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* From the Departments of Pediatrics, Medicine, and Cell Biology and Physiology, Washington University School of Medicine at St. Louis Childrens Hospital, St. Louis, MO.
Correspondence to: Steven D. Shapiro, MD, FCCP, Division of Allergy and Pulmonary Medicine, St. Louis Childrens Hospital, One Childrens Pl, St. Louis, MO 63110; e-mail: shapiro_s{at}kids.wustl.edu
| Introduction |
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Abbreviations:
1-AT =
1-antitrypsin; MMP = matrix
metalloproteinase; MMP-12-/- mice = macrophage elastase-deficient
mice; MMP-12+/+ mice = wild-type mice; NE = neutrophil
elastase; PPE = porcine pancreatic elastase
Animal
models were critical in ushering in the modern era of COPD, after Gross
et al1
found that intratracheal administration of papain
resulted in emphysema in experimental animals. This discovery, combined
with the clinical finding by Laurell and Erikkson2
that patients with
1-antitrypsin
(
1-AT) deficiency were at increased risk for
emphysema, formed the scientific basis for the elastase-antielastase
hypothesis for the pathogenesis of emphysema. Today, 35 years later,
the elastase-antielastase hypothesis is still the prevailing theory for
the development of emphysema, and animal models of COPD remain a
critical experimental tool.
| Elastase-Induced Emphysema |
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The development of emphysema following instillation of other elastases including neutrophil elastase (NE)7 8 and proteinase-3,9 but not nonelastolytic enzymes such as bacterial collagenase, further supports the elastase-antielastase hypothesis. Elastase-induced emphysema remains a useful model of emphysema since it is relatively simple to perform and replicates many aspects of the disease. Of course, exposure to cigarette smoke may cause a variety of other abnormalities not observed in this model. Elastase instillation recently has been used to demonstrate that retinoic acid has the capacity to promote alveolarization and lung repair in adult male rats.10 This model will continue to be most useful in assessing the efficacy of therapeutic agents, particularly those with the capacity to repair lung damage, a critical need in the field.
| Other Models |
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1-AT to
limit NE-mediated lung destruction is currently unknown. Cadmium
chloride is a chemical agent that has been extensively used to generate
airspace enlargement.4
However, airspace enlargement in
this model appears to be secondary to fibrosis with subsequent
tethering and enlargement of airspaces. While this has been viewed as a
disadvantage of the model, we now appreciate that this mechanism also
might be operative in humans with centrilobular
emphysema.11
12
Irritants such as pollutants, oxidants
(nitrogen dioxide), and ozone also have been applied to experimental
animals. These agents cause airway changes, such as injury to
epithelial cells and loss of cilia, but little emphysema. Inorganic
dusts, such as silica, have been associated with neutrophil and
macrophage accumulation and with emphysema.13
Severe
starvation also has been shown to cause emphysema in animals through
unknown mechanism(s). | Natural Genetic Models of Emphysema in Mice |
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| Cigarette Smoke Exposure |
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Murine Model of Cigarette Smoke-Related COPD
We have begun to characterize the similarities and differences
between mice and human lungs following chronic cigarette smoke
exposure. Using smoking chambers similar to those described in the past
for other species,17
we found that mice tolerate at least
two cigarettes per day with carboxyhemoglobin levels of 10 to 14%
following smoke exposure.18
C57BL/6-J mice tolerate
cigarette smoke for at least 1 year, although their activity
decreases and they occasionally die. Unlike humans, mice are obligate
nose-breathers; yet, despite an intricate and extensive nasal sinus
pathway, most of their epithelial cells are olfactory in nature without
extensive cilia, so that they inefficiently filter tobacco smoke
products. Mice have few submucosal glands, which are located
exclusively in the trachea. They also contain Clara cells and
epithelial cells but lack true goblet cells. In C57BL/6-J and A/J mice
at least, ciliated epithelium extend throughout the airway with
increased density in proximal airways. In response to 2 months of
exposure to cigarette smoke, we observed a loss of ciliated epithelial
cells and infiltration of immune and inflammatory cells (T cells,
macrophages, neutrophils, and eosinophils), but saw no change in the
number of Clara cells (S. Seoane, MD, and S.D. Shapiro, MD; unpublished
observations; 1999). We also found that with prolonged cigarette smoke
exposure (> 6 months) small airways are occasionally obstructed with
inflammatory cells and debris and that there are fewer alveolar
attachments. Both of these changes in the small airways have been
hypothesized to contribute to airflow obstruction in
COPD.19
20
Mouse airways have much less extensive
branching than those in humans and lack respiratory bronchioles. In
alveolar spaces, we observed inflammatory cell recruitment and airspace
enlargement in response to cigarette smoke, which is similar to humans.
