Compartment analysis of vascular effects of neuropeptides and capsaicin in the pig nasal mucosa

Comparison of CGRP distributions in the maxillary sinus and trigeminal ganglion between elderly dentulous and edentulous humans

Thickening of the Schneiderian membrane (SM, mucosa of the maxillary sinus) appears in the paranasal sinus. Information on SM thickening is available for patients receiving sinus lift treatments, which is a risk factor for SM excretory dysfunction. However, more information is needed on the structure of the SM and the relationship between the maxilla sinus and palatine with the alveolar bone and the SM for dental implant treatment in the human maxilla. One hundred twenty-six sides of the maxilla from 71 cadavers were subjected to cone-beam computed tomography analysis and macroscopic and immunohistochemical observations in this study. A thickened SM was mainly observed in the middle region of the basal layer of the maxillary sinus (MS). Strong calcitonin gene-related peptide (CGRP)-positive reactions were observed in the alveolar bone, oral mucosa, mucosa of the MS, and trigeminal ganglion (TG) cells in dentulous samples compared with edentulous samples. TG cells play important roles in delivering CGRP through axons to the mucosal gland and in regulating the maxilla-related thickening of the SM. These data could help determine CGRP functions in the mucosal gland and bone formation between dentulous and edentulous samples and indicate that CGRP may pass from the TG to the MS glands.

Actin reorganization is involved in vasoactive intestinal peptide induced human mast cells priming to fraktalkine-induced chemotaxis

We recently reported a novel neuro-immuno co-operation between vasoactive intestinal peptide (VIP) and fraktalkine (FKN) in recruiting human mast cells to the asthmatic airway that provided a classical example of priming effect on mast cells migratory function, but the role of the F-actin in human mast cell chemotaxis’ priming is poorly defined. Therefore the aim of this study was to further investigate the biophysical role of the cytoskeletal element; the F-actin, intracellular reorganization and its polymerization in mast cell priming of chemotaxis function. In the present communication it is shown by immunofluoresence confocal microscopy analysis that physical F-actin intracellular reorganization in a membrane bound manner on human mast cell is involved in VIP-induced priming of human mast cell chemotaxis against FKN. The F-actin reorganization was calcium independent and without modification of its contents as assessed by fluorescence-activated cell scanning analysis. These results identify a novel role for the biophysical association of F-actin in the crosstalk between neuro-inflammatory mediators and mast cells and may be an important target for therapeutic modalities in allergic inflammation.

Histamine H3 receptor activation inhibits neurogenic sympathetic vasoconstriction in porcine nasal mucosa

Histamine release from mast cells is a primary mediator of rhinorrhea, nasal mucosal swelling, increased secretion, sneezing, pruritus and congestion that occur in allergic rhinitis. It is well known that histamine H(1) receptor antagonists inhibit the itch and rhinorhea, but do not block the allergic nasal congestion. A growing body of evidence shows that in addition to histamine H(1) receptors, activation of H(3) receptors may contribute to the procongestant nasal actions of histamine. Activation of the prejunctional histamine H(3) receptor modulates sympathetic control of nasal vascular tone and resistance. The present study was conducted to further characterize the role of histamine H(3) receptors on neurogenic sympathetic vascular contractile responses in isolated porcine nasal turbinate mucosa. We presently found that the histamine H(3) receptor agonist, (R)-alpha-methylhistamine (10-1000 nM), inhibited electrical field stimulation-induced sympathetic vasomotor contractions in a concentration-dependent fashion. Pretreatment with either of the selective histamine H(3) receptor antagonists, thioperamide and clobenpropit, blocked the sympathoinhibitory effect of (R)-alpha-methylhistamine in porcine turbinate mucosa. The effect of compound 48/80, an agent that elicits the release of endogenous histamine from mast cells on nasal sympathetic contractile responses, was also tested. The action of compound 48/80 to release mast cell-derived histamine in the nose mimics many of the nasal responses associated with allergic rhinitis, extravascular leakage and decreased nasal patency. We presently found that compound 48/80 also inhibited the electrical field stimulation-induced sympathetic response. Pretreatment with the H(3) receptor antagonist clobenpropit blocked the sympathoinhibitory action of compound 48/80 on sympathetic contractile responses in nasal mucosa. Taken together, these studies indicate that histamine H(3) receptors modulate vascular contractile responses by inhibition of noradrenaline release from sympathetic nerve terminals in nasal mucosa. It is further suggested that histamine H(3) receptors may play a role in the regulation of vascular tone and nasal patency in allergic nasal congestive disease.

