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Anidi IU, Olivier KN. Host-Directed Therapy in Nontuberculous Mycobacterial Pulmonary Disease: Preclinical and Clinical Data Review. Clin Chest Med 2023; 44:839-845. [PMID: 37890920 PMCID: PMC10614072 DOI: 10.1016/j.ccm.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Standard treatment of nontuberculous mycobacterial pulmonary disease (NTM-PD) infection involves a multi-drug antimicrobial regimen for at least 12 months. The length, complexity, and side effect profile of antibiotic therapy for NTM-PD pose significant difficulties for maintaining patient adherence. Furthermore, physician adherence to NTM guidelines suffers for similar reasons to the extent that a study evaluating treatment approaches across multiple specialties found that only 13% of antibiotic regimens met ATS/IDSA guidelines. For this reason, a great need exists for therapy that augments the current armamentarium of antimicrobial chemotherapeutics or provides an alternative approach for decreasing host mycobacterial burden. As our knowledge of the mechanisms driving protective responses to NTM-PD infections by mammalian hosts expand, these processes provide novel therapeutic targets. These agents, which are commonly referred to as host-directed therapies (HDTs) have the potential of providing the much-needed boost to the nontuberculous mycobacterial therapeutic pipeline. In this review, we will focus on translational research and clinical trial data that detail the creation of therapeutic modalities developed to improve host mechanical protection and immunologic responses to PNTM infection.
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Affiliation(s)
- Ifeanyichukwu U Anidi
- Pulmonary Division, National Heart, Lung and Blood Institute, National Institutes of Health, 33 North Drive, Room 1W10A, Bethesda, MD 20892, USA.
| | - Kenneth N Olivier
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, 125 Mason Farm Road, CB#7248, 7214 Marsico Hall, Chapel Hill, NC 27599-7248, USA
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White CJ, Lehnert N, Meyerhoff ME. Electrochemical Generation of Nitric Oxide for Medical Applications. ELECTROCHEMICAL SCIENCE ADVANCES 2022; 2:e2100156. [PMID: 36386004 PMCID: PMC9642980 DOI: 10.1002/elsa.202100156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022] Open
Abstract
Over the past 30 years, the significance of nitric oxide (NO) has become increasingly apparent in mammalian physiology. It is biosynthesized by three isoforms of nitric oxide synthases (NOS): neuronal (nNOS), endothelial (eNOS), and inducible (iNOS). Neuronal and eNOS both produce low levels of NO (nM) as a signaling agent and vasodilator, respectively. Inducible (iNOS) is present in activated macrophages at sites of infection to generate acutely toxic (μM) levels of NO as part of the mammalian immune defense mechanism. These discoveries have led to numerous animal and clinical studies to evaluate the potential therapeutic utility of NO in various medical operations/treatments, primarily using NO gas (via gas-cylinders) as the NO source. In this review, we focus specifically on recent advances in the electrochemical generation of NO (E-NOgen) as an alternative means to generate NO from cheap and inert sources, and the fabrication and testing of biomedical devices that utilize E-NOgen to controllably generate NO for medical applications.
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Affiliation(s)
- Corey J White
- Department of Chemistry, University of Michigan, 930 North University Avenue, Ann Arbor, MI 48109-1055, USA
| | - Nicolai Lehnert
- Department of Chemistry, University of Michigan, 930 North University Avenue, Ann Arbor, MI 48109-1055, USA
| | - Mark E Meyerhoff
- Department of Chemistry, University of Michigan, 930 North University Avenue, Ann Arbor, MI 48109-1055, USA
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3
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Laselva O, Guerra L, Castellani S, Favia M, Di Gioia S, Conese M. Small-molecule drugs for cystic fibrosis: Where are we now? Pulm Pharmacol Ther 2021; 72:102098. [PMID: 34793977 DOI: 10.1016/j.pupt.2021.102098] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/24/2021] [Accepted: 11/12/2021] [Indexed: 01/05/2023]
Abstract
The cystic fibrosis (CF) lung disease is due to the lack/dysfunction of the CF Transmembrane Conductance Regulator (CFTR), a chloride channel expressed by epithelial cells as the main regulator of ion and fluid homeostasis. More than 2000 genetic variation in the CFTR gene are known, among which those with identified pathomechanism have been divided into six VI mutation classes. A major advancement in the pharmacotherapy of CF has been the development of small-molecule drugs hitting the root of the disease, i.e. the altered ion and fluid transport through the airway epithelium. These drugs, called CFTR modulators, have been advanced to the clinics to treat nearly 90% of CF patients, including the CFTR potentiator ivacaftor, approved for residual function mutations (Classes III and IV), and combinations of correctors (lumacaftor, tezacaftor, elexacaftor) and ivacaftor for patients bearing at least one the F508del mutation, the most frequent mutation belonging to class II. To cover the 10% of CF patients without etiological therapies, other novel small-molecule CFTR modulators are in evaluation of their effectiveness in all the CFTR mutation classes: read-through agents for Class I, correctors, potentiators and amplifiers from different companies for Class II-V, stabilizers for Class VI. In alternative, other solute carriers, such as SLC26A9 and SLC6A14, are the focus of intensive investigation. Finally, other molecular targets are being evaluated for patients with no approved CFTR modulator therapy or as means of enhancing CFTR modulatory therapy, including small molecules forming ion channels, inhibitors of the ENaC sodium channel and potentiators of the calcium-activated chloride channel TMEM16A. This paper aims to give an up-to-date overview of old and novel CFTR modulators as well as of novel strategies based on small-molecule drugs. Further investigations in in-vivo and cell-based models as well as carrying out large prospective studies will be required to determine if novel CFTR modulators, stabilizers, amplifiers, and the ENaC inhibitors or TMEM16A potentiators will further improve the clinical outcomes in CF management.
