Bronchoconstrictor response to inhaled capsaicin in humans

The effect of inhaled capsaicin, the irritant extract of pepper, on airway tone has been studied in humans. Inhaled capsaicin (2.4 X 10(-10) and 2.4 X 10(-9) mol) caused a dose-dependent fall in specific airways conductance (maximum fall 28 +/- 19 and 38 +/- 19%, respectively; means +/- SD, n = 17). This was maximal within 20 s of exposure and lasted for less than 60 s. There was no difference in the magnitude or duration of bronchoconstriction between normal, smoking, or asthmatic subjects. Capsaicin also caused coughing and retrosternal discomfort. On repeated exposure to capsaicin, there was no evidence for a reduced response (tachyphylaxis). Ipratropium bromide (0.25 mg by inhalation) significantly (P less than 0.05) reduced the bronchoconstriction (maximum falls 34 +/- 14 and 15 +/- 9% after saline and ipratropium bromide, respectively; means +/- SD n = 6), indicating that it was dependent on a cholinergic vagal reflex rather than on local release of substance P from nerves in the airway. Inhaled sodium cromoglycate (10 mg by nebulizer or 40 mg as a dry powder), however, had no significant effect on the bronchoconstrictor response. Capsaicin may be a useful tool for investigating nonmyelinated nerve reflexes in human airways.

Circulating catecholamines in acute asthma

Plasma catecholamine concentrations were measured in 15 patients (six male) aged 14-63 years attending the casualty department with acute severe asthma (peak expiratory flow 27% (SEM 3%) of predicted). Nine patients were admitted and six were not. The plasma noradrenaline concentration, reflecting sympathetic nervous discharge, was two to three times normal in all patients and was significantly higher in those who required admission compared with those discharged home (mean 7.7 (SEM 0.6) v 4.7 (0.5) nmol/l (1.3 (SEM 0.1) v 0.8 (0.08) ng/ml); p less than 0.001). Plasma adrenaline concentration, however, was not increased in any patient. This surprising failure of the plasma adrenaline concentration to increase during the stress of an acute attack of asthma was unexplained and contrasts with the pronounced rise in plasma adrenaline and noradrenaline concentrations in acute myocardial infarction, heart failure, and septicaemia. The failure of plasma adrenaline concentration to increase in acute asthma is unlikely to be explained by adrenal exhaustion, but it may be another example of impaired adrenaline secretion in asthma.

Histamine increases lung permeability by an H2-receptor mechanism

The effect of specific H1 and H2 receptor antagonists on bronchial reactivity and increase in lung epithelial permeability in response to inhaled histamine was measured in 5 non-smoking men (age range 24-36 years). Inhaled histamine produced a short-lived but consistent increase in permeability to 99Tc-diethylenetriamine penta-acetate. An H1-receptor antagonist, terfenadine (60 mg), protected against the bronchoconstrictor effect but had no significant influence on the increase in permeability. The H2-receptor antagonist ranitidine (150 mg) significantly reduced the permeability response without having an effect on bronchial reactivity. These results demonstrate that the bronchoconstrictor effect of histamine is mediated by H1 receptors and permeability increase is mediated by H2 receptors. H2-receptor mediated increase in lung epithelial permeability may be important clinically.

The effect of inhaled vasoactive intestinal peptide on bronchial reactivity to histamine in humans

Nonadrenergic, noncholinergic nerves are the predominant inhibitory nervous pathway in human airway smooth muscle, and there is evidence in animals that the major neurotransmitter of this system is vasoactive intestinal peptide (VIP). We have investigated the effect of VIP on bronchomotor tone and bronchial responsiveness to inhaled histamine in 6 atopic asthmatic subjects. The VIP was given by inhalation to avoid any indirect effects on the airways that might arise from the potent cardiovascular actions of this peptide when given systemically. The VIP (100 micrograms) was compared with control solution (diluent: 1% human serum albumin in 2 ml 0.9% saline) and with beta 2-agonist (salbutamol, 200 micrograms) given double blind in random order on separate days. Specific airway conductance (SGaw) did not change after control or VIP inhalations, but it significantly increased after salbutamol inhalation. The provocation concentration of histamine causing a 35% fall in SGaw (PC35) did not change after control inhalation, but significantly increased after VIP (from 2.18 +/- 1.04 to 5.00 +/- 2.31 mg/ml histamine, mean +/- SE; p less than 0.05), and after salbutamol (from 1.71 +/- 0.83 to 15.6 +/- 4.2 mg/ml, p less than 0.01), the increase after salbutamol being significantly greater than after VIP. No changes in heart rate or blood pressure were found after any inhalation. We conclude that VIP protects against histamine-induced bronchoconstriction in human airways in vivo, and therefore has the capacity to be the neurotransmitter of nonadrenergic, noncholinergic inhibitory nerves in human airway smooth muscle.

