RationaleDendritic cells (DC) accumulate in the lungs of patients with idiopathic lung fibrosis, but their pathogenetic relevance is poorly defined.ObjectivesTo assess the role of the FMS-like tyrosine kinase-3 ligand (Flt3L)-lung dendritic cell axis in lung fibrosis.Measurements and main resultsWe demonstrate in a model of adenoviral gene transfer of active TGF-β1 that established lung fibrosis was accompanied by elevated serum Flt3L levels and subsequent accumulation of CD11bpos DC in the lungs of mice. Patients with idiopathic pulmonary fibrosis also demonstrated increased levels of Flt3L protein in serum and lung tissue and accumulation of lung DC in explant subpleural lung tissue specimen. Mice lacking Flt3L showed significantly reduced lung DC along with worsened lung fibrosis and reduced lung function relative to wild-type (WT) mice, which could be inhibited by administration of recombinant Flt3L. Moreover, therapeutic Flt3L increased numbers of CD11bpos DC and improved lung fibrosis in WT mice exposed to AdTGF-β1. In this line, RNA-sequencing analysis of CD11bpos DC revealed significantly enriched differentially expressed genes within extracellular matrix degrading enzyme and matrix metalloprotease gene clusters. In contrast, the CD103pos DC subset did not appear to be involved in pulmonary fibrogenesis.ConclusionsWe show that Flt3L protein and numbers of lung DC are upregulated in mice and humans during pulmonary fibrogenesis, and increased mobilisation of lung CD11bpos DC limits the severity of lung fibrosis in mice. The current study helps to inform the development of DC-based immunotherapy as a novel intervention against lung fibrosis in humans.

Type 2 helper cell (Th2) dominated chronic lung diseases such as asthma are characterized by an increased risk for bacterial lung infections. However, the underlying mechanisms are poorly defined. Arginase 1 (Arg1) has been suggested to play an important role in the pathophysiology of asthma, and is rapidly induced in lung macrophages by Th2 cytokines, thereby limiting macrophage-derived antimicrobial nitric oxide (NO) production. Here we examined the effect of Th2 cytokine induced upregulation or lung myeloid cell specific conditional knockdown of Arg1 on lung resistance against Streptococcus pneumoniae (Spn) in mice. Lung macrophages responded with a profound induction of Arg1 mRNA and protein to treatment with IL-13 both in vitro and in vivo. IL-13-induced Arg1 activity in the lungs of mice led to significantly attenuated lung-protective immunity against Spn, while conditional Arg1 knockdown had no effect on lung-protective immunity against Spn. Collectively, the data show that Th2 cytokine induced increased Arg1 activity worsens lung-protective immunity against Spn, and interventions to block Th2 cytokine induced lung Arg1 activity may thus be a novel immunomodulatory strategy to lower the risk of bacterial infections in asthmatic patients. Keywords:Alternative macrophage activation r Arg1 r IL-13 r Inflammation r Lung Additional supporting information may be found in the online version of this article at the publisher's web-site IntroductionAllergic asthma is a chronic inflammatory disease of the central and peripheral airways characterized by allergen-induced, immunoglobulin (Ig) E mediated early and late bronchial obstruction, chronic airway inflammation, and airway hyperresponsiveness (AHR), eventually leading to large and small airway remodeling [1,2]. Previous studies have implicated type 2 helper cell (Th2) cytokines including IL-4, IL-5, and IL-13 released by various leukocyte subsets such as eosinophils, mast cells, lymphocytes, as well as basophils and macrophages in the pathogenesis of allergic asthma [1,3].Correspondence: Prof. Ulrich A. Maus e-mail: Maus. Ulrich@mh-hannover.de More recent studies in asthmatic patients and animal models of allergic asthma have identified arginase 1 (Arg1) as a key player in the pathophysiology of this disease [3][4][5]. Arg1 is a cytosolic enzyme that hydrolyzes L-arginine to L-ornithine and urea and is constitutively expressed in the liver as a component of the urea cycle [6]. In the so-called classically activated macrophages, particularly Th1 cytokines such as TNF-α together with IFN-γ and IL-12 as well as inducible NO synthase (iNOS, NOS2), which produces antimicrobial NO as part of the innate immune response to bacterial infections, shape their activation profile [7]. In response to Th2 cytokines however, alveolar macrophages are polarized toward a state of alternative activation, which may be achieved in * These authors are co-first authors.C 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim www.eji-journal.eu Eur. J. Immunol. 2015. 45: 1716-1726 Immunity ...

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Idiopathic pulmonary fibrosis (IPF) is an irreversible, age-related diffuse parenchymal lung disease of poorly defined etiology. Many patients with IPF demonstrate distinctive lymphocytic interstitial infiltrations within remodeled lung tissue with uncertain pathogenetic relevance. Histopathological examination of explant lung tissue of patients with IPF revealed accentuated lymphoplasmacellular accumulations in close vicinity to, or even infiltrating, remodeled lung tissue. Similarly, we found significant accumulations of B cells interfused with T cells within remodeled lung tissue in two murine models of adenoviral TGF-β1 or bleomycin (BLM)-induced lung fibrosis. Such B cell accumulations coincided with significantly increased lung collagen deposition, lung histopathology, and worsened lung function in wild-type (WT) mice. Surprisingly, B cell–deficient µMT knockout mice exhibited similar lung tissue remodeling and worsened lung function upon either AdTGF-β1 or BLM as for WT mice. Comparative transcriptomic profiling of sorted B cells collected from lungs of AdTGF-β1– and BLM-exposed WT mice identified a large set of commonly regulated genes, but with significant enrichment observed for Gene Ontology terms apparently not related to lung fibrogenesis. Collectively, although we observed B cell accumulations in lungs of IPF patients as well as two experimental models of lung fibrosis, comparative profiling of characteristic features of lung fibrosis between WT and B cell–deficient mice did not support a major involvement of B cells in lung fibrogenesis in mice.

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Background: The association of malignant tumors and sarcoidosis is uncommon in clinical practice. It has been supposed, but not clearly demonstrated, that the two entities may be etiologically related. Case Report: A patient with a rectal carcinoid tumor and a bilateral hilar enlargement due to sarcoidosis is described. The patient had no specific symptoms from the endocrine tumor, and sarcoidosis was a coincidental finding. He underwent a low anterior rectal resection. Histological examination of the specimen revealed a T3–4 N0 carcinoid tumor, and sarcoidosis was proven by mediastinal biopsy. The patient received no further therapy for sarcoidosis. One year postoperatively the patient has no evidence for recurrent disease or metastasis, but bilateral hilar enlargement due to sarcoidosis is present even now. Conclusion: Only 4 patients with sarcoidosis and intestinal carcinoid tumor are reported in the literature. This is the first report of a patient with rectal carcinoid tumor associated with sarcoidosis. We emphasize the importance of mediastinal biopsy in patients with cancer and associated hilar lymphadenopathy in order to avoid the diagnosis of disseminated malignant disease.

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