Targeting TRP channels for chronic cough: from bench to bedside

Cough is currently the most common reason for patients to visit a primary care physician in the UK, yet it remains an unmet medical need. Current therapies have limited efficacy or have potentially dangerous side effects. Under normal circumstances, cough is a protective reflex to clear the lungs of harmful particles; however, in disease, cough can become excessive, dramatically impacting patients' lives. In many cases, this condition is linked to inflammatory diseases such as asthma and chronic obstructive pulmonary disease (COPD), but can also be refractory to treatment and idiopathic in nature. Therefore, there is an urgent need to develop therapies, and targeting the sensory afferent arm of the reflex which initiates the cough reflex may uncover novel therapeutic targets. The cough reflex is initiated following activation of ion channels present on vagal sensory afferents. These ion channels include the transient receptor potential (TRP) family of cation-selective ion channels which act as cellular sensors and respond to changes in the external environment. Many direct activators of TRP channels, including arachidonic acid derivatives, a lowered airway pH, changes in temperature, and altered airway osmolarity are present in the diseased airway where responses to challenge agents which activate airway sensory nerve activity are known to be enhanced. Furthermore, the expression of some TRP channels is increased in airway disease. Together, this makes them promising targets for the treatment of chronic cough. This review will cover the current understanding of the role of the TRP family of ion channels in the activation of airway sensory nerves and cough, focusing on four members, transient receptor potential vanilloid (TRPV) 1, transient receptor potential ankyrin (TRPA) 1, TRPV4, and transient receptor potential melastatin (TRPM) 8 as these represent the channels where most information has been gathered with relevance to the airways. We will describe recent data and highlight the possible therapeutic utility of specific TRP channel antagonists as antitussives in the clinic.

The prevalence of cough in lung cancer: Its characteristics and predictors

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Background: Cough commonly affects patients with LC but quoted prevalence figures vary and most were obtained before advances in anticancer treatment for LC. This study aimed to determine its prevalence and characteristics (severity, impact and potential predictors) in patients undergoing standard treatment and follow up. Methods: Consecutive LC patients attending clinics at The Christie Hospital, UK during a predefined 5 week period were asked whether they had a cough and invited to participate in its further evaluation according to an ethically approved protocol. Demographic, cancer and cancer treatment data were collected in all. Patients with a cough also completed subjective assessments using the validated cough impact Manchester cough in LC scale (MCLCS) and cough severity visual analogue scale (VAS). Standard statistical tests were used for analysis with significance (p<0.05). Results: Of 223 consecutive LC outpatients approached, the prevalence of cough was 57% (128/223); 202/223 (86%) consented to further data collection (study population) and of these 115 (57%) reported cough. The majority (60/115, 52%) felt that their cough warranted treatment and 23% reported their cough to be painful (26/115). The median VAS score (n=115) was 32mm (25th-75th IQR 20-51, range 0-100, high scores = worse cough severity). The median MCLCS score (n=113) was 22 (25th-75th IQR 16-27, range 1-50, high scores = worse cough impact). There was no significant difference between coughers and non-coughers with respect to age, sex, co-morbidities, smoking, performance status, treatment intent, treatment type, reasons for not receiving treatment, stage and histology. The proportion of non-coughers was lower among patients receiving anticancer therapy (45/115 39% vs 47/87 54%, p=0.04) in univariate analysis. Conclusions: Cough is present in the majority of LC patients, even in those undergoing treatment. Many patients feel that it warrants treatment. Whilst many consider factors such smoking, stage, histology and cancer treatment type to be important determinants of the presence of cough, our data does not reflect this. Improving LC related cough requires more than better cancer therapies.

Cross-sectional association of dietary patterns with asthma and atopic sensitization in childhood - in a cohort study

BACKGROUND

Many studies have investigated individual nutrients or foods as risk factors for allergic disease, but few have studied dietary patterns. We aimed to use principal component analysis (PCA) to determine dietary patterns in school age children and examine associations between these dietary patterns and wheeze, asthma and sensitization.

METHODS

Participants in a population-based birth cohort attended review clinics at ages 8 and 11 yr. A validated questionnaire was interviewer-administered to collect information on parentally reported symptoms and doctor-diagnosed asthma. Atopic sensitization was ascertained by skin-prick tests. Current asthma was defined as doctor-diagnosed asthma and wheezing in the previous 12 months. A validated semi-quantitative food frequency questionnaire was completed at age 8 yr, and PCA was used to determine dietary patterns.

RESULTS

Principal component analysis identified three dietary components, which based on their characteristics we termed as Traditional (mixed meat, fish, fruit and vegetables), Western (predominantly high fat content, processed foods) and Other (predominantly grains and nuts) dietary patterns. High adherence to the Western diet pattern was significantly associated with doctor-diagnosed asthma and current asthma at age 8 yr [aOR (95% CI): 2.19 (1.20-4.01), p = 0.01; 2.59 (1.15-5.81), p = 0.02; respectively]. A similar association was found for current asthma at age 11 yr [aOR (95% CI): 2.20 (1.07-4.51), p = 0.03]. There was no evidence of an association between dietary patterns and current wheeze and allergic sensitization at either age 8 or 11 yr.

CONCLUSION

School age children adhering strongly to a Western diet, high in fat and processed foods, had a higher risk of current asthma and doctor-diagnosed asthma.

Bedside ultrasound of the neck confirms endotracheal tube position in emergency intubations

PURPOSE

In controlled environments such as the operating room, bedside ultrasound (BUS) of the neck has shown high accuracy for distinguishing endotracheal (ETI) from esophageal intubations. We sought to determine the accuracy of BUS for endotracheal tube (ETT) position in the emergency department (ED) setting.

MATERIALS AND METHODS

We assessed the utility of BUS in a single-center observational study in an ED setting. BUS was performed either simultaneously with ED intubation (S/ED), within < 3 minutes of ED intubation (A/ED), or in < 3 minutes of patient's ED arrival after pre-hospital intubation (A/EMS). Trained ED providers performed BUS; intubators were blinded to ultrasound findings. We used Cormack and Lehane categories (CL) to classify intubation attempts as "easy" (CL-I/II), "moderate" (CL-III) and "difficult" (CL-IV). Additional data included the diagnostic accuracy of the sonographer and intubator compared to the clinical outcome, anatomy identified by sonography and time to diagnosis.

RESULTS

During a 10-month period, 89 subjects with 115 intubation attempts were included in the study, and 86 patients/101 attempts with complete data were used in the study (63-easy, 19-moderate, 19-difficult). The sonographers achieved 100 % accuracy with respect to determining the correct ETT position utilizing an anterior neck approach, while the intubators' accuracy in assessing correct tube location was 97 % compared to the clinical outcome. A blinded review of sonography findings confirmed all BUS anatomical findings. A sonographically empty esophagus was 100 % specific for endotracheal intubation, and a "double trachea sign" was 100 % sensitive and 91 % specific for esophageal intubation. The sonographic time to diagnosis was significantly faster than the intubator time to diagnosis ("easy" p < 0.001; n = 47; "moderate" p = 0.001; n = 15; "difficult" p < 0.001; n = 19); Wilcoxon test; A/EMS cases excluded).

