Peter M. Lackie

Epithelial-mesenchymal interactions in the pathogenesis of asthma.

Abstract During lung development, repair, and inflammation, local production of cytokines (eg, transforming growth factor-β) and growth factors (eg, epidermal growth factor) by epithelial and mesenchymal cells mediate bidirectional growth control effectively creating an epithelial-mesenchymal trophic unit. In asthma the bronchial epithelium is highly abnormal, with structural changes involving separation of columnar cells from their basal attachments and functional changes including increased expression and release of proinflammatory cytokines, growth factors, and mediator-generating enzymes. Beneath this damaged structure there is an increase in the number of subepithelial myofibroblasts that deposit interstitial collagens causing thickening and increased density of the subepithelial basement membrane. Our recent studies suggest that the extent of epithelial damage in asthma may be the result of impaired epidermal growth factor receptor–mediated repair. In view of the close spatial relationship between the damaged epithelium and the underlying myofibroblasts, we propose that impaired epithelial repair cooperates with the TH2 environment to shift the set point for communication within the trophic unit. This leads to myofibroblast activation, excessive matrix deposition, and production of mediators that propagate and amplify the remodeling responses throughout the airway wall. (J Allergy Clin Immunol 2000;105:193-204.)

Rhinoviruses Infect the Lower Airways

Rhinoviruses are the major cause of the common cold and a trigger of acute asthma exacerbations. Whether these exacerbations result from direct infection of the lower airway or from indirect mechanisms consequent on infection of the upper airway alone is currently unknown. Lower respiratory infection was investigated in vitro by exposing primary human bronchial epithelial cells to rhinoviruses and in vivo after experimental upper respiratory infection of human volunteers. Bronchial infection was confirmed by both approaches. Furthermore, rhinoviruses induced production of interleukin-6, -8, and -16 and RANTES and were cytotoxic to cultured respiratory epithelium. This evidence strongly supports a direct lower respiratory epithelial reaction as the initial event in the induction of rhinovirus-mediated asthma exacerbations. The frequency of infection and the nature of the inflammatory response observed are similar to those of the upper respiratory tract, suggesting that rhinovirus infections may be one of the most important causes of lower in addition to upper respiratory disease.

A genome-wide association study identifies CDHR3 as a susceptibility locus for early childhood asthma with severe exacerbations

Asthma exacerbations are among the most frequent causes of hospitalization during childhood, but the underlying mechanisms are poorly understood. We performed a genome-wide association study of a specific asthma phenotype characterized by recurrent, severe exacerbations occurring between 2 and 6 years of age in a total of 1,173 cases and 2,522 controls. Cases were identified from national health registries of hospitalization, and DNA was obtained from the Danish Neonatal Screening Biobank. We identified five loci with genome-wide significant association. Four of these, GSDMB, IL33, RAD50 and IL1RL1, were previously reported as asthma susceptibility loci, but the effect sizes for these loci in our cohort were considerably larger than in the previous genome-wide association studies of asthma. We also obtained strong evidence for a new susceptibility gene, CDHR3 (encoding cadherin-related family member 3), which is highly expressed in airway epithelium. These results demonstrate the strength of applying specific phenotyping in the search for asthma susceptibility genes.

The bronchial epithelium as a key regulator of airway inflammation and remodelling in asthma

While asthma is an inflammatory disorder of the airways involving mediator release from mast cells and eosinophils and orchestrated by T cells, inflammation alone is insufficient to explain the chronic nature of the disease and its progression. Evidence is presented that the epithelium is fundamentally disordered in chronic asthma manifest by increased fragility, and an altered phenotype to one that secretes mucus, mediators, cytokines, chemokines and growth factors. Epithelial injury is mediated by exogenous factors such as air pollutants, viruses and allergens as well as by endogenous factors including the release of proteolytic enzymes from mast cells (tryptase, chymase) and eosinophils (MMP‐9). Following injury, the normal epithelium should respond with increased proliferation driven by ligands acting on epidermal growth factor (EGF) receptors or through transactivation of the receptor. The epithelial response to these stimuli in asthma appears to be impaired despite upregulation of CD44 capable of enhancing presentation of EGF ligands to epidermal growth factor receptors (EGFR). Because the epithelium is ‘held’ in this repair phenotype, it becomes a continuous source of proinflammatory products as well as growth factors that drive airway wall remodelling.

Mechanisms of airway epithelial damage: epithelial-mesenchymal interactions in the pathogenesis of asthma

The aims of this article are to understand the shortfalls in thinking of asthma purely as an atopic disorder, to gain insight into the epithelial abnormalities of asthma and how these interface with the environment, and to view asthma as a disease of airway wall restructuring that engages activation of the epithelial mesenchymal trophic unit (EMTU). Furthermore, based on these developments, possible novel therapeutic targets for chronic asthma are identified. It has long been recognised that T‐helper cell (Th) type‐2 airway inflammation underpins airway dysfunction in asthma. Atopy is also a key feature of this disease but accounts for <40% of the population attributable risk. Based on a careful pathological and functional assessment of chronic asthma, the authors propose that altered epithelial-mesenchymal communication is also fundamental to disease pathogenesis. A number of factors contribute to a thickened hyperresponsive airway that provides an ideal microenvironment for the persistence of Th2‐mediated inflammation, including a more susceptible epithelium to injury, delayed epithelial repair, an altered trajectory of epithelial repair to a mucus-secreting phenotype, generation of growth factors that drive mesenchymal cell proliferation and differentiation towards increased matrix deposition and smooth muscle, and the production of neural and vascular growth factors. Cytokines and mediators derived from infiltrating inflammatory cells interact with this EMTU to augment and prolong responses. The “remodelling” changes of asthma have been observed in childhood asthma and may, indeed, precede the development of the disease. The recent recognition that atopy per se is not a key factor in the initiation of asthma (although it is important in aggravating the disease) suggests that gene-environmental interactions involving similar processes to those occurring in branching morphogenesis are critical for the full asthma phenotype to develop. A recent National Institutes for Health Workshop and a European Respiratory Society Task Force both concluded that more work …

