Effects of a hydrochloric acid spill on neurobehavioral and pulmonary function

The Heat Shock Protein 90 Inhibitor, AT13387, Protects the Alveolo-Capillary Barrier and Prevents HCl-Induced Chronic Lung Injury and Pulmonary Fibrosis

Hydrochloric acid (HCl) exposure causes asthma-like conditions, reactive airways dysfunction syndrome, and pulmonary fibrosis. Heat Shock Protein 90 (HSP90) is a molecular chaperone that regulates multiple cellular processes. HSP90 inhibitors are undergoing clinical trials for cancer and are also being studied in various pre-clinical settings for their anti-inflammatory and anti-fibrotic effects. Here we investigated the ability of the heat shock protein 90 (HSP90) inhibitor AT13387 to prevent chronic lung injury induced by exposure to HCl in vivo and its protective role in the endothelial barrier in vitro. We instilled C57Bl/6J mice with 0.1N HCl (2 µL/g body weight, intratracheally) and after 24 h began treatment with vehicle or AT13387 (10 or 15 mg/kg, SC), administered 3×/week; we analyzed histological, functional, and molecular markers 30 days after HCl. In addition, we monitored transendothelial electrical resistance (TER) and protein expression in a monolayer of human lung microvascular endothelial cells (HLMVEC) exposed to HCl (0.02 N) and treated with vehicle or AT13387 (2 µM). HCl provoked persistent alveolar inflammation; activation of profibrotic pathways (MAPK/ERK, HSP90); increased deposition of collagen, fibronectin and elastin; histological evidence of fibrosis; and a decline in lung function reflected in a downward shift in pressure–volume curves, increased respiratory system resistance (Rrs), elastance (Ers), tissue damping (G), and hyperresponsiveness to methacholine. Treatment with 15 mg/kg AT13387reduced alveolar inflammation, fibrosis, and NLRP3 staining; blocked activation of ERK and HSP90; and attenuated the deposition of collagen and the development of chronic lung injury and airway hyperreactivity. In vitro, AT13387 prevented HCl-induced loss of barrier function and AKT, ERK, and ROCK1 activation, and restored HSP70 and cofilin expression. The HSP90 inhibitor, AT13387, represents a promising drug candidate for chronic lung injury that can be administered subcutaneously in the field, and at low, non-toxic doses.

Dietary Phytoestrogens Ameliorate Hydrochloric Acid-Induced Chronic Lung Injury and Pulmonary Fibrosis in Mice

We previously reported that female mice exhibit protection against chemically induced pulmonary fibrosis and suggested a potential role of estrogen. Phytoestrogens act, at least in part, via stimulation of estrogen receptors; furthermore, compared to residents of Western countries, residents of East Asian countries consume higher amounts of phytoestrogens and exhibit lower rates of pulmonary fibrosis. Therefore, we tested the hypothesis that dietary phytoestrogens ameliorate the severity of experimentally induced pulmonary fibrosis. Male mice placed on either regular soybean diet or phytoestrogen-free diet were instilled with 0.1 N HCl to provoke pulmonary fibrosis. Thirty days later, lung mechanics were measured as indices of lung function and bronchoalveolar lavage fluid (BALF) and lung tissue were analyzed for biomarkers of fibrosis. Mice on phytoestrogen-free diet demonstrated increased mortality and stronger signs of chronic lung injury and pulmonary fibrosis, as reflected in the expression of collagen, extracellular matrix deposition, histology, and lung mechanics, compared to mice on regular diet. We conclude that dietary phytoestrogens play an important role in the pathogenesis of pulmonary fibrosis and suggest that phytoestrogens (e.g., genistein) may be useful as part of a therapeutic regimen against hydrochloric acid-induced lung fibrosis and chronic lung dysfunction.