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Affiliation(s)
- Onofrio Laselva
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lorenzo Guerra
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy
| | - Stefano Castellani
- Department of Medical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Maria Favia
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy
| | - Sante Di Gioia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Conese
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
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Bogdanovski K, Chau T, Robinson CJ, MacDonald SD, Peterson AM, Mashek CM, Wallin WA, Rimkus M, Montgomery F, Lucas da Silva J, Gupta S, Ghaffari A, Zelazny AM, Olivier KN. Antibacterial activity of high-dose nitric oxide against pulmonary Mycobacterium abscessus disease. Access Microbiol 2020; 2:acmi000154. [PMID: 33195983 PMCID: PMC7656188 DOI: 10.1099/acmi.0.000154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Mycobacterium abscessus is an emerging pulmonary pathogen with limited treatment options. Nitric oxide (NO) demonstrates antibacterial activity against various bacterial species, including mycobacteria. In this study, we evaluated the effect of adjunctive inhaled NO therapy, using a novel NO generator, in a CF patient with pulmonary M. abscessus disease, and examined heterogeneity of response to NO in vitro. Methods In the compassionate-use treatment, a 24-year-old CF patient with pulmonary M. abscessus was treated with two courses of adjunctive intermittent NO, first at 160 p.p.m. for 21 days and subsequently by escalating the dose up to 240 p.p.m. for 8 days. Methemoglobin, pulmonary function, 6 min walk distance (6MWD), qualify of life and sputum microbiology were assessed. In vitro susceptibility tests were performed against patient's isolate and comparison clinical isolates and quantified by Hill's slopes calculated from time-kill curves. Results M. abscessus lung infection eradication was not achieved, but improvements in selected qualify of life domains, lung function and 6MWD were observed during the study. Inhaled NO was well tolerated at 160 p.p.m. Dosing at 240 p.p.m. was stopped due to adverse symptoms, although methemoglobin levels remained within safety thresholds. In vitro susceptibility tests showed a dose-dependent NO effect on M. abscessus susceptibility and significant heterogeneity in response between M. abscessus clinical isolates. The patient's isolate was found to be the least susceptible strain in vitro. Conclusion These results demonstrate heterogeneity in M. abscessus susceptibility to NO and suggest that longer treatment regimens could be required to see the reduction or eradication of more resistant pulmonary strains.
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Affiliation(s)
- Kristijan Bogdanovski
- Laboratory of Chronic Airway Infection, Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Trisha Chau
- Laboratory of Chronic Airway Infection, Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Chevalia J Robinson
- Laboratory of Chronic Airway Infection, Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandra D MacDonald
- Laboratory of Chronic Airway Infection, Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ann M Peterson
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Christine M Mashek
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Windy A Wallin
- Critical Care Therapy Section, Clinical Center, National Institutes of Health, Bethesda, USA
| | | | | | - Joas Lucas da Silva
- Laboratory of Chronic Airway Infection, Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shashank Gupta
- Laboratory of Chronic Airway Infection, Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Adrian M Zelazny
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth N Olivier
- Laboratory of Chronic Airway Infection, Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Lautner G, Lautner-Csorba O, Stringer B, Meyerhoff ME, Schwendeman SP. Feedback-controlled photolytic gas phase nitric oxide delivery from S-nitrosothiol-doped silicone rubber films. J Control Release 2020; 318:264-269. [PMID: 31778741 PMCID: PMC7895313 DOI: 10.1016/j.jconrel.2019.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/28/2019] [Accepted: 11/24/2019] [Indexed: 12/19/2022]
Abstract
Constant therapeutic gas phase nitric oxide (NO) delivery is achieved from S-nitrosothiol (RSNO) type NO donor doped silicone rubber films using feedback-controlled photolysis. For photo-release of the NO gas, the intensity of the LED light source is controlled via a PID (proportional-integral-derivative) controller implemented on a microcontroller. The NO concentration within the emitted gas phase is monitored continuously with a commercial amperometric NO gas sensor. NO release was accurately adjustable up to 10 ppm across a broad range of setpoints with response times of roughly 1 min or less. When NO is generated into an air recipient stream, lower NO yields and a comparable level of toxic nitrogen dioxide (NO2) formation is observed. However, NO gas generated into an N2 recipient gas stream can be blended into pure O2 with very low NO2 formation. Following scale-up, this technology could be used for point-of-care gas phase NO generation as an alternative for currently used gas cylinder technology for treatment of health conditions where inhaled NO is beneficial, such as pulmonary hypertension, hypoxemia, and cystic fibrosis.
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Affiliation(s)
- Gergely Lautner
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI 48109, USA; Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Blake Stringer
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mark E Meyerhoff
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Steven P Schwendeman
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI 48109, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA.
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Wu YS, Jiang J, Ahmadi S, Lew A, Laselva O, Xia S, Bartlett C, Ip W, Wellhauser L, Ouyang H, Gonska T, Moraes TJ, Bear CE. ORKAMBI-Mediated Rescue of Mucociliary Clearance in Cystic Fibrosis Primary Respiratory Cultures Is Enhanced by Arginine Uptake, Arginase Inhibition, and Promotion of Nitric Oxide Signaling to the Cystic Fibrosis Transmembrane Conductance Regulator Channel. Mol Pharmacol 2019; 96:515-525. [PMID: 31427400 DOI: 10.1124/mol.119.117143] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022] Open
Abstract
ORKAMBI, a combination of the corrector, lumacaftor, and the potentiator, ivacaftor, partially rescues the defective processing and anion channel activity conferred by the major cystic fibrosis-causing mutation, F508del, in in vitro studies. Clinically, the improvement in lung function after ORKAMBI treatment is modest and variable, prompting the search for complementary interventions. As our previous work identified a positive effect of arginine-dependent nitric oxide signaling on residual F508del-Cftr function in murine intestinal epithelium, we were prompted to determine whether strategies aimed at increasing arginine would enhance F508del-cystic fibrosis transmembrane conductance regulator (CFTR) channel activity in patient-derived airway epithelia. Now, we show that the addition of arginine together with inhibition of intracellular arginase activity increased cytosolic nitric oxide and enhanced the rescue effect of ORKAMBI on F508del-CFTR-mediated chloride conductance at the cell surface of patient-derived bronchial and nasal epithelial cultures. Interestingly, arginine addition plus arginase inhibition also enhanced ORKAMBI-mediated increases in ciliary beat frequency and mucociliary movement, two in vitro CF phenotypes that are downstream of the channel defect. This work suggests that strategies to manipulate the arginine-nitric oxide pathway in combination with CFTR modulators may lead to improved clinical outcomes. SIGNIFICANCE STATEMENT: These proof-of-concept studies highlight the potential to boost the response to cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulators, lumacaftor and ivacaftor, in patient-derived airway tissues expressing the major CF-causing mutant, F508del-CFTR, by enhancing other regulatory pathways. In this case, we observed enhancement of pharmacologically rescued F508del-CFTR by arginine-dependent, nitric oxide signaling through inhibition of endogenous arginase activity.