Autonomic regulation of the airways

The airways are innervated by a sympathetic, a parasympathetic, and a third [perhaps vasoactive intestinal peptide (VIP) releasing] nervous system. These nerves modulate smooth muscle tone and submucosal gland secretion and possibly other cell systems in the airways. Adrenergic and cholinergic receptors are distributed unevenly in airways of different sizes and among different cells. Considerable evidence is presented that implicates abnormalities of autonomic function in asthma.

Effect of vasoactive intestinal peptide on ion transport across dog tracheal epithelium

Under short-circuit conditions, vasoactive intestinal peptide (VIP) did not alter net Na+ movement but selectively stimulated net Cl- secretion across dog tracheal epithelium with a high affinity (Km congruent to 10(-8) M). The increase in Cl- secretion was not different from the rise in short-circuit current (Isc). However, stimulation of Cl- secretion was not maximal, because the addition of isoproterenol (10(-6) M) to VIP-treated tissues further increased the Isc by 54%. The effect of exogenous VIP was not blocked by a combination of atropine, phentolamine, propranolol (10(-5) or 10(-6) M), or tetrodotoxin (10(-6) M). Under open-circuit conditions, VIP caused an increase in the net secretion of Cl- and Na+, but the changes did not reach statistical significance. We conclude that VIP acts directly on receptors on the surface of epithelial cells to stimulate active Cl- secretion. The abundance of VIP nerves in the submucosa suggests that VIP may be important in regulation of fluid movement across the epithelium.

Mapping of adrenergic receptors in the trachea by autoradiography

We investigated the distribution of adrenergic receptors in ferret trachea using autoradiography. [3H]Dihydroalprenolol, used to identify beta-adrenoceptors, revealed a high density of specific binding sites over surface epithelium and submucosal glands, with less labelling of smooth muscle. [3H]prazosin labelling showed that alpha 1-receptors were numerous in glands and epithelium, but sparse in smooth muscle. Comparison of adrenergic receptor densities in tracheal sections from the same animals showed a rank order for submucosal glands of alpha 1 greater than beta, for epithelium beta greater than alpha 1 and for smooth muscle beta greater than alpha 1. Within the submucosal glands, alpha 1- and beta-adrenergic receptors were differentially distributed, with alpha 1-receptors being significantly more numerous over serous than mucous cells and beta receptors being significantly more numerous over mucous than serous cells. This technique provides insight into adrenergic regulation of airway function and should be useful in investigations of how relative receptor densities may be altered in disease.

Vasoactive intestinal peptide stimulates tracheal submucosal gland secretion in ferret

We studied the effect of vasoactive intestinal peptide (VIP) on the output of 35S-labeled macromolecules from ferret tracheal explants either placed in beakers or suspended in modified Ussing chambers. In Ussing chamber experiments, the radiolabel precursor, sodium [35S]sulfate, and all drugs were placed on the submucosal side of the tissue. Washings were collected at 30-min intervals from the luminal side and were dialyzed to remove unbound 35S, leaving radiolabeled macromolecules. Vasoactive intestinal peptide at 3 X 10(-7) M stimulated bound 35S output by a mean of + 252.6% (n = 14). The VIP response was dose-dependent with a near maximal response and a half maximal response at approximately 10(-6) M and 10(-8), M, respectively. The VIP effect was not inhibited by a mixture of tetrodotoxin, atropine, I-propranolol, and phentolamine. Vasoactive intestinal peptide had no effect on the electrical properties of the of the tissues. We conclude that VIP stimulates output of sulfated-macromolecules from ferret tracheal submucosal glands without stimulating ion transport. Our studies also suggest that VIP acts on submucosal glands via specific VIP receptors. Vasoactive intestinal peptide has been shown to increase intracellular levels of cyclic AMP, and we suggest that this may be the mechanism for its effect on the output of macromolecules. This mechanism may be important in the neural regulation of submucosal gland secretion.