Hypertonic saline nasal provocation and acoustic rhinometry

BACKGROUND

Hypertonic saline (HTS) acts as an airway irritant in human nasal mucosa by stimulating nociceptive nerves and glandular secretion. HTS does not change vascular permeability. In asthma, HTS causes airflow obstruction.

OBJECTIVE

To determine the effect of HTS on mucosal swelling using acoustic rhinometry (AcRh). Potential vasodilator effects were controlled by maximally constricting mucosal vessels with oxymetazoline (Oxy).

METHOD

Normal subjects had AcRh before and 30 min after either 0.05% Oxy or saline (0.9% NaCl) nasal treatments. Nasal provocations followed immediately with five step-wise incremental escalating doses of HTS administered at 6-min intervals. AcRh was performed 1, 3 and 5 min after each HTS administration, and then after blowing the nose at 5 min. The minimum cross-sectional area (Amin), volume of the anterior 6 cm of nasal cavity (V6) and incremental changes from pre-drug treatment baseline levels (delta, mean +/- SEM) were calculated.

RESULTS

Oxy increased Amin by 46% (delta = 0.48 +/- 0.07 cm2, P = 0.0001) and V6 by 53% (Delta = 9.9 +/- 1.5 mL, P < 1 x 10-7) during the first 30 min. Saline (vehicle) treatment had no effect. The maximum HTS dose had no effect after 1 or 3 min. However, in the 4th and 5th minutes there were reductions in Amin (delta = 0.07 +/- 0.03 cm2, P = 0.035) and V6 (delta = 1.57 +/- 0.42 mL, P = 0.004) with an increase in the weight of secretions (delta = 700 +/- 100 mg, P < 0.05). Blowing the nose returned Amin and V6 towards baseline. Oxy had no effect on HTS-induced changes in Amin, V6, pain, rhinorrhea or weight of secretions.

CONCLUSION

HTS induced nociceptive nerve stimulation and mucus secretion, and reduced V6 and Amin. Oxy caused vasoconstriction but did not alter HTS-induced effects. HTS may stimulate neurogenic axon response-mediated glandular secretion that contributes to perceptions of nasal obstruction in normal subjects.

Upper airway neurogenic mechanisms

Stimulation of the nasal sensory nerves leads to sensations of pain and stuffiness. Type C nociceptive nerve releases neuropeptides including substance P and calcitonin gene related peptides that increase plasma extravasation and glandular secretion. This axonal response acts as an immediate protective mucosal defense mechanism. Recruited parasympathetic reflexes cause submucosal gland secretion via acetylcholine and muscarinic M(3) receptors. Itching, sneezing, and other avoidance behaviors rapidly clear the offending agents from the upper airways and protect the lower airways. Dysfunction of these nerves may contribute to allergic rhinitis, infectious rhinitis, nasal hyperresponsiveness, and possibly sinusitis. Sympathetic arterial vasoconstriction reduces mucosal blood flow, sinusoidal filling, and mucosal thickness, and so restores nasal patency. Loss of sympathetic tone may contribute to some chronic, nonallergic rhinopathies. Human axon responses differ from those in animals, an important distinction that limits extrapolation from other species.

Mechanisms of allergic rhinitis

The pathogenesis of allergic rhinitis can be better appreciated by understanding the numerous protective mechanisms available for mucosal defense. The system of TH2 lymphocytes, IgE production, mast cell degranulation, eosinophil infiltration, and resident cell responses are central to our understanding and treatment of allergic rhinitis. Histamine remains preeminent in causing the cardinal symptoms of the immediate allergic reaction: itching, watery discharge, and nasal swelling. Recruitment and activation mechanisms responsible for the late-phase allergic response are also reviewed.

