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Am. J. Respir. Crit. Care Med., Volume 158, Number 5, November 1998, 1607-1612

Human Lung Parenchyma Responds to Contractile Stimulation

M. DOLHNIKOFF, J. MORIN, and M. S. LUDWIG

Meakins-Christie Laboratories, Department of Medicine, Royal Victoria Hospital, and Department of Surgery, Royal Victoria Hospital, McGill University, Montreal, Canada

    ABSTRACT
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

Tissue resistance increases after agonist challenge. Parenchymal contractile cells may be the responsible element. We investigated the viscoelastic properties of human parenchymal strips before and after challenge with acetylcholine (ACh) (10-3 M). Thirteen subpleural strips were oscillated in the organ bath, and measurements of resistance (R), elastance (E), and hysteresivity (eta ) were obtained. After physiologic measurements, tissues were fixed for morphometric and immunohistochemical analysis. We quantitated the volume proportion of alveolar, airway, and blood vessel wall in individual strips. Smooth-muscle-specific actin was identified using a monoclonal antibody and the volume proportion of actin quantitated by point counting. After ACh, there was a significant increase in tension (2.6 ± 0.6%), R (11.0 ± 1.8%), E (4.3 ± 0.7%), and eta  (8.2 ± 2.4%) (p < 0.002). Four strips contained no identifiable airways, yet in strips with and without airways there was no difference in the magnitude of the mechanical response or in the volume proportion of smooth-muscle-specific actin in the alveolar walls. We conclude that human lung parenchymal strips respond to ACh challenge with changes in dynamic mechanical behavior. Furthermore, small airways are not required for such a response to occur. This implicates a direct contractile response at the level of the alveolar wall and/or the alveolar duct.

    INTRODUCTION
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

It has been shown in different animal species that tissue resistance, the pressure drop in phase with flow between the alveolus and the pleura, increases during both exogenous and endogenous constriction (1). In humans, the role of the lung tissues in contributing to the contractile response is less clear. Kariya and colleagues (5) reported that the parenchymal tissues contribute minimally to methacholine-induced responses. More recently, Kaczka and colleagues (6) showed that tissue resistance, measured using the optimal ventilator waveform, increased in normal humans during induced constriction. Kraft and coworkers (7) showed a predominantly alveolar eosinophil infiltration in patients suffering from nocturnal asthma. These latter data suggest the possibility that tissue responses may also be important in contributing to the contractile response in humans.

The site of the contractile response at the alveolar level is controversial. Potential mechanisms that may contribute include constriction of myofibroblasts or contractile interstitial cells (8, 9), alterations in the air-liquid interface, constriction-induced alterations in the mechanics of the collagen-elastin-proteoglycan matrix, and/or constriction of smooth muscle in alveolar ducts, small airways, and small vessels present at the level of the lung periphery (10). We have utilized rat lung parenchymal strips to study contractile responses in the periphery as these strips are fluid-filled and, therefore, changes in the air-liquid interface do not contribute to the contractile response (11, 12). However, the rat subpleural parenchymal strip contains substantial amounts of small airway and vessel, which may contribute to the contractile response (13, 14).

Similarly, human parenchymal strips contain small airways and vessels. Bertram and colleagues (15) have shown that the amount of airway and vessel is important in determining changes in isometric tension with contractile stimulation in human parenchymal lung strips. Whether this observation holds for changes in the dynamic mechanical behavior is not known. Indeed, there has been no data published on whether contractile stimulation results in changes in the dynamic measures of resistance (R), elastance (E), and hysteresivity (eta ) in human parenchymal strips. We believe that the response in the dynamic measures is most pertinent to the in vivo state as energy losses during tidal breathing are reflected by changes in R and eta . Furthermore, Gunst and colleagues (16, 17) have shown that oscillation reduces the response of airway smooth muscle to contractile stimulation both in vivo and in vitro.

In order to address the question of whether changes in dynamic mechanical behavior occur during induced constriction in human parenchymal strips and whether the amount of airway versus alveolar wall is important in determining the response, we performed the following experiment. We obtained subpleural parenchymal strips from lungs surgically resected for tumor. R, E, and eta  were measured during dynamic oscillations before and after acetylcholine-induced constriction. Strips were then fixed for morphometric assessment; the volume proportion of airway, blood vessel, and alveolar wall was determined by point-counting. In addition, the amount of smooth-muscle-specific actin present in the parenchymal strip was measured in order to assess whether changes in parenchymal mechanics were correlated with the actual amount of smooth muscle present in the sample at either the alveolar or the small airway level.

