Hematopoietic cells of the myelomonocytic lineage play a central role in orchestrating both innate and adaptive immunity. They are important in the control of infectious agents and in the pathogenesis of diseases characterized by dysregulated immune response. Like allergic asthma in human patients, recurrent airway obstruction (RAO) of horses is a disease exemplified by chronic airway inflammation in the absence of infectious agents. However, unlike allergic asthma, RAO is marked by preponderance of neutrophils rather than eosinophils in the airways. Attempts to understand the immunological basis of RAO by studying lymphocytes produced equivocal results. This thesis examined the possible role of alveolar macrophages (AM) recovered from bronchoalveolar lavage fluid (BALF) in RAO. Since macrophages are predominantly derived from circulating monocytes, the thesis investigated first the phenotypic characteristics of circulating monocytes, second those of macrophages in vitro derived from monocytes, and finally attributes of AM derived in vivo. Flow cytometric analysis following antibody staining of monocytes from 61 horses showed that the clustering pattern of human leukocytes may not always be extrapolated to horses when using this technique since clusters of granulocytes often spill over into the monocyte population. The study showed that DH24A, a monoclonal antibody directed against CD90, which recognizes T cells in other species, will specifically recognize granulocytes in horses and was therefore used to separate neutrophils from monocytes during analysis. In addition, investigation of circulating monocytes showed that expression of the hemoglobin-haptoglobin receptor CD163 on circulating monocytes is significantly increased in horses with systemic inflammation when compared with healthy horses. Evaluating cytokine and chemokine production by macrophages, it was demonstrated that CD163+ macrophages preferentially expressed IL10 while CD163- macrophages showed predominant expression of CCL17. It was, therefore, concluded that CD163+ IL10-producing macrophages of horses are homologues of the alternatively activated anti-inflammatory macrophage subset of humans. Finally, probing of alveolar macrophages for CD163 and CD206 expression showed a significant reduction in the proportion of CD163+ macrophages in horses with RAO. These findings suggest that RAO is associated with a reduction in anti-inflammatory macrophages, an observation that may in part explain the chronic airway inflammation associated with this disease.

Recurrent Airway Obstruction (RAO)-affected horses experience bronchoconstriction and airway inflammation in response to inhalation of irritants including hay molds. Steaming hay reduces fungal content, but the effect on the antigenic potential has not been investigated. We tested the hypothesis that RAO-affected horses develop less severe clinical disease when fed steamed versus non-steamed hay and this reduction coincides with decreased hay fungal content. Six RAO-affected horses in clinical remission were divided in two groups and fed steamed or non-steamed hay for 10 days using a two-way cross-over design. Hay was steamed using a commercial hay-steamer. Clinical assessment was performed daily. Full assessment, including airway endoscopy, tracheal mucous scores and maximal change in pleural pressure, was performed on days 1, 5, and 10. Bronchial fluid sampling and cytology were performed on days 1 and 10. Hay core samples were collected pre- and post-steaming and cultured to determine fungal and bacterial concentrations. Statistical analysis was based on data distribution and quantity and performed using SAS®. P-value <0.05 was significant. Steaming significantly decreased the number of bacterial and fungal colony-forming-units in hay. Horses fed non-steamed hay experienced a significant increase in clinical score and a trend towards airway neutrophilia, while parameters were unchanged in horses fed steamed hay. Only horses fed non-steamed hay experienced a significant increase in tracheal mucous score. Horses fed steamed hay gained significantly more weight compared to horses fed non-steamed hay, even though the amount of hay consumed not greater on a dry matter basis. These results indicate that steaming reduces the RAO-affected horse's response to hay which coincides with a reduction in viable fungal content of hay. / Master of Science

Summer pasture-associated recurrent airway obstruction (SPARAO) is characterized by reversible airway obstruction resulting from airway hyper-reactivity to aeroallergens, mucus accumulation, and airway inflammation. These are key clinical features that are shared with human asthma, suggesting SPARAO’s utility as an animal asthma model. SPARAO affects horses maintained on pasture in conditions of high heat and humidity. Common in the southeastern United States, the cause of SPARAO is unknown, but is presumed to reflect reactivity to seasonally inhaled pasture-associated aeroallergens. This investigation sought to identify well-characterized histopathological lesions of human asthma, collectively termed ‘asthmatic remodeling’, in lung tissue from horses with SPARAO. Two histological staining techniques were used: H&E and Movat’s Pentachrome. Similar to chronic asthma, lung tissue from horses with SPARAO demonstrates statistically significant increases in airway smooth muscle, fibrosis, airway occlusion and inflammation, goblet cell hyperplasia, and remodeling of terminal bronchioles and elastin fibers.