Neurogenic mechanisms in rhinosinusitis

Nasal sensory nerve stimulation leads to sensations of pain and congestion and nociceptive nerve axon response-mediated release of substance P that stimulates glandular secretion as an immediate-acting protective mucosal defense. Recruited parasympathetic reflexes cause submucosal gland secretion via muscarinic M3 receptors. Parasympathetic reflexes, sneezing, and other avoidance behaviors rapidly clear the upper airway of offending agents while protecting the lower airways. Dysfunction contributes to allergic, infectious, and other nonallergic rhinitides and possibly sinusitis. Sympathetic arterial vasoconstriction reduces mucosal blood flow, sinusoidal filling, and mucosal thickness, restoring nasal patency. Loss of sympathetic tone may contribute to some chronic, nonallergic rhinopathies.

Calcitonin gene-related peptide (CGRP) expression in the human neonatal paravertebral ganglia

The distribution of calcitonin gene-related peptide-immunoreactivity (CGRP-IR) in human neonatal paravertebral ganglia was demonstrated by the method of indirect immunohistochemistry. A marked population (up to 21%) of CGRP-IR neurons and varicose nerve fibres was observed. The number of calcionin gene-related peptide-immunoreactive neurons varied from ganglion to ganglion in the sympathetic trunk. In addition to its cotransmitter functions, the existence of CGRP in neonatal ganglionic nerve cells was suggested by its inductive and trophic actions on the growth and differentiation of neurons.

Ultracytochemical localization of the NADPH-d activity in the human nasal respiratory mucosa in vasomotor rhinitis

OBJECTIVES

Description of the ultrastructural localization of nitric oxide synthase in the blood vessels of the nasal respiratory mucosa in patients with vasomotor rhinitis.

STUDY DESIGN

This research was conducted on seven patients--men and women, ages 20 to 45 years--suffering from vasomotor rhinitis and who had undergone surgical therapy for reduction of the inferior turbinates.

METHODS

To study the ultrastructural localization of nitric oxide synthase, NADPH-diaphorase cytochemistry was employed. Samples of the nasal mucosa were obtained from inferior turbinates.

RESULTS

The endothelial cells of the arterioles, capillaries, venules and cavernous sinuses revealed a distribution of the enzymatic activity similar to that found in unaffected subjects. A strong enzymatic activity was recognized in the smooth muscle cells of the cavernous sinuses. The smooth muscle cells of arterioles and venules were generally found to be negative to enzymatic reaction.

CONCLUSIONS

This study suggests that the vascular disorders of the vasomotor rhinitis depend, at least in part, from nitric oxide synthase induction in the smooth muscle cells of the cavernous sinuses.

Role of vascular reflex in nasal mucosal swelling in nasal allergy

OBJECTIVE

In patients with nasal allergy, antigen challenge on the unilateral nasal mucosa results in nasal secretion not only in the ipsilateral but also in the contralateral nasal cavities that can be inhibited almost completely by premedication with atropine sulfate. The present study was performed to elucidate if centrally mediated vascular reflex induced by antigen challenge plays a role in nasal mucosal swelling in subjects with nasal allergy.

METHODS

Variations of mucosal swelling and mucosal blood flow in the ipsilateral and the contralateral nasal cavities after unilateral antigen challenge were evaluated by acoustic rhinometry and laser Doppler flowmetry in 20 patients with perennial nasal allergy.

RESULTS

Unilateral antigen challenge caused ipsilateral and contralateral nasal mucosal swelling in 17 and 13 patients, respectively. Incidence of contralateral nasal mucosal swelling after unilateral antigen challenge was significantly higher compared with that after control disc challenge (P < .001). In 10 patients in whom unilateral antigen challenge caused bilateral nasal mucosal swelling, significant swelling of the nasal mucosa lasted for more than 30 minutes in the ipsilateral nasal cavity after antigen challenge compared with only 15 minutes in the contralateral nasal cavity. Peak values of contralateral mucosal swelling were 45.3% of those of ipsilateral nasal mucosa.

CONCLUSIONS

Centrally mediated vascular reflex is partially involved in the onset of nasal mucosal swelling observed after antigen challenge in subjects with nasal allergy. However, nasal mucosal swelling that persists and proceeds even 20 minutes after antigen challenge is caused by the direct effects of chemical mediators on the nasal vasculature.