CONCLUSION

In this emergency setting, ultrasound determined ETT locations rapidly with 100 % accuracy and independently of the CL-category.

A worldwide survey of chronic cough: a manifestation of enhanced somatosensory response

Reports from individual centres suggest a preponderance of females with chronic cough. Females also have heightened cough reflex sensitivity. Here we have reviewed the age and sex of unselected referrals to 11 cough clinics. To investigate the cause of any observed sex dimorphism, functional magnetic resonance imaging of putative cough centres was analysed in normal volunteers. The demographic profile of consecutive patients presenting with chronic cough was evaluated. Cough challenge with capsaicin was undertaken in normal volunteers to construct a concentration-response curve. Subsequent functional magnetic resonance imaging during repeated inhalation of sub-tussive concentrations of capsaicin observed areas of activation within the brain and differences in the sexes identified. Of the 10,032 patients presenting with chronic cough, two-thirds (6591) were female (mean age 55 years). The patient profile was largely uniform across centres. The most common age for presentation was 60-69 years. The maximum tolerable dose of inhaled capsaicin was lower in females; however, a significantly greater activation of the somatosensory cortex was observed. Patients presenting with chronic cough from diverse racial and geographic backgrounds have a strikingly homogeneous demographic profile, suggesting a distinct clinical entity. The preponderance of females may be explained by sex-related differences in the central processing of cough sensation.

A quantum cascade laser-based water vapor isotope analyzer for environmental monitoring

A field-deployable mid-infrared quantum cascade laser-based spectrometer was designed and developed for measurements of H2(16)O and H2(18)O at 7.12 μm. H2(16)O and H2(18)O absorption features at 1390.52 cm(-1) and 1389.91 cm(-1), respectively, accessible within current tuning range of the laser, were targeted. The target lines were carefully selected to assure similar absorption levels and similar temperature sensitivities of the line strength due to comparable lower state energies. A real-time spectral fitting algorithm was implemented for isotopic concentration retrieval. Detection limits for H2(16)O and H2(18)O of 2.2 ppm and 7.0 ppb, respectively, were achieved at a dew point of 14 °C (volume mixing ratio of 15,766 ppm) in 1 s integration time, which resulted in a δ(18)O isotopic ratio measurement precision of 0.25‰. The ultimate minimum detection limits obtained after 160 s integration time for H2(16)O and H2(18)O, and δ(18)O measurements were 0.6 ppm, 1.7 ppb, and 0.05‰, respectively.

Expert opinion on the cough hypersensitivity syndrome in respiratory medicine

In 2011, a European Respiratory Society Task Force embarked on a process to determine the position and clinical relevance of the cough hypersensitivity syndrome, a disorder characterised by troublesome coughing often triggered by low levels of thermal, mechanical or chemical exposure, in the management of patients with chronic cough. A 21-component questionnaire was developed by an iterative process supported by a literature review. 44 key opinion leaders in respiratory medicine were selected and interviewed as to their opinions. There was a high degree of unanimity in the responses obtained, with all opinion leaders supporting the concept of cough hypersensitivity as a clinically useful paradigm. The classic stratification of cough into asthmatic, rhinitic and reflux-related phenotypes was supported. Significant disparity of opinion was seen in the response to two questions concerning the therapy of chronic cough. First, the role of acid suppression in reflux cough was questioned. Secondly, the opinion leaders were split as to whether a trial of oral steroids was indicated to establish a diagnosis of eosinophilic cough. The cough hypersensitivity syndrome was clearly endorsed by the opinion leaders as a valid and useful concept. They considered that support of patients with chronic cough was inadequate and the Task Force recommends that further work is urgently required in this neglected area.

First Report of Laurel Wilt Caused by Raffaelea lauricola on Bay Laurel (Laurus nobilis) in the United States

Bay laurel (Laurus nobilis L.) is an economically important evergreen tree of the family Lauraceae. It is native to Asia Minor and the Balkans and was introduced into the United States for its ornamental and culinary uses (4). In September 2013, a 6-m-tall bay laurel in Gainesville, FL, attracted our attention because it had wilted leaves, discolored sapwood, and ambrosia beetle entrance holes, all symptoms of laurel wilt. In addition, the tree was growing close to an avocado that succumbed to the disease months earlier. In an effort to determine whether the laurel wilt pathogen (Raffaelea lauricola T.C. Harr., Fraedrich & Agaveya) was, indeed, involved in the decline of the tree of current interest, discolored sapwood was sectioned into 5-mm² pieces, surface disinfested for 30 s in a 4% sodium hypochlorite solution, and plated onto CSMA media (1,2). Within 7 to 14 days, cream-colored, adpressed fungal growth typical of R. lauricola grew from the sapwood pieces (2). DNA was extracted from an isolate of a single conidium (PL1634) and a portion of the 18S rRNA gene was PCR-amplified with primers NS1/NS4, resulting in a 1,021-bp amplicon (GenBank Accession No. KF913344.1), with a BLASTn search revealing 100% homology to several R. lauricola isolates (3). To confirm pathogenicity, six bay laurel seedlings (0.5 m) and a silk bay (0.65 m) (Persea humilis, susceptible control) were wounded twice with a 0.5-mm-diameter drill bit. Then, 30 μl of a spore suspension of PL1634 (1.38 × 10⁵ condia/plant) were introduced into the xylem by pipette and the wounds were wrapped in Parafilm (1). Negative controls consisted of a mock-inoculated (water) and non-inoculated bay laurel plus a mock-inoculated silk bay. Plants were placed in a growth chamber set to a 16/8 h (25/22°C) diurnal light/temperature cycle. After 60 days, all fungal-inoculated plants were completely wilted with dead leaves and subsequent necrosis of stems, while mock- and non-inoculated controls remained asymptomatic. Sapwood dissection revealed xylem discoloration similar to the original infected tree, and fungi morphologically similar to PL1634 were recovered from all inoculated plants upon isolation on CSMA media. Mock- and non-inoculated controls lacked vascular discoloration and fungal growth on media. In order to determine if the redbay ambrosia beetle, Xyleborus glabratus Eichoff (laurel wilt vector) could successfully reproduce in this host, symptomatic branches (7 cm in diameter) of L. nobilis with external evidence of ambrosia beetle attack (frass "toothpicks") were placed in a plastic rearing box within a growth chamber (25°C). Within 4 weeks of incubation, dozens of immature and mature X. glabratus beetles emerged. This is the first record of Koch's postulates being completed for R. lauricola on L. nobilis and the ability of X. glabratus to infest and breed in its stems. This information may be of importance in the event of an introduction of X. glabratus and its fungal associate to Mediterranean areas where bay laurel is either growing wild or being cultivated as valuable commercial crop. References: (1) S. W. Fraedrich et al. Plant Dis. 92:215, 2008. (2) T. C. Harrington et al. Mycotaxon 104:399, 2008. (3) M. A. Innis et al., eds. PCR Protocols: A Guide to Methods and Applications. Academic Press. San Diego, CA, 1990. (4) A. O. Sari et al. New Forest 31:403, 2006.

