Calculating gambling odds and lung ages for smokers.

Interpreting spirometry as normal or abnormal using 95% confidence limits can obscure milder airflow decreases. Other analyses might better persuade cigarette smokers to quit. High-quality spirometric data of ambulatory never- and current-smokers of African-, European- and Latin-American ethnicity from the Third National Health and Nutrition Evaluation Survey (n>9000) were analysed. We desired to calculate, for each decade of life, the odds that specific ratios of forced expiratory volume in 1 s to 6 s (%FEV(1)/FEV(6)) and to forced vital capacity (%FEV(1)/FVC) values came from a current- or never-smoker. We also desired to develop new, simpler and better formulas to estimate changes in physiological lung age (Deltalung age) for males and females. For each decade of life, odds increase strikingly that smoking decreases %FEV(1)/FEV(6) and %FEV(1)/FVC. At least for these three ethnicities, Deltalung age can be easily calculated as the product of (predicted - actual) %FEV(1)/FEV(6) x 4 or (predicted - actual) %FEV(1)/FVC x 3. Through the sixth decade of life, smokers' Deltalung age increase rapidly but little thereafter, presumably due to the inabilities of older smokers to participate in the survey or their deaths. Using odds and Deltalung ages rather than traditional 95% confidence limits might better persuade smokers to quit.

Should forced expiratory volume in six seconds replace forced vital capacity to detect airway obstruction?

It has been suggested that forced expiratory volume in six seconds (FEV(6)) should be substituted for forced vital capacity (FVC) to measure fractions of timed expired volume for airflow obstruction detection. The present authors hypothesised that this recommendation might be questionable because flow after 6 s of forced expiration from more diseased lung units with the longest time constants was most meaningful and should not be ignored. Furthermore, previous studies comparing FEV(6) and FVC included few subjects with mild or no disease. The present study used spirometric data from the USA Third National Health and Nutrition Evaluation Survey with prior published ethnicity- and sex-specific equations for FEV(1)/FEV(6), FEV(1)/FVC and FEV(3)/FVC, and new equations for FEV(3)/FEV(6), all derived from approximately 4,000 adult never-smokers aged 20-80 yrs. At 95% confidence intervals, 21.3% of 3,515 smokers and 41.3% of smokers aged >51 yrs had airway obstruction; when comparing FEV(1)/FEV(6) with FEV(1)/FVC, 13.5% were concurrently abnormal, 1.5% were false positives and 4.1% were false negatives; and when comparing FEV(3)/FEV(6) with FEV(3)/FVC, 11.6% were concurrently abnormal, 3.3% were false positives and 5.7% were false negatives. Substituting forced expiratory volume in six seconds for forced vital capacity to determine the fractional rates of exhaled volumes reduces the sensitivity of spirometry to detect airflow obstruction, especially in older individuals and those with lesser obstruction.

Anaerobic threshold and cardiovascular function.

The cardiopulmonary exercise test is a valuable method for quantifying global cardiovascular function. It is quantitative, cheap, safe and highly reproducible. Unfortunately, it is highly under-utilized in favor of less quantitative, more expensive and perhaps less safe and reproducible methods. But even if performed, the peak Vo2 is often the only measurement made, and the data for determining the patient's anaerobic threshold (AT) and other parameters are discarded by the examiner. The discarding of such valuable physiological data is likely due to the lack of recognition by the physician that these measurements, and the physiological parameters that could be calculated from them, reflect cardiovascular function. Furthermore, the information can be extracted without additional expense. The AT, as a marker of the severity of cardiovascular function, is particularly, under-utilized relative to its clinical usefulness. With the development of the V-slope method, the AT is easily measured in all patients whose exercise is limited by cardiovascular factors. While the AT is a very valuable measurement in all patients, it is especially valuable in patients who should not be maximally stressed, e.g., the elderly or post-myocardial infarction patients.

Gas exchange responses to continuous incremental cycle ergometry exercise in primary pulmonary hypertension in humans.

