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Hancock DG, Berry L, Scott NM, Mincham KT, Ditcham W, Larcombe AN, Clements B. Treatment with inhaled aerosolised ethanol reduces viral load and potentiates macrophage responses in an established influenza mouse model. Exp Lung Res 2024; 50:118-126. [PMID: 38683138 DOI: 10.1080/01902148.2024.2346320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
AIM Treatment options for viral lung infections are currently limited. We aimed to explore the safety and efficacy of inhaled ethanol in an influenza-infection mouse model. MATERIALS AND METHODS In a safety and tolerability experiment, 80 healthy female BALB/c mice (20 per group) were exposed to nebulized saline (control) or three concentrations of ethanol (40/60/80% ethanol v/v in water) for 3x30-minute periods, with a two-hour break between exposures. In a separate subsequent experiment, 40 Female BALB/c mice were nasally inoculated with 104.5 plaque-forming units of immediate virulence "Mem71" influenza. Infection was established for 48-h before commencing treatment in 4 groups of 10 mice with either nebulized saline (control) or one of 3 different concentrations of ethanol (40/60/80% ethanol v/v in water) for 3x30-minute periods daily over three consecutive days. In both experiments, mouse behavior, clinical scores, weight change, bronchoalveolar lavage cell viability, cellular composition, and cytokine levels, were assessed 24-h following the final exposure, with viral load also assessed after the second experiment. RESULTS In uninfected BALB/c mice, 3x30-minute exposures to nebulized 40%, 60%, and 80% ethanol resulted in no significant differences in mouse weights, cell counts/viability, cytokines, or morphometry measures. In Mem71-influenza infected mice, we observed a dose-dependent reduction in viral load in the 80%-treated group and potentiation of macrophage numbers in the 60%- and 80%-treated groups, with no safety concerns. CONCLUSIONS Our data provides support for inhaled ethanol as a candidate treatment for respiratory infections.
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Affiliation(s)
- David G Hancock
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Luke Berry
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
| | - Naomi M Scott
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
| | - Kyle T Mincham
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
- National Heart and Lung Institute, Imperial College London, London, UK
| | - William Ditcham
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Alexander N Larcombe
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
- Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, WA, Australia
| | - Barry Clements
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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2
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Hancock DG, Ditcham W, Ferguson E, Karpievitch YV, Stick SM, Waterer GW, Clements BS. A phase I clinical trial assessing the safety, tolerability, and pharmacokinetics of inhaled ethanol in humans as a potential treatment for respiratory tract infections. Front Med (Lausanne) 2024; 11:1324686. [PMID: 38504921 PMCID: PMC10949138 DOI: 10.3389/fmed.2024.1324686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/12/2024] [Indexed: 03/21/2024] Open
Abstract
Background Current treatments for respiratory infections are severely limited. Ethanol's unique properties including antimicrobial, immunomodulatory, and surfactant-like activity make it a promising candidate treatment for respiratory infections if it can be delivered safely to the airway by inhalation. Here, we explore the safety, tolerability, and pharmacokinetics of inhaled ethanol in a phase I clinical trial. Methods The study was conducted as a single-centre, open-label clinical trial in 18 healthy adult volunteers, six with no significant medical comorbidities, four with stable asthma, four with stable cystic fibrosis, and four active smokers. A dose-escalating design was used, with participants receiving three dosing cycles of 40, 60%, and then 80% ethanol v/v in water, 2 h apart, in a single visit. Ethanol was nebulised using a standard jet nebuliser, delivered through a novel closed-circuit reservoir system, and inhaled nasally for 10 min, then orally for 30 min. Safety assessments included adverse events and vital sign monitoring, blood alcohol concentrations, clinical examination, spirometry, electrocardiogram, and blood tests. Results No serious adverse events were recorded. The maximum blood alcohol concentration observed was 0.011% immediately following 80% ethanol dosing. Breath alcohol concentrations were high (median 0.26%) following dosing suggesting high tissue levels were achieved. Small transient increases in heart rate, blood pressure, and blood neutrophil levels were observed, with these normalising after dosing, with no other significant safety concerns. Of 18 participants, 15 completed all dosing cycles with three not completing all cycles due to tolerability. The closed-circuit reservoir system significantly reduced fugitive aerosol loss during dosing. Conclusion These data support the safety of inhaled ethanol at concentrations up to 80%, supporting its further investigation as a treatment for respiratory infections.Clinical trial registration: identifier ACTRN12621000067875.