Multicarbohydrase Enzymes for Non-ruminants

The first purpose of this review is to outline some of the background information necessary to understand the mechanisms of action of fibre-degrading enzymes in non-ruminants. Secondly, the well-known and understood mechanisms are described, i) eliminating the nutrient encapsulating effect of the cell wall and ii) ameliorating viscosity problems associated with certain Non Starch Polysaccharides, particularly arabinoxylans and β-glucans. A third, indirect mechanism is then discussed: the activity of such enzymes in producing prebiotic oligosaccharides and promoting beneficial cecal fermentation. The literature contains a wealth of information on various non starch polysaccharide degrading enzyme (NSPase) preparations and this review aims to conclude by discussing this body of work, with reference to the above mechanisms. It is suggested that the way in which multi- versus single-component products are compared is often flawed and that some continuity should be employed in methods and terminology.

Unilateral nevoid telangiectasia syndrome (UNTS) associated with chronic hepatitis C virus and positive immunoreactivity for VEGF

Unilateral Nevoid Telangectasia Syndrome (UNTS) is characterized by superficial telangiectasias in a unilateral distribution. Vascular endothelial growth factor (VEGF) may play a role in the pathogenesis of UNTS in patients with underlying hepatic disease. We report a case of a patient with UNTS accompanied by chronic hepatitis C virus infection, with a normal serum estrogen profile and strong positive immunohistochemical staining of lesional skin with VEGF.

Breathing hot humid air induces airway irritation and cough in patients with allergic rhinitis

We studied the respiratory responses to an increase in airway temperature in patients with allergic rhinitis (AR). Responses to isocapnic hyperventilation (40% of maximal voluntary ventilation) for 4min of humidified hot air (HA; 49°C) and room air (RA; 21°C) were compared between AR patients (n=7) and healthy subjects (n=6). In AR patients, cough frequency increased pronouncedly from 0.10±0.07 before to 2.37±0.73 during, and 1.80±0.79coughs/min for the first 8min after the HA challenge, but not during the RA challenge. In contrast, neither HA nor RA had any significant tussive effect in healthy subjects. The HA challenge also caused respiratory discomfort (mainly throat irritation) measured by the handgrip dynamometry in AR patients, but not in healthy subjects. Bronchoconstriction was not detected after the HA challenge in either group of subjects. In conclusion, hyperventilation of HA triggered vigorous cough response and throat irritation in AR patients, indicating the involvement of sensory nerves innervating upper airways.

Antitussive drugs--past, present, and future

Cough remains a serious unmet clinical problem, both as a symptom of a range of other conditions such as asthma, chronic obstructive pulmonary disease, gastroesophageal reflux, and as a problem in its own right in patients with chronic cough of unknown origin. This article reviews our current understanding of the pathogenesis of cough and the hypertussive state characterizing a number of diseases as well as reviewing the evidence for the different classes of antitussive drug currently in clinical use. For completeness, the review also discusses a number of major drug classes often clinically used to treat cough but that are not generally classified as antitussive drugs. We also reviewed a number of drug classes in various stages of development as antitussive drugs. Perhaps surprising for drugs used to treat such a common symptom, there is a paucity of well-controlled clinical studies documenting evidence for the use of many of the drug classes in use today, particularly those available over the counter. Nonetheless, there has been a considerable increase in our understanding of the cough reflex over the last decade that has led to a number of promising new targets for antitussive drugs being identified and thus giving some hope of new drugs being available in the not too distant future for the treatment of this often debilitating symptom.

Transient receptor potential vanilloid 1 (TRPV1) antagonism in patients with refractory chronic cough: a double-blind randomized controlled trial

BACKGROUND

Inhalation of capsaicin, the extract of hot chili peppers, induces coughing in both animals and human subjects through activation of transient receptor potential vanilloid 1 (TRPV1) on airway sensory nerves. Therefore the TRPV1 receptor is an attractive target for the development of antitussive agents.

OBJECTIVE

We sought to assess the antitussive effect of TRPV1 antagonism in patients with refractory chronic cough.

METHODS

Twenty-one subjects with refractory chronic cough (>8 weeks) attending a specialist clinic were recruited to a randomized, double-blind, placebo-controlled crossover trial assessing a TRPV1 antagonist (SB-705498). Cough reflex sensitivity to capsaicin (concentration of capsaicin inducing at least 5 coughs) and 24-hour cough frequency were coprimary end points assessed after a single dose of SB-705498 (600 mg) and matched placebo. Cough severity and urge to cough were reported on visual analog scales, and cough-specific quality of life data were also collected.

RESULTS

Treatment with SB-705498 produced a significant improvement in cough reflex sensitivity to capsaicin at 2 hours and a borderline significant improvement at 24 hours compared with placebo (adjusted mean difference of +1.3 doubling doses at 2 hours [95% CI, +0.3 to +2.2; P = .0049] and +0.7 doubling doses at 24 hours [95% CI, +0.0 to +1.5; P = .0259]). However, 24-hour objective cough frequency was not improved compared with placebo. Patient-reported cough severity, urge to cough, and cough-specific quality of life similarly suggested no effect of SB-705498.

CONCLUSION

This study raises important questions about both the role of TRVP1-mediated mechanisms in patients with refractory chronic cough and also the predictive value of capsaicin challenge testing in the assessment of novel antitussive agents.

Rapid thinning of Pine Island Glacier in the early Holocene

Pine Island Glacier, a major outlet of the West Antarctic Ice Sheet, has been undergoing rapid thinning and retreat for the past two decades. We demonstrate, using glacial-geological and geochronological data, that Pine Island Glacier (PIG) also experienced rapid thinning during the early Holocene, around 8000 years ago. Cosmogenic (10)Be concentrations in glacially transported rocks show that this thinning was sustained for decades to centuries at an average rate of more than 100 centimeters per year, which is comparable with contemporary thinning rates. The most likely mechanism was a reduction in ice shelf buttressing. Our findings reveal that PIG has experienced rapid thinning at least once in the past and that, once set in motion, rapid ice sheet changes in this region can persist for centuries.

First Report of Diplodia quercivora Causing Shoot Dieback and Branch Cankers on Live Oak (Quercus virginiana) in the United States