In patients suffering from primary pulmonary hypertension (PPH), a raised pulmonary vascular resistance may limit the ability to increase pulmonary blood flow as work rate increases. We hypothesised that oxygen uptake (VO2) may not rise appropriately with increasing work rate during incremental cardiopulmonary exercise tests. Nine PPH patients and nine normal subjects performed symptom-limited maximal continuous incremental cycle ergometry exercise. Mean peak VO2 [1.00 (SD 0.22) compared to 2.58 (SD 0.64) l x min(-1)] and mean VO2 at lactic acidosis threshold [LAT, 0.73 (SD 0.17) compared to 1.46 (SD 0.21 x 1) ml x min(-1)] were much lower in patients than in normal subjects (both P<0.01, two-way ANOVA with Tukey test). The mean rate of change of VO2 with increasing work rate above the LAT [5.9 (SD 2.1) compared to 9.4 (SD 1.3) ml x min(-1) x W(-1), p<0.01)] was also much lower in patients than in normal subjects [apparent delta efficiency 60.3 (SD 38.8)% in patients compared to 31.0 (SD 4.9)% in normal subjects]. The patients displayed lower mean values of end-tidal partial pressure of carbon dioxide than the normal subjects at peak exercise [29.7 (SD 6.8) compared to 42.4 (SD 5.8) mm Hg, P<0.01] and mean oxyhaemoglobin saturation [89.1 (SD 4.1) compared to 93.6 (SD 1.8)%, P<0.05]. Mean ventilatory equivalents for CO2 [49.3 (SD 11.4) compared to 35.0 (SD 7.3), P<0.05] and O2 [44.2 (SD 10.7) compared to 29.9 (SD 5.1), P<0.05] were greater in patients than normal subjects. The sub-normal slopes for the VO2-work-rate relationship above the LAT indicated severe impairment of the circulatory response to exercise in patients with PPH. The ventilatory abnormalities in PPH suggested that the lung had become an inefficient gas exchange organ because of impaired perfusion of the ventilated lung.

Differential expression and responsiveness of chemokine receptors (CXCR1-3) by human microvascular endothelial cells and umbilical vein endothelial cells.

The basis for the angiogenic effects of CXC chemokines such as interleukin 8 (IL-8) and for angiostatic chemokines such as interferon-inducible protein 10 (IP-10) has been difficult to assess. We recently reported, based on an RNase protection assay, that human umbilical vein endothelial cells (HUVECs) did not express detectable mRNA for the IL-8 receptors CXCR1 and CXCR2. This raised the possibility of heterogeneity of receptor expression by different endothelial cell (ECs) types. Since systemic angiogenesis induced by IL-8 would more likely involve microvessel ECs, we investigated CXC receptor expression on human microvascular dermal endothelial cells (HMECs). By confocal microscopy and immunofluorescence we observed that HMECs consistently expressed high levels of CXCR1 and CXCR4 (mean fluorescence intensity of 261+/-22.1 and 306.2+/-19, respectively) and intermediate levels of CXCR3 and CXCR2 (173.9+/-30. 2 and 156+/-30.9, respectively). In contrast, only a small proportion of HUVEC preparations expressed low levels of CXCR1, -2, and -3 (66+/-19.9; 49+/-15, and 81.4+/-17.9, respectively). However, both HMECs and HUVECs expressed equal levels of CXCR4. As expected, HMECs had more potent chemotactic responses to IL-8 than HUVECs, and this was correlated with the levels of IL-8 receptors on the ECs. Antibodies to CXCR1 and CXCR2 each had inhibitory effects on chemotaxis of HMECs to IL-8, indicating that both IL-8 receptors contributed to the migratory response of these cells toward IL-8. Assessment of the functional capacity of CXCR3 unexpectedly revealed that HMECs migrated in response to relatively higher concentrations (100-500 ng/ml) of each of the 'angiostatic' chemokines IP-10, ITAC, and MIG. Despite this, the 'angiostatic' chemokines inhibited the chemotactic response of HMECs to IL-8. IL-8 and SDF-1alpha but not IP-10 induced calcium mobilization in adherent ECs, suggesting that signaling events associated with calcium mobilization are separable from those required for chemotaxis. Taken together, our data indicated that functional differences among EC types is dependent on the level of the expression of CXC chemokine receptors. Whether this heterogeneity in receptor expression by ECs reflects distinct differentiation pathways remains to be established.