    METHODS
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

Tissue Preparation

Peripheral lung tissue was obtained from 13 patients undergoing therapeutic lung resections for central lung tumor. Strips were placed in iced Krebs solution (mM: NaCl, 118; KCl, 4.5; NaHCO3, 25.5; CaCl2, 2.5; MgSO4, 1.2; KH2PO4, 1.2; glucose, 10. [Sigma Chemical, St. Louis, MO]) continuously bubbled with 95% O2/5% CO2 at a pH of 7.40. Subpleural lung strips (2 × 2 × 10 mm) were cut, and the resting length (Lr) and wet weight (Wo) of each strip were recorded.

Experimental Apparatus

Metal clips were glued to either end of the tissue strip with cyanoacrylate. Steel music wires (diameter, 0.5 mm) were attached to the clips and the strip suspended vertically in an organ bath. A mercury bead was placed in the bottom of the organ bath, allowing the music wire to pass through the bath but preventing the Krebs solution from leaking out. The bath was filled with 15 ml Krebs solution, maintained at 37° C, and continuously bubbled with 95% O2/5% CO2. One end of the strip was attached to a force transducer (Model 400A; Cambridge Technologies, Watertown, MA), which had an operating range of ± 10 g, resolution of ± 200 µg, and compliance of 1 µm/g, and the other end was connected to a servo-controlled lever arm (Model 300B; Cambridge Technologies). The lever arm was capable of peak-to-peak length excursions of 8 mm and length resolution of 1 µm and was in turn connected to a function generator (Model 3030; BK Precision, Chicago, IL), which controlled the frequency, amplitude, and waveform of the oscillation. The resting tension (T) was set by movement of a screw thumb wheel system, which effected slow vertical displacements of the force transducer. Length and force signals were low-pass-filtered (8-pole Bessel 902LPF; Frequency Devices, Haverhill, MA) with a corner frequency of 30 Hz, and converted from analog to digital with an analog-to-digital converter (DT2801-A; Data Translation Inc., Marlborough, MA) and recorded on an A/T compatible computer.

The linearity and hysteresis of the system were tested by measuring the moduli of a steel spring of stiffness comparable with that of the tissue strip. The spring was suspended in the bath by music wire in the same manner as the strip. The frequency and amplitude-dependence of the system were assessed over a range of frequencies (0.1 to 10 Hz). The spring stiffness did not show any dependence upon oscillatory frequency below 5 Hz. The hysteresivity of the system was independent of frequency and had a value < 0.003.

Protocol

Strips were preconditioned by slowly cycling tension from 0 to 2 g three times. On the third cycle strips were unloaded from a tension of 2 g to a tension of 1 g, and sinusoidal length oscillations of 2.5% Lr at a frequency of 0.25 Hz were applied. After 60 min of stress relaxation, the final resting tension was approximately 0.7 g. Baseline recordings were then obtained and ACh (10-3 M) (BDH, Inc., Toronto, Canada) was added to the organ bath. Measurements of length and T were collected continuously for an additional 15 min. Subsequent to the initial preconditioning, strips were continuously oscillated throughout the entire protocol.

Measurement of Strip Mechanics

Elastance (E) and resistance (R) were estimated by applying the recursive least-squares algorithm to the equation of motion (18):
T=EΔl+R(Δl/Δt)+K (1)

where l = length, Delta l/Delta t is the length change per unit time, and K is a constant reflecting resting tension. Results were standardized for strip size. The unstressed cross-sectional area (Ao) of the strip was obtained from the formula:
A<SUB>o</SUB>(cm<SUP>2</SUP>)=W<SUB>o</SUB>/(ρ×L<SUB>r</SUB>) (2)

where rho  is the mass density of the tissue taken as 1.06 g cm-3, Wo is the wet weight in grams, and Lr is the unloaded length in cm. Values of E and R were multiplied by Lr/Ao. Hysteresivity, eta , a dimensionless variable coupling the dissipative and elastic behavior, was calculated by the equation:
η=(R/E)2πf (3)

where f is frequency (19).

