Airway responsiveness to beta-adrenergic agonist (salbutamol) in asthma

Respiratory effects of sulfur mustard exposure, similarities and differences with asthma and COPD

CONTEXT

Previous research has found relationships between sulfur mustard (SM) toxicity and its adverse effects.

OBJECTIVE

SM is highly toxic to the respiratory system, leading to hacking cough, rhinorrheachest tightness, acute pharyngitis and laryngitis, chronic bronchitis and lung fibrosis. In this review, based on the scientific literature, we provide an updated summary of information on SM exposures and their differences with asthma and COPD.

METHOD

Information of this review was obtained by searching Medline/PubMed, ScienceDirect, Scopus, Google Scholar, ISI Web of Knowledge and Chemical Abstracts.

RESULTS

SM exposure can decrease pulmonary function tests (PFTs) values. In addition, inflammatory cell accumulation in the respiratory tract and increased expression of some pro-inflammatory cytokines including tumor necrosis factor-α (TNFα), IL-1a, IL-1β, and reactive oxygen radicals due to SM exposure have been shown. Matrix metalloproteinase (MMP) which degrade extracellular matrix proteins, contributing to inflammatory cell recruitment, tissue injury and fibrosis are also up-regulated in the lung after SM exposure. In the lung, SM exposure also can cause serious pathological changes including airway inflammation, parenchymal tissue destruction and airway obstruction which can lead to asthma or chronic obstructive pulmonary disease (COPD). Following SM poisoning, DNA damage, apoptosis and autophagy are observed in the lung along with the increased expression of activated caspases and DNA repair enzymes.

CONCLUSION

In the present article, respiratory symptoms, changes in PFTs, lung pathology and lung inflammation due to SM exposure and the similarities and differences between them and those observed in asthma and COPD were reviewed.

Beta-Adrenoceptor Activation Reduces Both Dermal Microvascular Endothelial Cell Migration via a cAMP-Dependent Mechanism and Wound Angiogenesis

Angiogenesis is an essential process during tissue regeneration; however, the amount of angiogenesis directly correlates with the level of wound scarring. Angiogenesis is lower in scar-free foetal wounds while angiogenesis is raised and abnormal in pathophysiological scarring such as hypertrophic scars and keloids. Delineating the mechanisms that modulate angiogenesis and could reduce scarring would be clinically useful. Beta-adrenoceptors (β-AR) are G protein-coupled receptors (GPCRs) expressed on all skin cell-types. They play a role in wound repair but their specific role in angiogenesis is unknown. In this study, a range of in vitro assays (single cell migration, scratch wound healing, ELISAs for angiogenic growth factors and tubule formation) were performed with human dermal microvascular endothelial cells (HDMEC) to investigate and dissect mechanisms underpinning β-AR-mediated modulation of angiogenesis in chick chorioallantoic membranes (CAM) and murine excisional skin wounds. β-AR activation reduced HDMEC migration via cyclic adenosine monophosphate (cAMP)-dependent and protein kinase A (PKA)-independent mechanisms as demonstrated through use of an EPAC agonist that auto-inhibited the cAMP-mediated β-AR transduced reduction in HDMEC motility; a PKA inhibitor was, conversely, ineffective. ELISA studies demonstrated that β-AR activation reduced pro-angiogenic growth factor secretion from HDMECs (fibroblast growth factor 2) and keratinocytes (vascular endothelial growth factor A) revealing possible β-AR-mediated autocrine and paracrine anti-angiogenic mechanisms. In more complex environments, β-AR activation delayed HDMEC tubule formation and decreased angiogenesis both in the CAM assay and in murine excisional skin wounds in vivo. β-AR activation reduced HDMEC function in vitro and angiogenesis in vivo; therefore, β-AR agonists could be promising anti-angiogenic modulators in skin. J. Cell. Physiol. 230: 356–365, 2015. © 2014 The Authors. Journal of Cellular Physiology Published by Wiley Periodicals, Inc.

