Particle deposition and clearance in the bronchial tree

A comparison of CFPD, compartment, and uniform distribution models for radiation dosimetry of radionuclides in the lung

Radioactive aerosols that arise from natural sources and nuclear accidents can be a long-term hazard to human health. Despite the heterogeneous particle deposition in the respiratory tract, uniform aerosol doses have long been assumed in respiratory radiation dosimetry predictions, such as in the compartment and uniform distribution models. It is unclear how these deposition patterns affect internal radiation doses, which are critical in the health assessment of radioactive hazards. This work seeks to quantify the radio-dosimetry sensitivity to initial deposition patterns by comparing computational and compartment/uniform models. A new approach was developed to implement the compartment model into voxel phantoms (e.g. VIP-man) for radiation dosimetry. The calculated radiation fluence, energy deposition density and organ doses were compared to those obtained from coupling computational fluid-particle dynamics (CFPD) with Monte Carlo radiation transport and to those obtained from uniform source distribution approximation. The results show that the source particle distribution within the respiratory system substantially influences the radiation dosimetry distribution. The compartment and uniform models underestimated aerosol deposition in the crania ridge, leading to lower doses in the trachea and surrounding organs. For 0.5 MeV gammas, the CFPD-Monte Carlo N-particle (MCNP) model predicted a tracheal dose twice that of the compartment model and four times the uniform model. For 1 MeV betas, the CFPD-MCNP-predicted tracheal dose is 2.6 times that of the compartment model and 14 times the uniform model. Compared to the compartment/uniform models, the CFPD approach predicted a 50% lower beta dose in the lung but higher beta doses in the heart (six times), liver (four times) and stomach (2.5 times). It is suggested that including compartments for the lung periphery and tracheal carina ridge may improve the dosimetry accuracy of compartment models.

Deposition and cellular interaction of cancer-inducing particles in the human respiratory tract: Theoretical approaches and experimental data

Inhaled particles that are deposited on the epithelial surface of the human respiratory tract (HRT) may act as serious health hazards, in the worst case inducing the development of various types of lung cancer. In the past, several particle types, such as asbestos fibers, hard wood dust and cigarette smoke were identified and classified as human carcinogens. Due to their different physical and chemical properties these particles are characterized by remarkable discrepancies concerning their transport, deposition, and epithelial interaction in the HRT. In order to continuously increase the knowledge on carcinogenic particle behavior in the HRT, theoretical models describing single stages of particulate action in the lung airways were developed over the last few decades. With the help of these mathematical approaches physical characteristics of aerosolized drugs as well as protocols of inhalative therapies for the treatment of lung diseases could be significantly optimized. In addition, new experimental setups for the enlightenment of possible mechanisms underlying particle-lung interaction were, among other things, founded upon the results of theoretical computations. This review summarizes the efforts and advances of theoretical lung modeling from the early 1970s till today, thereby mainly directing the attention to the simulation of carcinogenic particle behavior in the HRT.

Strategies for improving mucosal drug delivery

Within this review we will provide a comprehensive understanding in order to improve existing strategies and to develop new systems to lower the barrier for improving mucosal drug delivery. Mucosal administration of drugs achieves a therapeutical effect as the permeation of significant amounts of a drug is permitted through the absorption membrane. The absorption membrane relies on the mucosal layer and the epithelial tissue. In order to overcome barriers, drug delivery systems have to exhibit various functions and features, such as mucoadhesive and protective activity, solubility improving, permeation and uptake enhancing, and drug release controlling properties. This review also aims to provide an insight of well-distinguished strategies to date, as well as provide a focus on the enhancement of membrane permeability. Furthermore, since the development and functions of drug delivery systems exert a high influence on the ability of drug permeation through membrane, these considerations will also be discussed in this review.