Human endothelial cells express CCR2 and respond to MCP-1: direct role of MCP-1 in angiogenesis and tumor progression.

Although several CXC chemokines have been shown to induce angiogenesis and play roles in tumor growth, to date, no member of the CC chemokine family has been reported to play a direct role in angiogenesis. Here we report that the CC chemokine, monocyte chemotactic protein 1 (MCP-1), induced chemotaxis of human endothelial cells at nanomolar concentrations. This chemotactic response was inhibited by a monoclonal antibody to MCP-1. MCP-1 also induced the formation of blood vessels in vivo as assessed by the chick chorioallantoic membrane and the matrigel plug assays. As expected, the angiogenic response induced by MCP-1 was accompanied by an inflammatory response. With the use of a rat aortic sprouting assay in the absence of leukocytic infiltrates, we ruled out the possibility that the angiogenic effect of MCP-1 depended on leukocyte products. Moreover, the direct effect of MCP-1 on angiogenesis was consistent with the expression of CCR2, the receptor for MCP-1, on endothelial cells. Assessment of supernatant from a human breast carcinoma cell line demonstrated the production of MCP-1. Treatment of immunodeficient mice bearing human breast carcinoma cells with a neutralizing antibody to MCP-1 resulted in significant increases in survival and inhibition of the growth of lung micrometastases. Taken together, our data indicate that MCP-1 can act as a direct mediator of angiogenesis. As a chemokine that is abundantly produced by some tumors, it can also directly contribute to tumor progression. Therefore, therapy employing antagonists of MCP-1 in combination with other inhibitors of angiogenesis may achieve more comprehensive inhibition of tumor growth.

Tumor-induced immune dysfunction.

Immune system-based approaches for the treatment of malignant disease over the past decades have often focused on cytolytic effector cells such as cytotoxic T lymphocytes (CTL), and natural killer (NK) cells. It has also been demonstrated that tumor-bearing mice can be cured using a wide variety of approaches, some of which involve cytokine-mediated enhancement of CTL and NK cell activity. However, the apparent success in mice stands in contrast to the current situation in the clinic, wherein only a minority of patients have thus far benefited from CTL- or NK cell-based antitumor approaches. The underlying causes of tumor-associated immune suppression of CTL and NK cell activity are discussed, and features of interest shared with HIV infection, leprosy, and rheumatoid arthritis are also be mentioned. Remarkable and very recent observations have shed more light upon the causes of dysfunctional alterations in CTL and NK cells often associated with these diseases, that in turn have suggested new immunotherapeutic approaches for cancer and infectious disease.

Generation and function of bone marrow-derived dendritic cells from CD4/CD8(-/-) double-knockout mice.

We present a novel, simple and straightforward method to obtain mouse bone marrow-derived dendritic cells (DC) from C57Bl/6 CD4/CD8(-/-) double knock-out mice. This new method, involving culture of bone marrow cells in medium supplemented with Interleukin 4 and Granulocyte-Macrophage Colony-Stimulating Factor, does not involve negative immunodepletion of CD4+ and CD8+ populations, or extensive prior manipulations of the starting population. The resulting, loosely adherent cell population, exhibited the morphological characteristics and typical surface markers of DCs, and were endowed with the functional activities characteristic of bone marrow-derived DCs of wild-type mice. Interestingly, LCMV GP33-41 peptide-loaded CD4/CD8(-/-) DCs were efficiently lysed by peptide-specific activated CTLs in vitro. Furthermore, these peptide-loaded CD4/CD8(-/-) DCs induced a peptide-specific CTL response upon immunization of wild-type C57Bl/6 mice.

