1
|
Fluid replacement and respiratory function: comparison of whole blood with colloid and crystalloid: A randomised animal study. Eur J Anaesthesiol 2016; 33:34-41. [PMID: 25760681 DOI: 10.1097/eja.0000000000000251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fluid replacement with blood products, colloids and crystalloids is associated with morbidity and mortality. Despite this, the consequences of fluid administration on airway and respiratory tissue properties are not fully understood. OBJECTIVE Comparison of respiratory effects of fluid replacement with autologous blood (Group B), colloid (HES 6% 130/0.4, Group CO) or crystalloid solution (NaCl 0.9%, Group CR) after haemorrhage with separate assessments of airway resistance and respiratory tissue mechanics. DESIGN A randomised study. SETTING An experimental model of surgical haemorrhage and fluid replacement in rats. PARTICIPANTS Anaesthetised, ventilated rats randomly allocated into three groups (Group B: n = 8, Group CO: n = 8, Group CR: n = 9). INTERVENTION Animals were bled in six sequential steps, each manoeuvre targeting a loss of 5% of total blood volume. The blood loss was then replaced stepwise in a 1 : 1 ratio with one of the three fluids. MAIN OUTCOME MEASURE After each step, airway resistance (Raw), tissue damping and elastance (H) were determined by forced oscillations. Oedema indices from lung weights and histology were also measured. RESULTS Raw (mean ± SD) decreased in all groups following blood loss (-20.3 ± 9.5% vs. baseline, P < 0.05), and remained low following blood replacement (-21.7 ± 14.5% vs. baseline, P < 0.05), but was normalised by colloid (5.5 ± 10.7%, NS). Crystalloid administration exhibited an intermediate reversal effect (-8.4 ± 14.7%, NS). Tissue viscoelasticity increased following both blood loss and replacement, with no evidence of a significant difference in H between Groups CO and CR. More severe oedema was observed in Groups CR and CO than in Group B (P < 0.05), with no difference between the colloid and crystalloid solutions. CONCLUSION This model, which mimics surgical haemorrhage, yields no evidence of a difference between colloids and crystalloids with regard to the pulmonary consequences of blood volume restoration. Functional changes in the lung should not be a key concern when choosing fluid replacement therapy with these solutions.
Collapse
|
2
|
Chiang G, Patra P, Letourneau R, Jeudy S, Boucher W, Green M, Sant GR, Theoharides TC. Pentosanpolysulfate (Elmiron) is a potent inhibitor of mast cell histamine secretion. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 539:713-29. [PMID: 15176320 DOI: 10.1007/978-1-4419-8889-8_44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- George Chiang
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, USA
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Abstract
Although the symptoms of interstitial cystitis (IC)--a debilitating, chronic disease characterized by urinary urgency and frequency, and bladder and pelvic pain on bladder filling--are easily confused with those of urinary tract infections, there is an absence of an underlying infection, and antibiotic therapy is of no therapeutic benefit. Severe cases of this disorder, which affects mainly women, can have a great negative impact on the quality of life of patients because of extreme urinary frequency. The diagnosis of IC is difficult and should be based on patient history, physical examination, and cystoscopy. A large number of pharmacologic treatments have been used to treat this condition with limited success, including pentosan polysulfate, heparin, antihistamines, tricyclic antidepressants, intravesical dimethyl sulfoxide, and bacille Calmette-Guérin. Among the potentially effective new treatment modalities currently under investigation are suplatast tosilate, resiniferatoxin, botulinum toxin, and gene therapy to modulate the pain response. As knowledge of the pathogenesis of IC increases through intensified research, the ability to provide effective treatment to patients with this disease will improve.
