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Jones VC, Birrell MA, Maher SA, Griffiths M, Grace M, O'Donnell VB, Clark SR, Belvisi MG. Role of EP2 and EP4 receptors in airway microvascular leak induced by prostaglandin E2. Br J Pharmacol 2016; 173:992-1004. [PMID: 26639895 PMCID: PMC4831025 DOI: 10.1111/bph.13400] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/21/2015] [Accepted: 11/30/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND PURPOSE Airway microvascular leak (MVL) involves the extravasation of proteins from post-capillary venules into surrounding tissue. MVL is a cardinal sign of inflammation and an important feature of airway inflammatory diseases such as asthma. PGE2, a product of COX-mediated metabolism of arachidonic acid, binds to four receptors, termed EP1–4. PGE2 has a wide variety of effects within the airway, including modulation of inflammation, sensory nerve activation and airway tone. However, the effect of PGE2 on airway MVL and the receptor/s that mediate this have not been described. EXPERIMENTAL APPROACH Evans Blue dye was used as a marker of airway MVL, and selective EP receptor agonists and antagonists were used alongside EP receptor-deficient mice to define the receptor subtype involved. KEY RESULTS PGE2 induced significant airway MVL in mice and guinea pigs. A significant reduction in PGE2-induced MVL was demonstrated in Ptger2−/− and Ptger4−/− mice and in wild-type mice pretreated simultaneously with EP2 (PF-04418948) and EP4 (ER-819762) receptor antagonists. In a model of allergic asthma, an increase in airway levels of PGE2 was associated with a rise in MVL; this change was absent in Ptger2−/− and Ptger4−/− mice. CONCLUSIONS AND IMPLICATIONS PGE2 is a key mediator produced by the lung and has widespread effects according to the EP receptor activated. Airway MVL represents a response to injury and under ‘disease’ conditions is a prominent feature of airway inflammation. The data presented highlight a key role for EP2 and EP4 receptors in MVL induced by PGE2.
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MESH Headings
- Allergens
- Animals
- Asthma/metabolism
- Azetidines/pharmacology
- Benzazepines/pharmacology
- Bronchi/metabolism
- Capillary Permeability
- Dinoprostone/analogs & derivatives
- Dinoprostone/metabolism
- Dinoprostone/pharmacology
- Guinea Pigs
- Imidazoles/pharmacology
- Male
- Methyl Ethers/pharmacology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Ovalbumin
- Receptors, Prostaglandin E, EP2 Subtype/agonists
- Receptors, Prostaglandin E, EP2 Subtype/antagonists & inhibitors
- Receptors, Prostaglandin E, EP2 Subtype/genetics
- Receptors, Prostaglandin E, EP2 Subtype/metabolism
- Receptors, Prostaglandin E, EP4 Subtype/agonists
- Receptors, Prostaglandin E, EP4 Subtype/antagonists & inhibitors
- Receptors, Prostaglandin E, EP4 Subtype/genetics
- Receptors, Prostaglandin E, EP4 Subtype/metabolism
- Trachea/metabolism
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Zou H, Fang QH, Ma YM, Wang XY. Analysis of growth factors in serum and induced sputum from patients with asthma. Exp Ther Med 2014; 8:573-578. [PMID: 25009622 PMCID: PMC4079436 DOI: 10.3892/etm.2014.1759] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 05/16/2014] [Indexed: 12/28/2022] Open
Abstract
Epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), the AA and BB isoforms of platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF) are involved in the pathogenesis of airway inflammation in asthma. In the present study, the associations between asthmatic phenotypes and the expression levels of these mediators in induced sputum and serum were investigated. A total of 62 asthmatic patients were divided into eosinophilic or neutrophilic phenotypes by cytological classification of the induced sputum. In addition, patients were classified according to lung function (FEV1/FVC >70% or FEV1/FVC <70%) and asthma severity (mild, moderate or severe). The concentrations of EGF, bFGF, PDGF-AA, PDGF-BB and VEGF in the serum and induced sputum were measured using sandwich enzyme immunoassays. VEGF levels in the serum and induced sputum were higher in patients with an eosinophilic phenotype compared with those with a neutrophilic phenotype. In addition, VEGF expression was higher in patients with an FEV1/FVC value of <70% as compared with patients with an FEV1/FVC value of >70%. Furthermore, the levels of VEGF were higher in patients with severe asthma compared with the patients with mild and moderate asthma. There were no statistically significant differences observed with regard to EGF, bFGF, PDGF-AA and PDGF-BB levels among the various phenotypes. Therefore, the observations of the present study indicated that increased VEGF expression in the serum and induced sputum of patients may be associated with eosinophilic airway inflammation, severe airflow limitation and the severity of asthma.
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Affiliation(s)
- Hui Zou
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Qiu-Hong Fang
- Department of Pulmonary and Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Ying-Min Ma
- Department of Pulmonary and Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Xue-Yan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
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3
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Bonini M, Permaul P, Kulkarni T, Kazani S, Segal A, Sorkness CA, Wechsler ME, Israel E. Loss of salmeterol bronchoprotection against exercise in relation to ADRB2 Arg16Gly polymorphism and exhaled nitric oxide. Am J Respir Crit Care Med 2014; 188:1407-12. [PMID: 24228710 DOI: 10.1164/rccm.201307-1323oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE β2-Agonists are the treatment of choice for exercise-induced bronchoconstriction (EIB) and act through specific receptors (ADRB2). Arg16Gly polymorphisms have been shown to affect responses to regular use of β2-agonists. OBJECTIVES To evaluate the influence of the Arg16Gly receptor polymorphism on salmeterol bronchoprotection in EIB and assess predictors of bronchoprotection. METHODS A prospective, genotype-blinded, randomized trial was performed in 26 subjects (12 Arg16Arg and 14 Gly16Gly) with EIB who were not on controller therapy. Subjects were administered salmeterol, 50 μg twice a day for 2 weeks, and underwent an exercise challenge 9 hours after the first and last drug dose. In addition to genotype, FEV1, response to salmeterol, degree of EIB, and exhaled nitric oxide (FE(NO)) at baseline were examined for their association with loss of bronchoprotection (LOB). MEASUREMENTS AND MAIN RESULTS The maximum exercise-induced FEV1 fall was 27.9 ± 1.4% during the run-in period, 8.1 ± 1.2% (70.3 ± 4.1% bronchoprotection) after the first salmeterol dose, and 22.8 ± 3.2% (18.9 ± 11.5% bronchoprotection) after 2 weeks of salmeterol (P = 0.0001). The Arg16Gly polymorphisms were not associated with the LOB in response to salmeterol. FeNO values at baseline were significantly related to the LOB (r = 0.47; P = 0.01). Mean change was a 74 ± 13% LOB in subjects with FE(NO) levels greater than 50 ppb and a 7 ± 16% gain in bronchoprotection in those with FE(NO) levels less than 25 ppb (P = 0.01). CONCLUSIONS The LOB that occurs with chronic long-acting β2-agonists use is not affected by ADRB2 Arg16Gly polymorphisms. High FE(NO) was associated with marked LOB. Use of long-acting β2-agonists before achieving a reduction in FeNO may need to be avoided. Clinical trial registered with www.clinicaltrials.gov (NCT 00595361).
