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Abstract
Drug delivery using a surfactant vehicle has the potential to prevent systemic side effects by delivering therapeutic agents directly to the respiratory system. The inherent chemical properties of surfactant allows it to readily distribute throughout the respiratory system. Therapeutic agents delivered by surfactant can primarily confer additional benefits but have potential to improve surfactant function. It is critically important that additional agents do not interefere with the innate surface tension lowering function of surfactant. Systemic evaluation through benchtop, translational and human trials are required to translate this potential technique into clinical practice.
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Affiliation(s)
- Arun Sett
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Services, Joan Kirner Women's and Children's, Sunshine Hospital, Victoria, Australia.
| | - Charles C Roehr
- Newborn Services, Southmead Hospital, North Bristol NHS Trust Bristol, Bristol, UK; Faculty of Health Sciences, University of Bristol, Bristol, UK; Oxford Population Health, National Perinatal Epidemiology Unit, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Brett J Manley
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia
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Hasan D, Shono A, van Kalken CK, van der Spek PJ, Krenning EP, Kotani T. A novel definition and treatment of hyperinflammation in COVID-19 based on purinergic signalling. Purinergic Signal 2021; 18:13-59. [PMID: 34757513 PMCID: PMC8578920 DOI: 10.1007/s11302-021-09814-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/18/2021] [Indexed: 12/15/2022] Open
Abstract
Hyperinflammation plays an important role in severe and critical COVID-19. Using inconsistent criteria, many researchers define hyperinflammation as a form of very severe inflammation with cytokine storm. Therefore, COVID-19 patients are treated with anti-inflammatory drugs. These drugs appear to be less efficacious than expected and are sometimes accompanied by serious adverse effects. SARS-CoV-2 promotes cellular ATP release. Increased levels of extracellular ATP activate the purinergic receptors of the immune cells initiating the physiologic pro-inflammatory immune response. Persisting viral infection drives the ATP release even further leading to the activation of the P2X7 purinergic receptors (P2X7Rs) and a severe yet physiologic inflammation. Disease progression promotes prolonged vigorous activation of the P2X7R causing cell death and uncontrolled ATP release leading to cytokine storm and desensitisation of all other purinergic receptors of the immune cells. This results in immune paralysis with co-infections or secondary infections. We refer to this pathologic condition as hyperinflammation. The readily available and affordable P2X7R antagonist lidocaine can abrogate hyperinflammation and restore the normal immune function. The issue is that the half-maximal effective concentration for P2X7R inhibition of lidocaine is much higher than the maximal tolerable plasma concentration where adverse effects start to develop. To overcome this, we selectively inhibit the P2X7Rs of the immune cells of the lymphatic system inducing clonal expansion of Tregs in local lymph nodes. Subsequently, these Tregs migrate throughout the body exerting anti-inflammatory activities suppressing systemic and (distant) local hyperinflammation. We illustrate this with six critically ill COVID-19 patients treated with lidocaine.
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Affiliation(s)
| | - Atsuko Shono
- Department of Anaesthesiology and Critical Care Medicine, School of Medicine, Showa University, Tokyo, 142-8666, Japan
| | | | - Peter J van der Spek
- Department of Pathology & Clinical Bioinformatics, Erasmus MC, Erasmus Universiteit Rotterdam, 3015 CE, Rotterdam, The Netherlands
| | | | - Toru Kotani
- Department of Anaesthesiology and Critical Care Medicine, School of Medicine, Showa University, Tokyo, 142-8666, Japan
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Scanziani M, Amigoni M, Bellani G, Zambelli V, Masson S, Radaelli E, Pesenti A, Latini R. The effect of a single bolus of exogenous surfactant on lung compliance persists until two weeks after treatment in a model of acid aspiration pneumonitis. Pulm Pharmacol Ther 2011; 24:141-6. [DOI: 10.1016/j.pupt.2010.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/14/2010] [Accepted: 07/22/2010] [Indexed: 10/19/2022]
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Affiliation(s)
- M E Bernal
- Universidad de Monterrey, Escuela de Medicina, Monterrey, Nuevo León, MéxicoThe University of Texas Health Science Center of Houston, The University of Texas Medical Branch at Galveston, St. Luke's Episcopal Hospital/Texas Heart Institute, Houston, TX, USA The University of Texas Medical Branch, Galveston, TX, USAWorld Foundation for AIDS Research and Prevention, Paris, France