Collapse
Affiliation(s)
- Michael B Chancellor
- Department of Urology, the University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
| | | |
Collapse
|
4
|
INTRAVESICAL SODIUM HYALURONATE INHIBITS THE RAT URINARY MAST CELL MEDIATOR INCREASE TRIGGERED BY ACUTE IMMOBILIZATION STRESS. J Urol 2002. [DOI: 10.1097/00005392-200201000-00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
BOUCHER W, LETOURNEAU R, HUANG M, KEMPURAJ D, GREEN M, SANT G, THEOHARIDES T. INTRAVESICAL SODIUM HYALURONATE INHIBITS THE RAT URINARY MAST CELL MEDIATOR INCREASE TRIGGERED BY ACUTE IMMOBILIZATION STRESS. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65472-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- W.S. BOUCHER
- From the Departments of Pharmacology and Experimental Therapeutics, and Urology, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts
| | - R. LETOURNEAU
- From the Departments of Pharmacology and Experimental Therapeutics, and Urology, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts
| | - M. HUANG
- From the Departments of Pharmacology and Experimental Therapeutics, and Urology, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts
| | - D. KEMPURAJ
- From the Departments of Pharmacology and Experimental Therapeutics, and Urology, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts
| | - M. GREEN
- From the Departments of Pharmacology and Experimental Therapeutics, and Urology, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts
| | - G.R. SANT
- From the Departments of Pharmacology and Experimental Therapeutics, and Urology, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts
| | - T.C. THEOHARIDES
- From the Departments of Pharmacology and Experimental Therapeutics, and Urology, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts
| |
Collapse
|
6
|
Abstract
Glycosaminoglycans (GAGs) are large, polyanionic molecules expressed throughout the body. The GAG heparin, co-released with histamine, is synthesised by and stored exclusively in mast cells, whereas the closely related molecule heparan sulphate is expressed, as part of a proteoglycan, on cell surfaces and throughout tissue matrices. These molecules are increasingly thought to play a role in regulation of the inflammatory response and heparin, for many years, has been considered to hold potential in the treatment of diseases such as asthma. Heparin and related molecules have been found to exert antiinflammatory effects in a wide range of in vitro assays, animal models and, indeed, human patients. Moreover, the results of studies carried out to date indicate that the antiinflammatory activities of heparin are dissociable from its well-established anticoagulant nature, suggesting that the separation of these characteristics could yield novel antiinflammatory drugs which may be useful in the future treatment of diseases such as asthma
Collapse
Affiliation(s)
- R Lever
- Sackler Institute of Pulmonary Pharmacology, GKT School of Biomedical Sciences, 5th Floor Hodgkin Building, Guy's Campus, London SE1 9RT, UK
| | | |
Collapse
|
7
|
Theoharides TC, Sant GR. New agents for the medical treatment of interstitial cystitis. Expert Opin Investig Drugs 2001; 10:521-46. [PMID: 11227050 DOI: 10.1517/13543784.10.3.521] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Interstitial cystitis (IC) is a painful, sterile, disorder of the urinary bladder characterised by urgency, frequency, nocturia and pain. IC occurs primarily in women but also in men with recent findings indicating that chronic, abacterial prostatitis may be a variant of this condition. The prevalence of IC has ranged from about 8 - 60 cases/100,000 female patients depending on the population evaluated. About 10% of patients have severe symptoms that are associated with Hunner's ulcers on bladder biopsy; the rest could be grouped in those with or without bladder inflammation. Symptoms of IC are exacerbated by stress, certain foods and ovulatory hormones. Many patients also experience allergies, irritable bowel syndrome (IBS) and migraines. There have been various reports indicating dysfunction of the bladder glycosaminoglycan (GAG) protective layer and many publications showing a high number of activated bladder mast cells. Increasing evidence suggests that neurogenic inflammation and/or neuropathic pain is a major component of IC pathophysiology. Approved treatments so far include intravesical administration of dimethylsulphoxide (DMSO) or oral pentosanpolysulphate (PPS). New treatments focus on the combined use of drugs that modulate bladder sensory nerve stimulation (neurolytic agents), inhibit neurogenic activation of mast cells, or provide urothelial cytoprotection, together with new drugs with anti-inflammatory activity.