Hypertonic saline nasal provocation stimulates nociceptive nerves, substance P release, and glandular mucous exocytosis in normal humans

Hypertonic saline (HTS) induces bronchoconstriction. Potential mechanisms were evaluated in a human nasal provocation model. Aliquots of normal saline (1 x NS, 100 microliters) and higher concentrations (3 x NS, 6 x NS, 12 x NS, 24 x NS) were sprayed into one nostril at 5-min intervals. Lavage fluids were collected from the ipsilateral and contralateral sides to determine the concentrations of specific mucus constituents. Nasal cavity air-space volume was assessed by acoustic rhinometry (AcRh). The distribution of substance-P-preferring neurokinin-1 (NK-1) receptor mRNA was assessed by in situ reverse transcriptase-polymerase chain reaction. Unilateral HTS induced unilateral dose-dependent increases in sensations of pain, blockage, and rhinorrhea, the weights of recovered lavage fluids, and concentrations of total protein, lactoferrin, mucoglycoprotein markers, and substance P. Contralateral, reflex-mediated effects were minor. There were no changes in IgG or AcRh measurements. NK-1 receptor mRNA was localized to submucosal glands. HTS caused pain with unilateral substance P release. The presumed nociceptive nerve efferent axon response led to glandular exocytosis, presumably through actions on submucosal gland NK-1 receptors. Vascular processes, including plasma exudation, filling of venous sinusoids, and mucosal edema were not induced in these normal subjects.

Neuropeptides

Sensory, parasympathetic, and sympathetic nerves innervate many structures in airways. The anatomy, histology, and function of these nerves and their varied neurotransmitters will be reviewed. Changes that may contribute to the pathophysiology of allergic, viral, and nonallergic rhinitis will be described.

Pathogenesis of allergic rhinitis

Allergic rhinitis is an increasing problem for which new and exciting therapies are being developed. These can be understood through an appreciation of the newer concepts of pathogenesis of allergic rhinitis. Allergen induces Th2 lymphocyte proliferation in persons with allergies with the release of their characteristic combination of cytokines including IL-3, IL-4, IL-5, IL-9, IL-10, and IL-13. These substances promote IgE and mast cell production. Mucosal mast cells that produce IL-4, IL-5, IL-6, and tryptase proliferate in the allergic epithelium. Inflammatory mediators and cytokines upregulate endothelial cell adhesion markers, such as vascular cell adhesion molecule-1. Chemoattractants, including eotaxin, IL-5, and RANTES, lead to characteristic infiltration by eosinophils, basophils, Th2 lymphocytes, and mast cells in chronic allergic rhinitis. As our understanding of the basic pathophysiologic features of allergic rhinitis continues to increase, the development of new diagnostic and treatment strategies may allow more effective modulation of the immune system, the atopic disease process, and the associated morbidity.

Intranasal administration of neuropeptide Y in man: systemic absorption and functional effects

1. Exogenous neuropeptide Y (NPY, 10 nmol, 50 nmol and 100 nmol) and its vehicle (NaCl 0.9%) were administered in a double blind, randomized and controlled manner by intranasal spray in 7 healthy volunteers. Variations of plasma NPY concentration over time were measured during 120 min. Forty min after the administration of 50 nmol and 100 nmol of exogenous NPY, plasma NPY increased from 5.5 +/- 1.1 pM to 9.8 +/- 2.3 pM (P < 0.05) and from 9.06 +/- 5.1 pM to 20.8 +/- 6.16 pM (P < 0.001), respectively. There was no significant modification of the mean arterial blood pressure and no subjective discomfort was reported. 2. Nasal airway resistance (NAR) was measured by anterior rhinomanometry and was reduced by 25 +/- 3% and 32 +/- 5% after the spray of 50 nmol and 100 nmol, respectively, for about 90 min. 3. Double-blind, randomized, placebo-controlled and 3-way crossover design experiments were performed in 8 healthy volunteers to evaluate the influence of intranasal pretreatment with NPY (20 nmol) and the mixed alpha 1/alpha 2-adrenoceptor agonist oxymetazoline (20 nmol) on the functional effects of subsequent local irritation evoked by capsaicin (3.3 x 10(-4) mol). Subjective evaluation of NAR and local intensity of discomfort were evaluated by means of a visual analogue scale. Nasal secretions were collected and objective NAR was recorded by rhinomanometry. 4. Subjective NAR, nasal secretions and rhinomanometry recordings were not modified by intranasal application of saline, NPY or oxymetazoline. Subjective nasal obstruction, local discomfort, nasal secretions and NAR increase evoked by capsaicin were markedly reduced by NPY pretreatment (P < 0.05) when compared to saline or oxymetazoline. 5. It is concluded that intranasal application of exogenous NPY has very low systemic absorption but induced long lasting nasal vasoconstriction without cardiovascular effects. Pretreatment of the nasal mucosa with exogenous NPY reduces both secretagogue and vasodilator responses to subsequent application of capsaicin.