In September 2010, live oak (Quercus virginiana Mill.) trees in an Alachua County, FL, shopping center parking lot were observed with shoot dieback and cankers on small branches. Isolations were made from canker margins by surface sterilizing tissue in 2.5% sodium hypochlorite and plating on potato dextrose agar (PDA) and incubating at 23°C. Fungi morphologically similar to Diplodia quercivora Linaldeddu & A.J.L. Phillips (mycelium initially velvety and white and later turning pale to dark olivaceous and grayish in reverse) were consistently isolated from symptomatic tissue (2). The two loci used by Linaldeddu et al. (2) in the description of D. quercivora were sequenced to identify a representative isolate (PL1345) as D. quercivora. The internal transcribed spacer (ITS) (GenBank Accession No. KF386635) and translation factor 1-alpha (EF-1α) (KF386636) regions were amplified and sequenced using primers ITS1F/ITS4 (3) and EF1-728F/EF1-986R (1). BLASTn searches of the two sequences resulted in 99% (467 of 469 and 257 of 259, respectively) homology with D. quercivora CBS 133852, confirming the fungal isolates' identity as D. quercivora. In October 2011, Koch's postulates were verified by inoculating, repeated twice, three Q. virginiana saplings (stem diameters, 12 to 14 mm; at inoculation sites approximately 50 mm above soil line) with isolate PL1345. Agar plugs (3 × 3 mm) taken from the margin of a 12-day-old culture on PDA were inserted into flaps in the stems made by a sterile blade with the mycelia facing the cambial tissue. One negative control tree was mock inoculated with a sterile PDA plug. All inoculation sites were sealed with Parafilm and maintained in a greenhouse (19 to 29°C). Trees were assessed for symptoms 90 days after inoculation. External bleeding was noted on all but one tree, and all flaps became necrotic. Pycnidia were observed on the outer surface of the flap on one inoculated tree. Negative controls showed no bleeding and their tissue flaps remained alive. Vertical length of phloem necrosis and percent of stem girdling were measured after removing the bark. Mean necrotic length and percent girdling for inoculated saplings were 48 mm (standard error [SE] = 10.6) and 26.6% (SE = 5.7) for the first inoculation and 46 mm (SE = 17) and 25% (SE = 5) for the second, respectively. Controls showed no internal necrosis and all produced healthy callus tissue at inoculation sites. Two of the pathogen-inoculated trees per inoculation were sampled and the pathogen was re-isolated from each. Recovered fungal isolates were confirmed as D. quercivora based on morphology and 100% ITS sequence homology to PL1345. D. quercivora was first described as causing shoot dieback and cankers on Q. canariensis in Tunisia and was found to be pathogenic to three additional Mediterranean oak species, Q. ilex, Q. pubescens, and Q. suber (2). To our knowledge, this is the first report of D. quercivora causing cankers on Q. virginiana and the first report of the fungus outside of Tunisia. Given the damage this pathogen has caused there, efforts to monitor the spread of this disease would seem warranted. More research is needed to assess the risk this pathogen poses to North American oaks, however. References: (1) I. Carbone et al. Mycologia 91:553, 1999. (2) B. T. Linaldeddu et al. Mycologia 105:1266, 2013. (3) T. J. White et al. PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

A causal relationship between cough and gastroesophageal reflux disease (GERD) has been established: a pro/con debate

Along with upper airway cough syndrome (formerly, postnasal drip syndrome) and eosinophilic airway inflammation (asthma, nonasthmatic eosinophilic bronchitis), gastroesophageal reflux disease (GERD) is generally considered among the most common etiologies of chronic cough. Indeed, cough management guidelines published by numerous respiratory societies worldwide recommend evaluation and treatment of GERD as an integral component of the diagnostic/therapeutic algorithm for the management of chronic cough. However, a significant number of patients with chronic cough presumed due to GERD do not report improvement despite aggressive acid-suppressive therapy. Some of these refractory cases may be due to the recently appreciated entity of nonacid or weakly acidic reflux. Further contributing to the controversy are recent studies that demonstrate that patients with chronic cough do not have excessive reflux events relative to healthy volunteers. Although a temporal relationship between cough and reflux events has been suggested by studies utilizing impedance-pH monitoring of reflux events and objective cough recording, consensus is lacking in terms of whether this temporal relationship proves a causal link between reflux and cough. The fourth American Cough Conference (New York, June 2013) provided an ideal forum for the debate of this issue between two internationally recognized experts in the field of reflux and chronic cough.

Rheology of protic ionic liquids and their mixtures

The rheological properties of five pure protic ionic liquids (ILs), ethylammonium nitrate (EAN), propylammonium nitrate (PAN), ethanolammonium nitrate (EtAN), ethylammonium formate (EAF), and dimethylethylammonium formate (DMEAF), are characterized and interpreted by considering the effects of both the H-bond network and the solvophobic nanostructure of the liquids. The results demonstrate that these effects are not, however, independent or simply additive. At 20 °C, EtAN has the highest zero shear viscosity of 156.1 mPa·s, followed by PAN (89.3 mPa·s), EAN (35.9 mPa·s), EAF (23.1 mPa·s), and DMEAF (9.8 mPa·s). The primary ammonium ILs behave as Newtonian fluids at low shear rates but shear thin at high shear. Fits to the Vogel-Fulcher-Tammann model reveal that nanostructure is not affected appreciably by temperature and that all the ILs studied are of intermediate fragility. The rheology of binary mixtures of these ILs was analyzed and used to demonstrate fundamental differences in the way IL cations and anions interact. IL mixtures containing both nitrate and formate anions resist flow more strongly than the pure liquids, which is a consequence of the difference in hydrogen bonding capacity of the anions. Mixing cations can give rise to complex behavior due to the offsetting effects of hydrogen bonding and solvophobic nanostructure formation.

Nucleotide receptor P2RX7 stimulation enhances LPS-induced interferon-β production in murine macrophages

Stimulation of P2RX(7) with extracellular ATP potentiates numerous LPS-induced proinflammatory events, including cytokine induction in macrophages, but the molecular mechanisms underlying this process are not well defined. Although P2RX(7) ligation has been proposed to activate several transcription factors, many of the LPS-induced mediators affected by P2RX(7) activation are not induced by P2RX(7) agonists alone, suggesting a complementary role for P2RX(7) in transcriptional regulation. Type I IFN production, whose expression is tightly controlled by multiple transcription factors that form an enhanceosome, is critical for resistance against LPS-containing bacteria. The effect of purinergic receptor signaling on LPS-dependent type I IFN is unknown and would be of great relevance to a diverse array of inflammatory conditions. The present study demonstrates that stimulation of macrophages with P2RX(7) agonists substantially enhances LPS-induced IFN-β expression, and this enhancement is ablated in macrophages that do not express functional P2RX(7) or when the MAPK MEK1/2 pathways are inhibited. Potentiation of LPS-induced IFN-β expression following P2RX(7) stimulation is likely transcriptionally regulated, as this enhancement is observed at the IFN-β promoter level. Furthermore, P2RX(7) stimulation is able to increase the phosphorylation and subsequent IFN-β promoter occupancy of IRF-3, a transcription factor that is critical for IFN-β transcription by TLR agonists. This newly discovered role for P2RX(7) in IFN regulation may have implications in antimicrobial defense, which has been linked to P2RX(7) activation in other studies.

Effect of chipping on emergence of the redbay ambrosia beetle (Coleoptera: Curculionidae: Scolytinae) and recovery of the laurel wilt pathogen from infested wood chips

Significant mortality ofredbay trees (Persea borbonia (L.) Spreng.) in the southeastern United States has been caused by Raffaelea lauricola, T.C. Harr., Fraedrich, & Aghayeva (Harrington et al. 2008), a fungal symbiont of the exotic redbay ambrosia beetle, Xyleborus glabratus, Eichhoff (Fraedrich et al. 2008). This pathogen causes laurel wilt, which is an irreversible disease that can kill mature trees within a few weeks in summer. R. lauricola has been shown to be lethal to most native species of Lauraceae and cultivated avocado (Persea americana Mill.) in the southeastern United States. In this study, we examined the survival of X. glabratus and R. lauricola in wood chips made from infested trees by using a standard tree chipper over a 10-wk period. After 2 wk, 14 X. glabratus were recovered from wood chips, whereas 339 X. glabratus emerged from nonchipped bolts. R. lauricola was not found 2 d postchipping from wood chips, indicating that the pathogen is not likely to survive for long inside wood chips. In contrast, R. lauricola persisted in dead, standing redbay trees for 14 mo. With large volumes of wood, the potential for infested logs to be moved between states or across U.S. borders is significant. Results demonstrated that chipping wood from laurel wilt-killed trees can significantly reduce the number of X. glabratus and limit the persistence of R. lauricola, which is important for sanitation strategies aimed at limiting the spread of this disease.