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Affiliation(s)
- Matteo Bonini
- 1 Asthma Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
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Chinellato I, Piazza M, Peroni D, Sandri M, Chiorazzo F, Boner AL, Piacentini G. Bronchial and alveolar nitric oxide in exercise-induced bronchoconstriction in asthmatic children. Clin Exp Allergy 2012; 42:1190-6. [PMID: 22805466 DOI: 10.1111/j.1365-2222.2012.03973.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidemiological studies have shown an association between the severity of exercise-induced bronchoconstriction (EIB) and fractional exhaled nitric oxide at the flow of 50 mL/s (FeNO(50)). However, no study has assessed the correlation between alveolar production (C(alv)) and bronchial flux (J(NO)) of nitric oxide (NO) and EIB in asthmatic children. OBJECTIVE To identify the relationship between severity of EIB and bronchial or alveolar nitric oxide. METHODS Our group included 36 allergic children with intermittent asthma. The EIB was determined by a standard exercise challenge and the severity was expressed as the maximum change in percentage from the baseline value of lung function (ΔFEV(1)%, ΔFEF(25-75)%) after exercising. A chemiluminescence analyser at multiple flows was used to calculate FeNO(50), J(NO) and C(alv,) which reflect large airways, J(NO) and alveolar concentration of NO respectively. RESULTS Sixteen (44.4%) children presented a ∆FEV(1) ≥ 10%, eight (22.2%) had ∆FEV(1) ≥ 15% and nine (25%) children had a ∆FEF(25-75) ≥ 26%. A significant correlation was observed between severity of EIB and FeNO(50) , J(NO) and C(alv.) EIB was significantly more severe in children sensitive to indoor allergens compared with outdoor allergens only (P = 0.014); those children showed also higher levels of C(alv) (P = 0.003) and of J(NO) (P = 0.044). CONCLUSIONS AND CLINICAL RELEVANCE Our results suggest that inflammation is present in the central and peripheral airways and that it is associated with the severity of EIB. Clinicaltrials.gov NCT00952835.
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Affiliation(s)
- I Chinellato
- Department of Pediatrics, University of Verona, Verona, Italy
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Tecklenburg-Lund S, Mickleborough TD, Turner LA, Fly AD, Stager JM, Montgomery GS. Randomized controlled trial of fish oil and montelukast and their combination on airway inflammation and hyperpnea-induced bronchoconstriction. PLoS One 2010; 5:e13487. [PMID: 20976161 PMCID: PMC2956690 DOI: 10.1371/journal.pone.0013487] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 08/12/2010] [Indexed: 01/07/2023] Open
Abstract
Background Both fish oil and montelukast have been shown to reduce the severity of exercise-induced bronchoconstriction (EIB). The purpose of this study was to compare the effects of fish oil and montelukast, alone and in combination, on airway inflammation and bronchoconstriction induced by eucapnic voluntary hyperpnea (EVH) in asthmatics. Methods In this model of EIB, twenty asthmatic subjects with documented hyperpnea-induced bronchoconstriction (HIB) entered a randomized double-blind trial. All subjects entered on their usual diet (pre-treatment, n = 20) and then were randomly assigned to receive either one active 10 mg montelukast tablet and 10 placebo fish oil capsules (n = 10) or one placebo montelukast tablet and 10 active fish oil capsules totaling 3.2 g EPA and 2.0 g DHA (n = 10) taken daily for 3-wk. Thereafter, all subjects (combination treatment; n = 20) underwent another 3-wk treatment period consisting of a 10 mg active montelukast tablet or 10 active fish oil capsules taken daily. Results While HIB was significantly inhibited (p<0.05) by montelukast, fish oil and combination treatment compared to pre-treatment, there was no significant difference (p>0.017) between treatment groups; percent fall in forced expiratory volume in 1-sec was −18.4±2.1%, −9.3±2.8%, −11.6±2.8% and −10.8±1.7% on usual diet (pre-treatment), fish oil, montelukast and combination treatment respectively. All three treatments were associated with a significant reduction (p<0.05) in FENO, exhaled breathe condensate pH and cysteinyl-leukotrienes, while the fish oil and combination treatment significantly reduced (p<0.05) urinary 9α, 11β-prostaglandin F2 after EVH compared to the usual diet; however, there was no significant difference (p>0.017) in these biomarkers between treatments. Conclusion While fish oil and montelukast are both effective in attenuating airway inflammation and HIB, combining fish oil with montelukast did not confer a greater protective effect than either intervention alone. Fish oil supplementation should be considered as an alternative treatment for EIB. Trial Registration ClinicalTrials.gov NCT00676468
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Affiliation(s)
- Sandra Tecklenburg-Lund
- Human Performance and Exercise Biochemistry Laboratory, Department of Kinesiology, Indiana University, Bloomington, Indiana, United States of America
- Health and Human Performance, Nebraska Wesleyan University, Lincoln, Nebraska, United States of America
| | - Timothy D. Mickleborough
- Human Performance and Exercise Biochemistry Laboratory, Department of Kinesiology, Indiana University, Bloomington, Indiana, United States of America
- * E-mail:
| | - Louise A. Turner
- Human Performance and Exercise Biochemistry Laboratory, Department of Kinesiology, Indiana University, Bloomington, Indiana, United States of America
| | - Alyce D. Fly
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, United States of America
| | - Joel M. Stager
- Human Performance and Exercise Biochemistry Laboratory, Department of Kinesiology, Indiana University, Bloomington, Indiana, United States of America
| | - Gregory S. Montgomery
- Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
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Kanazawa H. Relationship between hepatitis C virus infection and pulmonary disorders: potential mechanisms of interaction. Expert Rev Clin Immunol 2010; 2:801-10. [PMID: 20477634 DOI: 10.1586/1744666x.2.5.801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recently, an increasing number of reports have suggested that chronic hepatitis C virus (HCV) infection is associated with pulmonary disorders. The effects of HCV on the lung may present as worsening of lung function and impaired responses to therapy in patients with chronic obstructive pulmonary disease and asthma. Moreover, chronic HCV infection may be associated with the pathogenesis of interstitial lung disease. It is believed that chronic HCV infection may contribute to the immune responses modulating the pathogenic processes underlying pulmonary disorders and, therefore, may lead to a wide spectrum of clinical presentations. Potential candidates for a role in these immune responses are the CD8(+) T lymphocytes and inflammatory cytokines. In this review, the effects of HCV on the lung and the potential mechanisms of interaction between chronic HCV infection and pulmonary disorders will be discussed.
