Subclinical Surface Alterations of Human Pleura

Peng, Ming-Jen; Wang, Nai‐San; Vargas, Francisco Suso; Light, Richard W.

doi:10.1378/chest.106.2.351

Cited by 25 publications

(13 citation statements)

References 5 publications

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“…In rabbits, they are y80 times more dense in the diaphragmatic than in the intercostal pleura [49,50], and absent in the apical regions. Recently, stomas were also found in man [52]. Stomas are the only pathway for cells and particle egress, while protein could also exit the pleural space by solvent drag and transcytosis, possibilities rarely considered [2,4,53].…”

Section: Morphological Basis Of Transpleural Exchangementioning

confidence: 99%

“…Direct in vitro measurements of the biophysical properties of the pleura appear unreliable, because the mesothelium is very labile [6,20,52], and the procedures required to obtain the specimens are likely to damage it [6]. Indeed, studies performed on pleura specimens stripped from the underlying tissues [72,73] provided extremely high values of permeability to water and solutes, which are now regarded as being due to the experimental conditions [28-30, 40-42, 55, 56, 64].…”

Section: Permeability Characteristicsmentioning

confidence: 99%

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Physiology and pathophysiology of pleural fluid turnover

Zocchi¹

2002

Eur Respir J

183

102

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Tight control of the volume and composition of the pleural liquid is necessary to ensure an efficient mechanical coupling between lung and chest wall. Liquid enters the pleural space through the parietal pleura down a net filtering pressure gradient. Liquid removal is provided by an absorptive pressure gradient through the visceral pleura, by lymphatic drainage through the stomas of the parietal pleura, and by cellular mechanisms. Indeed, contrary to what was believed in the past, pleural mesothelial cells are metabolically active, and possess the cellular features for active transport of solutes, including vesicular transport of protein. Furthermore, the mesothelium was shown, on the basis of recent experimental evidence, both in vivo and in vitro, to be a less permeable barrier than previously believed, being provided with permeability characteristics similar to those of the microvascular endothelium. Direct assessment of the relative contribution of the different mechanisms of pleural fluid removal is difficult, due to the difficulty in measuring the relevant parameters in the appropriate areas, and to the fragility of the mesothelium. The role of the visceral pleura in pleural fluid removal under physiological conditions is supported by a number of findings and considerations.Further evidence indicates that direct lymphatic drainage through the stomas of the parietal pleura is crucial in removing particles and cells, and important in removing protein from the pleural space, but should not be the main effector of fluid removal. Its importance, however, increases markedly in the presence of increased intrapleural liquid loads. Removal of protein and liquid by transcytosis, although likely on the basis of morphological findings and suggested by recent indirect experimental evidence, still needs to be directly proven to occur in the pleura. When pleural liquid volume increases, an imbalance occurs in the forces involved in turnover, which favours fluid removal. In case of a primary abnormality of one ore more of the mechanisms of pleural liquid turnover, a pleural effusion ensues. The factors responsible for pleural effusion may be subdivided into three main categories: those changing transpleural pressure balance, those impairing lymphatic drainage, and those producing increases in mesothelial and capillary endothelial permeability. Except in the first case, pleural fluid protein concentration increases above normal: this feature underlies the classification of pleural effusions into transudative and exudative. Eur Respir J 2002; 20: 1545-1558. The thin layer of liquid present between the pleural surfaces has the important function of providing the mechanical coupling between the chest wall and lung, which ensures instantaneous transmission of perpendicular forces between the two structures, and allows their sliding in response to shearing forces [1,2]. It also provides lubrication of the reciprocal motions of the two structures during breathing. Two views, in part compatible, exist on the nature of t...

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Section: Morphological Basis Of Transpleural Exchangementioning

confidence: 99%

Section: Permeability Characteristicsmentioning

confidence: 99%

Physiology and pathophysiology of pleural fluid turnover

Zocchi¹

2002

Eur Respir J

183

102

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“…The difficulty of sampling the thin plural surfaces has been well documented. As summarized by Zocchi (2002), direct in vitro measurements of the biophysical properties of the pleura appear unreliable, because the mesothelium is very labile (Fentie et al, 1986; Peng et al, 1994; Agostoni, 1998), and the procedures required to obtain specimens are likely to compromise it (Agostoni, 1998). In order to minimize pleural sampling artifacts, two independent methods were developed for examining the translocation of fibers to the pleural cavity and any associated inflammatory response following exposure either to the chrysotile and sanded particulate (CSP) or to the amosite asbestos.…”