Morphometric Study

After physiologic study, strips were fixed with 4% paraformaldehyde and embedded in paraffin for morphometric and immunohistochemical study.

Immunohistochemical staining using the APAAP method was performed in slides 5 µm thick using a monoclonal antibody to alpha -smooth muscle actin (Dako, Carpenteria, CA). Sections were deparaffinized, hydrated, and incubated in 2% normal human serum (NHS) for 1 h at room temperature. Sections were then rinsed with TBS (0.5 M TRIS; pH, 7.6; 1.5 M NaCl) and incubated with antiactin (1:400 in TBS) overnight at 4° C. After washing with TBS, the tissue was incubated with an unconjugated rabbit antibody against mouse immunoglobulin (Dako) (1:30 in 20% NHS) for 30 min, washed again, and incubated with APAAP (soluable complexes of calf alkaline phosphatase and murine monoclonal antibody to alkaline phosphatase) (Dako) (1:30 in 20% NHS) for 30 min. After further washing, sections were developed with Fast Red salt (Sigma) (1 mg/ml in alkaline phosphatase substrate) for 10 min at room temperature. Sections were counterstained with Harris Hematoxylin for 1 min. Negative controls were made by exclusion of the primary antibody.

A semiquantitative analysis was performed on the slides stained for actin by applying point-counting. Using a 121-point grid, we calculated the volume proportion of actin in airways, vessels, and parenchyma as the relation between the number of points falling on actin-stained and nonstained tissue. Measurements were performed in 20 fields per slide, using a magnification ×200. Using the same method, we also measured the fractional area of tissue constituents. Fractional areas were measured for bronchial wall (BW), blood vessel wall (BVW), and alveolar wall (AW). BW and BVW were counted when the point fell on the smooth muscle, the epithelial layer, the endothelial layer, or its associated connective tissue. Points falling on airway lumen and blood vessel lumen were excluded.

Data Analysis

A paired two-tailed t test was used to compare the different mechanical parameters in strips before and after challenge. An unpaired two-taled t test was used to compare the % increase in T, E, R, and eta  and the volume proportion of actin in the parenchyma in the two groups of strips (those with and without airways). Results were considered statistically significant at a probability level of 5%. Values are reported as means ± standard error.

    RESULTS
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

The mean area fraction of alveolar (AW), blood vessel (BVW), and bronchial (BW) walls for the 13 parenchymal strips studied are shown in Table 1. AW represented 68 ± 3%, BVW 26 ± 2%, and BW 6 ± 2% of the volume proportion of the tissue. We defined two subpopulations of parenchymal strips---one in which small airways were present (n = 9) and one in which, despite repeated sectioning of the tissue blocks, no airways were identifiable (n = 4).

                              
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TABLE 1

AREA FRACTION OF LUNG TISSUE

Baseline values of R, E, and eta  are shown in Table 2. There were no differences in the baseline values of T, R, and E between the subgroups of strips with and without airways. There was, however, a difference in the baseline values of eta  between the two groups (p < 0.05). ACh caused a significant increase in the values of T, R, E, and eta  in the 13 parenchymal strips studies (2.6 ± 0.6%, 11.0 ± 1.8%, 4.3 ± 0.7%, and 8.2 ± 2.4%, respectively, p < 0.002). The percent increase in T, R, E, and eta  was compared between strips with and without airways. There was no significant difference in the response (Figure 1).

                              
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TABLE 2

BASELINE VALUES OF TENSION, ELASTANCE, RESISTANCE, AND HYSTERESIVITY*


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Figure 1.   Percent increase in tension (T), resistance (R), elastance (E), and hysteresivity (eta ) after acetylcholine in parenchymal strips with and without airways. There was no statistically significant difference in the magnitude of the response between the two groups. *p < 0.05 versus baseline.

Photomicrographs showing actin staining in strips with and without airways are shown in Figure 2. Note the presence of actin positivity in small airways, alveolar ducts, and alveolar walls. The volume proportion of actin staining is presented in Table 3 for all strips and for the two subpopulations, i.e., strips with and without airways. There was no significant difference in the volume proportion of actin in the parenchyma between the airway and the no airway groups. Finally, we tested to see whether there was a correlation between the amount of actin in a given strip and the magnitude of the contractile response. No significant correlation was determined (data not shown).