Vascular endothelial growth factor and basic fibroblast growth factor induce expression of CXCR4 on human endothelial cells: In vivo neovascularization induced by stromal-derived factor-1alpha.

The contribution of chemokines toward angiogenesis is currently a focus of intensive investigation. Certain members of the CXC chemokine family can induce bovine capillary endothelial cell migration in vitro and corneal angiogenesis in vivo, and apparently act via binding to their receptors CXCR1 and CXCR2. We used an RNAse protection assay that permitted the simultaneous detection of mRNA for various CXC chemokine receptors in resting human umbilical vein endothelial cells (HUVECs) and detected low levels of only CXCR4 mRNA. Stimulation of HUVECs with vascular endothelial growth factor (VEGF) or basic fibroblast growth factor (bFGF) up-regulated levels of only CXCR4 mRNA. CXCR4 specifically binds the chemokine stromal-derived factor-1alpha (SDF-1alpha). Competitive binding studies using 125I-labeled SDF-1alpha with Scatchard analysis indicated that VEGF or bFGF induced an average number of approximately 16,600 CXCR4 molecules per endothelial cell, with a Kd = 1.23 x 10(-9) mol/L. These receptors were functional as HUVECs and human aorta endothelial cells (HAECs) migrated toward SDF-1alpha. Although SDF-1alpha-induced chemotaxis was inhibited by the addition of a neutralizing monoclonal CXCR4 antibody, endothelial chemotaxis toward VEGF was not altered; therefore, the angiogenic effect of VEGF is independent of SDF-1alpha. Furthermore, subcutaneous SDF-1alpha injections into mice induced formation of local small blood vessels that was accompanied by leukocytic infiltrates. To test whether these effects were dependent on circulating leukocytes, we successfully obtained SDF-1alpha-induced neovascularization from cross sections of leukocyte-free rat aorta. Taken together, our data indicate that SDF-1alpha acts as a potent chemoattractant for endothelial cells of different origins bearing CXCR4 and is a participant in angiogenesis that is regulated at the receptor level by VEGF and bFGF.

Lung function and exercise gas exchange in chronic heart failure.

BACKGROUND: The ventilatory response to exercise in patients with chronic heart failure (HF) is greater than normal for a given metabolic rate. The objective of the present study was to determine the mechanism(s) for the high ventilatory output in patients with chronic HF. METHODS AND RESULTS: Centers in Germany, Italy, Japan, and the United States participated in this study. Each center contributed studies on patients and normal subjects of similar age and sex. One hundred thirty patients with chronic HF and 52 healthy subjects participated. Spirometric and breath-by-breath gas exchange measurements were made during rest and increasing cycle exercise. Arterial blood was sampled for measurement of pH, PaCO2, PaO2, and lactate during exercise in 85 patients. Resting forced expiratory volume in 1 second (FEV1) and vital capacity (VC) were proportionately reduced at all levels of impairment. Patients with more severe HF had greater tachypnea and a smaller tidal volume (VT) at a given exercise expired volume per unit time (VE). This was associated with an expiratory flow pattern characteristic of lung restriction. VE and VCO2 as a function of VO2 were increased during exercise in HF patients. The increases were greater the lower the peak VO2 per kilogram of body weight. The ratio of VD (physiological dead space) to VT and the difference between arterial and end tidal PCO2 at peak VO2 also increased inversely with peak VO2/kg. In contrast, the difference between alveolar and arterial PO2 and PaCO2 were both normal, on average, at peak VO2 regardless of the level of impairment. The more severe the exercise limitation, the higher the lactate and the lower the HCO3- at a given VO2, although pH was tightly regulated. CONCLUSIONS: The increase in VE in chronic HF patients is caused by an increase in VD/VT due to high ventilation/perfusion mismatching, an increase in VCO2 relative to VO2 resulting from HCO3- buffering of lactic acid, and a decrease in PaCO2 due to tight regulation of arterial pH. With regard to the excessive VE in HF patients, the increases in VD/VT and VCO2 relative to VO2 are more important as the patient becomes more exercise limited. Regional hypoperfusion but not hypoventilation typifies lung gas exchange in HF. This and other mechanisms might account for the restrictive changes leading to exercise tachypnea in HF patients.

