Jonathan C. Weissler

Adult-onset pulmonary fibrosis caused by mutations in telomerase

Idiopathic pulmonary fibrosis (IPF) is an adult-onset, lethal, scarring lung disease of unknown etiology. Some individuals with IPF have a familial disorder that segregates as a dominant trait with incomplete penetrance. Here we used linkage to map the disease gene in two families to chromosome 5. Sequencing a candidate gene within the interval, TERT, revealed a missense mutation and a frameshift mutation that cosegregated with pulmonary disease in the two families. TERT encodes telomerase reverse transcriptase, which together with the RNA component of telomerase (TERC), is required to maintain telomere integrity. Sequencing the probands of 44 additional unrelated families and 44 sporadic cases of interstitial lung disease revealed five other mutations in TERT. A heterozygous mutation in TERC also was found in one family. Heterozygous carriers of all of the mutations in TERT or TERC had shorter telomeres than age-matched family members without the mutations. Thus, mutations in TERT or TERC that result in telomere shortening over time confer a dramatic increase in susceptibility to adult-onset IPF.

Exome sequencing links mutations in PARN and RTEL1 with familial pulmonary fibrosis and telomere shortening

Idiopathic pulmonary fibrosis (IPF) is an age-related disease featuring progressive lung scarring. To elucidate the molecular basis of IPF, we performed exome sequencing of familial kindreds with pulmonary fibrosis. Gene burden analysis comparing 78 European cases and 2,816 controls implicated PARN, an exoribonuclease with no previous connection to telomere biology or disease, with five new heterozygous damaging mutations in unrelated cases and none in controls (P = 1.3 × 10−8); mutations were shared by all affected relatives (odds in favor of linkage = 4,096:1). RTEL1, an established locus for dyskeratosis congenita, harbored significantly more new damaging and missense variants at conserved residues in cases than in controls (P = 1.6 × 10−6). PARN and RTEL1 mutation carriers had shortened leukocyte telomere lengths, and we observed epigenetic inheritance of short telomeres in family members. Together, these genes explain ∼7% of familial pulmonary fibrosis and strengthen the link between lung fibrosis and telomere dysfunction.

Separation of potent and poorly functional human lung accessory cells based on autofluorescence

Human alveolar macrophages obtained by bronchoalveolar lavage are usually poor accessory cells in in vitro lymphoprollferation assays. However, we recently described a subpopulation of pulmonary mononuclear cells, obtained from minced and enzyme‐digested lung, which were potent stimulators of allogeneic T‐lymphocyte proliferation. These cells were enriched in loosely adherent mononuclear cell (LAM) fractions, but further study of these accessory cells was hampered by the heterogeneous nature of LAM. It was observed that in the majority of lung tissue sections, most alveolar macrophages were autofluorescent, whereas most interstitial HLA‐DR positive cells were not. Therefore autofluorescence was utilized to fractionate LAM in an attempt to remove alveolar macrophages and selectively purify interstitial accessory cells. LAM were separated by flow cytometry using forward and side scatter to exclude lymphocytes, and red autofluorescence to obtain brightly autofluorescent (A pos) and relatively nonautofluorescent (A neg) mononuclear cells. Although both populations contained over 80% HLA‐DR positive cells, A pos cells were poor accessory cells, whereas A neg cells were extremely potent stimulators of a mixed leukocyte reaction at all stimulator ratios tested. When A pos cells were added to A neg cells, T‐cell proliferation was markedly suppressed in the majority of experiments. Morphologically, A pos cells appeared similar to classical alveolar macrophages with 95% of the cells being large and intensely nonspecific esterase positive. In contrast, the majority of A neg were smaller, B‐cell antigen‐negative, nonspecific esterase negative, and had a distinctive morphology on Wright‐stained smears. We conclude that fractionation of LAM based on autofluorescence is a powerful tool to isolate and characterize lung mononuclear cells that act either as stimulators or as suppressors of immune responses in the lung.

Idiopathic Pulmonary Fibrosis: Cellular and Molecular Pathogenesis

Diffuse involvement of the pulmonary interstitium with abnormal fibrous tissue is a process that occurs in many settings. There are many possible etiologies for pulmonary fibrosis, but in the majority of individuals, a clear cause cannot be determined and a diagnosis of idiopathic pulmonary fibrosis (IPF) results. Despite limited knowledge concerning the etiology, recent advances in biomedical technology offer great promise for increasing our understanding of IPF. This review will focus on current concepts of the pathogenesis and therapy of IPF.

Mononuclear cells from human lung parenchyma support antigen-induced T lymphocyte proliferation.

