N-Heterocyclic carbene-functionalized metal nanoparticles and nanoclusters for nanocatalysis.

N-Heterocyclic carbenes (NHCs) have recently emerged as a popular ligand for the functionalization of metal nanoparticles and atomically precise metal clusters. The strong electron-donating properties of NHCs and robust NHC-metal covalent bonding endow metal nanostructures with improved stability and enhanced catalytic performances. In this review, we focus on NHC-coordinated metal nanoparticles and nanoclusters for the electrochemical CO2 reduction reaction (eCO2RR), selective hydrogenation of unsaturated compounds, and asymmetrical catalytic reactions. We discuss the underlying factors that may be at play in determining the improved activity of NHC-functionalized metals and address a few promising perspectives of NHC functionalization for new and better catalytic metal nanostructures.

Synthesis and Photophysical Properties of Silole-Fused Cycloparaphenylenes.

Herein, we report the introduction of a silole unit into cycloparaphenylenes (CPPs), and two compounds [12]Si3CPP and [16]Si4CPP are obtained by a platinum- and gold-mediated cyclooligomerization strategy. Their optical and electronic properties are studied by UV-vis absorption and fluorescence spectra, which show red shifts and higher photoluminescence quantum yields (PLQYs) compared with the corresponding CPPs.

Mechanofluorochromism of 2-Biarylyl Cinchoninic Acids with High Sensitivity and Large Mechanochromic Shift.

In recent years, organic mechanofluorochromism (MFC) materials have attracted wide attention in many fields. However, the exploration of MFC materials with high-contrast, high-sensitivity and high-responsiveness remains a challenge. Herein, a series of MFC materials with 2-biarylyl cinchoninic acid skeleton were successfully established, which are based on interconversion of classical/frustrated Brønsted pairs. These compounds have the mechanochromic shift of up to 115 nm, as well as the property of stunning sensitivity and multiple responses to external mechanical force stimuli. The luminescence properties can be easily tuned by changing the substituents.

Mechanochromic Luminescence of 2,6-Bis(4-biphenyl)isonicotinic Acid via Interconversion of Classical/Frustrated Brönsted Pair.

A practicable strategy to a reversible mechanochromic material featuring interconversion of classical/frustrated Brönsted pairs has been established. We report the mechanochromic property of 2,6-bis(4-biphenyl)isonicotinic acid (1), which features a frustrated Brönsted pair in the crystalline form and a classical Brönsted pair after grinding. A large mechanochromic shift was found from 428 to 505 nm. In addition, compound 1 also exhibits acidochromic behavior, which further proves that the formation of an acid-base interaction is responsible for the mechanochromic phenomenon.

Nucleophilic Activation of Sulfur Hexafluoride by N-Heterocyclic Carbenes and N-Heterocyclic Olefins: A Computational Study.

Sulfur hexafluoride (SF6 ) is considered as a potent greenhouse gas, whose effective degradation is challenging. Here we report a computational study on the nucleophilic activation of sulfur hexafluoride by N-heterocyclic carbenes and N-heterocyclic olefins. The result shows that the activation of SF6 is both thermodynamically and kinetically favorable at mild condition using NHOs with fluoro-substituted azolium and sulfur pentafluoride anion being formed. The Gibbs free energy barrier during the activation of SF6 has a linear relationship with the energy of HOMO of substrates, which could be a guideline for applying those compounds that feature higher energy in HOMO to activate SF6 in high efficiency.

Interaction of Organic Anion Transporter 3-Mediated Uptake of Steviol Acyl Glucuronide, a Major Metabolite of Rebaudioside A, with Selected Drugs.

Organic anion transporter 3 (OAT3) plays a critical role in the renal excretion of many xenobiotics. Because steviol acyl glucuronide (SVAG), an OAT3 substrate, is the major circulating metabolite after oral ingestion of steviol glycosides and is excreted into the urine, inhibition of OAT3 activity may alter pharmacokinetic profiles of SVAG. The present study showed that drugs such as probenecid and glimepiride displayed potent inhibition toward the OAT3-mediated SVAG transport, with IC50 values of 4.9 and 0.8 µM, respectively. No species differences were observed. Probenecid and glimepiride could significantly elevate plasma concentrations of SVAG after oral administration of rebaudioside A, with significant increases in plasma maximum (Cmax) and area under the plasma time-concentration curve values. The inhibitory effect on the OAT3-mediated SVAG transport exemplified a unique case between drugs and the metabolite of a food additive. Our data suggest that caution should be exercised when giving steviol glycoside products to human subjects with compromised renal function.

