The propulsion of mucus by cilia

Delivery systems for penetration enhancement of peptide and protein drugs: design considerations

This paper discusses the challenges to be met in designing delivery systems that maximize the absorption of peptide and protein drugs from the gastrointestinal and respiratory tracts. The ideal delivery system for either route of administration is one that will release its contents only at a favorable region of absorption, where the delivery system attaches by virtue of specific interaction with surface determinants unique to that region and where the delivery system travels at a rate independent of the transitory constraints inherent of the route of administration. Such a delivery system, which is as yet unavailable, will benefit not only peptide and protein drugs, but other poorly absorbed drugs.

Microscopic modeling of NO and S-nitrosoglutathione kinetics and transport in human airways

Nitric oxide (NO) appears in the exhaled breath and is elevated in inflammatory diseases. We developed a steady-state mathematical model of the bronchial mucosa for normal small and large airways to understand NO and S-nitrosoglutathione (GSNO) kinetics and transport using data from the existing literature. Our model predicts that mean steady-state NO and GSNO concentrations for large airways (generation 1) are 2.68 nM and 113 pM, respectively, in the epithelial cells and 0.11 nM (approximately 66 ppb) and 507 nM in the mucus. For small airways (generation 15), the mean concentrations of NO and GSNO, respectively, are 0.26 nM and 21 pM in the epithelial cells and 0.02 nM (approximately 12 ppb) and 132 nM in the mucus. The concentrations in the mucus compare favorably to experimentally measured values. We conclude that 1) the majority of free NO in the mucus, and thus exhaled NO, is due to diffusion of free NO from the epithelial cell and 2) the heterogeneous airway contribution to exhaled NO is due to heterogeneous airway geometries, such as epithelium and mucus thickness.

Serous or mucoid effusion in the course of secretory otitis media: influence of ion transport modulation

OBJECTIVE

Secretory otitis media is defined by a chronic effusion in the middle ear cavities, behind an intact tympanic membrane without acute infection. In the course of secretory otitis media, the effusion is sometimes thick (or mucoid) and other times thin (or serous). For several authors, these differences might be related to different inflammatory levels rather than to distinct pathophysiological mechanisms. The purpose of this study was to determine whether the modulation of ion transport by inflammation could account for the differences observed in the aspect of ME effusion.

METHODS

Hydrogen peroxide (H2O2), used as an inflammation model was tested on a middle ear cell line (MESV) in culture.

RESULTS

Results show that low and high concentrations of H2O2 have opposite effects on ion (and then water) absorption by the middle ear epithelium.

CONCLUSION

the modulation of ion and water absorption by inflammation could modify the mucins concentration in the effusion, and explain observed viscosity differences in the course of secretory otitis media.

Sinonasal disease in cystic fibrosis: clinical characteristics, diagnosis, and management

Cystic fibrosis is an autosomal recessive genetic disorder that causes dysfunction of exocrine glands, and has several clinical manifestations. Among those, sinonasal involvement is almost universal, with or without chronic sinusitis and/or nasal polyposis. This review will detail the pathophysiologic changes of the sinonasal mucosa, and the clinical manifestations, diagnosis, and treatment. Developmental anatomic abnormalities, which are identified radiologically, will also be demonstrated. Medical management is the first treatment for patients with cystic fibrosis, but effective treatment of sinonasal disease in cystic fibrosis relies heavily on surgery. In the past, nasal polyposis was the main indication for surgery, and consisted mostly of polypectomy alone. This procedure was associated with a high recurrence rate. The development of functional endoscopic sinus surgery has contributed to decreasing the morbidity of sinonasal surgery and the recurrence of nasal polyposis in cystic fibrosis. The evolution of the surgical techniques will be discussed and a review of the literature will be provided.

The effect of inflammation on mucociliary clearance in asthma: an overview

Mucociliary clearance (MCC) is one of the most important nonspecific defense mechanisms of the respiratory tract, and its impairment is a well-documented feature of chronic respiratory diseases, including asthma. In vitro and in vivo data suggest that several inflammatory mediators influence the mucociliary apparatus. Epithelial damage and functional abnormalities have been described in bronchial asthma, along with changes in mucus-secreting cells and the chemical and rheological properties of airway fluid. Although the mechanisms of MCC impairment in asthma are not clearly understood, data in the recent literature suggest that airway inflammation plays a major role. In this article, we review studies on MCC alterations in light of up-to-date findings on pathogenetic mechanisms in asthma.

Effect of viscosity on metachrony in mucus propelling cilia

In the present work we report that increasing the viscosity of the medium caused not only a decrease in the ciliary beat frequency but also changes in the metachrony and correlation between cilia. The study was performed using double and triple simultaneous photoelectric measurements on cultured ciliary cells from the frog esophagus in the viscosity range of 1-2,000 cp. We observed that increasing the viscosity intensified the fluctuations in all the measured parameters. Ciliary beat frequency decreased moderately. Even at quite high viscosities (circa 2000 cp.), cilia were still active with beating frequencies of 3-5 Hz. In addition, the degree of correlation between cilia parallel to the effective stroke direction (ESD) decreased, while that perpendicular to the ESD at a low range of viscosities remained unchanged and even increased at high viscosities. Medium viscosities in the range of 30-1,500 cp. altered the metachronal wave properties of cultured frog esophagus. The metachronal wavelength increased by up to 50%, and the wave direction changed towards more orthoplectic type of coordination. According to our recently suggested model [Gheber and Priel, 1990: Cell Motil. Cytoskeleton 16:167-181], these effects can be explained by a decrease in the temporal asymmetry of the ciliary beat. Since similar results were observed in water propelling cilia of Paramecium subjected to medium viscosity ranges of up to 40 cp. [Machemer, 1972: J. Exp. Biol. 57:239-259], we conclude that hydrodynamic interactions govern the metachronal wave properties of both mucus and water propelling cilia, though mucus propelling cilia, with their better adaptation to increased load, are affected at much higher viscosities than water propelling cilia.

The significance of moulting in Ecdysozoan evolution

Three major bilaterian clades first appear in the Early Cambrian fossil record: Deuterostomia, Lophotrochozoa, and Ecdysozoa. The taxa placed in Ecdysozoa are characterized by a moulting habit, unknown in the other major clades. The origin and consequences of moulting are of fundamental importance to the history of the ecdysozoan clade, chiefly because moulting precludes motile ectodermal cilia. Moulting may have originated as an adaptation to permit the enlargement, during growth, of secreted cuticular spines, flanges, and other structures used as ancillary locomotory devices. A combination of phylogenetic and fossil evidence suggests that the early members of these clades were small vermiform paracoelomates that likely lacked indirect-developing planktotrophic larvae. Thus, the evolution of planktotrophic larvae may have been independently achieved at least three times within Bilateria. The nonmoulting clades evolved larvae that swim and feed via ciliated tufts and bands, presumably intercalating these forms within their early developmental systems. Within Ecdysozoa, feeding larvae lacked ciliary feeding tracts and evolved by modification of early instars, employing limbs or setae to generate feeding currents. The setting aside during larval life of cells that give rise to adult features is probably an adaptation associated with metamorphosis.