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Affiliation(s)
- Yu-Sheng Wu
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Janet Jiang
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Saumel Ahmadi
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Alexandria Lew
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Onofrio Laselva
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Sunny Xia
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Claire Bartlett
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Wan Ip
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Leigh Wellhauser
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Hong Ouyang
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Tanja Gonska
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Theo J Moraes
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - Christine E Bear
- Programmes in Translational Medicine (Y.-S.W., C.B., W.I., H.O., T.G., T.J.M.) and Molecular Medicine (Y.-S.W., J.J., S.A., A.L., O.L., S.X., L.W., C.E.B.), Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Departments of Laboratory Medicine and Pathobiology (T.J.M.), Biochemistry (C.E.B.), Physiology (Y.-S.W., S.A., O.L., S.X., C.E.B.), and Paediatrics (T.G., T.J.M.), University of Toronto, Toronto, Ontario, Canada
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7
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Bentur L, Gur M, Ashkenazi M, Livnat-Levanon G, Mizrahi M, Tal A, Ghaffari A, Geffen Y, Aviram M, Efrati O. Pilot study to test inhaled nitric oxide in cystic fibrosis patients with refractory Mycobacterium abscessus lung infection. J Cyst Fibros 2019; 19:225-231. [PMID: 31129068 DOI: 10.1016/j.jcf.2019.05.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Airways of Cystic Fibrosis (CF) patients are Nitric Oxide (NO) deficient which may contribute to impaired lung function and infection clearance. Mycobacterium abscessus (M. abscessus) infection prevalence is increasing in CF patients and is associated with increased morbidity and mortality. Here, we assess the safety and efficacy of intermittent inhaled NO (iNO) as adjuvant therapy in CF patients with refractory M. abscessus lung infection. METHODS A prospective, open-label pilot study of iNO (160 ppm) administered five times/day during hospitalization (14 days), and three times/day during ambulatory treatment (7 days) was conducted. The primary outcome was safety measured by NO-related adverse events (AEs). Secondary outcomes were six-minute walk distance (6MWD), forced expiratory volume in 1 s (FEV1), and M. abscessus burden in airways. RESULTS Nine subjects were recruited. INO at 160 ppm was well-tolerated and no iNO-related SAEs were observed during the study. Mean FEV1 and 6WMD were increased relative to baseline during NO treatment. M. abscessus culture conversion was not achieved, but 3/9 patients experienced at least one negative culture during the study. Mean time to positivity in M. abscessus culture, and qPCR analysis showed reductions in sputum bacterial load. The study was not powered to achieve statistical significance in FEV1, 6WMD, and bacterial load. CONCLUSIONS Intermittent iNO at 160 ppm is well tolerated and safe and led to increases in mean 6MWD and FEV1. INO exhibited potential antibacterial activity against M. abscessus. Further evaluation of secondary endpoints in a larger cohort of CF patients is warranted to demonstrate statistical significance.
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Affiliation(s)
- Lea Bentur
- Pediatric Pulmonary Institute and CF Center, Ruth Children's Hospital, Rambam Health Care Campus, POB 9602, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel.
| | - Michal Gur
- Pediatric Pulmonary Institute and CF Center, Ruth Children's Hospital, Rambam Health Care Campus, POB 9602, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel
| | - Moshe Ashkenazi
- Pediatric Pulmonary Institute and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer 52621, Ramat-Gan, Israel; Pediatric Pulmonary Unit, Soroka University Medical Center POB 151, Beer-Sheva, Israel
| | - Galit Livnat-Levanon
- Pediatric Pulmonology Unit and CF Center, Lady Davis Carmel Medical Center, Haifa, Israel
| | | | - Asher Tal
- AIT Therapeutics Inc, Garden City, NY 11530, USA
| | | | - Yuval Geffen
- Microbiology Laboratory, Rambam Health Care Campus, POB 9602, Haifa, Israel
| | - Micha Aviram
- Pediatric Pulmonary Unit, Soroka University Medical Center POB 151, Beer-Sheva, Israel
| | - Ori Efrati
- Pediatric Pulmonary Institute and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer 52621, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, POB 39040, Tel-Aviv, Israel
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8
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Qin Y, Zajda J, Brisbois EJ, Ren H, Toomasian JM, Major TC, Rojas-Pena A, Carr B, Johnson T, Haft JW, Bartlett RH, Hunt AP, Lehnert N, Meyerhoff ME. Portable Nitric Oxide (NO) Generator Based on Electrochemical Reduction of Nitrite for Potential Applications in Inhaled NO Therapy and Cardiopulmonary Bypass Surgery. Mol Pharm 2017; 14:3762-3771. [DOI: 10.1021/acs.molpharmaceut.7b00514] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Yu Qin
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Joanna Zajda
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Elizabeth J. Brisbois
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Hang Ren
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - John M. Toomasian
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Terry C. Major
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Alvaro Rojas-Pena
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Benjamin Carr
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Thomas Johnson
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Jonathan W. Haft
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Robert H. Bartlett
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Andrew P. Hunt
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Nicolai Lehnert
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Mark E. Meyerhoff
- Department of Chemistry and ‡Department of
Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
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9
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Carlsten C, MacNutt MJ, Zhang Z, Sava F, Pui MM. Anti-oxidant N-acetylcysteine diminishes diesel exhaust-induced increased airway responsiveness in person with airway hyper-reactivity. Toxicol Sci 2014; 139:479-87. [PMID: 24814479 DOI: 10.1093/toxsci/kfu040] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Inhalation of diesel exhaust (DE) at moderate concentrations causes increased airway responsiveness in asthmatics and increased airway resistance in both healthy and asthmatic subjects, but the effect of baseline airway responsiveness and anti-oxidant supplementation on this dynamic is unknown. OBJECTIVES We aimed to determine if changes in airway responsiveness due to DE are attenuated by thiol anti-oxidant supplementation, particularly in those with underlying airway hyper-responsiveness. METHODS Participants took N-acetylcysteine (600 mg) or placebo capsules three times daily for 6 days. On the last of these 6 days, participants were exposed for 2 h to either filtered air (FA) or DE (300 μg/m(3) of particulate matter smaller than 2.5 microns). Twenty-six non-smokers were studied under each of three experimental conditions (filtered air with placebo, diesel exhaust with placebo, and diesel exhaust with N-acetylcysteine) using a randomized, double-blind, crossover design, with a 2-week washout between conditions. Methacholine challenge was performed pre-exposure (baseline airway responsiveness) and post-exposure (effect of exposure). RESULTS Anti-oxidant supplementation reduced baseline airway responsiveness in hyper-responsive individuals by 20% (p = 0.001). In hyper-responsive individuals, airway responsiveness increased 42% following DE compared with FA (p = 0.03) and this increase was abrogated with anti-oxidant supplementation (diesel exhaust with N-acetylcysteine vs. filtered air with placebo, p = 0.85). CONCLUSIONS Anti-oxidant (N-acetylcysteine) supplementation protects against increased airway responsiveness associated with DE inhalation and reduces need for supplement bronchodilators in those with baseline airway hyper-responsiveness. Individuals with variants in genes of oxidative stress metabolism when exposed to DE are protected from increases in airway responsiveness if taking anti-oxidant supplementation.