UGT-dependent regioselective glucuronidation of ursodeoxycholic acid and obeticholic acid and selective transport of the consequent acyl glucuronides by OATP1B1 and 1B3.

Ursodeoxycholic acid (UDCA) is a major effective constituent of bear bile powder, which is widely used as function food in China and is documented in the Chinese pharmacopoeia as a traditional Chinese medicine. UDCA has been developed as the only accepted therapy by the US FDA for primary biliary cholangitis. Recently, the US FDA granted accelerated approval to obeticholic acid (OCA), a semisynthetic bile acid derivative from chenodeoxycholic acid, for primary biliary cholangitis. However, some perplexing toxicities of UDCA have been reported in the clinic. The present work aimed to investigate the difference between UDCA and OCA in regard to potential metabolic activation through acyl glucuronidation and hepatic accumulation of consequent acyl glucuronides. Our results demonstrated that the metabolic fates of UDCA and OCA were similar. Both UDCA and OCA were predominantly metabolically activated by conjugation to the acyl glucuronide in human liver microsomes. UGT1A3 played a predominant role in the carboxyl glucuronidation of both UDCA and OCA, while UGT2B7 played a major role in their hydroxyl glucuronidation. Further uptake studies revealed that OATP1B1- and 1B3-transfected cells could selectively uptake UDCA acyl glucuronide, but not UDCA, OCA, and OCA acyl glucuronide. In summary, the liver disposition of OCA is different from that of UDCA due to hepatic uptake, and liver accumulation of UDCA acyl glucuronide might be related to the perplexing toxicities of UDCA.

Involvement of CYP4F2 in the Metabolism of a Novel Monophosphate Ester Prodrug of Gemcitabine and Its Interaction Potential In Vitro.

Compound-3 is an oral monophosphate prodrug of gemcitabine. Previous data showed that Compound-3 was more potent than gemcitabine and it was orally active in a tumor xenograft model. In the present study, the metabolism of Compound-3 was investigated in several well-known in vitro matrices. While relatively stable in human and rat plasma, Compound-3 demonstrated noticeable metabolism in liver and intestinal microsomes in the presence of NADPH and human hepatocytes. Compound-3 could also be hydrolyzed by alkaline phosphatase, leading to gemcitabine formation. Metabolite identification using accurate mass- and information-based scan techniques revealed that Compound-3 was subjected to sequential metabolism, forming alcohol, aldehyde and carboxylic acid metabolites, respectively. Results from reaction phenotyping studies indicated that cytochrome P450 4F2 (CYP4F2) was a key CYP isozyme involved in Compound-3 metabolism. Interaction assays suggested that CYP4F2 activity could be inhibited by Compound-3 or an antiparasitic prodrug pafuramidine. Because CYP4F2 is a key CYP isozyme involved in the metabolism of eicosanoids and therapeutic drugs, clinical relevance of drug-drug interactions mediated via CYP4F2 inhibition warrants further investigation.

CYP2C8-mediated interaction between repaglinide and steviol acyl glucuronide: In vitro investigations using rat and human matrices and in vivo pharmacokinetic evaluation in rats.

CYP2C8 is involved in the metabolic clearance of several important drugs and recent reports have shown that acyl glucuronides of gemfibrozil and clopidogrel are potent time-dependent inhibitors of CYP2C8 activity. In the present study, the inhibitory effect of steviol acyl glucuronide (SVAG), a circulating metabolite formed after the ingestion of rebaudioside A, was investigated using in vitro and in vivo systems. Results indicated that SVAG was a reversible but not a time-dependent inhibitor of CYP2C8-mediated paclitaxel 6α-hydroxylation. SVAG was also capable of inhibiting CYP2C8-mediated repaglinide 3'-hydroxylation in human liver microsomes and recombinant human CYP2C8, with Ki values of 15.8 µM and 11.6 µM, respectively. In contrast, SVAG did not exhibit inhibitory effect on CYP2C8 activity in rat liver microsomes. In addition, co-administration of rebaudioside A with repaglinide in rats did not lead to AUC and Cmax changes of repaglinide. Although mathematic prediction using a simplified mechanistic model revealed a moderate interaction potential between repaglinide and SVAG, cautions should be given to patients with hypoglycemia if repaglinide and rebaudioside A are used in combination for the blood sugar control.

