SUMMARYSkin fibroblasts derived from 6 patients with cystic fibrosis (CF), 1-6 months old, and from 6 age matched donors were investigated for their ability to accumulate cyclic adenosine 3':s'-monophosphate (c-AMP) in response to isoproterenol and prostaglandin E (PGE1) using strictly defined culture conditions. In order to ob&ain, as far as possible,constant protein content and cell number, cultures were synchronized in the early G phase of the cell cycle by growing them in serum free medium bhfore adding stimulating drugs. There were no statistically significant differences both in basal c-AMP or after incubation with theophylline alone. When cultures were thoroughly washed prior to stimulation, c-AMP accumulation in response to isoproterenol was consistently higher (p<0.001) in CF than in normal fibroblasts, whereas response to PGE did not differ significantly. This difference in response can!iot be attributed to differences in doseor time-response curves, or to differential escape of CAMP into the culture medium. Returning the conditioned media (CM) to the cultures after the washing procedure, or omitting the washing procedure altogether, normalized the CAMP response of CF cells. These data indicate that CF fibroblasts "delete" or "add to" the conditioned medium a substance when washed out of the cultures leave the cells hypersensitized to 0-adrenergic stimulation.
SPECULATIONThe enhanced cAMP response to isoproterenol stimulation of CFcells is most likely related to the washing off of a soluble substance which is secreted or deleted into the culture medium in excess of normals. This "factor" could exert its effect in the manner of an antagonist regulating catecholamine responsiveness as a part of a negative feed back loop. Water, electrolyte and macromolecular secretions of exocrine cells are controlled by the action of neurotransmitters of the autonomic nervous system (ANs) (11). Since in CF the disturbance of the exocrine secretions is one of the main symptoms, ANS regulated functions have repeatedly been investigated. Clinical observations in CF patients have demonstrated abnormal pupillary reactions (28) and a clearing of the abnormal turbidity of the saliva after guanethidine treatment, which is an antiadrenergic agent (9). Furthermore a paradoxical discordance between the pulmonary response of the CF-patients to isoproterenol and the response to oral theophylline has been shown (30). In rats, chronically treated with isoproterenol or reserpine, morphological and secretory changes of the salivary glands were reported that strongly resembled the ones observed in CF (31,21,22,23). All these observations lend support to the concept that the primary defect in CF could be linked to a derangement of the ANS in the patients. Adrenergic neurotransmitters stimulate their target cells through specific binding to* and 0-receptor sites on the surface of the cells. As a consequence of the binding to O-receptors, cAMP is formed from ATP by the activation of the enzyme adenylate cyclase present in the plasma membran...