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Affiliation(s)
- Hiroshi Kanazawa
- Osaka City University, Department of Respiratory Medicine, Graduate School of Medicine, 1-4-3, Asahi-machi, Abenoku, Osaka 545-8585, Japan.
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Nomura S, Kanazawa H, Hirata K, Iwao H, Yoshikawa J. Relationship Between Vascular Endothelial Growth Factor and Angiopoietin-2 in Asthmatics Before and After Inhaled Beclomethasone Therapy. J Asthma 2009. [DOI: 10.1081/jas-51346] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kanazawa H, Tochino Y, Asai K. Angiopoietin-2 as a contributing factor of exercise-induced bronchoconstriction in asthmatic patients receiving inhaled corticosteroid therapy. J Allergy Clin Immunol 2007; 121:390-5. [PMID: 18037159 DOI: 10.1016/j.jaci.2007.09.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 08/22/2007] [Accepted: 09/19/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND Airway microcirculation has the potential to contribute to the pathogenesis of exercise-induced bronchoconstriction (EIB) in asthma. Recently, angiopoietin-1 has been found to stabilize microvessels and make them leak resistant, whereas angiopoietin-2 is an antagonist of angiopoietin-1 and enhances microvascular permeability. OBJECTIVE We sought to examine the roles of angiopoietin-2 in EIB in asthmatic patients with inhaled corticosteroid therapy. METHODS Levels of angiopoietin-1 and angiopoietin-2 in induced sputum were examined in 32 asthmatic patients who were receiving inhaled corticosteroid therapy for more than 6 months at the entry of this study and 14 healthy control subjects. All asthmatic patients performed an exercise test. RESULTS The degree of eosinophilic airway inflammation did not differ significantly between asthmatic patients and healthy control subjects. Angiopoietin-1 levels were also similar in the 2 groups (asthmatic patients: median, 6.0 ng/mL [range, 2.0-10.7 ng/mL]; healthy control subjects: median, 4.2 ng/mL [range, 1.5-10.7 ng/mL]). In contrast, angiopoietin-2 levels were significantly higher in asthmatic patients than in healthy control subjects (asthmatic patients: median, 0.74 ng/mL [range, 0.3-1.2 ng/mL]; healthy control subjects: median, 0.26 ng/mL [range, 0.05-0.47 ng/mL]; P < .001). There was no significant correlation between angiopoietin-1 levels and the severity of EIB in asthmatic patients. However, angiopoietin-2 levels were significantly correlated with the severity of EIB and airway microvascular permeability index. CONCLUSION Angiopoietin-2 levels were increased in the airways of asthmatic patients with inhaled corticosteroid therapy, and its levels were associated with the severity of EIB.
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Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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Belda J, Ricart S, Casan P, Giner J, Bellido-Casado J, Torrejon M, Margarit G, Drobnic F. Airway inflammation in the elite athlete and type of sport. Br J Sports Med 2007; 42:244-8; discussion 248-9. [PMID: 17711871 DOI: 10.1136/bjsm.2007.036335] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The prevalence of asthma and bronchial hyper-responsiveness is greater in elite athletes than in the general population, and its association with mild airway inflammation has recently been reported. OBJECTIVE To study the relationship between the type of sport practised at the highest levels of competition (on land or in water) and sputum induction cell counts in a group of healthy people and people with asthma. MATERIAL AND METHODS In total, 50 athletes were enrolled. Medical history, results of methacholine challenge tests and sputum induced by hypertonic saline were analysed RESULTS Full results were available for 43 athletes, who were classified by asthma diagnosis and type of sport (land or water sports). Nineteen were healthy (10 land and 9 water athletes) and 24 had asthma (13 land and 11 water athletes). Although the eosinophil counts of healthy people and people with asthma were significantly different (mean difference 3.1%, 95% CI 0.4 to 6.2, p = 0.008), analysis of variance showed no effect on eosinophil count for either diagnosis of asthma or type of sport. However, an effect was found for neutrophil counts (analysis of variance: F = 2.87, p = 0.04). There was also a significant correlation between neutrophil counts and both duration of training and bronchial hyper-responsiveness among athletes exposed to water (Spearman's rank correlations, 0.36 and 0.47, p = 0.04 and 0.04, respectively). CONCLUSIONS Elite athletes who practice water sports have mild neutrophilic inflammation, whether or not asthma is present, related to the degree of bronchial hyper-reactivity and the duration of training in pool water.
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Affiliation(s)
- J Belda
- Hospital General Universitario de Valencia, Valencia, Spain
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10
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Kanazawa H, Nomura S, Asai K. Roles of angiopoietin-1 and angiopoietin-2 on airway microvascular permeability in asthmatic patients. Chest 2007; 131:1035-41. [PMID: 17426207 DOI: 10.1378/chest.06-2758] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) increases microvascular permeability. Recently, considerable attention has been devoted to the physiologic roles of angiopoietin-1 and angiopoietin-2 as regulatory factors of VEGF. This study was designed to examine the roles of angiopoietin-1 and angiopoietin-2 in controlling airway microvascular permeability in asthma. METHODS Levels of these angiogenic factors and airway vascular permeability index were examined in 30 asthmatics and 12 control subjects. After 2-week run-in period, all asthmatics were randomly assigned to receive fluticasone propionate (400 mug/d) or montelukast (10 mg) for 12 weeks. RESULTS VEGF, angiopoietin-1, and angiopoietin-2 levels in induced sputum were significantly higher in asthmatics than in control subjects. We found an inverse correlation between angiopoietin-1 level and vascular permeability index in asthmatics, while there was a positive correlation between angiopoietin-2 level and that index. VEGF and angiopoietin-1 levels were significantly decreased after fluticasone therapy, while VEGF and angiopoietin-2 levels were significantly decreased after montelukast therapy. Although VEGF levels after treatment were different between two groups, vascular permeability index in the montelukast group was the same level as that in the fluticasone group. Moreover, improvement in vascular permeability index after fluticasone therapy was inversely correlated with decrease in angiopoietin-1 level, while that after montelukast therapy was positively correlated with decrease in angiopoietin-2 level. CONCLUSIONS Angiopoietin-1 and angiopoietin-2 play complementary and coordinated roles in regulating microvascular permeability stimulated by VEGF in asthma. Combination of corticosteroids with leukotriene antagonists might effectively improve plasma leakage and provide a new strategy in treating bronchial asthma.
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Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abenoku, Osaka, 545-8585, Japan.