Enhanced Antitumor Activity of Monophosphate Ester Prodrugs of Gemcitabine: In Vitro and In Vivo Evaluation.

The prodrug strategy has been explored frequently for a number of marked drugs to obtain better pharmaceutical properties and efficacy and safety profiles. For gemcitabine, a nucleoside analog that has been used widely as a chemotherapeutic agent for the treatment of a variety of cancers, the protection of the amino group from extensive deamination and increase of permeability have been used for oral prodrug development. In the present study, several novel and proprietary monophosphate ester prodrugs of gemcitabine representing different "tail" structures were evaluated for their antiproliferation activities in various tumor cell lines. As compared to LY2334737, a prototype oral prodrug of gemcitabine, the monophosphate ester prodrugs exhibited superior in vitro antiproliferation activity. Among those, compound-3 emerged as a promising prodrug candidate. Data revealed that cellular concentrations of compound-3 were correlated well with its antiproliferation activity and its cellular uptake did not involve human equilibrative nucleoside transporter, suggesting a potential to treat gemcitabine resistant tumors. Compound-3 demonstrated equal or better antitumor efficacy after oral administration as compared to intraperitoneally injected gemcitabine. Taken together, compound-3 has the potential for further development as an orally active antitumor agent.

Potential role of organic anion transporting polypeptide 1B1 (OATP1B1) in the selective hepatic uptake of hematoporphyrin monomethyl ether isomers.

AIM: Hematoporphyrin monomethyl ether (HMME), which consists of equal amounts of isomers HMME-1 and HMME-2, is a novel porphyrin-related drug for photodynamic therapy. This study was aimed to investigate the uptake transporter-mediated selective uptake of HMME into the liver and to identify the major uptake transporter isoforms involved. METHODS: Adult SD rats were intravenously injected with a single dose of HMME (5 mg/kg) with or without rifampicin (an inhibitor of organic anion transporting polypeptides OATP1B1 and OATP1B3, 25 mg/kg). Blood samples were collected, and HMME concentrations were measured using LC-MS/MS. Rat hepatocytes, human hepatocytes and HEK293 cells expressing OATP1B1, OATP1B3, or OATP2B1 were used to investigate the uptake of HMME or individual isomers in vitro. RESULTS: Co-administration of rifampicin significantly increased the exposure of HMME isomers, and decreased the AUC ratio of HMME-1 to HMME-2 from 1.98 to 1.56. The uptake of HMME-2 into human hepatocytes and the HEK293 cells expressing OATP1B1 or OATP2B1 in vitro was 2-7 times greater than that of HMME-1, whereas OATP1B3 mediated a higher HMME-1 uptake. OATP1B1 exhibited a higher affinity for HMME-2 than for HMME-1 (the Km values were 0.63 and 5.61 µmol/L, respectively), which were similar to those in human hepatocytes. By using telmisartan (a non-specific OATP inhibitor) and rifampicin, OATP2B1 was demonstrated to account for <20% of hepatic HMME uptake. CONCLUSION: OATP1B1 is the major transporter involved in the rapid hepatic uptake of HMME, and the greater uptake of HMME-2 by OATP1B1 may lead to a lower exposure of HMME-2 than HMME-1 in humans.

Pathway-dependent inhibition of paclitaxel hydroxylation by kinase inhibitors and assessment of drug-drug interaction potentials.

Paclitaxel is often used in combination with small molecule kinase inhibitors to enhance antitumor efficacy against various malignancies. Because paclitaxel is metabolized by CYP2C8 and CYP3A4, the possibility of drug-drug interactions mediated by enzyme inhibition may exist between the combining agents. In the present study, a total of 12 kinase inhibitors were evaluated for inhibitory potency in human liver microsomes by monitoring the formation of CYP2C8 and CYP3A4 metabolites simultaneously. For reversible inhibition, nilotinib was found to be the most potent inhibitor against both CYP2C8 and CYP3A4, and the inhibition potency could be explained by strong hydrogen binding based on molecular docking simulations and type II binding based on spectral analysis. Comparison of K(i) values revealed that the CYP2C8 pathway was more sensitive toward some kinase inhibitors (such as axitinib), while the CYP3A4 pathway was preferentially inhibited by others (such as bosutinib). Pathway-dependent inactivation (time-dependent inhibition) was also observed for a number of kinase inhibitors against CYP3A4 but not CYP2C8. Further studies showed that axitinib had a K(I) of 0.93 µM and k(inact) of 0.0137 min(-1), and the observed inactivation toward CYP3A4 was probably due to the formation of reactive intermediate(s). Using a static model, a reasonably accurate prediction of drug-drug interactions was achieved by incorporating parallel pathways and hepatic extraction ratio. The present results suggest that potent and pathway-dependent inhibition of CYP2C8 and/or CYP3A4 pathways by kinase inhibitors may alter the ratio of paclitaxel metabolites in vivo, and that such changes can be clinically relevant as differential metabolism has been linked to paclitaxel-induced neurotoxicity in cancer patients.