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Affiliation(s)
- David G. Hancock
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- UWA Medical School, University of Western Australia, Perth, WA, Australia
| | - William Ditcham
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Eleanor Ferguson
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Yuliya V. Karpievitch
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Stephen M. Stick
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- UWA Medical School, University of Western Australia, Perth, WA, Australia
| | - Grant W. Waterer
- UWA Medical School, University of Western Australia, Perth, WA, Australia
| | - Barry S. Clements
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- UWA Medical School, University of Western Australia, Perth, WA, Australia
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3
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Perroni G, Radovanovic D, Mondoni M, Mangiameli G, Giudici VM, Crepaldi A, Giatti V, Morenghi E, Stella GM, Pavesi S, Mantero M, Corsico AG, Spotti M, Premuda C, Mangili SA, Franceschi E, Narvena VM, Vanoni N, Pilocane T, Russo G, Di Marco F, Alloisio M, Aliberti S, Marulli G, Bertuzzi AF, Cipolla G, Centanni S, Blasi F, Santus P, Cariboni U. Incidence of Tracheal Stenosis in ICU Hospitalized COVID-19 Patients: Results from a Prospective, Observational, Multicenter Study. J Pers Med 2023; 14:39. [PMID: 38248740 PMCID: PMC10817429 DOI: 10.3390/jpm14010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Tracheal stenosis represents a fearsome complication that substantially impairs quality of life. The recent SARS-CoV-2 pandemic increased the number of patients requiring invasive ventilation through prolonged intubation or tracheostomy, increasing the risk of tracheal stenosis. Study design and methods: In this prospective, observational, multicenter study performed in Lombardy (Italy), we have exanimated 281 patients who underwent prolonged intubation (more than 7 days) or tracheostomy for severe COVID-19. Patients underwent CT scan and spirometry 2 months after hospital discharge and a subsequent clinical follow-up after an additional 6 months (overall 8 months of follow-up duration) to detect any tracheal lumen reduction above 1%. The last follow-up evaluation was completed on 31 August 2022. Results: In the study period, 24 patients (8.5%, CI 5.6-12.4) developed tracheal stenosis in a median time of 112 days and within a period of 200 days from intubation. Compared to patients without tracheal stenosis, tracheostomy was performed more frequently in patients that developed stenosis (75% vs 54%, p = 0.034). Tracheostomy and alcohol consumption (1 unit of alcohol per day) increased risk of developing tracheal stenosis of 2.6-fold (p = 0.047; IC 0.99-6.8) and 5.4-fold (p = 0.002; CI 1.9-16), respectively. Conclusions: In a large cohort of patients, the incidence of tracheal stenosis increased during pandemic, probably related to the increased use of prolonged intubation. Patients with histories of prolonged intubation should be monitored for at least 200 days from invasive ventilation in order to detect tracheal stenosis at early stage. Alcohol use and tracheostomy are risk factors for developing tracheal stenosis.
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Affiliation(s)
- Gianluca Perroni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
| | - Dejan Radovanovic
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy; (M.M.); (S.P.)
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Alessandro Crepaldi
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
| | - Valentina Giatti
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
| | - Emanuela Morenghi
- Biostatistics Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Giulia Maria Stella
- Department of Internal Medicine and Medical Therapeutics, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (G.M.S.); (A.G.C.)
- Unit of Respiratory Diseases, Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Stefano Pavesi
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy; (M.M.); (S.P.)
| | - Marco Mantero
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Angelo Guido Corsico
- Department of Internal Medicine and Medical Therapeutics, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (G.M.S.); (A.G.C.)
- Unit of Respiratory Diseases, Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Maura Spotti
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Chiara Premuda
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | | | - Elisa Franceschi
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | | | - Nicolò Vanoni
- Unit of Pneumology, ASST Lodi, 26900 Lodi, Italy; (N.V.); (G.C.)
| | - Tommaso Pilocane
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Gianluca Russo
- Unit of Pain Medicine, Department of Emergency, ASST Lodi, 26900 Lodi, Italy;
| | - Fabiano Di Marco
- Department of Health Sciences, Università degli Studi di Milano, Pneumologia, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
- Unit of Pneumology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Giuseppe Marulli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | | | - Giuseppe Cipolla
- Unit of Pneumology, ASST Lodi, 26900 Lodi, Italy; (N.V.); (G.C.)