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10
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Kolpen M, Bjarnsholt T, Moser C, Hansen CR, Rickelt LF, Kühl M, Hempel C, Pressler T, Høiby N, Jensen PØ. Nitric oxide production by polymorphonuclear leucocytes in infected cystic fibrosis sputum consumes oxygen. Clin Exp Immunol 2014; 177:310-9. [PMID: 24611476 DOI: 10.1111/cei.12318] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 11/30/2022] Open
Abstract
Chronic Pseudomonas aeruginosa lung infection in cystic fibrosis (CF) patients is characterized by persisting mucoid biofilms in hypoxic endobronchial mucus. These biofilms are surrounded by numerous polymorphonuclear leucocytes (PMNs), which consume a major part of present molecular oxygen (O(2)) due to production of superoxide (O(2)(-)). In this study, we show that the PMNs also consume O(2) for production of nitric oxide (NO) by the nitric oxide synthases (NOS) in the infected endobronchial mucus. Fresh expectorated sputum samples (n = 28) from chronically infected CF patients (n = 22) were analysed by quantifying and visualizing the NO production. NO production was detected by optode measurements combined with fluorescence microscopy, flow cytometry and spectrophotometry. Inhibition of nitric oxide synthases (NOS) with N(G) -monomethyl-L-arginine (L-NMMA) resulted in reduced O(2) consumption (P < 0·0008, n = 8) and a lower fraction of cells with fluorescence from the NO-indicator 4-amino-5-methylamino-2',7'-difluorofluorescein diacetate (DAF-FM) (P < 0·002, n = 8). PMNs stained with DAF-FM and the superoxide indicator hydroethidine (HE) and host cells with inducible NOS (iNOS) were identified in the sputum. In addition, the production of the stable end-products of NO in CF sputum was correlated with the concentration of PMNs; NO(3)(-) (P < 0·04, r = 0·66, n = 10) and NO(2)(-) (P< 0·006, r = 0·78, n = 11). The present study suggests that besides consumption of O(2) for production of reactive oxygen species, the PMNs in CF sputum also consume O(2) for production of NO.
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Affiliation(s)
- M Kolpen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Helsingør, Denmark
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11
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Kolpen M, Kühl M, Bjarnsholt T, Moser C, Hansen CR, Liengaard L, Kharazmi A, Pressler T, Høiby N, Jensen PØ. Nitrous oxide production in sputum from cystic fibrosis patients with chronic Pseudomonas aeruginosa lung infection. PLoS One 2014; 9:e84353. [PMID: 24465406 PMCID: PMC3894955 DOI: 10.1371/journal.pone.0084353] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/14/2013] [Indexed: 02/01/2023] Open
Abstract
Chronic lung infection by Pseudomonas aeruginosa is the major severe complication in cystic fibrosis (CF) patients, where P. aeruginosa persists and grows in biofilms in the endobronchial mucus under hypoxic conditions. Numerous polymorphonuclear leukocytes (PMNs) surround the biofilms and create local anoxia by consuming the majority of O2 for production of reactive oxygen species (ROS). We hypothesized that P. aeruginosa acquires energy for growth in anaerobic endobronchial mucus by denitrification, which can be demonstrated by production of nitrous oxide (N2O), an intermediate in the denitrification pathway. We measured N2O and O2 with electrochemical microsensors in 8 freshly expectorated sputum samples from 7 CF patients with chronic P. aeruginosa infection. The concentrations of NO3− and NO2− in sputum were estimated by the Griess reagent. We found a maximum median concentration of 41.8 µM N2O (range 1.4–157.9 µM N2O). The concentration of N2O in the sputum was higher below the oxygenated layers. In 4 samples the N2O concentration increased during the initial 6 h of measurements before decreasing for approximately 6 h. Concomitantly, the concentration of NO3− decreased in sputum during 24 hours of incubation. We demonstrate for the first time production of N2O in clinical material from infected human airways indicating pathogenic metabolism based on denitrification. Therefore, P. aeruginosa may acquire energy for growth by denitrification in anoxic endobronchial mucus in CF patients. Such ability for anaerobic growth may be a hitherto ignored key aspect of chronic P. aeruginosa infections that can inform new strategies for treatment and prevention.
