Calcium ions, drug action and airways obstruction

Calcium, calcium channel blockade and airways function

This review will highlight recent advances in understanding the physiological role of calcium and effects of calcium channel blockers on pathogenetic factors in asthma, including airway smooth muscle contraction, mast cell degranulation and mucus secretion. A review of clinical studies with calcium channel blockers in asthma will also be presented.

Respiratory therapeutics

Treatment of small animal respiratory diseases tends to target bronchodilators. Although this is not inappropriate, recent advances in the understanding of respiratory diseases have underscored the importance of inflammatory mediators in the pathophysiology of respiratory diseases. Drug therapy of the respiratory tract in small animals is most successful when it is based on a knowledge of normal physiology and disease pathophysiology of respiratory tract diseases.

Low potency of Ca antagonists in smooth muscle from different levels of the respiratory tract

Respiratory smooth muscle at different levels of the respiratory tract was isolated from rabbit, rat and guinea-pig and incubated with the Ca antagonists, verapamil, D-600, felodipine, and nifedipine. There was no effect of the Ca antagonists when added on top of an already developed contraction. When added before the contractile agent at high concentrations (10-100 microM) the Ca antagonists reduced the contractions. Lanthanum (2 mM) was considerably more effective to prevent contractions than the Ca antagonists. Preparations from the trachea and bronchus responded in all animals, whereas the third generation bronchus from rat and guinea-pig failed to contract and that from rabbit showed very weak contractions. The failure to contract was not specific for the agonist, as depolarization with isotonic potassium solution (124 mM) did not evoke contractions either. Microscopic investigation showed well-developed smooth muscle in the trachea and main bronchus of the rat, whereas the muscle of the third generation bronchus was inhomogenous with scattered groups of muscle cells.

Differential calcium movements induced by agonists in guinea pig tracheal muscle

The effects of high potassium, carbachol and histamine on tension responses and 45Ca fluxes in tracheal smooth muscle were examined. Calcium depletion or nitrendipine (10(-8) M) inhibited potassium-induced contractile responses more than those obtained with either histamine or carbachol, whereas Sr2+ inhibited mainly responses to histamine or carbachol. The Ca2+ entry facilitator, CGP 28392 (3 X 10(-6) M), potentiated contractions induced only by potassium. Uptake of 45Ca in guinea pig tracheal muscle can be separated into high and low affinity components. The 45Ca efflux rate from tracheal muscle into a La3+-substituted solution was over four-fold higher than in other smooth muscles. Potassium, carbachol and histamine induced sustained increases in 45Ca efflux into solutions containing 1.5 mM Ca2+; only transient increases in 45Ca efflux with carbachol and histamine were obtained after Ca2+ depletion. These agonists elicit contractile responses in tracheal muscle by selectively mobilizing different cellular and extracellular Ca2+ components.

The dependence of airway smooth muscle on extracellular Ca2+ for contraction is influenced by the presence of cartilage

Isolated guinea-pig and rabbit airway smooth muscle preparations lacking cartilage are less able to contract, in response to methacholine, histamine and K+, in the absence of extracellular Ca2+ than cartilage-containing preparations removed from the same animal. Cartilage apparently provides utilizable Ca2+ for contraction of airway smooth muscle. The presence of cartilage, therefore, affects the apparent dependence of the isolated smooth muscle on extracellular Ca2+ for contraction.

Relative activities of three calcium channel antagonists on histamine, acetylcholine and antigen-induced contractions of guinea pig ileum

The molar concentrations of verapamil, diltiazem, nifedipine, tripelennamine and atropine necessary to block histamine, acetylcholine (ACH) and ovalbumin-induced contractions of the isolated guinea pig ileum were compared. The calcium blockers inhibited ovalbumin contractions in previously sensitized ilea at lower concentrations than those required to block the phasic component of histamine and ACH contractions. These compounds were, however, more active in blocking the tonic phase of histamine and ACH concentrations than ovalbumin contractions. Tripelennamine was almost as active against ovalbumin contractions as it was against histamine concentrations, while atropine was inactive against ovalbumin. The results are interpreted as being supportive of continued efforts to develop calcium channel antagonists which selectively block the smooth muscle effects of inflammatory mediators.

Calcium-channel blockers in prophylaxis and treatment of asthma

Calcium-channel blocking drugs do not induce bronchoconstriction in susceptible persons with cardiac disease and concomitant hyperreactive airways (such as asthma or chronic bronchitis). The ways in which calcium blockers might in fact play a beneficial role in preventing bronchoconstriction or inducing bronchodilation in asthma are explored. Nifedipine and verapamil have been shown to inhibit the bronchoconstriction provoked by exercise, histamine, methacholine and antigen. The potential mechanisms by which this protective effect is mediated--whether by direct action on tracheobronchial smooth muscle, inhibition of release of mediators from activated mast cells or both--are examined by reviewing in vitro studies of both cell systems. Calcium blockers also exhibit some bronchodilating activity in vitro. Early clinical trials of these drugs in ambulatory asthmatic patients have shown little, if any, therapeutic benefit, but results must be considered preliminary in view of the nature of the short-term, small-scale trials performed to date. Regardless of their therapeutic potential in obstructive lung diseases, the calcium-channel blockers offer a powerful probe into the role of calcium in the physiologic make-up of airways and, in particular, the pathophysiologic features of airway hyperreactivity.

Role of calcium in airway smooth muscle contraction and mast cell secretion

The principal pathological features of asthma, including tracheobronchial smooth muscle contraction and mast cell mediator synthesis and release, are calcium-dependent processes. Calcium plays an integral role in transmitting signals at the cell surface to the enzymatic machinery of the cell interior; its role as the agent for "excitation-contraction coupling" of airway smooth muscle and for "stimulus-secretion coupling" of mast cells is reviewed. A rise in intracellular calcium ion concentration triggers cellular activation. In smooth muscle, calcium bound to calmodulin stimulates the myosin light chain kinase which is important in the regulation of actin-myosin interaction. In mast cells, calcium may bind to calmodulin or to a calmodulinlike regulatory protein, and it also stimulates enzymes important in the synthesis of newly generated mediators including prostaglandins and leukotrienes. The regulatory role of cyclic AMP in both cell systems is discussed, especially as it pertains to calcium metabolism. By interfering with transmembrane calcium fluxes, the calcium channel blocking drugs have the potential for significantly modifying bronchoconstriction and airway inflammation in asthma and related bronchospastic disorders. Some of the in vitro studies of calcium channel blockers in these two cell systems are reviewed. Finally a speculation about the role of abnormal sensitivity to calcium in airway smooth muscle as a potential cause of airway hyperreactivity is entertained.