Nitroxidergic vasodilator nerve in the canine nasal mucosa

The canine nasal mucosa was studied by in vitro bioassay. Non-adrenergic, non-cholinergic (NANC) vasodilator response to transmural electrical stimulation was observed in the presence of guanethidine and atropine. This vasodilator response was abolished by NG-nitro-L-arginine (L-NA) which is an inhibitor of nitric oxide (NO) formation but not by NG-nitro-D-arginine. The inhibitory effect of L-NA was partially reversed by treatment with L-arginine but not with D-arginine. The vasodilator response was significantly suppressed by tetrodotoxin. The present results indicate that NO may mediate neurogenic vasodilation in the canine nasal mucosa.

Nonallergic rhinitis. Pathophysiology and models for study

Nonallergic rhinitis is a diagnosis of exclusion which is given to patients who suffer perennial nasal congestion, rhinorrhea, and/or sneezing with no identifiable allergic etiology. Because there is still no clear understanding of the pathophysiology, it is possible that a number of different disease processes may be included within this clinically defined entity. This report does not attempt to present an overall discussion of the clinical approaches to patients with nonallergic rhinitis. Instead, an outline is presented of various research approaches which may be used in its study. A number of nasal provocation models using nonallergic stimuli are available for application in the laboratory. These include intranasal methacholine challenges, intranasal histamine challenges, nasal inhalation of cold dry air, and intranasal capsaicin challenges. These models provide certain insights into mechanisms of nonallergic hyper-responsiveness. An additional approach to the study of nonallergic rhinitis is to examine available therapies, allowing the clinician to evaluate various pathways of importance in the disease process. These approaches provide a certain understanding of this common but perplexing entity, although further study is still required.

Ruthenium red selectively attenuates capsaicin induced vasodilation in pig nasal mucosa

The effect of ruthenium red, a blocker of transmembrane Ca2+ fluxes, on vasodilation in pig nasal mucosa induced by capsaicin, nicotine, bradykinin or histamine was evaluated in an in vivo preparation. To decrease toxic systemic effects pretreatment with ruthenium red was performed locally, intra-arterially in a nasal artery. Pretreatment with two doses of ruthenium red was evaluated (0.25 and 2.5 mg kg-1). Ruthenium red, in the low dose, resulted in a marked attenuation of the capsaicin-induced nasal vasodilation while the effect on the nicotine-induced vasodilation was not as prominent. Pretreatment with the high dose significantly blocked the vasodilatory effects of capsaicin, nicotine, bradykinin and histamine. Our series indicates that low concentration ruthenium red selectively modulates capsaicin induced vasodilation in pig nasal mucosa in vivo, probably via a direct blocking effect on cation channels opened by capsaicin. A high concentration of ruthenium red may exert a general inhibitory effect on transmembrane Ca2+ transport.

Effects of NK1 receptor antagonists on vasodilation induced by chemical and electrical activation of sensory C-fibre afferents in different organs

The effects of the non-peptide NK1 receptor antagonists, CP 96,345 and RP-67,580, were investigated in a model using anaesthetized pigs. Both the blood flow in the internal maxillary and the bronchial artery (ultrasonic flowmetry) and the superficial blood flow in nasal mucosa and the skin (laser-Doppler flowmetry) were monitored simultaneously. Vasodilation induced by substance P administered i.v. systemically was blocked by pretreatment with CP-96,345, 3 mg kg-1 but not by RP-67,580. CP-96,345 had no effects on the vasodilation induced by calcitonin gene-related peptide or vasoactive intestinal polypeptide. The capsaicin-induced vasodilation in the superficial blood flow of the nasal mucosa and the skin, was reduced after the CP-96,345 pretreatment. The vasodilation induced by capsaicin infusion in the internal maxillary or the bronchial artery was not affected by the CP-96,345 pretreatment. Electrical stimulation of the vagal nerve induced a vasodilation in the bronchial circulation which was not attenuated by pretreatment with CP-96,345. In the nasal mucosa and the skin NK1 receptors seem to be involved in the vasodilation in the superficial small vessels, due to chemical activation of sensory C-fibre afferents. Furthermore, CP-96,345 is a useful tool in the evaluation of NK1 receptor-mediated responses. RP-67,580 which has been shown to have NK1 antagonistic properties in the rat has no such effects in the domestic pig.

