Sulfur dioxide and tracheobronchial clearance in man

Safety of inhaled proteins for therapeutic use

The use of the inhalation route for delivery of inhaled proteins has received increasing attention recently. The purpose of this article is to review the available information related to the safety aspects of inhaled proteins. The review focuses primarily on possible toxicity to the respiratory tract, because usually one is either considering an agent to treat the lung or an agent for which the systemic toxicity has been investigated following subcutaneous (s.c.) administration in its clinical use as a therapeutic agent. Some background is provided on mechanisms of absorption and reasons why inhalation delivery is considered for many proteins. Available data are summarized from clinical trials of proteins and protein-like biomolecules, generally showing minimal, if any, adverse respiratory effects. The results of the animal toxicology studies that have been published are presented. In general, the observed lung toxicity has been relatively low, and it has been difficult to interpret in cases where the animal protein differs considerably from the human protein. Discussion is presented on the possibility of adverse immune reactions, suggesting that this is not likely to be any greater issue than it is for subcutaneously injected materials. Although the safety information is relatively sparse at present, the available data suggest that the inhalation route can be an attractive route to consider for many therapeutic proteins.

Effect of sulfur dioxide on mucociliary activity and ciliary beat frequency in guinea pig trachea

The effects of 30 min exposure to sulfur dioxide on mucociliary activity (MCA) and ciliary beat frequency (CBF) were studied in 31 guinea pig tracheas. MCA was measured by recording the light reflected from ciliated mucous membranes using an infrared bar code reader. CBF of single ciliated cells obtained by brushing was measured with phase-contrast microscopy. Each tracheal sample was exposed to SO2 at concentrations ranging from 2.5 to 12.5 ppm, or to air for control purposes. MCA and CBF were measured before and immediately after gas exposure. A reduction in mean MCA of 63% (P = 0.0007) and statistically insignificant changes in CBF (P > 0.05) were recorded at concentrations of 2.5 ppm SO2. Higher SO2 concentrations caused a further impairment of MCA as well as a dose-dependent decrease in CBF (P = 0.002). A concentration of 12.5 ppm SO2 induced a decrease from baseline values of approximately 80% in mean MCA and of roughly 70% in mean CBF. This study demonstrates a dose-dependent SO2-induced decrease in MCA of guinea pig tracheas. The decrease in MCA was associated with an impairment of CBF only at SO2 concentrations higher than 5.0 ppm.

Acute effects of sulfur dioxide exposure on the middle ear mucosa

A variety of atmospheric pollutants are known to depress mucociliary function in the respiratory system. Since the mucociliary function in the middle ear is similar, and the middle ear may be invaded by atmospheric pollutants, we decided to investigate the possible contribution of sulfur dioxide to middle ear effusion. Guinea pigs were exposed for 24 hours to 300 ppm of sulfur dioxide or air. Immediately after exposure, ciliary activity and epithelial structure were examined close to the tympanic orifice (proximal site) and more distal to it (distal site). In the animals exposed to sulfur dioxide, no effusion was found in the tympanic cavity. Ciliary activity was reduced only in the distal site. Electron microscopy demonstrated hypersecretion in the proximal site and severe pathologic changes in the distal site. Although the normally functioning cilia in the proximal site may prevent retention of surplus secretions in the ear, sulfur dioxide may promote middle ear effusion when combined with other detrimental factors, because it stimulates mucus secretion in the proximal site and impairs ciliary function in the distal site.

