AU2002360332A1 - Surfactant protein D for the prevention and diagnosis of pulmonary emphysema - Google Patents

Description

SURFACTANT PROTEIN D FOR THE PREVENTION AND DIAGNOSIS OF PULMONARY EMPHYSEMA

GOVERNMENT INTEREST IN THE INVENTION Certain aspects of the invention disclosed herein were made with United States government support under National Institutes of Health grants HL 41320, SCOR HL 56387, HL 28623, HL 58795, and HL03905. The United States government has certain rights in these aspects of the invention.

FIELD OF THE INVENTION The present invention relates generally to the field of biologically active proteins. More specifically the present invention relates to SP-D proteins involved in pulmonary surfactant homeostasis and structure, and alveolar structure in the lungs and SP-D (-/-) null mice.

BACKGROUND OF THE INVENTION Pulmonary surfactant is essential for normal lung mechanics and gas exchange in the lung. Pulmonary surfactant is produced by type II epithelial cells and is made up of a phospholipid component which confers the ability of surfactant to lower surface tension in the lung. In addition, there are proteins associated with the surfactant called collectins which are collagenous, lectin domain-containing polypeptides. Two of these, designated surfactant protein A (SP-A) and surfactant protein D (SP-D), are likely involved in surfactant structure and function and host defense. Both quantitative and qualitative deficiencies in pulmonary surfactant are associated with neonatal respiratory distress, adult respiratory distress syndrome, congenital deficiencies of surfactant protein B, and allergic asthma. In addition, deficiency in pulmonary surfactant may contribute to the increased susceptibility of some individuals to microbial challenge, especially in the setting of inadequate or impaired specific immunity. These disorders as well as some disorders associated with increased risk of pneumonia (cystic fibrosis, asthma, prematurity, chronic bronchitis, diffuse alveolar damage) may also be associated with acquired defects or deficiency in collectin function. Alveolar surfactant pools are regulated at multiple levels including intracellular synthesis, secretion, re-uptake and degradation of these components by alveolar macrophages. The synthesis and clearance of surfactant phospholipids and proteins is further influenced by developmental, mechanical, and humoral stimuli that serve to maintain steady-state surfactant concentrations after birth.

The role of the collectins in surfactant and noπnal lung function has been extensively investigated. The collectin family of C-type lectins includes a number of molecules with known host defense functions. SP-A and SP-D, also C-type lectins, bind influenza and herpes simplex viruses as well as gram positive and gram-negative bacteria and various fungi. By binding they enhance uptake by alveolar macrophages and neutrophils. Various cellular binding sites for SP-A and SP-D have been identified on alveolar macrophages or, in the case of SP-A, on type II epithelial cells. The critical role of SP-A in host defense was supported by the observation that SP- A-deficient mice are susceptible to infections by group B streptococcus, Pseudomonas aeruginosa, Respiratory syncytial virus, adenovirus, and mycoplasma in vivo. Thus, there is a clear role for SP- A and a likely role for SP-D in respiratory defense mechanisms. Collectins may also participate in the recognition or clearance of other complex organic materials, such as pollens and dust mite allergens. However, to date no human diseases have been associated with specific deficiencies in SP-A or SP-D. SP-D is a 43 kilodalton protein that has been proposed to play a role in host defense in the lung. Its cDNA and gene have been sequenced in various mammals including humans. SP-D shares considerable structural homology with other C-type lectins, including surfactant protein A (SP-A), conglutinin, bovine collectin-43, and mannose binding protein. In vitro studies and its close structural relationship to a mammalian Ca²⁺-dependent lectin family (particularly shared structural motifs) support its role in host defense. SP-D is synthesized primarily and at relatively high concentrations by Type II epithelial cells and nonciliated bronchiolar epithelial cells in the lung but may also be expressed in the gastrointestinal tract, heart, kidney, pancreas, genitourinary tract and mesentery cells. In vitro studies demonstrated that SP-D binds to the surface of organisms via its lectin domain (or sugar binding domain) which leads to binding, aggregation, opsonization and, in some instances, activation of killing by phagocytes in vitro. SP-D binds to lipopolysaccharide, various bacteria, fungi and viruses, including influenza virus. It also binds to both alveolar macrophages and polymorphonuclear cells. It may possibly play a role in surfactant phospholipid homeostasis, including the effects of SP-A on phospholipid metabolism by Type II cells in vitro, however, this is controversial and the precise role of SP-D in vivo is still unclear. In vitro studies support the concept that surfactant proteins may be important in the regulation of surfactant homeostasis. Although the hydrophobic surfactant proteins SP-B and SP- C have roles in production of the surfactant monolayer, in vitro studies indicated that surfactant protein A may also facilitate surfactant uptake and/or secretion by type II epithelial cells. In fact, it was widely believed that SP-A would have a major role in surfactant homeostasis. However, recent studies of SP-A null mice have not supported the primary role of surfactant protein A in surfactant secretion or re-uptake. The absence of SP-A does not lead to obvious physiologic or morphologic structural abnormalities of the lung. SP-A null mutant mice lack tubular myelin figures but produce highly functional surfactant that absorbs rapidly and produces monolayers. Surfactant lipid synthesis, secretion, and re-uptake were essentially normal in SP-A null mice. Therefore, the additional surfactant protein which acts in surfactant regulation is still not identified. In addition, the precise role of SP-D in normal lung function has not been clearly defined at this point and its role in disease or disease susceptibility is unclear.

SUMMARY OF THE INVENTION The present invention provides an SP-D(-/-) mouse which can be used as a model for emphysema. Previously it was not lαiown that SP-D protein was involved in lung lipid homeostasis. Nor was it lαiown that an SP-D null mouse would have the symptoms of emphysema.

One embodiment of the invention is a non-human mammalian model for emphysema comprising an SP-D(-/-) non-human mammal.

A further embodiment is a method for the purification and treatment of pulmonary disease by introducing mammalian SP-D protein, or vectors expressing the mammalian SP-D protein into a human or mammal in an amount effective to reduce the symptoms of the disease or to prevent the disease. A further embodiment is a pharmaceutical composition effective in treating pulmonary disease which is a mixture of SP-D protein with a pharmaceutically acceptable carrier.

A further embodiment is a biologically active agent for heating pulmonary disease in mammals which is an agent that up-regulates SP-D.

A further embodiment is a biologically active agent for treating pulmonary disease in mammals which is an agent that interacts with the SP-D protein.

A further embodiment is a method for diagnosing susceptibility to pulmonary disease in mammals by identifying a mutation in the SP-D gene which results in deficient SP-D, identifying that mutation in a test mammal by PCR, hybridization, or ELISA.

A further embodiment is a method of identifying pharmaceutical agents useful in treating pulmonary disease by allowing the SP-D null mouse to develop pulmonary disease, administering a pharmaceutical agent to the mammal, and identifying the agent as effective is the pulmonary disease improves.

A further embodiment is a method of purifying SP-D antibodies with a solid phase lung homogenate from any mouse which does not produce SP-D protein. A further embodiment is a method for the prevention of pulmonary disease by introducing mammalian SP-D protein, or vectors expressing the mammalian SP-D protein into a human in an amount effective to reduce the symptoms of or prevent pulmonary disease, wherein the pulmonary disease is selected from the group consisting of: reactive oxygen-mediated disease, chemically induced lung injury, injury due to oxygen radicals, injury due to ozone, injury due to chemotherapeutic agents, inflammatory and infectious diseases, reperfusion injury, drowning, transplantation, and rejection.

A further embodiment of the invention is a method for the treatment of viral disease by introducing mammalian SP-D protein, or vectors expressing the mammalian SP-D protein into a human in an amount effective to reduce the number of viruses or symptoms of the viral disease. Preferably, the viruses are adenovirus, RSV, and Influenza virus.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 : Comparison of changes in fractional areas (% Fx Area) of airspace (a) and respiratory parenchyma (b) with age in SP-D (-/-) mice and age-matched SP-D (+/+) controls. Analysis of changes in these parameters with age for each individual genotype (c and d). Data are expressed as % fractional area and represent the mean ± SE.

Figure 2: Deflation limbs of pressure-volume curves from SP-D (+/+) and SP-D (-/-) mice. Data are expressed as ml/kg and represent the mean ± SE.

Figure 3: Pro-inflammatory cytokines in lung homogenates from SP-D (-/-) mice. Concentrations of TNF-α, IL-lβ, IL-6 and MIP-2 were assessed in lung homogenates from SP-D (- /-) (solid bar) and SP-D (+/+) (hatched bar) mice. Data are expressed as pg/ml and represent the mean ± SE with n=5 mice per group; *p<0.05 compared to SP-D (+/+) mice.

Figure 4: Hydrogen peroxide production in alveolar macrophages from SP-D (-/-) (solid bar) was assessed from 1 x 10⁶ macrophages isolated from broncho alveolar lavage fluid (BALF) as compared to SP-D (+/+) mice (hatched bar) with and without PMA stimulation. Data are expressed as μM of H₂0₂ and represent the mean ± SE with n=4 mice per group; *p<0.05 compared to SP-D (+/+) mice.

Figure 5: Lung colony counts in SP-D(-/-) and SP-D(+/+) mice after infection with Gp B Streptococcus (GBS). Figure 6: Lung colony counts in SP-D(-/-) and SP-D(+/+) mice after infection with

Haemophilus influenzae (H. flu).

Figure 7: Total cell count in Bronchoalveolar lavage (BAL) fluid after infection with GBS and H. flu.

Figure 8: Cytokine levels in lung homogenates after infection with GBS and H.flu. Figure 9: BAL nitrite levels after infection with GBS and H.flu.

Figure 10: Phagocytosis analyzed by light microscopy and FACS analysis after infection with GBS and H.flu.

Figure 11 : Hydrogen peroxide and superoxide levels in macrophages isolated from BAL after infection with GBS and H.flu. Figure 12: Effects of SP-D protein treatment on SP-D (-/-) mice. Figure 13: Total lung and alveolar lavage clearance kinetics of SP-D protein in mice.

Figure 14: Adeno viral vector Ad-rSPD containing rat SP-D cDNA.

Figure 15: Quantification of immunoblots of SP-A and SP-D in alveolar washes from wild type and CCSP-IL-4 mice (IL-4 mice). p<0.01. Figure 16: RSV and IAV liters were deteπnined by quantitative plaque assays of lung homogenates. Viral titers of RSV were significantly greater 3 and 5 days after adminisfration of 10⁷ pfu RSV(Graph A) in SP-D -/- (open bar) compared to wild type (hatched bar) mice. Lung homogenate titers of IAV were significantly greater for SP-D -/- (open bar) compared to wild type (hatched bar) mice 3 and 5 days after infection (Graph B). Data are mean ± SEM with n=15 mice per group (Graph A) and n=10 mice per group (Graph B). *p<0.05 compared to wild type mice.

Figure 17: Lung cells were recovered by bonchoalveolar lavage, stained with trypan blue and counted under light microscopy. SP-D -/- mice (open bar) had increased total cell counts in

BAL fluid 3 and 5 days after RSV infection (graph A) compared to wild type mice (hatched bar).

SP-D -/- (open bar) had increased total cell counts in BAL fluid 3 and 5 days after IAV infection (graph B). Data are mean ± SEM with n=8 mice per group, *p<0.05 compared to wild type mice.

Figure 18: Cytospin preparations of bonchoalveolar lavage fluid were stained with DIFF- QUIK to identify macrophages, lymphocytes and polymorphonuclear leukocytes. The percentage of neutrophils in BAL fluid was significantly greater 3 and 5 days after administration of 10⁷ pfu RSV to SP-D -/- (open bar) compared to wild type (hatched bar) mice (Graph A). Similarly, the percentage of neutrophils in BAL fluid was significantly greater 3 and 5 days after administration of 10⁵ pfu IAV to SP-D -/- (open bar) mice compared to wild type (Graph B). Data are mean ± SEM with n=8 mice per group, *p<0.05 compared to wild type mice.

Figure 19 shows increased total cell counts and neufrophils in BAL fluid from SP-D -/- mice: Lung cells were recovered by bronchoalveolar lavage, stained with trypan blue and counted under light microscopy. Cytospin preparations of bronchoalveolar lavage fluid were stained with Diff-Quik to identify macrophages, lymphocytes and polymorphonuclear leukocytes. Baseline total cell counts from controls inoculated with PBS were not significantly different in SP-D -/- (open bar) and SP-D +/+ (hatched bar) mice. SP-D -/- mice had increased total cell counts in BAL fluid 3 and 5 days after IAV infection compared to SP-D +/+ mice (graph A). The percentage of neufrophils in BAL fluid was significantly greater 3 and 5 days after adminisfration of 10⁵ ff IAV to SP-D -/- (open bar) compared to SP-D +/+ (hatched bar) mice (graph B). Data are mean ± SEM with n = 8 mice per group, *p<0.05 compared to SP-D +/+ mice.

Figure 20 shows increased viral titers in lung homogenates from SP-D -/- mice: IAV titers were determined by quantitative plaque assays of lung homogenates. Viral titers of IAV were significantly greater 3 and 5 days after adminisfration of 10⁵ ff IAV for SP-D -/- (open bar) compared to SP-D +/+ (hatched bar) mice. Data are mean ± SEM with n = 10 mice per group, *p<0.05 compared to SP-D +/+ mice.

Figure 21 shows increased pro-inflammatory cytokines in lung homogenates from SP-D -/- mice after IAV infection: Concentrations of TNF- , IL-1 , IL-6 and MIP-2 were assessed in lung homogenates from SP-D -/- (open bar) and SP-D +/+ (hatched bar) mice. Increased concentrations of the pro-inflammatory cytokines TNF- , IL-6, IL-13 and MIP-2 were found in lung homogenates from the SP-D -/- mice 3 and 5 days after IAV infection. Data is expressed as pg/ml and represent mean ± SEM with n=10 mice per group. *p<0.05 compared to SP-D +/+ mice.

Figure 22 shows CD4 and CD8 T lymphocytes in BALF after IAV infection: Three days after IAV infection, CD4 and CD8 T lymphocyte subsets were measured in BALF by flow cytometry with fluorescent isothiocyanate (FITC) conjugated mouse CD4 and phycoerytherin (PE) conjugated mouse CD8 antibodies. There was no difference in the percentage of CD4 (graph A) and CD8 (graph B) T lymphocytes in BALF between SP-D -/- (open bar) and SP-D +/+ (hatched bar) mice. CD4 and CD8 T lymphocytes in BALF were similar for uninfected SP-D +/+ and SP-D -/- mice. Data represent mean ± SEM with n = 8 mice per group, *p<0.05 compared SP-D +/+ mice.

Figure 23 shows neufrophil myeloperoxidase activity was decreased from SP-D -/- mice: Myeloperoxidase activity was measured in BAL neutrophils 3 days after intranasal infection with IAV at a concentration of 10⁶ ff. Isolated blood neutrophils from uninfected wild type mice were used as controls. Neutrophils were lysed to allow release of MPO from the granules and the MPO activity measured as described in the methods. MPO activity from BAL neufrophils was significantly decreased in SP-D -/- (open bar) compared to SP-D +/+ (hatched bar) mice 3 days after IAV infection. Blood neufrophils from uninfected SP-D +/+ (solid bar, WT blood) mice had significantly greater MPO activity compared to SP-D -/- BAL neufrophils and less MPO activity compared to SP-D +/+ BAL neutrophils after infection. Data represent mean ± SEM with n = 8 mice per group, *p<0.05 compared to SP-D +/+.

Figure 24 shows increased SP-D concentrations in the lung following IAV infection: Concentrations of SP-D in lung homogenates were determined with an enzyme-linked immunosorbent assay (ELISA). Three days after IAV infection, SP-D concentrations in the lung of SP-D +/+ (hatched bar) mice were significantly greater compared to uninfected SP-D +/+ (open bar) mice. Five days after IAV infection, SP-D concentrations in the lung of SP-D +/+ mice (solid bar) decreased to levels similar to uninfected SP-D +/+ mice. Data represent mean ± SEM with n = 10 mice per group, *p<0.05 compared to uninfected SP-D +/+ mice.

Figure 25. Lung lipid hydroperoxidase concentrations are increased in lungs of SP-D(-/-) mice. Lung tissues from adult WT and SP-D (-/-) mice were homogenized, and the content of malonaldehyde and 4-hydroxyalkanels measured colorimefrically. LPO was significantly increased in lungs from SP-D (-/-) mice. Values shown are means ± SE, n=5, *p < 0.05.

Figure 26. Increased reactive carbonyls in lungs of SP-D (-/-) mice. Frozen sections of lung from WT and SP-D (-/-) mice were incubated with OHNAH, followed by coupling with diazonium. Reactive carbonyls were observed at the sites of foamy alveolar macrophage infiltration in SP-D (-/-) (B) but not in control mice (A). Figures are representative of three separate experiments.

Figure 27. Increased intracellular ROS in alveolar macrophages from SP-D (-/-) mice.

AMs from wild type and SP-D (-/-) mice were incubated with CD-CFH for 30 min. Increased fluorescence was observed in AMs from SP-D (-/-) mice (B) compared to those from controls (A).

Data are representative of three separate experiments.

Figure 28. NF-κB activation in AMs from SP-D (-/-) mice. Panel (A)

Immunofluorescence staining for NF-κB p65 in AMs from WT and SP-D (-/-) mice. Lavaged cells from SP-D (-/-) mice and age matched controls were prepared for immunohistochemistry. Intense staining for NF-κB was observed in the cytoplasm and nuclei of AMs from SP-D (-/-) compared to

WT mice. Panel (B) EMS A for NF-κB. Nuclear exfracts of AMs were obtained from WT and SP-

D (-/-) mice and NF-κB activation assessed by EMSA. Enhanced DNA binding activities of NF-

KB were detected in the nuclear extracts from SP-D (-/-) compared to those from WT mice.