Collapse
Affiliation(s)
- T C Theoharides
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
| | | |
Collapse
|
8
|
|
9
|
CHIANG GEORGE, PATRA PHANI, LETOURNEAU RICHARD, JEUDY SHEILA, BOUCHER WILLIAM, GREEN MARLON, SANT GRANNUMR, THEOHARIDES THEOHARISC. PENTOSANPOLYSULFATE INHIBITS MAST CELL HISTAMINE SECRETION AND INTRACELLULAR CALCIUM ION LEVELS:: AN ALTERNATIVE EXPLANATION OF ITS BENEFICIAL EFFECT IN INTERSTITIAL CYSTITIS. J Urol 2000. [DOI: 10.1016/s0022-5347(05)66981-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- GEORGE CHIANG
- From the Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Department of Urology, New England Medical Center, Boston, Massachusetts
| | - PHANI PATRA
- From the Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Department of Urology, New England Medical Center, Boston, Massachusetts
| | - RICHARD LETOURNEAU
- From the Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Department of Urology, New England Medical Center, Boston, Massachusetts
| | - SHEILA JEUDY
- From the Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Department of Urology, New England Medical Center, Boston, Massachusetts
| | - WILLIAM BOUCHER
- From the Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Department of Urology, New England Medical Center, Boston, Massachusetts
| | - MARLON GREEN
- From the Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Department of Urology, New England Medical Center, Boston, Massachusetts
| | - GRANNUM R. SANT
- From the Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Department of Urology, New England Medical Center, Boston, Massachusetts
| | - THEOHARIS C. THEOHARIDES
- From the Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Department of Urology, New England Medical Center, Boston, Massachusetts
| |
Collapse
|
10
|
Theoharides TC, Patra P, Boucher W, Letourneau R, Kempuraj D, Chiang G, Jeudy S, Hesse L, Athanasiou A. Chondroitin sulphate inhibits connective tissue mast cells. Br J Pharmacol 2000; 131:1039-49. [PMID: 11082109 PMCID: PMC1572430 DOI: 10.1038/sj.bjp.0703672] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
1. Mast cells derive from the bone marrow and are responsible for the development of allergic and possibly inflammatory reactions. Mast cells are stimulated by immunoglobulin E (IgE) and specific antigen, but also by a number of neuropeptides such as neurotensin (NT), somatostatin or substance P (SP), to secrete numerous pro-inflammatory molecules that include histamine, cytokines and proteolytic enzymes. 2. Chondroitin sulphate, a major constituent of connective tissues and of mast cell secretory granules, had a dose-dependent inhibitory effect on rat peritoneal mast cell release of histamine induced by the mast cell secretagogue compound 48/80 (48/80). This inhibition was stronger than that of the clinically available mast cell 'stabilizer' disodium cromoglycate (cromolyn). Inhibition by chondroitin sulphate increased with the length of preincubation and persisted after the drug was washed off, while the effect of cromolyn was limited by rapid tachyphylaxis. 3. Immunologic stimulation of histamine secretion from rat connective tissue mast cells (CTMC) was also inhibited, but this effect was weaker in umbilical cord-derived human mast cells and was absent in rat basophilic leukemia (RBL) cells which are considered homologous to mucosal mast cells (MMC). Oligo- and monosaccharides were not as effective as the polysaccharides. 4. Inhibition, documented by light and electron microscopy, involved a decrease of intracellular calcium ion levels shown by confocal microscopy and image analysis. Autoradiography at the ultrastructural level showed that chondroitin sulphate was mostly associated with plasma and perigranular membranes. 5. Chondroitin sulphate appears to be a potent mast cell inhibitor of allergic and nonimmune stimulation with potential clinical implications.
Collapse
Affiliation(s)
- T C Theoharides
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, 136 Harrison Avenue, Boston, Massachusetts, MA 02111, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Ahmed T, Gonzalez BJ, Danta I. Prevention of exercise-induced bronchoconstriction by inhaled low-molecular-weight heparin. Am J Respir Crit Care Med 1999; 160:576-81. [PMID: 10430731 DOI: 10.1164/ajrccm.160.2.9812076] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Because many biological actions of heparin including the antiallergic activity are molecular weight dependent, we hypothesized that low-molecular-weight heparin (LMWH) may have greater potency in attenuating exercise-induced bronchoconstriction (EIB). Therefore, in the present investigation we studied the effects of inhaled LMWH, enoxaparin, and unfractionated heparin on EIB in subjects with asthma. Thirteen asthmatic subjects performed a standardized exercise challenge on a treadmill to document the presence of EIB. The workload was increased until 85% of predicted maximal heart rate was achieved, and the exercise was sustained at that workload for 10 min. EIB was assessed by measuring FEV(1) before and immediately after the exercise. On five different experiment days the subjects were pretreated with 4 ml of aerosolized heparin (80,000 units = 7.5 mg/kg), placebo, or 3 different doses of enoxaparin (0.5 mg/kg, 1 mg/kg, 2 mg/kg) in a double-blind, randomized, crossover design, and exercise challenge was performed 45 min later. Bronchial provocation with methacholine was also performed in five subjects on two additional days after pretreatment with either placebo or inhaled enoxaparin (2 mg/kg), and venous blood was obtained for analysis of plasma antifactor Xa. Postexercise, the maximal decreases in FEV(1) (mean +/- SE) were 30 +/- 4% and 29 +/- 5% on control and placebo days. The exercise-induced decreases in FEV(1) were inhibited by 31% with heparin (DeltaFEV(1) = 20 +/- 4%); and by 28%, 38%, and 48% by enoxaparin at doses of 0.5 mg/kg (DeltaFEV(1) = 21 +/- 5%), 1 mg/kg (DeltaFEV(1) = 18 +/- 5%), and 2 mg/kg (DeltaFEV(1) = 15 +/- 3%), respectively (p < 0.05). The inhibitory effect of 0.5 mg/kg dose of enoxaparin was comparable to heparin (7.5 mg/kg), whereas 2 mg/ kg dose of enoxaparin was the most potent. Inhaled enoxaparin failed to modify the bronchoconstrictor response to methacholine, and did not change the plasma antifactor Xa activity. These data demonstrate that inhaled enoxaparin prevents EIB in a dose-dependent manner; and its antiasthmatic activity is independent of its effect on plasma antifactor Xa activity.