Conversion of in vitro cultured human monocytes into effective presenters of an HER2/neu-encoded CTL peptide epitope.

Tumour-derived peptides have been surveyed, in a variety of systems, for their ability to elicit cytokine release from class I restricted T cells. Analogous studies on ovarian carcinoma have employed the antigen-processing defective T2 cell line, Purified dendritic cells (DC) have been reported to act as highly effective APC. A facile method was developed whereby DC-like cells were generated from monocyte precursors. Herein, evidence is presented suggesting DC-like cells are superior to T2 with respect to their ability to present a defined CTL epitope associated with ovarian carcinoma.

Hydrogen peroxide secreted by tumor-derived macrophages down-modulates signal-transducing zeta molecules and inhibits tumor-specific T cell-and natural killer cell-mediated cytotoxicity.

Although alterations in CD3-associated signal-transducing molecules in tumor-infiltrating T cells of patients with advanced cancer have been previously described, the mechanism behind these changes is not known. We demonstrate that macrophages isolated from metastatic lymph nodes of patients with malignant melanoma down-regulate levels of CD3 zeta in autologous peripheral blood T cells. Lipopolysaccharide (LPS)- or phorbol 12-myristate 13-acetate (PMA)-stimulated monocytes derived from peripheral blood of healthy donors also induced decreased expression of CD3 and CD16-associated zeta chains similar to that observed in T cells and natural killer (NK) cells of patients with advanced cancer. Co-culture with activated monocytes impaired Ca2+ mobilization in peripheral blood derived-T cells when stimulated with monoclonal antibodies to CD3 and also strongly inhibited melanoma-specific cytotoxic T lymphocyte (CTL) activity and NK activity. The presence of catalase, a scavenger of H2O2, during co-culture almost totally abrogated the inhibitory effect of activated monocytes on melanoma-specific CTL lines and on NK cells. Pre-treatment of CTL or NK cells with nontoxic concentrations (1 x 10(-5) M) of H2O2 also severely reduced their cytotoxic activity which could be prevented by catalase. The decrease in CD3 zeta and in CD16 zeta expression, induced by macrophages isolated from metastatic lymph nodes or by LPS-stimulated monocytes, was also prevented by catalase when maintained throughout the co-culture period. The possibility that monocyte/macrophage-derived reactive oxygen metabolites contribute directly to alterations in signal transducing molecules of T cells and NK cells and to the mechanism of immunosuppression in individuals with cancer should be considered.

Muscle substrate utilization from alveolar gas exchange in trained cyclists.

The respiratory exchange ratio (R) during steady-state exercise is equivalent to whole-body respiratory quotient (RQ), but does not represent muscle metabolism alone. If steady-state values of carbon dioxide production (VCO2) and oxygen uptake (VO2) are plotted for different work rates, the slope of the line fitting these points should estimate muscle RQ. Twelve cyclists randomly performed five 8-min, constant work rate tests of 40, 80, 120, 160 and 200 W. Whole-body R, averaged over the final 2 min of each exercise bout, increased with increasing work rate. When VCO2 was plotted as a function of VO2, the regression lines through the five points displayed excellent linearity, had negative y-intercepts, and a slope of 0.915 (0.043) [mean (SD)], which was greater than the whole-body R at any individual work rate [range 0.793 (0.027) at 40 W to 0.875 (0.037) at 200 W]. This slope was comparable to the lower slope of the VCO2 versus VO2 plot of an increasing work rate (ramp) protocol [0.908 (0.054)]. We conclude that, during mild and moderate exercise of relatively short duration, contracting muscle has a high and constant RQ, indicating that carbohydrate is the predominant metabolic substrate. Whole-body R does not accurately reflect muscle substrate utilization and probably underestimates muscle RQ at a given work rate.