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Tecklenburg SL, Mickleborough TD, Fly AD, Bai Y, Stager JM. Ascorbic acid supplementation attenuates exercise-induced bronchoconstriction in patients with asthma. Respir Med 2007; 101:1770-8. [PMID: 17412579 DOI: 10.1016/j.rmed.2007.02.014] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 02/08/2007] [Accepted: 02/20/2007] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous research has shown that diet can modify the bronchoconstrictor response to exercise in asthmatic subjects. OBJECTIVE Determine the effect of ascorbic acid supplementation on pulmonary function and several urinary markers of airway inflammation in asthmatic subjects with exercise-induced bronchoconstriction (EIB). METHODS Eight asthmatic subjects with documented EIB participated in a randomized, placebo controlled double-blind crossover trial. Subjects entered the study on their usual diet and were placed on either 2 weeks of ascorbic acid supplementation (1500 mg/day) or placebo, followed by a 1-week washout period, before crossing over to the alternative diet. Pre- and post-exercise pulmonary function, asthma symptom scores, fraction of exhaled nitric oxide (FENO), and urinary leukotriene (LT) C4-E4 and 9alpha, 11beta-prostagladin (PG) F2] were assessed at the beginning of the trial (usual diet) and at the end of each treatment period. RESULTS The ascorbic acid diet significantly reduced (p < 0.05) the maximum fall in post-exercise FEV1 (-6.4 +/- 2.4%) compared to usual (-14.3 +/- 1.6%) and placebo diet (-12.9 +/- 2.4%). Asthma symptoms scores significantly improved (p<0.05) on the ascorbic acid diet compared to the placebo and usual diet. Post-exercise FENO, LTC4-E4 and 9alpha, 11beta-PGF2 concentration was significantly lower (p<0.05) on the ascorbic acid diet compared to the placebo and usual diet. CONCLUSION Ascorbic acid supplementation provides a protective effect against exercise-induced airway narrowing in asthmatic subjects.
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Affiliation(s)
- Sandra L Tecklenburg
- Human Performance and Exercise Biochemistry Laboratory, Department of Kinesiology, Indiana University, 1025 E. 7th St, HPER 112, Bloomington, IN 47401, USA
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12
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Lewis MJ, Short AL, Lewis KE. Autonomic nervous system control of the cardiovascular and respiratory systems in asthma. Respir Med 2006; 100:1688-705. [PMID: 16524708 DOI: 10.1016/j.rmed.2006.01.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 01/19/2006] [Accepted: 01/25/2006] [Indexed: 12/01/2022]
Abstract
Patients with asthma have exaggerated bronchoconstriction of their airways in response to certain indirect (e.g. cold air, allergens, dust, exercise) or direct (e.g. inhaled methacholine) stimuli. This 'hyper-reactivity' usually co-exists with airway inflammation, although the pathophysiological mechanisms underlying these changes are not fully understood. It is likely that this hyper-reactivity is associated with abnormal autonomic nervous system (ANS) control. In particular, the parasympathetic (vagal) component of the ANS appears to be implicated in the pathogenesis of asthma. In addition, several studies have suggested the existence of differential alteration in ANS function following exercise in asthmatics compared with non-asthmatic individuals. Several early studies suggested that the altered autonomic control of airway calibre in asthma might be reflected by a parallel change in heart rate. Cardiac vagal reactivity does indeed appear to be increased in asthma, as demonstrated by the cardiac response to various autonomic functions tests. However, other studies have reported a lack of association between bronchial and cardiac vagal tone, and this is in accord with the concept of system-independent ANS control. This review provides a discussion of cardiovascular-autonomic changes associated with either the pathophysiology of asthma per se or with asthma pharmacotherapy treatment. Previous investigations are summarised suggesting an apparent association between altered autonomic-cardiovascular control and bronchial asthma. The full extent of autonomic dysfunction, and its clinical implications, has yet to be fully determined and should be the subject of future investigation.
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Affiliation(s)
- M J Lewis
- Department of Sports Science, University of Wales Swansea, Singleton Park, Swansea SA2 8PP, UK.
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Kanazawa H, Tochino Y, Ichimaru Y, Kodama T, Kyoh S, Umeda N. Role of vascular endothelial growth factor in pulmonary endothelial cell injury by exercise challenge in asthmatic patients. J Asthma 2006; 43:267-71. [PMID: 16809239 DOI: 10.1080/02770900600622653] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study was designed to examine the role of vascular endothelial growth factor (VEGF) in pulmonary endothelial cell injury by exercise in asthmatics. Post-exercise circulating thrombomodulin (TM) levels were significantly increased in asthmatics. Moreover, the increase in TM levels with exercise was significantly correlated with VEGF level in induced sputum from asthmatics (r = 0.80, p = 0.0007). After inhaled steroid therapy, post-exercise TM levels were significantly decreased, but the increase in TM levels with exercise was also correlated with VEGF level (r = 0.60, p = 0.01). Thus, pulmonary endothelial cells stimulated by VEGF in asthmatic airways may be sensitive to exercise challenge.
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Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Abenoku, Osaka, Japan.
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Shin HW, Schwindt CD, Aledia AS, Rose-Gottron CM, Larson JK, Newcomb RL, Cooper DM, George SC. Exercise-induced bronchoconstriction alters airway nitric oxide exchange in a pattern distinct from spirometry. Am J Physiol Regul Integr Comp Physiol 2006; 291:R1741-8. [PMID: 16840654 DOI: 10.1152/ajpregu.00178.2006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Exhaled nitric oxide (NO) is altered in asthmatic subjects with exercise-induced bronchoconstriction (EIB). However, the physiological interpretation of exhaled NO is limited because of its dependence on exhalation flow and the inability to distinguish completely proximal (large airway) from peripheral (small airway and alveolar) contributions. We estimated flow-independent NO exchange parameters that partition exhaled NO into proximal and peripheral contributions at baseline, postexercise challenge, and postbronchodilator administration in steroid-naive mild-intermittent asthmatic subjects with EIB (24-43 yr old, n = 9) and healthy controls (20-31 yr old, n = 9). The mean +/- SD maximum airway wall flux and airway diffusing capacity were elevated and forced expiratory flow, midexpiratory phase (FEF(25-75)), forced expiratory volume in 1 s (FEV(1)), and FEV(1)/forced vital capacity (FVC) were reduced at baseline in subjects with EIB compared with healthy controls, whereas the steady-state alveolar concentration of NO and FVC were not different. Compared with the response of healthy controls, exercise challenge significantly reduced FEV(1) (-23 +/- 15%), FEF(25-75) (-37 +/- 18%), FVC (-12 +/- 12%), FEV(1)/FVC (-13 +/- 8%), and maximum airway wall flux (-35 +/- 11%) relative to baseline in subjects with EIB, whereas bronchodilator administration only increased FEV(1) (+20 +/- 21%), FEF(25-75) (+56 +/- 41%), and FEV(1)/FVC (+13 +/- 9%). We conclude that mild-intermittent steroid-naive asthmatic subjects with EIB have altered airway NO exchange dynamics at baseline and after exercise challenge but that these changes occur by distinct mechanisms and are not correlated with alterations in spirometry.