Asthma is a chronic disease of airway hyper-responsiveness, airway inflammation and episodic bronchoconstriction. With asthma forecasted to increase by an additional 100 million cases by 2025, there is a critical and immediate need to address new asthma therapies. Guidelines for asthma treatment in the emergency department conditionally recommend intravenous magnesium sulfate (MgSO4). However, some investigations have failed to demonstrate beneficial effects. Ethical constraints limit evaluation of the bronchodilatory effects of MgSO4 alone in patients with acute asthma exacerbation, independent of other conventional therapeutics. To address this ethical dilemma, this study consisted of two phases: 1) quantification of the independent pulmonary effect of three doubling doses of MgSO4 in the spontaneous equine model of asthma during naturally occurring exacerbations of bronchoconstriction, and 2) evaluation of arterial blood gas parameters in response to administration of MgSO4 at a dose identified in phase 1 that yielded greatest efficacy without deleterious side effects.

Pulmonary surfactant is synthesized in the alveoli and lines the respiratory epithelium of the airways. Phospholipids, the main component of surfactant, confer it its ability to lower surface tension and to prevent alveolar collapse. Airway surfactant helps maintain smaller airway patency, improves muco-ciliary clearance, decreases bronchoconstriction, and modulates pulmonary immunity. Surfactant alterations in human asthma are therefore believed to contribute to the severity of airway obstruction. The goal of our first study was to characterize surfactant phospholipid composition and function in healthy horses, and to investigate the influence of age and bronchoalveolar lavage fluid (BALF) sample characteristics on surfactant. For that purpose, BALF was collected from 17 healthy horses and evaluated for BALF recovery percentage, cell count, and cell differential. BALF was separated into crude surfactant pellets (CSP) and supernatant and was analyzed for phospholipid content, protein content, phospholipid composition, and surface tension. Interestingly, phospholipid (surfactant) content in CSP significantly decreased with age. BALF recovery percentage, nucleated cell count, and cytological profile did not affect surfactant composition or function. The hypothesis of our second study was that surfactant alterations in RAO-affected horses are related to clinical stage of RAO. The objectives were 1) to compare surfactant phospholipid composition and function between Non-RAO and RAO horses at clinical stages and 2) to investigate relationships between surfactant alterations and variables assessing clinical stage of RAO. Seven horses with confirmed RAO and seven Non-RAO horses were evaluated in pairs (RAO/Non-RAO) at baseline, during exposure to hay, and post-exposure. Assessments included: clinical scoring, measure of maximal change in pleural pressure (ΔPplmax), airway endoscopy, and BALF cell counts and differentials. Samples were processed and analyzed as described above. Phospholipid levels in BALF were significantly lower in RAO versus Non-RAO horses, even in the absence of clinical signs. In the group of RAO horses, phospholipid content was significantly lower during exposure versus baseline. Furthermore, exposure to hay led to an increase in the protein versus phospholipid ratio in BALF from RAO horses. No significant differences were found in BALF protein content, phospholipid composition, or surface tension between or within groups of horses. Phosphatidylglycerol percentage had a tendency to be lower in RAO horses with higher clinical scores. Supernatant protein content was related to BALF neutrophilia in RAO crisis and overall ΔPplmax . In conclusion, our study demonstrated that surfactant alterations in RAO horses are present in remission and are exacerbated following exposure to hay. It is conceivable that a lower amount of surfactant in bronchioli of RAO horses may contribute to the horses' propensity to develop airway obstruction, mucous accumulation, and bronchial hyperresponsiveness. This may be exacerbated during crisis by a relatively higher protein versus phospholipid ratio. Furthermore, a progressive decrease of surfactant levels in older horses may contribute to a worsening of clinical signs in older RAO-affected horses. / Ph. D.