Autoradiographic localization of autonomic receptors in airway smooth muscle. Marked differences between large and small airways

Autoradiographic methods were used to determine the distribution of autonomic receptors in airway smooth muscle of ferret from trachea to terminal bronchioles; [3H]dihydroalprenolol, [3H]prazosin, and [3H]quinuclidinyl benzilate were used to label beta-adrenergic, alpha-adrenergic, and muscarinic receptors, respectively, using experimental conditions that gave maximal specific receptor binding. Marked differences were found in the longitudinal distribution of each receptor and in distribution of the various receptors in each caliber airway. Beta-receptors were present in high density throughout the airways, with the highest density in bronchioles. Alpha-receptors were sparse in large airways, but numerous in small bronchioles, whereas cholinergic receptors were numerous in bronchial smooth muscle, sparse in proximal bronchioles, and almost absent from distal bronchioles. This method may be useful in studying alterations of autonomic receptors distribution in small and large airways after experimental manipulation and in disease.

Activation of alpha-adrenergic response in tracheal smooth muscle: a postreceptor mechanism

We have investigated the activation of alpha-adrenergic contractile responses in dog tracheal smooth muscle. After cholinergic and beta-adrenergic blockade, neither electrical field stimulation nor alpha-adrenergic agonists caused contraction of trachealis strips in vitro, but after exposure to histamine or serotonin a striking contractile response was obtained. Similar activation of the contractile response to norepinephrine was seen in isolated tracheal segments in vivo after exposure to histamine and serotonin. This response was mediated predominantly by alpha 2-adrenoceptors, because the alpha 2-antagonist yohimbine was a potent inhibitor whereas the alpha 1-antagonist prazosin was a weak inhibitor of the response to both electrical stimulation and exogenous agonists. Using [3H]yohimbine to label alpha 2-receptors and [3H]prazosin to label alpha 1-receptors, we confirmed the preponderance of alpha 2-receptors in trachealis membranes but found no increase in either receptor number or affinity after incubating muscle strips with histamine. The magnitude of alpha-adrenergic contraction was significantly related to the magnitude of precontraction by histamine and serotonin both in vitro and in vivo but persisted after washout. Acetylcholine was much less potent in activating the alpha-adrenergic response. We conclude that activation of airway alpha-adrenergic responses involves a postreceptor mechanism not directly related to membrane depolarization, but involving some related process such as activation of calcium channels.

Dose-response curves to inhaled beta-adrenoceptor agonists in normal and asthmatic subjects

We have compared bronchodilator dose-response curves to inhaled salbutamol in seven normal and eight asthmatic subjects. In all normal subjects maximal bronchodilatation measured by partial flow volume curves was achieved at a cumulative dose of 110 micrograms. The dose necessary to produce half maximal response (ED50) was 23 +/- 2 micrograms (mean +/- s.e. mean) with a range of 18-28 micrograms. In asthmatic subjects maximal bronchodilatation measured by FEV1 and by maximal flow volume curves was achieved at significantly higher (P less than 0.01) doses of salbutamol with a mean ED50 of 83 +/- 28 micrograms and range of 25-251 micrograms. There was a significant (P less than 0.05) correlation between ED50 and % predicted baseline FEV1. This is more likely to reflect impaired access of drug for airway beta-adrenoceptors than impaired beta-adrenoceptor function in asthma. In five asthmatic subjects dose-response curves to salbutamol and isoprenaline were compared and found to be similar, thus providing no evidence that salbutamol is a partial agonist in vivo, as it appears to be in vitro.

Characterization of beta adrenoceptor subtypes in canine airway smooth muscle by radioligand binding and physiological responses