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Affiliation(s)
- Hye-Won Shin
- Department of Biomedical Engineering, Division of Pulmonary and Critical Care, 3120 Natural Sciences II, University of California-Irvine, Irvine, CA 92697-2715, USA
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15
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Kanazawa H, Yoshikawa J. A case-control study of bronchial asthma associated with ulcerative colitis: role of airway microvascular permeability. Clin Exp Allergy 2006; 35:1432-6. [PMID: 16297138 DOI: 10.1111/j.1365-2222.2005.02358.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent attention has been devoted to the respiratory manifestations that may be associated with diseases of distant organs. The most prevalent and distinctive pattern of respiratory involvement in ulcerative colitis (UC) is airway inflammation. OBJECTIVE This study was designed to examine the contribution of airway microvascular permeability to the pathophysiological association of asthma with UC. METHODS Sputum induction and methacholine provocation test were performed in 27 asthmatic patients (15 without UC and 12 with UC), nine patients with UC and 15 normal controls. Inflammatory indexes, vascular endothelial growth factor (VEGF) levels in induced sputum, airway vascular permeability index and exhaled nitric oxide (NO) levels were examined in all subjects. RESULTS The percentage of eosinophils and concentration of eosinophil cationic protein in induced sputum were similar in all four groups. Though exhaled NO levels were significantly higher in asthmatics with or without UC than in normal controls or UC patients, these levels were comparable in asthmatics with and without UC. VEGF levels in induced sputum and airway vascular permeability index were significantly higher in asthmatics without UC (VEGF: 1920 (990) pg/mL; airway vascular permeability index: 0.018 (0.008)) and asthmatics with UC (6570 (1000) pg/mL; 0.040 (0.006)) than in normal controls (950 (700) pg/mL; 0.009 (0.003)), whose levels were comparable to those of UC patients (900 (600) pg/mL; 0.011 (0.003)). In particular, these parameters were markedly increased in asthmatics with UC than in asthmatics without UC. VEGF level was significantly correlated with airway vascular permeability index in asthmatics with UC. Moreover, VEGF level and airway vascular permeability index was inversely correlated with degree of airway obstruction and airway hyper-reactivity to methacholine in these asthmatics. CONCLUSION Airway microvascular hyper-permeability induced by VEGF may have a profound effect on airway function and can explain the heightened airway hyper-responsiveness characteristic of asthma associated with UC.
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Affiliation(s)
- H Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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16
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Kanazawa H, Yoshikawa J. Effect of beclomethasone dipropionate on basic fibroblast growth factor levels in induced sputum samples from asthmatic patients. Ann Allergy Asthma Immunol 2006; 95:546-50. [PMID: 16400894 DOI: 10.1016/s1081-1206(10)61017-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Airway remodeling in asthma refers to certain structural changes and is regulated by several growth factors. One molecule of potential relevance to these pathologic changes is basic fibroblast growth factor (bFGF). OBJECTIVES To examine the relationship between bFGF levels and type III collagen synthesis in asthmatic airways and the effect of inhaled corticosteroid therapy on bFGF levels. METHODS We simultaneously measured bFGF, vascular endothelial growth factor (VEGF), and procollagen type III peptide (P-III-P) levels in induced sputum samples from 17 asthmatic patients and 10 controls. Sputum induction was performed before and after 1 year of inhaled beclomethasone dipropionate therapy. RESULTS Before beclomethasone dipropionate therapy, mean (SD) VEGF and bFGF levels were significantly higher in asthmatic patients (VEGF: 4270 [650] pg/mL; bFGF: 46.4 [20.0] pg/mL; P < .001 for both) than in controls (VEGF: 1730 [1140] pg/mL; bFGF: 6.0 [3.0] pg/mL). Although P-III-P was detected in none of the controls, P-III-P levels could be measured in all the asthmatic patients. No significant correlation was found between P-III-P and VEGF levels in asthmatic patients. However, a close correlation was found between bFGF and P-III-P levels in these patients (r = 0.84; P < .001). After 1 year of beclomethasone dipropionate therapy, VEGF levels were significantly decreased, whereas bFGF and P-III-P levels did not differ before vs after therapy. There remained a significant correlation between bFGF and P-III-P levels even after beclomethasone dipropionate therapy. CONCLUSIONS A close correlation between bFGF and P-III-P levels was observed in asthmatic airways. However, corticosteroid therapy might not prevent airway remodeling via the bFGF-dependent pathway.
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Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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17
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Kanazawa H, Eguchi Y, Nomura N, Yoshikawa J. Analysis of vascular endothelial growth factor levels in induced sputum samples from patients with cough variant asthma. Ann Allergy Asthma Immunol 2005; 95:266-71. [PMID: 16200818 DOI: 10.1016/s1081-1206(10)61224-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND We previously found that vascular endothelial growth factor (VEGF) levels in induced sputum samples are increased in patients with classic asthma and are associated with the degree of airflow obstruction and airway microvascular permeability. OBJECTIVE To examine VEGF levels and the degree of airway microvascular permeability in patients with cough variant asthma (CVA). METHODS Levels of VEGF in induced sputum samples and airway microvascular permeability were examined in 12 controls, 16 patients with CVA, and 16 patients with classic asthma. We also evaluated the relationship between VEGF level and the clinical features of these 2 disorders. RESULTS Mean (SD) VEGF levels and airway vascular permeability index values were significantly higher in patients with CVA (VEGF: 2,520 [1,050] pg/mL; P < .001; vascular permeability index: 0.017 [0.006]; P = .003) and classic asthma (4,750 [1,260] pg/mL; P < .001; 0.028 [0.009]; P < .001) than in controls (1,420 [1,230] pg/mL; 0.009 [0.003]). Furthermore, these values were significantly higher in patients with classic asthma vs CVA. We also found significant correlations between VEGF level and airway vascular permeability index in patients with CVA (r = 0.60; P = .02) vs classic asthma (r = 0.83; P = .001). Furthermore, VEGF levels were inversely correlated with the degree of airflow obstruction and airway hyperresponsiveness to methacholine in patients with CVA and classic asthma. CONCLUSIONS Airway microvascular hyperpermeability induced by elevated VEGF levels contributes to abnormal airway function in CVA and classic asthma, and differences in the clinical features of these 2 disorders may depend on airway VEGF levels.
