Published ahead of print on March 24, 2005, doi:10.1165/rcmb.2004-0293OC
© 2005 American Thoracic Society DOI: 10.1165/rcmb.2004-0293OC Defective Surfactant Secretion in a Mouse Model of Hermansky-Pudlak SyndromeDivision of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia; Institute for Environmental Medicine and Department of Physiology, and Pulmonary and Critical Care Division, Department of Medicine University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and Department of Molecular and Cellular Biology, Roswell Park Cancer Institute, Buffalo, New York Correspondence and requests for reprints should be addressed to Susan Guttentag, M.D., Abramson Research Center 416G, Children's Hospital of Philadelphia, 3516 Civic Center Blvd., Philadelphia, PA 19104-4318. E-mail: guttentag{at}email.chop.edu
Hermansky-Pudlak syndrome (HPS) in humans represents a family of disorders of lysosome-related organelle biogenesis associated with severe, progressive pulmonary disease. Human case reports and a mouse model of HPS, the pale ear/pearl mouse (ep/pe), exhibit giant lamellar bodies (GLB) in type II alveolar epithelial cells. We examined surfactant proteins and phospholipid from ep/pe mice to elucidate the process of GLB formation. The 2.8-fold enrichment of tissue phospholipids in ep/pe mice resulted from accumulation from birth through adulthood. Tissue surfactant protein (SP)-B and -C were increased in adult ep/pe mice compared with wild-type mice (WT), whereas SP-A and -D were not different. Large aggregate surfactant (LA) from adult ep/pe mice had decreased phospholipid, SP-B, and SP-C, with no differences in SP-A and -D compared with WT. Although LA from ep/pe animals exhibited an increased total proteintototal phospholipid ratio compared with WT, surface tension was not compromised. Phospholipid secretion from isolated type II cells showed that basal and stimulated secretion from ep/pe cells were 50% of WT cells. Together, our data indicate that GLB formation is not associated with abnormal trafficking or recycling of surfactant material. Instead, impaired secretion is an important component of GLB formation in ep/pe mice.
Key Words: alveolar type II cell Hermansky-Pudlak syndrome lamellar body secretion surfactant
The lamellar body of alveolar epithelial type II cells is a lysosome-related, intracellular storage organelle for newly synthesized and recycled surfactant components. As such, this organelle interfaces with both the secretory and endosomal pathways within the type II cell. Newly synthesized hydrophobic surfactant proteins, surfactant protein (SP)-B and -C, traffic to (and, in the case of SP-C, complete post-translational processing in) the lamellar body (1), whereas the hydrophilic surfactant protein, SP-A, only enters the lamellar body after it is recycled into the type II cell via receptor-mediated endocytosis (2). Surfactant-specific phospholipids, such as disaturated phosphatidylcholine, are packaged into lamellar bodies through a mechanism that is, at present, poorly understood. The recent description of ABCA3, an ATP-binding cassette transporter, in the limiting membrane of lamellar bodies suggests that this protein may play a role in concentrating phospholipid into lamellar bodies (3).