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Figure 2.   Immunohistochemical staining for smooth-muscle-specific actin. (A) Strip with small airway (A) also showing positive staining for actin (red ) in alveolar duct (arrowhead ) and blood vessels (V). (B) Strip without airway. Note positive staining in alveolar ducts (arrowheads). (C ) Smooth muscle actin staining in alveolar ducts (arrowheads). (D) Smooth muscle actin staining in alveolar walls (arrows).

                              
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TABLE 3

VOLUME PROPORTION OF alpha  SMOOTH MUSCLE ACTIN*

    DISCUSSION
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

In the current study, human lung parenchymal strips responded to contractile stimulation with increases in the dynamic mechanical parameters, elastance, resistance, and hysteresivity. Equivalent increases were found regardless of whether strips contained or were devoid of small airways. These data argue that contractile responses occur at the parenchymal level.

A number of studies in which tissue resistance has been directly measured with alveolar capsules have shown that tissue resistance increases with both endogenous and exogenous contractile stimulation (1). The site of that response has been controversial. Potential mechanisms include smooth muscle cells at the level of the alveolar duct; pericytes, filament-containing cells that lie alongside capillaries; and contractile interstitial cells or myofibroblasts (20, 21). These last cells have been documented to respond to stimuli such as hypoxia and smooth muscle agonists (8, 9).

The lung parenchymal strip has been used as a model for the study of the mechanical and pharmacologic properties of the lung periphery (11, 12, 15). We and others (13, 14, 22) have published data showing changes in oscillatory mechanics after exposure to a range of contractile agonists in guinea pig and rat parenchymal strips. Human lung parenchymal strip studies have focused on investigating the isometric and isotonic behavior of the tissue before and after agonist challenge (15). Bertram and colleagues (15) measured isometric responses to 5-hydroxytryptamine and norepinephrine in human parenchymal strips. Stereologic examination showed that the lung strips contained 16.8% blood vessels, 4.8% airway walls, and 78.4% alveolar parenchyma, results similar to those of the current experiment. These investigators showed a significant correlation between the magnitude and type of response (contraction versus relaxation) and the ratio of blood vessel to airway volume. There was no correlation between the response and the proportion of alveolar tissue.

There have been no data published on whether contractile stimulation results in changes in the dynamic measures of R, E, and eta  in human parenchymal strips. We believe that the response in the dynamic measures is most pertinent to the in vivo state as energy losses during tidal breathing are reflected by changes in R and eta . Moreover, Gunst and colleagues (16, 17) have shown that oscillation in and of itself can affect the contractile response in isolated smooth muscle preparations. In the current experiment, we observed a significant increase in all dynamic mechanical parameters after ACh treatment.

The question arises as to what components within the strip account for the response. Contraction of small peripheral airways could be one important mechanism. Salerno and colleagues (13) assessed the relationship between dynamic oscillatory behavior and the fractional proportion of the different anatomic constituents in subpleural parenchymal lung strips of Sprague-Dawley rats. They observed a significant correlation between increases in the mechanical parameters and the amount of small airways and vessels when more proximal strips containing greater amounts of blood vessel and bronchial wall were examined, suggesting a major contribution of these structures to the response. In more peripheral strips, which contained lesser amounts of blood vessel and bronchial wall, no correlation was seen.

In the present study, the morphologic evaluation showed that, despite repeated sectioning of the tissue blocks, in some of the strips no airways could be identified. These strips devoid of airways showed a contractile response of the same magnitude as those strips containing small airways. Small vessels are unlikely to be the source of the contractile response, as in a previous experiment from this laboratory, vessels of the size present in the parenchymal strip (< 0.2 mm) did not react to ACh (14). This observation leads us to suggest a significant role for contractile cells at the extreme lung periphery in the response to ACh.

Data from other species corroborate these results. Drazen and Schneider (23) showed that ultrathin guinea-pig lung strips, which contained no conducting airways or blood vessels, contracted after histamine or carbachol challenge. These investigators concluded that alveolar interstitial cells and/or alveolar duct smooth muscle were responsible for the response. Evans and Adler (24) observed increases in isometric tension in rabbit parenchymal strips exposed to histamine, acetylcholine, and epinephrine. While they did not detect interstitial smooth muscle cells or significant amounts of alveolar duct smooth muscle when the strips were stained with Masson trichrome, indirect immunofluorescence showed positivity for actin in the interstitium. Electron microscopy confirmed the presence of filaments composed of actin in interstitial cells. These investigators concluded that the response of parenchymal strips could not be attributed solely to airway smooth muscle contraction.