Steviol glucuronidation and its potential interaction with UDP-glucuronosyltransferase 2B7 substrates.

Hydrolysis of stevioside and rebaudioside A in the gastrointestinal tract after oral intake leads to the formation of steviol, the aglycone, which is absorbed into the circulation. Although in vivo studies have shown that steviol is cleared from the body via glucuronidation, the role of liver vs. intestine in steviol glucuronidation has not been well defined and related UDP-glucuronosyltransferases (UGTs) have not been identified. The present study investigated steviol glucuronidation and obtained kinetic parameters in liver and intestinal microsomes of human and rat, as well as in recombinant human UGT systems. Results suggest that organ specificity exists in the intrinsic clearance of the glucuronidation reaction. Steviol glucuronidation was primarily mediated by UGT2B7 at low concentration and UGT2B7 and UGT1A3 at high concentration. Inhibition studies with selected UGT2B7 substrates indicate that diclofenac displayed a relatively strong inhibition (Ki, 4.2 µM) against steviol glucuronidation in human liver microsomes. Taken together, the identification of the involvement of UGT2B7 in steviol glucuronidation would provide a mechanistic basis for the evaluation of the interaction between steviol and diclofenac. As metabolic clearance of botanical-derived products can be the objects (victims) of botanical-drug interactions, further studies are needed to investigate the in vivo relevance of such interactions.

Characterization of a soluble B7-H3 (sB7-H3) spliced from the intron and analysis of sB7-H3 in the sera of patients with hepatocellular carcinoma.

B7-H3 is a recently discovered member of the B7 superfamily molecules and has been found to play a negative role in T cell responses. In this study, we identified a new B7-H3 isoform that is produced by alternative splicing from the forth intron of B7-H3 and encodes the sB7-H3 protein. Protein sequence analysis showed that sB7-H3 contains an additional four amino acids, encoded by the intron sequence, at the C-terminus compared to the ectodomain of 2Ig-B7-H3. We further found that this spliced sB7-H3 plays a negative regulatory role in T cell responses and serum sB7-H3 is higher in patients with hepatocellular carcinoma (HCC) than in healthy donors. Furthermore, we found that the expression of the spliced sb7-h3 gene is higher in carcinoma and peritumor tissues than in PBMCs of both healthy controls and patients, indicating that the high level of serum sB7-H3 in patients with HCC is caused by the increased expression of this newly discovered spliced sB7-H3 isoform in carcinoma and peritumor tissues.

[Regional gene delivery via the bile duct to damaged liver using peptide/DNA particles: experiment with rats].

OBJECTIVE: To evaluate the efficacy of gene delivery to the right lateral lobe of liver via a branch of the bile duct. METHODS: Twenty LEW rats underwent intraperitoneal injection of D-galactosamine to establish acute liver damage models and were randomly divided into 5 groups to undergo ligation of the common bile duct and left bile duct 4, 5, 6, or 7 days after the acute liver damage. Non-viral vector gene compound, polylysine-molossin/pGL3 containing firefly luciferin gene or CMVbeta containing beta-galactosidase of Escherichia coli/fusogenic) was injected in to the right lateral lobes 2 and 3 via the branch of right bile duct. Four rats without injection of D-galactosamine but undergoing injection of polylysine-molossin/pGL3 or CMVbeta/fusogenic were used as normal controls. Twenty-four hours after the regional gene delivery the rats were killed. The expressions of luciferin and beta-galactosidase in different lobes were detected. Pathological examination of liver was conducted. RESULTS: All rats survived after the operation. The expression levels of luciferin in the liver on the days 4, 5, and 6 were all significantly higher than that of the normal control rats (all P < 0.05). The expression levels of luciferin in the liver on the day 7 was the highest compared with the normal control rats (P = 0.01). However, the level of luciferin in the liver on the day 9 was lower and not significantly different from that of the normal rats (P > 0.05). Scattered distribution of beta-galactosidase was seen in the lobe 2 of the rats with acute liver damage. The levels of alanine transaminase and aspartate aminotransferase were slightly increased and the albumin level was slightly decreased in the rats with acute liver damage on the days 4 and 7, however, these biochemical indexes were not significantly correlated with the gene expression. There was no obvious histological difference between the lobes 2 and 3 and lobe 1. CONCLUSION: Gene delivery with peptide/DNA complexes shows a good expression in the acute damaged liver without aggravating the liver damage, thus providing a technical platform for the experimental research of liver gene therapy.

