aaIn cystic fibrosis (CF), the most common autosomal recessive disorder of white populations, abnormal exocrine gland secretions lead to persisting endobronchial bacterial infections [1]. Consequently, large numbers of polymorphonuclear leukocytes (PMN) are recruited to the infected airways where PMN activation and lysosomal enzyme release occur [2]. In particular PMN-elastase (PMN-Ela) has been implicated in chronic lung destruction [2], the major cause of morbidity and mortality in CF, and, consequently, trials of aerosol therapy with a 1 -proteinase inhibitor (α 1 -PI, synonymous: α 1 -antitrypsin) have been initiated [3].It is not yet certain whether toxic oxygen metabolites produced by stimulated PMN also contribute to lung injury in CF, as has been suggested in other airway diseases [4][5][6][7]. However, indirect evidence may support this hypothesis; high sputum concentrations of extracellular myeloperoxidase (MPO), a PMN-derived enzyme which transforms hydrogen peroxide (H 2 O 2 ) into highly reactive oxygen metabolites, have been detected in CF patients [8][9][10][11], and lung function has been inversely correlated with MPO levels [9][10][11]. In addition, increased lipid peroxidation [12], reduced free-radical-trapping capacity [13] and altered plasma antioxidant status [12][13][14] have been reported to occur in CF patients.In this study, we have attempted to test this hypothesis by measuring H 2 O 2 concentrations in breath condensates of CF patients, to determine in CF sputum samples activities and concentrations of MPO and catalase (CAT), an enzyme that detoxifies H 2 O 2 to oxygen and water, and, also, to investigate a possible cytotoxic effect of CF sputum on cells and on α 1 -PI in vitro.
Materials and methods
PatientsA total of 63 CF patients from six German CF clinics were studied. Patients (mean±SD (range) age 24±8 (8-37) yrs, males n=30; females n=33) had significantly increased sweat electrolyte levels [15], and were chronically infected by Pseudomonas aeruginosa (n=30) or other pathogens (n=33). All patients were receiving pancreatic enzyme replacement therapy, but no anti-inflammatory medication. All hospitalized patients (n=23) were being treated with parenteral antibiotics against P. aeruginosa. Of the hospitalized patients 10 suffered from acute exacerbations. Mean±SD maximal vital capacity (VCmax) (75±19%) and forced expiratory volume in one second (FEV1) (69±25%) in the CF patients ranked below normal age-predicted values. A total of 54% of the patients had moderately reduced lung function and 46% had severely reduced lung function. Controls included 51 healthy, nonsmoking subjects (27±8 (12-61) yrs) and 23 patients with bronchial asthma (36±16 (12-61) In conclusion, catalase, sulphated glycoconjugates and deoxyribonucleic acid may prevent myeolperoxidase-mediated oxygen radical generation in cystic fibrosis sputum.