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Affiliation(s)
- Mette Kolpen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of International Health, Immunology and Microbiology, Faculty of Health Sciences University of Copenhagen, Copenhagen, Denmark
| | - Michael Kühl
- Marine Biological Section, Department of Biology, University of Copenhagen, Helsingør, Denmark
- Plant Functional Biology and Climate Change Cluster, University of Technology Sydney, Sydney, Australia
- Singapore Centre on Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Thomas Bjarnsholt
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of International Health, Immunology and Microbiology, Faculty of Health Sciences University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Lars Liengaard
- Marine Biological Section, Department of Biology, University of Copenhagen, Helsingør, Denmark
| | - Arsalan Kharazmi
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Tanja Pressler
- Copenhagen CF Centre, Rigshospitalet, Copenhagen, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of International Health, Immunology and Microbiology, Faculty of Health Sciences University of Copenhagen, Copenhagen, Denmark
| | - Peter Østrup Jensen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
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12
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Ralph AP, Yeo TW, Salome CM, Waramori G, Pontororing GJ, Kenangalem E, Sandjaja, Tjitra E, Lumb R, Maguire GP, Price RN, Chatfield MD, Kelly PM, Anstey NM. Impaired pulmonary nitric oxide bioavailability in pulmonary tuberculosis: association with disease severity and delayed mycobacterial clearance with treatment. J Infect Dis 2013; 208:616-26. [PMID: 23737604 DOI: 10.1093/infdis/jit248] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Nitric oxide (NO), a key macrophage antimycobacterial mediator that ameliorates immunopathology, is measurable in exhaled breath in individuals with pulmonary tuberculosis. We investigated relationships between fractional exhale NO (FENO) and initial pulmonary tuberculosis severity, change during treatment, and relationship with conversion of sputum culture to negative at 2 months. METHODS In Papua, we measured FENO in patients with pulmonary tuberculosis at baseline and serially over 6 months and once in healthy controls. Treatment outcomes were conversion of sputum culture results at 2 months and time to conversion of sputum microscopy results. RESULTS Among 200 patients with pulmonary tuberculosis and 88 controls, FENO was lower for patients with pulmonary tuberculosis at diagnosis (geometric mean FENO, 12.7 parts per billion [ppb]; 95% confidence interval [CI], 11.6-13.8) than for controls (geometric mean FENO, 16.6 ppb; 95% CI, 14.2-19.5; P = .002), fell further after treatment initiation (nadir at 1 week), and then recovered by 6 months (P = .03). Lower FENO was associated with more-severe tuberculosis disease, with FENO directly proportional to weight (P < .001) and forced vital-capacity (P = .001) and inversely proportional to radiological score (P = .03). People whose FENO increased or remained unchanged by 2 months were 2.7-fold more likely to achieve conversion of sputum culture than those whose FENO decreased (odds ratio, 2.72; 95% CI, 1.05-7.12; P = .04). CONCLUSIONS Among patients with pulmonary tuberculosis, impaired pulmonary NO bioavailability is associated with more-severe disease and delayed mycobacterial clearance. Measures to increase pulmonary NO warrant investigation as adjunctive tuberculosis treatments.
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Affiliation(s)
- Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory 0810, Australia.
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13
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Miller C, Miller M, McMullin B, Regev G, Serghides L, Kain K, Road J, Av-Gay Y. A phase I clinical study of inhaled nitric oxide in healthy adults. J Cyst Fibros 2012; 11:324-31. [PMID: 22520076 DOI: 10.1016/j.jcf.2012.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/18/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nitric oxide (NO) is an approved pulmonary vasodilator for neonates and full term infants up to a dose of 80 ppm. At 100 ppm to 200 ppm, NO has potent antimicrobial activities in vitro and in animal studies which suggest its therapeutic use for infectious diseases in humans. However, whether inhaled NO is safe at 160 ppm in healthy human adults is unknown. The aim of the phase I study was to assess the safety of delivery and the physiologic effects of intermittent 160 ppm NO in healthy human adults. METHODS Ten healthy adult volunteers (5 males, 5 females; 20-62 years) were recruited and inhaled 163.3 ppm (SD: 4.0) NO for 30 min, 5 times daily, for 5 consecutive days. Lung function and blood levels of methemoglobin, nitrites/nitrates, prothrombin, pro-inflammatory cytokines and chemokines were determined before and during treatment. RESULTS All individuals tolerated the NO treatment courses well. No significant adverse events occurred and three minor adverse events, not attributable to NO, were reported. Forced expiratory volume in 1 sec % predicted and other lung function parameters, serum nitrites/nitrates, prothrombin, pro-inflammatory cytokine and chemokine levels did not differ between baseline and day 5, while methemoglobin increased significantly during the study period to a level of 0.9% (SD: 0.08) (p<0.001). CONCLUSION These data suggest that inhalation of 160 ppm NO for 30 min, 5 times daily, for 5 consecutive days, is safe and well tolerated in healthy individuals.
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Affiliation(s)
- Chris Miller
- Respiratory Division, Department of Medicine, University of British Columbia, Vancouver, Canada.
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14
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Abstract
AIM To determine the difference in the levels of nitrites in induced sputum of children with cystic fibrosis (CF) and controls. Furthermore, to evaluate the association between induced sputum nitrites and lung function in children with CF. METHODS Nitrites, cell differentials, white blood cell count, were estimated in induced sputum of 20 children with CF and 10 age-matched healthy controls. Nitrites in induced sputum samples were measured using the Greiss assay. Lung function was ascertained by spirometry. RESULTS We observed high levels of nitrites in CF (184.8 +/- 11.07 microM/L) versus controls (56.4 +/- 5.7 microM/L) (p < 0.01). A positive correlation between neturophil percent and nitrites, white blood cell count and nitrites (p < 0.05) in children with CF was observed. Sputum nitrites correlated negatively with FEV(1) (p < 0.05) in children with CF. CONCLUSION Induced sputum nitrite could serve as a useful non invasive marker for assessing the degree of inflammation in the airways of children with CF.