In healthy airways, mucus forms part of the innate immune response protecting the respiratory epithelium from damage by pathogens and environmental debris (Rose and Voynow, 2006). Conversely, in many respiratory diseases, mucus becomes part of the airway disease pathology. Mucus hypersecretion along with reduced clearance can cause blockage of the small airways, impairing gas exchange, promoting inflammation and becoming a culture medium for bacterial colonisation (Thornton et al., 2008). Recurrent airway obstruction (RAO) is a common yet poorly understood equine chronic respiratory disease where such altered mucus properties and clearance have been identified as major factors in the disease pathology (Davis and Rush, 2002; Gerber et al., 2000; Kaup et al., 1990; Robinson, 2001). The gel-forming mucins are largely responsible for the transport properties of mucus. The major equine airway gel-forming mucin in health is Muc5b and to a lesser extent Muc5ac; produced in specialised respiratory epithelial goblet cells and sub-mucosal glands (Rousseau et al., 2011b). Changes in mucin relative and net amounts and their macromolecular properties and interactions have been attributed to the altered physical properties of airway mucus in airways disease (Groneberg et al., 2002a; Jefcoat et al., 2001; Kirkham et al., 2002; Robinson et al., 2003; Sheehan et al., 1995).The project investigates the biochemical properties of mucins present in mucus from healthy horses and horses with RAO. This project identifies the anatomical presence of mucin-producing goblet cells and glands in fixed tissues from the respiratory tracts of healthy horses and subsequently examines mucin-production sites in respiratory tracts from horses with RAO. Finally the project investigates a methodology for the study of mucin production in airway cells harvested from live horses suffering from RAO.Our investigations confirmed that horses with RAO have more endotracheal mucus than healthy controls, and that Muc5b is the predominant mucin with Muc5ac also present in RAO horse mucus, both during symptomatic disease and when horses are asymptomatic. Mucins are produced in epithelial goblet cells and sub-mucosal glands dispersed throughout the length and circumference of the equine trachea and bronchi. Goblet cell hyperplasia occurs in symptomatic exposed RAO horse airways, although goblet cells are smaller than in asymptomatic RAO horse airways. Exposure to a dusty stable environment is associated with more goblet cells per length of bronchial compared to tracheal epithelium in all horses. RAO horses have larger sub-mucosal glands containing more mucin than control horses. Primary epithelial cell cultures grown at an air liquid interface are an alternative approach to study equine airway mucus, although the use of this culture system is in its early stages. We have developed novel ways to harvest equine airway epithelial cells (tracheal brushing) and shown it is possible to freeze cells collected via tracheal epithelial brushing in 20 % FBS and then culture to ALI at a later date.

