To determine if the abnormalities of exocrine secretion characteristic of cystic fibrosis could be investigated in vitro, I studied the synthesis of 3':5'-cyclic AMP after isoproterenol stimulation in skin fibroblasts derived from patients with cystic fibrosis and from normal individuals. Comparison of normal and cystic fibrosis cells showed that the latter had 2-to 5-fold greater levels of intracellular cyclic AMP after stimulation with isoproterenol. The (3)(4)(5)(6) have shown that the spent medium from such cultures contains a factor, the ciliary dyskinesia factor, which disrupts normal ciliary motion in several tissues (7,8). Also, there have been reports that CF fibroblast strains and lymphoid cell lines may differ from normal ones with respect to the activity of lysosomal enzymes (9, 10), glycogen content (11), mucopolysaccharide metabolism (12), and some ultrastructural features (13). However, these results have not provided a clear-cut indication of the biochemical basis of the defect in CF.An alternative approach has been to study the nature and control of exocrine secretions in CF patients. Chernick et al. (14) observed 2-to 5-fold increases in submaxillary amylase and ribonuclease and, more recently, Bloomfield and her coworkers have shown elevations in calcium, protein, and amylase in both submandibular (15) and parotid secretions (16). These results support the suggestion (17) that the CF phenotype may be due to hyperactivity of the autonomic nervous system, a hypothesis also supported by the observation that chronic treatment of rats with isoproterenol (18) or reserpine (19) causes morphologic and physiologic changes in parotid and submaxillar glands that resemble those seen in CF patients.Strong evidence implicates 3':5'-cyclic AMP (cAMP) as a crucial component of the secretory response of a wide variety of mammalian cells to hormonal stimulation (20,21). Human diploid fibroblasts have been shown to possess the elements necessary for the control of cAMP metabolism and to possess cell surface receptors capable of recognizing certain agents that raise intracellular cAMP levels (22-27). Since such cells from CF patients are known to secrete the anticiliary factor (3-5), Abbreviations: CF, cystic fibrosis; cAMP, adenosine 3':5'-cyclic monophosphate.it seemed possible that they might also demonstrate an abnormality in the hormonal control of cAMP metabolism that might be relevant to the regulation of the secretory process in these cells. To examine this question, I have studied the effect of isoproterenol on intracellular cAMP levels and I report here the observation that cultured skin fibroblasts from patients with CF synthesize about 3-fold more cAMP after stimulation with isoproterenol than do cells from normal donors.
MATERIALS AND METHODSOrigin and Handling of Strains. The origins of the skin fibroblast strains used in this work are given in Table 1. Strains were started from skin biopsies as described by Goldstein and Littlefield (28). Cell culture was always done with a-medium (29), ...