| | - Stefano Centanni
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
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4
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Vasudeva A, Patel TK. Alcohol consumption: An important epidemiological factor in COVID-19? J Glob Health 2020; 10:020335. [PMID: 33110535 PMCID: PMC7561277 DOI: 10.7189/jogh.10.020335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Abhimanyu Vasudeva
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Gorakhpur Gorakhpur, Uttar Pradesh, India
| | - Tejas K Patel
- Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, Uttar Pradesh, India
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5
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Persistence of Burkholderia thailandensis E264 in lung tissue after a single binge alcohol episode. PLoS One 2019; 14:e0218147. [PMID: 31821337 PMCID: PMC6903738 DOI: 10.1371/journal.pone.0218147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 11/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background Binge drinking, an increasingly common form of alcohol use disorder, is associated with substantial morbidity and mortality; yet, its effects on the immune system’s ability to defend against infectious agents are poorly understood. Burkholderia pseudomallei, the causative agent of melioidosis can occur in healthy humans, yet binge alcohol intoxication is increasingly being recognized as a major risk factor. Although our previous studies demonstrated that binge alcohol exposure increased B. pseudomallei near-neighbor virulence in vivo and increased paracellular diffusion and intracellular invasion, no experimental studies have examined the extent to which bacterial and alcohol dosage play a role in disease progression. In addition, the temporal effects of a single binge alcohol dose prior to infection has not been examined in vivo. Principal findings In this study, we used B. thailandensis E264 a close genetic relative of B. pseudomallei, as useful BSL-2 model system. Eight-week-old female C57BL/6 mice were utilized in three distinct animal models to address the effects of 1) bacterial dosage, 2) alcohol dosage, and 3) the temporal effects, of a single binge alcohol episode. Alcohol was administered comparable to human binge drinking (≤ 4.4 g/kg) or PBS intraperitoneally before a non-lethal intranasal infection. Bacterial colonization of lung and spleen was increased in mice administered alcohol even after bacterial dose was decreased 10-fold. Lung and not spleen tissue were colonized even after alcohol dosage was decreased 20 times below the U.S legal limit. Temporally, a single binge alcohol episode affected lung bacterial colonization for more than 24 h after alcohol was no longer detected in the blood. Pulmonary and splenic cytokine expression (TNF-α, GM-CSF) remained suppressed, while IL-12/p40 increased in mice administered alcohol 6 or 24 h prior to infection. Increased lung and not intestinal bacterial invasion was observed in human and murine non-phagocytic epithelial cells exposed to 0.2% v/v alcohol in vitro. Conclusions Our results indicate that the effects of a single binge alcohol episode are tissue specific. A single binge alcohol intoxication event increases bacterial colonization in mouse lung tissue even after very low BACs and decreases the dose required to colonize the lungs with less virulent B. thailandensis. Additionally, the temporal effects of binge alcohol alters lung and spleen cytokine expression for at least 24 h after alcohol is detected in the blood. Delayed recovery in lung and not spleen tissue may provide a means for B. pseudomallei and near-neighbors to successfully colonize lung tissue through increased intracellular invasion of non-phagocytic cells in patients with hazardous alcohol intake.
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6
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Balansky R, Ganchev G, Iltcheva M, Nikolov M, La Maestra S, Micale RT, Steele VE, De Flora S. Interactions between ethanol and cigarette smoke in a mouse lung carcinogenesis model. Toxicology 2016; 373:54-62. [PMID: 27840117 DOI: 10.1016/j.tox.2016.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 01/11/2023]
Abstract
Both ethanol and cigarette smoke are classified as human carcinogens. They can synergize, especially in tissues of the upper aerodigestive tract that are targeted by both agents. The main objective of the present study was to evaluate the individual and combined effects of ethanol and smoke in the respiratory tract, either following transplacental exposure and/or postnatal exposure. We designed two consecutive studies in mouse models by exposing Swiss H mice to oral ethanol and/or inhaled mainstream cigarette smoke for up to 4 months, at various prenatal and postnatal life stages. Clastogenic effects and histopathological alterations were evaluated after 4 and 8 months, respectively. Ethanol was per se devoid of clastogenic effects in mouse peripheral blood erythrocytes. However, especially in mice exposed both transplacentally throughout pregnancy and in the postnatal life, ethanol administration was associated not only with liver damage but also with pro-angiogenetic effects in the lung by stimulating the proliferation of blood vessels. In addition, these mice developed pulmonary emphysema, alveolar epithelial hyperplasias, microadenomas, and benign tumors. On the other hand, ethanol interfered in the lung carcinogenesis process resulting from the concomitant exposure of mice to smoke. In fact, ethanol significantly attenuated some smoke-related preneoplastic and neoplastic lesions in the respiratory tract, such as alveolar epithelial hyperplasia, microadenomas, and even malignant tumors. In addition, ethanol attenuated cigarette smoke clastogenicity. In conclusion, preclinical studies provide evidence that, in spite of its pulmonary toxicity, ethanol may mitigate some noxious effects of cigarette smoke in the respiratory tract.
