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Lung Fibroblast Repair Functions in Patients with Chronic Obstructive Pulmonary Disease Are Altered by Multiple Mechanisms

¹ Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska; ² Hosptial Grosshansdorf, Center for Pneumology and Thoracic Surgery, Grosshansdorf, Germany; ³ Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan; and ⁴ Division of Respiratory Medicine, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden

Correspondence and requests for reprints should be addressed to Stephen I. Rennard, M.D., University of Nebraska Medical Center, 985885 Nebraska Medical Center, Omaha, NE 68198-5885. E-mail: srennard{at}unmc.edu

Rationale: Fibroblasts are believed to be the major cells responsible for the production and maintenance of extracellular matrix. Alterations in fibroblast functional capacity, therefore, could play a role in the pathogenesis of pulmonary emphysema, which is characterized by inadequate maintenance of tissue structure.

Objectives: To evaluate the hypothesis that deficient fibroblast repair characterizes cells obtained from individuals with chronic obstructive pulmonary disease (COPD) compared with control subjects.

Methods: Fibroblasts were cultured from lung tissue obtained from individuals undergoing thoracotomy and were characterized in vitro. Measurements and Main Results: Fibroblasts from individuals with COPD, defined by reduced FEV₁, manifested reduced chemotaxis toward fibronectin and reduced contraction of three-dimensional collagen gels, two bioassays associated with fibroblast repair function. At least two mechanisms appear to account for these differences. Prostaglandin E (PGE), a known inhibitor of fibroblast repair functions, was produced in increased amount by fibroblasts from subjects with COPD, which also expressed increased amounts of the receptors EP2 and EP4, both of which signal through cyclic AMP. Incubation of fibroblasts with indomethacin or with the PKA inhibitor KT-5720 partially restored COPD subject fibroblast function. In addition, fibroblasts from subjects with COPD produced more transforming growth factor (TGF)-β1, but manifested reduced response to TGF-β1. The functional alterations in fibroblasts correlated with both lung function assessed by FEV₁ and, for the data available, with severity of emphysema assessed by DL_CO.

Conclusions: Fibroblasts from individuals with COPD have reduced capability to sustain tissue repair, which suggests that this may be one mechanism that contributes to the development of emphysema.

Key Words: fibroblasts • prostaglandin E • transforming growth factor-β • chemotaxis • contraction

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Altered tissue structure is a key factor in chronic obstructive pulmonary disease (COPD). What This Study Adds to the Field Lung fibroblasts from patients with COPD demonstrated less activity in several in vitro measures associated with tissue repair. These appeared to be mediated by both increased production of prostaglandin E and decreased sensitivity to transforming growth factor-β.