Published ahead of print on November 15, 2002, doi:10.1164/rccm.200206-531OC
© 2003 American Thoracic Society
Hydrogen PeroxideScavenging Properties of Normal Human Airway SecretionsDivision of Pulmonary and Critical Care Medicine, Department of Anesthesiology, and Department of Cell Biology and Anatomy, University of Miami School of Medicine, Miami, Florida Correspondence and requests for reprints should be addressed to Rosanna Forteza, Division of Pulmonary and Critical Care Medicine (R-47), University of Miami School of Medicine, 1600 NW 10th Avenue, RMSB 7072, Miami, FL 33136. E-mail: rforteza{at}miami.edu
To examine the antioxidant capacity of normal human airway secretions and to characterize its molecular components, tracheal lavages were obtained from eight patients intubated for elective surgery and free of lung disease. These samples (20 µl, approximately 6.8 µg of protein) scavenged 0.57 ± 0.09 nmol of added 0.96 nmol hydrogen peroxide (H2O2) within 10 minutes at room temperature (n = 8). The scavenging activity was inhibited 60 ± 4% by azide (an inhibitor of heme-containing peroxidases and catalase) and 42 ± 9% by dapsone (an inhibitor of lactoperoxidase). Mercaptosuccinic acid (an inhibitor of glutathione peroxidase) did not significantly inhibit H2O2 scavenging by these secretions. Fourfold diluted secretions showed only nonenzymatic scavenging activity, but the addition of thiocyanate to these samples (0.4 mM; substrate for lactoperoxidase) restored their ability to scavenge H2O2. The addition of reduced glutathione (8 µM) only enhanced nonenzymatic scavenging activity. These data provide evidence that multiple enzymatic and nonenzymatic systems coexist in human airway secretions that contribute to H2O2 scavenging. It appears, however, that H2O2 is mainly consumed by the lactoperoxidase system.
Key Words: oxidants peroxidase hydrogen peroxide antioxidants Reactive oxygen species (ROS) are produced by airway epithelial cells and seem to be specifically released toward the luminal side of the airways (1). Although they likely serve specific functions (e.g., host defenses and signaling), ROS can also damage or adversely affect airway epithelial cells. Naturally occurring antioxidants thus play a major role in protecting the cells from damage and possibly regulating ROS-mediated signaling. Several enzymatic and nonenzymatic ROS scavenging mechanisms have been implicated and identified in airway epithelial surface liquids. Enzymes that provide such a function include airway lactoperoxidase (LPO) (2), glutathione peroxidase (GPx) (3, 4), superoxide dismutase (5), and catalase (6). Nonenzymatic components such as mucins (7) and low molecular weight compounds such as vitamin E (8) may also play a role. Antioxidant functions of the airway surface liquid may be even more important in airway diseases when increased ROS production occurs. For instance, hydrogen peroxide (H2O2) was detected at sixfold higher levels in breath condensates from patients with asthma (9) and at 20-fold higher levels in patients with chronic obstructive pulmonary disease (COPD) compared with normal subjects (10). Although several articles have investigated the role of single enzymes in scavenging ROS and H2O2 in particular, no investigation to date has looked at the contribution of each system to the total antioxidant capacity of airway secretions. Furthermore, most studies of human samples have used bronchoalveolar lavages. Although the interpretation of such studies is complicated by contamination with antioxidants derived from the alveolar space, they suggested that GPx is an important scavenger in the airway (3, 4). On the other hand, airway LPO has been found to be the most important H2O2 scavenger in sheep airway mucus when only tracheal secretions were collected and examined (2, 11). Thus, there is uncertainty about the role of each of these enzymatic and nonenzymatic antioxidant defense molecules in the airways. The balance of these systems in protecting the airway epithelium from H2O2 (downstream from superoxide dismutase) will depend on both enzyme as well as specific substrate availability. Because catalase is not a secreted extracellular enzyme, H2O2 scavenging in normal conditions in which peroxidases from inflammatory cells are absent (such as myeloperoxidase [MPO] and eosinophil peroxidase) will mainly depend on the availability of GPx and its substrate, reduced glutathione (GSH), as well as on airway LPO and its substrate, thiocyanate (SCN-). In addition, nonspecific scavengers such as sulfhydryl groups may play a role as well. The purpose of this study was to examine the contribution of the different components of normal human airway secretions (not contaminated by products from the alveolar space) to H2O2 scavenging. The results suggested that LPO is the major consumer of H2O2 in normal human airway secretions.
Chemicals Unless specified, all chemicals were purchased from Sigma-Aldrich (St. Louis, MO).