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Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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18
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Kanazawa H, Yoshikawa J. Alterations in T-lymphocyte subsets in the airways of asthmatic patients with active hepatitis C virus infection. Respiration 2005; 73:318-23. [PMID: 16179822 DOI: 10.1159/000088357] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 04/12/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The interaction between hepatitis C virus (HCV) infection and certain pulmonary disorders is of considerable interest. We have previously found that active HCV infection in asthmatic patients is associated with impaired responses to inhaled corticosteroid therapy. OBJECTIVES To examine differences in T-lymphocyte subsets in asthmatic airways with or without HCV infection. METHODS 12 HCV-negative and 29-HCV positive asthmatics were included in this study. All HCV-positive asthmatics received interferon (IFN) therapy (11 IFN responders and 18 IFN non-responders). T-lymphocyte subsets in induced sputum were analyzed before and 1 year after IFN therapy. RESULTS Before IFN therapy, percentages of lymphocytes and CD8+ T lymphocytes in induced sputum were higher in HCV-positive asthmatics than in HCV-negative asthmatics. After IFN therapy, there was no significant change in percentages of lymphocytes and T-lymphocyte subsets in IFN non-responders. However, percentage of lymphocytes and CD8+ T lymphocytes in IFN responders significantly decreased, while CD4+ T lymphocytes increased. Therefore, the CD4/CD8 ratio significantly increased following IFN therapy in IFN responders. In IFN responders, forced expiratory volume in 1 s (FEV(1)) after salbutamol administration significantly increased following IFN therapy, while it did not change in non-responders. In addition, in IFN responders, the change in the CD4/CD8 ratio after IFN therapy was significantly correlated with the increase in FEV(1) after salbutamol administration. CONCLUSIONS The number of CD8+ T lymphocytes increases in the airways of asthmatic patients with active HCV infection, and this may be associated with airway dysfunction in these patients.
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Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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Chiron R, Vachier I, Godard P, Chanez P. [The measurement of exhaled nitric oxide, a new tool in the management of asthma?]. Presse Med 2005; 33:1451-8. [PMID: 15611680 DOI: 10.1016/s0755-4982(04)98953-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A GOOD DIAGNOSTIC TEST FOR ASTHMA: Chronic airway inflammation, main feature of asthma, can be assessed by measuring the exhaled nitric oxide (NO) level. Measurement of NO is standardized, non-invasive and easy to use in both children and adults. Studies have shown that it is a good diagnostic test for asthma when NO is high. However, other conditions or pathologies must be searched for because they may influence the results. ITS PLACE IN TREATMENT: Although exhaled NO helps to characterise the patients with asthma, other studies are required to show that it can help to improve the follow-up of such patients. Nevertheless, this tool has not yet been validated in the daily treatment of asthma and further research is still ongoing.
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Affiliation(s)
- Raphaël Chiron
- Service des maladies respiratoires, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 05, France.
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20
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Otani K, Kanazawa H, Fujiwara H, Hirata K, Fujimoto S, Yoshikawa J. Determinants of the severity of exercise-induced bronchoconstriction in patients with asthma. J Asthma 2004; 41:271-8. [PMID: 15260459 DOI: 10.1081/jas-120026083] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM In examining the mechanisms of exercise-induced bronchoconstriction (EIB), it is important to determine which factors most strongly affect the severity of EIB. We determined such factors in patients with asthma by stepwise multiple-regression analysis. METHODS Twenty-three patients with asthma underwent pulmonary function tests, methacholine provocation test, and sputum induction. Eosinophilic inflammatory indices and airway vascular permeability index (ratio of albumin concentrations in induced sputum and serum) were examined in sputum samples, and then an exercise test was performed by all asthmatics. RESULTS There was a significant correlation between the severity of EIB and degree of eosinophilic inflammation in induced sputum. Moreover, there was a significant correlation between the severity of EIB and airway vascular permeability index. Although we could not find a significant correlation between the severity of EIB and 1-sec forced expired volume, 20% provocation concentration of (PC20) methacholine tended to be correlated with the severity of EIB. By stepwise multiple-regression analysis, we also found that airway vascular permeability index, eosinophil cationic protein levels in sputum, and PC20 methacholine are independent predictors of the severity of EIB. CONCLUSION We found that airway vascular hyperpermeability, eosinophilic inflammation, and bronchial hyperreactivity are independent factors predicting the severity of EIB.
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Affiliation(s)
- Kenichiro Otani
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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21
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Kanazawa H, Yoshikawa T, Hirata K, Yoshikawa J. Effects of pranlukast administration on vascular endothelial growth factor levels in asthmatic patients. Chest 2004; 125:1700-5. [PMID: 15136379 DOI: 10.1378/chest.125.5.1700] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
STUDY OBJECTIVES We have previously found that vascular endothelial growth factor (VEGF) levels in induced sputum were increased in asthmatic patients, and that its levels were closely associated with the degree of airway obstruction and microvascular permeability. Therefore, this study was designed to examine the effects of pranlukast, a selective leukotriene receptor antagonist, on VEGF levels in induced sputum from steroid-untreated or steroid-treated asthmatic patients. DESIGN Double-blind, randomized, placebo-controlled, crossover study. SETTING University hospital. PARTICIPANTS Twenty-three asthmatic patients (steroid-untreated, 13 patients; steroid-treated, 10 patients) and 10 healthy control subjects. INTERVENTIONS All asthmatic patients received 4-weeks of therapy with pranlukast (225 mg bid), and sputum induction was performed before and after the 4-week treatment course. MEASUREMENTS AND RESULTS In steroid-untreated asthmatic patients, the mean percentage of eosinophils (%EOS) and mean eosinophil cationic protein (ECP) levels in induced sputum were significantly decreased after 4 weeks of pranlukast administration (%EOS: before, 16.7% [SD, 7.1%]; after, 12.3% [SD, 4.0%]; p = 0.03; ECP levels: before, 774 ng/mL [SD, 258 ng/mL]; after, 564 ng/mL [SD, 204 ng/mL]; p = 0.034). Moreover, VEGF levels in the induced sputum and the airway vascular permeability index also were decreased after pranlukast administration (VEGF levels: before, 5,670 pg/mL [SD, 1,780 pg/mL]; after, 4,380 pg/mL [SD, 1,540 pg/mL]; p = 0.026; airway vascular permeability index: before, 0.032 [SD, 0.012]; after, 0.017 [SD, 0.006]; p = 0.01). In addition, the change in airway vascular permeability index from before to after pranlukast administration was significantly correlated with the change in VEGF levels (r = 0.782; p = 0.007). However, in steroid-treated asthmatic patients there was no significant difference in mean VEGF levels in induced sputum between placebo administration (before, 3,640 pg/mL [SD, 1,020 pg/mL]; after, 3,640 pg/mL [SD, 960 pg/mL] and pranlukast administration (before, 3,660 pg/mL [SD, 940 pg/mL]; after, 2,950 pg/mL [SD, 890 pg/mL]). CONCLUSIONS Pranlukast administration decreased airway microvascular permeability through, at least in part, a decrease in airway VEGF levels in steroid-untreated asthmatic patients. However, it is likely that pranlukast administration added little efficacy to inhaled corticosteroid therapy for reduction in airway VEGF levels.
