Maestrelli P, Occari P, Turato G, Papiris S A, Di Stefano A, Mapp C E, Milani G F, Fabbri L M, Saetta M
Institute of Occupational Medicine, University of Padova, Italy.
Clin Exp Allergy. 1997 Nov;27(11):1292-8.
TDI-induced asthma exhibits clinical, functional and morphological similarities with allergen-induced asthma, suggesting that an immunological mechanism is involved in the sensitization to TDI. In vitro studies using the technique of cloning lymphocytes demonstrated that a great proportion of T-cell clones derived from bronchial mucosa of subjects with TDI-induced asthma produced IL-5 and interferon-gamma, but not IL-4, upon in vitro stimulation.
To investigate in vivo the role of IL-4 and IL-5 on the inflammatory response of the bronchial mucosa to TDI in sensitized subjects, we performed a quantitative analysis of bronchial biopsies.
We obtained bronchial biopsies from six subjects with TDI asthma 48 h after an asthmatic reaction induced by TDI challenge (challenged group), in six subjects with TDI asthma 1-4 weeks after the last exposure to TDI (chronic group), and in six non-asthmatic controls. The number of eosinophils, mast cells, T-lymphocytes, and IL-4 and IL-5 protein positive cells was determined by immunohistochemistry in the area 100 microm beneath the epithelial basement membrane.
The characteristic increase of submucosal eosinophils, but not of mast cells and T-lymphocytes, was observed in the subjects with TDI-induced asthma when compared with controls. No differences were detected between the two groups of asthmatics. In the subjects with TDI-induced asthma, cell immunoreactivity for IL-5 was increased when compared with normal controls. There was no difference in the expression of IL-5 protein between challenged and chronic asthmatics. In contrast, the expression of IL-4 protein was increased only in the asthmatic subjects tested after recent exposure to TDI.
We demonstrated that TDI asthma 48 h after specific bronchial challenge was associated with increased numbers of cells expressing IL-4 and IL-5, whereas chronic TDI asthma was associated with increased expression of IL-5, but not of IL-4. The results suggest that subjects who developed TDI asthma exhibit increased production of IL-5 even in the absence of a recent trigger by the exogenous sensitizer and that production of TH2-like cytokines in TDI-induced asthma may not always be co-ordinately regulated in vivo.
甲苯二异氰酸酯(TDI)诱发的哮喘在临床、功能和形态学上与变应原诱发的哮喘相似,这表明免疫机制参与了对TDI的致敏过程。利用淋巴细胞克隆技术进行的体外研究表明,来自TDI诱发哮喘患者支气管黏膜的很大一部分T细胞克隆在体外刺激后产生白细胞介素-5(IL-5)和干扰素-γ,但不产生IL-4。
为了在体内研究IL-4和IL-5对致敏个体支气管黏膜对TDI炎症反应的作用,我们对支气管活检组织进行了定量分析。
我们从6名TDI哮喘患者在TDI激发诱发哮喘反应后48小时获取支气管活检组织(激发组),从6名TDI哮喘患者在最后一次接触TDI后1 - 4周获取支气管活检组织(慢性组),以及从6名非哮喘对照者获取支气管活检组织。通过免疫组织化学法测定上皮基底膜下方100微米区域内嗜酸性粒细胞、肥大细胞、T淋巴细胞以及IL-4和IL-5蛋白阳性细胞的数量。
与对照组相比,TDI诱发哮喘患者黏膜下嗜酸性粒细胞有特征性增加,而肥大细胞和T淋巴细胞无增加。两组哮喘患者之间未检测到差异。在TDI诱发哮喘患者中,与正常对照相比,IL-5的细胞免疫反应性增加。激发组和慢性哮喘患者之间IL-5蛋白表达无差异。相反,仅在近期接触TDI后接受检测的哮喘患者中IL-4蛋白表达增加。
我们证明,特异性支气管激发后48小时的TDI哮喘与表达IL-4和IL-5的细胞数量增加有关,而慢性TDI哮喘与IL-5表达增加有关,但与IL-4无关。结果表明,即使在没有外源性致敏原近期激发的情况下,发生TDI哮喘的个体也表现出IL-5产生增加,并且在TDI诱发的哮喘中,TH2样细胞因子的产生在体内可能并非总是协同调节的。