Nasal exposure to airway irritants triggers a mucociliary defence reflex in the rabbit maxillary sinus

The effect on mucociliary (m.c.) activity in the rabbit maxillary sinus of cigarette smoke and ammonia (NH3) vapour delivered through a tracheal cannula or as nasal challenges was investigated by a photo-electric technique, and compared with simultaneously induced changes in the respiratory rate. Neither irritant had any effect on m.c. activity in the sinus after tracheo-bronchial exposure. However, the respiration rate was increased by NH3 vapour (2.5 ml, diluted 1:1 with room air) and neat cigarette smoke (10 ml) by 76.9% and 24.3% respectively (median values). In contrast, nasal challenges with both irritants increased m.c. activity by 24.1% (NH3) and 19.1% (cigarette smoke), and reduced the respiration rate by 31.0% (NH3) and 28.4% (cigarette smoke) (median values). NH3 vapour sometimes produced an apnea proper. Identical results were obtained in laryngectomized rabbits, indicating that laryngeal afferents were not involved in the responses. Moreover, topical application of the C-fibre stimulant capsaicin mimicked the effects produced by the airway irritants. It is concluded that nasal exposure to irritants triggers at least two different protective reflexes. One is the increase of m.c. activity in the upper airways involving sensory C-fibres and the other the apneic reflex of Kratschmer.

Epidemiological-environmental study of diesel bus garage workers: acute effects of NO2 and respirable particulate on the respiratory system

Personal samples of nitrogen dioxide (NO2) and respirable particulate (RP) were collected over the shift on 232 workers in four diesel bus garages. Response was assessed by an acute respiratory questionnaire and before and after shift spirometry. Measures of exposure to NO2 and RP were associated with work-related symptoms of cough; itching, burning, or watering eyes; difficult or labored breathing; chest tightness; and wheeze. The prevalence of burning eyes, headaches, difficult or labored breathing, nausea, and wheeze experienced at work were higher in the diesel bus garage workers than in a comparison population of battery workers, while the prevalence of headaches was reduced. Mean reductions in forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), peak flow, and flows at 50 and 75% of FVC were not obviously different from zero. There was no detectable association of exposure to NO2 or respirable particulate and acute reductions in pulmonary function. Workers who often had respiratory work-related symptoms generally had a slightly greater mean acute reduction in FEV1 and FEF50 than did those who did not have these symptoms, but these differences were not statistically significant.

Effects of neurokinin A and calcitonin gene-related peptide on mucociliary activity in rabbit maxillary sinus

Substance P (SP) released from sensory C-fibers in the airways increases the mucociliary (m.c.) activity in the rabbit maxillary sinus. The purpose of the present study was to investigate the m.c. effects of two other neuropeptides, coexisting with SP in sensory neurones, neurokinin A (NKA) and calcitonin gene-related peptide (CGRP). NKA increased the m.c. activity dose-dependently (dose range 0.1-10.0 micrograms/kg, 88 pmol to 8.8 nmol/kg), the maximum increase being 41.9 +/- 2.6%. The effect was inhibited by pretreatment with the tachykinin antagonist (D-Pro2,D-Trp7,9)SP, but not with atropine or hexamethonium. Thus NKA released from sensory C-fibers may contribute to the non-cholinergic increase of m.c. activity observed after C-fiber stimulation. In contrast CGRP did not influence the m.c. activity. Neither did it influence the responses to NKA or SP. It is concluded that CGRP is unlikely to be involved in the control of m.c. function.

Acute exposure of symptomatic steelworkers to sulphur dioxide and carbon dust: effects on mucociliary transport, pulmonary function, and bronchial reactivity

Nine steel workers participated in controlled exposures to sulphur dioxide alone and sulphur dioxide plus carbon dust (5 ppm and 10 mg/m3, respectively). All were experiencing work related respiratory difficulties. Bronchial clearance was measured using radioaerosol inhalations and external detection. Results were variable and no statistically significant changes were observed. One asthmatic showed a complete cessation of clearance during exposure to sulphur dioxide and carbon dust. Bronchial reactivity was found to be significantly raised after exposure to sulphur dioxide but equivocal results were found after exposure to sulphur dioxide and carbon dust. Pronounced changes in pulmonary function were seen only in the two asthmatic subjects. They could not tolerate the levels, indicating that these threshold limit values are too high, at least for these individuals who showed much greater sensitivity to the pollutants than the others.