β2-adrenoceptor activation modulates skin wound healing processes to reduce scarring

During wound healing, excessive inflammation, angiogenesis, and differentiated human dermal fibroblast (HDF ) function contribute to scarring, whereas hyperpigmentation negatively affects scar quality. Over 100 million patients heal with a scar every year. To investigate the role of the beta 2 adrenergic receptor (β2AR) in wound scarring, the ability of beta 2 adrenergic receptor agonist (β2ARag) to alter HDF differentiation and function, wound inflammation, angiogenesis, and wound scarring was explored in HDFs, zebrafish, chick chorioallantoic membrane assay (CAM), and a porcine skin wound model, respectively. Here we identify a β2AR-mediated mechanism for scar reduction. β2ARag significantly reduced HDF differentiation, via multiple cAMP and/or fibroblast growth factor 2 or basic FGF (FGF2)-dependent mechanisms, in the presence of transforming growth factor betaβ1, reduced contractile function, and inhibited mRNA expression of a number of profibrotic markers. β2ARag also reduced inflammation and angiogenesis in zebrafish and CAMs in vivo, respectively. In Red Duroc pig full-thickness wounds, β2ARag reduced both scar area and hyperpigmentation by almost 50% and significantly improved scar quality. Indeed, mechanisms delineated in vitro and in other in vivo models were evident in the β2ARag-treated porcine scars in vivo. Both macrophage infiltration and angiogenesis were initially decreased, whereas DF function was impaired in the β2ARag-treated porcine wound bed. These data collectively reveal the potential of β2ARag to improve skin scarring.

The effect of chemical warfare on respiratory symptoms, pulmonary function tests and their reversibility 23–25 years after exposure

Pulmonary complications due to mustard gas exposure range from no effect to severe bronchial stenosis. Pulmonary function tests (PFTs) and respiratory symptoms in chemical war victims were studied 23–25 years after exposure to sulfur mustard (SM). Respiratory symptoms were evaluated in a sample of 142 chemical war victims and 120 control subjects with similar age from the general population using a questionnaire including questions on respiratory symptoms in the past year. PFT values were also measured in chemical war victims before and 15 min after the inhalation of 200 µg salbutamol and baseline PFT in controls. All chemical war victims (100%) reported respiratory symptoms. Wheezing (66.19%), cough (64.78%), and chest tightness (54.4%) were the most common symptoms and only 15.5% of chemical war victims reported sputum ( p < 0.01 for sputum and p < 0.001 for other symptoms compared with control group). In addition, 49.3% of chemical war victims had wheeze in chest examination, which were significantly higher than control group ( p < 0.001). The severity of respiratory symptoms was also significantly higher than control subjects ( p < 0.05 for sputum and p < 0.001 for other symptoms). All the PFT values were also significantly lower in chemical war victims than that in control subjects ( p < 0.001 for all cases). In addition, all the PFT values improved significantly after the inhalation of 200 µg salbutamol ( p < 0.05– p < 0.001). These results showed that chemical war victims, 23–25 years after exposure to chemical warfare have higher frequencies and severity of respiratory symptoms. PFT values were also significantly reduced among chemical war victims, which showed reversibility due to the inhalation of 200 µg salbutamol.

Feasibility of percutaneous vagus nerve stimulation for the treatment of acute asthma exacerbations

OBJECTIVES

This study assessed the feasibility of an investigational vagus nerve stimulation (VNS) device for treating acute asthma exacerbations in patients not responding to at least 1 hour of initial standard care therapy.

METHODS

This was a prospective, nonrandomized study of patients treated in the ED for moderate to severe acute asthma (forced expiratory volume in 1 second [FEV(1)] 25% to 70% of predicted). Treatment entailed percutaneous placement of an electrode near the right carotid sheath and 60 minutes of VNS and continued standard care. VNS voltage was adjusted to perceived improvement, muscle twitching, or adverse events (AEs). All AEs, vital signs, FEV(1), perceived work of breathing (WOB), and final disposition were recorded.

RESULTS

Twenty-five subjects were enrolled. There were no serious AEs and no significant changes in vital signs. No subject required terminating VNS. One patient had minor bleeding from the procedure, and one had a hematoma and withdrew prior to VNS. AEs related to VNS were temporary and included cough (1 of 24), swallowing difficulty (2 of 24), voice change (2 of 24), and muscle twitching (14 of 24). These resolved when VNS ended. The FEV(1) improved at 15 minutes (median = 15.8%, 95% confidence interval [CI] = 9.3% to 22.4%), 30 minutes (median = 21.3%, 95% CI = 8.1% to 36.5%), and 60 minutes (median = 27.5%, 95% CI = 11.3% to 43.5%). WOB improved at 15 minutes (median = 53.9%, 95% CI = 33.7% to 73.9%), 30 minutes (median = 69.1%, 95% CI = 56.4% to 81.8%), and 60 minutes (median = 81.0%, 95% CI = 68.5% to 93.5%).

CONCLUSIONS

Percutaneous VNS did not result in serious AEs and was associated with improvements in FEV(1) and perceived dyspnea. Percutaneous VNS appears to be feasible for use in the treatment of moderate to severe acute asthma in patients unresponsive to initial standard care treatment.