In our study, immunohistochemical staining for actin was most prominent in alveolar ducts, with relatively little actin staining in alveolar walls. Actin-positive cells corresponded to 4.3% of the parenchymal tissue. We did not find a correlation between the volume proportion of actin in parenchyma or airways and the magnitude of the response. It is possible that changes in the alveolar geometry secondary to smooth muscle contraction are more important in determining the magnitude of response than the absolute actin content. Alternately, the small splay in both the magnitude of the response and the actual actin content may have made a correlation difficult to find. Finally, the specific antibody used, that against alpha -smooth muscle actin, may be more effective at identifying smooth muscle in alveolar ducts and in pericytes and less specific for myofibroblasts, at least in "normal" lungs (20, 25). It is possible we would have obtained a positive correlation had we used an antibody which sampled all the contractile elements in the lung periphery.

The data of the current experiment have potential implications for human asthmatic disease. Recently, there have been provocative reports implicating the lung periphery in the human asthmatic response. Kaminsky and colleagues (26) have published data examining the effects of hyperpnea in asthmatics and showed a predominantly peripheral response. Kraft and colleagues (7) have demonstrated in transbronchial biopsy specimens from nocturnal asthmatics that there is a primarily alveolar inflammatory infiltration. These data, coupled with our findings regarding the ability of human peripheral tissue to respond directly to contractile stimulation, suggest the possibility that the lung parenchyma plays a more prominent role in asthmatic disease than has previously been appreciated.

    Footnotes

Correspondence and requests for reprints should be addressed to Dr. M. S. Ludwig, McGill University, Meakins-Christie Laboratories, 3626 St. Urbain Street, Montreal, PQ, H2X 2P2 Canada.

(Received in original form January 20, 1998 and in revised form April 16, 1998).

Dr. Dolhnikoff is the recipient of a Fellowship from CNPq and FAPESP Brazil.
Dr. Ludwig is a research scholar of the Fonds de la Recherche en Santé du Québec.

Acknowledgments: Supported by the J. T. Costello Memorial Research Fund and MRC Canada.
    References
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

1. Ludwig, M. S., I. Dreshaj, J. Solway, A. Munoz, and R. H. Ingram Jr.. 1987. Partitioning of pulmonary resistance during constriction in the dog: effects of volume history. J. Appl. Physiol. 62: 807-815 [Abstract/Free Full Text].

2. Ingenito, E. P., B. Davison, and J. J. Fredberg. 1993. Tissue resistance in the guinea pig at baseline and during methacholine constriction. J. Appl. Physiol. 75: 2541-2548 [Abstract/Free Full Text].

3. Dreshaj, I. A., R. J. Martin, M. J. Miller, and M. A. Haxhiu. 1994. Responses of lung parenchyma and airways to tachykinin peptides in piglets. J. Appl. Physiol. 77: 147-151 [Abstract/Free Full Text].

4. Nagase, T., A. Moretto, M. J. Dallaire, D. H. Eidelman, J. G. Martin, and M. S. Ludwig. 1994. Airway and tissue responses to antigen challenge in sensitized brown Norway rats. Am. J. Respir. Crit. Care Med. 150: 218-226 [Abstract].

5. Kariya, S. T., L. M. Thompson, E. P. Ingenito, and R. H. Ingram Jr.. 1989. Effects of lung volume, volume history, and methacholine on lung tissue viscance. J. Appl. Physiol. 66: 977-982 [Abstract/Free Full Text].

6. Kaczka, D. W., E. P. Ingenito, B. Suki, and K. R. Lutchen. 1997. Partitioning airway and lung tissue resistances in humans: effects of bronchoconstriction. J. Appl. Physiol. 82: 1531-1541 [Abstract/Free Full Text].

7. Kraft, M., R. Djukanovic, S. Wilson, S. T. Holgate, and R. J. Martin. 1996. Alveolar tissue inflammation in asthma. Am. J. Respir. Crit. Care Med. 154: 1505-1510 [Abstract].