Specific competition with a excess of unlabeled NF-κB oligonucleotide eliminated the NF-κB band. Likewise AP-1 binding activities were enhanced in the nuclear exfracts from SP-D (-/-) mice. Panel (C) Supershift assay demonstrated bands containing the p50 and p65 subunit, but not c-Rel.

Figure 29. Effects of antioxidants on MMP expression by AMs from SP-D (-/-) mice.

Alveolar macrophages were isolated from SP-D (-/-) mice and treated with 20 mM N- acetylcysteine (NAG) or 200 μM pyrrolidine dithiocarbamate (PDTC). Conditioned media from the AMs were collected after 24 hrs incubation and MMP-2 and 9 activity determined by gelatin zymography. Both NAC (A) and PDTC (B) inhibited gelatinolytic activities of MMP-2 and 9 in the conditioned media from SP-D (-/-) mice. Figures are representative of at least 3 independent experiments. Densitometric analysis of gelatinolytic activity with (solid bar) or without (open bar) treatment showed that both NAC (C) and PDTC (D) significantly inhibited gelatinolytic activities of MMP-2 and 9 in the conditioned media from SP-D (-/-) mice. Values were normalized to matched untreated control ± SE, n=3, *p< 0.05.

Figure 30. NADPH oxidase inhibitors decrease MMP production by AMs from SP-D (-/-) mice. AMs from SP-D (-/-) mice were treated with 1 μM diphenylene iodonium chloride (DPI) and 1 mM apocynin. (A) Conditioned media from AMs were analyzed by SDS-PAGE zymography. DPI and apocynin markedly decreased MMP activity. (B) MMP-2 and 9 mRNA were detected by RT-PCR using specific primers for the cDNA sequences of MMP-2 and 9 as follows: Total RNA from macrophages was extracted by TRIzol reagent (GIBCO, BRL, Gaithersburg, MD) according to the manufacture's protocol. Reverse transcription, was carried out for 45 min at 42°C with oligo(dT) and Moloney murine leukemia virus reverse transcriptase (GIBCO, BRL). cDNA were amplified using various primers specific for the cDNA sequences of the following molecules: MMP-2 (5'-TCT GCG GGT TCT CTG CGT CCT GTG C-3', 5'-GTG CCC TGG AAG CGG AAC GGA AAC T-3') (SEQ ID NO: l), MMP-9 (5'-TTC TCT GGA CGT CAA ATG TGG-3')(SEQ ID NO:2), 5'-CAA AGA AGG AGC CCT AGT TCA AGG-3')(SEQ ID NO:3), β-actin (5'-GTG GGC CGC TCT AGG CAC CAA-3', 5'-CTC TTT GAT GTC ACG CAG GAT TTC-3')(SEQ ID NO:4). The PCR products were electrophoresed in 1% agarose gels and stained with ethidium bromide-stained gels that were imaged using the Alpha-Imager 2000 Documentation and Analysis Software (Alpha Innotech, San Leandro, CA). MMP-2 and 9 mRNA were also decreased by the NADPH oxidase inhibitor. (C) EMSA analysis demonstrated that treatment of apocynin reduced DNA binding activity of NF-κB in AMs isolated from SP-D (-/-) mice.

Figure 31. SN-50 inhibits MMP expression by AMs from SP-D (-/-) mice. AMs isolated from SP-D (-/-) mice were treated with SN-50, a synthetic NF-κB inhibitory peptide. Conditioned media from the AMs was subjected to zymography in gelatin substrate. SN-50 significantly reduced gelatinolytic activities of MMP-2 and 9 (A). The zymogram is representative of three separate experiments. Densitometric analysis of gelatinolytic activity with (solid bar) or without (open bar) treatment showed that SN-50 inhibited gelatinolytic activities of MMP-2 and 9 in the conditioned media from SP-D (-/-) mice (B). Values were normalized to matched untreated control ± SE, n=3, *p< 0.05. DETAD ED DESCRIPTION OF THE INVENTION

We have produced an SP-D (-/-) knockout mouse to identify the role of SP-D in normal lung function and development and to demonstrate the temporal progression of postnatal airspace enlargement and spontaneous inflammatory changes in the lungs of these mice. SP-D (-/-) mice develop progressive pulmonary emphysema, associated with clironic inflammation and increased oxidant production by alveolar macrophages. The lung abnormalities make this mouse an excellent model for emphysema. Because there are very few existing therapies for treatment of emphysema, the most common being lung volume reduction surgery, the model is urgently needed. Based on the mouse model for emphysema, we have proposed a number of ways to test SP-D protein and expression vectors, and potential pharmaceuticals in the mouse model for efficacy in treating emphysema or other forms of clironic lung injury. We have also proposed the use of SP-D protein and expression vectors to treat various other diseases of aberrant surfactant production, pulmonary fibrosis, sarcoidosis, lung injury, toxicant/oxygen exposure, infection, increased oxidant exposure. Lastly, we have proposed using SP-D cDNA, SP-D antibodies, PCR, and differential hybridization techniques to identify patients at risk for emphysema, pulmonary distress syndromes, and other types of respiratory diseases. Although other materials and methods similar or equivalent to those described herein can be used in the practice or testing of the present invention, the preferred methods and materials are now described. Example 1 describes the steps required to produce the SP-D (-/-) mouse.

Table 1 : Comparison of Body Weights, Lung Volumes, and Volume-to-Body Weight Rations (Mean ± SE)

AGE BODY WEIGHTS LUNG VOLUMES LVBW

(g) (ml) (Ml/g x lO-²)

SP-D (-/-) SP-D(+/+) SP-D (-/-) SP-D(+/+) SP-D (-/-) SP-D(+/+)

2 day 1.8 ± 0.1* 3.4 ± 0.1 ND ND ND ND

5 day 3.7 ± 0.3 4.6 ± 0.2 ND ND ND ND

7 day 3.9 ± 0.2* 5.3 ± 0.2 ND ND ND ND

14 day 6.6 ± 0.2* 7.7 ± 0.2 ND ND ND ND

17 day 10.9 ± 0.5 10.6 ± 0.7 0.36 ± 0.02 0.36 ± 0.03 3.25 ± 0.05 3.36 ± 0.03

3 wk 10.9 ± 0.5* 14.1 ± 1.2 0.36 ± 0.01 0.37 ± 0.03 3.43 ± 2.50 ± 0.18

0.21**

6 wk 23.2 ± 0.6 24.7 ± 0.5 0.63 ± 0.03 0.58 ± 0.02 2.71 ± 2.25 ± 0.18

0.13**

9 k 25.2 ± 1.2 27.8 ± 1.3 0.55 ± 0.03 0.61 ± 0.02 2.10 ± 0.16 2.20 ± 0.09

28 wk 36.9 ± 4.3 31.2 ± 1.6 0.67 ± 0.09 0.58 ± 0.06 2.03 ± 0.51 1.86 ± 0.10

* Significant statistical differences were observed in body weights at 2 day, p = 0.00001 ; 7 day, p = 0.0002; 2 wk, p = 0.007; and 3 wk, p = 0.04. ** Significant statistical differences in LV:BW rations were observed at 3 wk (p = 0.02), due to differences in body weight, and at 6 wk (p = 0.03), although body weights and lung volumes weere not statistically different at this latter time point. N = 3-71 animals per group. LV:BW, lung volume-to-body weight ratio; ND, not determined.

EXAMPLE 1 SP-D (-/-) Knockout Mouse construction

SP-D (-/-) mice were generated by targeted gene inactivation. Integration of a pGKneo targeting vector containing sequences from exon 2 of the SP-D gene generated a deletion of the second exon of the SP-D gene, which included removal of the initiating methionine and translation initiation sequences. The mouse SP-D gene sequence of Exons 1 and 2 can be found under Genbank accession No. AF047741. The targeting vector was designed using pGKneo by first subcloning a 5.1-kb blunt ended Kpnl-tailed Hindlll genomic fragment encoding infron 2 through exon 6 into a Kpnl site between the neomycin-resistance cassette and the thymidine kinase cassette. Subsequently, a 1.5-kb genomic Pstl fragment containing a portion of infron I was tailed with Xhol linkers and cloned into an Xhol site 5' from the neomycin-resistance cassette Eight of 104 ES clones surviving the double selection process were correctly targeted as determined by both 5' and 3' PCR analyses. Clone 93, a highly undifferentiated and proliferative clone, was expanded and injected into C57/B16 blastocysts generating chimeric males. Chimeric males were bred to NIH Swiss Black females. A female bearing the targeted gene was obtained and bred to NIH Swiss Black males to generate normal SP-D (-/-) and SP-D (±) mice. The distribution of genotypes from heterozygotic matings followed a Mendelian pattern, with 30 (+/+), 45 (+/-), and 25% (-/-) of 115 offspring, indicating that there were no obvious abnormalities in survival related to SP-D alleles. SP-D(-/-) mice survive and breed normally in the vivarium under barrier containment facilities at Children's Hospital Medical Center, Cincinnati, Ohio. Mice have been viral free as assessed by serology. No serological evidence of viral infection in SP-D(-/-) mice was detected at necropsy.

To determine genotype, DNA from tail clips was digested with BaniRΪ and probed with a PCR product derived from genomic mouse DNA, containing exon 2 and part of infron 2, and with the G418 resistance cDNA clone. This demonstrated a simultaneous loss of exon 2 with appearance of sequences encoding G418 resistance in SP-D (±) and SP-D (-/-) mice.

To demonstrate that SP-D was not expressed in null animals, RNA blot analysis was conducted with total lung RNA from null, normal, and heterozygotic animals. The results showed approximately 50% reduction in the intensity of the SP-D hybridization band in heterozygous animals with a total absence of normally sized SP-D mRNA in null animals. After prolonged exposure, a diffuse mRNA band approximately 150 nucleotides smaller than the noπnal SP-D mRNA was detected. By scanning densitometry, this band represents less than 5% of the intensity of the noπnal SP-D transcript from heterozygous animals. Western blot analysis of lung homogenates using rabbit anti-rat SP-D antiserum revealed

SP-D was reduced approximately 50% in heterozygous SP-D (+/-) mice and was absent in SP-D (-/-) mice.

Both SP-D (-/-) and SP-D (+/-) mice survived normally in perinatal and postnatal periods. At selected ages, body, lung, and heart weights were obtained by direct measurement; and lung and heart volumes were obtained by fluid displacement. Lung protein and DNA content were assessed using bovine serum albumin and salmon sperm DNA, respectively, as standards. Body weights of SP-D (-/-) mice were slightly smaller prior to weaning, but were not significantly different from SP-D (+/+) mice after 3 weeks of age, Table 1. While lung volumes were not significantly different, lung- volume-to-body-weight ratios were increased in SP-D (-/-) mice at 3 and 6 weeks of age, Table 1. No significant differences were observed in heart volumes or heart- olume-to-body- weight ratios. At maturity (5 months), no changes in wet lung weight, total lung DNA or protein were noted.

However, while no abnormalities were observed in body weight, examples 2 through 5 describe the other abnormalities or changes found in SP-D (-/-) mice. Example 2 demonstrates the effect on phospholipid levels. Alveolar and tissue phospholipid levels, specifically phosphatidylcholine pool levels, were markedly increased while total brochoalveolar lavage (BAL) protein levels remained unchanged.

EXAMPLE 2 Phospholipid levels in the SP-D (-/-) Mouse Alveolar, tissue and total saturated phosphatidylcholine (Sat-PC) (p<0.001) was increased about 3-fold in SP-D (-/-) mice. Levels of Sat-PC were not altered in SP-D (+/-) mice. For alveolar lavage phospholipid composition analysis, two to four samples consisting of the pooled lavage from two to three mice were evaluated for the relative abundance of phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol, phosphatidylinositol, sphingomyelin, and lyso- bis-phosphatidic acid. Phospholipid composition did not differ among genotypes. Incorporation of (³H)choline into total lung Sat-PC was slightly increased 8 hr following injection, incorporation being approximately 20% greater in SP-D (-/-) mice (p < 0.05).

This result was completely unexpected in that previous work suggested a definite role for SP-A and a limited role for SP-D in lung phospholipid homeostasis. Previous diseases associated with surfactant homeostasis involved accumulations of both surfactant proteins and lipids, thus the SP-D (-/-) null mouse demonstrates for the first time that SP-D is an important player in surfactant lipid homeostasis and that surfactant lipid and protein homeostasis can be dissociated in vivo, since the total protein concentration in the surfactant did not change. However, there was a modest decrease in the total concentration of SP-A as explained in example 3. EXAMPLE 3

Reduction in SP-A Levels in the SP-D (-/-) Mouse No differences in SP-B and SP-C mRNAs or proteins were observed in SP-D (-/-) mice. In contrast, Northern blot hybridization of total lung RNA from SP-D (+/+), SP-D (+/-), and SP-D (-/- ) mice and hybridization with and SP-A probe showed that SP-A mRNA was reduced in SP-D (-/-) mice. Consistent with the reduction in SP-A mRNA, BAL SP-A protein was apparently reduced by about 25% in SP-D (-/-) mice as assessed by Western blot analysis of alveolar lavage from three mice.

Therefore, SP-D has a role in the regulation of SP-A production. Since SP-A is involved in host defense in the lungs, SP-D can affect host defense in two ways. By up-regulation of SP-A production and by direct interaction with immune and microbial cells.

The ulfrastructure of the phospholipid rich material isolated form the BAL of the SP-D (-/- ) mice was evaluated as explained in example 4.

EXAMPLE 4 Changes in Surfactant Stucture in SP-D (-/-) mouse Large aggregate surfactant was isolated from pooled alveolar lavage of SP-D (-/-) and SP-

D (+/+) mice and examined by EM using the technique outlined below. Lipid aggregates in SP-D (-/-) mice were enlarged and organized into electron dense phospholipid arrays and contained less tubular myelin compared with SP-D (+/+) mice. The ulfrastructure proved to be markedly abnormal, containing reduced quantities of tubular myelin and foπning unique densely packed lipid structures. Therefore, SP-D has a role in the structural organization of alveolar lipids. Aggregate forms from alveolar lavage

Surfactant in alveolar was can be separated into large aggregate (heavy, dense) and small aggregate (light, vesicular) fractions by centrifugation. Alveolar washes were cenfrifuged at 40,000 x g over 0.8 M sucrose cushion for 15 min. The large aggregate surfactant then was collected from the interface, diluted with normal saline and cenfrifuged again at 40,000 x g for 15 min. The supernatant from the first 40,000 x g centrifugation that contains small aggregate surfactant is concentrated at 4°C by ultrafiltration using a 300,000 molecular weight retention filter (Minitan, Miliore Corp., Bedford, MA) or centrifugal concentrators (Amicon Corp., Danvers, MA). The small aggregate surfactant is diluted with 50 ml normal saline and ultrafiltered 3 times to remove soluble proteins.

Lastly, the structure of the lung was analyzed. Although, normal in SP-D (+/-) mice, increased numbers of large foamy alveolar macrophages and enlarged alveoli were observed in SP- D (-/-) mice. In example 5 the method and results for identifying lung abnormalities is outlined.

EXAMPLE 5 Lung Abnormalities in the SP-D (-/-) mouse

To deteπnine whether absence of SP-D expression led to structural abnoπnalities, lungs from null, normal, and heterozygous mice were inflation fixed, and morphology and histochemical analysis was done on sections by light microscopy. There was no evidence of infection and no obvious alterations in airway epithelial cells at the level of light microscopy. However, heterogeneous abnormalities in lung parenchyma, with enlarged alveoli, were consistently observed in the SP-D (-/-) but not SP-D (+/-) or SP-D (+/+) controls. Morphological and histochemical method

Lung tissue from SP-D (+/+) and SP-D (-/-) mice were sacrificed at 2 weeks, 3 weeks and 6 weeks. Animals were weighed, anesthetized with a 4:1:1 mixture of ketamine, acepromazine and xylazine, and exsanguinated by severing the inferior vena cava and descending aorta. The trachea was cannulated, and the lungs were collapsed by piercing the diaphragm. The lungs were inflation- fixed at 25 cm of water pressure with 4% paraformaldehyde in phosphate buffered saline (PBS) for 1 minute. The trachea was tied off as the cannula was removed in order to maintain the fixative in the inflated lung. Excised lungs and heart were allowed to equilibrate in cold fixative until they had sunk to the bottom of the container. Lung and heart volumes were then determined by fluid displacement. Each lobe was measured along its longest axis, bisected perpendicularly to the long axis, and processed into paraffin blocks. Five micron sections were cut in series throughout the length of each lobe, loaded onto polysine-coated slides, and stained with hematoxylin and eosin, Masson's frichrome stain for collagen, or ocein for elastin. Lung morphology

In more detail, examination within the first 2 weeks of life demonstrated no detectable abnormalities in lung morphology, although increased numbers of noπnal appearing alveolar macrophages were noted in the alveoli of SP-D (-/-) mice at 14 days of age. In contrast abnomialities in lung histology were observed in SP-D (-/-) mice at 3 and 6 weeks of age consisting of enlarged airspaces and infiltration with atypical, foamy, alveolar macrophages. Enlarged airspaces associated with the accumulation of hypertrophic, foamy, alveolar macrophages and perivascular/peribronchiolar monocytic infiltrates were observed by 6 to 7 months of age, although the extent of airspace enlargement in individual SP-D (-/-) mice varied from moderate to severe in this age group.