Chronic cough: relationship between microaspiration, gastroesophageal reflux, and cough frequency

BACKGROUND

Microaspiration is often considered a potential cause of cough. The aim of this study was to investigate the relationship between microaspiration, the degree and type of gastroesophageal reflux, and the frequency of coughing in patients with chronic cough.

METHODS

One hundred patients with chronic cough (mean [± SD] age, 55.8 years [± 11.0 years]; 65 women) and 32 healthy volunteers (median age, 43.5 years [interquartile range (IQR), 30-50.8 years]; 16 women) were recruited. Patients with chronic cough performed 24-h objective cough frequency with simultaneous esophageal impedance/pH monitoring and measurement of pepsin concentrations in sputum and BAL. Twelve healthy volunteers underwent bronchoscopy/BAL, and 20 underwent impedance/pH monitoring.

RESULTS

Patients with chronic cough had significantly more reflux episodes than healthy volunteers (median, 63.5 reflux episodes [IQR, 52.5-80.0] vs 59.0 [IQR, 41.8-66.0]; P = .03), although the absolute difference was small, and there was no difference in numbers of events extending into the proximal esophagus (median, 17.2% [IQR, 8.0%-26.0%] vs 20.3% [IQR, 5.1%-32.1%]; P = .36). BAL pepsin levels were also similar in chronic cough to control subjects (median, 18.2 ng/mL [range, 0-56.4 ng/mL] vs 9.25 ng/mL [range, 0-46.9 ng/mL]; P = .27). Sputum but not BAL pepsin weakly correlated with the number of proximally occurring reflux events (r = 0.33, P = .045) but was inversely related to cough frequency (r = −0.52, P = .04). Sputum pepsin was, therefore, best predicted by combining the opposing influences of cough and proximal reflux (r = 0.50, P = .004).

CONCLUSIONS

Proximal gastroesophageal reflux and microaspiration into the airways have limited roles in provoking chronic cough. Indeed, coughing appears to be protective, reducing pepsin concentration in the larger airways of patients with chronic cough.

Pharmacodynamic modeling of cough responses to capsaicin inhalation calls into question the utility of the C5 end point

BACKGROUND

Inhaled capsaicin elicits cough reproducibly in human subjects and is widely used in the study of cough and antitussive therapies. However, the traditional end points C2 and C5 (the concentrations of capsaicin inducing at least 2 or 5 coughs, respectively) display extensive overlap between health and disease and therefore might not best reflect clinically relevant mechanisms.

OBJECTIVES

We sought to investigate capsaicin dose responses in different disease groups.

METHODS

Two novel capsaicin cough challenges were compared in patients with chronic cough (CC; n = 20), asthmatic patients (n = 18), and healthy volunteers (HVs; n = 20). Increasing doubling doses of capsaicin (0.48-1000 μmol/L, 4 inhalations per dose) were administered in challenge 1, whereas the order of the doses was randomized in challenge 2. A nonlinear mixed-effects model compared dose-response parameters by disease group and sex. Parameters were also correlated with objective cough frequency.

RESULTS

The model classified subjects based on maximum cough response evoked by any concentration of capsaicin (Emax) and the capsaicin dose inducing half-maximal response (ED50). HVs and asthmatic patients were not statistically different for either parameter and therefore combined for analysis (mean ED50, 38.6 μmol/L [relative SE, 28%]; mean Emax, 4.5 coughs [relative SE, 11%]). Compared with HVs/asthmatic patients, patients with CC had lower ED50 values (14.7 μmol/L [relative SE, 28%], P = .008) and higher Emax values (8.6 coughs [relative SE, 11%], P < .0001). Emax values highly correlated with 24-hour cough frequency (r = 0.71, P < .001) and were 37% higher in female compared with male subjects, regardless of disease group (P < .001).

CONCLUSIONS

Nonlinear mixed-effects modeling demonstrates that maximal capsaicin cough responses better discriminate health from disease and predict spontaneous cough frequency and therefore provide important insights into the mechanisms underlying CC.

Gastro-oesophageal reflux and cough

Gastro-oesophageal reflux, either singly or in association with postnasal drip and/or asthma is considered to be a cause of chronic cough. The amount and nature of gastro-oesophageal reflux however is often normal with acid suppression having very little, if any therapeutic effect in these patients. This review examines the challenges posed when exploring the reflux-cough link, and discusses the merits and limitations of the proposed mechanisms of reflux leading to cough.

The oesophagus and cough: laryngo-pharyngeal reflux, microaspiration and vagal reflexes

Gastro-oesophageal reflux disease is generally considered to be one of the commonest causes of chronic cough, however randomised controlled trials of proton pump inhibitors have often failed to support this notion. This article reviews the most recent studies investigating the mechanisms thought to link reflux and cough, namely laryngo-pharyngeal reflux, micro-aspiration and neuronal cross-organ sensitisation. How recent evidence might shed light on the failure of acid suppressing therapies and suggest new approaches to treating reflux related cough are also discussed.

Females do not have increased risk of early or late mortality after isolated aortic valve replacement: results from a multi-institutional Australian study

AIM

There is controversy regarding whether isolated aortic valve replacement (AVR) in women is associated with an increased risk of early and late mortality. The current study evaluates the impact of gender as an independent risk factor for early and late mortality after isolated AVR.

METHODS

Data obtained between June 2001 and December 2009 by the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program was retrospectively analysed. Demographic, operative data and postoperative complications were compared between male and female patients using χ(2) and t-tests. Long-term survival analysis was performed using Kaplan Meier survival curves and the log rank test. Independent risk factors for short term and long term mortality were identified using binary logistic and Cox regression, respectively.

RESULTS

Isolated aortic valve replacement was undertaken for 2790 patients in 18 Australian institutions; 41.9% were female. Female patients were generally older (mean age 72 vs. 66 years (P<0.001) and presented more often with hypertension (P<0.001) and obesity (P<0.001). They were less likely to present with cerebrovascular disease (P=0.018), renal failure (P=0.017) and non-elective presentation (P=0.017). Women were observed to have a lower 30-day mortality (1.7% vs. 2.1%) but there was no difference on univariate (P=0.490) or multivariate analysis (P=0.983). There was no difference in the incidence of early complications but women were more likely to require red blood cell transfusion (P<0.001). Long-term survival was comparable between men and women (P=0.662).

CONCLUSION

Female patients undergoing isolated AVR do not have an increased risk of early and late mortality. Further investigation is required to delineate the impact of gender on early and late outcomes following AVR.

Recommended standards for newborn ICU design, eighth edition

This is the eighth edition of the Recommended Standards for Newborn ICU Design. It contains substantive changes in recommendations for patient room size and feeding preparation areas, and a number of refinements of previous Recommended Standards with respect to family space, hand hygiene, lighting and other aspects of the newborn intensive care unit (NICU) design.

