Muco-Obstructive Lung Diseases

A systematical strategy for quality markers screening of different methods processing Platycodonis radix based on phytochemical analysis and the impact on Chronic Obstructive Pulmonary Disease

ETHNOPHARMACOLOGICAL RELEVANCE

Baihezhijiegeng is a processed product of Platycodonis radix, and it's effective in the treatment of Chronic Obstructive Pulmonary Disease (COPD). However, the specific mechanism of action has not been reported in the literature.

AIM OF THE STUDY

We attempted to evaluate the phytochemical composition and pharmaco-dynamics of Platycodon grandiflorum (PG) and BJ to clarify the mechanism behind the expectorant effect of BJ.

MATERIALS AND METHODS

We integrated the ultra-high-performance liquid chromatography-linear trap quadrupole orbitrap velos mass spectrometry (UPLC-LTQ Orbitrap MS/MS) and the ultra-performance liquid chromatography quadrupole-time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS) methods to identify the chemical constituents of PG and BJ. Moreover, correlation and multivariate statistical analyses were utilized to seek the candidate quality markers of PG and BJ. Analysis of effective herbal chemical components using UPLC-Q-TOF-MS/MS and retrieval of COPD disease targets from OMIM, TTD, GeneCard databases. Protein-protein interaction (PPI) and topology analyses were performed using the String database and Cytoscape 3.7.2 software; gene ontology (GO) functional enrichment analysis and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis were performed using the Metescape platform on common targets. Moreover, we used molecular docking to predict the potential mechanism of quality markers for developing anti-COPD activity. Simultaneously, the model of COPD was established by exposing the animals to cigarette smoke combined with a tracheal drip injection of lipopolysaccharide (LPS). Using the ELISA method, quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting (WB) to determine tumor-necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and matrix metalloproteinase (MMP)9 levels in serum and IL-4, IL-10, IFN-γ levels, epidermal growth factor receptor (EGFR) and MUC5AC expression in lung tissue of COPD rats to explore the therapeutic effects of PG and BJ on the COPD rat model.

RESULTS

The chemical identification of JG and PG extracts using UPLC-Q-TOF-MS/MS and UPLC-LTQ Orbitrap MS/MS showed 71 compounds, including 47 saponins, 16 phenolic acids, four flavonoids, and four other components. The multivariate statistical analysis showed that seven quality markers were screened. Network pharmacology results showed a role in biological processes such as cellular response to hydrogen peroxide, positive regulation of pri-miRNA transcription from RNA polymerase II promoter, molecular functions such as oxidoreductase activity, acting on NAD(P)H, quinone or similar compound as acceptor, bile acid binding and other molecular functions. In COPD rats, histopathological findings depicted that BJ administration could effectively inhibit inflammatory cell infiltration and mucus hypersecretion, and improve the lung pathological status in rats with COPD. Moreover, BJ could significantly decrease TNF-α, IL-1β, IL-6, and matrix metalloproteinase (MMP)9 levels in the serum and interferon (IFN)-γ levels in lung tissues of rats with COPD (p < 0.01), and significantly increase IL-4 and IL-10 levels in their lung tissues (p < 0.01), suggesting its inhibition of the inflammatory response in vivo. Additionally, EGFR and MUC5AC were reduced in the lung tissues of rats with COPD and airway mucus hypersecretion in rats with COPD.

CONCLUSION

This study revealed the material basis of PG and BJ for anti-COPD activity and discovered the quality markers of PG and BJ which could affect the anti-COPD activity. The therapeutic effects of BJ may be attributed to the regulation of the inflammatory mediators and mediation of the EGFR/MUC5AC pathway in rats with COPD.

SNSP113 (PAAG) improves mucociliary transport and lung pathology in the Scnn1b-Tg murine model of CF lung disease

BACKGROUND

Mucus stasis, a hallmark of muco-obstructive disease, results from impaired mucociliary transport and leads to lung function decline and chronic infection. Although therapeutics that target mucus stasis in the airway, such as hypertonic saline or rhDNAse, show some therapeutic benefit, they do not address the underlying electrostatic defect apparent in mucins in CF and related conditions. We have previously shown poly (acetyl, arginyl) glucosamine (PAAG, developed as SNSP113), a soluble, cationic polymer, significantly improves mucociliary transport in a rat model of CF by normalizing the charge defects of CF mucin. Here, we report efficacy in the CFTR-sufficient, ENaC hyperactive, Scnn1b-Tg mouse model that develops airway muco-obstruction due to sodium hyperabsorption and airway dehydration.

METHODS

Scnn1b-Tg mice were treated with either 250 µg/mL SNSP113 or vehicle control (1.38% glycerol in PBS) via nebulization once daily for 7 days and then euthanized for analysis. Micro-Optical Coherence Tomography-based evaluation of excised mouse trachea was used to determine the effect on the functional microanatomy. Tissue analysis was performed by routine histopathology.

RESULTS

Nebulized treatment of SNSP113 significantly improved mucociliary transport in the airways of Scnn1b-Tg mice, without altering the airway surface or periciliary liquid layer. In addition, SNSP113 significantly reversed epithelial hypertrophy and goblet cell metaplasia. Finally, SNSP113 significantly ameliorated eosinophilic crystalline pneumonia and lung consolidation in addition to inflammatory macrophage influx in this model.