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Affiliation(s)
- Roumen Balansky
- National Center of Oncology, Str. Plovdivsko pole 6, Sofia, 1756, Bulgaria; Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
| | - Gancho Ganchev
- National Center of Oncology, Str. Plovdivsko pole 6, Sofia, 1756, Bulgaria.
| | - Marietta Iltcheva
- National Center of Oncology, Str. Plovdivsko pole 6, Sofia, 1756, Bulgaria.
| | - Manasi Nikolov
- National Center of Oncology, Str. Plovdivsko pole 6, Sofia, 1756, Bulgaria.
| | - S La Maestra
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
| | - Rosanna T Micale
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
| | - Vernon E Steele
- National Cancer Institute, Chemoprevention Agent Development Research Group, Division of Cancer Prevention,9609 Medical Center Drive, Bethesda, MD 20892, USA.
| | - Silvio De Flora
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
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7
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Yeligar SM, Chen MM, Kovacs EJ, Sisson JH, Burnham EL, Brown LAS. Alcohol and lung injury and immunity. Alcohol 2016; 55:51-59. [PMID: 27788778 DOI: 10.1016/j.alcohol.2016.08.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/07/2016] [Accepted: 08/24/2016] [Indexed: 02/06/2023]
Abstract
Annually, excessive alcohol use accounts for more than $220 billion in economic costs and 80,000 deaths, making excessive alcohol use the third leading lifestyle-related cause of death in the US. Patients with an alcohol-use disorder (AUD) also have an increased susceptibility to respiratory pathogens and lung injury, including a 2-4-fold increased risk of acute respiratory distress syndrome (ARDS). This review investigates some of the potential mechanisms by which alcohol causes lung injury and impairs lung immunity. In intoxicated individuals with burn injuries, activation of the gut-liver axis drives pulmonary inflammation, thereby negatively impacting morbidity and mortality. In the lung, the upper airway is the first checkpoint to fail in microbe clearance during alcohol-induced lung immune dysfunction. Brief and prolonged alcohol exposure drive different post-translational modifications of novel proteins that control cilia function. Proteomic approaches are needed to identify novel alcohol targets and post-translational modifications in airway cilia that are involved in alcohol-dependent signal transduction pathways. When the upper airway fails to clear inhaled pathogens, they enter the alveolar space where they are primarily cleared by alveolar macrophages (AM). With chronic alcohol ingestion, oxidative stress pathways in the AMs are stimulated, thereby impairing AM immune capacity and pathogen clearance. The epidemiology of pneumococcal pneumonia and AUDs is well established, as both increased predisposition and illness severity have been reported. AUD subjects have increased susceptibility to pneumococcal pneumonia infections, which may be due to the pro-inflammatory response of AMs, leading to increased oxidative stress.
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Affiliation(s)
- Samantha M Yeligar
- Department of Medicine, Emory University and Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, USA
| | - Michael M Chen
- Burn and Shock Trauma Research Institute, Alcohol Research Program, Integrative Cell Biology Program, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
| | - Elizabeth J Kovacs
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Joseph H Sisson
- Pulmonary, Critical Care, Sleep and Allergy Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Ellen L Burnham
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Lou Ann S Brown
- Department of Pediatrics, Emory University, Atlanta, GA 30322, USA.
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8
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Traphagen N, Tian Z, Allen-Gipson D. Chronic Ethanol Exposure: Pathogenesis of Pulmonary Disease and Dysfunction. Biomolecules 2015; 5:2840-53. [PMID: 26492278 PMCID: PMC4693259 DOI: 10.3390/biom5042840] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/04/2015] [Accepted: 09/28/2015] [Indexed: 12/18/2022] Open
Abstract
Ethanol (EtOH) is the world’s most commonly used drug, and has been widely recognized as a risk factor for developing lung disorders. Chronic EtOH exposure affects all of the organ systems in the body and increases the risk of developing pulmonary diseases such as acute lung injury and pneumonia, while exacerbating the symptoms and resulting in increased mortality in many other lung disorders. EtOH and its metabolites inhibit the immune response of alveolar macrophages (AMs), increase airway leakage, produce damaging reactive oxygen species (ROS), and disrupt the balance of antioxidants/oxidants within the lungs. In this article, we review the role of EtOH exposure in the pathogenesis and progression of pulmonary disease.