Like other lysosome-related organelles, such as melanosomes and platelet dense granules, lamellar bodies undergo a process of maturation and regulated secretion. Maturation is implied from the observation that not all lamellar bodies are released upon secretagogue stimulation (4). Lamellar body secretion is triggered via at least three signaling pathways: activation of adenylate cyclase, protein kinase C, a cAMP-dependent protein kinase, and Ca++-regulated activation of Ca++-calmodulin-dependent protein kinase (reviewed in Ref. 5). Lamellar bodies engage the exocytic machinery in part through the actions of annexin II (6) and Despite the wealth of information on lamellar body contents and secretion, surprisingly little is known about the process of lamellar body genesis. Electron microscopic studies have suggested that the lamellar body results from redistribution of phospholipid membranes within and repeated fusion with multivesicular bodies (1). These late endosomes develop through the invagination of limiting membrane into the interior of the organelle, and in theory, through the action of the fusogenic SP-B, resulting in lysis of the interior vesicles. The role of SP-B is supported by the presence of multivesicular bodies but not lamellar bodies in mice in which the SP-B gene has been deleted (9), in addition to prior demonstration of the fusogenic potential of SP-B in vitro (10). Organelles in transition between multivesicular bodies and lamellar bodies, referred to as composite bodies, have similarly been described within type II cells (1). Disorders of lamellar body genesis currently fall into two categories: (1) failure of production, and (2) formation of giant lamellar bodies. In addition to SP-B deficiency (11, 12), impaired lamellar body genesis was observed in patients with neonatal respiratory failure associated with defects in the ATP-binding cassette protein, ABCA3 (13). Giant lamellar bodies have been described in human patients and in animal models. For example, Hermansky-Pudlak syndrome consists of several different genetic defects sharing the common clinical phenotype of oculocutaneous albinism and defective platelet dense granule function. Selected subsets of patients with Hermansky-Pudlak syndrome also exhibit pulmonary pathology, including enlarged foamy type II cells and progressive pulmonary fibrosis, often leading to death (14). The etiology of the severe, progressive pulmonary fibrosis that develops in the fourth decade is unclear (15). Bred initially for their attractive coat colors, there are several congenic strains of mice notable for varying degrees of oculocutaneous albinism (recently reviewed in Ref. 16). Many of these coat color mutant mice carry genetic defects homologous to mutations in patients with Hermansky-Pudlak Syndrome and phenocopy the human disease with the exception of the pulmonary fibrosis. Instead, the common pulmonary finding in the mouse mutants is progressive emphysema (17). Attempts to mimic the human phenotype using intercrosses enhanced the mouse phenotype but did not result in pulmonary fibrosis. Offspring of intercrosses between pale ear (involving the HPS1 protein of the BLOC-3 complex) and pearl (involving the Ap3b1 subunit of the AP-3 complex) mice exhibited enlarged foamy alveolar type II cells, inflammation, and reduced survival due to severe emphysema (double mutant ep/ep, pe/pe, herein designated as ep/pe, 18). The observed increases in surfactant components in the tissues of ep/pe mice are consistent with the giant lamellar bodies demonstrated by electron microscopy and with the purported role of these protein complexes in post-Golgi vesicular trafficking. In this report, we examined the surfactant protein and phospholipid composition of tissues and bronchoalveolar lavage from ep/pe animals to begin to understand the mechanism for giant lamellar body formation in alveolar type II cells. The lamellar body lies at the intersection of the synthetic, lysosomal, and endocytic pathways; therefore, we chose to focus on surfactant components that participate in these pathways to investigate the mechanism of giant lamellar body formation. In vitro studies of isolated alveolar type II cells indicate that lamellar body secretion is impaired but not abrogated, thus leading to tissue accumulation and alveolar deficiency of surfactant phospholipid and hydrophobic proteins. Furthermore, the developmental accumulation of phospholipids indicates that this is a lifelong process in ep/pe mice. After demonstrating that synthesis and recycling of surfactant components are essentially intact, we suggest that the impaired secretion of giant lamellar bodies is a problem of lamellar body maturation.
Animals Wild type C57BL/6J mice and mutant Hps1ep/Hps1ep, Ap3b1pe/Ap3b1pe (ep/pe) mice on the same C57BL/6J background at 1015 wk old (unless otherwise specified) were all maintained and bred at the Roswell Park Cancer Institute as previously described (19). Male animals were used exclusively for these studies; however, prior work indicated no differences between male and female animals (18). Animals were shipped for surfactant studies as described below and killed within 2 d of transport. All animal protocols were reviewed and approved by the Institutional Animal Care and Use Committees and adhered to the principles of the National Institutes of Health Guide for the Care and Use of Laboratory Animals.