The effect of Nigella sativa alone, and in combination with dexamethasone, on tracheal muscle responsiveness and lung inflammation in sulfur mustard exposed guinea pigs

ETHNOMEDICAL RELEVANCE: The anti-inflammatory activity of both systemic and local administrations of essential oil from Nigella sativa L. has been shown.

AIM OF THE STUDY

Therefore, the effect of Nigella sativa on tracheal responsiveness (TR) and lung inflammation of sulfur mustard (SM) exposed guinea pigs was examined.

MATERIALS AND METHODS

Guinea pigs were exposed to diluent solution (control group), inhaled SM (SME group), SME treated with Nigella sativa (SME+N), SME treated with dexamethasone (SME+D) and SME treated with both drugs (SME+N+D), (n=7 for each group). TR to methacholine, total white blood cell (WBC) and differential WBC count of lung lavage, and serum cytokines were measured 14 days post-exposure.

RESULTS

The values of TR, eosinophil, monocyte, lymphocyte, interleukine-4 (IL-4) and interferon gamma (IFN-γ) of SME group were significantly higher than those of controls (p<0.05 to p<0.001). The TR in SME+N, SME+D and SME+N+D was significantly lower compared to that of SME group (p<0.01 for all cases). The percentage of eosinophil in SME+D, and the percentage of monocyte in SME+N+D (p<0.05 to p<0.01) were significantly lower than those in SME group. The neutrophil number was decreased in SME+N and SME+N+D groups compared to SME animals (p<0.05 to p<0.01). IL-4 levels in serum of SME+N (p<0.01), SME+D (p<0.05), SME+N+D (p<0.01) and IFN-γ in SME+N (p<0.05) were greater than those in SME animals.

CONCLUSIONS

These results showed a preventive effect of Nigella sativa on TR and lung inflammation of SM exposed guinea pigs.

Novel propellant-driven inhalation formulations: engineering polar drug particles with surface-trapped hydrofluoroalkane-philes

Challenges in reformulating pressurized metered-dose inhalers (pMDIs) with hydrofluoroalkane (HFA) propellants, and the potential of inhalation formulations for the delivery of drugs to and through the lungs have encouraged the development of novel suspension-based pMDI formulations. In this work we propose a new methodology for engineering polar drug particles with enhanced stability and aerosol characteristics in propellant HFAs. The approach consists in 'trapping' HFA-philic moieties at the surface of particles, which are formed using a modified emulsification-diffusion method. The trapped moieties act as stabilizing agents, thus preventing flocculation of the otherwise unstable colloidal drug particles. This approach has advantages compared to surfactant-stabilized colloids in that no free stabilizers remain in solution (reduced toxicity), and the challenges associated with the synthesis of well-balanced amphiphiles are circumvented. The methodology was tested by trapping polyethylene glycol (PEG) at the surface of particles of a model polar drug-salbutamol sulfate. Colloidal probe microscopy is used to quantitatively demonstrate the trapping of the HFA-phile at the surface, and the ability of PEG in screening particle-particle cohesive interactions. Both physical stability and the corresponding aerosol characteristics are significantly improved compared to those of a commercial formulation. The fine particle fraction of PEG-coated salbutamol sulfate was observed to be 42% higher than that of Ventolin HFA. The formation of stable dispersions of terbutaline hemisulfate using the same approach, suggests this to be a generally applicable methodology to polar drugs.

Core-shell particles for the dispersion of small polar drugs and biomolecules in hydrofluoroalkane propellants

PURPOSE

Demonstrate the applicability of a novel particle-based technology for the development of suspensions of small polar drugs and biomolecules in hydrofluoroalkane (HFA) propellants for pressurized metered-dose inhalers (pMDIs).

MATERIALS AND METHODS

Emulsification diffusion was used to prepare core-shell particles. The shell consisted of oligo(lactide) grafts attached onto a short chitosan backbone. The active drug was arrested within the particle core. Colloidal Probe Microscopy (CPM) was used to determine the cohesive forces between particles in a model HFA propellant. The aerosol characteristics of the formulations were determined using an Anderson Cascade Impactor (ACI). Cytotoxicity studies were performed on lung epithelial and alveolar type II cells.

RESULTS

CPM results indicate that particle cohesive forces in liquid HFA are significantly screened in the presence of the polymeric shell and correlate well with the physical stability of suspensions in propellant HFA. The proposed formulation showed little or no cytotoxic effects on both Calu-3 and A549 cells.