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Affiliation(s)
- Nicole Traphagen
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida Health, Tampa, FL 33612, USA.
| | - Zhi Tian
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida Health, Tampa, FL 33612, USA.
| | - Diane Allen-Gipson
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida Health, Tampa, FL 33612, USA.
- Department of Internal Medicine, Division of Allergy and Immunology, University of South Florida Health, Tampa, FL 33612, USA.
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9
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Potential Role of the Gut/Liver/Lung Axis in Alcohol-Induced Tissue Pathology. Biomolecules 2015; 5:2477-503. [PMID: 26437442 PMCID: PMC4693244 DOI: 10.3390/biom5042477] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/11/2015] [Accepted: 09/21/2015] [Indexed: 01/01/2023] Open
Abstract
Both Alcoholic Liver Disease (ALD) and alcohol-related susceptibility to acute lung injury are estimated to account for the highest morbidity and mortality related to chronic alcohol abuse and, thus, represent a focus of intense investigation. In general, alcohol-induced derangements to both organs are considered to be independent and are often evaluated separately. However, the liver and lung share many general responses to damage, and specific responses to alcohol exposure. For example, both organs possess resident macrophages that play key roles in mediating the immune/inflammatory response. Additionally, alcohol-induced damage to both organs appears to involve oxidative stress that favors tissue injury. Another mechanism that appears to be shared between the organs is that inflammatory injury to both organs is enhanced by alcohol exposure. Lastly, altered extracellular matrix (ECM) deposition appears to be a key step in disease progression in both organs. Indeed, recent studies suggest that early subtle changes in the ECM may predispose the target organ to an inflammatory insult. The purpose of this chapter is to review the parallel mechanisms of liver and lung injury in response to alcohol consumption. This chapter will also explore the potential that these mechanisms are interdependent, as part of a gut-liver-lung axis.
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10
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Butler JP, Tsuda A. Transport of gases between the environment and alveoli--theoretical foundations. Compr Physiol 2013; 1:1301-16. [PMID: 23733643 DOI: 10.1002/cphy.c090016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The transport of oxygen and carbon dioxide in the gas phase from the ambient environment to and from the alveolar gas/blood interface is accomplished through the tracheobronchial tree, and involves mechanisms of bulk or convective transport and diffusive net transport. The geometry of the airway tree and the fluid dynamics of these two transport processes combine in such a way that promotes a classical fractionation of ventilation into dead space and alveolar ventilation, respectively. This simple picture continues to capture much of the essence of gas phase transport. On the other hand, a more detailed look at the interaction of convection and diffusion leads to significant new issues, many of which remain open questions. These are associated with parallel and serial inhomogeneities especially within the distal acinar units, velocity profiles in distal airways and terminal spaces subject to moving boundary conditions, and the serial transport of respiratory gases within the complex acinar architecture. This article focuses specifically on the theoretical foundations of gas transport, addressing two broad areas. The first deals with the reasons why the classical picture of alveolar and dead space ventilation is so successful; the second examines the underlying assumptions within current approximations to convective and diffusive transport, and how they interact to effect net gas exchange.
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Affiliation(s)
- James P Butler
- Harvard School of Public Health, Boston, Massachusetts, USA.