Interspecies comparisons of particle deposition and mucociliary clearance in tracheobronchial airways

Inhaled insoluble particles that deposit along normal healthy tracheobronchial airways of humans and other mammals are transported on the proximally moving mucous lining to the larynx, where they are swallowed. The transit time from the most distal ciliated airways varies from 0.1 to 1 d, with each individual having a relatively constant, characteristic time. The exact time course of clearance depends on the distributions of both particle deposition and mucus velocities along the airways. There are too few data on intrabronchial deposition and mucociliary transport rates for laboratory animals to permit a thorough intercomparison among species. However, enough is known about the relative lung sizes and anatomical differences among the various species to make some preliminary, but important, distinctions. As compared to commonly used experimental animals, humans have larger lungs and a more symmetric upper bronchial airway branching pattern. In addition, humans do considerable oral breathing, thus bypassing the effective air cleaning capability of the nasal airways. These differences contribute to a greater amount of upper bronchial airway particle deposition in humans, as well as to greater concentrations of deposition on localized surfaces near airway bifurcations. Airborne irritants that deposit in small ciliated airways may produce marked changes in mucociliary transport. Such materials include cigarette smoke, submicrometer-sized sulfuric acid mist, nitrogen dioxide, and ozone. For cigarette smoke and sulfuric acid, which have been studied for transient effects following single brief exposures in both humans and animals, the responses are similar. Upon repetitive exposures in animals, both of these irritants produce persistant alterations in clearance rates and airway morphometry. Studies of the effects of ozone on mucociliary clearance have, up to now, been limited to tests of the responses of rats to single exposures. The similarities between the known effects of various irritants suggests a nonspecific response.

Effects of sulfur dioxide and formaldehyde on particle clearance in the rat

The effects of exposures to sulfur dioxide and formaldehyde atmospheres on the clearance of inhaled, insoluble tracer particles from the lungs of rats have been studied. The tracer particles employed were polystyrene latex microspheres radio-labeled with 51Cr. Following the deposition of the 1.9-micron activity median aerodynamic diameter (AMAD) particles, the rats were divided into 3 groups for a single 4-h exposure to purified air, 20 ppm sulfur dioxide, or 20 ppm formaldehyde. Early, presumably upper-respiratory-tract, clearance was monitored by analysis of radioactivity excreted in feces, while late, presumably deep-lung, clearance was followed by thoracic counting of the animals. Both the sulfur dioxide and formaldehyde atmospheres did significantly delay early clearance (p less than 0.1, two-tailed t-test). However, the late clearance rates of the two pollutant-exposed groups of rats were not significantly different from that of the purified air-exposed group of rats. Although sulfur dioxide had numerically greater effects than formaldehyde, the differences were not statistically significant at the p less than 0.1 level.

Effect of SO2 exposure on nasal mucociliary clearance in intact chickens

The time required for mucociliary clearance from the chicken nasal turbinate and from the maxillary sinus was investigated in individual animals by using a newly designed plastic holder for the experimental animals. Determined in this way were: 1) the effect of SO2 exposure on sinus and turbinate clearance time, 2) the effect of the nerve blocking drugs atropine, scopolamine, reserpine, and propranolol on turbinate clearance time, and 3) the effect of these nerve blockers on clearance rates in chickens exposed to SO2. Turbinate mucociliary clearance was measured at 5 intervals per day, during 1 to 7 hr after exposure, for 7 consecutive days. Sinus clearance time was measured twice daily 1 to 4 hr after exposure. Turbinate clearance time in birds exposed to 6 ppm, and sinus clearance time in birds exposed to 40 ppm intermittently for 2 consecutive days both increased strikingly as a direct effect of SO2 exposure. However, continuous exposure to 6 ppm of SO2 during 16 hr per day for 7 consecutive days produced double peaks of increased turbinate clearance time with intervening recovery periods, suggesting an intranasal mucociliary homeostatic response. In individual animals, 26 of 35 animals (75%) exposed to 5 ppm, and 5 of 10 animals (50%) exposed to 20 ppm continuously during 16 hr per day for 7 consecutive days showed the same patterns. Reserpine and propranolol, which are sympatholytic agents, produced decelerated intranasal transport rates. Atropine and scopolamine, which are parasympatholytic agents, did not affect clearance rates. These nerve blockers, however, blocked the biphasic recovery pattern due to SO2 exposure. This blocking effect was statistically significant for atropine and reserpine 1 hr after injection.