Local mucociliary defence mechanisms

The lung is continually at risk of exposure to noxious environmental agents and respiratory pathogens. An elaborate series of defence mechanisms have been developed to protect the airways from these insults. The lower respiratory tract is protected by local mucociliary mechanisms that involve the integration of the ciliated epithelium, periciliary fluid and mucus. Mucus acts as a physical and chemical barrier onto which particles and organisms adhere. Cilia lining the respiratory tract propel the overlying mucus to the oropharynx where it is either swallowed or expectorated. Regulation of periciliary fluid is thought essential to maintenance of both mucociliary clearance and to produce an environment in which airway antimicrobial peptides and defensins are effective. Disruption of mucociliary clearance may be caused by diseases such as cystic fibrosis, primary ciliary dyskinesia and asthma or may be secondary to pollutant exposure and viral or bacterial infections.

Exogenous surfactant therapy and mucus rheology in chronic obstructive airway diseases

Exogenous surfactant is a specialized biomaterial used for substitution of the lipoprotein mixture normally present in the lungs-pulmonary surfactant. Respiratory Distress Syndrome is a disease of preterm infants mainly caused by pulmonary immaturity as evidenced by a deficiency of mature lung surfactant. Pulmonary surfactant is known to stabilize small alveoli and prevent them from collapsing during expiration. However, apart from alveoli, surfactant also lines the narrow conducting airways of the tracheobronchial tree. This paper reviews the role of this surfactant in the airways and its effect on mucus rheology and mucociliary clearance. Its potential role as a therapeutic biomaterial in chronic obstructive airway diseases, namely asthma, chronic bronchitis, and respiratory manifestations of cystic fibrosis, are discussed. This paper also attempts to elucidate the exact steps in the pathogenic pathway of these diseases which could be reversed by supplementation of exogenous surfactant formulations. It is shown that there is great potential for the use of present day surfactants (which are actually formulated for use in Respiratory Disease Syndrome) as therapy in the aforementioned diseases of altered mucus viscoelasticity and mucociliary clearance. However, for improved effectiveness, specific surfactant formulations satisfying certain specific criteria should be tailor-made for the clinical condition for which they are intended. The properties required to be fulfilled by the optimal exogenous surfactant in each of the above clinical conditions are enumerated in this paper.

Humidification difficulties in two tracheostomized children

Effective humidification is sometimes difficult to achieve in children when normal mechanisms are bypassed by having a tracheostomy in situ. The humidification options available in the paediatric population are heat and moisture exchangers (HMEs) and heated humidifiers, both of which are reviewed and discussed. In some circumstances the humidification achieved with HMEs is inadequate. We outline the hospital and subsequent home management of two infants, both with tracheostomies in situ, who unsuccessfully trialed HMEs and subsequently achieved effective humidification with heated humidifiers. We propose that heated humidifiers would help more tracheostomized infants who are suffering from similar problems.

Nasal Mucociliary Clearance and Nasal and Oral pH in Patients with Insulin-Dependent Diabetes

We studied 32 patients with insulin-dependent diabetes mellitus to determine how their rate of mucociliary clearance and their levels of nasal and oral pH compared with those of 10 nondiabetic controls and how these rhinologic measurements varied within different subsets of diabetic patients. Although we found very few statistically significant differences in all our comparisons, we did find that nasal mucociliary clearance and oral pH levels in the diabetic patients were significantly different from those of healthy subjects.

Intranasal insulin delivery and therapy

Intranasal insulin delivery has been widely investigated as an alternative to subcutaneous injection for the treatment of diabetes. The pharmacokinetic profile of intranasal insulin is similar to that obtained by intravenous injection and, in contrast to subcutaneous insulin delivery, bears close resemblance to the 'pulsatile' pattern of endogenous insulin secretion during meal-times. The literature suggests that intranasal insulin therapy has considerable potential for controlling post-prandial hyperglycaemia in the treatment of both IDDM and NIDDM. However, effective insulin absorption via the nasal route is unlikely without employing the help of absorption enhancers or promoters which are able to modulate nasal epithelial permeability to insulin and/or prolong the residence time of the drug formulation in the nasal cavity. This article discusses the structure and function of the nasal cavity, the barriers which prevent nasal insulin absorption and through the use of absorption enhancers or promoters methods by which these barriers may be overcome.

Ciliary activity in differentiating and reactivated human respiratory epithelial cells

OBJECTIVE

Experimental studies of mucociliary clearance, especially those involving drug effects, suffer from the difficulty of determining whether drugs act directly on ciliary motility or whether their effects are indirect, acting via changes in cell metabolism, viscous load, or alternative mechanisms. The present study provides a solution to this problem by comparing the motile characteristics of ciliated cells that have differentiated in primary cell culture with those of demembranated cilia reactivated with MgATP.

METHODS

Human respiratory epithelial cells (REC) were dissociated from trachea, bronchus, nasal polyps, or turbinates and then placed in a dissociated cell culture system. Thirty-three percent of the dissociated cells contain beating cilia. Following 1 week in culture, the REC dedifferentiated, but then redifferentiated within 96 hours after they were brought to an air interface.

RESULTS

The cilia on such cells beat with planar waves consisting of power and recovery strokes. Beat frequencies at 20 degrees C were 15+/-2.3 Hz. Ciliary beating often was coordinated both within and between cells with a defined antilaeoplectic pattern of coordination. Either fresh or cultured cells could be demembranated with Triton X-100 and reactivated with MgATP. The activity of these reactivated models was equivalent to those observed in living cells.

CONCLUSION

The authors have demonstrated that ciliary beat frequency of demembranated human respiratory epithelial cells can be modulated by MgATP and can be adjusted to the same level of activity as measured in living cells. This allows them to selectively test whether a drug's effects on mucociliary transport are the result of direct interactions with the ciliary apparatus or are produced through other indirect mechanisms.

Role of CFTR in airway disease

Role of CFTR in Airway Disease. Physiol. Rev. 79, Suppl.: S215-S255, 1999. - Cystic fibrosis (CF) is caused by mutations in the gene encoding the CF transmembrane conductance regulator (CFTR), which accounts for the cAMP-regulated chloride conductance of airway epithelial cells. Lung disease is the chief cause of morbidity and mortality in CF patients. This review focuses on mechanisms whereby the deletion or impairment of CFTR chloride channel function produces lung disease. It examines the major themes of the channel hypothesis of CF, which involve impaired regulation of airway surface fluid volume or composition. Available evidence indicates that the effect of CFTR deletion alters physiological functions of both surface and submucosal gland epithelia. At the airway surface, deletion of CFTR causes hyperabsorption of sodium chloride and a reduction in the periciliary salt and water content, which impairs mucociliary clearance. In submucosal glands, loss of CFTR-mediated salt and water secretion compromises the clearance of mucins and a variety of defense substances onto the airway surface. Impaired mucociliary clearance, together with CFTR-related changes in the airway surface microenvironment, leads to a progressive cycle of infection, inflammation, and declining lung function. Here, we provide the details of this pathophysiological cascade in the hope that its understanding will promote the development of new therapies for CF.