In 7 month old SP-D (-/-) mice, subpleural fibrotic lesions were observed that stained intensely for collagen. Abnormalities in elastin deposition were also observed in the parenchyma of lungs from SP-D (-/-) mice at this time point. These consisted of regions of lung parenchyma with short thick, and more highly coiled elastic fibers, as well as regions of inflammation where elastin staining was decreased in adjacent alveolar septa (adjacent to macrophage accumulation and fibrosis) .

Increased bronchial-associated lymphocytic tissue (BALT) was noted in the SP-D (-/-) mice. Intensity of SP-B immunostaining in type II cells was similar among the three genotypes. Type II cells were purified as outlined below. However, there were focal areas of increased numbers of large, foamy infra-alveolar cells, which appeared to be alveolar macrophages containing abundant cytoplasmic vesicles. These cells increased in size as a result of increasing number and volume of cytoplasmic vesicles. The vesicles stained with Nile Red and fluoresced when excited with 520-550 nm green light after staining with Nile Blue and thus contained lipid or phospholipid. These macrophages were also stained by SP-B antiserum. In alveolar lavage, approximately 4-fold more macrophages (1.2 X 10^δ per mouse) were observed in SP-D (-/-) compared with normal mice (0.36 X 10⁶/mouse), but there were no changes in relative neufrophil or lymphocyte cell counts. Macrophage size was estimated from the diameter of fixed and stained macrophages from cytospin preparations sedimented onto glass slides at 1500 X g for 2 min. Mean diameter of macrophages from (+/+) was 11.75 ± 1.75 μm compared with (-/-) mice 18.75 ± 7.25 μm. Abnormally large macrophages, defined as those with a diameter of twice normal, comprised 22.4 ± 0.6% of the macrophages from (-/-) mice compared with 18 ± 1.0% from (+/+) mice. Numbers and morphology of alveolar macrophages were not different in SP-D (+/-) mice. Ulfrastructural characteristics of type II cells were similar in SP-D (-/-) compared with SP-D (+/+) mice. The morphology of the alveolar macrophages is consistent with that of activated "foam" cells, known to be associated with inflammation. Isolation of murine type II cells

Type II cells are routinely isolated in this laboratory using the following method. Mice are anesthetized by infraperitoneal injection and pentobarbital (50 mg/ml 3.25 ml/kg body weight). After opening the abdominal cavity, mice are exsanguinated by severing the inferior vena cava. The trachea is exposed, cannulated with a 20 gauge Iuer stub adaptor, and secured by a suture. The chest plate is removed and lungs perfused with 10-20 ml sterile saline via the pulmonary artery until visually free of blood. Dispase (Collaborative Research, Inc., Bedford, MA) is instilled into the lungs via the tracheal catheter, followed by 1% low melt agarose, warmed to 45° C. Lungs are immediately covered with ice and incubated for 2 minutes to set the agarose. Lungs are dissected out, put in a culture tube containing an additional 1 ml Dispase, and incubated for 45 minutes at room temperature. Lungs are next transferred to a 60 mm culture dish containing 100 U/ml DNAase 1 (Sigma, St. Louis, MO) in 7 ml DMEM (Gibco BRL, Gaithersburgh, MD). The tissue is gently teased away from the airways and swirled for 5 minutes. Cells are then placed on ice until being filtered. The cell suspension is successively filtered through lOOμm and 40 μm cell sfrainers, and then through 25 μm nylon gauze (Tetko, Briarcliff Manor, NY). Cells are pelleted for 7 min at 130 x g at 4°C and resuspended in 10 ml DMEM with 10% FBS (Intergen Co., Purchase, NY). Crude cell suspensions are added to 100 mm culture dishes that were previously coated with CD-45 and CD-32 antibodies (Phaπnigen. San Diego, CA) and incubated for 102 hours at 37° in the presence of 5% C0₂. Plates are removed from the incubator and gently "panned" to free settled type II cells. The cell suspension is cenfrifuged at 130 x g at 4°C and resuspended in 10 ml DMEM with 10% FBS (Intergen Co., Purchase, NY). Crude cell suspensions are added to 100 mm culture dishes that were previously coated with CD-45 and CD- 32 antibodies (Pharmigen. San Diego, CA) and incubated for 102 hours at 37°C in the presence of 5% C0₂ Plates are removed from the incubator and gently "panned" to free settled type II cells. The cell suspension is cenfrifuged at 130 x g for 7 minutes and cells are resuspended in DMEM containing 10% FBS Airspace and respiratory parenchyma

Morphomefric measurements were performed on mice at 5 days (0.5 weeks), 14 days (2 weeks) and 17 days (2.5 weeks), 3 and 6 weeks, and 6 to 7 months of age. the overall proportion (% fractional area) of respiratory parenchyma and airspace was deteπmned using a point counting method. Measurements were performed on sections taken at intervals throughout the left, right upper, oi right lower lobes. Slides were viewed using a 20x objective, and the images (fields) were transferred by video camera to a computer screen using MetaMorph imaging software (Universal Imaging Corp , West Chester, PA) A computer-generated, 121-pomt lattice grid was superimposed on each field, and the number of intersections (points) falling over respiratory parenchyma (alveoli and alveolar ducts) or airspace was counted. Points falling over bronchioles, large vessels, and smaller arteπoles and venules were excluded from the study. Fractional areas (% Fx Area) were calculated by dividing the number of points for each compartment (n) by the total number of points contained within the field (N), and then multiplying by 100: % Fx Area = n/N x 100

Ten fields per section were analyzed to gather the data. The x and y coordinates for each field measured were selected using a random number generator.

While, as shown in Figure 1, no differences the relative proportion (% fractional area) of airspace (a) and respiratory parenchyma (b) were observed at 5 days (0.5 weeks), 14 days (2 weeks), or 17 days (2.5 weeks) of age, the % fractional area of airspace was increased significantly (p=0.013) m SP-D (-/-) mice by 3 weeks of age. More specifically, the fractional area devoted to both airspace (a ) and parenchyma (b) diveiged significantly between the two different genotypes at 3 weeks (« p = 0.013), 6 weeks (*p = 0.0007), and 28 weeks (*p = 0.004) of age. Likewise, the % fractional area of respiratory parenchyma was decreased in SP-D (-/-) mice compared to age- matched SP-D (+/+) confrols (34% parenchyma/66% airspace compared to 42.5% parenchuma/57 5% airspace, respectively), Figure 1. Relative proportions of airspace and respnatory parenchyma continued to diverge significantly from controls at later time points, the % fractional areas ranging from 27% parenchyma/73% airspace to 37% parenchyma/63% airspace m 7 month old SP-D (-/-) mice (n=5). Age-matched SP-D (+/+) controls showed less variability, ranging from 45% parenchuma/55% airspace to 47% parenchyma/53% airspace, at this time point (n=4). The overall percent reduction in parenchyma at 7 months of age in the SP-D (-/-) mice was 32% of control values, while the percent increase in airspace in the SP-D (-/-) mice was 27% of control values. Cellular Proliferation Animals were pre-injected with BrdU 4 hours prior to sacrifice in order to assess alterations in cellular proliferation. Immunohistochemical detection of incorporated BrdU was perfoπned using a commercially available kit (Zymed Laboratories, Inc., San Francisco, CA). Sections of small intestine from each animal were immunostained in parallel with the lung sections as a positive control for BrdU incoφoration. BrdU labeling indices were relatively low, and no changes in BrdU labeling of respiratory parenchymal cells or alveolar macrophages were observed in the lungs from SP-D (-/-) mice compared to controls. Lung volumes

Detennination of lung volumes using pressure-volume curves was as follows: Twelve week-old mice were injected with sodium pentobarbital and placed in a chamber containing 100% oxygen to ensure complete collapse of alveoli by oxygen absoiption. Mice were killed by exsanguination, the trachea cannulated and connected to a syringe linked to a pressure sensor via a three-way connector (Mouse Pulmonary Testing System, TSS Incorporated, Cincinnati, OH). After opening the diaphragm, lungs were inflated in 75 μl increments every 10 seconds to a maximum pressure of 28 cm of water and then deflated. Pressure-volume curves were generated for each animal, detennining lung volumes (divided by body weight) at 10, 5, and 0 cm of water during the deflation curve. In figure 2, pressure-volume curves were generated in 5-6 mice at 12 weeks of age. Lung volumes associated with the deflation limbs of pressure-volume curves were significantly greater for 12 week old SP-D (-/-) mice compared age-matched to SP-D (+/+) mice at 10 cm H₂0 and at the maximum pressure of 28 cm H₂0 (*p<0.05).

Statistically significant differences were determined by using either analysis of variance for fractional areas and pressure-volume curves, followed by the Student-Newman-Keuls procedure, or the student's T test for comparison of body weights, lung and heart volumes, volume:body weight ratios, total protein and DNA content. Differences of p<05 were considered significant. Values are given as mean ± SE.

Increased lung volumes were readily apparent in SP-D(-/-) mice at 12 weeks of age, consistent with histologic and morphometric studies demonstrating emphysema, see Figure 2. Alveoli

The enlarged alveoli were consistently observed in the SP-D (-/-) mice. Therefore, SP-D is very likely to be involved in the regulation of alveolar remodeling in the lungs. Because abnormalities and airspace remodeling is a defining characteristic of emphysema, the SP-D (-/-) mouse is an ideal model for emphysema.

EXAMPLE 6 Cytokines, Hydrogen Peroxide Production, and Metalloproteinase Activities Methods

Cytokine measurements

Lung homogenates from 6 to 9 week-old mice were cenfrifuged at 2000 RPM and stored at -20°C. Tumor necrosis factor alpha (TNF-α), interleukin (IL)-lβ, IL-6, and macrophage inflammatory protein (MIP)-2 were quantitated using murine sandwich ELISA kits (R&D Systems, Minneapolis, MN) according to the manufacturer's directions. All plates were read on a microplate reader (Molecular Devices, Menlo Park, CA) and analyzed with the use of a computer- assisted analysis program (Softmax; Molecular Devices). Only assays having standard curves with a calculated regression line value of >0.95 were accepted for analysis. Hydrogen Peroxide Production Alveolar macrophages were collected by bronchoalveolar lavage with 1 ml of dye-free

RPMI media (Gibco, Grand Island, NY) times three. Bronchoalveolar lavage fluid (BALF) from 8-10 mice was pooled to provide sufficient numbers of macrophages for analysis. The lavage was cenfrifuged at 1200 RPM for 10 minutes and one million macrophages were resuspended in PBS. Hydrogen peroxide production by macrophages was measured using a commercially available assay (Bioxytech H₂0, -560 assay, OXIS International, Portland, OR), based on the oxidation of feπous ions (Fe²⁺) to ferric ions (Fe³⁺) by hydrogen peroxide under acidic conditions. Methods followed the manufacturer's recommendations. Hydrogen peroxide production was deteπnined after activation with 100 ng/ml phorbol myristate acetate (PMA) or without stimulation. Metalloproteinase Activity Mouse lavage samples were cenfrifuged (100,000 x g, 1 hour) in a SW-28 rotor (Beckman,

Palo Alto, CA). The supernatants were concentrated using Centricon-30 filtration units (Amicon, Inc., Beverly, MA). Samples (200 μg protein) were elecfrophoresed under nonreducing conditions (laemmli) into 10% Zymogram, gelatin and casein gels (Novex, San Diego, CA). Following electrophoresis, gels were washed twice with 2.5% Triton X-100 (37°C, 15 min.) and incubated for 16 hours with 40 mM Tris-HCI, pH 7.5, 10 mM CaCl₂, luM ZnCl₂. Gels were stained with 0.5% (w/v) Coomassie Blue in 50% methanol, 10% acetic acid for 1 hour, then destained. Metalloproteinases were detected as clear bands against the blue background. Metalloproteinase 2 and 9 mRNA's were quantitated by Northern blot analyses of total lung mRNA from wild type and SP-D (-/-) mice using [³²P]-labeled cDNA probes (Chemicon International, Inc., Temecula, CA). Results

At 6 to 9 weeks of age, lung homogenates from SP-D (-/-) mice did not contain inflammatory levels of the pro-inflammatory cytokines TNF-α, IL-lβ, IL-6 or MIP-2, although basal levels of IL-lβ were increased significantly, Figure 3. In contrast, oxidant production, as assessed by measuring hydrogen peroxide production by alveolar macrophages isolated from SP-D (-/-) mice, was increased 10 fold, Figure 4. Hydrogen peroxide and superoxide production is a measure of macrophage activation, particularly the microbicidal activation. Since oxidant production has been associated with activation of a number of metalloproteinases and with emphysema in both human and animal studies, metalloproteinase activities were estimated by degradation of gelatin substrates after SDS-PAGE of BALF supernatants isolated from SP-D (-/-) and SP-D (+/+) mice. Bands of activity consistent with metalloproteinases -2 and -9 were readily detected in both genotypes, but were not altered in lung tissue from SP-D (-/-) mice. Likewise, the abundance of metalloproteinasese -2 and -9 mRNA's were similar in whole lung RNA samples from SP-D (-/-) and SP-D (+/+) mice as assessed by Northern blot analysis. However, production of MMP-2 and 9 by alveolar macrophages isolated from SP-D (-/-) mice were markedly increased. Likewise, immuno-staining for MME (macrophage metalo-elastase) and MMP-9 were increased in the lungs of the SP-D (-/-) mice.

The results in Examples 1-6 were completely unexpected. There is nothing in the literature to suggest an SP-D null mouse is a model for emphysema. In summary, the SP-D (-/-) mouse conclusively demonstrates a remarkable and surprising role for SP-D in regulation of surfactant homeostasis, the structure of alveolar surfactant in the lung, regulation of SP-A expression, or plays a critical inhibitory role in oxidant, hydrogen peroxide production in the lung. Therefore, its levels are important for suppression of ongoing oxidant production and injury and the regulation of alveolar remodeling and suppression of proteases that cause emphysema. This makes the SP-D (-/-) mouse an excellent model for emphysema. Example 7 will summarize the results for the mouse model of emphysema.

EXAMPLE 7 SP-D (-/-) mouse as a model for Emphysema SP-D deficiency caused inflammation, increased oxidant production by isolated alveolar macrophages, emphysema, and localized fibrosis in gene-inactivated SP-D (-/-) mice. The timing and progressive nature of these pulmonary abnomialities support the conclusion that alveolar enlargement in SP-D (-/-) mice is caused by alveolar remodeling associated with chronic inflammation, rather than with development abnormal ties occurring during alveologenesis. The present findings are consistent with an important and unanticipated role of SP-D in the modulation of pulmonary inflammation and oxidant production and suggest that changes in the regulation or function SP-D may play a role in the pathologic processes leading emphysema following clironic lung injury.

Histologic and morphomefric analyses of lungs from SP-D (-/-) mice revealed no abnormalities in lung structure until 3 weeks of postnatal age, one week after alveologenesis is completed in the mouse. This was consistent with the observation that the relative proportions of respiratory parenchyma and airspace were similar in both SP-D (-/-) and SP-D (+/+) mice between postnatal days 5 and 17. After 2 weeks of age, increased parenchymal-airspace ratios were observed in SP-D (-/-) mice, consistent with ongoing remodeling of the parenchyma and alveolar spaces. Enlarged airspaces were generally associated with focal accumulation of large, foamy, alveolar macrophages, although there was some heterogeneity in both localization and extent of inflammatory infiltrates and remodeling in older mice While focal accumulation of alveolar macrophages in lungs of SP-D (-/-) mice were observed as early as 2 weeks of age, macrophage morphology remained noπnal at this time. Abnoπnal alveolar macrophage morphology, consisting of enlarged foamy cells, was noted by 3 weeks of age and was coincident with enlargement of alveolar structures thereafter. Previous studies demonstrated increased numbers of enlarged alveolar macrophages in SP-D (-/-) mice by 8 weeks of age. Thus, the development of emphysema in SP-D (-/-) mice is consistent with the temporal and spatial accumulation of activated macrophages, and increased production of proteases MMP-2, 9 and MME, suggesting their role in the remodeling process. The present findings do not support a role for SP-D in normal long morphogenesis and alveologenesis, a process generally completed by approximately 2 weeks of postnatal age in mice.

The present findings do support an important role for SP-D in the modulation of alveolar macrophage activation and oxidant production, leading to protease activation, emphysema and fibrosis. Macrophage infiltration and lung remodeling in SP-D (-/-) mice were associated with modest but significant differences in inflammatory levels of various pro-inflammatory mediators, including IL-lb, MIP-2, but not TNF-α and IL-6, but rather with markedly increased hydrogen peroxide production by isolated alveolar macrophages. Although basal levels of IL-βl were significantly increased in SP-D (-/-) mice, IL-βl was not increased to levels typically detected in severe inflammation. While increased IL-lβ and hydrogen peroxide production were observed in SP-D (-/-) mice, it remains unclear whether the pulmonary abnormalities seen in these mice were directly mediated by cytokine or oxidant-induced injury. Although SP-D has been proposed to play an important role in host defense, there was no histologic or serologic evidence of infection in the SP-D (-/-) colony.