Subject Selection and Tracheal Secretions Collection
H2O2 Scavenging
Determination of Total Protein and LPO Activity Protein assays were performed using the bicinchoninic acid assay according to the manufacturer's instructions (Pierce, Rockford, IL).
Determination of GPx Activity
Immunoblotting
Statistical Analysis
H2O2 Scavenging Activity in Airway Secretions We have previously shown that sheep airway secretions scavenged H2O2 (2). To assess similar capabilities of human airway secretions, secretions were diluted into 10 µM of H2O2, as no H2O2 was detectable in these samples, as assessed by the phenol red assay (less than 1 µM). Then H2O2 disappearance was measured. Twenty microliters of human secretions scavenged 0.57 ± 0.09 nmol of H2O2 within 10 minutes (n = 8), reducing the original H2O2 concentration to 4.1 ± 0.9 µM (Table 1).
To assess the contribution of nonenzymatic scavenging, samples were heated to 100°C for 5 minutes. Heat treatment reduced H2O2 scavenging activity of airway secretions by 80 ± 3% (n = 8; p < 0.05 compared with no inhibitor). This suggested that a substantial amount of H2O2 scavenging activity (approximately 20%) was heat insensitive and presumably nonenzymatic (Figure 1) .
To differentiate the enzymatic components involved in scavenging and to determine the contribution of each of them to the total scavenging activity, the influence of the following inhibitors was tested: azide (10 µM; a broad inhibitor of heme-containing peroxidases and catalase but not GPx [16]), dapsone (100 µM; an inhibitor of heme-containing peroxidases at the assay pH of 7.4, but not catalase or GPx [13]), and mercaptosuccinic acid (100 µM; an inhibitor of selenium containing GPx [17]). Standard curves for these assays were generated by adding the inhibitors to the control sample buffer that did not contain human secretions. The inhibitors were also tested in specific peroxidase activity assays (see METHODS) and in the phenol red assay using, instead of secretions, purified bovine milk LPO, canine MPO (a gift of Dr. Roger Fenna, University of Miami), and gluthatione peroxidase, respectively (Figure 2) .
Azide (10 µM), a broad inhibitor of heme-containing peroxidases and catalase (but not the selenium-containing GPx), reduced the H2O2 scavenging activity of airway secretions by 60 ± 4% (n = 8, p < 0.05 compared with no inhibitor; Figure 1). Dapsone, an inhibitor of both LPO (70%) and MPO (100%) at pH 7.4 and at 100 µM (Figure 2) (18), reduced the H2O2 scavenging activity of airway secretions by 42 ± 9% (n = 8, p < 0.05 compared with no inhibitor; Figure 1). No statistically significant difference between azide and dapsone inhibition of H2O2 scavenging activity was found. Mercaptosuccinic acid (100 µM), an inhibitor of GPx with no effect on LPO or MPO (Figure 2), did not influence scavenging activity of airway secretions. The samples still scavenged 0.5 ± 0.08 nmol of H2O2 (n = 8, p > 0.05 compared with no inhibitor), decreasing the original scavenging activity by only 12 ± 14% within 10 minutes (Figure 1).
Peroxidase Activities of Human Airway Secretions
GPx activity in airway secretions was measured by following the oxidation of nicotinamide adenine dinucleotide phosphate. The lower detection limit of this assay was 5 mU per assay with 1 U of activity defined as the oxidation of 1 µmol nicotinamide adenine dinucleotide phosphate per minute using an extinction coefficient of 6.22 x 106 x M-1 x cm-1 for nicotinamide adenine dinucleotide phosphate (19). No GPx activity was detected in any of the eight samples. The lack of measured activity was not due to the absence of substrate because GSH was provided and continuously replenished in these assays (see METHODS). Therefore, the secretions contain less than 0.33 mU/µl GPx if any. These data suggested that virtually all of the measurable peroxidase activity in airway secretions was due to the presence of LPO.
Reconstitution of Scavenging Activity after Dilution by Replenishing Different Substrates To evaluate whether enzymatic scavenging activity could be restored by specific substrate repletion, SCN- or GSH was added to the diluted samples to levels thought to be present in airway secretions, and H2O2 scavenging was re-evaluated. H2O2 scavenging in diluted samples in which SCN- was restored to 0.4 mM increased to 209 ± 19% of unreplenished, diluted samples (n = 8, p < 0.05; Figure 5) . Azide (10 µM) addition to SCN--replenished samples again reduced H2O2 scavenging activity to 96 ± 20% of unreplenished, diluted samples (n = 8, p > 0.05; Figure 5). Thus, SCN- replenishment of diluted samples restored an enzymatic scavenging activity consistent with LPO. This was further supported by the fact that a linear correlation existed between the recovered, SCN--dependent scavenging activity and the TMB-assessed LPO activity in these samples (r2 = 0.74; Figure 6) .
