From the authors:
We would like to thank C.G.A. Persson and L. Uller for their interesting observations and suggestions concerning our recently published article [1]。另外,我们想评论他们提出的问题。
他们指出,我们在patie表现我们的研究nts (and controls), using blood and bronchoalveolar lavage (BAL) neutrophils forin vivo/离体experiments. We did not include tissue samples due to the difficulty of obtaining them, just as C.G.A. Persson and L. Uller acknowledge. We analysed neutrophils from BAL fluid from non-responding community-acquired pneumonia (NCAP) patients to whom bronchoscopy was indicated and had signed informed consent. Bronchoscopy has the advantage of being a technique that is able to sample around 106 alveoli and, in addition, it is indicated for patients with NCAP [2]。所有这些都可以提供有关NCAP的相关信息,实际上,它确实反映在揭示了一些细胞因子水平(白介素(IL)-6,-8和-10)和NCAP患者凋亡率的关系中的关系。与临床结果。
我们同意需要更多的研究来解决我们的发现中出现的几个问题。具体而言,NCAP患者中凋亡中性粒细胞的吞噬是其中之一。正如他们所表明的那样,缺乏凋亡中性粒细胞的吞噬可能意味着继发性坏死,这反过来也可能是要分析的重要致病事件。我们还同意,仅凋亡就不足以解决炎症。因此,在我们的研究中,我们还研究了炎症性局部和全身细胞因子谱以及传染性参数的临床分辨率。实际上,我们的结果清楚地表明,中性粒细胞凋亡与降低促炎细胞因子水平和更快的临床稳定性有关。如果我们获得了肺活活检,这可能不会改变。
一个nother comment refers to transepithelial elimination of neutrophils during resolution of NCAP. The interesting proposed hypothesis of inflammatory resolution through egression of leukocytes is very attractive [3]。C.G.A.Persson和L. Uller认为,消除具有支气管炎症的气道(transepithepithial Egression)是一种解决炎症的方式。这种具有挑战性的解释在哮喘和慢性阻塞性肺部疾病中的人和动物模型中很好地表现出来。然而,在肺炎中,宿主对微生物的急性炎症反应是气道炎症的完全不同的模型。在肺炎中,先天反应和肺泡巨噬细胞策划了肺实质中的炎症反应,中性粒细胞在毛细血管水平上退出肺循环,即主要在肺泡空气空间中。显然,尽管该主题值得关注,但我们的设计并未指示评估肺泡或上皮衬里的中性粒细胞迁移。
referring to the comments that evidence of neutrophil apoptosis in inflammation resolution is not very strong, it is worth mentioning that our results and those from other researchers seem to indicate the contrary [4-6]。我们发现中性粒细胞凋亡与肺炎结局之间存在显着相关性。我们的结果与M的评论一致atute-BElloand Martin[[7],表明对人类的研究表明,急性呼吸窘迫综合征的早期嗜中性粒细胞凋亡受到抑制,但随着炎症的消退,中性粒细胞凋亡恢复正常。这些作者还指出了必须探索的其他步骤才能理解所有过程,但它们并不是我们目前工作的目标。droemann等。[[8]与我们的结果一致,中性粒细胞凋亡率的差异可能是由于肺炎的初始阶段(24小时)。
因此,我们认为NACP的BAL液中细胞因子模式和中性粒细胞凋亡的研究是评估正在进行的炎症过程的绝佳选择离体。关于从C.G.A.提出的气道的白细胞出口的作用Persson和L. uller用于哮喘和慢性阻塞性肺疾病,不应直接翻译为肺炎,肺炎是完全不同的急性感染Restutio In Integrum。Finally, we totally agree that regarding the host response against micro-organisms and resolution of inflammation, there are still many missing important pieces and new approaches are welcome.
Footnotes
statement of Interest
None declared.
- ©ERS 2012