Deposition, retention, and clearance of inhaled particles

The relation between the concentrations and characteristics of air contaminants in the work place and the resultant toxic doses and potential hazards after their inhalation depends greatly on their patterns of deposition and the rates and pathways for their clearance from the deposition sites. The distribution of the deposition sites of inhaled particles is strongly dependent on their aerodynamic diameters. For normal man, inhaled non-hygroscopic particles greater than or equal to 2 micrometers that deposit in the conducting airways by impaction are concentrated on to a small fraction of the surface. Cigarette smoking and bronchitis produce a proximal shift in the deposition pattern. The major factor affecting the deposition of smaller particles is their transfer from tidal to reserve air. For particles soluble in respiratory tract fluid, systemic uptake may be relatively complete for all deposition patterns, and there may be local toxic or irritant effects or both. On the other hand, slowly soluble particles depositing in the conducting airways are carried on the surface to the glottis and are swallowed within one day. Mucociliary transport rates are highly variable, both along the ciliated airways of a given individual and between individuals. The changes in clearance rates produced by drugs, cigarette smoke, and other environmental pollutants can greatly increase or decrease these rates. Particles deposited in non-ciliated airways have large surface-to-volume ratios, and clearance by dissolution can occur for materials generally considered insoluble. They may also be cleared as free particles either by passive transport along surface liquids or, after phagocytosis, by transport within alveolar macrophages. If the particles penetrate the epithelium, either bare or within macrophages, they may be sequestered within cells or enter the lymphatic circulation and be carried to pleural, hilar, and more distant lymph nodes. Non-toxic insoluble particles are cleared from the alveolar region in a series of temporal phases. The earliest, lasting several weeks, appears to include the clearance of phagocytosed particles via the bronchial tree. The terminal phases appear to be related to solubility at interstitial sites. While the mechanisms and dynamics of particle deposition and clearance are reasonably well established in broad outline, reliable quantitative data are lacking in many specific areas. More information is needed on: (1) normal behaviour, (2) the extent of the reserve capacity of the system to cope with occupational exposures, and (3) the role of compensatory changes in airway sizes and in secretory and transport rates in providing protection against occupational exposures, and in relation to the development and progression of dysfunction and disease.

Aerosol therapy with Sch 1000. Short-term mucociliary clearance in normal and bronchitic subjects and toxicology in normal subjects

The anticholinergic bronchodilator drug, Sch 1000, was administered as an aerosol by a metered-dose inhaler (200 microgram) to six normal and six bronchitic subjects. The short-term effect on mucociliary clearance was assessed and compared to a placebo (propellant and dispersal agent) in a double-blind crossover study. Mucociliary clearance in the normal group was significantly faster with administration of Sch 1000 than with placebo (P less than 0.01). There was no significant difference between the effects of administration of Sch 1000 and placebo on mucociliary clearance in the bronchitic group. Pulmonary function was significantly increased by therapy with Sch 1000 (as compared to administration of placebo) in the bronchitic group for two hours (P less than 0.05) and in the normal group for one hour (P less than 0.05). In another study, 12 normal subjects inhaled aerosols containing 40 microgram of placebo or 400 microgram of Sch 1000 from metered-dose inhalers on separate days in a randomized double-blind fashion. A significant sustained improvement in pulmonary function (P less than 0.05) and a transient fall in diastolic blood pressure were observed after administration of Sch 1000.