The Manchester cough in lung cancer scale: the development and preliminary validation of a new assessment tool

CONTEXT

Cough is a common distressing symptom in lung cancer patients. Its assessment is hampered by the lack of a validated scale to measure the complex cough experience in this population.

OBJECTIVES

To describe the development and preliminary validation of a scale to measure cough in lung cancer patients.

METHODS

In the first phase, collection of qualitative data from patient interviews, a review of literature, and identification of noncancer cough scales resulted in the development of a pool of 30 items. This item pool was tested for appropriateness of content and breadth of coverage with 18 patients with lung cancer and 25 health care professionals. The second phase was the operationalization/phrasing of items. The final phase was the scale's field testing with 139 patients, 49 of whom repeated the assessment after one week.

RESULTS

The first phase led to the deletion of several items and the addition of four, resulting in a final scale for field testing of 21 items. In the field testing, the scale was decreased to 10 items, eliminating items on psychometric grounds. The final scale's Cronbach alpha (internal consistency) was 0.86, item to total correlations ranged from 0.40 to 0.76, and test-retest reliability was high (intraclass correlation=0.83).

CONCLUSION

We have developed a promising tool to assess cough in lung cancer, but this needs validation, and future studies should determine whether this is a sensitive and responsive tool. A fully validated tool can be used in the clinical assessment of cough in cancer patients, and as a unidimensional impact scale in the measurement of cough as an outcome in intervention studies.

Abstract P5-20-05: A Phase 2 trial of RAD 001 and Carboplatin in patients with triple negative metastatic breast cancer

BACKGROUND: RAD001 is an oral mTOR inhibitor that has exhibited activity in breast cancer. Triple negative breast cancer cells are unable to repair double stranded DNA breaks and hence have sensitivity to platinum agents that cause interstrand cross-links. Rapamycin acts synergistically with platinum agents to induce apoptosis and inhibit proliferation in at least two different breast cancer cell lines (including ER/PR negative cell lines). We propose that combination RAD001 and carboplatin may have activity in triple-negative breast cancer.

MATERIALS AND METHODS: The primary objective of the study is to determine clinical benefit (complete remission (CR) + partial remission (PR) + stable disease (SD more than 6 months)) and the toxicity of this combination in triple negative metastatic breast cancer who have had 0–3 prior chemotherapy regimens for metastatic disease. Twenty-five subjects were to be entered in this Phase II study. This design has greater than 80% power to test the null hypothesis that the clinical benefit rate is less than or equal to 10% versus the alternative hypothesis that clinical benefit rate is greater than or equal to 30%. Prior carboplatin is allowed. Women with treated brain metastasis are eligible. Secondary objectives are to determine progression free survival and relationship between pretreatment sensitivity (biopsy at baseline) and clinical response (biopsy post 2 cycles) using IHC staining for abundance of key proteins in the Akt-mTOR pathway and their activity using surrogate phosphorylation site-specific antibodies. According to the original study plan, carboplatin AUC 6, was to be given intravenously every three weeks. Five mg of RAD001 was to be given daily with a 3 patient run-in and then 10 mg daily if there were no dose-limiting toxicities. Due to a surprising amount of thrombocytopenia with this combination the dose of carboplatin was first amended to AUC 5 and most recently to AUC 4 with 5 mg of RAD001 (and no plan to escalate to 10 mg).

RESULTS: 23 patients of a planned 25 have been recruited thus far. Median age is 59. Of the 20 patients assessable for response at this time, there have been 1 CR, 5 PRs, 8 SDs and 6 PDs. One SD was achieved in a patient progressing on single agent Carboplatin at study entry. Median duration of CR+ SD +PR thus far is 13 weeks (range: 6–74 weeks). 5 of 22 patients assessable for toxicity had grade 3/4 thrombocytopenia and 4 patients had grade 3 neutropenia (no febrile neutropenia). 13 out of eighteen patients have had treatment held and/or dose reductions secondary to hematological toxicity, however, since amendment for starting dose of Carboplatin to AUC 4 the regimen has been very well tolerated with only 1 out of eleven patients with grade 3 neutropenia and grade 3 thrombocytopenia. 1 patient suffered from grade 3 dehydration. The estimated clinical benefit rate is 45% (95% confidence interval: 23%, 67%). Median time to progression or death is 85 days from start of treatment.

CONCLUSIONS: Our study has met the primary end point of demonstrating clinical benefit in triple negative metastatic breast cancer. Dose limiting thrombocytopenia was an unexpected side effect requiring protocol amendment. We continue to accrue study subjects at the amended dosing.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-20-05.

Considerations in developing and delivering a nonpharmacological intervention for symptom management in lung cancer: the views of patients and informal caregivers

CONTEXT

Few studies consider patient's and caregiver's preferences when developing nonpharmacological interventions. This is important to develop acceptable and accessible nonpharmacological interventions for patients with cancer.

OBJECTIVES

The objective of this study was to identify the views of patients with lung cancer and their informal caregivers on the desirable components of a novel nonpharmacological intervention for the management of the symptom cluster of cough, breathlessness, and fatigue, and their needs and preferences regarding uptake and delivery of the intervention.

METHODS

This study was qualitative in orientation, using semistructured interviews and framework analysis to elicit the views of 37 patients with lung cancer and 23 caregivers regarding the issues that were perceived to be important regarding the development and delivery of a nonpharmacological intervention.

RESULTS

A number of key issues were identified that carried important implications for patient participation and adherence to the intervention, including the perceived relevance of potential techniques; appreciable benefits in the short term; convenience; variation in patient preferences; timing of the intervention; venue; caregiver involvement; the provider of the intervention, and contact with other patients.

CONCLUSION

The data from this study have provided insight into the key issues that are likely to influence the development, uptake, and delivery of a nonpharmacological intervention to help manage the respiratory symptom cluster of cough, breathlessness, and fatigue. It is crucial that these findings are considered when developing and modeling a nonpharmacological symptom management intervention.

PCR based bronchoscopic detection of common respiratory pathogens in chronic cough: a case control study

BACKGROUND

Viral respiratory tract infection is the most frequent cause of acute cough and is reported at onset in about one third of patients with chronic cough. Persistent infection is therefore one possible explanation for the cough reflex hypersensitivity and pulmonary inflammation reported in chronic cough patients.

METHODS

Bronchoscopic endobronchial biopsies and bronchoalveolar lavage cell counts were obtained from ten healthy volunteers and twenty treatment resistant chronic cough patients (10 selected for lavage lymphocytosis). A screen for known respiratory pathogens was performed on biopsy tissue. Chronic cough patients also underwent cough reflex sensitivity testing using citric acid.

RESULTS

There was no significant difference in incidence of infection between healthy volunteers and chronic cough patients (p = 0.115) or non-lymphocytic and lymphocytic groups (p = 0.404). BAL cell percentages were not significantly different between healthy volunteers and chronic cough patients without lymphocytosis. Lymphocytic patients however had a significantly raised percentage of lymphocytes (p < 0.01), neutrophils (p < 0.05), eosinophils (p < 0.05) and decreased macrophages (p < 0.001) verses healthy volunteers. There was no significant difference in the cough reflex sensitivity between non-lymphocytic and lymphocytic patients (p = 0.536).