Tachykinins and kinins in antigen-evoked plasma extravasation in guinea-pig nasal mucosa

The plasma extravasation evoked by instillation of 5% ovalbumin in the nasal mucosa of sensitized guinea-pigs was potentiated by the neutral endopeptidase inhibitor, phosphoramidon, and was reduced by the tachykinin NK1 receptor antagonist, CP-96,345. The bradykinin B2 receptor antagonist, HOE 140, also reduced the plasma extravasation evoked by the antigen. The combination of HOE 140 and CP-96,345 did not increase further the inhibition caused by HOE 140 alone. Plasma extravasation evoked by instillation of capsaicin was abolished by CP-96,345. HOE 140 blocked and CP-96,345 markedly reduced plasma extravasation caused by instillation of bradykinin. Plasma extravasation evoked by instillation of substance P was not affected by HOE 140. We conclude that antigen challenge causes plasma extravasation in the nasal mucosa of sensitized guinea-pigs, an effect that is due in part to the release of tachykinins from sensory nerve endings. Our evidence suggests that tachykinin release in response to antigen is provoked mainly by the release of kinins.

Effects of ipratropium bromide on bradykinin nasal provocation in chronic allergic rhinitis

Bradykinin (BK) induces albumin exudation and glandular secretion in chronic allergic rhinitis subjects. Since bradykinin may stimulate nociceptive sensory nerves, neural reflex arcs could contribute to the secretion process. Six chronic allergic rhinitis subjects received 1000 nM bradykinin by unilateral nasal provocation using the method of Raphael et al. This dose induces optimal contralateral glandular secretion. Ipratropium bromide (80 micrograms) or saline were applied topically before the challenges. Total protein, albumin, glycoconjugate, and lysozyme were measured in lavage fluids. On the ipsilateral side, bradykinin induced significant total protein, glycoconjugate, and albumin secretion. None of these were affected by ipratropium. On the contralateral side, total protein and glycoconjugates were increased by bradykinin, while albumin and lysozyme were not significantly affected. Ipratropium bromide completely ablated total protein and glycoconjugate secretion on the contralateral side indicating that cholinergic reflexes mediated the glandular secretion. In chronic allergic rhinitis, bradykinin directly stimulated albumin secretion, but also stimulates nociceptive neuron--parasympathetic nerve reflexes to induce glandular secretion. The reflex loop was apparent on the contralateral side to the unilateral bradykinin challenge. This loop induced mucoglycoconjugate, but not serous cell, secretion in chronic allergic rhinitis subjects and can be inhibited by iptratropium bromide.

Mechanical stimulation and capsaicin evoked vasodilation by parasympathetic reflex mechanisms in the pig nasal mucosa

A model was developed using pentobarbital anesthetized pigs to study bilateral blood flow changes in the nasal mucosa by flow-probes on both sphenopalatine arteries. Unilateral mechanical stimulation of the nasal mucosa for 10s as well as close intra-arterial capsaicin infusion induced bilateral vasodilation. The magnitude of the vasodilator responses were similar on both sides, although the capsaicin effect (maximal increase in arterial blood flow by about 100 ml/min) was larger than that of the mechanical stimulation. Pretreatment with atropine (0.5 mg x kg-1) had no effect on the vascular responses to capsaicin or mechanical stimulation. However, when the pigs were pretreated with the ganglionic nicotinic receptor blocking agent, chlorisondamine (3 mg x kg-1), the vasodilatory responses to mechanical stimulation were abolished and the responses to capsaicin infusion markedly reduced (90-95%). These data indicate that unilateral mechanical stimulation as well as capsaicin infusion evoke bilateral nasal vasodilation which is probably mediated via a central reflex arch with a parasympathetic non-cholinergic final step.

