Interactions between histamine and leukotrienes in the microcirculation. Aspects of relevance to acute allergic inflammation

Simvastatin regulates CXC chemokine formation in streptococcal M1 protein-induced neutrophil infiltration in the lung

Streptococcus pyogenes of the M1 serotype can cause streptococcal toxic shock syndrome and acute lung injury. Statins exert beneficial effects in septic patients although the mechanisms remain elusive. This study examined effects of simvastatin on M1 protein-provoked pulmonary inflammation and tissue injury. Male C57BL/6 mice were pretreated with simvastatin or a CXCR2 antagonist before M1 protein challenge. Bronchoalveolar fluid and lung tissue were harvested for determination of neutrophil infiltration, formation of edema, and CXC chemokines. Flow cytometry was used to determine Mac-1 expression on neutrophils. Gene expression of CXC chemokines was determined in alveolar macrophages by using quantitative RT-PCR. M1 protein challenge caused massive infiltration of neutrophils, edema formation, and production of CXC chemokines in the lung as well as upregulation of Mac-1 on circulating neutrophils. Simvastatin reduced M1 protein-induced infiltration of neutrophils and edema in the lung. In addition, M1 protein-induced Mac-1 expression on neutrophils was abolished by simvastatin. Furthermore, simvastatin markedly decreased pulmonary formation of CXC chemokines and gene expression of CXC chemokines in alveolar macrophages. Moreover, the CXCR2 antagonist reduced M1 protein-induced neutrophil expression of Mac-1 and accumulation of neutrophils as well as edema formation in the lung. These novel findings indicate that simvastatin is a powerful inhibitor of neutrophil infiltration in acute lung damage triggered by streptococcal M1 protein. The inhibitory effect of simvastatin on M1 protein-induced neutrophil recruitment appears related to reduced pulmonary generation of CXC chemokines. Thus, simvastatin may be a useful tool to ameliorate acute lung injury in streptococcal infections.

Second-generation antihistamines: a comparative review

Second-generation histamine H1 receptor antagonists (antihistamines) have been developed to reduce or eliminate the sedation and anticholinergic adverse effects that occur with older H1 receptor antagonists. This article evaluates second-generation antihistamines, including acrivastine, astemizole, azelastine, cetirizine, ebastine, fexofenadine, ketotifen, loratadine, mizolastine and terfenadine, for significant features that affect choice. In addition to their primary mechanism of antagonising histamine at the H1 receptor, these agents may act on other mediators of the allergic reaction. However, the clinical significance of activity beyond that mediated by histamine H1 receptor antagonism has yet to be demonstrated. Most of the agents reviewed are metabolised by the liver to active metabolites that play a significant role in their effect. Conditions that result in accumulation of astemizole, ebastine and terfenadine may prolong the QT interval and result in torsade de pointes. The remaining agents reviewed do not appear to have this risk. For allergic rhinitis, all agents are effective and the choice should be based on other factors. For urticaria, cetirizine and mizolastine demonstrate superior suppression of wheal and flare at the dosages recommended by the manufacturer. For atopic dermatitis, as adjunctive therapy to reduce pruritus, cetirizine, ketotifen and loratadine demonstrate efficacy. Although current evidence does not suggest a primary role for these agents in the management of asthma, it does support their use for asthmatic patients when there is coexisting allergic rhinitis, dermatitis or urticaria.

Antiedematous effects of combination therapies with the leukotriene synthesis inhibitor BAY X 1005 in the archidonic acid-induced mouse ear inflammation test

The leukotriene synthesis inhibitor (LSI) BAY X 1005 was tested in the arachidonic acid (AA)-induced mouse ear inflammation test (AA-MEIT) alone and in combination with other representative anti-inflammatory compounds for antiedematous effects. When BAY X 1005 was used as a monotherapy, the ED50 (half-maximal effect) was observed at 5.1 mg/kg per os (p.o.) and at 0.8 microg for topical application. The maximal inhibition of edema formation was estimated to be 63% for p.o. application and 54% for topical application. Furthermore, experiments were carried out in which the animals were conditioned with a combination of the H1/5-HT receptor antagonists pyrilamine and methysergide in addition to treatment with BAY X 1005. This conditioning treatment alone, without BAY X 1005, resulted in a 45 +/- 13% reduction in edema formation. ED50 substance effects were observed at 5.3 mg/kg p.o. and at 0.02 microg per ear for topical application. The maximal inhibition of edema formation in the conditioned groups was 82% for the oral administration of BAY X 1005 and 72% for the topical application. To further characterize the antiinflammatory properties of BAY X 1005 in the conditioned and unconditioned AA-MEIT, BAY X 1005 was tested in combination with the nitric oxide (NO) synthase inhibitor L-NAME, with the cyclooxygenase inhibitor indomethacin, and in combination with both compounds. BAY X 1005 consistently exerted anti-inflammatory effects in the AA-MEIT. The effects of a combination of different inhibitors of inflammatory mediators were not simply additive in this model, as was demonstrated in the case of the combination of L-NAME and indomethacin where a smaller inhibition than with either substance alone was observed. In the conditioned model, a combination of BAY X 1005 with L-NAME or indomethacin, or with both compounds together was less effective than the monotherapy with BAY X 1005. Taken together, these data suggest that cyclooxygenase products and NO have little effect on edema formation in the conditioned and unconditioned AA-MEIT model and that their interaction with leukotrienes is of minor quantitative importance. Our results underline the complexity of the AA-MEIT model and provide a rationale for H1/5-HT-conditioning animals to compensate for peculiarities in the mouse-specific mediator spectrum and to recognize the importance of the leukotriene-specific inflammatory response.