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Affiliation(s)
- N Anil
- .Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.Department of Cytology and Gynaepathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M Singh
- .Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.Department of Cytology and Gynaepathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Rajwanshi
- .Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.Department of Cytology and Gynaepathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - H Vohra
- .Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.Department of Cytology and Gynaepathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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15
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Grasemann H, Kurtz F, Ratjen F. Inhaledl-Arginine Improves Exhaled Nitric Oxide and Pulmonary Function in Patients with Cystic Fibrosis. Am J Respir Crit Care Med 2006; 174:208-12. [PMID: 16627863 DOI: 10.1164/rccm.200509-1439oc] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Nitric oxide formation is deficient in airways of patients with cystic fibrosis (CF). Since nitric oxide has bronchodilatory effects, nitric oxide deficiency may contribute to airway obstruction in CF. OBJECTIVES We reasoned that inhalation of l-arginine, the precursor of enzymatic nitric oxide formation, could improve airway nitric oxide formation and pulmonary function in patients with CF. MEASUREMENTS Exhaled nitric oxide, pulmonary function, and peripheral oxygen saturation were measured before and after a single inhalation of nebulized l-arginine solution in patients with CF and in healthy subjects. A saline solution of similar osmolarity (1.7%) was used as control. RESULTS Nebulized l-arginine not only significantly increased exhaled nitric oxide concentrations but also resulted in a sustained improvement of FEV(1) in patients with CF. Oxygen saturation also increased significantly after the inhalation of l-arginine. Nebulized saline resulted in a small but significant increase in exhaled nitric oxide but a decrease in FEV(1) in patients with CF. In control subjects inhalation of l-arginine increased exhaled nitric oxide concentrations, but FEV(1) decreased. No effect of saline on exhaled nitric oxide, pulmonary function, or oxygen saturation was observed in healthy subjects. CONCLUSIONS These data suggest that a single inhalation of l-arginine acutely and transiently improves pulmonary function in CF through the formation of nitric oxide. Augmentation of airway nitric oxide formation by inhalation of l-arginine is a promising therapeutic approach in patients with CF.
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Affiliation(s)
- Hartmut Grasemann
- The Hospital for Sick Children, Division of Respiratory Medicine, 555 University Ave., Toronto, ON, M5G 1X8 Canada.
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16
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Yoon SS, Coakley R, Lau GW, Lymar SV, Gaston B, Karabulut AC, Hennigan RF, Hwang SH, Buettner G, Schurr MJ, Mortensen JE, Burns JL, Speert D, Boucher RC, Hassett DJ. Anaerobic killing of mucoid Pseudomonas aeruginosa by acidified nitrite derivatives under cystic fibrosis airway conditions. J Clin Invest 2006; 116:436-46. [PMID: 16440061 PMCID: PMC1350997 DOI: 10.1172/jci24684] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 11/29/2005] [Indexed: 11/17/2022] Open
Abstract
Mucoid, mucA mutant Pseudomonas aeruginosa cause chronic lung infections in cystic fibrosis (CF) patients and are refractory to phagocytosis and antibiotics. Here we show that mucoid bacteria perish during anaerobic exposure to 15 mM nitrite (NO2) at pH 6.5, which mimics CF airway mucus. Killing required a pH lower than 7, implicating formation of nitrous acid (HNO2) and NO, that adds NO equivalents to cellular molecules. Eighty-seven percent of CF isolates possessed mucA mutations and were killed by HNO2 (3-log reduction in 4 days). Furthermore, antibiotic-resistant strains determined were also equally sensitive to HNO2. More importantly, HNO2 killed mucoid bacteria (a) in anaerobic biofilms; (b) in vitro in ultrasupernatants of airway secretions derived from explanted CF patient lungs; and (c) in mouse lungs in vivo in a pH-dependent fashion, with no organisms remaining after daily exposure to HNO2 for 16 days. HNO2 at these levels of acidity and NO2 also had no adverse effects on cultured human airway epithelia in vitro. In summary, selective killing by HNO2 may provide novel insights into the important clinical goal of eradicating mucoid P. aeruginosa from the CF airways.
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Affiliation(s)
- Sang Sun Yoon
- Department of Molecular Genetics, Biochemistry, and Microbiology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0524, USA
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17
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Abstract
Cystic fibrosis (CF) is characterized by chronic airway infection and inflammation, which accounts for most morbidity and deaths. Exhaled nitric oxide (NO), elevated in most inflammatory lung diseases, is decreased in CF, suggesting decreased formation, increased metabolism or loss of NO. The nitrogen oxide metabolism in CF airways is complex and not yet fully understood. In this article we will summarize current understanding of the origin and function of NO in (patho)physiological processes in the lung of normal subjects and CF patients, possible explanations for and consequences of reduced NO concentrations in CF and possible therapetic strategies for treatment of CF patients.
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Affiliation(s)
- Karin M de Winter-de Groot
- Department of Pediatric Respiratory Medicine of the University Medical Center Utrecht, Utrecht, The Netherlands.
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18
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Cetin I, Ozçelik U, Goçmen A, Kiper N, Doğru D, Yalçin E. BALF nitrite as an indicator of inflammation in children with cystic fibrosis. Respiration 2005; 71:625-9. [PMID: 15627874 DOI: 10.1159/000081764] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2003] [Accepted: 03/17/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A unique substance reflecting the degree of inflammation localized to the lower respiratory tract in patients with cystic fibrosis (CF) has been the concern of several investigators and nitric oxide has gained interest for this purpose in the last decades. OBJECTIVES The aim of this study was to evaluate the cytokine and nitrite levels by showing the relationship between them in serum and bronchoalveolar lavage fluid (BALF) of patients with CF and patients in which flexible fiberoptic bronchoscopy (FFB) was applied because of indications other than infection. METHODS 20 children with CF with mean age 8.2 years and 10 children as control group with mean age 4.2 years were included in the study. Cultures for aerobes, anaerobes, fungi and mycobacteria, cell differentials, cytokine and nitrite measurements were made from BALF specimens. White blood cell (WBC) count, erythrocyte sedimentation rate (ESR), quantitative C-reactive protein (QCRP), cytokine and nitrite levels were measured from serum samples. RESULTS BALF neutrophil, TNF-alpha, IL-8 and nitrite levels were significantly higher in patients with CF than control patients. There was no correlation between serum and BALF cytokine and nitrite levels. However, there was a significantly positive correlation between BALF IL-8 and nitrite levels in patients with CF (r = 0.5) and also in control patients (r = 0.6). CONCLUSIONS The results suggest that BALF nitrite levels reflect the degree of inflammation localized to lower respiratory tract and may be a useful indicator of airway inflammation for patients with CF.
