INTRODUÇÃO: O transplante traqueal continua um desafio. Contudo, avanços nas técnicas de revascularização dos enxertos traqueais e no conhecimento da imunobiologia da traquéia, indicam que esta técnica pode ser utilizada com freqüência no futuro próximo. A depuração mucociliar (DM) é o mecanismo de defesa inato mais importante das vias aéreas. A traquéia age como um órgão de defesa devido à DM. A DM ocorre por ação do batimento ciliar do epitélio respiratório que impele o muco que atapeta as vias respiratórias, carreando substâncias nocivas. Idealmente, a DM deve ser preservada em enxertos traqueais passíveis de utilização para transplante traqueal. Nosso intuito foi: 1) avaliar os efeitos da isquemia fria sobre a DM; e 2) avaliar a ação de soluções de preservação administradas por via tópica na manutenção da DM após isquemia fria. MÉTODOS: De 109 ratos Wistar foram obtidos 217 segmentos traqueais. Os segmentos foram distribuídos entre três grupos experimentais e um grupo Controle. Cada segmento foi submergido em LPD-glicose (grupo LPD), histidina-triptofano-cetoglutarato (grupo HTK) ou solução salina (grupo Salina). Avaliou-se a DM após 6,10,16 ou 24 horas de isquemia fria. No grupo Controle os segmentos foram analisados imediatamente após a extração, não havendo isquemia fria, nem submersão em soluções. A velocidade de transporte mucociliar (VTM) foi medida através de microscópio de luz, pela observação do movimento das partículas de muco na superfície dos segmentos traqueais. A freqüência de batimento ciliar (FBC) foi obtida pela sincronização entre o movimento ciliar observado pelo microscópio de luz e um estroboscópio. Em seguida, os segmentos foram corados com hematoxilina-eosina para analisar a integridade epitelial (IE) e a inflamação subepitelial (IS). Foi realizada análise quantitativa do muco intracelular por um programa de computador após coloração com azul de alcião (MI-AA) e PAS (MI-PAS). As amostras mais significativas foram analisadas qualitativamente por microscopia eletrônica de transmissão (ME). Foram realizadas duas análises: 1) grupo Controle e tempos de isquemia; e 2) grupo Controle e soluções de preservação (agrupado pelo tempo de isquemia). RESULTADOS: 1) grupo Controle e tempos de isquemia: O grupo controle foi melhor que os grupos submetidos a isquemia fria quanto à VTM (p=0,0001) e FBC (p=0,012). Contudo, não houve diferença na IE, IS e MI entre o grupo Controle e os demais grupos. 2) grupo Controle e soluções de preservação: O grupo controle apresentou melhor VTM que os grupos LPD, HTK e Salina após isquemia de 6h (p=0,001), 16h (p=0,009) e 24h (p=0,001). O grupo controle apresentou melhor FBC que os grupos LPD, HTK e Salina após isquemia de 24h (p=0,001). Não houve diferença entre os grupos na IE e IS. O grupo Controle apresentou melhor MI-AA que os grupos LPD após 16h (p=0,02) e HTK após 24h de isquemia (p=0,04). Não houve diferença entre os grupos à MI-PAS. À ME, o grupo Salina apresentou maiores alterações secundárias à isquemia do que os demais grupos. CONCLUSÕES: 1) A isquemia fria piora a DM; e 2) O uso de soluções de preservação administradas por via tópica não contribui para manutenção da DM após isquemia fria / INTRODUCTION: Tracheal transplantation is a challenging problem. Recent advances in graft revascularization, and reepithelialization renewed the interest on airway transplantation. Mucociliary clearance (MC) is the most important innate defense mechanism of the respiratory system. MC works by mucous transport carried out by ciliary beating function of the airway epithelium. Trachea acts as a defense organ in the respiratory system through the MC. Ideally, MC should be preserved in tracheal grafts used for transplantation. Preservation solutions improve organ preservation by decreasing ischemic injury. The purpose of the study was: 1) to evaluate the effects of cold ischemia on MC; and 2) to evaluate the impact of topically-applied preservation solutions on MC after cold ischemia. METHODS: From 109 male Wistar rats we obtained 217 tracheal segments. The segments were allocated to one of four groups. Segments were submerged in LPD-glucose (LPD group), histidine-tryptophan-ketoglutarate (HTK group), or saline solution (Saline group), and stored at 4C. MC was analyzed after 6, 10, 16 or 24h of ischemia. Control group have only segments that were analyzed right after extraction, not submitted to cold ischemia or submersion in preservation solutions. The mucociliary transport velocity (MTV) was measured by observation of mucous particle under the surface of the segments, through a light microscope. Ciliary beating frequency (CBF) was achieved by synchronization between cilia movement and a stroboscope flashlight. Tracheas were stained with hematoxylin-eosin in order to analyze the epithelial integrity (EI) and the subepithelial inflammation (SI). A quantitative analysis of the intracellular mucus stained with alcian blue (IM -AB) and PAS (IM-PAS) was achieved by a software. The most significant samples of the tracheal segments were qualitatively analyzed by transmission