Enhanced hydrogen peroxide production and increased numbers of alveolar macrophages found in the lungs of SP-D (-/-) mice support the concept that SP-D plays a critical anti- inflammatory role in the lung and regulates hydrogen peroxide production by alveolar macrophages in vivo. Relationships between oxidant injury and the development of emphysema and pulmonary fibrosis are well established in numerous animal and genetic models. For example, neonatal exposure to hyperoxia caused alveolar remodeling and fibrosis in newborn mice. Since activation of metalloproteinases has been associated with oxidant injury and emphysema, metalloproteinase activities were assessed in BALF from the SP-D (-/-) mice. While protease activity consistent with metalloproteinase -2 and -9 were readily detected by zymography in lung homogenates, but, no consistent changes in the activities of these proteinases or their mRNAs were detected in SP-D (-/-) mice. However, markedly increased production of MMP-2 and MMP-9 were demonstrated in isolated alveolar macrophages from SP-D (-/-) mice in vitro and immuno- staining for MME and MMP-2 were increased in the lungs of SP-D (-/-) mice in vivo. Thus, localized increased concentrations of metalloproteinases and/or alterations in other proteases or antiproteases is associated with SP-D deficiency. Deficiencies in antiproteases, as well as smoking and oxidant injury from oxidizing toxicants (e.g., bleomycin or paraquat), have all been associated with emphysema or pulmonary fibrosis in human lung.

While surfactant phospholipid content was increased in SP-D (-/-) mice and was associated with increased numbers of large, foamy, alveolar macrophages, increased phospholipid content alone is not likely to be sufficient to cause the alveolar remodeling observed in SP-D (-/-) mice. In fact, the overall effect of surfactant phospholipids appears to be anti-inflammatory, altering phagocytosis, oxidant production, and cytokine release, and inhibiting lymphocyte proliferation, immunoglobulin production, and expression of adhesion molecules. On the other hand, transgenic mice in which GM-CSF was over-expressed in the respiratory epithelium had markedly increased numbers of nornial appearing alveolar macrophages, but did not develop pulmonary alveolar proteinosis/lipoidosis, emphysema, or fibrosis. In contrast, surfactant phospholipids and proteins were markedly increased in lungs from both GM-CSF (-/-) and GM-receptor common beta subunit (βc) deficient mice in association with alveolar macrophage accumulation and perivascular/peribronchiolar monocyte infiltrates; however, neither model of pulmonary alveolar proteinosis/lipoidosis was associated with emphysema or fibrosis. Likewise, transgenic mice over- expressing IL-4 in the lung also exhibited increased amounts of surfactant protein and lipids, as well as increased numbers of inflammatory cells, but did not develop emphysema.

Although concentrations of SP-D in the lung change during development, increasing with advancing age, SP-D levels are also influenced by various clinical conditions. Recent studies demonstrated marked reduction of SP-D concentrations in BALF obtained from patients with cystic fibrosis (CF), supporting a potential role for SP-D in the pathogenesis of the chronic inflammation associated with CF lung disease. SP-D levels were also reduced in BALF of smokers, suggesting that decreased levels of SP-D may contribute to later development of chronic obstructive pulmonary disease (COPD) and emphysema in these patients. Although concentrations of SP-D in BALF were increased in patients with pulmonary alveolar proteinosis (PAP), patients with idiopathic pulmonary fibrosis (IPF) and interstitial pneumonia associated with collagen vascular disease (IPCD) had decreased BALF levels of SP-D. On the other hand, serum concentrations of SP-D were increased in patients with PAP, IPF, and IPCD; although serum levels of both SP-A and SP-D varied with the severity of IPF and during the course of anti-inflammatory therapies. These clinical findings, as well as the present study, demonstrating that SP-D is required for maintenance of normal lung architecture and suppression of oxidant production, support the concept that changes in SP-D concentrations may be involved in the pathogenesis of lung injury associated with various clinical conditions, including oxidant injury, lung abcesses, secondary diseases, cystic fibrosis, interstitial pumonary fibrosis (IPF), and chronic obstructive pulmonary disease (COPD), various lung infections, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), chemotherapy-induced lung injury, lung fibrosis secondary to primary abcess (ie: sarcoid), and asthma.

In our previous studies, no abnormalities in alveolar macrophages or lung morphology were observed in the heterozygous SP-D (+/-) mice, demonstrating that a 50% reduction in SP-D concentration in BALF is not sufficient to cause pulmonary abnoπnalities. The precise concentrations of SP-D that are required for inhibition of oxidant-induced injury and lung remodeling are unclear at present. Whether further injury or oxidant stress to the lungs of SP-D (+/-) or SP-D (-/-) mice will exacerbate emphysema and fibrosis in this animal model remains to be determined.

The modest reduction of lung SP-A concentrations found in SP-D (-/-) mice is not likely to contribute to the changes in lung morphology observed in these mice, since neither SP-A (+/-) nor SP-A (-/-) mice developed emphysema. Furthermore, lung moφhology of SP-A deficient mice was noπnal, and, in contrast to SP-D (-/-) mice, SP-A deficiency was associated with decreased hydrogen peroxide production by isolated alveolar macrophages.

SP-D (-/-) mice developed severe and progressive emphysema. Alveolar remodeling and macrophage abnormalities were apparent as early as 3 weeks of age, while mild, focal, pulmonary fibrosis was observed at 6 to 7 months of age, demonstrating a role for SP-D in the regulation of inflammation and alveolar remodeling. The present study also demonstrated an unexpected role for SP-D in the regulation of hydrogen peroxide production and metalloprotease production by alveolar macrophages in vivo, which may contribute to the development of emphysema in the lungs of SP-D (-/-) mice. Whether SP-D deficiency contributes to ongoing inflammation or to the development of emphysema and fibrosis found in various human chronic lung diseases, including those caused by smoking and other oxidants, remains to be determined. Testing Therapies in the Mouse Model

Because of the lack of pharmaceutical therapies for the treatment of emphysema, a model for testing possible therapies is imperative. The SP-D (-/-) mouse provides that model. Therefore, Example 6 provides a sample framework for testing pharmaceuticals, protein preparations, or genetic manipulations for the treatment of emphysema.

EXAMPLE 8 A number of doses or concentrations of protein or pharmaceutical diluted in an appropriate buffer is administered to SP-D (-/-) mice infrafracheally. Protein and phaπnaceutical is purified as appropriate for in vivo use. Recombinant adeno virus or other genetic vectors containing the gene of interest is administered as follows. SP-D (-/-) mice are immunosuppressed to block specifically T cell-mediated immune responses, and treated with an adenoviral construct designed to express the gene of interest in transduced cells. Mice are injected intraperitoneally with H57 antibody 3 days prior to receiving the adenoviral construct. H57 alters immune recognition at the T cell receptor and decreases splenic and lung T and B lymphocytes. One dose is instilled infrafracheally and another group is treated intraperitoneally with H57 followed by intratracheal administration of vehicle alone. Levels of the protein of interest is measured 1 week after administration to detect uptake and expression of the vector. Four mice are tested and untreated SP-D (-/-) mice are used as a confrol. Intratracheal inoculation involves anesthetizing with isofluorane, and an anterior midline incision is made to expose the trachea. A 30-gauge needle attached to a tuberculin syringe is inserted into the trachea, and a 100-μl inoculum of protein or phaπnaceutical is dispersed into the lungs. The incision is closed with one drop of Nexaband. Nonpyogenic PBS is injected intratracheally as a control. To test for efficacy of the protein, phaπnaceutical, or genetic manipulation at diminishing the effects of emphysema, a number of tests are perfoπned.

To deteπnine the effects of the protein or phaπnaceutical on the lung structure lungs are inflation fixed and sections evaluated by electron microscopy. Lungs from treated and untreated mice are inflated via a fracheal cannula at 20 cm of pressure with 4% paraforaialdehyde and removed en bloc from the thorax. Lungs are dehydrated and embedded in paraffin. Tissue sections (5μm) are stained with hematoxylin and eosin.

To test the number and moφhology of macrophages: Staining with Nile Red detects vesicles and staining with Nile Blue and exciting with 520-550 mm green light is an additional method to detect lipid or phospholipid. Macrophage number is deteπnined by staining with anti MAC-1 or other macrophage specific antisemm. Macrophage size is estimated from the diameter of fixed and stained macrophages from cytospin preparations sedimented onto glass slides at 1500 x g for 2 min.

Surfactant composition and ulfrastructure is analyzed as follows: The structure of surfactant is analyzed by isolating large aggregates from pooled alveolar lavage of SP-D (-/-) treated and untreated mice and examined by EM (see protocol below). For alveolar lavage phospholipid composition analysis, two to four samples consisting of the pooled lavage from two to three mice are evaluated for the relative abundance of phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol, phosphatidylinositol, sphingomyelin, and lyso- bis-phosphatidic acid. Incoφoration of (³H)choline into total lung Sat-PC is evaluated to determine total phospholipid concentration Aggregate forms from alveolar lavage

Surfactant in alveolar was can be separated into large aggregate (heavy, dense) and small aggregate (light, vesicular) fractions by centrifugation. Alveolar washes were cenfrifuged at 40,000 x g over 0.8 M sucrose cushion for 15 min. The large aggregate surfactant then was collected from the interface, diluted with normal saline and cenfrifuged again at 40,000 x g for 15 min. The supernatant from the first 40,000 x g centrifugation that contains small aggregate surfactant is concentrated at 4°C by ultrafiltration using a 300,000 molecular weight retention filter (Minitan, Miliore Coip., Bedford, MA) or centrifugal concentrators (Amicon Coφ., Danvers, MA). The small aggregate surfactant is diluted with 50 ml normal saline and ulfrafiltered 3 times to remove soluble proteins.

SP-D as a Treatment for Pulmonary Diseases

Because deletion of SP-D produced the mouse model for emphysema, SP-D is an obvious choice as a treatment for or prevention of emphysema. It is also an obvious treatment for other types of pulmonary disease since many of these diseases are characterized by aberrant surfactant production. In addition, its affect on SP-A and its possible role in host defense makes it a useful tool to augment immune function in the lungs. The feasibility of gene transfer to the respiratory epithelium is very promising as a treatment for various pulmonary diseases. A variety of viral and non-viral-based vectors have been developed to transfer genes to cells of the airways, including recombinant adenoviral vectors. These vectors are particularly promising for use in respiratory treatment because they have the potential of being aerosolized. Therefore, Example 9 is an experiment using purified mouse SP-D protein for treatment of emphysema in SP-D(-/-) mice. Example 10 is an experiment using adenovirus to express rat SP-D for treatment of emphysema in SP-D(-/-) mice. Example 11 provides a sample framework for the use of SP-D peptide, or vectors expressing SP-D for the prevention and treatment of these diseases. Emphysema is used as an exemplary pulmonary disease. Adenovirus is used as an exemplary vector. EXAMPLE 9 Treatment with purified SP-D

SP-D(-/-) mice were treated with purified mouse SP-D, purified as outlined below. Saturated PC levels were analyzed in alveolar lavage and total lung lavage. Repeated doses infrafracheally at 24 hour intervals resulted in partial coπection of lipid accumulation after 3 to 7 doses, see Figure 12.

The half life of SP-D in the airway was detennined as 13 hours in mouse (see Figure 13) (the technique is outlined below); therefore, the SP-D deficiency^' can be treated by replacement of SP-D protein at a reasonable interval by aerosol or particulate inhaler or surfactant mixtures. Purification of mouse SP-D

Mouse bronchoalveolar lavage (BAL) fluid from GMCSF and SP-A double null mutant mice was collected, frozen, and pooled for later purification of SP-D. Maltosyl-agarose (Sigma) was packed in a gravity flow column (10 x 80 mm) and equilibrated with buffer containing 20 mM Tris-HCI, pH 7.4, 10 mM calcium chloride, 0.02% (W/V) sodium azide (TCB). The BAL was made 20 mM with respect to Tris-HCI, and 10 mM with respect to EDTA, ph 7.4 and stirred for one hour at room temperature. The turbid solution was cenfrifuged at 10,000 X g for 40 minutes at 4 degrees C. The supernatant was made 20 mM with respect to calcium chloride and readjusted to pH 7.4 before loading on the maltosyl-agarose column. The column was washed to background absorbence with TCB followed by washing with TCB containing 1.0 M Sodium Chloride. The SP- D, which has a specific requirement for calcium in binding to maltose was eluted with 50 mM manganese chloride, 20 mM Tris-HCI, 0.02% (W/V) sodium azide, pH 7.4. The fractions containing SP-D were detennined by SDS polyacrylamide gel electrophoresis or by direct ELISA, pooled, and dialysed against three changes of 20 mM Tris-HCI, 100 mM sodium Chloride, 5 mM EDTA pH 7.4. This protocol was adapted from Strong, Peter; Kishore, Uday; Morgan, Cliff; ^• Bemal, Andres Lopez; Singh, Mamta; and Reid, Kenneth B.M.; Journal of Immunological Methods 220 (1998) 139-149. Treatment of mice with surfactant components

We have successfully used a technique for oral blind intubation using 26 g feeding tubes in mice under anesthesia with isoflurane for repetitively treating mice with SP-D daily for up to 7 days without problems. This approach avoids surgeiy and permits the type of experiments proposed for SP-D replacement and treatment with mutant SP-D proteins.

Initially SP-D(-/-) mice were treated with purified mouse SP-D by tracheal instillation. Three or more doses of 2.9 μg SP-D given at 24 hour intervals decreased both alveolar and saturated PC pools (see Figure 14). This dose of SP-D given is approximately the amount present in the endogenous pool in SP-D(+/+) mice. Given the lung association and clearance kinetics, this is a low dose. Thus exogenous administration of SP-D directly influences surfactant lipid metabolism and provides an experimental model in which we can test the function of modified SP-D molecules in vivo. Biological half-life protocol We have measured the biological half-life of SP-D m mice m order to design experiments for treatment with SP-D. We lodmated purified mouse SP-D with ¹²⁵I using the Bolton-Hunter reagent as we have done previously for SP-A and the other surfactant proteins. The clearance of SP-D from alveolar lavages of SP-D(+/+) and SP-D (-/-) mice was similar with a half life of about 13 hours (see Figure 13). The t"² of 17 h for SP-D in the lungs of SP-D(-/-) mice was somewhat longer than the t"² of 13 hours for SP-D(+/+) mice.

GM-CSF deficiency causes a 48 fold increase in SP-D, and the GM-CSF (-/-) x SP-A(-/-) cross has similarly elevated SP-D but no SP-A. We have isolated SP-D from alveolar washes from GM-CSF(-/-) x SP-A (-/-) mice in high purity and m large amounts by the methods described by Persson et al. using an affinity column of mannose-Sepharose 6B in the presence of Ca2+. EXAMPLE 10

Treatment with SP-D expressed from an adenovirus We made a new adenovims expressing rat SP-D. The vims produces SP-D in cells and in the lungs of normal or SP-D deficient mice. We have Western blots of the rat SP-D produced in 293 cells and m mice. Construction of Ad-rSPD adenovirus (see Figure 14)

Wild type rat SPD cDNA was liberated from plasmid WT-rSPD/pG3Z with EcoR I digestion and the 3' ends filled in with Klenow. The 1 3 kB rSPD cDNA was inserted into the EcoR V site of plasmid pAvS6a to make plasmid pAvS6a-rSPD. Plasmid pAvS6a-rSPD has a RSV promoter, a rSPC cDNA, an SV40 poly A signal and an Ad5 sequence (9.24-17.34 mu). Not I linearized pAvS6a-rSPD was co-transfected into 293 cells with Cla I digested large fragment of adenovirual DNA Ad dl327, which has E3 region (78.5-84.7 mu) deleted. After homologous recombination, individual plaques were analyzed by Western blot assay to determine rSPD protein expression. One rSPD positive clone was subject to one round of plaque purification. The Ad- rSPD adenovirus has deletions in El and E3 regions and is replication deficient. After amplification m 293 cells, the purified Ad-rSPD adenovirus was produced through two rounds of CsCl gradient ultiacentπfugation. The adenovirus expressed SP-D and therefore could be used to restore pulmonary abnormalites by intratracheal administration. Therefore, this remains a very positive possibility for treatment of emphysema and many other SP-D deficiency illnesses as well as various other forms of pulmonary injury and deficiency. EXAMPLE 11 Treatment with SP-D expressed from other vectors, proteins, or pharmaceuticals

The temporal, spatial and stoichiometric requirements for SP-D in the restoration of phospholipid homeostasis were determined in example 9. Initial studies to determine the kinetics of clearance of SP-D were performed with ¹²⁵I labeled SP-D administered infratracheally; half-life was calculated and the information used in design of SP-D replacement experiments. The dose of SP-D required to achieve normal physiologic concentrations of SP-D after administration was clarified.

Adminisfration of purified SP-D protein was used to treat various pulmonary disease in Example 9. However, physiologic abnomialities in pulmonary disease may require long term correction of SP-D in the lungs. Therefore, recombinant adenovirus or other genetic vectors containing the mammalian SP-D gene will be used (see Example 10 and 11). Recombinant adenovirus vectors or Clara cell secretory protein (CCSP) and SP-C promoters can be used to selectively express SP-D in bronchiolar (Clara cell) and alveolar (Type II cell) compartments (see Example 10). Three days prior to treatment with adenoviral vector the mice are immunosuppressed by injection intraperitoneally with 200 ug of monoclonal anti-T cell receptor antibody, H57. Adenovirus was administered by intratracheal injection of 5 X 10^s PFU of virus. Levels of SP-D protein were measured 1 week after administration to detect uptake and expression of the vector. Four mice were tested and SP-D (-/-) mice receiving no treatment are used as a control. To test for efficacy of the SP-D at diminishing the effects of emphysema, a number of tests are perfoπned as follows.