8. Kapanci, Y., A. Assimacopoulos, C. Irle, A. Zwahlen, and G. Gabbiani. 1974. "Contractile interstitial cells" in pulmonary alveolar septa: a possible regulator of ventilation/perfusion ratio? J. Cell Biol. 60: 375-392 [Abstract/Free Full Text].

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10. Ludwig, M. S. 1997. Role of lung parenchyma. In P. J. Barnes, M. M. Grunstein, A. R. Leff, and A. J. Woolcock, editors. Asthma. Lippincott-Raven, Philadelphia. 1319-1334.

11. Lulich, K. M., H. W. Mitchell, and M. P. Sparrow. 1976. The cat lung strip as an in vitro preparation of peripheral airways: a comparison of beta -adrenoceptor agonists, autocoids and anaphylactic challenge on the lung strip and trachea. Br. J. Pharmacol. 58: 71-79 [Medline].

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13. Salerno, F. G., M. Dallaire, and M. S. Ludwig. 1995. Does the anatomic makeup of parenchymal lung strips affect oscillatory mechanics during induced constriction. J. Appl. Physiol. 79: 66-72 [Abstract/Free Full Text].

14. Salerno, F. G., H. Kurosawa, D. H. Eidelman, and M. S. Ludwig. 1996. Characterization of the anatomical structures involved in the contractile response of the rat lung periphery. Br. J. Pharmacol. 118: 734-740 [Medline].

15. Bertram, J. F., R. G. Goldie, J. M. Papadimitriou, and J. W. Paterson. 1983. Correlations between pharmacological responses and structure of human lung parenchyma strips. Br. J. Pharmacol. 80: 107-114 [Medline].

16. Tepper, R. S., X. Shen, E. Bakan, and S. J. Gunst. 1995. Maximal airway response in mature and immature rabbits tidal ventilation. J. Appl. Physiol. 79: 1190-1198 [Abstract/Free Full Text].

17. Shen, X., M. F. Wu, R. S. Tepper, and S. J. Gunst. 1997. Pharmacological modulation of the mechanical response of airway smooth muscle to length oscillation. J. Appl. Physiol. 83: 739-745 [Abstract/Free Full Text].

18. Lauzon, A.-M., and J. H. T. Bates. 1991. Estimation of time-varying respiratory mechanical parameters by recursive least squares. J. Appl. Physiol. 71: 1159-1165 [Abstract/Free Full Text].

19. Fredberg, J. J., and D. Stamenovic. 1989. On the imperfect elasticity of lung tissue. J. Appl. Physiol. 67: 2408-2419 [Abstract/Free Full Text].

20. Kapanci, Y., and G. Gabbiani. 1997. Contractile cells in pulmonary alveolar tissue. In R. G. Crystal, J. B. West, et al., editors. The Lung: Scientific Foundations. Lippincott-Raven, Philadelphia. 697-707.

21. Lai, J., R. A. Rogers, B. A. Ekstein, and J. J. Fredberg. 1994. Dynamic changes in alveolar duct geometry in response to 10-3 M histamine (abstract). Am. J. Respir. Crit. Care Med. 149: A538 .

22. Fredberg, J. J., D. Bunk, E. Ingenito, and S. S. Shore. 1993. Tissue resistance and the contractile state of lung parenchyma. J. Appl. Physiol. 74: 1387-1397 [Abstract/Free Full Text].

23. Drazen, J. M., and M. W. Schneider. 1978. Comparative responses of tracheal spirals and parenchymal strips to histamine and carbachol in vitro. J. Clin. Invest. 61: 1441-1447 .

24. Evans, J. N., and K. B. Adler. 1981. The lung strip: evaluation of a method to study contractility of pulmonary parenchyma. Exp. Lung Res. 2: 187-205 [Medline].

25. Mitchell, J., J. Woodcock-Mitchell, S. Reynolds, R. Low, K. Leslie, K. Adler, G. Gabbiani, and O. Skalli. 1989. alpha -Smooth muscle actin in parenchymal cells of bleomycin-injured rat lung. Lab. Invest. 60: 643-650 [Medline].

26. Kaminsky, D. A., S. E. Wenzel, C. Carcano, D. Gurka, D. Feldsien, and C. G. Irvin. 1997. Hyperpnea-induced changes in parenchymal lung mechanics in normal subjects and in asthmatics. Am. J. Respir. Crit. Care Med. 155: 1260-1266 [Abstract].





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