To demonstrate further the enzymatic nature of the recovered scavenging activity by replenishing fourfold diluted tracheal lavages with 0.4 mM of SCN-, samples were heated to 100°C for 5 minutes. Heated and diluted samples, replenished with SCN-, scavenged 131 ± 11% of nonheated diluted control subjects (n = 8, p > 0.05 compared with both nonheated, diluted samples and heated, diluted samples; p < 0.05 compared with nonheated, SCN--replenished, diluted samples; Figure 5). Thus, SCN- replenishment of diluted samples restored an enzymatic scavenging activity consistent with LPO. Diluted samples in which GSH was replenished to 8 µM also revealed increased scavenging activity: These samples scavenged 171 ± 8% of nonheated, diluted samples (n = 8, p < 0.05). This activity could not be due to GPx because it would have reflected an amount of enzyme 40 times the detection limit of the specific GPx assays discussed previously here. Because no GPx activity was detected by direct enzyme assay, the H2O2 scavenging ability recovered with GSH replenishment was not due to GPx. Scavenging was also not due to direct reaction of H2O2 with GSH because standard curves were performed in the presence of GSH, and thus, any direct H2O2 consumption by GSH was already accounted for. Others have shown that LPO can use GSH as a substrate (20). Thus, diluted and GSH replenished samples were assayed in the presence of 10 µM of azide. The measured scavenging in these samples was 166 ± 17% of nonheated, diluted samples (n = 8), a value not significantly different from samples replenished with GSH but with no added azide. Thus, the activity recovered after GSH replenishment was not due to LPO (Figure 5). To see whether the GSH-dependent, recovered activity was enzymatic at all, samples were heated to 100°C for 5 minutes. These samples still scavenged 171 ± 13% of nonheated, diluted samples (n = 8, p > 0.05 compared with samples with GSH replenishment). Thus, scavenging activity recovered by replenishing GSH to 8 µM was nonenzymatic in nature (Figure 5).
Immunoblotting
To show that these bands were indeed human LPO (because the anti-MPO antibody did not detect bovine milk LPO), Western blots using anti-LPO antibody were examined showing again an immunoreactive band at approximately 90 kD, consistent with LPO (Figure 7C) (21). In addition, human MPO control subjects (60 ng) cross-reacted with the anti-LPO antibody. Because the concentration of the secondary antibody was higher compared with the anti-MPO blots, the nonspecific bands seen at approximately 50 kD were stronger (Figure 7B). These data confirm the estimated amounts of MPO and LPO in these samples as measured in enzymatic assays: Western blotting showed more prominent bands for LPO than for MPO, consistent with the MPO and LPO control lanes.
The surfaces of the airways are naturally exposed to a variety of potentially injurious airborne materials, including inorganic and organic particulate and gaseous matter. Of specific interest is the exposure of the airways to ROS, which can adversely affect tracheal epithelial cells (6). In light of their adverse effects, it may be unexpected on first thought that superoxide radicals (O2-) as well as H2O2 are produced by the airway epithelium (22, 23). Although the levels of H2O2 encountered in the airway are not expected to be antibacterial (10-6 M or less), H2O2 is a required substrate for LPO antibacterial activity, and thus, it is logical that these oxidants are produced in the airway. Not surprisingly, the airway surface liquids have antioxidant properties to protect airway epithelial cells from injury. Because no data are available on the balance of these systems in normal human airway, this article examined the balance of enzymatic and nonenzymatic processes to scavenge H2O2 (downstream from superoxide dismutase). The results indicated that LPO was the major enzymatic H2O2 consumer in normal airway secretions and that approximately 20% of the total activity appeared to be nonenzymatic in nature under the conditions of this experimental model. Prior studies addressing H2O2 scavenging by human airway secretions used secretions collected by bronchoalveolar lavage and found it to be rich in GSH and GPx (24). Because bronchoalveolar lavage is contaminated with antioxidant substances from alveoli that are usually not present in the airways, data obtained with such collection methods may not accurately reflect the situation in the airway. Although extracellular GPx is produced by bronchial epithelial cells (4), it is not clear whether GPx and GSH levels measured in BAL reflect levels in the airways. To our knowledge, only one study has been published in which GSH was directly assessed in airways and found it to be around 2 µM (25); however, the studied species was the rhesus monkey. Indirect data using induced sputum from healthy human subjects showed a GSH concentration of 510 µM (26). Thus, GSH levels may be much lower in the airway than previously thought using bronchoalveolar lavage. We therefore used for our study