Mucus-penetrating nanoparticles for drug and gene delivery to mucosal tissues

Mucus is a viscoelastic and adhesive gel that protects the lung airways, gastrointestinal (GI) tract, vagina, eye and other mucosal surfaces. Most foreign particulates, including conventional particle-based drug delivery systems, are efficiently trapped in human mucus layers by steric obstruction and/or adhesion. Trapped particles are typically removed from the mucosal tissue within seconds to a few hours depending on anatomical location, thereby strongly limiting the duration of sustained drug delivery locally. A number of debilitating diseases could be treated more effectively and with fewer side effects if drugs and genes could be more efficiently delivered to the underlying mucosal tissues in a controlled manner. This review first describes the tenacious mucus barrier properties that have precluded the efficient penetration of therapeutic particles. It then reviews the design and development of new mucus-penetrating particles that may avoid rapid mucus clearance mechanisms, and thereby provide targeted or sustained drug delivery for localized therapies in mucosal tissues.

Estimating the lung burden from exposure to aerosols of depleted uranium

Following exposure to aerosols of depleted uranium (DU), biological samples show the presence of a synthetic mixture of natural uranium and DU. By partitioning the uranium in the 24-h urine sample along the isotopic fractions of natural uranium and DU, one can study the kinetics of these subpopulations independently. A linear model is developed to estimate the lung burden of DU from measurements of DU in 24-h urine samples, years after inhalational exposure to aerosols of DU. This model takes into account the intracellular dissolution of the retained particles and the precipitation of a significant fraction of the dissolved DU as insoluble uranyl phosphates.

Peripheral opioidergic regulation of the tracheobronchial mucociliary transport system

We hypothesized that, in the airway mucosa, opioids are inhibitory neural modulators that cause an increase in net water absorption in the airway mucosa (as in the gut). Changes in bidirectional water fluxes across ovine tracheal mucosa in response to basolateral application of the opioid peptides beta-endorphin, dynorphin A-(1-8), and [d-Ala(2), d-Leu(5)]-enkephalin (DADLE) were measured. beta-Endorphin and dynorphin A-(1-8) decreased luminal-to-basolateral water fluxes, and dynorphin A-(1-8) and DADLE increased basolateral-to-luminal water flux. These responses were electroneutral. In seven beagle dogs, administration of aerosolized beta-endorphin (1 mg) to the tracheobronchial airways decreased the clearance of radiotagged particles from the bronchi in 1 h from 34.7 to 22.0% (P < 0.001). Naloxone abrogated the beta-endorphin-induced changes in vitro and in vivo. Contrary to our hypothesis, the opioid-induced changes in water fluxes would all lead to a predictable increase in airway surface fluid. The beta-endorphin-induced increases in airway fluid together with reduced bronchial mucociliary clearance may produce procongestive responses when opioids are administered as antitussives.

Stationary and nonstationary correlation-frequency analysis of heterodyne mode laser light scattering: magnitude and periodicity of canine tracheal ciliary beat frequency in vivo

Stationary and nonstationary correlation-frequency analysis of heterodyne laser light scattering were utilized to make automated, on-line, objective measurements of tracheal ciliary beat frequency (CBF) in intact, anesthetized canines. The stationary correlation-frequency analysis laser light-scattering technique was used to assess the magnitude of the CBF stimulatory responses induced by aerosolized 10(-5) M fenoterol (sympathomimetic), and 10(-8) M and 10(-6) M methacholine (parasympathomimetic) delivered to the whole lungs of eight barbiturate-anesthetized beagles. The nonstationary correlation-frequency analysis laser light-scattering technique was used to measure the effect on tracheal CBF of increasing the cytosolic calcium ion concentration with a calcium ionophore, A23187. Aerosolized A23187 was delivered to the isolated tracheal lumens of eight beagle dogs in cumulative doses ranging from 10(-9)M to 10(-6) M. Administration of the ionophore synchronized the CBF with a period of 5.3 min. Dose dependencies were observed in both the time to the peak CBF stimulation and the magnitude of the stimulatory response. The magnitude of CBF stimulation was inhibited by prior administration of aerosolized nifedipine (2 mg/ml), a voltage-operated calcium channel blocker. The A23187-induced modulation period of tracheal CBF, was unchanged by nifedipine. These are the first data to demonstrate that the magnitude and periodicity of CBF are two independent coupled processes. The cooperativity of these two processes could be determined in the effectiveness of mucociliary transport.

