an automated, portable instrument, was then tested as the fiber optic biosensor platform. Positive biosensor detection was obtained 75% of the time at cell concentrations of 1,000,000 CFU/ml, 95% of the time at 10,000,000 CFU/ml, and 99% of the time at 100,000,000 CFU/ml. Live attenuated M. tuberculosis suspended in PBST and seeded into decedent lung tissue was tested using the RAPTOR. Positive detection was obtained 21% of the time at cell concentrations of 1,000,000 CFU/ml, 86% of the time at 10,000,000 CFU/ml and 100% of the time at 100,000,000 CFU/ml. Antibody specificity studies using ELISA were performed to determine the anti-M. tuberculosis antibody's cross reactivity with microorganisms other than M. tuberculosis. M. tuberculosis actively growing in the lung of an individual is found at levels of 10,000,000 to 1,000,000,000 CFU in the lesions of the lung. This study determined that the RAPTOR biosensor assay was capable of detecting the presence of M. tuberculosis in lung tissue homogenate within three hours when the concentration of M. tuberculosis was 10,000,000 to 1,000,000,000 CFU/ml.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24132号 / 医博第4872号 / 新制||医||1059(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 平井 豊博, 教授 湊谷 謙司, 教授 羽賀 博典 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Invasive Pulmonary Apsergillosis (IPA) is caused by inhalation of fungal conidia to the deep lung followed by germination and invasive hyphal growth in heavily immunosuppressed patients (e.g. those with hematologic malignancies, hematopoietic stem cell transplant recipients, and those undergoing solid organ transplantation). Hyphal growth into pulmonary capillaries often leads to dissemination of the infection and high mortality rates despite current treatment and prophylactic modalities. In addition, systemic antifungal therapy is often limited by drug toxicities, low and variable bioavailability, erratic pharmacokinetics, and drug interactions. Although targeted drug delivery to the lungs has been investigated to reduce adverse events and promote drug efficacy, inconsistent pharmacokinetic properties following inhalation of poorly water soluble antifungals has prompted variable drug efficacy. In this dissertation, inhaled voriconazole was investigated through in vitro and in vivo testing to evaluate pharmacokinetic properties, characterize drug safety and, determine drug efficacy as prophylaxis against IPA. In Chapter 2, the in vitro evaluation of solution properties and aerosol characterization of aqueous voriconazole was evaluated. Subsequent in vivo single and multiple dose pharmacokinetic studies demonstrated high drug concentrations were achieved in lung tissue and plasma following inhalation in contrast to previous reports of inhaled antifungals. Inhaled voriconazole was then administered twice daily (BID, at 08:00 and 16:00) in a murine model of IPA as described in Chapter 3 with significant improvements in animal survival over 12 days compared to both positive and negative control groups. As described in Chapter 4, voriconazole was then chronically administered BID at a high and low dose to rats over 21 days with a 7 day recovery period to assess dose tolerability through laboratory tests and histopathological changes to lung, liver, kidney, and spleen tissues. Inhaled voriconazole was well tolerated through all assessments but with signs of mild acute histiocytosis in lung tissue without other signs of inflammation. Chapter 5 expanded the single inhaled dose pharmacokinetic profile in lung tissue and plasma with determination of additional pharmacokinetic parameters through compartmental modeling. Peak and trough voriconazole concentrations were also evaluated in mice as well as rats following multiple doses administered over 12 hours (Q12H) as opposed to BID. / text