Reagents
Preparation and Analysis of Surfactant Fractions from Bronchoalveolar Lavage Large aggregate (LA) pellets resuspended in saline, and small aggregate (SA) fractions, were reserved for biochemical characterization. The total protein content of the samples from LA and SA fractions was determined with the method of Bradford, with bovine IgG as a standard (23). The total phospholipid content of the samples from LA and SA fractions was determined with the method of Bartlett (24).
Capillary Surfactometer
Real-Time RT-PCR
Western Immunoblotting
Type II Cell Isolation and Phospholipid Secretion Studies
Immunostaining and Fluorescence Microscopy
Statistical Analyses
Increased Surfactant Components in Lung Tissue from ep/pe Mice Total phospholipids in the lung tissue of ep/pe animals were elevated 2.8-fold compared with wild-type 10- to 15-wk-old adult animals (WT 134.7 ± 10.4 versus ep/pe 379.6 ± 39.5 mcg, ***P < 0.001), as previously noted (18). Examination of animals from birth through 15 wk revealed that tissue phospholipid content was statistically similar between WT and mutant mice on Postnatal Days 0 and 1, followed by a significant, progressive increase in tissue phospholipid that continued into adulthood in the ep/pe mice (Figure 1). Tissue phospholipid levels were nearly doubled by 3 d postnatally in ep/pe mice compared with WT controls.
Both mature hydrophobic surfactant proteins, SP-B and SP-C, were markedly increased in the lung tissue of ep/pe mice (Figure 2), whereas the hydrophilic surfactant proteins SP-A and SP-D were not different from WT animals. The levels of mature SP-C in WT mouse and human lung tissue homogenates are too low to be reliably detected by the SP-C antibody, whereas the antibody consistently detects SP-C in LA surfactant fractions. In keeping with this, the WT lung tissue homogenates exhibited poor immunoreactivity for SP-C. Conversely, the SP-C signal from the ep/pe lung tissue was robust, reflecting a large increase in tissue SP-C in the mutant animals (Figure 2b). The 2.2-fold induction of SP-B in ep/pe lung tissue was statistically significant, but because the SP-C levels in the WT lung tissue were not quantifiable, fold-induction could not be assessed for mature SP-C from ep/pe animals. Despite the increased lamellar body size described previously in ep/pe mice and the observed increases in tissue phospholipid and hydrophobic surfactant proteins, there were no significant differences in RNA for SP-A, -B, or -D by real-time RT-PCR (Figure 3). However, SP-C mRNA was decreased by 32% in ep/pe animals (WT 100.0 ± 3.6% versus ep/pe 67.9 ± 7.7%, *P < 0.05).
Altered Surfactant Phospholipid Content of BAL in ep/pe Animals Enlarged lamellar bodies, a feature of the ep/pe mice, have also been described in the beige mouse model of Chediak-Higashi syndrome, in which the gene defect is in the CHS1/LYST1 gene regulating lysosomal size (32). Because previous studies of beige mice indicated that the lavage phospholipid was decreased concomitantly with increased lung tissue phospholipid (33, 34), we examined total phospholipids from the bronchoalveolar lavage, and large and small aggregate surfactant fractions of individual animals, both WT and ep/pe. We found a 42% reduction in BAL total phospholipid in ep/pe mice compared with WT mice (Figure 4a), in spite of the 2.8-fold increase in tissue phospholipid. The total phospholipid in the large aggregate and small aggregate fractions from the ep/pe animals were proportionately decreased (LA: 44% reduction from WT; SA: 38% reduction from WT).
To examine the quality of the recovered surfactant, we examined both the SA:LA phospholipid ratio and the total protein: phospholipid ratio. The ratio of phospholipid in SA versus LA fractions is an indicator of surfactant function (35), with the ratio increasing as inactivated surfactant accumulates in the SA fraction. We found no difference in the SA:LA ratio (WT 0.58 ± 0.04, ep/pe 0.66 ± 0.11, n = 5, NS), suggesting that there was no increased conversion to inactive surfactant in the ep/pe mice. Furthermore, BAL and LA total protein levels were not significantly different in ep/pe and WT animals (Figure 4b), whereas SA surfactant total protein was increased by 2.2-fold compared with WT animals. However, when we examined these results together, ep/pe animals exhibited an increased total protein to total phospholipid ratio in BAL, LA, and SA surfactant fractions (Figure 4c).