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11
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Tu C, Mammen MJ, Li J, Shen X, Jiang X, Hu Q, Wang J, Sethi S, Qu J. Large-scale, ion-current-based proteomics investigation of bronchoalveolar lavage fluid in chronic obstructive pulmonary disease patients. J Proteome Res 2013; 13:627-639. [PMID: 24188068 DOI: 10.1021/pr4007602] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Proteomic analysis of bronchoalveolar lavage fluid (BALF) in chronic obstructive pulmonary disease (COPD) patients may provide new biomarkers and deeper understanding of the disease mechanisms but remains challenging. Here we describe an ion-current-based strategy for comparative analysis of BALF proteomes from patients with moderate and stable COPD versus healthy controls. The strategy includes an efficient preparation procedure providing quantitative recovery and a nano-LC/MS analysis with a long, heated column. Under optimized conditions, high efficiency and reproducibility were achieved for each step, enabling a "20-plex" comparison of clinical subjects (n = 10/group). Without depletion/fractionation, a total of 423 unique protein groups were quantified under stringent criteria with at least two quantifiable peptides. Seventy-six proteins were determined as significantly altered in COPD, which represent a diversity of biological processes such as alcohol metabolic process, gluconeogenesis/glycolysis, inflammatory response, proteolysis, and oxidation reduction. Interestingly, altered alcohol metabolism responding to oxidant stress is a novel observation in COPD. The prominently elevated key enzymes involved in alcohol metabolism (e.g., ADH1B, ALDH2, and ALDH3A1) may provide a reasonable explanation for a bewildering observation in COPD patients known for decades: the underestimation of the blood alcohol concentrations through breath tests. These discoveries could provide new insights for identifying novel biomarkers and pathological mediators in clinical studies.
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Affiliation(s)
- Chengjian Tu
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA.,New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
| | | | - Jun Li
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA.,New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
| | - Xiaomeng Shen
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA.,New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
| | - Xiaosheng Jiang
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA.,New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
| | - Qiang Hu
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY14203
| | - Jianmin Wang
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY14203
| | - Sanjay Sethi
- University at Buffalo, SUNY.,WNY VA Healthcare System, NY 14203 USA
| | - Jun Qu
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA.,New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
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Bailey KL, Robinson JE, Sisson JH, Wyatt TA. Alcohol decreases RhoA activity through a nitric oxide (NO)/cyclic GMP(cGMP)/protein kinase G (PKG)-dependent pathway in the airway epithelium. Alcohol Clin Exp Res 2011; 35:1277-81. [PMID: 21410486 DOI: 10.1111/j.1530-0277.2011.01463.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Alcohol has been shown to have a number of harmful effects on the lung, including increasing the risk of pneumonia and bronchitis. How alcohol increases the risk of these diseases is poorly defined. RhoA is a small guanosine triphosphate (GTP)ase that plays an integral role in many basic functions of airway epithelial cells. It is not known how alcohol affects RhoA activity in the airway epithelium. We hypothesized that brief alcohol exposure modulates RhoA activity in the airway epithelium through a nitric oxide (NO)/cyclic GMP (cGMP)/protein kinase G (PKG)-dependent pathway. METHODS Primary airway epithelial cells were cultured and exposed to ethanol at various concentrations and times. The cell layers were harvested and RhoA activity was measured. RESULTS Alcohol induced a time- and concentration-dependent decrease in RhoA activity in airway epithelial cells. We were able to block this decrease in activity using Nω-nitro-l-arginine methyl ester (L-NAME) hydrochloride, a nitric oxide synthase (NOS) inhibitor. Likewise, we were able to demonstrate the same decrease in RhoA activation using 0.1 μM sodium nitroprusside, an NO donor. To determine the role of cGMP/PKG, we pretreated the cells with a cGMP antagonist analog, Rp-8Br-cGMPS. This blocked the decrease in RhoA activity caused by alcohol, suggesting that alcohol exerts its effect on RhoA activity through cGMP/PKG. CONCLUSIONS Alcohol decreases airway epithelial RhoA activity through an NO/cGMP/PKG-dependent pathway. RhoA activity controls many aspects of basic cellular function, including cell morphology, tight junction formation, and cell cycle progression and gene regulation. Dysregulation of RhoA activity can potentially have several consequences, including dysregulation of inflammation. This may partially explain how alcohol increases the risk of pneumonia and bronchitis.
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Affiliation(s)
- Kristina L Bailey
- Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center, Omaha, NE 68198, USA.