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Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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22
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Kanazawa H, Nomura S, Yoshikawa J. Role of microvascular permeability on physiologic differences in asthma and eosinophilic bronchitis. Am J Respir Crit Care Med 2004; 169:1125-30. [PMID: 15044203 DOI: 10.1164/rccm.200401-123oc] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Asthma and eosinophilic bronchitis are characterized by a similar type of eosinophilic inflammation. However, eosinophilic bronchitis differs from asthma in that there is no variable airflow obstruction or airway hyperresponsiveness. We evaluated the roles of vascular endothelial growth factor (VEGF) and microvascular permeability in causing these differences between the two diseases. Inflammatory indexes in induced sputum, exhaled nitric oxide levels, and vascular permeability index were examined in 11 normal control subjects, 19 beclomethasone dipropionate (BDP)-treated subjects with asthma, 20 non-BDP-treated subjects with asthma, and 17 patients with eosinophilic bronchitis. The percentage of eosinophils in sputum and exhaled nitric oxide levels were significantly higher in non-BDP-treated subjects with asthma and patients with eosinophilic bronchitis than in other two groups; however, VEGF levels and vascular permeability index were significantly higher in non-BDP-treated (VEGF: mean; 4,710 [SD; 1,150] pg/ml, p < 0.0001; vascular permeability index: 0.028 [0.009], p < 0.0001) and BDP-treated (2,560 [1,070] pg/ml, p = 0.0002; 0.016 [0.006], p = 0.004) subjects with asthma than in patients with eosinophilic bronchitis (1,120 [800] pg/ml; 0.01 [0.005]) and normal control subjects (1,390 [1,280] pg/ml; 0.008 [0.003]). We found significant correlations between the VEGF level and the airway vascular permeability index in all patient groups. Thus, interaction between airway microcirculation and VEGF may be a key element in differences in airway function between asthma and eosinophilic bronchitis.
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Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abenoku, Osaka, 545-8585, Japan.
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Abstract
EIB is a common manifestation in diagnosed asthmatics and is a sensitive warning sign of worsening asthma. EIB may occur as an isolated entity in the absence of signs and symptoms of chronic asthma. Careful diagnosis is crucial in determining if this condition represents a preasthmatic state or simply a transient condition resulting from individual sensitivity to hyperventilation. The pathophysiology of EIB is hypothesized to result from rapid airway rewarming after hyperventilation. Effective treatment modalities include behavioral techniques and pharmacologic agents. Appropriate treatment regimens consisting of pharmacologic or behavioral modalities should prevent serious sequelae and should enable the patient to participate at all levels of athletics. The nurse is an essential member of the team identifying, preventing, and treating exercise-induced bronchospasm or asthma.
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Affiliation(s)
- Edward G Brooks
- Department of Pediatrics, Division of Infectious Disease and Immunology, Children's Asthma Program, University of Texas Medical Branch, 310 University Boulevard, Galveston, TX 77555-0366, USA.
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Abstract
Exercise is the most common trigger of persistent childhood asthma. The history for EIA can be complicated by the lack of perception of significant airway obstruction during exercise. One must carefully identify those children with EIA from the group of children who report low level of activity because of lack of interest or because they are out of shape. Baseline spirometry of children with persistent asthma is frequently normal. Spirometry is important to identify those children with EIA who underrecognize their disease, but normal results should not be used as evidence of absence of disease. Formal exercise testing should be considered when the diagnosis is unclear or if there seems to be a lack of bronchoprotection with inhaled albuterol. The goal of treatment of EIA should be the attainment of a normal activity level for children and adolescents. Identification of the limits imposed by EIA and establishment of goals of therapy with the child and family should be the initial action. Inactivity or reduced exertion, in the presence of this diagnosis. should not be accepted. Therapy for EIA starts with control of the underlying persistent asthma. Inhaled corticosteroids are the most effective initial treatment of both EIA and persistent asthma in children and adolescents. Exercise-induced asthma is a common aspect of a prevalent disease that warrants proper diagnosis and treatment. With appropriate therapy, children with EIA should be able to participate in sports and maintain normal activity. They should strive to compete in the same playing field as their peers and have the same goals as those children and athletes who do not have exercise-induced asthma.
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Affiliation(s)
- Ketan K Sheth
- Allergy/Asthma Section, Arnett Clinic, 1500 Salem Street, Lafayette, IN 47904, USA.
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Asai K, Kanazawa H, Kamoi H, Shiraishi S, Hirata K, Yoshikawa J. Increased levels of vascular endothelial growth factor in induced sputum in asthmatic patients. Clin Exp Allergy 2003; 33:595-9. [PMID: 12752587 DOI: 10.1046/j.1365-2222.2003.01576.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) is highly expressed in the airway of asthmatic patients. As VEGF increases airway vascular permeability, consequent thickening of the airway wall mucosa may lead to narrowing of the airway lumen. OBJECTIVE We evaluated the relationship between VEGF levels in induced sputum and eosinophilic inflammatory profiles, and the degree of airway vascular permeability in asthmatic patients and we evaluated the effect of inhaled corticosteroids on VEGF levels in induced sputum. METHODS Induced sputum specimens were obtained from 28 glucocorticosteroids free asthmatics and 11 healthy control subjects. We examined VEGF levels and airway vascular permeability index in induced sputum. After the initial sputum induction, 21 asthmatics received 8-week inhaled beclomethasone dipropionate (BDP, 800 micro g/day) therapy, then sputum induction was repeated. RESULTS The VEGF levels in asthmatics were significantly higher than in healthy control subjects (P < 0.0001). The VEGF levels were negatively correlated with forced expiratory volume of 1 s (FEV1, % predicted, r = - 0.68, P < 0.001), the percentage of eosinophils (r = 0.51, P < 0.01) and ECP levels (r = 0.39, P < 0.05). Moreover, the VEGF levels were significantly correlated with airway vascular permeability index (r = 0.61, P < 0.001). After 8-week inhaled BDP therapy, the VEGF levels were significantly decreased compared to pretreatment levels (P < 0.0001) and the VEGF levels were significantly correlated with airway vascular permeability index even in post-treatment asthmatics (r = 0.62, P < 0.01). CONCLUSION The VEGF levels in induced sputum were increased in asthmatics and its levels were associated with degree of airway narrowing and airway vascular permeability. These findings provide strong evidence that VEGF may play an important role in the pathogenesis of bronchial asthma.
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Affiliation(s)
- K Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Abeno-ku, Osaka, Japan.