The correlation between ciliary ultrastructure and ciliary beat frequency in experimental chronic sinusitis

Ciliary ultrastructural abnormalities secondary to chronic sinusitis may cause abnormal mucociliary transport clearance. We examined the relationship between anatomic abnormalities of ciliary ultrastructure secondary to chronic sinusitis and ciliary beat frequency (CBF) before and after middle meatal antrostomy (MMA) in rabbits. Ultrastructural abnormalities of cilia included absence of axoneme membrane, blebs of the axoneme membrane, compound cilia, and ciliary orientation. Two groups of rabbits were studied: Uninfected (group A control, n = 3) and infected (group B, n = 10); 10(8) CFU S. pneumoniae were used to infect the animals in group B after sinus ostial occlusion and chronic sinusitis developed. After 6 weeks with infection, 6 of 10 group B animals underwent MMA and were restudied 6 weeks later. Uninfected animals had mean CBF = 11.75 Hz. Animals with chronic sinusitis had mean CBF = 8.5 Hz (p < 0.05). Six weeks after MMA, mean CBF = 11.82 Hz. This was not different from control. There were significant changes in ciliary ultrastructure when uninfected and infected rabbits were compared. These changes were reversed with MMA. Changes in ciliary ultrastructure correlated significantly with changes in CBF for all animals. Abnormalities in ciliary ultrastructure may account for the abnormal mucociliary transport clearance seen in chronic sinusitis in rabbits.

Modeling bronchial circulation with application to soluble gas exchange: description and sensitivity analysis

The steady-state exchange of inert gases across an in situ canine trachea has recently been shown to be limited equally by diffusion and perfusion over a wide range (0.01-350) of blood solubilities (betablood; ml . ml-1 . atm-1). Hence, we hypothesize that the exchange of ethanol (betablood = 1,756 at 37 degrees C) in the airways depends on the blood flow rate from the bronchial circulation. To test this hypothesis, the dynamics of the bronchial circulation were incorporated into an existing model that describes the simultaneous exchange of heat, water, and a soluble gas in the airways. A detailed sensitivity analysis of key model parameters was performed by using the method of Latin hypercube sampling. The model accurately predicted a previously reported experimental exhalation profile of ethanol (R2 = 0.991) as well as the end-exhalation airstream temperature (34.6 degrees C). The model predicts that 27, 29, and 44% of exhaled ethanol in a single exhalation are derived from the tissues of the mucosa and submucosa, the bronchial circulation, and the tissue exterior to the submucosa (which would include the pulmonary circulation), respectively. Although the concentration of ethanol in the bronchial capillary decreased during inspiration, the three key model outputs (end-exhaled ethanol concentration, the slope of phase III, and end-exhaled temperature) were all statistically insensitive (P > 0.05) to the parameters describing the bronchial circulation. In contrast, the model outputs were all sensitive (P < 0.05) to the thickness of tissue separating the core body conditions from the bronchial smooth muscle. We conclude that both the bronchial circulation and the pulmonary circulation impact soluble gas exchange when the entire conducting airway tree is considered.

Effect of oral antibiotics on lung mucociliary clearance during exacerbation of chronic obstructive pulmonary disease

It has been well established that lung mucociliary clearance is depressed in patients with chronic obstructive pulmonary disease. This study examines whether oral antibiotics have a detectable effect on this clearance mechanism during exacerbation in patients with such disease. Twelve patients with a mean +/- SE age of 63 +/- 2 years participated in a randomized, double-blind, parallel group study to assess the effect of 1 week of treatment with amoxycillin (500 mg t.d.s.) or ciprofloxacin (500 mg b.d.) on lung mucociliary clearance during exacerbation. Lung mucociliary clearance rates were measured by a non-invasive radioaerosol technique. Both drugs on average resulted in small, non-significant, enhancement of mucociliary clearance. Following treatment, the numbers of coughs were reduced in both groups and significantly (P < 0.05) after treatment with ciprofloxacin. Sputum production was also significantly reduced (P < 0.01) in both groups. The magnitude of improvement in lung mucociliary clearance was relatively modest following 1 week of treatment with either antibiotic. Since the number of coughs was significantly less after ciprofloxacin treatment the measured enhancement of lung mucociliary transport is probably, however, an underestimate.

Regulation of the depth of surface liquid in bovine trachea

The luminal surface of airways is lined by a thin film of airway surface liquid (ASL). Physiological regulation of the depth of ASL has not been reported previously. In this paper, we have used low-temperature scanning electron microscopy of rapidly frozen specimens of bovine tracheal epithelium to demonstrate alterations in the depth of ASL in response to the cholinergic agonist methacholine. We first established that methacholine selectively stimulated airway glands, with maximal secretion at approximately 2 min and a return to baseline within approximately 5 min. A 2-min exposure to methacholine increased the depth of ASL from 23 to 78 microns. Thereafter, depth decreased linearly with time, reaching 32 microns at 30 min. The initial increase in depth was blocked by bumetanide, an inhibitor of active chloride secretion, whereas the slow decline back to baseline was inhibited by amiloride, a blocker of active sodium absorption. We conclude that the methacholine-induced changes in ASL depth reflect transient gland secretion followed by liquid absorption across the surface epithelium.

Nasal mucociliary clearance as a factor in nasal drug delivery

The nasal mucociliary clearance system transports the mucus layer that covers the nasal epithelium towards the nasopharynx by ciliary beating. Its function is to protect the respiratory system from damage by inhaled substances. Impairment of nasal mucociliary clearance can result in diseases of the upper airways. Therefore, it is important to study the effects of drugs and drug excipients on nasal mucociliary clearance. A large number of methods are used to assess mucociliary clearance. These methods study the effects of drug and excipients on the mucociliary system in vitro or in vivo in animals and humans. In some cases, the results of different in vitro and in vivo measurements do not correlate well. In vitro methods, especially ciliary beat frequency measurements, have been demonstrated to be valuable tools for toxicity screening. However, in vivo studies are essential to confirm the safety of nasal drug formulations. Nasal mucociliary clearance also has implications for nasal drug absorption. Drugs are cleared rapidly from the nasal cavity after intranasal administration, resulting in fast systemic drug absorption. Several approaches are discussed to increase the residence time of drug formulations in the nasal cavity, resulting in improved nasal drug absorption. However, more experimental evidence is needed to support the conclusion that this improved absorption is caused by a longer residence time of the nasal drug formulation.