Decellularized lung tissue has been recognized as a potential platform to engineer whole lung organs suitable for transplantation or for modeling a variety of lung diseases. However many technical hurdles remain before this potential may be fully realized. Inability to efficiently re-endothelialize the pulmonary vasculature with a functional endothelium appears to be the primary cause of failure of recellularized lung scaffolds in early transplant studies. This dissertation research aims to enhance the re-endothelialization of decellularized rodent lung scaffolds with rat lung microvascular endothelial cells. This was achieved by adjusting the posture of the lung to a supine position during cell seeding through the pulmonary artery. The supine position allowed for significantly more homogeneous seeding and better cell retention in the apex regions of all lobes than the traditional upright position, especially in the right upper and left lobes. Additionally, the supine position allowed for greater cell retention within large diameter vessels (proximal – 100 µm to 5,000 µm) than the upright position, with little to no difference in the small diameter distal vessels. Endothelial cell adhesion in the proximal regions of the pulmonary vasculature in the decellularized lung was dependent on the binding of endothelial cell integrins, specifically α1β1, α2β1 and α5β1 integrins to, respectively, collagen type-I, type-IV and fibronectin in the residual ECM. Following in vitro maturation of the seeded constructs under perfusion culture, the seeded endothelial cells spread along the vascular wall, leading to a partial re-establishment of endothelial barrier function as inferred from a custom-designed leakage assay. The results of this dissertation research suggest that attention to cellular distribution within the whole organ is of paramount importance for restoring proper vascular function. / Bioengineering

In the recent years, it has been well established that primary respiratory viral infection-induced lung resident memory CD8 T cells (TRM) characterized by the expression of integrins CD49a and CD103, as well as the early-activation marker CD69, constitute the first line of defense against reinfection. On the other hand, viral vector-based respiratory mucosal (RM) vaccination, as well as parenteral vaccination followed by airway luminal manipulation induce lasting and protective lung T cell immunity towards pulmonary tuberculosis (TB). However, it remains poorly understood whether and how these TB vaccination strategies induce TRM in the lung. As such, within this thesis we will investigate generation of lung CD8 TRM upon different TB vaccination strategies and the underlying mechanisms regulating establishment of such cells. Here using distinct models of replication-deficient adenoviral vector-based TB vaccination, we find that RM vaccination leads to generation of lung CD8 TRM identified by the expression of CD69, CD103, and very late activation Ag 1 (VLA-1). These TRM-associated molecules are acquired by CD8 T cells in distinct tissues. In this regard, VLA-1 is acquired during T cell priming in draining mediastinal lymph nodes (dMLNs) and the others acquired after T cells entered the lung. Once in the lung, Ag-specific CD8 TRM continue to express VLA-1 at high levels through the effector/expansion, contraction, and memory phases of T cell responses. We also reveal that VLA-1 is not required for homing of these cells to the lung, but it negatively regulates them in the contraction phase. Furthermore, VLA-1 has a negligible role in the maintenance of such cells in the lung. Separately, we have observed that while parenteral intramuscular vaccination alone does not induce lung CD8 TRM, subsequent RM inoculation of an Ag-dependent, but not a non-specific inflammatory agonist induces lung CD8 TRM. Such generation of lung CD8 TRM needs CD4 T cell help. These findings not only fill the current knowledge gap, but also hold important implications in developing effective vaccination strategies towards mucosal intracellular infectious diseases such as acquired immunodeficiency syndrome (AIDS), TB and herpes virus infection. / Thesis / Doctor of Philosophy (PhD)