To deteπnine the effects of a protein or pharmaceutical on the lung structure (Example 11), lungs are inflation fixed and sections evaluated by electron microscopy. Lungs are inflated via a tracheal cannula at 20 cm of pressure with 4% paraformaldehyde and removed en bloc from the thorax. Lungs are dehydrated and embedded in paraffin. Tissue sections (5μm) are stained with hematoxylin and eosin.

Number and moφhology of macrophages are analyzed. Staining with Nile Red detects vesicles and staining with Nile Blue and exciting with 520-550 mm green light is an additional method to detect lipid or phospholipid. Macrophage number is detennined by direct counting or macrophage cell surface markers. Macrophage size is estimated from the diameter of fixed and stained macrophages from cytospin preparations sedimented onto glass slides at 1500 x g for 2 min.

Surfactant composition and ulfrast crure are analyzed as follows: the structure of surfactant is analyzed by isolating large aggregates from pooled alveolar lavage of SP-D (-/-) freated and unfreated mice and examined by EM. For alveolar lavage phospholipid composition analysis, two to four samples consisting of the pooled lavage from two to three mice are evaluated for the relative abundance of phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol, phosphatidylinositol, sphingomyelin, and lyso-bis-phosphatidic acid. Incoφoration of (³H)choline into total lung Sat-PC is evaluated to determine total phospholipid concentration.

Once efficacy of the treatment is detennined, treatment can be tested on other appropriate mammals. Involvement of SP-D in Pulmonary Infection

The role of SP-D and SP-A in host defense in the lungs has been repeatedly demonstrated. SP-A and SP-D have specific interactions with various microorganisms in vitro, modifying pulmonary inflammation in vitro by altering cytokine and free radical production. The role of SP- D in bacterial clearance and inflammatory response of the lung was evaluated in vivo using a mouse model of SP-D deficiency. SP-A-deficient mice are lαiown to be more susceptible to infections. A number of in vitro studies have shown a possible role for SP-D in host defense in addition to its role in up-regulating SP-A. Examples 8-11 outline sample protocols for testing SP- D as a therapy in the, bacterially, or fungally infected SP-D (-/-) mice as well as in the SP-A (-/-) mice. Examples 12-14 are experiments showing the role of SP-D in the response to bacterial, fungal, and viral infection. Example 13 is an experiment showing the effect of infecting SP-D(-/-) mice with Respiratory Syncytial Virus. EXAMPLE 12

Clearance of bacterial agents from SP-D(-/-) mice SP-D deficient mice (SP-D -/-) were infrafracheally infected with Group B streptococcus (GBS) or Hemophilus influenzae (Hflu) to assess clearance compared to wild type mice. Group B Streptococcus was administered at 10⁴ CFU. Pulmonary inflammation was also assessed by analysis of BAL fluid for total cells (Figures 5, 6, and 7), cytokine levels in lung homogenates (Figure 8), oxygen radical production by alveolar macrophages (Figure 11) and nitrite levels in BAL (Figure 9).

SP-D -/- mice cleared the bacteria similarly to wild type mice (see Figures 5 and 6). Infection with GBS and Hflu resulted in significantly greater total cells in the BAL fluid of the SP- D -/- mice compared to wild type mice (figure 7). Selective alterations of cytokine levels were detected in SP-D -/- mice. Tumor necrosis factor α (TNF-α) and interleukin (IL)-6 levels were greater in lung homogenates from SP-D -/- mice early after infection with GBS or Hflu (Figure 8). Macrophage inflammatory protein-2 (MIP-2), a neutrophil chemoattractant, was significantly greater in lung homogenates from SP-A -/- mice after Hflu but not GBS infection (Figure 8). Macrophages from SP-D -/- mice generated significantly greater superoxide and hydrogen peroxide compared to wild type mice (Figure 11).

BAL nitrite levels were increase in SP-D (-/-) mice as compared to wildtype mice. Nitric oxide production was measured as nitrite in BALF. Nitric oxide plays a role in host defense by contributing to bacterial killing. Nitric oxide reacts with superoxide to foπn peroxynitrite which is a potent bacteriocidal agent.

In figure 10 phagocytosis was evaluated using light microscopy and flow cytometry. SP- D(-/-) mice showed significantly reduced phagocytosis of bacteria as compared to wildtype.

Therefore, in the absence of SP-D increased inflammatory responses were observed following bacterial infection of the lung with GBS or Hflu. Production of reactive oxygen species by alveolar macrophages was enhanced in SP-D -/- mice. These results support a critical and distinct role of SP-D in pulmonary immune and inflammatory responses to bacterial infection, in vivo.

In Example 13, the SP-D(-/-) mice were infected with Respiratory Syncytial Vims. Host defense mechanisms have evolved to maintain the lung clear of microbial pathogens including innate mediators of bacterial and viral clearance and acquired immune responses.

EXAMPLE 13

Clearance of virus from SP-D(-/-) mice

SP-D(-/-) mice were infrafracheally infected with respiratory syncytial virus (RSV), a common respiratory pathogen in children. Viral titers and lung inflammation were assessed in SP-

D (-/-) mice and wild type mice. RSV titers in lung homogenates were significantly increased in

SP-D (-/-) compared to wild type mice 3 and 5 days after adminisfration. However, significantly increased numbers of inflammatory cells were found in BAL fluid from SP-D (-/-) mice with a greater percentage of PMNs compared to wild type mice, 3 and 5 days after RSV infection. In addition, lung inflammation assessed by histology, 5 days after RSV infection was greater in SP-D

(-/-) compared to wild type mice. Pro-inflammatory cytokines, including TNF-a, IL-1, IL-6 and

MIP-2 were greater in lung homogenates from SP-D (-/-) mice 3 and 5 days after RSV infection.

SP-D (-/-) mice had less efficient viral clearance from the lung and demonstrated greater inflammatory responses following RSV infection than wild type mice. These findings demonstrate that SP-D plays an important role in innate defense and regulation of inflammation in the lung after

RSV infection in vivo. Similar findings were observed after Influenza and adenovirus infected the lung. EXAMPLE 14 Clearance of Fungi from the SP-D(-/-) mice

The mouse is infected as follows: an appropriate prototype of a fungal pathogen is used. The infectious agent is purified as appropriate and suspended in appropriate buffer and administered infrafracheally with or without SP-D into the SP-D (-/-) mouse (as in Examples 12 and 13). The fungal prototype is administered at an appropriate dose. SP-D (-/-) and SP-D (+/+) mice are used to test the effect of SP-D on susceptibility of mice to infection. SP-D (-/-) mice with or without SP-D protein is used to test SP-D as a therapy for infection. Clearance of infection is evaluated as in Examples 12 and 13 and as follows: Fungal clearance is detem ined by purifying lung and spleen homogenates at 6, 24, and 48 hours after inoculation of the animals with infectious agent or infectious agent with SP-D. Bacterial clearance from the lungs is determined after varying SP-D concentrations appropriately. Quantitative cultures are also detennined for the SP-D (+/-) mice a to determine if 50% reduction in SP-D provides sufficient endogenous SP-D for bacterial or viral clearance. Appropriate concentrations of mammalian SP-D are used in other mammals for treatment of pulmonary infections. Pharmaceuticals that Regulate SP-D Levels

The importance of SP-D in normal function and development of the lung is clearly demonstrated by the SP-D (-/-) null mouse. Therefore, agents that regulate production, expression, or the action of SP-D are important future phaπnaceuticals and experimental aids for identifying further such phaπnaceuticals. Many techniques for identifying such agents would suggest themselves to one having ordinary skill in the art. Examples 15 and 16 outline a sample protocol for two of these techniques. Example 17 shows that IL-4 markedly increases SP-D levels in vivo and could thus be used to treat various pulmonary diseases with or without the addition of SP-D. EXAMPLE 15

Proteins that interact with the SP-D promoter A one-hybrid technique is set up using the SP-D promoter to identify proteins that up- regulate expression of SP-D. These proteins are then tested on the SP-D (-/-) mouse for efficacy in treating emphysema and other pulmonary diseases and infections as in Example 8. EXAMPLE 16

Proteins that interact directly with the SP-D protein A two-hybrid technique is set up to identify proteins that interact directly with the SP-D protein. These proteins are then be tested on the SP-D (-/-) mouse for efficacy in treating emphysema and other pulmonary diseases and infections as in Example 8. EXAMPLE 17 IL-4 increases SP-D levels in vivo

Mice that express IL-4 in Clara cells (CCSP-IL-4) develop chronic airway inflammation and an alveolar proteinosis-like syndrome. In order to identify the role of IL-4 in surfactant homeostasis, we measured lipid and protein metabolism in the lungs of CCSP-IL-4 mice in vivo. Alveolar saturated phosphatidylcholine (Sat PC) pools were increased 6.5 fold and lung tissue Sat PC pools were increased 4.8 fold in the IL-4 transgenic mice (see Figure 15). SP-D was increased approximately 90 fold in the IL-4 mice compared to wild type mice and was associated with 2.8 fold increased SP-D mRNA (see Figure 15). The incoφoration of palmitate and choline into Sat PC was increased about 2 fold in CCSP-IL-4 mice. Net clearance of Sat PC from the lungs of CCSP-IL-4 mice was 6 fold higher (60 μmol/kg) in the IL-4 mice than in wild type mice (10.3 μmol/kg). Expression of IL-4 in Clara cells increased surfactant lipid synthesis and clearance, establishing a new equilibrium with increased surfactant pools and an alveolar proteinosis associated with a selective increase in SP-D protein, demonstrating a previously unexpected effect of IL-4 in pulmonary surfactant homeostasis and the regulation of SP-D levels by IL-4. Diagnosis Using SP-D Protein or Sequence

SP-D is important in normal lung function and development. SP-D (-/-) mice are a model for emphysema. This then suggests that mutations in the gene or alleles of the gene for SP-D have a profound effect on pulmonary disease susceptibility. Therefore, a method to identify mutations or alleles, and mutant protein identifies individuals at risk for emphysema, pulmonary infections, and a number of other respiratory diseases. Example 18 and 19 are sample protocols for these diagnostic techniques.

EXAMPLE 18 Diagnosis of Patients with Mutations in the SP-D gene

Mutations in the SP-D gene are likely involved in the symptoms and etiology of emphysema. Therefore, mutations are identified by sequence analysis of a statistically significant number of patients. These mutations are used to produce a diagnostic test. Mutations in the SP-D gene are detected in the following ways: PCR analysis of the SP-D gene using appropriate primers is perfoπned. Resulting PCR fragments are analyzed by SSCP and sequenced to determine mutation or allele. Alternatively, differential hybridization of genomic DNA or cDNA is used to detect mutations. EXAMPLE 19 Diagnosis of Patients With Mutant SP-D Protein

Monoclonal or polyclonal antibodies which specifically recognize mutant SP-D protein or an allele of SP-D associated with emphysema or other pulmonary diseases are produced. These antibodies are then used to set up an enzyme-linked immunoassay or Western blot assay for susceptibility to these pulmonary diseases. The antibodies of Example 20 can be used for this assay.

Example 20 presents a protocol for the purification of polyclonal or further purification of monoclonal antibodies using transgenic technology. EXAMPLE 20

Purification of SP-D specific monoclonal and polyclonal antibodies

The production of specific polyclonal antibodies with a high reactivity requires extensive purification of the antigen of interest. We have developed several polyclonal antibodies using partially purified antigens for injection which have resulted in antibodies which have a high titer with respect to the antigen of interest and are also reactive to impurities. Solid phase tissue from transgenic mice have been used to remove nonspecific antibodies from these antisera. Surfactant

Protein-D (SP-D) was purified using a maltose column with manganese elution. The purified SP-D was injected into New Zealand rabbits in incomplete Freund's adjuvant. The resulting antisera was tested against whole lung lavage on a Western Blot, revealing binding to the SP-D and to other proteins. This antisera was reacted overnight with a solid phased lung homogenate from a null mutant mouse which does not produce any SP-D protein. The antisera was reacted against whole lung lavage after absoφtion showing reactivities only against SP-D. This antisera was also evaluated in immunohistochemistry experiments which demonstrated very low reactivities to lung sections from SP-D null mutant mice and very specific type II cell reactivities in normal control mice. This teclmique greatly enhances the ability to prepare highly specific antibodies with high titers and eliminates the need to use blocking agents when using absorbed antibodies.

These antibodies could be used for the diagnosis, purification, and further research into the SP-D protein.

EXAMPLE 21 SP-D inhibits viral infection

Previous results (Example 13) showed that SP-D has a role in the clearance of RSV from the lungs of mice. Therefore, it was of interest to see if SP-D had a similar role in the clearance of other viruses.

SP-D(-/-) mice were infrafracheally infected with influenza A vims and separately with adenovirus. Viral titers and lung inflammation were assessed in SP-D (-/-) mice and wild type mice. Influenza A titers in lung homogenates were significantly increased in SP-D (-/-) compared to wild type mice 3 and 5 days after adminisfration. Significantly increased numbers of inflammatory cells were found in BAL fluid from SP-D (-/-) mice with a greater percentage of PMNs compared to wild type mice, after Influenza A infection. Therefore, SP-D deficient mice are susceptible to influenza A viral infection in vivo and developing markedly increased lung inflammatory responses to the vims and SP-D binds adenovirus in vitro and will likely play a role in clearance of adenovirus in vivo as well.

EXAMPLE 22 SP-D inhibits reactive lipid species SP-D deficient surfactant has increased oxygen-lipid intennediates (toxic lipid reactants).

Thus, SP-D inhibits reactive lipid species in the airspace and may have potential benefits for amelioration of reactive oxygen mediated disease, chemically induced lung injury, oxygen, ozone, chemotherapeutic agents and inflammatory diseases, reperfusion injury, drowning, transplantation, and rejection. Reactive oxygen species were measured by the Lipid Hydroperoxide (LPO) assay kit

(Caymen chemicals, Cat. No. 705002). Surfactant was isolated from SP-D knockout and wildtype mice by lung lavage and the lipid peroxidation products measured using redox reactions with feπous ions. No lipid peroxides were detected in surfactant from wild type mice (n=4) but were readily detected in lavage fluid from SP-D (-/-) mice, 0.896 ± 0.305 ng of lipid peroxidation product /mg of phospholipid (n=4).

Methods and Compositions Containing SP-D to Enhance Clearance of Virus from the Lung

There is increasing evidence that SP-D is involved in innate host defense against various bacterial, fungal and viral pathogens. In vitro, SP-D interacts with bacteria, fungi and viruses. SP-D also binds to alveolar macrophages and increases macrophage association with Escherichia Coli, Pseudomonas aeruginosa, Mycobacterium tuberculosis and Pneumocystis carinii. In vitro, mannose binding protein, conglutinin, SP-A and SP-D neutralize influenza A vims (IAV) and enhance the association of neufrophils with IAV.

A number of viruses are associated with respiratory disease in the upper and lower respiratory tract. These include RSV, Influenza, chickenpox, fifth disease (human parvovirus B19), parainfluenza virus types 1-3, cytomegalovirus, rhinovirus, adenovirus, hantavims and rubella. Influenza A virus infection is airborne and is primarily an infection of the upper respiratory tract. However, during infection, virus spreads to the lower respiratory tract and may result in viral pneumonia or may predispose a patient to secondary bacterial infections. Influenza infections are most frequent in children and young adults yet deaths are most frequent in very young (<1 yr), the elderly and persons of all ages with underlying heart or lung disease. Bronchopulmonary dysplasia has been associated with decreased secretion of SP-D, and Cystic Fibrosis has been associated with decreased SP-D concentrations in pulmonary washes, conditions that may increase susceptibility to infection by respiratory viruses such as IAV.

Specific as well as nonspecific immune mechanisms take part in the host response to influenza virus. Influenza A virus infection is a lytic infection and causes the breakdown of the blood-tissue baπier early in infection, resulting in the influx of macrophages, neutrophils, and natural killer cells into the lung. Specific immune responses to IAV are initiated by the influx of virus specific T lymphocytes and antibody production, and cytotoxic T lymphocytes are thought to be involved in viral clearance by direct cytolysis of virus-infected cells. Neufrophils also play an important role in viral clearance from the lung. Mice irradiated to reduce the number of peripheral polymoφhonuclear leukocytes have increased viral titers after- influenza infection in the lung. Defects in neufrophil and monocyte chemotactic, oxidative and bacterial killing functions have been documented in IAV infection. In vitro, neufrophil dysfunction resulting from IAV exposure is diminished when the virus is pre-incubated with SP-D. On the other hand, SP-D has been reported to have no effect on IAV uptake by alveolar macrophages.

Although there is compelling evidence that SP-D enhances host defense against viruses in vitro, its role in the clearance of viral pathogens in vivo has not been demonstrated. Thus, the role for SP-D in viral clearance was clarified in Examples 23-29 in which SP-D deficient mice were infected intranasally with SP-D sensitive and resistant strains of influenza A virus. Rescue experiments were performed using highly purified recombinant SP-D. IAV clearance, lung inflammation, cytokine production, and uptake of virus by macrophages and neufrophil activity were compared in SP-D -/- and SP-D +/+ mice in vivo. The experiments show a role for SP-D in clearance of the virus from the lungs as well as reduction in the inflammatory properties. Thus, SP-D can be used in the freatment of viral infections and the resulting inflammation in the lungs, particularly for the treatment of infections in the very young, very old, immunocompromised, and those with any types of lung deficiencies.

Thus, embodiments include a method for treating viral infections in a patient using SP-D or active SP-D variants. The SP-D can be administered as a protein as in Example 9. Alternatively, the SP-D can be expressed from an adenovirus, or other vector as in Examples 10 and 11. Alternatively, the an active SP-D gene can be upregulated using SP-D transcriptional activators.