[Primary application of identification-aided system for diagnosis and differential diagnosis of emerging infectious diseases].

OBJECTIVE: To verify the rate of diagnostic fitting between the clinic and the indentification-aided for diagnosis and differential diagnosis system, for emerging infections diseases (EID) established. METHODS: 314 cases of 49 kinds of contagious diseases diagnosed and another 186 patients with fever who not diagnosed were tested by the system. RESULTS: Preliminary verification was made in 314 cases diagnosed which classified to 49 kinds of contagious diseases of infectious diseases and the results showed that the coincidence rate of clinical diagnosis and first diagnosis of this system was 61.9%; the suggestive rate of first three diagnoses was 78.1%, and that of first five diagnoses was 86.6%. The diagnosis of another 186 patients with fever were diagnosed by the system and the results showed that the coincidence rate of clinical diagnosis and first diagnosis was 59.7%; the suggestive rate of first three diagnoses was 77.9%, and that of first five diagnoses was 85.4%. CONCLUSIONS: The system can accurately suggest impossible diagnosis and differential diagnosis, and be useful for our medical work.

[Comparison and analysis of two international diagnostic criteria for the diagnosis of 230 cases with drug-induced liver injury].

OBJECTIVE: To compare and analyze the accuracy of two diagnostic criteria of drug-induced liver injuries. METHODS: 230 cases of drug-induced liver injury diagnosed clinically in the 302 hospital of PLA were retrospectively studied. The drugs which induced liver injuries were summarized and analyzed. Danan's international consensus criteria and Maria's diagnostic scale were applied to diagnose these 230 cases again and then the differences of diagnostic results were analyzed and compared. RESULTS: The drugs which induced liver injuries in the 230 patients were arranged in order of their usage frequencies: traditional Chinese herbs and the like, antibiotics, antipyretic analgesics, antituberculosis medicines, cardiovascular drugs, over-the-counter health stuff, psychopharmaceuticals, dermatological agents, drug for diabetes, tapazol, and others. Based on the 230 adult inpatients with drug-induced liver injury, according to Danan's international consensus criteria, 149 cases (64.8%), 71 (30.9%) and 10 (4.3%) were classified as drug-related, indeterminate and drug-unrelated respectively; according to Maria's diagnostic scale, not one was a definite drug-induced liver injury, 55 cases (23.9%) were probable, while 126 (54.8%), 33 (14.3%) and 16 (7.0%) were possible, unlikely and excluded respectively. CONCLUSION: The accordance rate of Danan's international consensus criteria and clinical diagnosis was higher than that of Maria's diagnostic scale. Neverthelessìthe current diagnostic methods for drug-induced liver injury need to be revised for clinical practice.

Prognostic factors for severe acute respiratory syndrome: a clinical analysis of 165 cases.

This study analyzes single factors that affect the prognosis of severe acute respiratory syndrome (SARS) and establishes a prognosis model by multivariate analysis. We retrospectively analyzed the clinical features of SARS in 165 clinically confirmed severe cases. Both age and existence of other diseases before SARS were significantly correlated with prognosis (r=0.506 and r=0.457, respectively; P<.001). During the acute phase of SARS, lactate dehydrogenase level, degree of hypoxemia, respiratory rate, alpha -hydroxybutyric dehydrogenase level, creatine kinase isoenzyme-MB, platelet count, and number of involved lobes noted on chest radiographs, and so on, correlated markedly with the prognosis (r=0.257-0.788; P<.05). The multivariate prognosis regression model was associated with degree of hypoxemia and platelet count. The model was defined by the formula Py=1=es/(1+es), where S is [2.490 x degree of hypoxemia]-[0.050 x number of platelets], and it had a high sensitivity (91.67%), specificity (98.33%), and accuracy (96.42%). The model could be used to effectively judge the state of illness and the prognosis.

[Screening of the genes of hepatitis B virus PreS2 interacting proteins].