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Affiliation(s)
- Ilker Cetin
- Department of Pediatric Chest Diseases, Ihsan Doğramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
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19
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Zaman K, Palmer LA, Doctor A, Hunt JF, Gaston B. Concentration-dependent effects of endogenous S-nitrosoglutathione on gene regulation by specificity proteins Sp3 and Sp1. Biochem J 2004; 380:67-74. [PMID: 14766015 PMCID: PMC1224145 DOI: 10.1042/bj20031687] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2003] [Revised: 02/04/2004] [Accepted: 02/06/2004] [Indexed: 01/19/2023]
Abstract
The activities of certain nuclear regulatory proteins are modified by high concentrations of S-nitrosothiols associated with nitrosative stress. In the present study, we have studied the effect of physiological (low microM) concentrations of the endogenous S-nitrosothiol, GSNO (S-nitrosoglutathione), on the activities of nuclear regulatory proteins Sp3 and Sp1 (specificity proteins 3 and 1). Low concentrations of GSNO increased Sp3 binding, as well as Sp3-dependent transcription of the cystic fibrosis transmembrane conductance regulatory gene, cftr. However, higher GSNO levels prevented Sp3 binding, augmented Sp1 binding and prevented both cftr transcription and CFTR (cystic fibrosis transmembrane conductance regulator) expression. We conclude that low concentrations of GSNO favour Sp3 binding to 'housekeeping' genes such as cftr, whereas nitrosative stress-associated GSNO concentrations shut off Sp3-dependent transcription, possibly to redirect cellular resources. Since low micromolar concentrations of GSNO also increase the maturation and activity of a clinically common CFTR mutant, whereas higher concentrations have the opposite effect, these observations may have implications for dosing of S-nitrosylating agents used in cystic fibrosis clinical trials.
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Affiliation(s)
- Khalequz Zaman
- Division of Pulmonary Medicine, Department of Pediatrics, University of Virginia School of Medicine, P.O. Box 800356, Charlottesville, VA 22908, USA
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20
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Ricciardolo FLM, Sterk PJ, Gaston B, Folkerts G. Nitric oxide in health and disease of the respiratory system. Physiol Rev 2004; 84:731-65. [PMID: 15269335 DOI: 10.1152/physrev.00034.2003] [Citation(s) in RCA: 573] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
During the past decade a plethora of studies have unravelled the multiple roles of nitric oxide (NO) in airway physiology and pathophysiology. In the respiratory tract, NO is produced by a wide variety of cell types and is generated via oxidation of l-arginine that is catalyzed by the enzyme NO synthase (NOS). NOS exists in three distinct isoforms: neuronal NOS (nNOS), inducible NOS (iNOS), and endothelial NOS (eNOS). NO derived from the constitutive isoforms of NOS (nNOS and eNOS) and other NO-adduct molecules (nitrosothiols) have been shown to be modulators of bronchomotor tone. On the other hand, NO derived from iNOS seems to be a proinflammatory mediator with immunomodulatory effects. The concentration of this molecule in exhaled air is abnormal in activated states of different inflammatory airway diseases, and its monitoring is potentially a major advance in the management of, e.g., asthma. Finally, the production of NO under oxidative stress conditions secondarily generates strong oxidizing agents (reactive nitrogen species) that may modulate the development of chronic inflammatory airway diseases and/or amplify the inflammatory response. The fundamental mechanisms driving the altered NO bioactivity under pathological conditions still need to be fully clarified, because their regulation provides a novel target in the prevention and treatment of chronic inflammatory diseases of the airways.
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Affiliation(s)
- Fabio L M Ricciardolo
- Dept. of Pharmacology and Pathophysiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands
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21
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Firoved AM, Wood SR, Ornatowski W, Deretic V, Timmins GS. Microarray analysis and functional characterization of the nitrosative stress response in nonmucoid and mucoid Pseudomonas aeruginosa. J Bacteriol 2004; 186:4046-50. [PMID: 15175322 PMCID: PMC419947 DOI: 10.1128/jb.186.12.4046-4050.2004] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The type strain of Pseudomonas aeruginosa, PAO1, showed great upregulation of many nitrosative defense genes upon treatment with S-nitrosoglutathione, while the mucoid strain PAO578II showed no further upregulation above its constitutive upregulation of nor and fhp. NO* consumption however, showed that both strains mount functional, protein synthesis-dependent NO*-consumptive responses.
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Affiliation(s)
- Aaron M Firoved
- College of Pharmacy, Toxicology Program, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
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22
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Abstract
The formation and modulation of nitric oxide (NO) in the lungs is reviewed. Its beneficial and deleterious roles in airways diseases, including asthma, chronic obstructive pulmonary disease, and cystic fibrosis, and in animal models is discussed. The pharmacological effects of agents that modulate NO production or act as NO donors are described. The clinical pharmacology of these agents is described and the therapeutic potential for their use in airways disease is considered.
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Affiliation(s)
- B J Nevin
- Division of Pharmacology, Welsh School of Pharmacy, Cardiff University, Cathays Park, Cardiff, CF10 3XF, UK
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23
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Snyder AH, McPherson ME, Hunt JF, Johnson M, Stamler JS, Gaston B. Acute effects of aerosolized S-nitrosoglutathione in cystic fibrosis. Am J Respir Crit Care Med 2002; 165:922-6. [PMID: 11934715 DOI: 10.1164/ajrccm.165.7.2105032] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
S-nitrosoglutathione (GSNO), a naturally occurring constituent of airway lining fluid, enhances ciliary motility, relaxes airway smooth muscle, inhibits airway epithelial amiloride-sensitive sodium transport, and prevents pathogen replication. Remarkably, airway levels of GSNO are low in patients with cystic fibrosis (CF). We hypothesized that replacement of airway GSNO would improve gas exchange in CF. In a double-blind, placebo controlled study, we administered 0.05 ml/kg of 10 mM GSNO or phosphate buffered saline by aerosol to patients with CF and followed oxygen saturation, spirometry, respiratory rate, blood pressure, heart rate, and expired nitric oxide (NO). Nine patients received GSNO and 11 placebo. GSNO inhalation was associated with a modest but sustained increase in oxygen saturation at all time points. Expired NO increased in the low ppb range with GSNO treatment, peaking at 5 minutes but remaining above baseline at 30 minutes. There were no adverse effects. We conclude that GSNO is well tolerated in patients with CF and improves oxygenation through a mechanism that may be independent of free NO. Further, GSNO breakdown increases expired NO. We suggest that therapy aimed at restoring endogenous GSNO levels in the CF airway may merit study.
