Abstract
Chronic obstructive pulmonary disease (COPD) kills approximately 2.8 million people each year, and more than 80% of COPD cases can be attributed to smoking. Leukocytes recruited to the lung contribute to COPD pathology by releasing reactive oxygen metabolites and proteolytic enzymes. In this work, we investigated where leukocytes enter the lung in the early stages of COPD in order to better understand their effect as a contributor to the development of COPD. We simultaneously evaluated the parenchyma and airways for neutrophil accumulation, as well as increases in the adhesion molecules and chemokines that cause leukocyte recruitment in the early stages of tobacco smoke induced lung disease. We found neutrophil accumulation and increased expression of adhesion molecules and chemokines in the bronchial blood vessels that correlated with the accumulation of leukocytes recovered from the lung. The expression of adhesion molecules and chemokines in other vascular beds did not correlate with leukocytes recovered in bronchoalveolar lavage fluid (BALF). These data strongly suggest leukocytes are recruited in large measure through the bronchial circulation in response to tobacco smoke. Our findings have important implications for understanding the etiology of COPD and suggest that pharmaceuticals designed to reduce leukocyte recruitment through the bronchial circulation may be a potential therapy to treat COPD.
Highlights
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States [1], and 80–90% of COPD cases can be attributed to smoking [2]
More distal airways demonstrated an abundance of goblet cells lining the luminal surface and increased cellularity within the airway wall, including the presence of neutrophils and accumulation of macrophages and neutrophils within the lumen of the airways frequently enmeshed in a thick mucous lining
Consistent with the pathology observed in the hematoxylin and eosin staining, there was no increase in airspace enlargement after 3 days of smoke exposure compared to filtered air (3-day tobacco smoke (TS) vs. FA contrast in mean mean linear intercept (MLI) = 1.7; 95% CI = 29.8 to 13.3; p = 0.77)
Summary
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States [1], and 80–90% of COPD cases can be attributed to smoking [2]. COPD is characterized by airflow limitation presented as either chronic bronchitis, emphysema or both. Chronic bronchitis is distinguished by excessive mucous production, airway wall thickening, epithelial squamous metaplasia, and leukocyte recruitment to airway walls [3]. Emphysema is characterized by airspace enlargement and parenchymal destruction [4]. Leukocytes recruited to the lung in response to tobacco smoke contribute to the development of both airway and alveolar manifestations of COPD by releasing reactive oxygen metabolites and proteolytic enzymes. Positive feedback loops are triggered that perpetuate leukocyte recruitment, subsequent airway epithelial damage and airspace enlargement after smoking cessation [5]. Chemokines facilitate transmigration of leukocytes out of the blood vessels and to the inflamed tissue [6]
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