Filtration of particulates in the human nose

This report reviews the current theories on the deposition of inhaled particulates in the human nose. The inhalation of particulates represents a challenge to the upper respiratory tract. The concentration of airborne particulates and pollutants varies between occupational and nonoccupational exposure. Regional deposition of potentially hazardous inhaled material determines the local and systemic toxicity. In vitro experiments using casting and molding techniques with water dye models or laser Doppler anemometry indicate that nasal airflow is determined by the size of the nasal valve and the turbinates. The main airstream during inspiration passes through the lower nasal passage. Filtration capacity of the human nose can be expressed mathematically or experimentally. In vivo experiments applying monodisperse or polydisperse aerosols during single or multiple respiratory cycles have shown by using microscopic or laser-optic identification that particles larger than 3 microm have a maximum deposition in the anterior part of the nose (nasal valve). Particles smaller than 3 microm and larger than 0.5 microm are filtered by the nasal mucosa and transported by cilia propulsion to the nasopharynx. The filtration for particles smaller than 0.5 microm is low. They seem to pass easily into the lower respiratory tract. This knowledge has an impact on nasal septal surgery and rhinoplasty. By influencing the structure of the nasal valve and the lower turbinates, the filtration capacity of the nose can be significantly decreased.

Correlations among mucociliary transport, ciliary function, and ciliary structure

Mucociliary transport is one of the most important defense mechanisms of the airway. Mucociliary transport time or rate, as measured using the saccharin test or the radioisotope technique, respectively, is clinically the most relevant parameter, although subject to large intra- and interindividual variability. There is no correlation between mucociliary transport in vivo and ciliary beat frequency ex vivo. Preliminary evidence demonstrates that mucociliary transport correlates with ciliary structure and orientation as investigated with transmission and scanning electron microscopy. A correlation is presented between ciliary beat frequency and secondary ciliary abnormalities. This correlation can best be described according to the logistic sigmoid model (r = 0.69). Based on these functional data, an ultrastructural distinction is proposed among normal (less than 5%), light (5 to 15%), moderate (15 to 25%), and severe (more than 25%) secondary ciliary dyskinesia.

Cigarette smoke inhibits oocyte cumulus complex pick-up by the oviduct in vitro independent of ciliary beat frequency

The purpose of this study was to quantify the effects of acute exposure to mainstream (MS) and sidestream (SS) smoke solutions on oocyte cumulus complex pick-up rate in explants of hamster oviducts using a newly developed in vitro assay. Experiments were performed in handmade perfusion chambers using infundibula from hamster oviducts and oocyte cumulus complexes harvested from mature ovarian follicles. Oocyte cumulus complex pick-up rate was measured by placing a stained oocyte cumulus complex at the base of the infundibulum and recording the length of time needed for the complex to traverse a defined path to the ostium. Addition of either whole MS or SS smoke solutions to the perfusion chamber caused a dose dependent decrease in oocyte cumulus complex pick-up rate. Unexpectedly, upon washout of smoke solutions with control medium, oocyte cumulus complex pick-up rate continued to decline. The gas phase of MS smoke is more inhibitory than the particulate phase, while SS gas and particulate phases inhibit oocyte cumulus complex pick-up rate at equivalent doses. Ciliary beat frequency and oocyte cumulus complex pick-up rate were measured using the same infundibular explants to determine if smoke solutions decrease oocyte cumulus complex pick-up rate by inhibiting ciliary beat frequency. Ciliary beat frequency decreased in MS smoke solutions and recovered either partially or completely after washout of the smoke solutions. SS smoke solutions either produced no change in ciliary beat frequency or stimulated ciliary beat frequency. Oocyte cumulus complex pick-up rate decreased in both MS and SS smoke solutions and further declined during washout when ciliary beat frequency was equivalent to or higher than controls. These data show that oocyte cumulus complex pick-up rate and ciliary beat frequency can be uncoupled and that smoke solutions inhibit oocyte cumulus complex pick-up rate by affecting factors in addition to ciliary beat frequency. Possible reasons for the smoke induced decrease in oocyte cumulus complex pick-up rate are discussed. These results may explain the increased incidence of tubal infertility and ectopic pregnancy observed in women who smoke.

Interaction between ion transporters and the mucociliary transport system in dog and baboon

To gain insight into the role of epithelial ion channels, pumps, and cotransporters in regulating airway water and mucociliary transport, we administered inhibitors of the Na+ channel (amiloride), 3Na-2K-adenosinetriphosphatase (acetylstrophanthidin), and Na-K-2Cl cotransporter (furosemide) to anesthetized dogs and/or baboons. Tracheal ciliary beat frequency was measured by using heterodyne laser light scattering. Tracheal mucus velocity (TMV) and bronchial mucociliary clearance (BMC) or lung mucociliary clearance were measured by using radioaerosols and nuclear imaging. Respiratory tract fluid output was collected by using a secretion-collecting endotracheal tube. In six dogs, amiloride aerosol -lung deposition, 96 +/- 11 microg (means +/- SE)- had minimal effect, whereas acetylstrophanthidin aerosol (lung deposition, 71 +/- 9 microg) increased BMC, and furosemide (40 mg iv) markedly increased TMV. In five baboons, TMV increased after iv furosemide administration (2 mg/kg) as well as by aerosol (lung deposition, 20 +/- 3 mg), coincident with increases in ciliary-mucus coupling from 11.5 +/- 0. 1 to 29.5 +/- 0.4 and 46.5 +/- 0.7 microm/beat, respectively. Furosemide also increased lung mucociliary clearance in baboons. In dogs, respiratory tract fluid output increased after intravenous furosemide from 2.2 +/- 0.5 to 6.8 +/- 1.7 mg/min. When combined with dry-air inhalation, furosemide failed to stimulate TMV and reversed the inhibition of BMC by dry air. Thus pharmacological manipulation of the Na-K-2Cl cotransporter and the 3Na-2K-adenosinetriphosphatase pump may provide increases of clinical relevance in airway hydration and mucociliary transport.

Nasal mucosa inflammation induced by oxygen administration in humans

BACKGROUND

The effect of oxygen toxicity in human airways is still poorly documented. We prospectively evaluated the inflammatory reaction induced by nasal oxygen exposure in an experimental setting.

METHODS

Healthy subjects without nasal symptoms were exposed to high FIO2 during 5 h. Oxygen was delivered from a tank at a flow of 4 l/min to one nostril of each subject and both nostrils were studied. Mucociliary clearance was measured as saccharine nasal transit time (SNTT). Nasal lavage was performed with 5 ml normal saline and the fluid recovered was processed for cytology and measurements of cytokines concentrations: TNF alpha, IL-6, IL-8 and soluble ICAM-1. Under local anaesthesia, biopsies were performed for immunochemistry and electron microscopy.