Nitric oxide in primary ciliary dyskinesia

Nitric oxide is continually synthesised in the respiratory epithelium and is upregulated in response to infection or inflammation. Primary ciliary dyskinesia (PCD) is characterised by recurrent sinopulmonary infections due to impaired mucociliary clearance. Despite chronic infections, nasal nitric oxide in such patients is markedly reduced and is used as a screening test for this condition. These low levels were first described >15 yrs ago but the underlying mechanisms have yet to be fully elucidated. We review epithelial nitric oxide synthesis, release and measurement in the upper airways with particular reference to PCD. The key hypotheses that have been proposed to explain the low nitric oxide levels in this condition are explored and the potential benefits of augmenting airway nitric oxide levels are considered. Further work in these patients clarifying both whether the respiratory epithelium is able to biosynthesise normal levels of nitric oxide and the role played by abnormalities in the anatomy of the paranasal sinuses is essential. While nitric oxide augmentation is unlikely to be beneficial in common PCD phenotypes, it has potential in the treatment of secondary dyskinesias and may also improve treatment of bacterial infections, particularly where biofilms are implicated.

Invited Lecture: Activation of the Epithelial Mesenchymal Trophic Unit in the Pathogenesis of Asthma

Background: A recent NIH Workshop and an ERS Task Force concluded that more work was needed to understand mechanisms of severe and chronic asthma. This report describes a series of studies that identify aberrant epithelial mesenchymal signalling in the airways as an important event in maintaining inflammation and driving remodelling in response to environmental injury. Methods: Immunohistochemistry, genotyping and functional studies conducted on cultured asthmatic cells and mucosal biopsies were used to identify biochemical pathways involved in epithelial injury and repair in asthma and their relationship to disease severity. Results: Our findings suggest that the asthmatic state results from an interaction between a susceptible epithelium and Th-2-mediated inflammation to alter the communication between the epithelium and the underlying mesenchyme – the epithelial mesenchymal trophic unit – leading to disease persistence, airway remodelling and refractoriness to corticosteroid treatment. Conclusions: Asthma is more than an inflammatory disorder, but requires engagement of important signalling pathways involved in epithelial repair and tissue remodelling. These pathways involving EGFRs and TGF-βRs provide targets against which to develop novel therapies for chronic asthma.

Human bronchial epithelial cells express an active and inducible biosynthetic pathway for leukotrienes B4 and C4

Background Human bronchial epithelial cells synthesize cyclooxygenase and 15‐lipoxygenase products, but the 5‐lipoxygenase (5‐LO) pathway that generates the leukotriene (LT) family of bronchoconstrictor and pro‐inflammatory mediators is thought to be restricted to leucocytes.

Culture of Primary Ciliary Dyskinesia Epithelial Cells at Air-Liquid Interface Can Alter Ciliary Phenotype but Remains a Robust and Informative Diagnostic Aid

Background The diagnosis of primary ciliary dyskinesia (PCD) requires the analysis of ciliary function and ultrastructure. Diagnosis can be complicated by secondary effects on cilia such as damage during sampling, local inflammation or recent infection. To differentiate primary from secondary abnormalities, re-analysis of cilia following culture and re-differentiation of epithelial cells at an air-liquid interface (ALI) aids the diagnosis of PCD. However changes in ciliary beat pattern of cilia following epithelial cell culture has previously been described, which has brought the robustness of this method into question. This is the first systematic study to evaluate ALI culture as an aid to diagnosis of PCD in the light of these concerns. Methods We retrospectively studied changes associated with ALI-culture in 158 subjects referred for diagnostic testing at two PCD centres. Ciliated nasal epithelium (PCD n = 54; non-PCD n = 111) was analysed by high-speed digital video microscopy and transmission electron microscopy before and after culture. Results Ciliary function was abnormal before and after culture in all subjects with PCD; 21 PCD subjects had a combination of static and uncoordinated twitching cilia, which became completely static following culture, a further 9 demonstrated a decreased ciliary beat frequency after culture. In subjects without PCD, secondary ciliary dyskinesia was reduced. Conclusions The change to ciliary phenotype in PCD samples following cell culture does not affect the diagnosis, and in certain cases can assist the ability to identify PCD cilia.

Basement Membrane Pores in Human Bronchial Epithelium: A Conduit for Infiltrating Cells?

This study reports the presence of oval-shaped pores in the basement membrane of the human bronchial airway that may be used as conduits for immune cells to traffic between the epithelial and mesenchymal compartments. Human bronchial mucosa collected after surgery was stripped of epithelial cells without damaging the basement membrane. Both scanning and transmission electron microscopy showed oval-shaped pores 0.75 to 3.85 microm in diameter in the bronchial basement membrane at a density of 863 pores/mm2. Transmission electron microscopy showed that the pores spanned the full depth of the basement membrane, with a concentration of collagen-like fibers at the lateral edges of the pore. Infiltrating cells apparently moved through the pores, both in the presence and absence of the epithelium. Taken together, these results suggest that immune cells use basement membrane pores as predefined routes to move between the epithelial and mesenchymal compartments without disruption of the basement membrane. As a persistent feature of the basement membrane, pores could facilitate inflammatory cell access to the epithelium and greatly increase the frequency of intercellular contact between trafficking cells.