Post-treatment with a heat shock protein 90 inhibitor prevents chronic lung injury and pulmonary fibrosis, following acute exposure of mice to HCl

Aim/Purpose: Exposure to high levels of hydrochloric acid (HCl) is associated with severe lung injury including both acute inflammation and chronic lung disease, which leads to the development of pulmonary fibrosis. Currently, there are no specific therapeutic agents for HCl-induced lung injury. Heat shock protein 90 (HSP90) has been implicated in the pathogenesis of pulmonary fibrosis. Thus, we have used a murine model of intra-tracheal acid instillation to investigate the antidotal effects of AUY-922, a small molecule HSP90 inhibitor, already in clinical trials for various types of cancer, against HCl-induced chronic lung injury and pulmonary fibrosis.Methods: HCl (0.1 N, 2 μl/g body weight) was instilled into male C57Bl/6J mice at day 0. After 24 h, mice began receiving 1 mg/kg AUY-922, 2x/week for 15 or 30 days.Results: AUY-922 suppressed the HCl-induced sustained inflammation, as reflected in the reduction of leukocyte and protein concentrations in bronchoalveolar lavage fluid, and inhibited the activation of pro-fibrotic biomarkers, ERK and HSP90. Furthermore, AUY-922 improved lung function, decreased the overexpression and accumulation of extracellular matrix proteins and dramatically reduced histologic evidence of fibrosis in the lungs of mice exposed to HCl.Conclusions: We conclude that AUY-922, and possibly other HSP90 inhibitors, successfully block the adverse effects associated with acute exposures to HCl and may represent an effective antidote against HCl-induced chronic lung injury and fibrosis.

Acute exposure of mice to hydrochloric acid leads to the development of chronic lung injury and pulmonary fibrosis

Objective: Accidental exposure to hydrochloric acid (HCl) is associated with acute lung injury in humans, development of long-term chronic airway obstruction, and fibrosis. However, the mechanisms responsible for the progression to pulmonary fibrosis remain unclear. We utilized a mouse model of progressive lung injury from a single exposure to HCl to investigate the effects of HCl on the lower respiratory tract. Materials and methods: HCl (0.05-0.3 N) or saline was injected intratracheally into male C57Bl/6J mice. At 1, 4, 10 and 30 days post instillation, bronchoalveolar lavage fluid (BALF) and lung tissues were collected and examined for multiple outcomes. Results and discussion: We observed an early inflammatory response and a late mild inflammation present even at 30 d post HCl exposure. Mice treated with HCl exhibited higher total leukocyte and protein levels in the BALF compared to the vehicle group. This was characterized by increased number of neutrophils, monocytes, and lymphocytes as well as pro-inflammatory cytokines during the first 4 d of injury. The late inflammatory response exhibited a predominant presence of mononuclear cells, increased permeability to protein, and higher levels of the pro-fibrotic mediator TGFβ. Pro-fibrotic protein biomarkers, phosphorylated ERK, and HSP90, were also overexpressed at 10 and 30 d following HCl exposure. In vivo lung function measurements demonstrated lung dysfunction and chronic lung injury associated with increased lung hydroxyproline content and increased expression of extracellular matrix (ECM) proteins. The acute inflammation and severity of fibrosis increased in HCl-concentration dependent manner. Conclusions: Our findings suggest that the initial inflammatory response and pro-fibrotic biomarker upregulation may be linked to the progression of pulmonary fibrosis and airway dysfunction and may represent valuable therapeutic targets.