Decreased LA Surfactant Proteins in ep/pe Mice
To determine whether ep/pe mice exhibited altered surface tension properties as a result of these BAL abnormalities, we performed capillary surfactometry on individual LA surfactant samples from ep/pe and WT mice. All samples were corrected to a final concentration of 1 µg/µl phospholipid for these studies. The duration of capillary patency was not significantly different in comparing the ep/pe LA samples to LA surfactant from WT mice (ep/pe 77.4 ± 5.5% open, WT 87.3 ± 3.5% open, P = 0.15), indicating no surfactant dysfunction in ep/pe mice.
Decreased Stimulated Secretion by Type II Cells Isolated from ep/pe Mice
In vitro secretion under basal conditions and in response to secretagogue (1 mM ATP) was examined. Because phosphatidylcholine secretion from C57Bl/6 mice type II cells is linear over a 1- to 4-h time period (36), secretion was examined over a 2-h stimulation period. Incorporation of labeled choline into phosphatidylcholine was not different in type II cells from ep/pe or WT mice (428 ± 43 versus 414 ± 86 cpm/mcg protein, respectively, P = 0.875). Unstimulated release (basal) from ep/pe type II cells was 38% of WT type II cells, whereas stimulated release (ATP) from ep/pe type II cells was 46% of WT cells (Figure 7A). WT cells exhibited a significantly increased PC release upon ATP stimulation (1.73-fold). As also shown in the representative time course (Figure 7B), although ep/pe type II cells were responsive to ATP stimulation, the increase above basal secretion was not statistically significant.
We undertook these studies to characterize surfactant metabolism in the ep/pe mouse as a model of Hermansky-Pudlak syndrome, and we found that surfactant components were indeed altered in the ep/pe mouse lung. Giant lamellar body formation was associated with increased tissue phospholipids, as previously shown (18), and increased tissue content of the mature hydrophobic surfactant proteins SP-B and SP-C. Conversely, alveolar content of phospholipids and mature SP-B and -C proteins were decreased in ep/pe mice compared with WT animals. Furthermore, there were no abnormalities of SP-A or -D in either lung tissue or alveolar surfactant in the ep/pe animals. In vitro studies showed that giant lamellar body formation was also associated with decreased basal and stimulated secretion of surfactant. Together, these data strongly suggest that impaired lamellar body secretion is an important component of giant lamellar body formation in ep/pe mice. There are several possible mechanisms for giant lamellar body formation. Lamellar bodies are lysosome-like storage organelles derived from multivesicular bodies, receiving protein, phospholipids, and other constituents via the secretory, lysosomal, and endocytic pathways. Therefore, abnormal trafficking of lamellar body contents to the lamellar body, excessive re-uptake into the type II cell, defective intracellular transport to the plasma membrane, defective secretion at the plasma membrane, and abnormal lamellar body maturation might all result in giant lamellar body formation. Lamellar body formation is poorly understood, but several aspects of this process have been well described. SP-B deficiency, either due to a primary genetic defect or due to protease inhibition, impairs lamellar body formation from its precursor, the multivesicular body. In association with this defect, SP-C is incompletely processed leading to intracellular and extracellular accumulation of 7- to 10-kD intermediates of SP-C. Despite defective lamellar body formation, tissue and alveolar phospholipid content are minimally disturbed (37). The gene defect in the ep/pe mice compromised neither post-translational processing of SP-B and -C nor trafficking of the hydrophobic surfactant proteins to lamellar bodies, as determined by analysis of the lung tissue. In addition to verifying anterograde transport of SP-B and -C, these data also imply the proper trafficking of lysosomal enzymes required for the proteolytic processing of the hydrophobic surfactant proteins. In the ep/pe mice, the mature SP-B and SP-C accumulate because they are not being secreted. The previous report of this mouse model indicated that proSP-C was also increased (18). Because some of the processing events in SP-C biosynthesis occur within the lamellar body, it is reasonable that both proSP-C and mature SP-C proteins