CONCLUSION

Overall, this study extends the efficacy of SNSP113 as a potential therapeutic to alleviate mucus stasis in muco-obstructive diseases in CF and potentially in related conditions.

Epithelial-Mesenchymal Transition Mechanisms in Chronic Airway Diseases: A Common Process to Target?

Epithelial-to-mesenchymal transition (EMT) is a reversible process, in which epithelial cells lose their epithelial traits and acquire a mesenchymal phenotype. This transformation has been described in different lung diseases, such as lung cancer, interstitial lung diseases, asthma, chronic obstructive pulmonary disease and other muco-obstructive lung diseases, such as cystic fibrosis and non-cystic fibrosis bronchiectasis. The exaggerated chronic inflammation typical of these pulmonary diseases can induce molecular reprogramming with subsequent self-sustaining aberrant and excessive profibrotic tissue repair. Over time this process leads to structural changes with progressive organ dysfunction and lung function impairment. Although having common signalling pathways, specific triggers and regulation mechanisms might be present in each disease. This review aims to describe the various mechanisms associated with fibrotic changes and airway remodelling involved in chronic airway diseases. Having better knowledge of the mechanisms underlying the EMT process may help us to identify specific targets and thus lead to the development of novel therapeutic strategies to prevent or limit the onset of irreversible structural changes.

Effect of elexacaftor/tezacaftor/ivacaftor on airway and systemic inflammation in cystic fibrosis

Treatment with elexacaftor/tezacaftor/ivacaftor (ETI) has been shown to improve lung function in people with cystic fibrosis (PWCF). However, its biological effects remain incompletely understood. Here we describe alterations in pulmonary and systemic inflammation in PWCF following initiation of ETI. To address this, we collected spontaneously expectorated sputum and matching plasma from PWCF (n=30) immediately prior to ETI therapy, then again at 3 and 12 months. Within 3 months, PWCF demonstrated reduced activity of neutrophil elastase, proteinase three and cathepsin G, and decreased concentrations of interleukin (IL)-1β and IL-8 in sputum, accompanied by decreased Pseudomonas burden and restoration of secretory leukoprotease inhibitor levels. Once treated with ETI, all airway inflammatory markers studied in PWCF had reduced to levels found in matched non-CF bronchiectasis controls. In PWCF with advanced disease, ETI resulted in decreased plasma concentrations of IL-6, C-reactive protein and soluble TNF receptor one as well as normalisation of levels of the acute phase protein, alpha-1 antitrypsin. These data clarify the immunomodulatory effects of ETI and underscore its role as a disease modifier.

Current and Emerging Inhaled Antibiotics for Chronic Pulmonary Pseudomonas aeruginosa and Staphylococcus aureus Infections in Cystic Fibrosis

Characterized by impaired mucus transport and subsequent enhanced colonization of bacteria, pulmonary infection causes major morbidity and mortality in patients with cystic fibrosis (CF). Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) are the two most common types of bacteria detected in CF lungs, which undergo multiple adaptational mechanisms such as biofilm formation resulting in chronic pulmonary infections. With the advantages of greater airway concentration and minimized systemic toxicity, inhaled antibiotics are introduced to treat chronic pulmonary infection in CF. Inhaled tobramycin, aztreonam, levofloxacin, and colistin are the four most common discussed inhaled antibiotics targeting P. aeruginosa. Additionally, inhaled liposomal amikacin and murepavadin are also in development. This review will discuss the virulence factors and adaptational mechanisms of P. aeruginosa and S. aureus in CF. The mechanism of action, efficacy and safety, current status, and indications of corresponding inhaled antibiotics will be summarized. Combination therapy and the strategies to select an optimal inhaled antibiotic protocol will also be discussed.

The Contribution of Gut Microbiota-Brain Axis in the Development of Brain Disorders

Different bacterial families colonize most mucosal tissues in the human organism such as the skin, mouth, vagina, respiratory, and gastrointestinal districts. In particular, the mammalian intestine hosts a microbial community of between 1,000 and 1,500 bacterial species, collectively called "microbiota." Co-metabolism between the microbiota and the host system is generated and the symbiotic relationship is mutually beneficial. The balance that is achieved between the microbiota and the host organism is fundamental to the organization of the immune system. Scientific studies have highlighted a direct correlation between the intestinal microbiota and the brain, establishing the existence of the gut microbiota-brain axis. Based on this theory, the microbiota acts on the development, physiology, and cognitive functions of the brain, although the mechanisms involved have not yet been fully interpreted. Similarly, a close relationship between alteration of the intestinal microbiota and the onset of several neurological pathologies has been highlighted. This review aims to point out current knowledge as can be found in literature regarding the connection between intestinal dysbiosis and the onset of particular neurological pathologies such as anxiety and depression, autism spectrum disorder, and multiple sclerosis. These disorders have always been considered to be a consequence of neuronal alteration, but in this review, we hypothesize that these alterations may be non-neuronal in origin, and consider the idea that the composition of the microbiota could be directly involved. In this direction, the following two key points will be highlighted: (1) the direct cross-talk that comes about between neurons and gut microbiota, and (2) the degree of impact of the microbiota on the brain. Could we consider the microbiota a valuable target for reducing or modulating the incidence of certain neurological diseases?