ABSTRACT Heaves is triggered by exposure to dust and its components, such as endotoxin, and is characterized by clinical signs such as coughing, decreased exercise tolerance, difficulty breathing and abnormal lung sounds which are due to bronchoconstriction and accumulation of neutrophils in the airways. Pulmonary intravascular macrophages (PIMs) are believed to increase horses sensitivity to endotoxemia-induced lung inflammation. The first objective of this study was to investigate a hitherto unknown role of PIMs in equine heaves. I used mouldy hay (MH) to induce heaves and gadolinium chloride (GC) to deplete PIMs in order to compare responses between non-treated and GC-treated heaves horses. A modified randomized crossover study (2X2 factorial) was conducted in which mares (N=9) were exposed to 4 different treatments: alfalfa cubes (Cb), alfalfa cubes + GC (Cb-GC), mouldy hay (MH) and MH + GC (MH-GC). Each treatment was followed by broncholaveolar lavage (BAL). MH was fed for 7 days to induce heaves followed by Cb for 21 days to achieve remission, whereas the treatments in which heaves was not induced (Cb; Cb-GC), the cubes were fed prior to the BAL and for 14 days after the BAL to allow recovery from the BAL procedure. BAL fluids were processed to investigate total cell, neutrophil and alveolar macrophage concentrations. In addition, TNFá protein levels as well as TNFá, IL-8, and TLR4 mRNA expression in BAL cells were assessed in order to infer on their activation state.<p> Data showed higher concentration of dust (3X), endotoxin (20X), and endotoxin per milligram of dust (7X) in MH compared to the Cb environment. Clinical scores and neutrophil concentrations in BAL were higher when mares received MH compared to MH and GC (MH-GC). Real time reverse transcriptase PCR revealed a significant lower expression of IL-8 and TLR4 mRNA in BAL cells from MH-GC mares compared to MH. TNFá mRNA expression as well as protein concentration were not affected by the different treatments. In vitro secondary LPS challenge significantly increased IL-8 mRNA expression in cells from MH treatment compared to without LPS, but not in the MH-GC treatment. TLR4 expression was not affected by the secondary challenge. Although secondary LPS challenge increased expression of TNFá mRNA and protein, the differences among treatment groups were not meaningful. In conclusion, PIM depletion attenuates clinical scores, migration of inflammatory cells into the alveolar space and expression of pro-inflammatory molecules in BAL cells of heaves horses.<p> The observations on the role of PIMs in heaves in horses prompted me to examine the occurrence of PIMs in human lungs. I found a trend for higher numbers of septal macrophages in autopsied lungs from human patients who died of non-pulmonary pathologies compared to those having either COPD or asthma. If these septal macrophages indeed represent the PIMs, this finding is contrary to existing belief that humans, unlike horses, do not have PIMs.

ABSTRACT Heaves is triggered by exposure to dust and its components, such as endotoxin, and is characterized by clinical signs such as coughing, decreased exercise tolerance, difficulty breathing and abnormal lung sounds which are due to bronchoconstriction and accumulation of neutrophils in the airways. Pulmonary intravascular macrophages (PIMs) are believed to increase horses sensitivity to endotoxemia-induced lung inflammation. The first objective of this study was to investigate a hitherto unknown role of PIMs in equine heaves. I used mouldy hay (MH) to induce heaves and gadolinium chloride (GC) to deplete PIMs in order to compare responses between non-treated and GC-treated heaves horses. A modified randomized crossover study (2X2 factorial) was conducted in which mares (N=9) were exposed to 4 different treatments: alfalfa cubes (Cb), alfalfa cubes + GC (Cb-GC), mouldy hay (MH) and MH + GC (MH-GC). Each treatment was followed by broncholaveolar lavage (BAL). MH was fed for 7 days to induce heaves followed by Cb for 21 days to achieve remission, whereas the treatments in which heaves was not induced (Cb; Cb-GC), the cubes were fed prior to the BAL and for 14 days after the BAL to allow recovery from the BAL procedure. BAL fluids were processed to investigate total cell, neutrophil and alveolar macrophage concentrations. In addition, TNFá protein levels as well as TNFá, IL-8, and TLR4 mRNA expression in BAL cells were assessed in order to infer on their activation state.<p> Data showed higher concentration of dust (3X), endotoxin (20X), and endotoxin per milligram of dust (7X) in MH compared to the Cb environment. Clinical scores and neutrophil concentrations in BAL were higher when mares received MH compared to MH and GC (MH-GC). Real time reverse transcriptase PCR revealed a significant lower expression of IL-8 and TLR4 mRNA in BAL cells from MH-GC mares compared to MH. TNFá mRNA expression as well as protein concentration were not affected by the different treatments. In vitro secondary LPS challenge significantly increased IL-8 mRNA expression in cells from MH treatment compared to without LPS, but not in the MH-GC treatment. TLR4 expression was not affected by the secondary challenge. Although secondary LPS challenge increased expression of TNFá mRNA and protein, the differences among treatment groups were not meaningful. In conclusion, PIM depletion attenuates clinical scores, migration of inflammatory cells into the alveolar space and expression of pro-inflammatory molecules in BAL cells of heaves horses.<p> The observations on the role of PIMs in heaves in horses prompted me to examine the occurrence of PIMs in human lungs. I found a trend for higher numbers of septal macrophages in autopsied lungs from human patients who died of non-pulmonary pathologies compared to those having either COPD or asthma. If these septal macrophages indeed represent the PIMs, this finding is contrary to existing belief that humans, unlike horses, do not have PIMs.

