Asthma and diabetes mellitus: a biochemical basis for antithetical features

Recent findings on the pathogenesis of bronchial asthma. Part II. The role of hormonal predisposition, environmental influences and conditioning leading to bronchial asthma

In this second part of the review on the pathogenesis of asthma the hormonal factors and adverse external events are shortly reviewed which skew the balance of Th1 vs. Th2 CD4+ lymphocytes towards the latter ones and this way increase the probability of atopic diseases. Among other the role of transplacental priming, insulin, insulin-like and other growth factors, lack of the usual microbial infections in the early childhood (the so-called hygiene hypothesis), gender, diminished testosterone production, gastroesophageal reflux, adverse effects during pregnancy are discussed. A separate chapter deals with the role of central nervous system in the etiology and finally the most common allergizing and airway tissue damaging agents are listed in tabulated form.

Increased levels of cyclic adenosine monophosphate contribute to the hyporesponsiveness of mast cells in alloxan diabetes

In this study, we investigated the influence of intracellular cyclic adenosine monophosphate (cAMP) changes on the rat mast cell hyporesponsiveness following immunological and non-immunological stimuli. Compared with mast cells from normal rats, those recovered from 21-day diabetic animals showed a significant augmentation in the intracellular levels of cAMP, in directly correlated with secretion of lower amounts of histamine after stimulation with antigen, bradykinin and compound 48/80 in vitro. Incubation of normal mast cells with selective inhibitors of phosphodiesterase type 4 (PDE 4) rolipram, NCS 613 and RP 73401, or the cell permeable analogue N6-2'-O-dibutyryladenosine 3':5'-cyclic monophosphate (db cAMP), led to a decrease of histamine secretion in vitro. However, the effectiveness of either NCS 613 or db cAMP in inhibiting antigen-induced degranulation is comparable in both normal and diabetic mast cells. We suggest that (a) there is a close correlation between higher levels of intracellular cAMP and hyporesponsiveness of diabetic mast cells, phenomena probably associated with a reduction in the expression and/or activity of PDE 4 and that (b) the mechanism of cAMP-mediated down-regulation of mast cell function is saturated in diabetic rats.

Depressed ventilatory reflexes after capsaicin challenge in streptozotocin-treated rats

Diabetic sensory neuropathy is an affliction that decreases sensory perception in a number of organ systems. Although little is known of its pulmonary effects certain diabetic patients have reduced airway reactivity to cold air and elevated cough threshold to irritant inhalation, reflexes reported to be mediated by pulmonary C-fibers. Therefore we studied the effects the selective C-fiber activator capsaicin (0.01% aerosol, 30 s) on variables of ventilation using a whole-body plethysmograph in age-matched rats treated with streptozotocin (STZ) or its vehicle at 6 and 12 weeks after treatment. Body weight increased and plasma glucose and glycosylated hemoglobin were stable in vehicle-treated rats. In STZ-treated rats body weight decreased and plasma glucose and glycosylated hemoglobin increased. Capsaicin challenge decreased tidal volume, respiratory rate and therefore minute ventilation in non-treated and vehicle-treated rats. However capsaicin challenge increased tidal volume thereby altering minute ventilation in STZ-treated rats. Specific airway resistance increased in both groups after capsaicin challenge. Changes in ventilation in response to capsaicin challenge in STZ-treated rats may involve C-fiber sensory neuropathy.

Adoptive transfer of mast cells abolishes the inflammatory refractoriness to allergen in diabetic rats

Mast cells are pivotal secretory cells primarily implicated in allergen-evoked inflammatory responses and are downregulated following experimental chemical diabetes. Here we tested the hypothesis that a decrease in the number and reactivity of mast cells would account for the hyporesponsiveness of diabetic rats to allergen-induced inflammation. We found that the anaphylactic release of histamine from sensitized ileum, trachea and skin tissues was clearly reduced in rats turned diabetic via intravenous administration of alloxan. Likewise, actively and passively sensitized diabetic rats mounted a weaker allergen-evoked pleural mast cell degranulation and protein extravasation, as compared to sensitized nondiabetic animals, which paralleled a marked reduction in the mast cell population in the pleural cavity. The number of mast cells enumerated in the mesentery from diabetic rats was also clearly reduced. The allergen-evoked plasma leakage in diabetic rats was restored by the transfer of mast cells from sensitized nondiabetic rats. Moreover, the adoptive transfer of sensitized mast cells from diabetics to naive animals led to a lower allergen-induced exudation as compared to the response noted after the transfer of sensitized naive mast cells. Purified mast cells from diabetic rats were hyporesponsive to antigen and compound 48/80 stimulation in vitro as attested by histamine release. Thus, our results show that the phenomenon of refractoriness of diabetic animals to allergen challenge appears to be accounted for by a reduction in the number and reactivity of mast cells.

Is bronchial asthma a pancreatic disease?

Bronchial asthma and diabetes mellitus seldom occur in the same patient. The exact mechanism of this mutual exclusion is still unknown and its elucidation can make clear the physiopathology of both diseases. Clinical and experimental evidences suggest that insulin is a proinflammatory hormone and glucagon an antiinflammatory and a bronchodilator one. We hypothesize that the relationship between plasma insulin and glucagon may play an important role in bronchial asthma.