electronic microscopy (TEM). Two analyses were made: 1) Control group and ischemic time; and 2) Control group and preservation solutions. RESULTS: 1) Control group and ischemic time: Control group had better VTM (p=0,0001) and CBF (p=0,012) than the groups submitted to cold ischemia. However, there was no difference among Control group and the other groups on EI, SI, IM-AB, and IM-PAS. 2) Control group and preservation solutions: Control group showed better MTV than the LPD, HTK, and Saline groups after 6h (p=0,001), 16h (p=0,009) and 24h (p=0,001) of cold ischemia. Control group showed better CBF than the LPD, HTK, and Saline groups after 24h of ischemia (p=0,001). There was no difference among groups on EI and SI. Control group showed better IM-AB than both the LPD group after 16h of cold ischemia (p=0,02), and the HTK group after 24h of cold ischemia (p=0,04). There was no difference among the groups on IM-PAS. TEM showed more findings of ischemic lesion on Saline group. CONCLUSIONS: 1) Cold ischemia impairs MC; and 2) Topically-applied preservation solutions do not ameliorate MC after cold ischemia

Verschiedene Ursachen erfordern rekonstruktive Maßnahmen an der Trachea zur Erhaltung eines suffizienten Luftweges. Häufig treten im Rahmen dieser Eingriffe Infektionen und Schädigungen auf, die die Bildung von Granulationsgewebe nach sich ziehen und zu Stenosen führen können. Der Einsatz von epithelialisierten autogenen oder auch allogenen Transplantaten, die mit der Methode des Tissue Engineering hergestellt werden, bietet einen neuen Lösungsansatz, um Stenosen zu vermeiden. Diese Arbeit beschäftigt sich mit der Isolierung, Kultivierung und Charakterisierung von humanem respiratorischen Epithelzellen (hREC), sowie deren Einsatz in Co-Kulturen mit humanen Chondrozyten als einen ersten Schritt zur Transplantatherstellung. Die hREC wurden sowohl in nativem Gewebe als auch in Monolayerkultur und in verschiedenen Differenzierungkulturen histologisch und immunhistochemisch analysiert. Zusätzlich wurde die Ziliogenense mit der Elektronenmikroskop untersucht. Eine weitere Charakterisierung erfolgte durch die Genexpressionsanalyse einiger Cytokeratine auf RNA-Ebene mit der semiquantitativen real-time RT-PCR. Mittels Durchflusszytometrie konnten Basalzellen, die auch als Vorläuferzellen des humanen respiratorischen Epithels gelten, mit den Antikörpern CD49f und CD104 detektiert und analysiert und unter Verwendung der fluoreszenzaktivierten Zellsortierung (FACS) separiert werden. Es zeigte sich, dass die hREC in den Proliferationskulturen dedifferenzierten und durch spezielle Basalzellmarker angefärbt wurden. Die Differenzierungskulturen und ALI-Kulturen gaben erste Hinweise auf die Differenzierung der Zellen. In den Co-Kulturen konnte unter dem Einfluß eines Air-Liquid-Inteface ebenfalls eine Re-differenzierung der Zellen beobachtet werden. Die Ergebnisse zeigen, dass es möglich ist, eine Epithelialisierung von kollagenbeschichteten Biomaterialien oder auch autologem Knorpel zu erreichen, um diese Konstrukte für das Trachea Tissue Engineering einzusetzen. / The replacement of extensive tracheal defects resulting from intensive care medicine, trauma, or large resections is still challenged by the re-epithelialization of an autologous or alloplastic trachea replacement. Therefore, this thesis was performed to investigate the potential of culture expanded human respiratory epithelial cells (hREC) to regenerate a functional epithelium for trachea tissue engineering.hREC from nasal turbinates were freshly isolated, expanded and subsequently cultured in high-density multilayers to allow epithelial differentiation. Composition of epithelial cells in native respiratory epithelial tissue and culture expanded hREC were analyzed by histological staining and by immunohistochemical staining with the specific antibodies. Differentiation of culture expanded hREC was further characterized by gene expression analysis of a cytokeratin pattern using semi-quantitative real-time RT-PCR technique. Furthermore, basal cells known as progenitors of the respiratory epithelium were seperated by Fluorescense Activated Cell Sorting with the basal cell specific antibodies CD49f and CD104. Co-cultures of hREC and human chondrocytes (hCHO) or human cartilage respectively were compared to Air-Liquid-Interface cultures containing hREC and hCHO.Histological and immunohistochemical staining and Scanning Electron Microscopy pictures of hREC in differentiation cultures demonstrated basal cells covering the collagenous matrix. These cells formed a cellular multilayer, which is composed of a basal layer of undifferentiated basal cells and an upper layer of cells differentiating along the squamous metaplasia and ciliated cell lineage. Lineage development of cultured hREC was further documented by the induction of specific cytokeratins. Our results suggest that culture expanded hREC have the potential to colonize collagen coated biomaterials as well as autologous cartilage grafts and to regenerate epithelial cell types for trachea tissue engineering.