CONCLUSIONS

Core-shell particles with a shell containing the lactide moiety as the HFA-phile showed excellent dispersion stability and aerosol characteristics in HFA-based pMDIs. This is a general strategy that can be used for developing novel suspension pMDIs of both small polar drugs and large therapeutic molecules.

Influence of epithelium on beta-adrenoceptor desensitization of guinea pig tracheal smooth muscle

The effect of tissue incubation with a beta2-agonist of denuded and intact epithelium trachea on the responsiveness to isoprenaline and beta-receptor blocked by propranolol (CR-1) was examined in this study. We examined the effect of epithelium removal on the beta-adrenoceptor desensitization resulting from incubation of guinea pig trachea in the beta-adrenergic agonist isoprenaline (10 microM). Desensitization was measured as the change in EC50, the concentration of beta-agonist that produced 50% relaxation of tracheal rings contracted with methacholine. As a second measure of desensitization, we measured the shift in EC50 resulting from incubation of tracheal rings with the beta-adrenoceptor antagonist propranolol (20 nM), expressed as CR-1 ([post-propranolol EC50/baseline EC50]-1). Initially, we measured desensitization immediately after incubation in isoprenaline; subsequently, we repeated the protocol and allowed a 30 min rest between the end of incubation and the measurement. The sensitivity of denuded epithelium trachea to isoprenaline and (CR-1) was significantly higher than that of intact epithelium only in non-incubated preparations (p<0.05 to p<0.001). Incubation to isoprenaline caused a significant reduction in the tracheal response to isoprenaline in both the denuded groups (p<0.005 for both cases) and intact epithelium groups (p<0.05 for both cases). Incubation to isoprenaline also caused a significant reduction in (CR-1) value in both the denuded groups (p<0.005 for group 2 and p<0.001 for group 4) and intact epithelium only in group 1 (p<0.05). However, the changes in EC50 due to tissue incubation with isoprenaline were significantly greater in denuded than intact epithelium trachea (p<0.05 for all cases) and for CR-1 value only in groups 1 and 2 (p<0.05). These results indicate decrease in both tracheal response to beta-agonist (tolerance) and CR-1 (due to incubation of tissues with isoprenaline), which were greater in denuded epithelium groups.

Asma induzida pelo exercício: aspectos atuais e recomendações

OBJETIVO: Descrever os mecanismos da asma induzida pelo exercício (AIE), bem como os efeitos de diferentes tipos de treinamento físico na função pulmonar e nas capacidades aeróbia e anaeróbia. Destaca-se a importância de um diagnóstico correto mediante o teste de exercício e, no manejo, o uso de drogas beta-adrenérgicas e anticolinérgicas. FONTE DOS DADOS: Os artigos foram criteriosamente escolhidos utilizando as bases de dados PubMed e Scielo pelo ano de publicação e dando preferência a ensaios clínicos randomizados, com critérios de seleção da amostra bem definidos. SÍNTESE DOS DADOS: Os mecanismos para explicar a AIE permanecem sem conclusão, mas parece haver uma interação fisiológica entre as hipóteses aqui apresentadas. O uso de medicamentos e as freqüentes crises durante o exercício aparecem como fatores limitantes para a prática de exercícios físicos, conduzindo para um estilo de vida sedentário. CONCLUSÃO: Deve-se incentivar a prática de exercícios devidamente prescritos e minimizar as restrições aos sujeitos com AIE.

Tracheal responsiveness to both isoprenaline and beta2-adrenoreceptor blockade by propranolol in cigarette smoke exposed and sensitized guinea pigs

OBJECTIVE

Airway hyperresponsiveness is the main feature of asthma and also exists in cigarette smokers. In previous studies we have shown increased airway responsiveness to isoprenaline in asthmatic patients and smokers. In this study, tracheal responsiveness to isoprenaline and beta-adrenergic receptor blockade was investigated in animals exposed to cigarette smoke (AECS) with or without sensitization by ovalbumin (OA).

METHODOLOGY

Guinea pigs were exposed to cigarette smoke over a 3-month period with or without sensitization by injection and inhalation of OA. Tracheal responses in AECS, AECS + sensitized and control animals (n = 7 for each group) to isoprenaline in the absence and presence of 20 nmol/L propranolol were measured and EC(50) was established. The propranolol blockade (concentration ratio minus one (CR-1)) was calculated (post-propranolol EC(50)/EC(50)) - 1.