Section: Introductionmentioning

confidence: 99%

Quantification of the pathological response and fate in the lung and pleura of chrysotile in combination with fine particles compared to amosite-asbestos following short-term inhalation exposure

Bernstein

Rogers

Sepulveda

et al. 2011

Inhalation Toxicology

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The marked difference in biopersistence and pathological response between chrysotile and amphibole asbestos has been well documented. This study is unique in that it has examined a commercial chrysotile product that was used as a joint compound. The pathological response was quantified in the lung and translocation of fibers to and pathological response in the pleural cavity determined. This paper presents the final results from the study. Rats were exposed by inhalation 6 h/day for 5 days to a well-defined fiber aerosol. Subgroups were examined through 1 year. The translocation to and pathological response in the pleura was examined by scanning electron microscopy and confocal microscopy (CM) using noninvasive methods.The number and size of fibers was quantified using transmission electron microscopy and CM. This is the first study to use such techniques to characterize fiber translocation to and the response of the pleural cavity. Amosite fibers were found to remain partly or fully imbedded in the interstitial space through 1 year and quickly produced granulomas (0 days) and interstitial fibrosis (28 days). Amosite fibers were observed penetrating the visceral pleural wall and were found on the parietal pleural within 7 days postexposure with a concomitant inflammatory response seen by 14 days. Pleural fibrin deposition, fibrosis, and adhesions were observed, similar to that reported in humans in response to amphibole asbestos. No cellular or inflammatory response was observed in the lung or the pleural cavity in response to the chrysotile and sanded particles (CSP) exposure. These results provide confirmation of the important differences between CSP and amphibole asbestos.

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“…20 Peng et al observed several gaps between mesothelial cells in two of eleven adult human parietal pleural samples; however, it is uncertain whether these gaps directly communicated with the submesothelial lymphatics in their study. 21 Liu et al reported that the adult human pulmonary ligaments were characterized by the presence of stomata; 22 however, their study did not demonstrate lymphatic stomata properties. The lack of morphological evidence of lymphatic stomata prompted us to examine the adult human pleura.…”

Section: Introductionmentioning

confidence: 93%

Lymphatic Stomata in the Adult Human Pulmonary Ligament

Oshiro

Miura

Iobe

et al. 2015

Lymphatic Research and Biology

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Background: Lymphatic stomata are small lymphatic openings in the serosal membrane that communicate with the serosal cavity. Although these stomata have primarily been studied in experimental mammals, little is known concerning the presence and properties of lymphatic stomata in the adult human pleura. Thus, adult human pleurae were examined for the presence or absence of lymphatic stomata. Methods and Results: A total of 26 pulmonary ligaments (13 left and 13 right) were obtained from 15 adult human autopsy cases and examined using electron and light microscopy. The microscopic studies revealed the presence of apertures fringed with D2-40-positive, CD31-positive, and cytokeratin-negative endothelial cells directly communicating with submesothelial lymphatics in all of the pulmonary ligaments. The apertures' sizes and densities varied from case to case according to the serial tissue section. The medians of these aperture sizes ranged from 2.25 to 8.75 lm in the left pulmonary ligaments and from 2.50 to 12.50 lm in the right pulmonary ligaments. The densities of the apertures ranged from 2 to 9 per mm 2 in the left pulmonary ligaments and from 2 to 18 per mm 2 in the right pulmonary ligaments. However, no significant differences were found regarding the aperture size ( p = 0.359) and density ( p = 0.438) between the left and the right pulmonary ligaments. Conclusions: Our study revealed that apertures exhibit structural adequacy as lymphatic stomata on the surface of the pulmonary ligament, thereby providing evidence that lymphatic stomata are present in the adult human pleura.

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Subclinical Surface Alterations of Human Pleura

Cited by 25 publications

References 5 publications

Physiology and pathophysiology of pleural fluid turnover

Physiology and pathophysiology of pleural fluid turnover

Quantification of the pathological response and fate in the lung and pleura of chrysotile in combination with fine particles compared to amosite-asbestos following short-term inhalation exposure

Lymphatic Stomata in the Adult Human Pulmonary Ligament

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