RESULTS

After oxygen exposure mucociliary clearance decreased and SNTT increased from 16 [9-21] to 20.5 [14-32] min (median and extremes; P < 0.1). In the lavage fluid, concentration of IL-6 was higher in the oxygen-exposed nostril (40.5 [11-128] pg/ml) than in the non-exposed one (7 [0-34] pg/ml; P < 0.05). There was also a trend for a higher IL-8 in the exposed than in the non-exposed nostril, (respectively 501 [214-587] pg/ml and 214 [122-616] pg/ml, P < 0.08), and for a higher number of polymorphonuclear cells in exposed nostril. In the mucosal biopsies substance P was not found, but ICAM-1 expression was higher in the mucosa and submucosa of the exposed nostrils where mast cells were also more abundant and showed piecemeal degranulation.

CONCLUSION

In summary, we found clinical, functional and biological evidence of ongoing nasal inflammation following high FIO2 inhalation for 5 h. Since the histology and behaviour of nasal and bronchi mucosa are very similar, the same inflammatory events are likely to be occurring in the bronchi upon high concentrations of inhaled oxygen.

Pulmonary airway reopening: effects of non-Newtonian fluid viscosity

This paper considers the effects of non-Newtonian lining-fluid viscosity, particularly shear thinning and yield stress, on the reopening of the airways. The airway was simulated by a very thin, circular polyethylene tube, which collapsed into a ribbon-like configuration. The non-Newtonian fluid viscosity was described by the power-law and Herschel-Buckley models. The speed of airway opening was determined under various opening pressures. These results were collapsed into dimensionless pressure-velocity relationships, based on an assumed shear rate gamma = U/(0.5 H), where U and H are the opening velocity and fluid film thickness, respectively. It was found that yield stress, like surface tension, increases the yield pressure and opening time. However, shear thinning reduces the opening time. An increased film thickness of the non-Newtonian lining fluid generally impedes airway reopening; a higher pressure is needed to initiate the airway reopening and a longer time is required to complete the opening process.

Fluid transport across cultures of human tracheal glands is altered in cystic fibrosis

1. There is evidence that defective submucosal gland secretion contributes to the airway pathology of cystic fibrosis (CF). Using a capacitance probe technique, we have compared fluid transport across submucosal gland cultures from individuals with and without CF. 2. Under baseline conditions, approximately 60% of non-CF cultures secreted fluid; the rest absorbed. In secreting tissues, amiloride increased secretion, whereas in absorbing tissues it reduced or reversed absorption. 5-Nitro-2(3-phenylpropylamino)-benzoate (NPPB) a blocker of the CF transmembrane conductance regulator (CFTR), converted secretion to absorption. Thus, the direction and magnitude of baseline fluid movement depended on a balance between active absorption of Na+ and cAMP-dependent secretion of Cl-. 3. 8-(4-Chlorophenylthio)-adenosine 3',5'-cyclic monophosphate (CPT-cAMP), methacholine and luminal uridine 5'-triphosphate (UTP) all induced or increased fluid secretion across non-CF cultures. Results with NPPB and with 4,4'-diisothiocyanatostilbene-2,2'-disulphonate (DIDS), a blocker of Ca(2+)-activated Cl- channels, suggested that fluid secretion induced by CPT-cAMP was mediated primarily by CFTR; UTP acted entirely via Ca(2+)-activated Cl- channels, and methacholine activated both pathways. 4. All CF cultures showed baseline fluid absorption, which was abolished by amiloride. 5. CF cultures showed a normal secretory response to UTP, a reduced response to methacholine, and no response to CPT-cAMP. 6. Thus, the absorptive processes of airway glands are retained in CF, but the cAMP-dependent secretory process is lost. This would markedly reduce the water content of gland secretions. The resulting change in viscosity would contribute to the accumulation of airway mucus which is characteristic of this disease.

Extraction of cilium beat parameters by the combined application of photoelectric measurements and computer simulation

Photoelectric signals were created and used to investigate the features of the signals as a function of the ciliary beat parameters. Moreover, correlation between the simulated and the measured signals permitted measurement of the cilium beat parameters. The simulations of the signals were based on generation of a series of time-frozen top-view frames of an active ciliary area and determination of the amount of light passing through an observation area in each of these frames. All the factors that might contribute to the shape of the signals, namely, partial ciliary transmittance of light, three-dimensional ciliary beat (composed of recovery, effective, and pause parts), phase distribution on the ciliary surface, and the large number of cilia that contribute to the photoelectric signal, were taken into account in generation of the signals. Changes in the ciliary parameters influenced the shape of the photoelectric signals, and the different phases of the beat could not be directly and unequivocally identified in the signals. The degree of temporal asymmetry of the beat and the portion of the cycle occupied by the pause significantly influenced the shapes of both the lower and the upper parts of the signal and the slopes of the signal. Increases in the angle of the arc swept by the cilium during the effective stroke smoothed the signals and increased the duration of the upper part of the signal. The angle of the arc projected by the cilium onto the cell surface during the recovery stroke had minor effects on the signal's shape. Characteristics of the metachronal wave also influenced the signal's shape markedly. Decreases in ciliary spacing smoothed the signals, whereas ciliary length had a minor influence on the simulated photoelectric signals. Comparison of the simulated and the measured signals showed that the beat parameters of the best-fitting simulated signals converged to values that agree well with the accepted range of beat parameters in mucociliary systems.

Mucus quality on horse tracheal epithelium: microscopic grading based on transparency

The aim of this ex-vivo study on excised tracheas of healthy horses was to characterise the microscopic heterogeneity of mucus quality by a visual grading system based on transparency and to determine whether differences in mucus quality, assessed by a visual grading system, influence tracheal mucus velocity (TMV). Small pieces of each trachea were mounted into a humidified chamber under a microscope. Mucus quality was visually subdivided into four grades (MG) and ciliary beat frequency and TMV were determined. Mucus on excised horse tracheal epithelium does not form a homogenous layer. We observed flakes and streams of a great heterogeneity, which by the characteristic of transparency can be qualified and quantified. Visual characterisation of mucus was able to explain a considerable part of TMV variation. Therefore, it can be considered as a suitable non-invasive method for the evaluation of mucus quality and transport effectiveness.

Ring distraction technique for measuring surface tension of sputum: relationship to sputum clearability

Poor sputum clearance has been related to sputum adhesion tension. In this study, we describe a modified du Noüy ring method for measuring the surface tension (gamma) of small samples of sputum and for comparinge the calculated work of adhesion (Wad) for sputum specimens with the measured mucociliary transportability (MCTR) and cough transportability (CTR). The gamma, as measured by this method, correlates with gamma measured by sputum contact angle on a low-surface-energy solid (R2 = 0.368, P = 0.03). There is a small but significant difference in measurements made by these two methods (P = 0.03). Wad calculated from the surface tension ring method is inversely correlated with CTR (R2 = 0.181, P = 0.004) but has no correlation with MCTR in this study. The miniaturized ring method gives accurate and reproducible measurements of the surface tension of small amounts of respiratory secretions. Because sputum behaves enough like a liquid that the assumptions made in using the Young equation to calculate Wad appear valid, we also showed that the Neumann equation can be used to determine the surface tension of sputum by its contact angle on tetrafluoroethylene (Teflon).