Viral infections treatable using SP-D include any pulmonary viral infections, whether primary or secondary, including influenza A, rhinovirus and other viruses which cause the common cold or cold-related symptoms, RSV, chickenpox, fifth disease (human parvovirus B19), parainfluenza virus types 1-3, cytomegalovirus, rhinovirus, adenovirus, hantavims and rubella. Alternatively, the inflammation and symptoms associated with viral infections may be freated with SP-D. For example, colds and flus often result in inflammation even after the vims has been cleared. This inflammatory response or an equivalent response can be treated with SP-D. Patients for which SP-D treatment can be used include all patients with pulmonary viral infections. However, particularly patients with a reduced level of SP-D or inactive SP-D. Such patients include but are not restricted to patients with: asthma, emphysema, cystic fibrosis, patients who are immunocompromised, very young patients, particularly those with under-developed immune systems, and very old patients.

In the following examples, Influenza A vims (IAV) was administered to SP-D -/- and SP- D +/+ mice in order to identify the role that SP-D plays in viral infection in the lungs. Influenza A virus was used as a prototypical pulmonary virus. In Examples 24-29 the effect on viral clearance, neufrophil MPO activity, CD4 and CD8 T cell proliferation, surfactant protein D concentrations, and cytokine levels was evaluated. Lung viral titers, total cell counts, cytokines, MPO activity and SP-D levels were compared using analysis of variance (ANOVA) and Student's t test. Findings were considered statistically significant at probability levels <0.05.

In Examples 24-29, the pulmonary clearance of intranasally administered Phil/82 strain of influenza A virus was reduced in SP-D -/- mice compared to SP-D +/+ mice. However, the less glycosylated strain Mem/71, which is relatively resistant to SP-D in vitro, was cleared efficiently from the lungs of SP-D -/- mice. In addition, the co-administration of recombinant SP-D nomialized viral clearance. Thus, the impaired clearance of IAV can be directly attributed to the deficiency in SP-D rather than to other aspects of the SP-D null phenotype or more global host defense deficits. In this regard, previous results demonstrated that SP-D null mice show no impainnent of clearance of Group B streptococcus and Haemophilus inβuenzae. Pulmonary inflammation was increased in SP-D deficient mice compared to wild type confrols as indicated by increased total cell counts and pro-inflammatory cytokines in the lung after IAV infection. Neufrophil myeloperoxidase activity was decreased in SP-D -/- mice suggesting neufrophil clearance of IAV may be impaired. Pulmonary IAV infection increased SP-D concentrations in wild type mice. These findings demonstrate that SP-D plays' an important role in the initial pulmonary host defense against certain strains of IAV and other pulmonary viruses, in vivo. Impaired clearance of IAV from the lungs of SP-D -/- mice supports the importance of SP-

D in host defense. SP-D is a member of the C-type-lectin family of polypeptides that includes mannose binding protein, conglutinin and SP-A. C-type lectins share structural features including collagenous amino-terminal and "globular" carboxy-tenninal domains, the latter serving as a carbohydrate recognition domain that functions in opsonization. In the presence of calcium, SP-D binds to a variety of glycoconjugates, including di- and mono-saccharides such as maltose, glucose and mannose. Influenza virus has two membrane glycoproteins, the hemagglutinin (HA) and neuraminidase (NA). Collectins bind to oligosaccharides on influenza virus glycoproteins and neutralize virus infectivity in vitro, more heavily glycosylated strains of vimses being the most sensitive. SP-D may enhance viral clearance by binding to the. carbohydrate side chain of IAV blocking access of cell surface receptors to the receptor-binding site thus interfering with vims internalization by host cells. In addition, SP-D binds and agglutinates IAV, which may, in part, enhance viral removal from the lung through mucociliary and phagocytic clearance. However, the finding that uptake of the vims by alveolar macrophages is not reduced suggests that SP-D binding, aggregation and uptake by the alveolar macrophages is not a critical detenninant of decreased viral killing noted in the SP-D -/- mice.

In the absence of SP-D, IAV viral clearance from the lung was impaired. In addition, lung inflammation was more severe in SP-D -/- mice, suggesting that SP-D plays a role in modulating cytokine production and inflammatory responses during viral infection. SP-D has a further role by binding to and agglutinating IAV that may also enhance IAV removal from the lung through mucociliary clearance and enhanced recruitment and activation of polymoφhonuclear leukocytes. Since the airway is the usual portal of entry for influenza virus and other respiratory pathogens, the local production of SP-D may also be involved in innate defense responses to inhaled viruses.

EXAMPLE 23 Pulmonary Pathology of SP-D -/- mice After IAV Administration SP-D -/- mice were produced by targeted gene inactivation as presented in Example 1.

Lungs of SP-D -/- mice do not contain detectable SP-D. The original 129/NIH Swiss Black heterozygous mouse was bred to NIH Swiss Black mice, and SP-D -/- and SP-D +/+ colonies maintained. Mice were housed in baπier containment and remained viral free as assessed by serology. Studies were reviewed and approved by the Institutional Animal Care and Use Committee of the Children's Hospital Research Foundation, Cincinnati. Male and female mice of approximately 20-25 grams (35-42 days old) were used.

IAV to be used for administration to the SP-D -/- and SP-D +/+ mice was prepared as follows: IAV strain H₃N₂ A/Phillipines/82 (Phil/82) and H3N1 Mem71_H-Bel_N (Mem71) were a gracious gift from E.M. Anders to K. Hartshorn (University of Melbourne, Melbourne, Australia) and were grown in the chorioallantoic fluid of 10-day-old embryonated hen's eggs. Allantoic fluid was harvested after 48 h of incubation and clarified by centrifugation at 1,000 g for 40 min followed by centrifugation at 135,000 g to precipitate viruses. The virus-containing pellets were resuspended and purified on a discontinuous sucrose density gradient as previously described (Hartshorn, et al. 2000. Enhanced anti-influenza activity of a surfactant protein D and semm conglutinin fusion protein. Am. J. Physiol. Lung Cell. Mol Physiol. 278:L90-L98.). Vims stocks were dialyzed against phosphate buffered saline (PBS), separated into aliquots, and stored at -70°C until use. Hemagglutinin (HA) titers were detennined by titration of vims samples in PBS followed by the addition of thoroughly washed human type O red blood cells. The potency of each viral stock was measured by HA and protein assays after samples were thawed from frozen storage at -70°C. The virus was labelled with FITC using the following procedure:

Fluorescent isothiocyanate (FITC) stock was prepared at 1 mg/ml in 1 mol/L sodium carbonate, pH 9.6. FITC-labeled virus (Phil/82) was prepared by incubating concentrated vims stocks with FITC (10:1 mixture by volume of virus in PBS with FITC stock) for 1 hour, followed by dialysis of the mixture for 18 hours against PBS. Inoculation of FITC-labelled IAV Mice were lightly anesthetized with isoflurane and inoculated intranasally with 10⁵ fluorescent foci (ff) of IAV in 50μl of PBS. Quantitative IAV cultures of lung homogenates were perfoπned 3 and 5 days after inoculation of the animals with IAV. The entire lung was removed, homogenized in 2 ml of sterile PBS, quick-frozen, weighed and stored at -80°C. Madin-Darby canine kidney monolayers were prepared in 96-well plates for the viral focus assay as previously described (Hartshorn, et al. 2000. Enhanced anti-influenza activity of a surfactant protein D and serum conglutinin fusion protein. Am. J. Physiol. Lung Cell. Mol. Physiol. 278:L90-L98.). The layers were incubated with lung homogenates diluted in PBS containing 2 mM calcium for 45 minutes at 37°C, and the monolayers washed three times in virus-free DMEM containing 1% penicillin and streptomycin. The monolayers were incubated for 7 h at 37°C in DMEM and repeatedly washed, and the cells were fixed with 80% (vol/vol) acetone for 10 rain at -20°C. The monolayers were then incubated with monoclonal antibody directed against IAV nucleoprotein (monoclonal antibody A-3), and then with rhodamine-labeled goat anti-mouse IgG. Fluorescent foci were counted directly by fluorescent microscopy. The resulting titer was divided by the lung weight and reported as fluorescent foci (ff) /gram of lung. Infranasal adminisfration of IAV (10⁵ ff) was well tolerated and all animals survived the study period. Mice infected with IAV lost weight during the 4 days post infection. The percentage of weight loss was greater for the SP-D -/- mice with 14.4 ± 1.4%* compared to 1.5 ± 1.0% for the SP-D +/+ mice, mean ± SEM, n=6 mice, *p<0.05 compared to SP-D +/+ mice. Increased total cell counts in BALF were observed in SP-D -/- mice 3 and 5 days after IAV infection, see Figure 19. Baseline total cell counts in BAL fluid from controls inoculated with PBS were not significantly different for the SP-D +/+ and SP-D -/- mice, see Figure 19. A significantly greater percentage of PMNs was detected in BAL fluid from SP-D -/- compared to SP-D +/+ mice 3 and 5 days post infection, see Figure 19. Pulmonary infiltrates were not observed in wild type mice inoculated with sterile PBS (n=5). In Example 24, clearance of IAV was quantitated in SP-D -/- and wild-type mice. EXAMPLE 24 Viral Clearance in SP-D -/- Mice

Quantitative IAV cultures of lung homogenates were performed 3 and 5 days after inoculation of the animals with different strains of IAV. Strains of influenza virus differ in the extent of glycosylation of surface glycoproteins. To examine whether strain dependent changes in glycosylation influence SP-D dependent clearance, infection by Mem71_H-Bel_N (H3N1) (Mem/71) was compared with Phil/82. Previous studies have shown that Mem/71, which has a less glycosylated hemagglutinin than Phil/82, is relatively resistant to the effects of SP-D in vitro. Mem/71 shows less SP-D dependent viral agglutination and hemagglutination inhibition, decreased enhancement of neufrophil uptake and activation and decreased inhibition of infectivity as compared to SP-D sensitive strains. Significantly, titers in the lung of Mem/71 were similar for SP-D -/- (6.8 X 10³ ± 1.9 x 10³ ff/gram lung) and SP-D +/+ mice (5.9 x 10³ ± 1.4 x 10³), mean ± SEM, 8 mice per group.

However, increased viral titers of IAV (Phil/82) were observed in the lungs of SP-D -/- mice 3 and 5 days after infection compared to SP-D +/+ mice, see Figure 20.

Next, human SP-D was administered to the IAV-infected mice to analyze the effect. Human SP-D (hSP-D) was isolated as previously described (Hartshorn, et al. 1996, "Interactions of recombinant human pulmonary surfactant protein D and SP-D multimers with influenza A", Am. J. Physiol. 27LL753-L762). Briefly, CHO-K1 cells (ATCC CCL-61) were transfected with a full-length human cDNA in the pEE14 mammalian expression vector. Secreted SP-D was isolated by maltosyl-agarose affinity chiOmatography and SP-D dodecamers were resolved from larger multimers and trimers by gel filtration chromatography under non-denaturing conditions. Proteins were concentrated by re-chromatography on maltosyl-agarose. Bound proteins were eluted in HEPES-buffered saline containing 10 mM EDTA and stored at -80°C. The protein concentration was estimated using a dye binding assay with bovine serum albumin as standard. The level of endotoxin contamination was quantified using an end-point chromogenic microplate assay (Chromogenix, Sweden) with E. coli 0111:B4 endotoxin as a standard. The endotoxin content of the purified recombinant proteins used for these experiments was <2 ng/ml for stock solutions. Quantitative IAV cultures of lung homogenates were perfoπned 3 days after intranasal inoculation of mice with IAV followed by intratracheal inoculation with PBS or SP-D (5μg).

Intratracheal co-administration of recombinant SP-D (5μg) enhanced clearance of A/Phillipines/82 (H₃N₂) (Phil/82) virus from the lung of SP-D -/- (7.5 x 10⁴ ± 1.4 x 10⁴* ff / gram lung) compared to untreated SP-D -/- (1.6 x 10⁵ ± 4.0 x 10⁴) mice 3 days after infection, mean ± SEM, n = 8 mice per group, *p<0.05. This suggests that SP-D has a role in clearance of virus from the lung and that the administration of SP-D to a deficient animal enhances viral uptake, providing a method for the treatment of pulmonary viral infections.

In Example 25, cytokine levels were analyzed in IAV-mfected SP-D-/- and SP-D +/+ mice. EXAMPLE 25

Cytokine levels in lung homogenates Cytokme levels were analyzed 3 and 5 days after IAV infection of SP-D -/- and SP-D +/+ mice. Lung homogenates were cenfrifuged at 2000 RPM and the supematants stored at -20°C. Tumor necrosis factor alpha (TNF-α ), lnterleukin (IL)-lβ , IL-6, and macrophage inflammatory protein (MIP)-2 were quantitated using murme sandwich ELISA kits (R&D systems, Minneapolis, MN) according to the manufacturer's directions All plates were read on a microplate reader (Molecular Devices, Menlo Park, CA) and analyzed with the use of a computer-assisted analysis program (Softmax; Molecular Devices). Only assays having standard curves with a calculated regression line value > 0.95 were accepted for analysis. The results were that three and 5 days after IAV infection, pro-inflammatory cytokines

TNF-α, IL-lβ and IL-6 were significantly increased in lung homogenates from SP-D -/- compared to SP-D +/+ mice, Figure 21. IFN-γ was increased m the lungs of SP-D -/- mice compared to SP-D +/+ mice after IAV infection. Lungs from the SP-D -/- mice had the greatest concentration of IFN- γ 5 days after IAV infection with 91 ± 20 and 2398 ± 176 g/ml for SP-D+/+ and SP-D-/- mice respectively, mean ± SEM, ^"1p<0.05. MIP-2, a neufrophil chemoatfractant, was significantly greater in lung homogenates from SP-D -/- mice after viral infection, see Figure 21. Intratracheal freatment with SP-D significantly reduced TNF-α (from 67.2 ± 8.9 to 19.0 ± 7.0 pg/ml) and IL-6 (from 481 ± 73 to 295 ± 29" pg/ml) levels m the lung for untreated SP-D-/- and freated SP-D-/- mice, respectively (mean ± SEM, *p<0.05). Basal cytokine levels in the lungs of confrol mice inoculated with sterile PBS were low or absent and were not different in SP-D-/- and SP-D+/+ mice

After IAV infection, markers of inflammation, including inflammatory cells and cytokines were increased m the lungs of SP-D -/- mice and exogenous recombinant SP-D reduced IAV induced cytokine production. SP-D -/- mice were able to mount an immune response to IAV infection; however, the response was greatly increased compared to wild type controls. Increased cytokine production may have reflected increased cells m BAL fluid after viral infection. Uninfected SP-D -/- mice have modestly increased numbers of alveolar macrophages in the lung, however pro-mflammatory cytokine concentrations were not substantially increased. Increased cytokines, TNF-α, IL-l β, IL-6 and IFN-γ, were demonstrated in the mouse model of IAV infection associated with lymphocytic and mononuclear infiltrates in the lung. The cytokine response to IAV was similar in SP-D -/- mice with elevated TNF-α, IL-lβ, IL-6 and IFN-γ, however pulmonary cytokine responses to IAV were significantly greater in SP-D -/- mice than in the wild type mice. Augmented inflammatory responses have also been observed following bacterial challenge. These findings were consistent with the general hypothesis that SP-D plays important anti-inflammatory roles in vivo. It is possible that these effects served to minimize collateral damage to lung tissue while enhancing uptake or clearance.

In example 26, the effect of SP-D on phagocytosis was assessed.

EXAMPLE 26 Phagocytosis of IAV by Macrophages Phagocytosis of FITC-labeled IAV by alveolar macrophages was assessed by flow cytometry. Uptake of vims was similar in SP-D +/+ and SP-D -/- mice (11.1 ± 1.9% and 9.4 ± 1.9% phagocytosis, respectively), 2 hours after IAV infection, mean ± SEM. These results suggested that macrophage phagocytosis of IAV is not a major contributor to the decreased clearance of IAV seen in the absence of SP-D, in vivo. Phagocytosis of IAV by macrophages in vivo was measured by intranasally infecting mice with FITC labeled IAV followed by evaluation of cell associated fluorescence with a flow cytometer. Two hours after infection, macrophages from BAL fluid were incubated in buffer (PBS, 0.2% BSA fraction V, 0.02% sodium azide) with phycoerytherin (PE) conjugated murine CD16/CD32 antibodies (Pharmingen, San Diego, CA) for one hour on ice and washed two times in fresh buffer. Trypan blue (0.2 mg/ml) was added to quench fluorescence of extracellular FITC. Cell associated fluorescence was measured on a FACScan flow cytometer, using CELLQuest software (Becton Dickinson, San Jose, CA). For each sample of macrophages, 20,000 cells were counted in duplicate and the results expressed as the percentage of macrophage phagocytosis.

Phagocytosis of IAV by alveolar macrophages was similar for SP-D -/- and wild type mice, in vivo. Since macrophage phagocytosis is part of the early, non specific immune response, an early time point was chosen to assess macrophage phagocytosis, however, the optimal time point for assessing viral phagocytosis by macrophages is unknown. In addition, large quantities of ingested FITC-labeled vims are necessaiy to detect macrophage fluorescence. As indicated in the introduction, previous studies have suggested that SP-D does not enhance the uptake of some strains of IAV by alveolar macrophages in vitro. In the absence of SP-D, macrophage phagocytosis of IAV was similar to wild type mice suggesting that SP-D is not a critical determinant for macrophage clearance of IAV, in vivo. EXAMPLE 27 CD4 and CD8 T Lymphocytes in BALF

Three days after IAV infection, CD4 (helper T lymphocytes) and CD 8 (cytotoxic T lymphocytes) cells were measured in BALF. There was no difference in the percentage of CD4 and CD8 T lymphocytes in BALF between SP-D-/- and SP-D+/+ mice. Figure 22. The fractions of

CD4 and CD8 T lymphocytes in BALF were similar in uninfected SP-D+/+ and SP-D-/- mice, see

Figure 22.