| | - J Varon
- Universidad de Monterrey, Escuela de Medicina, Monterrey, Nuevo León, MéxicoThe University of Texas Health Science Center of Houston, The University of Texas Medical Branch at Galveston, St. Luke's Episcopal Hospital/Texas Heart Institute, Houston, TX, USA The University of Texas Medical Branch, Galveston, TX, USAWorld Foundation for AIDS Research and Prevention, Paris, France
| | - P Acosta
- Universidad de Monterrey, Escuela de Medicina, Monterrey, Nuevo León, MéxicoThe University of Texas Health Science Center of Houston, The University of Texas Medical Branch at Galveston, St. Luke's Episcopal Hospital/Texas Heart Institute, Houston, TX, USA The University of Texas Medical Branch, Galveston, TX, USAWorld Foundation for AIDS Research and Prevention, Paris, France
| | - L Montagnier
- Universidad de Monterrey, Escuela de Medicina, Monterrey, Nuevo León, MéxicoThe University of Texas Health Science Center of Houston, The University of Texas Medical Branch at Galveston, St. Luke's Episcopal Hospital/Texas Heart Institute, Houston, TX, USA The University of Texas Medical Branch, Galveston, TX, USAWorld Foundation for AIDS Research and Prevention, Paris, France
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Inci I, Arni S, Acevedo C, Jungraithmayr W, Inci D, Vogt P, Weder W. Surfactant alterations following donation after cardiac death donor lungs. Transpl Int 2010; 24:78-84. [PMID: 20723176 DOI: 10.1111/j.1432-2277.2010.01154.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The use of lungs from donation after cardiac death (DCD) donors is one of the strategies to increase the donor pool. The aim of this study was to assess the surfactant alterations in DCD donor lungs. Pigs were sacrificed and left untouched for 1 (DCD1), 2 (DCD2) and 3 (DCD3) h. Lungs were then topically cooled with saline for 1, 2 or 3 h to reach a total ischemic time of 4 h. Heart-beating donors (HBD) served as control group. Bronchoalveolar lavage (BAL) samples were assessed for protein levels and surfactant function. Left lungs were prepared for ex-vivo evaluation. Pulmonary vascular resistance (PVR), oxygenation, airway pressure (AWP) and wet-to-dry weight ratio were significantly different between HBD and DCD3 groups (P < 0.05). BAL protein levels were statistically higher in DCD3 compared with HBD group (P < 0.05). Surface tension and surface tension measured at minimal bubble diameter (adsorption) were lower in HBD compared with DCD groups (P < 0.05). Adsorption was also lower in DCD1 compared with DCD2 (P < 0.05). Adsorption and surface tension were correlated with oxygenation and AWP (P < 0.05). This study has shown that lung function deteriorates with increasing warm ischemic time intervals. BAL protein, surface tension, adsorption, peak AWP and PVR increase significantly after 2 h of warm ischemia together with a significant reduction of the ratio PaO(2)/FiO(2).
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Affiliation(s)
- Ilhan Inci
- Division of Thoracic Surgery, University Hospital, Zurich, Switzerland.
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Effect of inhaled and intravenous lidocaine on inflammatory reaction in endotoxaemic rats. Eur J Anaesthesiol 2010; 27:53-60. [DOI: 10.1097/eja.0b013e32832b8a70] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Caracas HCPM, Maciel JVB, Martins PMRES, de Souza MMG, Maia LC. The use of lidocaine as an anti-inflammatory substance: a systematic review. J Dent 2008; 37:93-7. [PMID: 19058888 DOI: 10.1016/j.jdent.2008.10.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 08/14/2008] [Accepted: 10/17/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To investigate existence of evidence that supports the therapeutical use of lidocaine as an anti-inflammatory substance. METHODS A search on health sciences databases was performed, including only papers published in English until May 2007 which reported in vivo experimental studies that tested lidocaine as an anti-inflammatory substance and used morphological and/or biochemical analysis. The keywords used were: "lidocaine & inflammation", "lidocaine & neutrophils" and "lidocaine & prostaglandin". The search results were previous selected by title and abstract, and then articles were read and those that met inclusion criteria were carefully analyzed and classified. RESULTS Only 10 articles met the inclusion criteria, and were carefully read. They were ranked (A, B, and C) according to the level of evidence produced. Seven articles were classified as C, two classified as B, and one classified as A. Despite methodological differences, all of them, except for one, reported that lidocaine showed anti-inflammatory effects. CONCLUSIONS According to the reviewed literature, lidocaine has a potential as an anti-inflammatory agent. However, there is still a lack of well-designed studies to support its clinical use, and none of them evaluated its effects on a mucous epithelium.