Die Recurrent airway obstruction (RAO), im deutschen auch als „Dämpfigkeit“ be-zeichnet, ist eine weltweit anerkannte und weit verbreitete Erkrankung der Luftwege beim Pferd, die durch eine hypersensitiv-vermittelte Entzündung der Atemwege und begleitende Neutrophilie charakterisiert ist. Ausgelöst durch ungünstige Umweltbedingungen umfasst der klassische Phänotyp dieses Krankheitsbildes Husten, Nasenausfluss, Dyspnoe und Leistungsabfall. Die pathophysiologischen Vorgänge äußern sich in Bronchialobstruktion, Schleimhypersekretion, Hyperreaktivität und Umbauvorgängen (Airway remodelling) der Atemwege. In der Literatur existieren bisher noch keine genaueren Daten zur sympathischen und parasympathischen Lungeninnervation beim Pferd. Die vorliegende Arbeit liefert erstmalig eine umfangreichere immunhistochemische Analyse der Nervenäste in der equinen Lunge. Durch Immunfluoreszenz-Markierungen von ChAT und TH wurden sympathische und parasympathische Fasern detektiert. Die hierfür eingesetzten hochgereinigten Antikörper haben sich hierbei als geeignete Marker für cholinerge bzw. katecholaminerge Zellstrukturen erwiesen. Hierbei gab es keinen Hinweis darauf, dass sich die Immunreaktivität im Faserverlauf ändert oder von kranial nach kaudal schwächer wird. Auffällig war die starke Immunreaktivität der ChAT in den untersuchten Gewebeschnitten eines an RAO erkrankten Pferdes, die auf eine Hochregulation des Parasympathikus im Verlauf dieser Lungenerkrankung deutet. Die zusätzliche Detektion weiterer neuronaler Marker wie z.B. MAP2 oder NF-L sowie von Mikroglia und Astrozyten erlaubte den Nachweis weiterer Veränderungen im Krankheitsverlauf. Die validierte Koexpression von katecholaminergen bzw. cholinergen Markerenzymen deutet auf eine autonome Regulationsweise mit dem Potential einer variablen Reaktion auf Umwelteinflüsse. Die in der vorliegenden Arbeit etablierte Immunfluoreszenz-Doppelmarkierung von cholinergen und katecholaminergen Zellstrukturen bildet eine solide Grundlage für weitere Untersuchungen in Pferdegeweben unter physiologischen und pathologischen Bedingungen.

Multiple biomarkers of oxidative stress have been measured and used in human medicine to diagnose and monitor airway disease. The purpose of the study was to determine if similar relationships existed between inflammatory and oxidative stress biomarkers in exhaled breath condensate (EBC), bronchoalveolar lavage fluid (BALF), red blood cells, white blood cells, and plasma; and cytokine expression in airway inflammatory cells and mucosal biopsies of RAO-affected horses and their controls. Sixteen horses in pairs were used: 8 non-RAO-affected (controls) and 8 RAO-affected horses. Samples from all horses were collected at remission (S1), during environmental challenge (S2) and at recovery (S3). RAO-affected horses had significant alterations in cellular glutathione peroxidase (cGPx) activity, ascorbic acid and pH in a number of biological samples. Concentrations of 8-isoprostanes, isofurans, amino acids and mRNA expression of interleukin 4 (IL4), gamma interferon (INFγ), inducible nitric oxide synthase (iNOS), extracellular glutathione peroxidase (GPx-3), and cytosolic superoxide dismutase (SOD-1) were not significantly different or were at the limits of detection. Conductivity was measured and assessed as a potential correctional factor for respiratory fluid dilution. The alterations in biomarker concentrations demonstrate that oxidative stress is an important component of airway inflammation in RAO-affected horses. Further research is warranted in the use of biomarkers and the effects of dietary interventions. / Master of Science