We have previously demonstrated that there is a subpopulation of loosely adherent pulmonary mononuclear cells that can be isolated from minced and enzyme‐digested lung tissue with a potent capacity to stimulate allogeneic T lymphocyte proliferation. We now demonstrate that these cells are also capable of stimulating an autologous mixed leukocyte reaction (AMLR) and presenting antigen to autologous T lymphocytes. These loosely adherent mononuclear cells (LAM) were more effective than either alveolar macrophages or monocytes as antigen‐presenting cells. Depletion of phagocytic or Fc receptor‐positive cells from the LAM population enhanced the stimulation of an reaction AMLR while preserving antigen‐induced T lymphocyte proliferation. These results indicate that there are nonphagocytic, Fc receptor‐negative accessory cells in human lung parenchyma capable of activating resting T cells in an AMLR and supporting antigen‐specific T lymphocyte proliferation. The identity of these cells is uncertain, but the data strongly suggest that the cell is not a classical monocyte‐derived macrophage. These antigen‐presenting cells may be critical in the initiation of immune responses within the lung.

Autoantigen Ro52 directly interacts with human IgG heavy chain in vivo in mammalian cells

Previously, when we used in vivo yeast two-hybrid and in vitro protein-protein interaction analyses, we demonstrated a direct interaction between autoantigen Ro52 and the human IgG heavy chain. This interaction occurred in the absence of antibody-antigen specific interaction. Here, by employing a novel strategy, we further demonstrated that Ro52 co-localized with IgG in transfected mammalian cells. The co-localization was specific to IgG1 but not IgG3. Co-immunoprecipitating IgG with Ro52 from transfected cell lysates suggested that protein complex containing Ro52 and IgG contributed to the in vivo co-localization. In addition, IgG from normal human serum was shown to bind to the surface of apoptotic keratinocytes and the binding could be competitively blocked by 50-fold excesses of IgG1, not IgG3. With a direct binding study, we also demonstrated that IgG1 could bind to the surface of apoptotic cells while IgG3 bound barely. This binding was not competed by Fcgamma fragments indicating a non-Fcgamma receptor mediated interaction. Finally, in a competition analysis the addition of GST-RFP could reduce the IgG binding to the cell surface. Thus, we suggested that the binding of IgG to the apoptotic keratinocytes might be mediated through the interactions with the surface exposed Ro52. The potential role of forming this protein complex on the apoptotic cells will be discussed.

Southwestern Internal Medicine Conference: Sarcoidosis: Immunology and Clinical Management

Sarcoidosis is a chronic inflammatory disease characterized by the presence of noncaseating granulomas in the lung and other organs. Current evidence suggests that this response is driven by a foreign antigen whose identity remains unclear. In this article, the nature of the cellular immune response is explored and the value of local markers of inflammation in predicting clinical course is examined.

Tuberculosis - Immunopathogenesis and therapy

Infection with Mycobacterium tuberculosis (TB) has returned to the forefront of public and medical concern because of the recent sharp increase in the number of cases. Major strides have been made in understanding the pathogenesis of TB, and some of these basic advances are being applied clinically. This review focuses on current concepts of the host response to TB, the changing epidemiology of TB, and optimal treatment strategies.

Southwestern Internal Medicine Conference: Pulmonary Emphysema: Current Concepts of Pathogenesis

Pulmonary emphysema is a major public health problem and is primarily a disease of smokers. The pathogenesis of emphysema in smokers is likely to be multifactorial and may involve protease-antiprotease imbalance, abnormal host response to injury, the inactivation of antiproteases by oxidants, and direct damage of lung tissue by pulmonary phagocytes. The data regarding current concepts of pathogenesis of emphysema in smokers are reviewed in this article.

BR22, a 26 kDa thyroid transcription factor‐1 associated protein (TAP26), is expressed in human lung cells

The current authors have previously identified BR22, a thyroid transcription factor (TTF)‐1 associated protein 26 (TAP26), which interacts with TTF‐1 to enhance human surfactant protein (SP)‐B promoter activity in transfected 293 cells. However, the expression of TAP26 in the lung cells and its biological relevance to the SP‐B production under physiological conditions were not examined. In this study, endogenous co-immunoprecipitation and in situ immunohistochemical staining techniques were employed to explore the presence of TAP26 and TTF‐1 complex in the lung epithelial cells. The correlation of TAP26, TTF‐1 and SP‐B expression was inspected in H441 cells in the presence of dexamethasone, a known positive effector of the SP‐B promoter. Monoclonal antibody (mAb) against TAP26 can co-immunoprecipitate both TAP26 and TTF‐1 from H441 cells. Using this antibody in in situ staining of human lung sections, the data show that TAP26 is present in the lung alveolar epithelial cells. Reverse transcriptase-polymerase chain reaction and Western blot analyses of type-II cells as well as dexamethasone-treated H441 cells suggest that TAP26 expression is modulated coordinately with SP‐B and TTF‐1 in these cells. In summary, the current study demonstrates that thyroid transcription factor‐1 associated protein 26 is an associated protein of thyroid transcription factor‐1 in the lung alveolar epithelial cells where surfactant protein gene expressions take place in vivo.