Lung cells were recovered by bronchoalveolar lavage (BAL). Animals were sacrificed as described for viral clearance and lungs were lavaged three times with 1 ml of sterile PBS. The fluid was cenfrifuged at 2000 RPM for 10 minutes, resuspended in 600 μl of PBS, total cells stained with trypan blue and counted under light microscopy.

Differential cell counts were performed on cytospin preparations stained with Diff-Quick (Scientific Products, McGaw Park, IN).

CD4 and CD 8 T lymphocytes were measured after infranasal IAV infection, staining of cells in BALF with fluorescent antibodies, followed by evaluation of cell-associated fluorescence by flow cytometry. Three days after infection, cells from BAL fluid were incubated in buffer (PBS, 0.2% BSA fraction V, 0.02% sodium azide) with rat anti-mouse CD16/CD32 antibodies (Fc Block), FITC conjugated mouse CD4 and phycoerytherin (PE) conjugated mouse CD8 antibodies (Phaπningen, San Diego, CA) for one hour on ice and washed two times in fresh buffer. Cell associated fluorescence was measured on a FACScan flow cytometer, using CELLQuest software (Becton Dickinson, San Jose, CA). For each sample, 20,000 cells were counted and the results expressed as the percentage CD4 and CD8 T lymphocytes in BALF.

Cytotoxic T cells play an important role in IAV clearance form the lung by direct cytolysis of vims-infected cells. In vitro, SP-D inhibits IL-2 dependent, mitogen-stimulated, T lymphocyte proliferation. However, the results showed that in the absence of SP-D, the percentage of CD4 and CD8 T lymphocytes in BALF were similar to that in wild type mice after IAV infection. Although the current study examined the number of T lymphocytes present in BAL fluid following IAV infection; the function and activation state of the T lymphocytes were not examined.

In example 28, the effect of SP-D on the myeloperoxidase (MPO) activity in neufrophills was examined.

EXAMPLE 28 Decreased Neutrophil MPO Activity in SP-D -/- Mice Myeloperoxidase (MPO) is stored in specific granules of neufrophils. As one measure of neufrophil function, the levels of MPO associated with neufrophils recovered in lung lavage was determined. After IAV infection, MPO activity from isolated BAL neutrophils was significantly decreased in SP-D-/- compared to SP-D+/+ mice, Figure 23. Confrol neufrophils isolated from the blood of uninfected SP-D+/+ mice had significantly greater MPO activity compared to BAL neutrophils from IAV infected SP-D-/- mice and significantly less MPO activity compared to BAL neutrophils from IAV infected SP-D+/+ mice, see Figure 24. Myeloperoxidase activity was measured in BAL neufrophils 3 days after intranasal infection with IAV at a concentration of 10⁶ ff. A higher concentration of virus was used to provide adequate neutrophils to study. BALF from three wild type mice was pooled to provide sufficient neutrophils, whereas a single SP-D-/- mouse was used. Blood obtained from uninfected SP-D+/+ mice was separated on a gradient of neufrophil isolation medium (NIM-1, Cardinal Associates, Santa Fe, NM ) to isolate blood neufrophils. Neutrophils were added to homogenate buffer (100 mM sodium acetate, pH 6.0; 20 mM ethylenediaminetetraacetic acid [EDTA] pH 7.0; 1% hexadecyl frimethylammonium bromide [HETAB]) in a 96 well microtiter plate in a final volume of 50 μl. The neufrophil mixtures were incubated at 37°C for 1 hour to lyse the neufrophils and allow release of MPO from the granules. Assay buffer (lOOμl) containing 1 mM H₂O₂, 1% HETAB, 3.2 mM 3,3'5,5'-tetramethylbenzidine (TMB) was added to each well and readings were taken at 650 nm using a THERMOMAX microplate reader for a period of 4 min. Readings were the average of at least 3 individual wells and MPO activity was reported as maximum MPO activity/4 minutes/ 10³ neufrophils.

After IAV infection, pulmonary neufrophil accumulation was greater in SP-D -/- mice then in wild type mice. However, neuti-ophil myeloperoxidase activity nomialized per cell was decreased after IAV infection in the SP-D deficient mice. Because the levels were normal in blood neufrophils, it is likely that the recruited cells had undergone a greater degree of degranulation in response to the viral challenge in the absence of SP-D. Defects in neufrophil chemotactic, oxidative and bacterial killing functions have been documented in IAV infection. In addition, it has been shown in animal models that there is a coπelation between impaiπnent of function of these cells and predisposition to bacterial superinfection. SP-D enhances the uptake and specific oxidative response to internalized virus in vitro. In addition, SP-D decreases the inhibitory effects of IAV on the neufrophil respiratory burst responses. Although the effects of SP-D and IAV on neufrophil degranulation and MPO activity have not yet been characterized in vitro, the findings emphasize the potential importance of neufrophils for the initial host response to IAV and suggest that SP-D may alter the neufrophil response to internalized vims.

EXAMPLE 29 IAV infection enhances SP-D Accumulation in the Lung Concentrations of SP-D in lung homogenates were increased approximately two fold 3 days following IAV infection in SP-D+/+ mice, see Figure 24. Five days after IAV infection, SP- D concentrations in the lung of infected SP-D+/+ mice decreased to concentrations similar to uninfected SP-D+/+ mice.

Concentrations of SP-D in lung homogenates were determined with an enzyme-linked immunosorbent assay (ELISA). Three and 5 days after infection with IAV, lungs from infected and uninfected wild type mice were removed and homogenized in 2 ml of PBS. The surfactant protein D concentrations were measured in a double antibody ELISA using rabbit and guinea pig anti-SP-D sera. Each assay plate included a standard curve generated with purified mouse SP-D. All samples were run in duplicate and the concentrations of the samples were calculated by graphing absorbance vs. concentrations of the standard. SP-D Regulates Nf-κB and Matrix Metalloproteinase Production in Alveolar Macrophages Via Oxidant-Sensitive Pathways

Targeted gene inactivation of the SP-D gene in mice caused the accumulation of surfactant phospholipids, emphysema, and increased numbers of lipid-laden, foamy alveolar macrophages. Emphysema in SP-D (-/-) mice was associated with increased production of matrix metalloproteinases (MMPs)-2,9,12, hydrogen peroxide (H₂0₂), and increased proinflammatory cytokine production following pulmonary infection. While focal production of cytokines, MMPs and H,0₂ may play a role in the development of emphysema in SP-D (-/-) mice, the mechanisms mediating the generation of these molecules have not been identified.

Reactive oxygen species (ROS), including superoxide anion (0₂ ^"), hydroxy radical (OH-), and hydrogen peroxide (H₂0₂) have been implicated in the pathogenesis of several lung diseases associated with oxidative stress, including emphysema, adult respiratory distress syndrome, asthma, and lung fibrosis. While ROS play a critical role in host defense, increased ROS generated during acute and chronic inflammation can be cytotoxic, causing oxidative damage to various macromolecules, lipid peroxidation, protein crosslinking, protein fragmentation, DNA damage and sfrand breaks. Oxidative stress has been associated with activation of franscriptional pathways mediating cellular responses to infection and injury. For example, activity of nuclear factor-κB (NF-κB) and activator protein- 1 (AP-1), were stimulated by oxidative stress. Binding sites for F- KB and AP-1 were identified in the promoters of numerous genes, including proinflammatory cytokines. Likewise, cis-acting elements binding NF-κB and/or AP-1 were present in the promoter regions of the MMP-2, 9, and 12 genes. Therefore, it was hypothesized herein that reactive oxygen species, generated by AMs in SP-D (-/-) mice, might activate redox-sensitive transcription factors, causing increased expression of the MMPs. In the present study, increased ROS were demonstrated in lungs of SP-D (-/-) mice. MMP-2 and MMP-9 production by alveolar macrophages from SP-D (-/-) mice was stimulated by oxidant sensitive pathways including NF-κB activation. In the following Examples the effect of SP-D on metalloproteinase production in alveolar macrophages was assessed. The SP-D(-/-) mouse was used as a model for emphysema and the SP-

D (+/+) was compared. Results are presented as means ± standard eπor (SE). Comparison was made by Student's t test. Statistical calculations were performed with the Statview II statistical package (Abacus Concepts, Berkeley, CA). A value of PO.05 was regarded as significant.

SP-D (-/-) mice used in the Examples were generated by targeted gene inactivation as in Example 1.

Isolation of alveolar macrophages (AMs) from Bronchoalveolar lavage (BAL) was performed by instilling ten, 1ml aliquots of phosphate-buffered saline (PBS). BAL fluid from several animals was pooled to provide sufficient numbers of macrophages for each analysis. The lavage was cenfrifuged at 1200 φin at 7 min and pelleted cells were resuspended in serum-free RPMI medium containing 1% of Nutriodoma (Boehringer Mannheim, Indianapolis, IN), and counted with a hemocytometer. More than 90% of BAL cells were AM in both WT and SP-D (-/-) mice. For some experiments, alveolar macrophages (AMs) were isolated by differential attachment to tissue culture flasks at 37°C. Non-adherent cells were then removed, and fresh, serum-free medium was added. The adherent AMs were maintained in a humidified atmosphere containing 5% CO, and 95% air until the end of the experiments.

The experiments in Examples 30-32 show that the SP-D signalling is required for the regulation of oxidant production or clearance of reactive oxygen species (ROS) by Alveolar macrophages in the lung and that the signalling occurs through the NF-κB pathway. More specifically, SP-D acts by inhibiting the action of NF-κB.

Thus, a method for the treatment of pulmonary diseases associated with over-activation of NF-κB is provided which uses SP-D as an inhibitor is provided. The SP-D can be administered in any of the ways used previously herein or outlined in Examples 9-12. EXAMPLE 30

Increased oxidant stress in lungs of SP-D (-/-) mice

To determine whether oxidant stress was increased in the lungs of SP-D (-/-) mice, lipid peroxide (LPO) concentrations were assessed. Lipid hydroperoxide (LPO) concentration was measured in whole lung from SP-D (-/-) and wild type mice using the LPO-586 assay kit (OXIS International, Inc., Portland, OR). Lungs were isolated and homogenized with PBS containing 5 mM butylated hydroxytoluene (BHT) and cenfrifuged at 15000 ιpm for 15 min at 4°C.

Supematants were collected and the content of malonaldehyde and 4-hydroxyalkenals was measured colorimetrically using manufacture's procedures. LPO content of lung homogenates was significantly increased in lungs of SP-D (-/-) compared to those from wild type mice (see Figure 25). Histochemical detection of lipid peroxidation-derived carbonyls was perfoπned as follows: lung sections (10 μm thick) obtained from frozen tissue specimens were exposed 1 hour at 60°C to a 0.1% 3-OH-2-naphtoic acid hydrazine (OHNAH) solution in 50% ethanol containing 5% acetic acid. After the reaction, the sections were washed thoroughly in 50% ethanol and stained 5-10 minutes with a 0.1% fast blue B solution in an alcoholic buffer prepared by mixing equal volumes of 100 mM phosphate buffer, pH 7,4, and 95% ethanol. Carbonyls were converted to naphtoic hydrazones by reaction with OHNAH. Coupling with the diazonium salt then yielded violet azo dyes. Histochemical staining with OHNAH tefrazolium demonstrated increased staining in lung sections from SP-D (-/-) mice. The intensity of OHNAH staining in SP-D (-/-) mice was not uniform, being most prominent at the sites of foamy macrophage infiltration (see Figure 26).

Infracellular reactive oxygen species (ROS) in AMs were determined using CDCFH, an indicator of infracellular peroxides, including H₂0₂ and lipid peroxides. CDCFH, 6-carboxy-2',7'- dichlorodihydrofluorescein diacetate (Molecular Probes, Inc., Eugene, OR) is a fluorescent probe. To allow staining, AMs were incubated with 10 μM CDCFH for 30 min, rinsed with PBS, and fixed with 4% parafonnaldehyde. Fluorescence was observed with fluoromicroscopy using excitation and emission wavelengths 485 and 530 respectively. Increased CDCFH fluorescence was observed in AMs from SP-D (-/-) compared to those from confrol mice (Figure 27). Taken together with previous findings, this demonstrates increased hydrogen peroxide production by AMs from SP-D (-/-) mice, the present data support the concept that oxidative stress is increased in pulmonary tissues in the absence of SP-D.

EXAMPLE 31 Activation of NF-κB in SP-D (-/-) mice ROS activate redox-sensitive franscription factors including NF-κB and AP-1. Thus, it was of interest to determine whether the presence of SP-D coπelated with production of either of these transcription factors. Immunostaining for NF-κB p65 was perfomied as follows: BAL cells were isolated from wild type and SP-D (-/-) mice, cytospun and fixed with cold methanol for 10 min, and washed in PBS. The slides were then incubated at 4°C overnight with a rabbit anti p65 antibody (Santa Cruz Biotechnology, Santa Cruz, CA). After incubation, the slides were washed in PBS and incubated with fluorescein isothiocyanate (FITC)-conjugated goat anti rabbit IgG (Santa Cruz Biotechnology) as a second antibody, and compared to samples prepared identically without primary antibody.

Immunofluorescence staining analysis with anti-NF-κB p65 antibody demonstrated that the p65 subunit of NF-i B was present in the cytoplasm of AMs from both wild type and SP-D (-/-) mice (Figure 28A). However, in AMs from SP-D (-/-) mice, increased staining for NF-icB p65 was observed; furtheπnore, nuclear staining was markedly increased in AMs from SP-D (-/-) mice and was almost never detected in AMs from WT mice. NF-κB activity was determined in nuclear exfracts from SP-D (-/-) mice by assessing binding to a consensus NF-icB oligonucleotide in EMSA (Figure 28B). Increased NF-κB binding was observed in nuclear exfracts from AMs of SP-D (-/-) mice. Binding of the nuclear extract to the NF-κB site was inhibited by co-incubation with the unlabeled NF-κB oligonucleotide, supporting the specificity of the EMSAs. Likewise, AP-1 binding activity was increased in nuclear exfracts from AMs of SP-D (-/-) mice. Supershift assay for NF-κB showed that the protein/DNA complex contained both components of NF-κB p50 and p65, but not c-Rel (Figure 28C).

Thus, SP-D deficiency caused increased oxidative stress in pulmonary tissues associated with redox-sensitive enhancement of NF-κB activity, and increased metalloproteinase production by AMs. Since NF-κB is a critical mediator of franscriptional responses during inflammation, these findings support the concept that SP-D is required for appropriate regulation of both oxidant production and inflammatory responses by AMs. SP-D is required for suppression of steady state NF-κB activation and metalloproteinase expression that may contribute to the emphysema characteristic of SP-D (-/-) mice. The increased nuclear translocation and activity of NF-κB seen in the AMs from SP-D (-/-) mice may influence the heightened inflammatory responses of AMs from these mice during pulmonary infections.

Increased oxidative stress in the lungs of SP-D (-/-) mice was supported by the increased production of reactive oxygen species by AMs, increased content of oxidized lipid species, reactive carbonyls, and CDCFH fluorescence. However, the mechanism underlying the oxidative stress in the lungs of SP-D (-/-) mice, remains unclear, and may relate either to increased oxidant production, decreased antioxidant activity, or failure to clear reactive oxygen species. The present studies support the concept that NF-κB activation by AMs was mediated, at least in part, by apocynin and DPI sensitive pathways, supporting a role of NADPH oxidase or other oxidases in the process. Recently NF-κB activation pathway by NADPH oxidase in alcoholic liver injury was also reported. However the specificity of these inhibitors for various oxidases has not been established. Indeed, DPI inhibits a wide range of flavoproteins including NADPH oxidase and complex I within the mitochondrial electron transport chain. Therefore, it is possible that pathways other than NADPH oxidase are involved in this process. Recent studies by Bridges et al. also demonstrated that SP-A and SP-D prevented oxidation of unsaturated phospholipids in vitro supporting a direct antioxidant function for these proteins. This activity may be particularly important in the lungs of SP-D (Λ-) mice, wherein concentrations of alveolar lipids are markedly increased and concentrations of SP-A are relatively low. Large aggregate surfactant from SP-D (-V) mice contained increased lipid peroxide species, perhaps reflecting increased oxidant production or decreased oxidant clearance by the lung. EXAMPLE 32

Antioxidants inhibit MMP expression by AMs from SP-D (-/-) mice

To determine whether increased oxidant production mediated the expression of MMPs by

AMs from SP-D (-/-) mice, the cells were treated with N-acetylcysteine (NAC) and pynOlidine dithiocarbamate (PDTC), both antioxidant reagents as follows: AMs from SP-D (-/-) mice were pooled and placed in culture at a concentration of 5 x 10⁵ cells per well in serum-free RPMI medium. The AMs were treated with 20 mM N-acetylcysteine (NAC), 200 μM pyrolidine dithiocarbamate (PDTC), 1 μM diphenylene iodonium chloride (DPI) (Sigma, St. Louis, MO), or 1 mM apocynin (Aldrich, Milwaukee, WI). Cells were also incubated with a 10 μM SN-50 (Calbiochem, LaJolla, CA), an inhibitor of NF-κB nuclear import. After 6h incubation, supematants were removed and the cells were washed and incubated with fresh media including the reagents for 24h. At the concentrations used, these agents did not alter macrophage viability, as determined by trypan blue exclusion or LDH measurement (Roche, Indianapolis, IN). RAW 264.7 murine macrophage cell line was obtained from the American Type Culture Collection (Rockville, MD) and maintained in DMEM containing 10% FBS, 10 mM HEPES, 50 U/ml penicillin and 50 μg/mL streptomycin. 2 x 10⁵ cells in 24- well plates were incubated with or without 10 μM menadione (Sigma, St. Louis, MO) for 24 hours.