Intranasal histamine challenge in normality and allergic rhinitis

A series of investigations was performed in which histamine challenge was used to compare nasal responsiveness in 20 normal subjects and 20 with allergic rhinitis. There was found to be a lower threshold of reactivity (D100) to histamine in allergic subjects as measured by resistance changes (geometric mean, 0.53 mg/ml; normal subjects, 2.15: p = 0.022). This may represent increased number or sensitivity of histamine receptors on the nasal capacitance vessels. The loss of a laser Doppler response to a supramaximal histamine stimulus (normal subjects, 102% increase in flux at 3 minutes; p < 0.05) was observed in patients with allergic rhinitis and indicates either a down-regulation of the capillary system or an altered effect of histamine on superficial vessels, perhaps mediated by a shift in histamine receptor type. There was an observed increase in neutrophils at the mucosal surface under baseline conditions (rhinitis median, 49.6%; normal subjects, 32.72%: p < 0.05), which suggests an important primary role in the pathogenesis of this condition for this active cell. The observed increase in secretory volume response to histamine in allergic subjects, which persisted beyond 40 minutes after a single D100 challenge, may be related to an altered sensitivity of glandular tissue. There are important changes in nasal reactivity to histamine challenge in allergic rhinitis that may have implications for its pathogenesis.

Effects of substance P and calcitonin gene related peptide (CGRP) on guinea pig nasal mucosal secretion in vivo

Trigeminal sensory nerves contain and release the neurotransmitters substance P (SP) and calcitonin gene related peptide (CGRP) in nasal mucosa. The effects of SP and CGRP on nasal secretion were tested in an in vivo model of guinea pig nasal mucosal secretion by topically applying the peptides directly to turbinates, and then lavaging the nostrils 10 min later. Concentrations of total protein, albumin, and 125I-bovine serum albumin (25I-BSA, injected intravenously at time 0 of the studies) were measured in lavage fluid. SP (beginning at 10(-8) M) and CGRP (beginning at 10(-6) M) stimulated the secretion of 125I-BSA indicating stimulation of plasma protein exudation. SP and CGRP increased total protein concentration at 10(-6) M indicating stimulation of glandular secretion. Topically applied thiorphan (1 microgram), an inhibitor of neutral endopeptidase, did not potentiate the maximal response to SP. However, thiorphan significantly prolonged the duration of 125I-BSA, total protein, and albumin secretion in response to SP indicating that the vascular and glandular responses were enhanced. This implies the presence of neutral endopeptidase, and demonstrates a regulatory role for this enzyme in vivo. These findings are consistent with the concept that SP and CGRP released by nociceptive sensory nerve axon responses in guinea pig nasal mucosa lead to plasma extravasation, albumin exudation, and glandular secretion, and that these mechanisms contribute to nasal responses to injury in this species.

Changes in nasal mucosal blood flux and air-flow resistance on unilateral histamine challenge

To investigate reflex vascular control in the nose, we challenged each side of the nose with 0.9% saline and histamine (0.3 mg aqueous) and observed changes in unilateral nasal airway resistance (Rnaw) and laser doppler flux (LDF) in response to contra-lateral and ipsilateral challenge in eight normal subjects. Preliminary studies demonstrated that the preferred site for observation of LDF was the nasal septum (same-day concordance 0.920; inferior turbinate 0.307). Ipsilateral contra-lateral saline induced no significant change to either parameter. Ipsilateral histamine produced a highly significant rise in LDF (757 arbitrary units SEM 94 at 3 min; baseline 489 SEM 75: P < 0.05) and Rnaw (baseline: 3.10, SEM 0.52; 5 min: 8.81, SEM 2.09 cmH2O/l/s: P < 0.01). Contra-lateral histamine produced a significant P < 0.05) fall in both (LDF 317, SEM 24 at 3 min; Rnaw 2.67, SEM 0.78 cm H2O/l/s at 6 min). This previously unrecorded observation suggests a neural reflex that increases the patency of the contra-lateral nostril after unilateral obstruction is provoked.