Purinergic stimulation of rabbit ciliated airway epithelia: control by multiple calcium sources

1. Simultaneous measurements of average intracellular calcium concentration ([Ca2+]i) and ciliary beat frequency (CBF) were carried out on ciliated rabbit tracheal cells in order to determine quantitatively the role of calcium in the regulation of mucus-transporting cilia. 2. Extracellular ATP caused a rapid increase in both [Ca2+]i and CBF in the 0.1-1000 microM concentration range. The rise in [Ca2+]i levelled off to an elevated [Ca2+]i plateau while the cilia remained in a high activation state. The magnitude of the rise in [Ca2+]i and CBF as well as the value of the elevated [Ca2+]i plateau and the value of the sustained CBF were dependent on the concentration of ATP in the solution. 3. No correlation was found between the mean values of [Ca2+]i and CBF at rest but a sigmoidal relationship was found to exist between the maximal rises of these parameters following excitation with extracellular ATP. This sigmoidal correlation incorporated the experiments where [Ca2+]i rise was induced by depletion of internal calcium stores with thapsigargin or by entry of calcium induced by ionomycin. 4. Extracellular ATP caused both the release of calcium from internal stores and calcium influx from the extracellular solution. The release of calcium was identified as originating from a thapsigargin-sensitive and a thapsigargin-insensitive calcium store. It is suggested that the release of calcium from these stores induces the initial rise in CBF. 5. The sustained activation of the cilia and elevated calcium plateau were found to be the result of the extracellular ATP-induced calcium influx. This calcium influx was insensitive to the voltage-gated calcium channel inhibitors verapamil and diltiazem, but was completely eliminated by lowering the extracellular calcium concentration to 0.1 microM. 6. We propose that the initial jump in the CBF is mediated by the calcium released from a thapsigargin-insensitive calcium store adjacent to the cilia, while the later, and longer, rise in CBF is the result of the calcium emanating from the thapsigargin-sensitive store which is positioned further away from the cilia within the cell cytoplasm. The calcium influx that follows is responsible for sustaining the cilia at a high level of excitation.

Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa

OBJECTIVE

To review the available literature on the relationship between the humidity and temperature of inspired gas and airway mucosal function.

DATA SOURCES

International computerized databases and published indices, experts in the field, conference proceedings, bibliographies.

STUDY SELECTION/DATA EXTRACTION

Two hundred articles/texts on respiratory tract physiology and humidification were reviewed. Seventeen articles were selected from 40 articles for inclusion in the published data verification of the model. Selection was by independent reviewers. Extraction was by consensus, and was based on finding sufficient data.

DATA SYNTHESIS

A relationship exists between inspired gas humidity and temperature, exposure time to a given humidity level, and mucosal function. This relationship can be modeled and represented as an inspired humidity magnitude vs. exposure time map. The model is predictive of mucosal function and can be partially verified by the available literature. It predicts that if inspired humidity deviates from an optimal level, a progressive mucosal dysfunction begins. The greater the humidity deviation, the faster the mucosal dysfunction progresses.

CONCLUSIONS

A model for the relationship between airway mucosal dysfunction and the combination of the humidity of inspired gas and the duration over which the airway mucosa is exposed to that humidity is proposed. This model suggests that there is an optimal temperature and humidity above which, and below which, there is impaired mucosal function. This optimal level of temperature and humidity is core temperature and 100% relative humidity. However, existing data are only sufficient to test this model for gas conditions below core temperature and 100% relative humidity. These data concur with the model in that region. No studies have yet looked at this relationship beyond 24 hrs. Longer exposure times to any given level of inspired humidity and inspired gas temperatures and humidities above core temperature and 100% relative humidity need to be studied to fully verify the proposed model.

Asymmetric interactions between phosphorylation pathways regulating ciliary beat frequency in human nasal respiratory epithelium in vitro

1. The effects of the sequential stimulation of ciliary beat frequency (CBF) via two different phosphorylation cascades (dependent on protein kinase A (PKA) and calmodulin, respectively) were determined using video microscopy applied to a perfused preparation of human nasal respiratory epithelium in vitro. Dibutyryl cyclic AMP (db-cAMP) (10(-3) M) was used to stimulate PKA and the calcium ionophore 4-Br-A23187 (10(-5) M) was used to stimulate calmodulin-dependent phosphorylation. 2. Perfusion with db-cAMP (10(-3) M) alone showed an early rise in CBF (15.0 +/- 4%, mean +/- S.E.M., P < 0.05) by 10 min which remained elevated for 35 min; in contrast, the highest CBF response to 4-Br-A23187 (10(-5) M) alone was not achieved until 35 min (16.1 +/- 1.8%, P < 0.05). 3. When a db-cAMP stimulus was applied to cells which had been pre-incubated with 4-Br-A23187 for 30 min, a further rise in CBF (maximal at 20 min, 14.3 +/- 2%, P < 0.05) was observed. Reversing the sequence of perfusions, cells pre-incubated with db-cAMP showed no further rise in response to stimulation with 4-Br-A23187. 4. We hypothesized that PKA inhibited the response to the 4-Br-A23187. This notion was supported by the restoration of the CBF response (22.8 +/- 4%, P < 0.05) to 4-Br-A23187 when the cells were pre-incubated with the protein kinase inhibitor 1-(5-isoquinolinyl-sulphonyl)-2-methylpiperazine (10(-3) M), before the sequential perfusions with db-cAMP and 4-Br-A23187. We conclude that the A23187-dependent pathway, which regulates intrinsic CBF, is inhibited by db-cAMP but not vice versa.

Purinergically induced membrane fluidization in ciliary cells: characterization and control by calcium and membrane potential

To examine the role of membrane dynamics in transmembrane signal transduction, we studied changes in membrane fluidity in mucociliary tissues from frog palate and esophagus epithelia stimulated by extracellular ATP. Micromolar concentrations of ATP induced strong changes in fluorescence polarization, possibly indicating membrane fluidization. This effect was dosage dependent, reaching a maximum at 10-microM ATP. It was dependent on the presence of extracellular Ca2+ (or Mg2+), though it was insensitive to inhibitors of voltage-gated calcium channels. It was inhibited by thapsigargin and by ionomycin (at low extracellular Ca2+ concentration), both of which deplete Ca2+ stores. It was inhibited by the calcium-activated potassium channel inhibitors quinidine, charybdotoxin, and apamine and was reduced considerably by replacement of extracellular Na+ with K+. Hyperpolarization, or depolarization, of the mucociliary membrane induced membrane fluidization. The degree of membrane fluidization depended on the degree of hyperpolarization or depolarization of the ciliary membrane potential and was considerably lower than the effect induced by extracellular ATP. These results indicate that appreciable membrane fluidization induced by extracellular ATP depends both on an increase in intracellular Ca2+, mainly from its internal stores, and on hyperpolarization of the membrane. Calcium-dependent potassium channels couple the two effects. In light of recent results on the enhancement of ciliary beat frequency, it would appear that extracellular ATP-induced changes both in ciliary beat frequency and in membrane fluidity are triggered by similar signal transduction pathways.