small-volume lavages from human trachea avoiding contamination of samples with products from the alveolar space or saliva. Our results indicated that approximately 80% of the measured H2O2 consumption was enzymatic in nature. Previous data from our laboratory suggested that LPO was the major enzymatic H2O2 scavenger in sheep airways (2, 11), and our current data also support this notion for human airways: azide, an inhibitor of heme-containing peroxidases and catalase but not GPx (16), decreased the scavenging ability of tracheal lavages by approximately 60%, whereas mercaptosuccinic acid, an inhibitor of GPx, had no significant effect despite GPx production by cultured human airway epithelial cells (3). Although azide also inhibits catalase, catalase is not a secreted enzyme (27) and is not present in significant concentrations in the airways (11). This notion is further supported by data obtained with dapsone, an inhibitor of heme peroxidases but not catalase: Dapsone, which inhibits 70% of LPO and all of MPO activity at the used pH of 7.4 (Figure 2), decreased the H2O2 scavenging by approximately 45%. Taking the incomplete inhibition of LPO by dapsone under the assay conditions and the TMB data into account, we concluded that LPO accounts for approximately 60% of the total scavenging activity and for approximately 80% of the enzymatic H2O2 scavenging activity in normal human airway secretions. These results could be influenced by dilution, unduly lowering substrate concentrations for certain enzymes such as GPx. To address this question and to confirm the inhibitor data, samples were further diluted until only nonenzymatic scavenging could be detected (heat treatment of the diluted samples did not further decrease scavenging activity). By adding specific substrates, we would be able to distinguish different enzymatic activities without the use of inhibitors. SCN- is the substrate for LPO and is found in sheep airways at a concentration of 0.16 mM (28). In addition, active transport of SCN- by human airway epithelial cells has been established (29), and unpublished data from our laboratory show concentrations of SCN- in human airways to be 0.4 mM. Replenishing SCN- to 0.4 mM in such diluted samples restored scavenging by LPO, a finding supported by the fact that the SCN- dependent, rescued scavenging activity was both azide and heat sensitive. The recovered activity also had a linear correlation with the amount of peroxidase activity calculated from TMB oxidation, further supporting the fact that the SCN--dependent H2O2 scavenging was due to LPO (Figure 6). GSH supplementation of diluted samples also restored H2O2 scavenging activity, despite the fact that the undiluted samples did not reveal significant GPx activity. If this recovered activity was due to GPx, we should have been able to measure GPx activities in our specific assays as the recovered activity was higher than the assay's lower detection limit of 5 mU/ml. We therefore considered that the activity rescued with addition of GSH was due to LPO, but scavenging was not inhibited by azide. The rescued activity was also heat insensitive, excluding an enzymatic process. Although we were mainly interested in the enzymatic aspects of H2O2 consumption by airway surface liquids, we found that approximately 20% of the total scavenging activity was nonenzymatic in nature. Interestingly, we found that a fourfold dilution of the samples increased the apparent nonenzymatic scavenging, perhaps because of less competition for the substrate H2O2. Without knowing more about the nonenzymatic nature of scavenging, such unexpected changes in nonenzymatic scavenging activity will have to remain unexplained. In summary, normal human tracheal secretions scavenge H2O2 both in a nonenzymatic (approximately 20%) and enzymatic (approximately 80%) fashion. The major enzymatic H2O2 consumption is due to LPO. Surprisingly, GPx plays only a minor role. It is interesting to speculate that H2O2 found in the airway lumen is produced as a substrate for LPO as LPO's oxidative function uses H2O2. It is well known that there is an increase in H2O2 concentrations in airway diseases (9, 10), and an H2O2 concentration of greater than 10 µM can be detrimental to airway epithelial cells (30). Studies have shown that pretreating sheep airways with a H2O2 scavenger such as catalase can significantly decrease bronchial hyperresponsiveness in response to allergen (31). In addition, the presence of pathophysiologically relevant levels of peroxidases and H2O2 reversibly inhibited nitric oxidedependent bronchodilation of preconstricted tracheal rings (32). Therefore, it is clear that ROS play a major role in airways diseases, and a better understanding of the mechanisms by which the airways scavenge H2O2 in normal conditions is crucial, as it will help to understand certain disease states and possibly lead to novel therapeutic approaches. Received in original form June 8, 2002; accepted in final form November 8, 2002
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