Increased pressure in venous sinusoids during decongestion of rat nasal mucosa induced by adrenergic agonists

The haemodynamic effects of sympathetic agonists causing decongestion of the nasal mucosa have been investigated in rats. Access to mucosa was obtained from the dorsal side through a small cavity drilled in the nasal bone. The pressures in the venous sinusoids and in the interstitial fluid of nasal mucosa were recorded by micropuncture technique. The local red cell flux (LDF) was monitored by laser Doppler flowmetry, and the blood volume in the mucosa was measured by radio-labelled erythrocytes and albumin. In control rats the tissue blood volume was 0.25 +/- 0.03 g (g wet wt)-1. The interstitial fluid pressure (IFP) was 2.4 +/- 0.6 mmHg and the average blood pressure in venous sinusoids (Ps) was 12.8 +/- 2.7 mmHg. After topical application of noradrenaline (NA) the local blood volume was reduced to 0.12 +/- 0.03 g g-1. Ps was increased to 18.0 +/- 4.0 mmHg, whereas IFP was maintained and LDF was reduced to 40.4% of control, indicating a greater rise in post than in presinusoid vascular resistance. Blocking of both alpha 1 and alpha 2-receptors by phentolamine caused a rise in mucosa blood volume and in LDF by 16 and 20% of control, respectively. Ps increased significantly to 15.2 +/- 3.3 mmHg. Specific stimulation or blocking of alpha 1-receptors by phenylephrine or prazosin induced similar or slightly smaller vascular responses than NA or phentolamine. The effects of the specific alpha 2-agonist (clonidine) or antagonist (yohimbine) on rat mucosa were small, indicating a domination of the alpha 1-receptors. Thus, application of NA caused a rise in blood pressure in the venous sinusoids of nasal mucosa. As LDF fell simultaneously, the reduced blood volume must be due to an increased tone in the muscular wall of venous sinusoids.

Improvement of symptoms of non-allergic chronic rhinitis by local treatment with capsaicin

Sixteen adult patients suffering from severe chronic non-allergic rhinitis with nasal vasoconstrictor abuse for more than a year, received, under local anaesthesia, an intranasal spray of capsaicin (3.3 x 10(-3) mol), the pungent agent in hot pepper, once weekly for 5 weeks. The subjective intensity of their nasal obstruction, rhinorrhoea and sneezing frequency were evaluated throughout the study and the vascular effects of capsaicin on the nasal mucosa were recorded by anterior rhinomanometry and laser Doppler flowmetry. Calcitonin gene-related peptide (CGRP) is a vasodilator agent present in sensory nerves and may play a major role in the vascular component of neurogenic inflammation. Therefore, the nasal mucosa content of CGRP-like immunoreactivity (CGRP-LI) was determined by radioimmunoassay in biopsies obtained before and after the capsaicin treatment. Intra-nasal capsaicin application evoked a larger vascular response in patients with rhinitis than in controls (P less than 0.05). Both nasal vascular responses and subjective discomfort following capsaicin were markedly reduced after the fifth application (P less than 0.01). In parallel, a 50% reduction of the CGRP-LI content in the nasal biopsies was observed. All symptoms were significantly improved throughout a 6 month follow-up period. No significant side-effects occurred and weaning from nasal vasoconstrictor agents was possible. Both the subjective symptom score and objective measurements of vascular reactivity suggest that repeated intra-nasal capsaicin application could be beneficial for patients with chronic rhinitis, possibly by reducing hyperreactive nasal reflexes.

Release of calcitonin gene-related peptide in the pig nasal mucosa by antidromic nerve stimulation and capsaicin

The overflow of calcitonin gene-related peptide like-immunoreactivity (CGRP-LI) in the nasal venous effluent upon antidromic stimulation of the maxillary division of the trigeminal nerve with 6.9 Hz for 3 min or upon capsaicin (0.3 mumol bolus injection) were analysed in the nasal mucosa of sympathectomized pentobarbital anaesthetized pigs. The overflow of CGRP-LI upon antidromic stimulation displayed a slower appearance in the venous effluent than the overflow upon bolus injection of capsaicin. The vascular effects as revealed by the arterial blood flow, the venous blood flow, the blood volume of the nasal mucosa, i.e., the filling of the capacitance vessels and the superficial mucosal blood flow as revealed by the laser-Doppler signal were also studied. Antidromic stimulation of the trigeminal nerve as well as capsaicin bolus injection induced a marked vasodilation which was parallel to the overflow of CGRP. However, capsaicin bolus injection also resulted in a marked increase in the mean arterial blood pressure which may be due to reflex activation of sympathetic fibers. In conclusion, we have demonstrated that chemical stimulation with capsaicin as well as antidromic stimulation of nasal sensory nerves in sympathectomized animals induces both vasodilation and overflow of CGRP-LI in vivo. This indicates that CGRP may contribute to the sensory regulation of the microcirculation in the nasal mucosa.