A Method for Assessing the Physiological Impairment Produced by Low-level Exposure to Pulmonary Irritants

Characterization of a nose-only inhaled phosgene acute lung injury mouse model

CONTEXT

Phosgene's primary mode of action is as a pulmonary irritant characterized by its early latent phase where life-threatening, non-cardiogenic pulmonary edema is typically observed 6-24 h post-exposure.

OBJECTIVE

To develop an inhaled phosgene acute lung injury (ALI) model in C57BL/6 mice that can be used to screen potential medical countermeasures.

METHODS

A Cannon style nose-only inhalation exposure tower was used to expose mice to phosgene (8 ppm) or air (sham). An inhalation lethality study was conducted to determine the 8 ppm median lethal exposure (LCt50) at 24 and 48 h post-exposure. The model was then developed at 1.2 times the 24 h LCt50. At predetermined serial sacrifice time points, survivors were euthanized, body and lung weights collected, and lung tissues processed for histopathology. Additionally, post-exposure clinical observations were used to assess quality of life.

RESULTS AND DISCUSSION

The 24-hour LCt50 was 226 ppm*min (8 ppm for 28.2 min) and the 48-hour LCt50 was 215 ppm*min (8 ppm for 26.9 min). The phosgene exposed animals had a distinct progression of clinical signs, histopathological changes and increased lung/body weight ratios. Early indicators of a 1.2 times the 24-hour LCt50 phosgene exposure were significant changes in the lung-to-body weight ratios by 4 h post-exposure. The progression of clinical signs and histopathological changes were important endpoints for characterizing phosgene-induced ALI for future countermeasure studies.

CONCLUSION

An 8 ppm phosgene exposure for 34 min (1.2 × LCt50) is the minimum challenge recommended for evaluating therapeutic interventions. The predicted higher mortality in the phosgene-only controls will help demonstrate efficacy of candidate treatments and increase the probability that a change in survival rate is statistically significant.

Enhanced and prolonged pulmonary influenza virus infection following phosgene inhalation

Animal infectivity models have been important in the demonstration of enhanced susceptibility to viral and bacterial infection as a result of low-level toxicant exposure. This study demonstrated an enhanced and prolonged viral infection using an influenza virus infectivity model in the rat following exposure to the toxicant gas phosgene. Fischer-344 rats exposed to either air or a sublethal concentration of phosgene demonstrated peak pulmonary influenza virus titers 1 d after infection. Virus titers in rats exposed to air declined rapidly falling below detectable levels by 4 d after infection. However, a significantly enhanced and prolonged pulmonary influenza virus infection was observed on d 3 and 4 after infection in rats exposed to phosgene. Virus was cleared below detectable limits on d 5 after infection in animals exposed to phosgene. Thus, inhalation of sublethal concentrations of phosgene resulted in an increased severity of pulmonary influenza virus infection. This study provides a demonstration of the effective use of a rat viral infectivity model to detect the immunotoxicity of inhaled pollutants. This model will allow future studies to focus on the immunological mechanism(s) responsible for the enhanced and prolonged pulmonary influenza virus infection.

Pathogenesis of phosgene poisoning

Phosgene inhalation in concentrations greater than 1 ppm may produce a transient bioprotective vagus reflex with rapid shallow breathing in some individuals. Phosgene concentrations greater than 3 ppm are moderately irritating to eyes and upper airways. Toxic phosgene doses (greater than or equal to 30 ppm X min) inhaled into the terminal respiratory passages render the blood-air-barrier more permeable to blood plasma, which gradually collects in the lung. Some time passes, however, until the collection of fluid provokes signs and symptoms. This period in which the patient experiences relative well-being is known as the clinical latent phase. The clinical symptoms which follow and the pathological changes underlying them are discussed in detail; dose-effect relationships are demonstrated. The regression phase after poisoning has been overcome is briefly sketched.

Early diagnosis of phosgene overexposure

At the present time, the following parameters can be recommended for "early diagnosis" of phosgene overexposure: Phosgene indicator paper badges, to be worn by all persons involved in handling phosgene (these badges permit immediate estimation of the exposure dose in each individual case); Observation of the initial irritative symptoms of the eye and the upper respiratory tract after phosgene inhalation can provide a rough indication of the inhalation concentration and dose; X-ray photographs of the lungs make it possible to detect incipient toxic pulmonary edema at an early stage, during the clinical latent period. A number of additional parameters require further critical investigation.

Pulmonary changes in the rat following low phosgene exposure

Minimal inhalation doses (or concentrations) of phosgene necessary for the production of changes within the blood-air barrier were determined in rats. At least 50 ppm.min (5 ppm X 10 min) was necessary for the production of alveolar oedema (the minimal effective phosgene concentration being 5 ppm). While the smallest phosgene dose to produce an increase in pulmonary lavage protein content was also 50 ppm.min and while the smallest phosgene dose to produce widening of pulmonary interstices was 25 ppm.min, there was no phosgene threshold concentration (down to 0.1 ppm) for these two latter parameters, which are assumed to be indicators of physiological compensatory mechanisms within the blood-air barrier. The primary localisation of pulmonary damage seemed to depend on the concentration of phosgene used: at low concentrations (0.1-2.5 ppm) the changes were primarily located at the transition from terminal bronchioles to the alveolar ducts; at higher concentrations (5 ppm) damage to the alveolar pneumocytes (type I) was more conspicuous.

A simple method for measuring the respiratory uptake of carbon monoxide in unanesthetized rats: an application to rats acutely exposed to ozone

A simple method for measuring the respiratory uptake of carbon monoxide in unanesthetized rats is described. This method is easy to operate, inexpensive, and is a sensitive means for detecting effects of short-term exposure to low concentrations of ozone. In this study, the exposure of 6- to 7-wk-old rats to 2 ppm ozone for 3 hr and 1 ppm ozone for 3-6 hr resulted in an apparent decrease in carbon monoxide uptake without significant change in the lung weight.

Long-term exposure to sulfur dioxide, sulfuric acid mist, fly ash, and their mixtures. Results of Studies in Monkeys and guinea pigs

Groups of cynomolgus monkeys and guinea pigs were exposed to mixtures of sulfur dioxide, fly ash, and sulfuric acid mist. The exposure concentrations varied between 0.1 and 5.0 ppm for sulfur dioxide, 0.1 and 1 mg/cu m for sulfuric acid mist, while a concentration of approximately 0.5 mg/cu m was used for fly ash. The duration of exposure was 52 weeks for guinea-pigs and 78 weeks for monkeys. Pulmonary function tests and serum biochemical and hematological analyses were conducted prior to and periodically during the exposure period. At the termination of exposure, the lungs were examined microscopically. Analysis of the data revealed that in groups exposed to the mixtures of pollutants, sulfuric acid mist was responsible for the effects observed. No synergistic action between the pollutants was detected.