CONCLUSIONS

This study indicates latent infection in the lung is unlikely to play an important role in chronic cough, but a role for undetected or undetectable pathogens in either the lung or a distal site could not be ruled out.

TRIALS REGISTRATION

Current Controlled Trials ISRCTN62337037 & ISRCTN40147207.

Hippocampal tissue of patients with refractory temporal lobe epilepsy is associated with astrocyte activation, inflammation, and altered expression of channels and receptors

Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy. Previous research has demonstrated several trends in human tissue that, undoubtedly, contribute to the development and progression of TLE. In this study we examined resected human hippocampus tissue for a variety of changes including gliosis that might contribute to the development and presentation of TLE. The study subjects consisted of six TLE patients and three sudden-death controls. Clinicopathological characteristics were evaluated by H&E staining. Immunohistological staining and Western blotting methods were used to analyze the samples. Neuronal hypertrophy was observed in resected epileptic tissue. Immunohistological staining demonstrated that activation of astrocytes was significantly increased in epileptic tissue as compared to corresponding regions of the control group. The Western blot data also showed increased CX43 and AQP4 in the hippocampus and downregulation of Kir4.1, α-syntrophin, and dystrophin, the key constituents of AQP4 multi-molecular complex. These tissues also demonstrated changes in inflammatory factors (COX-2, TGF-β, NF-κB) suggesting that these molecules may play an important role in TLE pathogenesis. In addition we detected increases in metabotropic glutamate receptor (mGluR) 2/3, mGluR5 and kainic acid receptor subunits KA1 (Grik4) and KA2 (Grik5) in patients' hippocampi. We noted increased expression of the α1c subunit comprising class C L-type Ca(2+) channels and calpain expression in these tissues, suggesting that these subunits might have an integral role in TLE pathogenesis. These changes found in the resected tissue suggest that they may contribute to TLE and that the kainic acid receptor (KAR) and deregulation of GluR2 receptor may play an important role in TLE development and disease course. This study identifies alterations in number of commonly studied molecular targets associated with astrogliosis, cellular hypertrophy, water homeostasis, inflammation, and modulation of excitatory neurotransmission in hippocampal tissues from TLE patients.

First Report of Laurel Wilt Disease Caused by Raffaelea lauricola on Silk Bay in Florida

Silk bay (Persea humilis Nash) is a member of the Lauraceae precinctive to the scrub forests of central and southern Florida and a sister species to the primary laurel wilt host, redbay (P. borbonia (L.) Spreng), which is generally not found in these ecosystems. In November 2011, observations of silk bay mortality near Lake Placid in Highlands County, FL, were reported to Florida Forest Service agents. A subsequent visit to roadside and homeowners' properties in the area revealed many dead and dying silkbays with characteristic laurel wilt symptoms, including wilted crowns with brown persistent foliage, frass accumulated at tree bases, sapwood with dark streaking, and ambrosia beetle entrance holes (1). Twig samples were taken and later confirmed as silk bay by the Florida Division of Plant Industry in Gainesville. Trunk samples were taken from four trees for fungal isolation. Stem sections with vascular discoloration were surface disinfested for 30 s in a 5% sodium hypochlorite solution and then plated onto cycloheximide streptomycin malt extract agar (CSMA) (1). All sapwood pieces from the four samples resulted in the same cream-buff submerged fungal growth characteristic of the laurel wilt pathogen Raffaelea lauricola T. C. Harr., Fraedrich & Aghayeva (2). DNA was extracted from a single-spore derived isolate, PL1389, and an 18S small subunit ribosomal RNA gene sequence was generated with primers NS1 and NS4, resulting in a 1,031-bp amplicon (3). A BLASTn search showed identical homology to R. lauricola strains PL159 and PL382 (GenBank Accessions No. EU257806 and JF797171, respectively, 100% similarity, e-value 0.0, and a total score of 1,982). The sequence was deposited into GenBank and assigned the accession No. JQ247569. In December 2011, a spore suspension was made by flooding a PL1389 culture plate with 2 ml of sterile water, collecting by pipette, and quantification and adjusting to 3.25 × 10⁶ spores/ml by hemacytometer. Pathogenicity was tested on potted plants in a growth chamber experiment. Five silk bays and three redbays were drill-wounded with a 3/32" drill bit and inoculated with 20 μl of the spore suspension. Three silk bays and two redbays served as water-inoculated controls. Within 5 weeks, all inoculated plants displayed the wilt and vascular discoloration characteristic of laurel wilt disease, while all water-inoculated controls remained healthy. Sapwood samples from all plants were plated onto the same CSMA media. R. lauricola was later recovered only from the wilted plants inoculated with PL1389, while no fungal growth was recovered from the asymptomatic water-inoculated controls. Silk bay, which plays a significant role in the limited scrub ecosystems of Florida, has now become another host in the laurel wilt epidemic, with its implications upon the scrub forests yet to be seen. References: (1) S. W. Fraedrich et al. Plant Dis. 92:215, 2008. (2) T. C. Harrington et al. Mycotaxon 104:399, 2008. (3) M. A. Innis et al. PCR Protocols: A Guide to Methods and Applications. Academic Press. San Diego, CA, 1990.

Chest wall dynamics during voluntary and induced cough in healthy volunteers

Coughing both protects the airways from foreign material and clears excessive secretions in respiratory diseases, and therefore requires high expiratory flows. We hypothesised that the volume inspired prior to coughing (operating volume) would significantly influence the mechanical changes during coughing and thus cough flow. Sixteen healthy volunteers (6 female, mean age 31 ± 10 years) performed six single voluntary coughs from four different operating volumes (10%, 30%, 60% and 90% of vital capacity) followed by three peals of voluntary and citric acid-induced coughs. During coughing we simultaneously measured (i) chest and upper abdominal wall motion using opto-electronic plethysmography (OEP), (ii) intra-thoracic and intra-abdominal pressures with a balloon catheter in each compartment and (iii) flow at the mouth. Operating volume was the most important determinant of the peak flow achieved and volume expelled during coughing, but had little influence on the pressures generated. The duration of single coughs increased with operating volume, whereas coughs were much shorter and varied little during peals. Voluntary cough peals were also associated with significant blood shift away from the trunk. In conclusion, this study has shown that operating volume is the most important determinant of cough peak flow and volume expelled in healthy individuals. During peals of coughs, similar mechanical effects were achieved more rapidly, suggesting a modification of the motor pattern with improved efficiency. Future studies investigating cough mechanics in health and disease should control for the influence of operating volume.