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Inci I, Ampollini L, Arni S, Jungraithmayr W, Inci D, Hillinger S, Leskosek B, Vogt P, Weder W. Ex Vivo Reconditioning of Marginal Donor Lungs Injured by Acid Aspiration. J Heart Lung Transplant 2008; 27:1229-36. [DOI: 10.1016/j.healun.2008.07.027] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 07/18/2008] [Accepted: 07/29/2008] [Indexed: 11/30/2022] Open
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Oliveira WRSD, Silva ID, Simões RS, Fuchs LFP, Oliveira-Filho RM, Oliveira-Júnior ISD. Effects of prone and supine position on oxygenation and inflammatory mediator in a hydrochloric acid-induced lung dysfunction in rats. Acta Cir Bras 2008; 23:451-5. [PMID: 18797691 DOI: 10.1590/s0102-86502008000500011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 06/24/2008] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare the effectiveness of mechanical ventilation of supine versus prone position in hydrochloric acid (HCl)-induced lung dysfunction. METHODS Twenty, adult, male, Wistar-EPM-1 rats were anesthetized and randomly grouped (n=5 animals per group) as follows: CS-MV (mechanical ventilation in supine position); CP-MV (mechanical ventilation in prone position); bilateral instillation of HCl and mechanical ventilation in supine position (HCl+S); and bilateral instillation of HCl and mechanical ventilation in prone position (HCl+P). All groups were ventilated for 180 minutes. The blood partial pressures of oxygen and carbon dioxide were measured in the time points 0 (zero; 10 minutes before lung injury for stabilization), and at the end of times acid injury, 60, 120 and 180 minutes of mechanical ventilation. At the end of experiment the animals were euthanized, and bronchoalveolar lavages (BALs) were taken to determine the contents of total proteins, inflammatory mediators, and lungs wet-to-dry ratios. RESULTS In the HCl+P group the partial pressure of oxygen increased when compared with HCl+S (128.0+/-2.9 mmHg and 111.0+/-6.7 mmHg, respectively) within 60 minutes. TNF-alpha levels in BAL do not differ significantly in the HCl+P group (516.0+/-5.9 pg/mL), and the HCl+S (513.0+/-10.6 pg/mL). CONCLUSION The use of prone position improved oxygenation, but did not reduce TNF-alpha in BAL upon lung dysfunction induced by HCl.
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Thammanomai A, Hueser LE, Majumdar A, Bartolák-Suki E, Suki B. Design of a new variable-ventilation method optimized for lung recruitment in mice. J Appl Physiol (1985) 2008; 104:1329-40. [DOI: 10.1152/japplphysiol.01002.2007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Variable ventilation (VV), characterized by breath-to-breath variation of tidal volume (Vt) and breathing rate (f), has been shown to improve lung mechanics and blood oxygenation during acute lung injury in many species compared with conventional ventilation (CV), characterized by constant Vt and f. During CV as well as VV, the lungs of mice tend to collapse over time; therefore, the goal of this study was to develop a new VV mode (VVN) with an optimized distribution of Vt to maximize recruitment. Groups of normal and HCl-injured mice were subjected to 1 h of CV, original VV (VVO), CV with periodic large breaths (CVLB), and VVN, and the effects of ventilation modes on respiratory mechanics, airway pressure, blood oxygenation, and IL-1β were assessed. During CV and VVO, normal and injured mice showed regional lung collapse with increased airway pressures and poor oxygenation. CVLB and VVN resulted in a stable dynamic equilibrium with significantly improved respiratory mechanics and oxygenation. Nevertheless, VVN provided a consistently better physiological response. In injured mice, VVO and VVN, but not CVLB, were able to reduce the IL-1β-related inflammatory response compared with CV. In conclusion, our results suggest that application of higher Vt values than the single Vt currently used in clinical situations helps stabilize lung function. In addition, variable stretch patterns delivered to the lung by VV can reduce the progression of lung injury due to ventilation in injured mice.
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Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand 2006; 50:265-82. [PMID: 16480459 DOI: 10.1111/j.1399-6576.2006.00936.x] [Citation(s) in RCA: 206] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Development of new local anesthetic agents has been focused on the potency of their nerve-blocking effects, duration of action and safety and has resulted in a substantial number of agents in clinical use. It is well established and well documented that the nerve blocking effects of local anesthetics are secondary to their interaction with the Na+ channels thereby blocking nerve membrane excitability and the generation of action potentials. Accumulating data suggest however that local anesthetics also possess a wide range of anti-inflammatory actions through their effects on cells of the immune system, as well as on other cells, e.g. microorganisms, thrombocytes and erythrocytes. The potent anti-inflammatory properties of local anesthetics, superior in several aspects to traditional anti-inflammatory agents of the NSAID and steroid groups and with fewer side-effects, has prompted clinicians to introduce them in the treatment of various inflammation-related conditions and diseases. They have proved successful in the treatment of burn injuries, interstitial cystitis, ulcerative proctitis, arthritis and herpes simplex infections. The detailed mechanisms of action are not fully understood but seem to involve a reversible interaction with membrane proteins and lipids thus regulating cell metabolic activity, migration, exocytosis and phagocytosis.
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Affiliation(s)
- J Cassuto
- Department of Anesthesiology and Intensive Care and Institution of Surgical Specialties, Sahlgrenska University Hospital, Mölndal, Sweden.
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