Response of Airway Cells to 20,000 EU of Endotoxin in Normal Adults

Twenty-four or forty-eight hours (study day 1) prior to the inhalation challenge, subjects
will undergo a physical examination of the ears, nose, throat and chest and will have an
assessment of vital signs (temperature, pulse, respiratory rate, blood pressure), oxygen
saturation, symptom score assessment and undergo spirometry to rule out acute illness prior
to challenge. All female volunteers will undergo a urine pregnancy test. A similar
examination will take place immediately prior to inhalation challenge with 20,000 EU of
CCRE, as well as 30, 60, 120, 180, 240, 300 and 360 minutes and 24 hours after challenge
(with the exception of a pregnancy test which will only be administered prior to sputum
induction on study day 1). Induced sputum will be 24 to 48 hours prior to challenge, and
again six hours after challenge on Study day 2. Sputum will be analyzed for PMN content,
CD14 expression on airway macrophages and monocytes, soluble CD14 levels, cytokine levels in
sputum and products of inflammatory cells (eosinophil, cationic protein, myeloperoxidase).
Blood will be collected for a CBC and differential when the pre- challenge induced sputum is
obtained and again 6 hours after challenge and 24 hours after challenge. Blood lymphocytes
from a 10 ml aliquot will be assessed for lymphocyte subset and activation markers, as well
as proliferative and cytokine responses. Blood will also be collected and will be assessed
by whole blood assays for markers of inflammatory and immune activation (CD11b, CD14, CD64,
CD16, HLA-DR, CD45, CD3, CD80, CD86, CD83, CD40) and function (phagocytosis and oxidative
burst) by three color flow cytometry. Plasma will be separated from 4 ml and frozen at 70°
C for future analysis of mediators of interest, such as cytokines, as well as other systemic
effects of endotoxin.

Subjects will then be discharged to home with contact information for study staff. If a
volunteer has an unexpected complication such as shortness of breath, decrease in pulmonary
function, unstable vital signs or other he or she will be admitted to the GCRC for overnight
observation. The next morning (study day 3) subjects will return to the CEMALB for a final
set of vital signs, spirometry, symptom scoring, a venipuncture and an examination by a
study physician.

Each volunteer will be given a symptom scoring sheet for each day up to 96 hours (4 days)
after challenge.

Each sheet will include the name and phone number of the study coordinator and study MD.
Sample home symptom scoring sheets and instructions are included with this protocol.

Between 48 and 96 hours after challenge, each volunteer will be called to determine their
status, inquiring about symptoms, symptom scoring, and need for medication and/or physician
visits.

Between 7 and 10 days of the challenge dose, each subject will be asked to return for a
study discontinuation visit. At that time temperature, pulse, systolic and diastolic BP,
respiratory rate, FVC and FEV1 and SpO2 (oxygen saturation), and symptoms scores will be
assessed and, if abnormal, medical evaluation as directed by the study physician will be
undertaken.