Evaluation of a symmetrically disposed Pitot tube flowmeter for measuring gas flow during exercise.

We evaluated the effect of airflow and gas composition on the linearity of measurement of airflow by a new disposable flowmeter. The flowmeter is based on the principle of differential pressure measurement across two symmetrically disposed Pitot tubes. Nonlinearities arising from the pressure-to-airflow relationship and sensitivity to changes in gas density were linearized with appropriate software and monitoring of the gas composition. With room air used as the respired gas, the measured tidal volume from a piston pump assembly was consistently within 1-2% of the target tidal volume for each of five flowmeters tested across physiological ranges of flow. Changing gas densities by varying concentrations of O2, CO2, and N2 led to errors in tidal volume measurement that ranged up to 6-8%. However, because the errors were predictable, they were corrected by software to within 0.6% of the target volume. Measurement of minute ventilation during exercise was within 1-2% of that determined from bag collections. We conclude that this type of flowmeter can accurately measure exercise minute ventilation and has advantages over some other flowmeters because of its ruggedness, reproducibility, and ease of sterilization or replacement compared with other flowmeters.

Nongranular proteolytic enzymes of rat IL-2-activated natural killer cells. II. Purification and identification of rat A-NKP 1 and A-NKP 2 as constituents of the multicatalytic proteinase (proteasome) complex.

We have recently described nongranular, cytosolic, high-molecular-weight trypsin-like (A-NKP 1) and chymotrypsin-like (A-NKP 2) proteases of interleukin-2-activated rat natural killer (A-NK) cells. A functional correlation between the inactivation of A-NKP 2 and the inhibition of rat A-NK cell-mediated cytotoxicity was found. Herein we describe the 6,000-fold purification of A-NKP 2 to apparent homogeneity following: isopycnic sucrose gradient fractionation of postnuclear supernatants, molecular sieve chromatography, and heparin-Sepharose chromatography. We also report the novel finding that A-NKP 2 as well as A-NKP 1, derived from either rat A-NK cells or the rat NK leukemic cell line CRNK-16, are constituents of the multicatalytic proteinase (MCP/proteasome) complexes of these cells. Characteristic biochemical, biophysical, and electron microscopic/ultrastructural similarity to the rat liver proteasome was observed. However, Western blot analysis using polyclonal antibodies to the rat liver proteasome clearly indicated differences in the rat hepatic proteasome and the CRNK-16-derived proteasomal subunits. The identification, characterization, and purification of A-NKP 1 and A-NKP 2, described herein, now allow for further investigation of the potential role of these proteasome components in NK cell function. Moreover, the proteasome of NK and A-NK cells can now be compared and contrasted to the granzymes of lytic granules with respect to their role in cell-mediated cytotoxicity.

Expression of surface markers on alveolar macrophages from symptomatic patients with HIV infection as detected by flow cytometry.