might be increased in the type II cells of ep/pe mice. Interestingly, although we found no impairment of SP-B mRNA, we noted a 32% decrease in SP-C mRNA associated with the accumulation of these hydrophobic proteins in ep/pe mice, suggesting that there may be an attempt to downregulate further production of SP-C. Given the recently described toxicity of aberrant SP-C proteins (38), it is possible that the accumulation of SP-C plays a role in the pulmonary pathophysiology in the ep/pe animals. We also found that the important lamellar body membrane protein ABCA3 was located in the membranes of the lamellar bodies in type II cells isolated from ep/pe mice. ABCA3, an ATP-binding cassette protein, localizes to the limiting membrane of the lamellar body and traffics between lamellar body and plasma membrane (3). Recently, ABCA3-deficient patients with neonatal respiratory failure were shown to have small lamellar bodies, data supporting a possible role of ABCA3 in lamellar body formation (13). The presence of ABCA3 in the limiting membrane of lamellar bodies of ep/pe mice indicates that anterograde trafficking of this lamellar body constituent is also normal in ep/pe mice. Finally, our in vitro studies indicate that phospholipid synthesis is similar in both WT and ep/pe mice, indicating that the formation of giant lamellar bodies is not due to over-production of phospholipids destined for lamellar body storage. Together our data indicate that it is unlikely that giant lamellar body formation is due to abnormal anterograde trafficking of lamellar body constituents. Up to 80% of alveolar surfactant is recycled back into type II cells for repackaging into lamellar bodies. Therefore, enhanced reuptake of surfactant components could explain both the tissue accumulation and alveolar deficit in the ep/pe mice. One of the primary modes of recycling surfactant into the type II cell involves the internalization of SP-A and lipid via a coated pit pathway into an early endosome compartment, possibly through interaction with an SP-A receptor (39, 40). SP-A recycles back to the surface of the cell and is resecreted while lipid is transferred to lamellar bodies (40, 41). If inhibition of this pathway were a primary mechanism for giant lamellar body formation, then SP-A would be expected to accumulate in the lung tissue and become depleted from the BAL of ep/pe mice. Instead we found that both hydrophilic surfactant proteins SP-A and SP-D were unaffected in lung tissue and BAL from ep/pe mice. Lamellar body maturation is also poorly understood; however, it is well known that upon a secretory stimulus, only a fraction of lamellar bodies in type II cells are secreted. Surfactant release after sustained exposure of type II cells to secretagogues is linear over 4 h and then plateaus, indicating that the lamellar bodies left within the type II cell are not yet capable of secretion (36). We have shown that both basal and stimulated secretion were decreased in the isolated type II cells of ep/pe mice. The 50% reduction in basal and stimulated phospholipid secretion from type II cells is consistent with our observed decrease in total LA surfactant phospholipid, SP-C and SP-B, all of which are secreted in concert from lamellar bodies (42). Importantly, secretion of lamellar bodies is not abolished in the ep/pe mice. The presence of surfactant in the BAL with normal phospholipid:hydrophobic protein ratios, despite reduced alveolar content, is evidence for lamellar body secretion. Although alternate pathways such as decreased catabolism or enhanced uptake of phospholipid components have not been ruled out, our studies strongly indicate that impaired maturation of lamellar bodies resulting in reduced secretion in the ep/pe mice is a major contributing factor in the tissue accumulation and BAL deficit of surfactant. The defect in the ep/pe pulmonary system is reminiscent of the reduced secretion of lysosomes in the beige mouse model of Chediak-Higashi syndrome, involving mutation of the CHS1/LYST1 gene (32). Beige mice develop foamy alveolar type II cells due to the presence of numerous large lamellar bodies, on average approaching 4-fold increased lamellar body diameter compared with control animals (43). Alveolar lavage DSPC pool size in beige mice was reduced to 60% of controls (34), similar to the 50% reduction in phospholipids we observed in the ep/pe mice. Although lamellar