Laurel Wilt, Caused by Raffaelea lauricola, is Confirmed in Miami-Dade County, Center of Florida's Commercial Avocado Production

Laurel wilt, caused by Raffaelea lauricola, threatens native and nonnative species in the Lauraceae in the southeastern United States, including the important commercial crop, avocado, Persea americana (2,4). Although the pathogen's vector, Xyleborus glabratus, was detected in Miami-Dade County, FL in January 2010, laurel wilt had not been reported (4). In February 2011, symptoms of the disease were observed on native swampbay, P. palustris, in Miami-Dade County (25°72'N, 80°48'W). Externally, foliage was brown, necrotic, and did not abscise; internally, sapwood was streaked with dark gray-to-bluish discoloration; and, in dead trees, holes of natal galleries of the vector from which columns of frass were attached were evident. On a semiselective medium for R. lauricola, a fungus with the pathogen's phenotype was isolated from symptomatic sapwood. Colonies were slow growing, light cream in color, with dendritic, closely appressed mycelium and often a slimy surface. A representative strain of the fungus was further identified with PCR primers for diagnostic small subunit (SSU) rDNA (1) and its SSU sequence (100% match, GenBank Accession No. JN578863). In each of two experiments, plants of 'Simmonds' avocado, the most important cultivar in Florida, were inoculated with three strains of the fungus, as described previously (3). Symptoms of laurel wilt developed in all inoculated plants and the fungus was recovered from each. After aerial and further ground surveys, additional symptomatic swampbay trees, some of which had defoliated, were detected in the vicinity of the original site. Since swampbay defoliates only a year or more after symptoms develop (4), the 2010 detection of X. glabratus may have coincided with an undetected presence of the disease. As of July 2011, a 6-km-diameter disease focus was evident in the area, the southernmost edge of which is 5 km from the nearest commercial avocado orchard. In August 2011, a dooryard avocado tree immediately north of the above focus was affected by laurel wilt, and an SSU sequence confirmed the involvement of R. lauricola (GenBank Accession No. JN613280). The outbreak of laurel wilt in Miami-Dade County represents a 150 km southerly jump in the distribution of this disease in the United States ( http://www.fs.fed.us/r8/foresthealth/laurelwilt/dist_map.shtml ) and is the first time this disease has been found in close proximity to Florida's primary commercial avocado production area. Approximately 98% of the state's commercial avocados, worth nearly $54 million per year, are produced in Miami-Dade County. Since effective fungicidal and insecticidal measures have not been developed for large, fruit-bearing trees, mitigation efforts will focus on the rapid identification and destruction of infected trees (3,4). References: (1) T. J. Dreaden et al. Phytopathology 98:S48, 2008. (2) S. W. Fraedrich et al. Plant Dis. 92:215, 2008. (3) R. C. Ploetz et al. Plant Dis. 95:977, 2011. (4) R. C. Ploetz et al. Recovery Plan for Laurel Wilt of Avocado. National Plant Disease Recovery System, USDA, ARS, 2011.

First Report of Laurel Wilt Disease Caused by Raffaelea lauricola on Pondspice in Florida

Laurel wilt is a fungal vascular disease of redbay (Persea borbonia (L.) Spreng) and other plants in the family Lauraceae in the southeastern United States (1). The disease is caused by Raffaelea lauricola T. C. Harr., Fraedrich & Aghayeva, which is vectored by the exotic redbay ambrosia beetle (Xyleborus glabratus Eichhoff) (2). Pondspice (Litsea aestivalis (L.) Fern.) is an obligate wetland shrub listed as endangered in Florida and Maryland and threatened in Georgia (4). On 29 August 2008, 369 of 430 (85%) pondspice trees observed at St. Marks Pond in St. John's County, Florida were dead and/or dying (4). Stem samples were collected from plants with wilted and reddened foliage, entrance holes with boring dust characteristic of ambrosia beetle attack, and dark discoloration in the outer sapwood. Discolored stem sections were surface disinfested for 30 s in a 5% sodium hypochlorite solution and then plated onto cycloheximide streptomycin malt extract agar (1). Smooth, cream-buff, submerge hyphae with uneven margins resembling R. lauricola (2) was observed growing from all sapwood pieces. DNA was extracted from a single isolate (PL 392) and the 18s small subunit rDNA was PCR amplified and sequenced with primers NS1 and NS4 (3), resulting in a 1,026-bp amplicon. A BLASTn search showed identical homology to R. lauricola strain PL 159 (GenBank Accession No. EU257806). The 18s small subunit rDNA sequence was deposited into GenBank (FJ514097). In May 2011, a spore suspension was made by flooding a single-spore culture plate of isolate PL 392 with 2 ml of sterile water, collecting the spores by pipette, and quantification by hemacyometer to 1.5 × 10⁶ spores/ml. Pathogenicity tests were conducted on 1 to 1.5 m tall pondspice plants. Six saplings were wounded by a 3/32-inch drill bit, with four receiving 50 μl of the spore suspension and two serving as water-inoculated controls. All plants were kept in a greenhouse under ambient temperature. Within 21 days, all fungal-inoculated saplings displayed complete canopy wilt, typical of laurel wilt. R. lauricola was later recovered from all four infected plants, completing Koch's postulates. To determine if the vector can reproduce in pondspice, infected stem sections were placed in a plastic rearing box indoors at room temperature, and both callow and mature adult female X. glabratus emerged in October and November 2008. Although laurel wilt has been previously observed on pondspice in South Carolina and Georgia (1), this is the first confirmation of the disease on pondspice in Florida and the first confirmation of the vector from stem material of this host. References: (1) S. W. Fraedrich et al. Plant Dis. 92:215, 2008. (2) T. C. Harrington et al. Mycotaxon 104:399, 2008. (3) M. A. Innis et al. PCR Protocols, A Guide to Methods and Applications. Academic Press. San Diego, CA, 1990. (4) J. A. Surdick and A. M. Jenkins. Pondspice (Litsea aestivalis) Population Status and Response to Laurel Wilt Disease in Northeast Florida. Florida Natural Areas Inventory, Tallahassee, FL, 2009.

Antitussive effects of memantine in guinea pigs

BACKGROUND

The treatment of cough is a significant clinical unmet need because there is little evidence that current therapies are effective. Based on evidence supporting a role for N-methyl D-aspartate receptors (NMDARs) in cough, we hypothesized that memantine, a low-affinity, uncompetitive NMDAR channel blocker in routine use for the treatment of Alzheimer disease, could be an effective, well-tolerated, antitussive therapy. The aim of this study was to establish preclinical evidence that memantine has antitussive effects.

METHODS

We studied the influence of memantine on experimentally induced coughing in response to citric acid and bradykinin inhalation in guinea pigs. We also compared the potency and efficacy of memantine as an antitussive to other NMDAR antagonists, dextromethorphan and ketamine, and to the γ-aminobutyric acid class B receptor agonist baclofen.

RESULTS

Compared with control subjects, 10 mg/kg memantine significantly reduced the cumulative number of coughs evoked by both citric acid (median, 24.0 [interquartile range (IQR), 13.0-25.5] vs 1.5 [IQR, 0.3-10.3] coughs; P = .012) and bradykinin aerosols (median, 16.0 [IQR, 9.5-18.5] vs 0.0 [IQR, 0-0.75] coughs; P = .002). Memantine 10 mg/kg produced a similar reduction in the cumulative number of coughs to baclofen 3 mg/kg and demonstrated comparatively greater cough suppression than 30 mg/kg dextromethorphan or 30 mg/kg ketamine. This dose of memantine produced no sedative or respiratory depressive effects.

CONCLUSIONS

This study illustrates that memantine has marked antitussive effects in guinea pigs, most likely mediated through NMDAR channel blockade. Memantine, therefore, has the potential to be a safe, effective, and well-tolerated antitussive agent.