Alveolar macrophages (AMs) harvested from 32 HIV-infected patients with respiratory problems (opportunistic pulmonary infections, n = 12; other lung disease, n = 20) and 13 healthy controls were stained with a panel of 15 monoclonal antibodies directed against surface antigens implicated in cell function. Antigen expression was quantified by flow cytometry and expressed as relative linear median fluorescence intensity (RLMFI). On AMs of patients, as compared with controls, there was a significant enhancement of HLA DP (12.1 +/- 1.5 vs 6.5 +/- 0.9, p = 0.01, M +/- SEM, RLMFI units), CD11b (3.4 +/- 0.5 vs 1.7 +/- 0.4, p = 0.014), CD11c (8.9 +/- 1.0 vs 4.8 +/- 0.8, p = 0.0046), CD14 (2.1 +/- 0.3 vs 1.0 +/- 0.2, p = 0.0009), and CD33 (1.7 +/- 0.1 vs 1.0 +/- 0.2, p = 0.0093). No significant differences could be established for HLA-DR (36.9 +/- 5.8 vs 30.9 +/- 7.5, NS), HLA-DQ (3.4 +/- 0.3 vs 3.1 +/- 0.6, NS), CD54 (1.9 +/- 0.3 vs 1.2 +/- 0.1, NS), CD13 (2.5 +/- 0.6 vs 1.5 +/- 0.3, NS), CD36 (1.4 +/- 0.2 vs 0.9 +/- 0.3, NS), CD71 (10.3 +/- 1.9 vs 8.9 +/- 1.8, NS), CD25 (0.8 +/- 0.0 vs 0.9 +/- 0.1, NS), 27E10 (1.1 +/- 0.1 vs 0.8 +/- 0.3, NS), RM3/1 (1.9 +/- 0.4 vs 1.5 +/- 0.4, NS), and CD4 (1.5 +/- 0.3 vs 1.0 +/- 0.0, NS). The expression of CD14 and CD11b, but not of HLA class II antigens and CD71, was increased in the smaller cell population compared with the larger, thus suggesting monocyte recruitment. The increased expression of HLA-DP, CD11c, CD14, and CD33 on the patients' AMs was independent of smoking habits. The degree of immunodeficiency as indicated by the absolute peripheral CD4 count, the character of HIV-related pulmonary disease, and the prophylactic use of pentamidine or zidovudine did not significantly modify the antigen expression pattern. It is concluded that HIV infection may lead, most probably indirectly, to enhanced expression of surface antigens by local upregulation and/or recruitment of monocytes from the peripheral circulation. The functional significance of enhanced marker expression requires further clarification.

Determination of the anaerobic threshold by gas exchange: biochemical considerations, methodology and physiological effects.

This paper explains the physiological and biochemical basis of the anaerobic threshold (AT), achieved during physical exercise. The lactate concentration is approximately the same at rest in relatively fit adults, in normal sedentary subjects in adult patients with heart disease. But during exercise, the increase of lactate is inversely related to the physical fitness of the individual. During incremental work, the lactate concentration increases initially very little until a distinct metabolic rate (VO2 AT) is reached at which lactate starts to increase steeply (anaerobic threshold/AT; VO2 AT). Above the anaerobic threshold, accelerated glycolysis increases muscle lactic acidosis. This acidosis is buffered primarily by bicarbonate. The bicarbonate-derived CO2 causes an increased alveolar CO2 output relative to O2 uptake. Oxygen uptake is increased virtually linearly with work rate in healthy subjects with a slope of approximately 10 ml O2/min/Watt. VCO2 starts to increase more steeply in the mid-work-rate range after an initial linear behavior. This steepening is caused by an increased CO2 production from the HCO3-buffering of lactic acid for the range of work rates above the AT. Below the AT, the slope of increase in VCO2 is 1 or slightly less, averaging 0.95. Above the AT, it is greater than 1. The submaximal exercise protocol for the determination of AT includes a period of 2-3 min of unloaded cycling, a ramp program with x Watt increase/minute and a recovery period of 2 min. X is the rate of work rate increase per min, so that the incremental period of the exercise test lasts 8-10 min, stressing the patient for only a short time. The anaerobic threshold can be determined during the ramp program using the following four parameters: 1) steeper increase of VCO2 as compared to VO2 (V-slope-method); 2) respiratory exchange ratio = 0.95; 3) PETO2 increase; 4) VE/VO2 increase. The V-slope-method can be successfully applied, not only in healthy volunteers, but also in patients suffering from cardiac and/or pulmonary (breathing abnormalities) diseases. The so far published data show that the anaerobic threshold in healthy people and patients is a highly reproducible, accurately measurable, securely achievable parameter for the non-invasive evaluation of the individual cardiopulmonary exercise capacity.