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Affiliation(s)
- Ashley H Snyder
- Division of Pediatric Respiratory Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Shin HW, Rose-Gottron CM, Perez F, Cooper DM, Wilson AF, George SC. Flow-independent nitric oxide exchange parameters in healthy adults. J Appl Physiol (1985) 2001; 91:2173-81. [PMID: 11641359 DOI: 10.1152/jappl.2001.91.5.2173] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Currently accepted techniques utilize the plateau concentration of nitric oxide (NO) at a constant exhalation flow rate to characterize NO exchange, which cannot sufficiently distinguish airway and alveolar sources. Using nonlinear least squares regression and a two-compartment model, we recently described a new technique (Tsoukias et al. J Appl Physiol 91: 477-487, 2001), which utilizes a preexpiratory breath hold followed by a decreasing flow rate maneuver, to estimate three flow-independent NO parameters: maximum flux of NO from the airways (J(NO,max), pl/s), diffusing capacity of NO in the airways (D(NO,air), pl x s(-1) x ppb(-1)), and steady-state alveolar concentration (C(alv,ss), ppb). In healthy adults (n = 10), the optimal breath-hold time was 20 s, and the mean (95% intramaneuver, intrasubject, and intrapopulation confidence interval) J(NO,max), D(NO,air), and C(alv,ss) are 640 (26, 20, and 15%) pl/s, 4.2 (168, 87, and 37%) pl x s(-1) x ppb(-1), and 2.5 (81, 59, and 21%) ppb, respectively. J(NO,max) can be estimated with the greatest certainty, and the variability of all the parameters within the population of healthy adults is significant. There is no correlation between the flow-independent NO parameters and forced vital capacity or the ratio of forced expiratory volume in 1 s to forced vital capacity. With the use of these parameters, the two-compartment model can accurately predict experimentally measured plateau NO concentrations at a constant flow rate. We conclude that this new technique is simple to perform and can simultaneously characterize airway and alveolar NO exchange in healthy adults with the use of a single breathing maneuver.
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Affiliation(s)
- H W Shin
- Department of Chemical and Biochemical Engineering and Materials Science, University of California, Irvine, Irvine, California 92697, USA
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Johannesson M, Lúdvíksdóttir D, Janson C. Lung function changes in relation to menstrual cycle in females with cystic fibrosis. Respir Med 2000; 94:1043-6. [PMID: 11127489 DOI: 10.1053/rmed.2000.0891] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oestrogen and progesterone have been shown to have impact on cystic fibrosis transmembrane conductance regulator (CFTR) gene expression, tone of smooth muscle in the airways, immune response, exhaled nitric oxide and cytology in the tracheobronchial epithelium. The aim of this investigation was to study the influence of menstrual cyclicity on airway symptoms among cystic fibrosis (CF) females. Twelve CF women (mean age 30 years, mean Shwachman score 85) kept daily records during three menstrual cycles of lung function, sputum quality and need for intravenous antibiotics. Paired t-test was used as a statistical method to compare the airway symptoms between the time of ovulation (high levels of oestrogen and low levels of progesterone), the luteal phase (high levels of oestrogen and progesterone) and menstruation (low levels of oestrogens and progesterone). Forced expiratory volume in 1 sec (FEV1) was significantly higher during the luteal phase (66% of predicted) compared to during ovulation (63%) and menstruation (61%) (P<0.01). Forced vital capacity (FVC) showed the same pattern, being significantly higher during the luteal phase compared with during menstruation (mean 75% vs. 70%, P<0.01). In conclusion, lung function changes were found during menstrual cycles in women with cystic fibrosis. These changes are probably related to changes in progesterone levels during the menstrual cycles. This result warrants further studies to understand the complexity of CF lung disease in women.
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Affiliation(s)
- M Johannesson
- Uppsala CF Center, Department of Paediatrics, Uppsala University Hospital, Sweden.
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Abstract
The pulmonary endothelium modulates vascular tone by the release of endothelium-derived constricting (EDCF) and relaxing (EDRF) factors, among them endothelin-1, nitric oxide, prostacyclin, and putative endothelium-derived hyperpolarizing factors. Abnormalities in EDCF and EDRF generation have been demonstrated in a number of cardiopulmonary disease states, such as primary and secondary pulmonary hypertension, chronic obstructive lung disease, cardiopulmonary bypass, and congestive heart failure. An imbalance between EDCF and EDRF, termed "pulmonary endothelial dysfunction," may contribute to the alteration in vascular tone characteristic of pulmonary disease. The following review summarizes the present knowledge of the role of EDCF and EDRF in such processes with major focus on pulmonary endothelial dysfunction in hypoxia-induced pulmonary hypertension.
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MESH Headings
- Animals
- Antihypertensive Agents/pharmacology
- Antihypertensive Agents/therapeutic use
- Atrasentan
- Bosentan
- Controlled Clinical Trials as Topic
- Disease Models, Animal
- Endothelin Receptor Antagonists
- Endothelin-1/metabolism
- Endothelins/genetics
- Endothelins/metabolism
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Epoprostenol/metabolism
- Heart Failure/physiopathology
- Humans
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/metabolism
- Hypertension, Pulmonary/physiopathology
- Hypoxia/metabolism
- Lung Diseases, Obstructive/physiopathology
- Nitric Oxide/genetics
- Nitric Oxide/metabolism
- Oligopeptides/pharmacology
- Peptides, Cyclic/pharmacology
- Piperidines/pharmacology
- Pulmonary Circulation
- Pyrrolidines/pharmacology
- RNA, Messenger/analysis
- Receptors, Endothelin/metabolism
- Sulfonamides/pharmacology
- Time Factors
- Vasoconstriction/drug effects
- Vasodilation/drug effects
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Affiliation(s)
- Y F Chen
- Department of Medicine, University of Alabama at Birmingham 35294-0007, USA
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