RESULTS

The tracheal response of AECS and AECS + sensitized guinea pigs to isoprenaline was significantly higher than that of control animals (EC(50): 4.24 +/- 0.54, 3.66 +/- 0.53 and 7.71 +/- 0.68.79 micromol for AECS, AECS + sensitized and control animals, respectively) (P < 0.001). There was no significant difference in EC(50) between AECS and AECS + sensitized. CR-1 was also significantly higher in the trachea of AECS and AECS + sensitized compared with controls (13.39 +/- 2.22 and 15.35 +/- 2.95 vs. 3.10 +/- 0.6, P < 0.05 in both cases). There was no significant difference in CR-1 between AECS and AECS + sensitized. There was a significant correlation between the tracheal response to isoprenaline (EC(50)) and CR-1 (r =-0.731, P < 0.001). There was no significant difference in tracheal maximum response to isoprenaline between the three groups of animals.

CONCLUSIONS

The results of this study indicate an increased tracheal response to a beta(2)-adrenergic stimulating drug and enhanced beta(2)-adrenergic blockade by propranolol in both AECS and AECS + sensitized. These results suggest similar increase in airway responsiveness to beta(2)-adrenergic agonists and beta(2)-receptor blockade in AECS and AECS + sensitized guinea pigs.

Airway hyperresponsiveness to methacholine in chemical warfare victims

BACKGROUND

The lung is one of the most exposable organs to chemical warfare agents such as sulfur mustard gas. Pulmonary complications as a result of this gas range from severe bronchial stenosis to mild or no symptoms. Airway hyperresponsiveness (AHR) which is usually assessed as response to inhaled methacholine is the most characteristic feature of asthma. AHR is reported in chronic obstructive pulmonary disease patients and smokers, and may also show in chemical warfare victims. However, there are little reports regarding AHR in chemical warfare victims.

OBJECTIVE

Therefore, in this study, airway responsiveness to methacholine in victims of chemical warfare was examined.

METHODS

The threshold concentrations of inhaled methacholine required for a 20% change in forced expiratory flow in 1 s (FEV1; PC20) or a 35% change in specific airway conductance (PC35) were measured in 15 chemical war victims and 15 normal control subjects.

RESULTS

In 10 out of 15 chemical warfare victims (two thirds), PC20 and PC35 methacholine could be measured and subjects were called responders. AHR to methacholine in responder chemical war victims (PC20 = 0.41 and PC35 = 0.82 g/l) was significantly lower than in normal subjects (PC20 = 5.69 and PC35 = 4.60 g/l, p < 0.001 for both cases). There was a significant correlation between FEV1 and PC20 methacholine (r = 0.688, p < 0.001). The correlations between PC20 and PC35 were statistically significant as well (r = 0.856, p < 0.001).

CONCLUSION

Results showed increased airway responsiveness of most chemical warfare victims to methacholine which correlated with the FEV1 value and which may be related to chronic airway inflammation or irreversible airway changes.

Beta-adrenoceptor responses of the airways: for better or worse?

Beta2-adrenoceptor agonists are the first-line treatment of asthma and chronic obstructive pulmonary disease (COPD), in which a short-acting beta2-adrenoceptor agonist is used as required for relief of bronchoconstriction. A long-acting beta2-adrenoceptor agonist may be added to an inhaled corticosteroid as step 3 in the management of chronic asthma. Long-acting beta2-adrenoceptor agonists may also be added in treatment of COPD. This review examines the beneficial and detrimental effects of beta2-adrenoceptor agonists. The beneficial effects of beta2-adrenoceptor agonists are mainly derived from their bronchodilator activity which relieves the bronchiolar narrowing and improves air flow. The potential anti-inflammatory actions of stabilizing mast cell degranulation and release of inflammatory and bronchoconstrictor mediators, is considered. Other potential beneficial responses include improvements in mucociliary clearance and inhibition of extravasation of plasma proteins that is involved in oedema formation in asthma. The side effects of beta2-adrenoceptor agonists are primarily related to beta2-adrenoceptor-mediated responses at sites outside the airways. Of major concern has been the development of tolerance and this is discussed in relation to incidence of increased morbidity and mortality to asthma over the past three decades. A clinical aspect of beta2-adrenoceptor pharmacology in recent years has been the recognition of genetic polymorphism of the receptor and how this affects responses to and tolerance to beta2-adrenoceptor agonists. A controversial feature of beta2-adrenoceptor agonists is their stereoisomerism and whether the inactive (S)-isomer of salbutamol had detrimental actions in the commercially used racemate. The consensus is that despite these adverse properties, beta2-adrenoceptor agonist remains the most useful pharmacological agents in the management of asthma and COPD.