Ozone, being an unstable molecule, is believed to be one of the strongest oxidant agents known to man. Rapid growth in the application of ozone — both as disinfectant and as form of alternative medicine — led to questions about the effects of uncontrolled ozone exposure and inhalation, whether intentional or unintentional, on the human body. This study specifically focussed on examining, identifying and substantiating the respiratory effect of acute exposure (10 min or less) to considerably higher ozone concentrations than reported on before (19.5 ± 0.5 ppm). Respiratory tissue of rodents (Duncan–Hartley guinea pigs of both sexes and Male Wistar rats) was subjected to ozone by utilising three distinctly diverse models of ozone introduction: (a) in vitro exposure, (b) in vivo exposure, and (c) ex vivo by employing an isolated lung perfusion model which allows for real–time, breath–by–breath data acquisition of ozone’s effect on respiratory mechanics. The effect of ozone on the isolated trachea in the presence of various drugs with well–known effects, including methacholine, isoproterenol and ascorbic acid was also examined. The results found in this study identified two direct effects on the isolated trachea due to ozone exposure: (1) a definite contraction of the isolated trachea immediately after exposure to ozone, and (2) a clearly visible and significant hyper responsiveness of the isolated trachea to irritants, e.g. methacholine. Although ozone has a negative effect on the trachea, it was concluded that ozone has no adverse effect on muscarinic acetylcholine receptors. An apparent EC50 value of ozone on the trachea was established by two different methods as (2.77 ± 0.02) x 10–3 M and (2.10 ± 0.03) x 10–3 M, respectively. Ozone furthermore displayed an attenuation of the beneficial pharmacological response of –sympathomimetic drugs (i.e. isoproterenol), while isoproterenol itself has a relaxing effect on the ozone–induced contraction of the isolated trachea. Indomethacin pre–treatment of isolated tracheal tissue significantly (77%) reduced the ozone–induced contraction of tracheal smooth muscle, suggesting that COXproducts of arachidonic acid play a prominent role in the development of pulmonary function decrements consequent to acute high–dose ozone exposure. Ascorbic acid exhibited a meaningful prophylactic effect on ozone–induced contraction of both isolated tracheal tissue and in the isolated lung perfusion model, emphasising the major role antioxidants play in both the epithelium lining fluid (ELF) of the respiratory system and in plasma throughout the body in protecting against the destructive effects of ozone. Surprisingly, pre–treatment with ascorbic acid did not prevent hyper responsiveness of isolated tracheal preparations to methacholine after a 10 min ozone (19.5 ± 0.5 ppm) exposure. In the lung perfusion model, the presence of ascorbic acid in the perfusion medium did, however, significantly reduce the magnitude and rate of decline in lung compliance after ozone exposure (46% decline with ascorbic acid versus 96% in the control study without ascorbic acid). Examination of a lung perfusion model exposed to ozone (19.5 ± 0.5 ppm O3; 5 seconds) presented a significant decline in lung compliance (95.6% within 2 min), tidal volume (70%) and maximum inspiratory flow (71.2%), with an ensuing reduction in lung elasticity and severely hampered breathing pattern. Microscopic examination after acute high–dose inhalation studies did not display any significant cellular damage, oedema or inflammation after acute high–dose ozone exposure. This suggests that significant cellular injury and inflammation is possibly not the causative factor of early breathing difficulty experienced after acute high–dose ozone inhalation, as these symptoms and particularly the result of inflammatory precursors, is believed to probably only set in at a later stage. Although the potential advantages of ozone in certain fields of medicine are not disputed, ozone, depending on its concentration and cumulative dose, can be either therapeutic or toxic. Observations in this study emphasised that even short bursts of high–dose ozone inhalation have deleterious effects on respiratory health and care should be taken not to jump to conclusions regarding ozone’s medical application without relevant scientific evidence. It must be stressed that high–dose inhalation of ozone should be avoided at all cost – especially by those with existing airway diseases. / Thesis (Ph.D. (Pharmacology))--North-West University, Potchefstroom Campus, 2011.