Mucociliary transport in ICU patients

OBJECTIVES

The objectives of this study were to determine the bronchial mucus transport velocities in ventilated ICU patients and to study the possible role of impaired mucus transport in the development of retention of secretion and pneumonia.

DESIGN

The patients were studied prospectively in a convenience sample trial.

SETTING

The study took place at a university hospital.

PATIENTS

Thirty-two ventilated patients in a surgical ICU were included in the study. The study was approved by the Ethics Committee of the University of Ulm.

INTERVENTIONS

Bronchial mucus transport velocity (BTV) was measured with a small volume of technetium 99m-labeled albumin microspheres within the first 3 days of mechanical ventilation. The radiolabeled bolus was deposited at the distal end of the right and left main bronchus via flexible bronchoscopy. The movement of the microspheres toward the trachea was visualized and recorded using a scintillation camera. After determination of BTV, the patients were examined daily for 4 days to record pulmonary complications (defined as retention of secretion and nosocomial pneumonia).

MAIN MEASUREMENTS AND RESULTS

The median BTV in the right primary bronchus was 0.8 mm/min and in the left it was 1.4 mm/min. In nine patients both radioactive drops remained at the application site. In 14 patients, a total of 19 pulmonary complications occurred (10 times retention of secretion, 9 times pneumonia). Patients with pulmonary complications had statistically significant lower BTV compared with patients without pulmonary complications; in the left bronchus 0 (0 to 6.5) mm/min (median with range) vs 3.5 (0 to 10.5) mm/min (p < 0.01) and in the right bronchus 0 (0 to 3.0) mm/min vs 4.7 (0 to 11.7) mm/min (p < 0.01).

CONCLUSIONS

Ventilated patients in the ICU frequently have impaired mucus transport, which is associated with the development of retention of secretion and pneumonia.

Measurement of mucociliary transport velocity in ventilated patients. Short-term effect of general anesthesia on mucociliary transport

OBJECTIVES

The objectives of this study were to evaluate a method for measuring BTV in ventilated patients and to study the short-term effect of general anesthesia with midazolam, Fentanyl, pancuronium and O2:N2O on BTV.

DESIGN

The study included phantom measurements on a bronchoscopy model and the determination of BTV in patients in a convenience sample trial.

SETTING

The study took place in a university hospital.

PATIENTS

Fourteen patients undergoing major abdominal surgery with planned postoperative mechanical ventilation were included in the study. All patients gave their written informed consent to participate in the study.

INTERVENTIONS

Bronchial mucus transport velocity was measured with a small volume (0.05 to 0.08 ml) of technetium 99m-labeled albumin microspheres with an activity of 3 MBq. The radiolabeled bolus was deposited on the dorsal mucosal surface at the distal end of the right and left main bronchus via flexible bronchoscopy. The movement of the microspheres toward the trachea was visualized and recorded using a scintillation camera; quantitative evaluation utilized the condensed image.

MAIN MEASUREMENTS AND RESULTS

The technique was validated in a bronchoscopy model and in an intubated patient by moving a radioactive drop in a catheter through the main bronchi at velocities from 0 to 20 mm/min. The velocities determined by the image processing technique correlated well with the data by the model and patient determination (right bronchus, r = 1.0; left bronchus, r = 1.0). In seven ventilated patients, mechanical irritation by the fiberscope produced no significant effect on BTV. The BTV was measured preoperatively in seven conscious patients one day before surgery while they received local anesthesia with 10 ml of 1 percent lidocaine and postoperatively while they received intubation anesthesia. The preoperative and postoperative BTV values showed no significant differences (10.5; 5.7 to 13.7 mm/min; vs 9.7 (3.7 to 15.3) (median with range).

CONCLUSION

By this method, bronchial transport velocity can be determined in a relatively short time in ventilated patients. General anesthesia with midazolam, Fentanyl, pancuronium and O2:N2O does not influence BTV.