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Das SK, Mukherjee S. Long term ethanol consumption leads to lung tissue oxidative stress and injury. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2010; 3:414-20. [PMID: 21307643 PMCID: PMC3154049 DOI: 10.4161/oxim.3.6.14417] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 11/25/2010] [Accepted: 12/06/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alcohol abuse is a systemic disorder. The deleterious health effects of alcohol consumption may result in irreversible organ damage. By contrast, there currently is little evidence for the toxicity of chronic alcohol use on lung tissue. Hence, in this study we investigated long term effects of ethanol in the lung. RESULTS Though body weight of rats increased significantly with duration of exposure compared to its initial weight, but there was no significant change in relative weight (g/100 g body weight) of lung due to ethanol exposure. The levels of thiobarbituric acid reactive substances (TBARS), nitrite, protein carbonyl, oxidized glutathione (GSSG), redox ratio (GSSG/GSH) and GST activity elevated; while reduced glutathione (GSH) level and activities of glutathione reductase (GR), glutathione peroxidase (GPx), catalase, superoxide dismutase (SOD) and Na(+)K(+) ATPase reduced significantly with duration of ethanol exposure in the lung homogenate compared to the control group. Total matrix metalloproteinase activity elevated in the lung homogenate with time of ethanol consumption. Histopathologic examination also demonstrated that severity of lung injury enhanced with duration of ethanol exposure. METHODS 16-18 weeks old male albino Wistar strain rats weighing 200-220 g were fed with ethanol (1.6 g/ kg body weight/ day) up to 36 weeks. At the end of the experimental period, blood samples were collected from reteroorbital plexus to determine blood alcohol concentration, and the animals were sacrificed. Various oxidative stress related biochemical parameters, total matrix metalloproteinase activity and histopathologic examinations of the lung tissues were performed. CONCLUSIONS Results of this study indicate that long term ethanol administration aggravates systemic and local oxidative stress, which may be associated with lung tissue injury.
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Affiliation(s)
- Subir Kumar Das
- Department of Biochemistry, ESI-PGIMSR, Joka, Kolkata, India.
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O'Hara ME, O'Hehir S, Green S, Mayhew CA. Development of a protocol to measure volatile organic compounds in human breath: a comparison of rebreathing and on-line single exhalations using proton transfer reaction mass spectrometry. Physiol Meas 2008; 29:309-30. [PMID: 18367807 DOI: 10.1088/0967-3334/29/3/003] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Analysis of volatile organic compounds (VOCs) on human breath has great potential as a non-invasive diagnostic technique. It is, therefore, surprising that no single, standard procedure has evolved for breath sampling. Here we present a novel repeated-cycle isothermal rebreathing method, where one cycle comprises five rebreaths, which could be adopted for breath analysis of VOCs. For demonstration purposes, we present measurements of three common breath VOCs: isoprene, acetone and methanol. Their concentrations measured in breath are shown to increase with number of rebreaths until a plateau value is reached by at least 20 rebreaths. The average ratio of plateau concentration to single mixed expired breath concentration was found to be 1.92 +/- 0.57 for isoprene, 1.25 +/- 0.13 for acetone and 1.12 +/- 0.12 for methanol (mean +/- standard deviation). Measurements from on-line single exhalations are presented which demonstrate a positive slope in the time-dependent expirograms of isoprene and acetone. The slope of the isoprene expirogram is persistently linear and the end-expired concentration of isoprene is highly variable in the same subject depending on the duration of exhalation. End-expired values of acetone are not as sensitive to the length of exhalation, and are the same to within measurement uncertainty for any duration of exhalation for any subject. It is concluded that uncontrolled single on-line exhalations are not suitable for the reliable measurement of isoprene in the breath and that rebreathing can be the basis of an easily tolerated protocol for the reliable collection of breath samples.
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Affiliation(s)
- M E O'Hara
- School of Physics and Astronomy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Abstract
The volatility of alcohol promotes the movement of alcohol from the bronchial circulation across the airway epithelium and into the conducting airways of the lung. The exposure of the airways through this route likely accounts for many of the biologic effects of alcohol on lung airway functions. The effect of alcohol on lung airway functions is dependent on the concentration, duration, and route of exposure. Brief exposure to mild concentrations of alcohol may enhance mucociliary clearance, stimulates bronchodilation, and probably attenuates the airway inflammation and injury observed in asthma and chronic obstructive pulmonary disease (COPD). Prolonged and heavy exposure to alcohol impairs mucociliary clearance, may complicate asthma management, and likely worsens outcomes including lung function and mortality in COPD patients. Nonalcohol congeners and alcohol metabolites act as triggers for airway disease exacerbations especially in atopic asthmatics and in Asian populations who have a reduced capacity to metabolize alcohol. Research focused on the mechanisms of alcohol-mediated changes in airway functions has identified specific mechanisms that mediate alcohol effects within the lung airways. These include prominent roles for the second messengers calcium and nitric oxide, regulatory kinases including PKG and PKA, alcohol- and acetaldehyde-metabolizing enzymes such as aldehyde dehydrogenase 2. The role alcohol may play in the pathobiology of airway mucus, bronchial blood flow, airway smooth muscle regulation, and the interaction with other airway exposure agents, such as cigarette smoke, represents opportunities for future investigation.