Effects of chlorine and its cresylate byproducts on brain and lung performance

Chlorine and potassium cresylate spilled from a train wreck forced evacuation of nearly 1000 people in and near the town of Alberton, Montana, in 1996. Because respiratory and other symptoms persisted in this population, neurobehavioral and pulmonary functions were evaluated in a cohort of exposed vs. unexposed individuals. Ninety-seven subjects were tested 7 wk after exposure. Three years later, 36 of the original subjects were retested, along with 21 new patients exposed in the same incident. These 57 were compared with 22 unexposed individuals. Twenty-six neurobehavioral functions were tested, and spirometry was performed on each subject. At 7 wk postexposure, patients showed significant differences in 5 neurobehavioral functions (i.e., balance, simple reaction time, abnormal visual quadrants, vocabulary, and information), compared with the unexposed individuals recruited in 1999. Patients' Profile of Mood States scores and frequencies of 35 symptoms were also elevated, compared with the unexposed group. At 3 yr postexposure, patients exhibited differences in 7 additional neurobehavioral functions (i.e., choice reaction time, balance with eyes open, color errors, visual fields, Culture Fair, and verbal recall). Respiratory symptoms were increased, but pulmonary functions did not change. Exposure to chlorine and potassium cresylate produced neurobehavioral impairments that have been observed to increase across 3 yr. Spills in heavily populated areas could injure thousands, overwhelming medical facilities.

Case series: use of induced sputum in the evaluation of occupational lung diseases

The authors recently reported that analysis of induced sputum may reveal the status of hazardous dust exposure (e.g., silica, hard metals) as effectively as does bronchoalveolar lavage. In the current study, the authors describe how induced sputum can assist in the evaluation and diagnosis of suspected occupational lung diseases. The 3 patients who underwent induced sputum testing included a miner with silicosis, a dental technician with berylliosis, and a teacher who suffered from undefined interstitial fibrosis and in whom induced sputum analysis revealed the presence of a high burden of calcium sulfate and silica. The data reported indicate that induced sputum--a known safe and simple procedure--can serve as a useful tool in the evaluation of patients with suspected occupational lung diseases.

Function testing for chemical brain damage: a review

Testing of neurobehavioral functions for evaluation of the effects of chemicals on the human brain from community (i.e., environmental) exposures is logical and may be a preferred initial step. Sensitivity is improved (1) by adjusting individual tests for influential factors, found by regression modeling and by retaining significant coefficients; and (2) by the calculation of predicted values for each test for each subject. This two-part approach allows for adjustments in age, sex, educational level, and other factors before comparisons are made. Visual fields, color discrimination, reaction time, balance, and digit symbol are the most sensitive tests, followed by 6 sensitive psychological tests and less-discriminating physiological measurements. Hydrogen sulfide, polychlorinated biphenyls, and arsenic are the most toxic chemicals, followed by chlorine, chlorpyrifos, formaldehyde, nickel carbonyl, and ammonia. The least toxic chemicals, which are hydrochloric acid and chlorine, were determined 7 wk following a community spill. The least toxic chemical among those identified herein is methyl ter butyl ether.

The factor structure of the Profile of Mood States (POMS) and its relationship to occupational lead exposure

The Profile of Mood States (POMS) is an instrument composed of six mood scales that were developed using clinical populations. This study examines the replicability of the POMS factor structure in lead-smelter workers and its association with demographic variables and lead exposure. Four hundred sixty-seven current and retired smelter workers completed the POMS, and a factor analysis was performed on the individual items. Two multiple regressions in the currently employed workers (n = 340) with a mean age of 40 years (range, 20-63 years) were used to compare the relationship of the resulting POMS factors with demographic characteristics and two measures of occupational lead exposure: current blood lead level (mean, 28 micrograms/dL; range, 4-62 micrograms/dL) and working-lifetime integrated blood lead level (mean, 711 micrograms-yr/dL; range, 1-1537 micrograms-yr/dL). Factor analysis produced one factor, labeled "general distress," that was composed mainly of items from five of the six POMS subscales (anger, confusion, depression, fatigue, and tension) and a second factor labeled "psychological adjustment." Demographic variables, including education, age, and alcohol use, were significantly related to the "general distress" factor score. After the effects of the demographic variables were accounted for, the "general distress" factor was significantly related to integrated blood lead level but not current blood lead level. Integrated blood lead level, a measure of cumulative lead exposure that included prior high exposure, was significantly related to the POMS "general distress" factor, while a current blood lead level that was relatively low was unrelated. As expected, POMS psychological adjustment was not related to lead exposure. Factor analysis did not support the use of six separate POMS subscales in this occupational population.