The effect of a new expectorant drug on mucus transport in chronic bronchitis

The expectorant effect of two weeks treatment with cistinexine dihydrochloride (Rec 15/1884/2, Recordati S.p.A, Milano), on mucus transport rate (MTR) was evaluated in a double-blind study on 30 chronic bronchitis patients, 20 treated with active drug (group D), 10 with placebo (group P). After inhalation of nebulized 99mTc labelled human albumin minimicrospheres (HAMM), MTR was determined by external gamma-camera counting over the thorax. To control initial particle deposition a penetration index (PI) was determined as the ratio of activity between peripheral and hilar regions of equal size. Before treatment no differences were found between groups in spirometry, PI, and MTR. After treatment spirometry and PI remained unchanged in both groups. MTR expressed as the half time (T1/2) of the exponential fitting between 0 and 40 minutes showed an interesting behaviour, particularly in group D. Considering the group as a whole, T1/2 did not vary significantly (381 +/- 400 min. before, vs 224 +/- 132 min. after treatment, p = 0.090). However, a statistically significant reduction of the index (815 +/- 396 min. before vs. 258 +/- 120 min. after treatment, p < 0.01) occurred in the seven patients showing at baseline a T1/2 higher than 338 +/- 182 min. (the reference value observed in our laboratory for 8 asymptomatic non smoker subjects). Therefore, the beneficial effect of the drug is seen only in patients with a severe impairment of MTR.

Influence of culture duration and ciliogenesis on the relationship between ciliary beat frequency and temperature in nasal epithelial cells

Human nasal epithelial cells from excised mucosal specimens were cultured directly in suspension and sequentially on monolayer and in suspension. Ciliary beat frequency (CBF) was measured by fast Fourier transform analysis of computerized microscopic photometry. In biopsy material CBF increased in an approximately linear fashion at 0.6 Hz/degree C between 20 degrees C and 35 degrees C. Above 35 degrees C the increase was lower and was 0.25 Hz/degree C between 40 degrees C and 44 degrees C. CBF increased more rapidly in suspension culture between 25 and 35 degrees C (1 Hz/degree C) but reached a plateau at approximately 40 degrees C and decreased with further temperature elevation. Up to 44 degrees C all changes were reversible, while irreversible slowing and deterioration occurred above 45 degrees C. Values found after 3 weeks' initial suspension culture were similar to those after 6 weeks' sequential monolayer suspension culture. After 3 weeks of ciliogenesis in sequential suspension culture, all values up to 41 degrees C were statistically significantly higher than those under the other conditions. Ciliary activity was maintained and expressed in culture. CBF was higher than in biopsy material and a reversible decrease was observed at high temperature.

The lack of effect of benzalkonium chloride on the cilia of the nasal mucosa in patients with perennial allergic rhinitis: a combined functional, light, scanning and transmission electron microscopy study

BACKGROUND

Controversy still exists about the effect of 0.02% benzalkonium chloride (BKC), a preservative in many nasal sprays, on human nasal epithelium in vivo.

OBJECTIVE

To determine the safety of BKC by assessing its effect on the function and morphology of cilia of human nasal epithelium.

METHODS

A single-centre, double-blind nasal biopsy study in 22 patients with perennial allergic rhinitis, receiving fluticasone propionate aqueous nasal spray (FPANS) containing BKC, BKC plus placebo or placebo alone for 6 weeks. Before, at two weekly intervals during treatment and 2 weeks after treatment ceased an indigocarmine saccharine transport time (ICST) was performed.

RESULTS

ICST results did not significantly vary between the groups. There was no statistical relationship between the number of ciliated cells present and the treatment the patients received. Scanning and transmission electron microscopy examination showed no effects of BKC.

CONCLUSION

Despite reports of its ciliostatic effects in vitro, BKC did not have such an effect when it was applied for 6 weeks (with/without fluticasone propionate) to the nasal mucosa of perennial allergic rhinitis patients in vivo.

Purification and characterization of factors produced by Aspergillus fumigatus which affect human ciliated respiratory epithelium

The mechanisms by which Aspergillus fumigatus colonizes the respiratory mucosa are unknown. Culture filtrates of eight of nine clinical isolates of A. fumigatus slowed ciliary beat frequency and damaged human respiratory epithelium in vitro. These changes appeared to occur concurrently. Culture filtrates of two clinical isolates of Candida albicans had no effect on ciliated epithelium. We have purified and characterized cilioinhibitory factors of a clinical isolate of A. fumigatus. The cilioinhibitory activity was heat labile, reduced by dialysis, and partially extractable into chloroform. The activity was associated with both high- and low-molecular-weight factors, as determined by gel filtration on Sephadex G-50. A low-molecular-weight cilioinhibitory factor was further purified by reverse-phase high-performance liquid chromatography and shown by mass spectrometry to be gliotoxin, a known metabolite of A. fumigatus. Gliotoxin significantly slowed ciliary beat frequency in association with epithelial damage at concentrations above 0.2 microgram/ml; other Aspergillus toxins, i.e., fumagillin and helvolic acid, were also cilioinhibitory but at much higher concentrations. High-molecular-weight (> or = 35,000 and 25,000) cilioinhibitory materials had neither elastolytic nor proteolytic activity and remain to be identified. Thus, A. fumigatus produces a number of biologically active substances which slow ciliary beating and damage epithelium and which may influence colonization of the airways.

Glycosaminoglycans in porcine lung: an ultrastructural study using cupromeronic blue

Glycosaminoglycans (GAGs) are essential components of the extracellular matrix contributing to the mechanical properties of connective tissues as well as to cell recognition and growth regulation. The ultrastructural localization of GAGs in porcine lung was studied by means of the dye Cupromeronic Blue in the presence of 0.3 M MgCl2 according to Scott's critical electrolyte concentration technique. GAGs were observed in locations described as follows. Pleura: Dermatan sulphate (DS) and chondroitin sulphate (CS) attached in the region of the d-band of collagen fibrils, interconnecting the fibrils; heparan sulphate (HS) at the surface of elastic fibers and in the basement membrane of the mesothelium and blood vessels. Bronchial cartilage: Abundant amounts of GAGs were observed in three zones: pericellular, in the intercellular matrix and at the perichondrial collagen. By enzyme digestion a superficial cartilage layer with predominantly CS could be distinguished from a deep zone with CS and keratan sulphate. The structure of the large aggregating cartilage proteoglycan was confirmed in situ. Airway epithelium: HS at the whole surface of cilia and microvilli and in the basement membrane of the epithelial cells. Alveolar wall: CS/DS at collagen fibrils, HS at the surface of elastic fibers and in the basement membranes of epithelium and endothelium.