OBJECTIVE: To screen and clone the genes of proteins in hepatocytes interacting with hepatitis B virus (HBV) PreS2 by yeast-two hybridization technique. METHODS: The HBV PreS2 gene was amplified by polymerase chain reaction (PCR) and HBV PreS2 bait plasmid was constructed by using yeast-two hybridization system 3, then transformed into yeast AH109, followed by mating with yeast Y187 containing liver cDNA library plasmid in 2 YPDA medium. Diploid yeast was plated on synthetic dropout nutrient medium (SD/-Trp-Leu-Ade-His) and synthetic dropout nutrient medium (SD/-Trp-Leu-Ade-His) containing X-alpha-gal for selecting positive blue clones, then amplified by PCR, sequenced, and performed bioinformatics analysis. RESULTS: HBV PreS2 gene was cloned successfully and expressed in yeast AH109.Twenty-six positive colonies were selected, among them, twelve containing metallothionein 2A, one cytochrome C oxidase II, two cytochrome P450 subfamily IV4F, two cytochrome c oxidase subunit 4 isoform 1, three albumin (ALB), one Na(+)K(+) transporting ATPase beta-1 polypeptide, two prealbumin, one lectin galactoside-binding subunit, and Two new genes with unknown function. CONCLUSION: Genes of HBV PreS2 interacting proteins have been successfully cloned, which brings some new clues for studying the biological functions of HBV PreS2 and related proteins.

[Clinical pathology and pathogenesis of severe acute respiratory syndrome].

BACKGROUND: To explore the pathological features and pathogenesis of severe acute respiratory syndrome (SARS) to provide evidence for the clinical treatment and prevention of SARS. METHODS: Pathological features of 2 cases of full autopsy and 4 cases of needle biopsy tissue samples from the patients who died from SARS were studied by light and electron microscopy. The distribution and quantity of lymphocyte subpopulations in the lungs and immune organs from SARS patients were analyzed by immunohistochemistry. The location and semi-quantitative analysis of SARS coronavirus in the tissue specimens were studied by electron microscopy, in situ hybridization and immunohistochemistry. RESULTS: In total of 6 cases, diffuse alveolar damage and alveolar cell proliferation were common. The major pathological changes of 2 autopsy cases of SARS in lung tissues were acute pulmonary interstitial and alveolar exudative inflammation, and 2 autopsy and one biopsy lung tissues showed alveolar hyaline membrane formation. Terminal bronchiolar and alveolar desquamation of lung tissues in one autopsy and 2 biopsy cases were noted. Among 6 cases, 2 biopsy cases presented early pulmonary fibrosis and alveolar organization. Meanwhile, the immune organs, including lymph nodes and spleens from 2 autopsy cases of SARS whose disease courses were less than 12 days showed extensive hemorrhagic necrosis, reactive macrophage/histocyte proliferation, with relative depression of mononuclear and granulocytic clones in the bone marrows. However, spleen and bone marrow biopsy tissue samples from 4 dead SARS cases whose clinical course lasted from 21 to 40 days presented repairing changes. SARS coronaviruses were mainly identified in type I and II alveolar epithelia, macrophages, and endothelia; meanwhile, some renal tubular epithelial cells, cardiomyocytes, mucosal and crypt epithelial cells of gastrointestinal tracts, parenchymal cells in adrenal glands, lymphocytes, testicular epithelial cells and Leydig's cells were also detected by electron microscopy combined with in situ hybridization. The semi-quantitative analysis of lymphocyte subpopulations revealed that the proportion of CD8+ T lymphocytes were about 80% of the total infiltrative inflammatory cells in the pulmonary interstitium, with a few CD4+ lymphocytes CD3+, CD4+, CD8+ or CD20+ lymphocyte subpopulations were obviously decreased and there was imbalance in number and proportion, while CD57+, CD68+, S-100+ and HLA-DR+ cells were relatively increased in lymph nodes and spleens. CONCLUSIONS: Histologically, the pulmonary changes could be divided into acute inflammatory exudative, terminal bronchiolar and alveolar desquamative and proliferative repair stages or types during the pathological process of SARS. SARS coronavirus was found in multi-target cells in vivo, which means that SARS coronavirus might cause multi-organ damages which were predominant in lungs. There were varying degrees of decrease and imbalance in number and proportion of lymphocyte subpopulations in the immune organs of the patients with SARS. However, these changes may be reversible. It was found that cellular immune responses were predominant in the lungs of SARS cases, which might play an important role in getting rid of coronaviruses in infected cells and inducing immune mediated injury.