Gelatinolytic activity in the culture media of unfreated and freated cells was analyzed by SDS-PAGE zymography (Figure 29). Gelatin Zymography was perfoπned as follows: MMP activities were measured in macrophage-conditioned media. Proteinases in the conditioned media were concentrated by incubation with gelatin-agarose beads (Amersham Phannacia, Arlington Heights, IL) for 2 h at 4 C. The beads were pelleted and washed, and proteinases eluted by incubation in sample buffer for 45 min at 37°C. The samples then were electrophoresed into 10% Zymogram gelatin gels (NO VEX, San Diego, CA). After electrophoresis, gels were washed twice with 2.5% Triton X-100 (37 C, 30 min) and incubated for 16 h with 40 mM Tris-HCI (pH 7.5), 10 mM CaCl₂, and 1 μM ZnCl₂. Gels were stained with 0.5% (wt/vol) Coomassie blue in 50% methanol and 10% acetic acid for 30 min, then destained. MMPs were detected as clear bands against a blue background.

Treatment of AMs from SP-D (-/-) mice with NAC and PDTC reduced gelatinolytic activity consistent with mobility of MMP-2 and 9. Since NADPH oxidases are important sources of ROS in macrophages, it was assessed whether ROS generated by NADPH oxidases or other oxidases mediated the increased MMP expression characteristic of SP-D (-/-) mice. AMs from SP- D (-/-) mice were incubated with NADPH oxidase inhibitors, diphenyleneiodonium chloride (DPI) and apocynin. SDS-PAGE-zymography demonstrated that both of NADPH oxidase inhibitors markedly suppressed MMP enzymatic activity (Figure 30A). Likewise, apocynin reduced MMP-2 and 9 mRNA in cultured AMs from SP-D (-/-) (Figure 30B).

To assess whether apocyanin affected binding of nuclear extracts, the following protocol was used: Nuclear exfracts were obtained using a modified method previously described (Sever Chroneos, et al. Am. J. Physiol. 277:L79). Lavaged cells were lysed with Buffer A (10 mM Hepes, 10 mM KC1, 0.1 mM EDTA, 1.5 mM MgCl,, 0.2% Nonidet P-40 (NP-40), 1 mM DTT, 0.5 mM PMSF), followed by vortexing to shear the cytoplasmic membranes. Nuclei were pelleted by centrifugation at 3000 rpm for 3 min at 4°C in a microcentrifuge. Nuclear proteins were extracted with high-salt buffer C (20 mM Hepes, 25% glycerol, 1.5 mM MgCl₂, 0.1 mM EDTA, 1.5 mM MgCl₂, 420 mM NaCl, 1 mM DTT, 0.5 mM PMSF) and stored at -80°C. Total nuclear protein concentrations were detennined by bicinchoninic acid (BCA) method.

Apocynin reduced binding of nuclear extracts from AMs isolated from SP-D (-Y-) mice to a NF-κB oligonucleotide (Figure 30C). Apocynin also decreased DNA binding activity to an AP-1 oligonucleotide. AMs were cultured with SN-50, a synthetic inhibitory peptide that blocks nuclear import of NF-κB. SN-50 markedly suppressed MMP-2 and 9 production by AM from SP-D (-/-) mice (Figure 31).

To assess whether ROS directly stimulated MMP production, RAW 264.7 macrophages were incubated with 10 μM of menadione, a ROS generator, for 24 hours. MMP-9 production was increased by menadione as assessed by zymography. Foamy macrophages are a prominent feature of the lung pathology in SP-D (-Y-) mice. The increased oxidant production and foamy alveolar macrophage fonnation seen in SP-D (Λ-) mice are reminiscent of findings in atheromas, wherein uptake of oxidized lipids by tissue macrophages further induced reactive oxygen species, and enhanced macrophage activation. While lung lipid concentrations are markedly increased in SP-D (-/-) mice, it is not likely that increased lipid content alone is a sufficient stimulus to generate the activated foamy macrophages. Indeed, similarly increased surfactant lipid concentrations and foamy macrophages were observed in GM- CSF and common ^β chain receptor deficient mice without the increased oxidant production or alveolar macrophage activation seen in the SP-D (-/-) mice. Taken together, the present findings support the concept that SP-D signaling is required for the regulation of oxidant production or clearance of ROS by AMs in the lung. Recent findings that SP-D binds to CD 14 via its carbohydrate recognition domain, inhibiting CD 14 lipopolysaccharide (LPS) interactions, suggests a mechanism by which alveolar macrophage activity may be modulated by SP-D. Since LPS- CD14 interactions may also influence NADPH oxidase and NF-κB, these pathways may mediate the increased inflammatory responses seen during pulmonary infections in the SP-D (-/-) mice. It was also observed herein that the addition of mouse (5 μg/ml) SP-D in vitro, did not reduce MMP production by AMs from SP-D (-/-) mice. This finding suggests that direct signaling via SP-D was not sufficient to inhibit MMP production by AMs from SP-D (-/-) mice in vitro, and that activation of AMs may be mediated indirectly by chemical messengers generated in the lungs of SP-D deficient mice. SP-D plays an important role in the modulation of pulmonary infection, caused by numerous pathogens. SP-D binds to various microorganisms and their products, including gram- negative and gram-positive bacteria, respiratory viruses, fungi, and endotoxin. In vitro studies support the role of SP-D in the binding and aggregation of pathogens, enhancing their phagocytosis and killing. Paradoxically, in the presence of some pathogens, oxidant production and killing by AMs in vitro was increased by SP-D, findings that confrast with the marked activation of endogenous oxidant production seen in AMs from the SP-D deficient mice. Thus SP-D actions on effector cells may be mediated by complex interactions among various receptors that may uniquely recognize the pathogen, SP-D-pathogen complexes, or SP-D. Since SP-D also binds to various lipid components, including phosphatidylinositol and glucosylceramide, lαiown second messengers involved in inflammatory responses, SP-D may also indirectly influence cell signaling by interacting with such molecules.

The work set out in Examples 30-32 demonstrates that the excess reactive oxygen species generated in the absence of SP-D, activate the redox sensitive franscription factor, NF-κB. Thus, SP-D appears to play a central role in the regulation of NF-κB activity in AMs. Since NF-κB regulates numerous proinflammatory response genes expressed by AMs, including IL-lβ, TNF-α, IL-6, MIP-2, and metalloproteinases-9, SP-D dependent pathways may be important modulators of the general response of the AM to infection and inflammation. Indeed, in recent studies, increased production of the cytokines TNF-α, IL-6, and IL-lβ was observed following pulmonary infection by bacterial pathogens in SP-D (-/-) mice, supporting the concept that SP-D orchestrates both steady state and infection induced proinflammatory cytokine production by AMs.

In the present studies, SN-50, a selective NF-κB inhibitor, suppressed MMP-2, MMP-9 production. SN-50 is lαiown to inhibit nuclear import of NF-κB, thereby inhibiting its transcriptional activity. An NF-κB element is present in the promoter region of the MMP-9 gene, supporting the concept that SN-50 may suppress MMP-9 production by blocking NF-κB activity. However, NF-κB binding sites have not been detected in the promoter region of the MMP-2, and it is unclear whether the inhibitory effects of SN-50 on MMP-2 production are regulated by direct or indirect effects on MMP-2 franscription. Alternatively, NF-κB may bind to and enhance expression of other franscription factors, including AP-1 and p53, that may increase MMP-2 expression directly or through protein-protein interactions. Finally, SN-50 shares the nuclear localization sequence which competes for the nuclear import of endogenous NF-κB. The specificity of SN-50 for NF-κB nuclear import has been questioned since other nuclear proteins share this nuclear import system. Nonetheless, present findings support the concept that SP-D plays a central role in the modulation of metalloproteinase expression in AMs by influencing NF- KB activity. The present study demonstrates an oxidant dependent activation of NF-κB and enhanced metalloproteinase expression by AMs from SP-D (-/-) mice that may be involved in the pathogenesis of emphysema characteristic of this model. Oxidants derived from air pollution, cigarette smoking, and activated inflammatory cells have been implicated in the pathogenesis of emphysema in human lung disease. Findings that SP-D concentrations are reduced in lung lavage from smoking individuals and patients with cystic fibrosis supports a potential role for SP-D in the regulation of oxidant induced lung inflammation.

EXAMPLE 33 Treatment of colds and flu and their symptoms with SP-D Because SP-D has a role in both the clearance of virus from the lungs and the reduction in inflammation, it is well-suited for use in the treatment of the infection and symptoms of colds and flus. Many patients experience continued coughing and discomfort even after the clearance of virus from the body. Thus, the use of SP-D allows for suppression of inflammation and, a reduction in the symptoms associated with it. Thus, a patient with the flu is treated with SP-D protein for 1-2 weeks until symptoms completely disappear. The SP-D protein structure and domains have been extremely well characterized as have many of the collectins (Hansen, et al. Immunobiology 1998 Aug;199(2):165-189). The protein is synthesized as dodecamers consisting of four homofrimers each stabilized by disulfide bonds (Zhang, et al. J. Biol. Chem. 2001 Jun 1;276(22):19214-19219). Studies have shown that SP-D is a 43 l Da polypeptide with a short NH2-teπuinal domain, a collagen-like sequence, and a C-terminal lectin domain (Crouch et al. J. Biol. Chem. 1994 Jun 24; 269(25):17311-17319). The carbohydrate recognition domains have been mapped in detail as have the N-tenninal and collagen domains. The carbohydrate recognition domain (CRD) can be expressed as a fusion protein or alone and is still able to bind carbohydrates (Kishore, et al. Biochem J. 1996 Sep l;318(Pt 2):505-511). In addition, chimeric proteins containing various domains from the different collectins have been produced (white, et al. J. Immunol. 2000 Aug 15;165(4):2108-2115). Variants lacking both the amino tenninal region and the collagen-like region were generated and analyzed (Ogasawara et al. J. Biol. Chem 1995 Aug 11;270(32):19052-19058). The ciystal structure of the frimeric alpha- helical coiled coil and the lectin domains of the SP-D protein have been analyzed (Hakansson, et al. Structure Fold Des. 1999 Mar 15;7(3):255-264). Thus, with the extensive characterization of SP-D, chimeras, and variants described in the field, one of skill in the art would be able to use this information to identify active variants of SP-D which would still be active in the methods disclosed herein. Although, variants which are as active or more active are desired, it is envisioned that variants which are 80% or more active would still be useful.

EXAMPLE 34 SP-D and Active Variants

SP-D variants which are still able to have the activity needed are produced. The activity may be as a surfactant, anti -inflammatory, or activity against infectious agents. In particular, the SP-D is still able to bind to the cell of choice, viruses, fungi, bacteria, or white blood cells. Much is lαiown about the domains and amino acid sequence of the SP-D needed for the specific activities. For example, the ability to bind to allergens, lipopolysaccharides (of Gram negative bacteria), and the interaction with phospholipids is associated with the carbohydrate recognition domains (CRDs). Thus, the CRD is an important domain in the activity of the protein, particularly in binding to bacteria, fungi, and viruses. Variants of SP-D are produced which contain an active CRD. Preferably, the variants are truncated or mutated in regions of SP-D other than the CRD. Variants with minor amino acid changes in the CRD region may be produced, particularly with amino acid changes which do not affect the activity, such as like amino acid changes (basic amino acid to basic amino acid). In addition, chimeras which incoφorate domains from other collectins or C-type lectins are envisioned.

The neck region of SP-D is believed to be important as a dimerizing or frimerizing region to bring together three CRDs and allowing multivalency and, thus, strong binding. Thus, bivalent, trivalent, and monovalent variants are envisioned which contain mutations or deletions in the neck region.

Chimeras containing domains from other collectins are envisioned which may, in fact, be more active than wild type SP-D. For example, a chimera of human serum mannose binding lectin (MBL) and SP-D was produced containing the N teπninus and collagen domain of human SP-D and the neck region and CRD of human MBL to create a novel collectin. The chimera bound to influenza A virus (IAV), inhibited IAV hemagglutination activity and infectivity, and induced aggregation of viral particles to a much greater extent than MBL (White et al. J. Immunol. 2000 Aug 15;165(4):2108-15). A second chimera containing bovine serum conglutinin and the amino tenninus and collagen domain of rat pulmonary SP-D fused to the neck and CRD of conglutinin also showed a high ability to inhibit IAV infection.

Thus, active variants are variants of SP-D which still possess at least 50% of the activity of wild-type SP-D, preferably 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 100% or more activity. Examples include truncations in which parts of the protein which are not important for activity are removed, point mutations in which parts of the protein which are not necessary for activity are mutated. Particularly advantageous mutations include mutations that either do not change the amino acid coded for or those that change from a like amino acid to a like amino acid, for example a basic amino acid. In addition, clearly the chimera which use domains from other collectins produce highly active versions of SP-D which can be used in the presently claimed invention.

The patient is freated as in Examples 12-14 in which SP-D variant protein of the vectors which express the SP-D variants are administered to the patient as needed until the pathogen is cleared from the body and the symptoms abate. Alternatively, the SP-D variant is administered to a patient with emphysema or other fonns of lung abnomialities or pathologies as in Examples 9-11.

Claims

WHAT IS CLAIMED TS:

1. A method for the prevention and freatment of pulmonary disease comprising: introducing mammalian SP-D protein or an active variant, or vectors expressing the mammalian SP-D protein or an active variant into a human in an amount effective to reduce the symptoms of or prevent pulmonary disease.

2. The method of Claim 1 wherein the pulmonary disease is emphysema.

3. The method of Claim 1 wherein said SP-D protein is administered intra-tracheally.

4. The method of Claim 1 wherein said SP-D protein is expressed from an adenoviral vector.

5. The method of Claim 1 wherein said adenoviral vector is introduced via aerosolization.

6. The method of Claim 1 wherein said adenoviral vector is the adenoviral vector Ad- rSPD.

7. The method of Claim 1 wherein said pulmonary disease is a disease selected from the group consisting of: Cystic fibrosis, emphysema, infectious diseases, inflammatory diseases, and transplantation rejection.

8. The method of Claim 7 wherein said infectious diseases are selected from the group consisting of bacterial, viral, fungal, and protozoal.

9. The method of Claim 8 wherein said viral diseases are any pulmonary viral diseases.

10. The method of Claim 9 wherein said pulmonary viral diseases are selected from the group consisting of influenza A, rhinovirus, coronavirus, RSV, chickenpox, human parvovirus B19, parainfluenza vims types 1-3, cytomegalovirus, adenovirus, hantavims and rubella.

11. The method of Claim 1 wherein said human is immunocompromised, has immature lung development, is elderly, or has a chronic lung disease.

12. The method of Claim 1, wherein said active variant of SP-D is selected from the group consisting of: a truncation, a base change, a chimera, or a deletion variant.

13. A method for the prevention and freatment of pulmonary disease comprising: infroducing mammalian SP-D protein or SP-D variants, or vectors expressing the mammalian SP-D protein or SP-D variants into a human in an amount effective to reduce the symptoms of or prevent pulmonary disease, wherein the pulmonary disease is selected from the group consisting of: reactive oxygen-mediated disease, chemically induced lung injury, injury due to oxygen radicals, injury due to ozone, injury due to chemotherapeutic agents, inflammatory and infectious diseases, reperfusion injury, drowning, transplantation, and rejection.

14. A method for the prevention and treatment of viral disease in a mammal comprising: infroducing mammalian SP-D protein, an active variant, or vectors expressing the mammalian SP-D protein or an active variant into a human in an amount effective to reduce the number of viruses or symptoms of the viral disease.

15. The method of Claim 14 wherein the viral disease is caused by a virus selected from the group consisting of: Adenovirus, RSV, Influenza virus, chickenpox, fifth disease, cytomegalovirus, rhinovirus, rubella virus, and cytomegalovirus.

16. The method of Claim 14 further comprising treating the symptoms which persist after the infection is cleared.

17. The method of Claim 14 wherein said mammal is a human patient selected from the group consisting of: an immunocompromised, an elderly, a patient with immature lung development, a patient with a chronic pulmonary disease.

18. A method of inhibition of metalloproteinase activity and reactive oxygen species in the lungs, comprising, administering SP-D to the lungs in an amount effective to inhibit metalloproteinase activity and reactive oxygen species.

19. A method for the inhibition of NF-κB activity in the lungs or lung cells of a mammal, comprising: administering an amount of SP-D or an active SP-D variant sufficient to inhibit NF-κB activity.

20. The method of claim 18, further comprising administering an NF-κB inhibitor selected from the group consisting of: SN-50, and IκB.

21. A method for the freatment of a disorder associated with reduced metalloproteinase activity or decreased reactive oxygen species in an alveolar macrophage of a mammal, comprising: administering or activating NF-κB systemically, or locally.

22. The method of Claim 21, wherein said NF-l B activators are selected from the group consisting of: .

23. A method for the treatment of the symptoms associated with colds, flus, and allergies in a mammal, comprising: administering an effective amount of SP-D or an active SP-D variant to the lung or lung cells of said mammal.