Sekundäre bakterielle Infektionen im Verlauf oder in Folge einer Infektion mit Influenza A Viren (IAV) steigern oftmals die Schwere des Krankheitsverlaufes, was besonders während der IAV Pandemien von 1918, 1968 und 2009 deutlich wurde. Genaue mechanistische Ursachen, welche dieser gesteigerten Kopathogenität zugrunde liegen wurden überwiegend in Tierversuchsmodellen adressiert und sind immunologisch unvollständig. Aufgrund organstruktureller und immunfunktioneller Speziesunterschiede ist ungewiss, inwieweit eine Übertragbarkeit der Daten zwischen Mensch und Maus besteht. Fokus der Arbeit bildete die Analyse potentieller IAV assoziierter Änderungen der angeborenen Immunität, welche sekundäre Pneumokokkeninfektionen in humanem ex vivo Lungengewebe begünstigen. Dafür wurden zentrale Zyto - bzw. Chemokine als Reaktion auf Einzelinfektionen mit dem saisonalen IAV Pan/99(H3N2) sowie Streptococcus pneumoniae D39 mit denen subsequenter viral-bakteriellen Koinfektion verglichen. Ausgelöst durch die antivirale Interferonantwort erfolgte die Reduktion der pneumokokkeninduzierten Bildung von IL-1β und GM-CSF auf translationaler und transkriptioneller Ebene. Vermutlich beeinflussen Typ I und II Interferone die IL-1β Bildung, welches über parakrine Wechselwirkungen an der GM-CSF Regulation beteiligt ist. Auf zellulärer Ebene verursachte IAV die Freisetzung von Typ I, II und III Interferonen aus primären humanen Alveolarepithelzellen vom Typ II. In humanen Alveolarmakrophagen unterdrückten Typ I und II Interferone die pneumokokkeninduzierte IL-1β Freisetzung. Folglich unterblieb die IL-1β-regulierte GM-CSF Sekretion aus Alveolarepithelzellen vom Typ II. Die Ergebnisse zeigen, dass influenzainduzierte Interferone durch die Unterdrückung der IL-1β regulierten Bildung von GM-CSF in humanem Lungengewebe beitragen. Damit unterstützt sie das Verständnis immunologischer Faktoren, welche diesem Krankheitsbild im Menschen pathophysiologisch zugrunde liegen können. / Secondary bacterial infections, which occur during or following an IAV infection, exaggerate the severity of the course of disease up to a lethal outcome, clearly recognizable during the fatal IAV pandemics from 1918, 1968 or 2009. Particular mechanisms underlying this exaggerated viral-bacterial copathogenity were almost solely addressed using animal models and are immunologically incomplete. Due to structural and immunofunctional interspecies differences the transferability of data between human and mice remains indeterminate. The study mainly purposed to investigate IAV associated modulations of innate immunity, which potentially facilitates secondary pneumococcal pneumonia in primary human ex vivo lung tissue. Hence secretion of central cyto- and chemokines initiated by single infection with the seasonal IAV Pan/99(H3N2) or the bacterium Streptococcus pneumoniae D39 were compared to subsequent viral-bacterial coinfection. In context of an antiviral interferon response the pneumococcal induced translation and transcription of IL-1β and GM-CSF were reduced. Probably type I and type II interferons affect generation of IL-1β, which participates in the regulation of GM-CSF by paracrine interactions. On a cellular basis the infection of primary human alveolar epithelial cells type II (AECII) with IAV triggered the release of interferon type I, II and III. In human alveolar macrophages type I and II interferons suppressed the pneumococcal induced release of IL-1β. Consequently, the IL-1β regulated generation of GM-CSF in AECII was impeded. The present study indicates, that influenza related induction of interferons suppresses the IL-1β related release of GM-CSF in human lung tissue. Thereby it takes part in contributing to pathophysiological comprehension of immunological factors underlying this copathogenity.

No description available.

Intravital microscopy (IVM) is a well-established imaging technique for real-time monitoring of microscale lung tissue dynamics. Although accepted as a gold standard in respiratory research, its characteristic image features are scarcely understood, especially when trying to determine the actual position of alveolar walls. To allow correct interpretation of these images with respect to the true geometry of the lung parenchyma, we analyzed IVM data of alveoli in a mouse model in comparison with simultaneously acquired optical coherence tomography images. Several IVM characteristics, such as double ring structures or disappearing alveoli in regions of liquid filling, could be identified and related to the position of alveoli relative to each other. Utilizing a ray tracing approach based on an idealized geometry of the mouse lung parenchyma, two major reflection processes could be attributed to the IVM image formation: partial reflection and total internal reflection between adjacent alveoli. Considering the origin of the reflexes, a model was developed to determine the true position of alveolar walls within IVM images. These results allow thorough understanding of IVM data and may serve as a basis for the correction of alveolar sizes for more accurate quantitative analysis within future studies of lung tissue dynamics.