body secretion from type II cells was not directly studied in the beige mouse, defective secretion of enlarged fibroblast (44) and kidney (45) lysosomes has been demonstrated, with remarkable similarity to the decreased lamellar body secretion we observed from the ep/pe mouse type II cells. CHS-1/LYST1 regulates lysosome size, and overexpression in fibroblasts is associated with small lysosomes, whereas the knockout phenotype results in giant lysosomes (reviewed in Ref. 46). In studies of macrophages isolated from beige mice, smaller lysosomes from beige mouse macrophages were capable of transport along microtubules while the giant lysosomes were not (44). Importantly, this defect could be duplicated in normal macrophages after phagocytosis of enlarged beads, suggesting that the lysosome size is a critical determinant in lysosomal transport. Previous studies of the secretion of kidney lysosomes indicated defective secretion in ep/ep and pe/pe mice (47). Although similar studies have not been undertaken in the ep/pe mice, the variability in lamellar body size and our observation that lamellar body secretion was impaired but not abolished in ep/pe mice are consistent a defect in transit to the plasma membrane of giant lamellar bodies. Regardless of mechanism, giant lamellar body formation is associated with progressive lung pathology in the ep/pe mice. Our data show that tissue phospholipid accumulation from the resulting giant lamellar bodies begins early in postnatal life and continues into adulthood as has been seen in gene-targeted SP-C and SP-D mice (4850). The observed pathology is unlikely due to the decreased BAL phospholipids, SP-B and SP-C, as we observed normal surface tension of the LA surfactant fraction. Although SP-B levels were decreased by > 50% in the ep/pe mouse LA fraction, capillary surfactometry was unchanged. This was not surprising in light of studies by Ikegami and colleagues showing that the presence of adequate SP-C can compensate for a paucity of SP-B in unstressed, transgenic mice (50). Thus, although the levels of surfactant are reduced, there is a sufficient quantity of normal material to maintain adequate respiratory function. Although there is evidence for the presence of lung inflammation and emphysema (18), further studies are needed to completely characterize the pulmonary complications in this mouse model as well as in patients with HPS. In summary, the results demonstrate that the cellular defect in the ep/pe mice does not interfere with synthesis of lamellar body contents or the initial transfer of these components into the lamellar body. Recycling is likewise normal in the ep/pe mice. Secretion is significantly impaired but not abrogated in this mouse model, indicating that, if able to engage the transport machinery, lamellar bodies are capable of secretion. One remaining cellular process that could explain giant lamellar body formation in the ep/pe mouse is the poorly understood area of lamellar body maturation, particularly events that regulate organelle size. In this way, the ep/pe mice appear to be similar to the CHS1/beige mice, in which dysregulation of the size of lysosomes and lysosome-related organelles impedes access to cellular transport, thus leading to impairment of secretion. Further studies elucidating the processes involved in lamellar body maturation will aid in the understanding of the mechanism of giant lamellar body formation in the ep/pe mouse and in patients with HPS.
The authors thank Seth Scanlon, Adam Inch, Gerald Jahreis, and Peggy Zhang for their technical assistance and Drs. Michael Beers and Edward Novak for editorial advice.
These studies were supported by: NIH HL56401 and HL59959 (S.H.G.); HL-51480, HL-31698 and EY-12104 (R.T.S.). This research used core facilities supported in part by the Roswell Park Cancer Institute's National Cancer Institute-funded Cancer Center Support Grant CA-16056. Conflict of Interest Statement: S.H.G. has no declared conflicts of interest; A.A. has no declared conflicts of interest; J.-Q.T. has no declared conflicts of interest; E.A. has no declared conflicts of interest; M.E.R. has no declared conflicts of interest; R.T.S. has no declared conflicts of interest; and S.R.B. has no declared conflicts of interest. Received in original form September 15, 2004 Received in final form March 10, 2005
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