Nasal mucus clearance in rats: differences with sex and phase of the oestrous cycle

We studied the changes in airway mucus rheology and clearability, as well as in morphometric indices, between male rats and females in either the oestrous or dioestrous phases of the oestrous cycle. Three-month-old Wistar rats were studied and the phases of the oestrous cycle were determined based on analysis of vaginal smears stained by a modified Shorr's procedure. Nasal mucus samples were analysed by means of magnetic rheometry and determination of in vitro transport rate in the frog palate preparation. In situ clearance on the exposed nasal septum was also determined. The mucociliary velocity in situ was significantly affected by both sex and the oestrous cycle phase. In female rats, dioestrous phase clearance was significantly slower than the oestrous phase one. Clearance in male rats was faster than that of both the phases studied in females. Mucus rigidity of females in the oestrous phase was more rigid than that of females in the dioestrous phase and that of males. Mucus viscosity/elasticity ratio for deformations performed at high frequencies was greater for females in comparison with males. Cough clearability computed on the basis of rheological parameters was predicted to be more favourable in females. There were no significant differences between the three groups in mucociliary clearance in vitro. Morphometric studies of the nasal epithelium showed that epithelial and glandular volumes did not exhibit sex- or oestrous-phase-related differences, but the amount of epithelial acidic glycoproteins was lower in females in the oestrous phase in comparison with males and those in the dioestrous phase, the same trend being observed in the glands of the lamina propria.(ABSTRACT TRUNCATED AT 250 WORDS)

Maxillary sinus aspergillosis: diagnosis and differentiation of the pathogenesis based on computed tomography densitometry of sinus concretions

PURPOSE

The efficacy of preoperative computed tomography (CT) densitometry in evaluating the origin of sinus concretions (SC) in sinus aspergillosis (SA) and its value for differentiation between a dental (endodontic) and an aerogenic pathogenesis were examined.

PATIENTS AND METHODS

Thirty-two patients who demonstrated radiodense maxillary sinus concretions in standard radiography underwent an additional preoperative CT examination of the maxillary sinus and the SC. The density of the SC and the root canal filling materials was assessed. The SC were subdivided into organic (< 1,500 HU) and inorganic (> 1,500 HU) masses; this classification was useful in the differentiation between a dental and an aerogenic pathogenesis of SA.

RESULTS

SA was diagnosed in 22 patients (68.8%). The SC of SA patients had a density of 2,566.5 +/- 713.6 HU, whereas those of patients without SA had a density of 1,159.9 +/- 1,008.4 HU (P < .01). A correlation between the density of inorganic SC and that of root filling materials was found (r = .78, P < .01).

CONCLUSION

CT densitometry allows a classification of SC into two subgroups. The correlation between the density of root filling materials and that of radiodense sinus concretions seems to point to a "dental" origin of some concretions in SA. However, "organic" masses found in CT densitomentric examinations represent endogenous fungal products, which indicate an aerogenic pathogenesis of SA. Additional CT examinations of radiodense sinus concretions may thus be of some value for diagnosing SA and differentiating their pathogenesis.

Species differences in the physical and transport properties of airway secretions

The clearance of airway secretions is vital in protecting the mammalian lung from pollution and infection. Diverse animal models have been used to study lung diseases associated with impaired secretion clearance. The extrapolation of data from animal models to humans is based on the assumption that there are structural and functional similarities in the airway epithelium and secretions. This manuscript reviews regulation of mucus secretion as well as the physical and transport properties of respiratory mucus. As tracheal size increases, the rigidity of airway secretions decreases, and rigidity is inversely correlated with mucociliary transportability. These differences are placed in the context of previously reported species and regional differences in transepithelial potential difference and the tracheobronchial epithelial cell population. Tracheal mucus transport velocity varies with the species studied and has been shown to positively correlate with tracheal surface area. A progressive increase in the rate of mucus transport from the small to the large airways has also been reported. The reduction in mucus rigidity from small to large airways could be one of the mechanisms responsible for velocity gradients, which facilitate mucociliary transport. Because airway dimensions, rather than anatomic level of the airway, may better predict epithelial secretory response, studies to assess the physiologic responses in human airways require the use of an animal model with a similar-sized airway.

Airway mucus and epithelial function in a canine model of single lung autotransplantation

Impaired mucociliary function following lung transplantation has been reported in several human and animal studies. This could be a result of altered ciliary function or mucus properties or both. We assessed airway epithelial function by means of transepithelial potential difference (PD) measurements and physical analysis of mucus. Six mongrel dogs underwent single lung autologous transplantation. Measurements were performed preoperatively and 1, 2, 4, and 10 months postoperatively. At 1 and 2 months postoperatively, there was a significant fall in PD for the transplanted, left mainstem bronchus only (-13.5 +/- 1.7 mV at 1 month and -14.6 +/- 1.7 mV at 2 months postoperatively vs -18.6 +/- 2.3 mV preoperatively, baseline; p < 0.001 for both). The PD values in the small airways, right mainstem bronchus, and the trachea remained unchanged. At 2 months postoperation, the mucus collection rate on the left side was increased (p = 0.03), while the mucus viscoelasticity was decreased (p = 0.04). By 4 months postoperation, all epithelial parameters had returned to baseline, and there was no difference in radioaerosol clearance between the two lungs. The PD decrease and alterations in secretion rate and viscoelasticity reflect disturbed epithelial functional integrity at the site of anastomosis still present at 2 months postoperation. Recovery of bronchial epithelial function and clearance in canine studies of lung autotransplantation after healing of the anastomosis area suggest that persistent impairment of lung clearance observed in some long-term human lung transplantation survivors may be due to other mechanisms such as impaired healing or epithelial function or both, during immunosuppressive therapy. Mucociliary function in the anastomosis area is compromised until complete healing ensues; we speculate that chest physiotherapy may aid in overcoming this obstacle.

The effect of long-term antibiotic therapy upon ciliary beat frequency in chronic rhinosinusitis

The mucociliary escalator is the first line of defence of the upper and lower respiratory tracts (Greenstone and Cole, 1985; Sleigh et al., 1988). Failure of mucociliary clearance is associated with chronic or recurrent respiratory tract infection. Ten patients with chronic rhinosinusitis underwent nasal brushings for the assessment of ciliary beat frequency. In two no beating cilia were seen; in the remainder the mean value was 9.3 Hz +/- 2.3; range 6.1-12.8 Hz (n = 8). Following three months continuous oral antibiotic therapy repeat nasal brushings demonstrated increased ciliary beat frequencies in all patients, mean value 13.7 Hz +/- 1.6; range 11.5-16.3 Hz (n = 10); (p < 0.01; paired t-test). Depression of mucociliary clearance can occur secondarily to chronic infection and is improved by prolonged antibiotics.