Beta adrenoceptor subtypes in canine tracheal smooth muscle have been investigated by radioligand binding and by physiological responses to beta agonists and sympathetic nerve stimulation in vitro. Specific binding of [3H]dihydroalprenolol to tracheal smooth muscle membranes was of high affinity (Kd = 1.0 +/- 0.08 nM), as in peripheral lung membranes from the same animals, but the concentration of binding sites (95.6 +/- 4.7 fmol/mg of protein) was much lower than in lung (532 +/- 48 fmol/mg of protein). Binding was stereoselective and agonists competed with the rank order of potency isoproterenol greater than epinephrine greater than norepinephrine, signifying a preponderance of beta-2 receptors. Using selective beta antagonists, we determined the ratio of beta-1/beta-2 receptors in tracheal smooth muscle membranes to be 1:4. The relaxation response of tracheal smooth muscle strips to exogenous beta agonists was mediated by beta-2 receptors, with a very small contribution from beta-1 receptors. However, the relaxation response to electrical field stimulation of sympathetic nerves was mediated predominantly by beta-1 receptors. Our results suggest that most beta receptors in dog tracheal smooth muscle are of the beta-2 subtype and mediate responses to circulating catecholamines, but there is a small concentration of beta-1 receptors which mediate the response to neurally released norepinephrine.

Postsynaptic alpha 2-adrenoceptors predominate over alpha 1-adrenoceptors in canine tracheal smooth muscle and mediate neuronal and hormonal alpha-adrenergic contraction

Alpha-adrenoceptor subtypes in canine tracheal smooth muscle were investigated by radioligand binding and by in vitro responses of muscle strips to electrical field stimulation and exogenous alpha-agonists. [3H]Yohimbine identified a high density of alpha 2-receptors (51.4 +/- 4.9 fmoles/mg of protein; n = 5) in tracheal smooth muscle membranes, whereas [3H]prazosin revealed a low density of alpha 1-receptors (11.1 +/- 2.9 fmoles/mg of protein; n = 5). In peripheral lung membranes, however, alpha 1-receptors predominated (46.8 +/- 7.7 fmoles/mg of protein; n = 4) over alpha 2-receptors (4.1 +/- 1.5 fmoles/mg of protein; n = 4). After pretreatment with atropine and propranolol and precontraction with serotonin or histamine, the contractile response of tracheal smooth muscle to electrical field stimulation was partially inhibited by 0.3 microM prazosin (16%), potently inhibited by 0.3 microM yohimbine (89%), and abolished by a combination of the two drugs. The response to neuronally released norepinephrine is therefore mediated predominantly by alpha 2-receptors. The rank order of potency for adrenergic agonists was clonidine greater than norepinephrine greater than phenylephrine in both competition studies with [3H]yohimbine and in contraction studies, signifying a predominance of postsynaptic alpha 2-receptors. The contractile responses to exogenous norepinephrine, clonidine, and phenylephrine were only weakly inhibited by 0.3 microM prazosin but markedly inhibited by 0.3 microM yohimbine, with a Kb of 1.2 nM, which was similar to the Kd of [3H]yohimbine binding to airway smooth muscle membranes (2.7 nM).

Pulmonary alpha-adrenoceptors: autoradiographic localization using [3H]prazosin

We determined the distribution of pulmonary alpha-adrenoceptors by autoradiographic localisation of [3H]prazosin binding to frozen sections of ferret lung. Specific binding of [3H]prazosin to lung sections was saturable and of high affinity (KD = 0.44 +/- 0.55 nM; mean +/- S.E., n = 5), with a specificity indicating binding to alpha 1-receptors. Autoradiographic showed that alpha 1-receptors were present in highest density in vascular smooth muscle (small vessels greater than large vessels), and were also present in airway submucosal glands and epithelium. There was also scanty labelling of alveolar walls which may be to contractile interstitial cells (Kapanci cells). Although smooth muscle of bronchi showed little labelling, surprisingly that of bronchioles was heavily labelled. The high density of alpha-receptors in small airways may be relevant to asthma in which alpha-adrenergic responses are activated. This method offers a means by which autonomic receptors of small airways may be investigated without the confusing contribution of other contractile elements and larger airways.

Muscarinic receptors in lung and trachea: autoradiographic localization using [3H]quinuclidinyl benzilate

[3H]Quinuclidinyl benzilate binding to slide-mounted frozen sections of ferret lung was of high affinity (KD 63 +/- 14 pM, mean +/- S.E., n = 4), and characteristic of interaction with muscarinic cholinergic receptors. Light microscopic autoradiography showed muscarinic receptors to be localized predominantly to smooth muscle of trachea and intrapulmonary cartilaginous airways, and to submucosal glands. There was much less labelling of bronchiolar smooth muscle, airway epithelium and vascular smooth muscle and no labelling of alveoli. This distribution of receptors parallels that of cholinergic innervation.