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Affiliation(s)
- Joseph H Sisson
- University of Nebraska Medical Center, Pulmonary, Critical Care, Sleep and Allergy Section, Department of Internal Medicine, 985300 Nebraska Medical Center, Omaha, NE 68198-5300, USA.
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Schulz H, Schulz A, Eder G, Heyder J. Labeled carbon dioxide (C18O2): an indicator gas for phase II in expirograms. J Appl Physiol (1985) 2004; 97:1755-62. [PMID: 15194679 DOI: 10.1152/japplphysiol.01360.2003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Carbon dioxide labeled with 18O (C18O2) was used as a tracer gas for single-breath measurements in six anesthetized, mechanically ventilated beagle dogs. C18O2 is taken up quasi-instantaneously in the gas-exchanging region of the lungs but much less so in the conducting airways. Its use allows a clear separation of phase II in an expirogram even from diseased individuals and excludes the influence of alveolar concentration differences. Phase II of a C18O2 expirogram mathematically corresponds to the cumulative distribution of bronchial pathways to be traversed completely in the course of exhalation. The derivative of this cumulative distribution with respect to respired volume was submitted to a power moment analysis to characterize volumetric mean (position), standard deviation (broadness), and skewness (asymmetry) of phase II. Position is an estimate of dead space volume, whereas broadness and skewness are measures of the range and asymmetry of functional airway pathway lengths. The effects of changing ventilatory patterns and of changes in airway size (via carbachol-induced bronchoconstriction) were studied. Increasing inspiratory or expiratory flow rates or tidal volume had only minor influence on position and shape of phase II. With the introduction of a postinspiratory breath hold, phase II was continually shifted toward the airway opening (maximum 45% at 16 s) and became steeper by up to 16%, whereas skewness showed a biphasic response with a moderate decrease at short breath holding and a significant increase at longer breath holds. Stepwise bronchoconstriction decreased position up to 45 ± 2% and broadness of phase II up to 43 ± 4%, whereas skewness was increased up to twofold at high-carbachol concentrations. Under all circumstances, position of phase II by power moment analysis and dead space volume by the Fowler technique agreed closely in our healthy dogs. Overall, power moment analysis provides a more comprehensive view on phase II of single-breath expirograms than conventional dead space volume determinations and may be useful for respiratory physiology studies as well as for the study of diseased lungs.
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Affiliation(s)
- Holger Schulz
- GSF-National Research Center for Environment and Health, Institute for Inhalation Biology, PO Box 1129, D-85758 Neuherberg/Munich, Germany.
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Levitt DG. PKQuest: volatile solutes - application to enflurane, nitrous oxide, halothane, methoxyflurane and toluene pharmacokinetics. BMC Anesthesiol 2002; 2:5. [PMID: 12182764 PMCID: PMC122062 DOI: 10.1186/1471-2253-2-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2002] [Accepted: 08/15/2002] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND: The application of physiologically based pharmacokinetic models (PBPK) to human studies has been limited by the lack of the detailed organ information that is required for this analysis. PKQuest is a new generic PBPK that is designed to avoid this problem by using a set of "standard human" default parameters that are applicable to most solutes. RESULTS: PKQuest is used to model the human pharmacokinetics of the volatile solutes. A "standard human" value for the lipid content of the blood and each organ (klip) was chosen. This set of klip and the oil/water partition coefficient then specifies the organ/blood partition for each organ. Using this approach, the pharmacokinetics of inert volatile solute is completely specified by just 2 parameters: the water/air and oil/water partition coefficients. The model predictions of PKQuest were in good agreement with the experimental data for the inert solutes enflurane and nitrous oxide and the metabolized solutes halothane and toluene. METHODS: The experimental data that was modeled was taken from previous publications. CONCLUSIONS: This approach greatly increases the predictive power of the PBPK. For inert volatile solutes the pharmacokinetics are determined just from the water/air and oil/water partition coefficient. Methoxyflurane cannot be modeled by this PBPK because the arterial and end tidal partial pressures are not equal (as assumed in the PBPK). This inequality results from the "washin-washout" artifact in the large airways that is established for solutes with large water/air partition coefficients.PKQuest and the worked examples are available on the web www.pkquest.com.
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Affiliation(s)
- David G Levitt
- Department of Physiology, 6-125 Jackson Hall, 321 Church St, S, E, Minneapolis, MN 55455.
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