There is increased alveolar duct area and enlarged alveolar
spaces18
(Fig 1
). Whether these pathologic changes are associated with abnormal
pulmonary function or gas exchange abnormalities awaits further study.
We have also observed marked strain-dependent variability with respect
to the findings discussed earlier, providing a unique opportunity to
uncover COPD susceptibility genes.
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| Gene Targeting |
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Mice are used mainly because of their unique capacity to achieve germline transmission of genetic information. Other advantages of the mouse over other experimental animals include a rapid reproductive cycle, large litter sizes, extensive knowledge of mouse biology, abundancy of mouse probes (such as antibodies and complementary DNAs), and lower cost. Importantly, evolutionary conservation has shown us that mice and other mammals are embarrassingly similar to humans. On the other hand, the applicability of these studies to understanding human biology and dissecting the mechanism of disease requires knowledge of similarities and differences with respect to protein profile between mouse and humans. With respect to COPD, long-term cigarette smoke exposure in mice results in many aspects of emphysema, and some aspects of large and small airway diseases that are observed in humans.
Gain-of-Function (Overexpression) Models
The overexpression of collagenase in the lung of transgenic mice
that results in airspace enlargement is discussed in the study by
DArmiento et al.21
Whether collagen degradation alone is
responsible for airspace enlargement in these mice remains unclear, but
this surprising result raises questions about the intriguing
role of collagen turnover in emphysema. Collagen turnover in emphysema
is complex. Overall, there is net collagen synthesis in COPD with areas
of increased deposition in small airways and depletion in alveolar
walls.12
Further investigation is required to determine
whether collagenase inhibition for emphysema will be beneficial or
harmful, causing increased small airway fibrosis with increased
tethering and enlargement of airspaces.
Loss-of-Function (Underexpression) Models
Strains of mice deficient in individual candidate proteinases can
be compared to determine their contributions to the development of
emphysema in response to cigarette smoke. Macrophage elastase (MMP-12),
nearly undetectable in healthy macrophages, is expressed in the
alveolar macrophages of human cigarette smokers. MMP-12 also may be
detected by immunohistochemistry and in situ hybridization
in macrophages in patients with emphysema, but not in healthy lung
tissue. To determine directly the contribution of macrophage elastase
to emphysema, we generated macrophage elastase-deficient (MMP-12-/-)
mice by gene targeting,22
and subjected MMP-12-/- mice
and wild-type (MMP-12+/+) littermates to chronic cigarette smoke
exposure.18
In contrast to MMP-12+/+ mice, MMP-12-/-
mice did not develop emphysema in response to long-term cigarette smoke
exposure. Surprisingly, MMP-12-/- mice also failed to recruit
macrophages into their lungs in response to cigarette smoke (Fig 2
). Monthly intratracheal instillation of monocyte chemoattractant
protein-1 in MMP-12-/- mice exposed to tobacco smoke resulted in
recruitment of MMP-12-/- alveolar macrophages but failed to cause
airspace enlargement. Thus, MMP-12 is required for both
macrophage accumulation and induction of emphysema resulting
from chronic inhalation of cigarette smoke. Our current working model
is that cigarette smoke induces constitutive macrophages to produce
MMP-12 that cleaves elastin, generating fragments that are chemotactic
for monocytes. This positive feedback loop perpetuates macrophage
accumulation and lung destruction. The concept that proteolytically
generated elastin fragments mediate monocyte chemotaxis is not
original. Independent studies by Senior et al23
as well as
by Hunninghake et al24
from the early 1980s demonstrated
that elastase-generated elastin fragments were chemotactic for
monocytes and fibroblasts. Gene targeting is merely reinforcing this as
a major in vivo mechanism of macrophage accumulation in a
chronic inflammatory condition.
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In summary, the exposure of gene-targeted mice to long-term cigarette
smoke demonstrates that macrophage MMPs have the capacity to cause
airspace enlargement. Moreover, neutrophils and macrophages have
significant interactions, with macrophage MMPs degrading
1-AT and NE degrading tissue inhibitors of
metalloproteinases, each augmenting the proteolytic capacity of the
other. In addition, NE may activate pro-MMPs into their active
form. Finally, macrophages may be required to remove apoptotic
neutrophils. Inefficient apoptosis leads to unopposed NE activity and
emphysema. One cannot rule out the contribution of T-cells,
eosinophils, mast cells, and structural cells of the lung.
| Future Utility of Animal Models for COPD |
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In the future, analysis of murine physiology would be of great assistance in assessing the mouse lesion. In addition, advances in imaging procedures such as CT scans, MRI, positron emission tomography scans, and, ultimately, optical coherence tomography will help to evaluate the pathologic and physiologic changes associated with COPD in mice. The ultimate goal is to utilize the knowledge gained from animal models in treating the many patients who have COPD.
| References |
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