Ozone, being an unstable molecule, is believed to be one of the strongest oxidant agents known to man. Rapid growth in the application of ozone — both as disinfectant and as form of alternative medicine — led to questions about the effects of uncontrolled ozone exposure and inhalation, whether intentional or unintentional, on the human body. This study specifically focussed on examining, identifying and substantiating the respiratory effect of acute exposure (10 min or less) to considerably higher ozone concentrations than reported on before (19.5 ± 0.5 ppm). Respiratory tissue of rodents (Duncan–Hartley guinea pigs of both sexes and Male Wistar rats) was subjected to ozone by utilising three distinctly diverse models of ozone introduction: (a) in vitro exposure, (b) in vivo exposure, and (c) ex vivo by employing an isolated lung perfusion model which allows for real–time, breath–by–breath data acquisition of ozone’s effect on respiratory mechanics. The effect of ozone on the isolated trachea in the presence of various drugs with well–known effects, including methacholine, isoproterenol and ascorbic acid was also examined. The results found in this study identified two direct effects on the isolated trachea due to ozone exposure: (1) a definite contraction of the isolated trachea immediately after exposure to ozone, and (2) a clearly visible and significant hyper responsiveness of the isolated trachea to irritants, e.g. methacholine. Although ozone has a negative effect on the trachea, it was concluded that ozone has no adverse effect on muscarinic acetylcholine receptors. An apparent EC50 value of ozone on the trachea was established by two different methods as (2.77 ± 0.02) x 10–3 M and (2.10 ± 0.03) x 10–3 M, respectively. Ozone furthermore displayed an attenuation of the beneficial pharmacological response of –sympathomimetic drugs (i.e. isoproterenol), while isoproterenol itself has a relaxing effect on the ozone–induced contraction of the isolated trachea. Indomethacin pre–treatment of isolated tracheal tissue significantly (77%) reduced the ozone–induced contraction of tracheal smooth muscle, suggesting that COXproducts of arachidonic acid play a prominent role in the development of pulmonary function decrements consequent to acute high–dose ozone exposure. Ascorbic acid exhibited a meaningful prophylactic effect on ozone–induced contraction of both isolated tracheal tissue and in the isolated lung perfusion model, emphasising the major role antioxidants play in both the epithelium lining fluid (ELF) of the respiratory system and in plasma throughout the body in protecting against the destructive effects of ozone. Surprisingly, pre–treatment with ascorbic acid did not prevent hyper responsiveness of isolated tracheal preparations to methacholine after a 10 min ozone (19.5 ± 0.5 ppm) exposure. In the lung perfusion model, the presence of ascorbic acid in the perfusion medium did, however, significantly reduce the magnitude and rate of decline in lung compliance after ozone exposure (46% decline with ascorbic acid versus 96% in the control study without ascorbic acid). Examination of a lung perfusion model exposed to ozone (19.5 ± 0.5 ppm O3; 5 seconds) presented a significant decline in lung compliance (95.6% within 2 min), tidal volume (70%) and maximum inspiratory flow (71.2%), with an ensuing reduction in lung elasticity and severely hampered breathing pattern. Microscopic examination after acute high–dose inhalation studies did not display any significant cellular damage, oedema or inflammation after acute high–dose ozone exposure. This suggests that significant cellular injury and inflammation is possibly not the causative factor of early breathing difficulty experienced after acute high–dose ozone inhalation, as these symptoms and particularly the result of inflammatory precursors, is believed to probably only set in at a later stage. Although the potential advantages of ozone in certain fields of medicine are not disputed, ozone, depending on its concentration and cumulative dose, can be either therapeutic or toxic. Observations in this study emphasised that even short bursts of high–dose ozone inhalation have deleterious effects on respiratory health and care should be taken not to jump to conclusions regarding ozone’s medical application without relevant scientific evidence. It must be stressed that high–dose inhalation of ozone should be avoided at all cost – especially by those with existing airway diseases. / Thesis (Ph.D. (Pharmacology))--North-West University, Potchefstroom Campus, 2011.