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26
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Kanazawa H, Hirata K, Yoshikawa J. Involvement of vascular endothelial growth factor in exercise induced bronchoconstriction in asthmatic patients. Thorax 2002; 57:885-8. [PMID: 12324676 PMCID: PMC1746203 DOI: 10.1136/thorax.57.10.885] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is evidence that the bronchial microcirculation has the potential to contribute to the pathophysiological mechanisms of exercise induced bronchoconstriction (EIB) in asthmatic subjects. Vascular endothelial growth factor (VEGF), which is highly expressed in asthmatic airways, increases vascular permeability. The relationship between VEGF levels in induced sputum and the severity of EIB in asthmatic subjects was studied. METHODS The concentration of VEGF in induced sputum was examined in 23 asthmatic subjects and 11 normal controls. The asthmatic subjects performed an exercise test and the % maximal fall in forced expiratory volume in 1 second (FEV(1)) was measured. Beclomethasone dipropionate (BDP) 400 micro g twice daily was administered to the asthmatic subjects for 8 weeks and the exercise test and sputum induction were repeated. RESULTS The concentration of VEGF in induced sputum was significantly higher in asthmatic subjects than in normal controls. There was a significant correlation between the concentration of VEGF and the % maximal fall in FEV(1) (r=0.826, p=0.0001) and between the concentration of VEGF and airway vascular permeability index (r=0.621, p=0.0037). After treatment with inhaled BDP there was a significant decrease in the concentration of VEGF in the asthmatic subjects (before treatment: 7051 (2361) pg/ml, after treatment: 4498 (2135) pg/ml, p<0.0001). The change in the concentration of VEGF was significantly correlated with the change in the % maximal fall in FEV(1) (r=0.463, p=0.031). CONCLUSIONS Excessive production of VEGF in asthmatic airways may contribute to the pathogenesis of EIB via increased airway vascular permeability.
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Affiliation(s)
- H Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abenoku, Japan.
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Kanazawa H, Asai K, Hirata K, Yoshikawa J. Vascular involvement in exercise-induced airway narrowing in patients with bronchial asthma. Chest 2002; 122:166-70. [PMID: 12114353 DOI: 10.1378/chest.122.1.166] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The bronchial microcirculation has the potential to contribute to the pathophysiologic mechanisms of exercise-induced bronchoconstriction (EIB) in asthmatic patients. This study was designed to determine whether increase in airway vascular permeability is associated with the severity of EIB in asthmatic patients. DESIGN Cross-sectional analysis. SETTING University hospital. PARTICIPANTS Twenty-five asthmatic patients and 12 normal control subjects. INTERVENTIONS All asthmatics performed an exercise test, and the percentage of maximal fall in FEV(1) and the area under the curve of the percentage fall in FEV(1) plotted against time for 30 min (AUC(0-30)) were determined. MEASUREMENTS AND RESULTS The inflammatory indexes, NO levels, and airway vascular permeability index (ratio of albumin concentrations in induced sputum and serum) were examined in all subjects. The airway vascular permeability index was significantly higher in EIB-positive asthmatics (0.031 +/- 0.009) than in EIB-negative asthmatics (0.020 +/- 0.005, p = 0.0011) and normal control subjects (0.008 +/- 0.003, p < 0.0001). We also found that there was a significant correlation between NO levels in induced sputum and the airway vascular permeability index (r = 0.525, p = 0.0101). Moreover, the airway vascular permeability index was significantly correlated with the severity of EIB (percentage of maximal fall in FEV(1) [r = 0.761, p = 0.0002], AUC(0-30) [r = 0.716, p = 0.0005]). However, this index was not significantly correlated with magnitude of eosinophilic inflammation. CONCLUSION Our findings suggest that increased airway vascular permeability due to excessive production of NO correlates with the severity of EIB in asthmatics, and that assessment of albumin flux in airway lining fluid stimulated by hypertonic saline solution is a sensitive predictor of the severity of EIB.
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Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Disease, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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Henriksen AH, Tveit KH, Holmen TL, Sue-Chu M, Bjermer L. A study of the association between exercise-induced wheeze and exercise versus methacholine-induced bronchoconstriction in adolescents. Pediatr Allergy Immunol 2002; 13:203-8. [PMID: 12144643 DOI: 10.1034/j.1399-3038.2002.01034.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Among asthmatics, exercise-induced wheeze (EIW) is a frequent symptom, and 40-77% of asthmatics demonstrate exercise-induced bronchoconstriction (EIB). In the North-Trøndelag population-based survey of 8,571 adolescents (YOUNG-HUNT), 26% reported wheeze during the previous 12 months (current wheeze). Of those subjects, 50% reported EIW. The aim of the present study was to investigate the association between EIW and EIB in randomly selected adolescents with EIW as the only or predominant asthma-like symptom, and to relate our findings to results from methacholine bronchoprovocation tests (MT) and measurements of exhaled nitric oxide (ENO). Sixty-three subjects with current wheeze induced by exercise, but not by allergen exposure, were investigated using a treadmill exercise test (ET) and measurements of ENO. Fifty-eight subjects completed a MT on a separate study day. EIB was defined as a fall of >or= 10% in the forced expiratory volume in 1 second (FEV1) after exercise (DeltaFEV1%ex). Twenty-one subjects (33%) had EIB and 33 (57%) had a positive MT. The degree of reported dyspnea during the ET was not correlated to the DeltaFEV1%ex. The correlation between EIB and methacholine-induced bronchoconstriction (MIB) was poor, and the DeltaFEV1%ex was more pronounced in smokers than in non-smokers. Moreover, ENO was not increased in subjects with positive vs. negative ET. Hence, EIW, when reported as the only or predominant asthma-like symptom, was linked to EIB in only one-third of the patients. We conclude that EIW is a poor predictor of EIB in epidemiological studies. The poor correlation between EIB and MIB indicates that these two tests measure different mechanisms of bronchial hyper-responsiveness.
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Affiliation(s)
- Anne Hildur Henriksen
- Department of Lung Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Hsieh YS, Wang HC, Tseng TH, Chang WC, Wang CJ. Gaseous nitric oxide-induced 8-nitroguanine formation in human lung fibroblast cells and cell-free DNA. Toxicol Appl Pharmacol 2001; 172:210-6. [PMID: 11312649 DOI: 10.1006/taap.2001.9148] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A time- and dose-dependent increase in 8-nitroguanine (8-NO(2)-G) was observed in human lung fibroblast cells (MRC-5) after treatment with gaseous NO-saturated buffer. It was also found that treatment with the inhibitor of inducible nitric oxide synthase (iNOS), N(G)-nitro-l-arginine methyl ester, significantly reduced the 8-NO(2)-G level in the gaseous NO-saturated buffer-treated MRC-5 cells. These results provide evidence indicating that NO gas causes DNA damage in mammalian cells, which involves the activation of iNOS and the subsequent generation of endogenous NO. On the other hand, a time- and dose-dependent increase in 8-NO(2)-G was also observed while DNA (isolated from MRC-5 cells) was incubated with gaseous NO-saturated buffer. These results suggest that part of the 8-NO(2)-G formation was due to direct modification of gaseous NO on DNA. Furthermore, an increase in nitrite concentration was found in both cell-free and MRC-5 cell-conditioned medium treated with gaseous NO-saturated buffer. Collectively, gaseous NO induced DNA damage by forming 8-NO(2)-G, a modification performed directly by the treated gaseous NO and indirectly by the following induction of endogenous NO. This effect might be an important pathway in genotoxicity of nitric oxides, and 8-NO(2)-G could act as a specific marker for DNA damage induced by gaseous NO, a common contaminatant in air pollution and cigarette smoke.
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Affiliation(s)
- Y S Hsieh
- Institute of Biochemistry, Chung Shan Medical and Dental College, Taichung, Taiwan
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