Collapse
Affiliation(s)
- T Ahmed
- Division of Pulmonary Disease, University of Miami School of Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | | | | |
Collapse
|
12
|
Yamakage M, Matsuzaki T, Tsujiguchi N, Mori T, Namiki A. The Direct Effects of Heparin and Protamine on Canine Tracheal Smooth Muscle Tone. Anesth Analg 1999. [DOI: 10.1213/00000539-199906000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
13
|
Yamakage M, Matsuzaki T, Tsujiguchi N, Mori T, Namiki A. The direct effects of heparin and protamine on canine tracheal smooth muscle tone. Anesth Analg 1999; 88:1232-8. [PMID: 10357324 DOI: 10.1097/00000539-199906000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Heparin and protamine are used for cardiopulmonary bypass in cardiac surgery; however, the direct effects and mechanisms of these drugs on airway smooth muscle tone are still not fully known. We investigated the in vitro effects of these drugs on canine tracheal smooth muscle by measuring the muscle tension and intracellular Ca2+ concentration ([Ca2+]i) and by measuring inward Ca2+ currents (I(Ca)) through voltage-dependent Ca2+ channels. [Ca2+]i was monitored by the 500-nm light emission ratio of preloaded Ca2+ indicator fura-2. Isometric tension was measured simultaneously. Whole-cell patch clamp recording techniques were used to investigate the effects of the drugs on I(Ca) in freshly dispersed smooth muscle cells. Heparin (0.12-120 U/mL), protamine (0.15-150 U/mL), or heparin-protamine complex (4:5 U/U) was introduced into a bath solution. Protamine and heparin-protamine complex dose-dependently inhibited both carbachol-induced contraction of the muscle and increase in [Ca2+]i. These drugs also decreased the I(Ca) of the muscle cells and shifted the inactivation curve to a more negative potential. Heparin itself had a slight enhancing effect on carbachol-induced muscle contraction without changing [Ca2+]i. Protamine and heparin-protamine complex can decrease the agonist-induced increase in [Ca2+]i by the inhibition of voltage-dependent Ca2+ channels both in the activated and inactivated states. IMPLICATIONS Protamine and heparin-protamine complex inhibited carbachol-induced canine tracheal smooth muscle contraction by inhibiting the increase in intracellular concentration of free Ca2+. These drugs can decrease the agonist-induced increase in intracellular Ca2+ by the inhibition of voltage-dependent Ca2+ channels in both the activated and inactivated states.
Collapse
Affiliation(s)
- M Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Hokkaido, Japan.
| | | | | | | | | |
Collapse
|
14
|
Campo C, Molinari JF, Ungo J, Ahmed T. Molecular-weight-dependent effects of nonanticoagulant heparins on allergic airway responses. J Appl Physiol (1985) 1999; 86:549-57. [PMID: 9931190 DOI: 10.1152/jappl.1999.86.2.549] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We have hypothesized that antiallergic activity of inhaled heparin is molecular weight dependent and mediated by "nonanticoagulant fractions" (NAF-heparin). Therefore, we studied comparative effects of high-, medium-, and ultralow-molecular-weight (HMW, MMW, and ULMW, respectively) NAF-heparins on acute bronchoconstrictor response (ABR) and airway hyperresponsiveness (AHR) in allergic sheep. Specific lung resistance was measured in 23 allergic sheep, before and immediately after challenge with Ascaris suum antigen, without and after pretreatment with inhaled NAF-heparins. Airway responsiveness was estimated before and 2 h postantigen as the cumulative provocating dose of carbachol in breath units, which increased specific lung resistance by 400%. NAF-heparins attenuated ABR and AHR in a molecular-weight-dependent fashion. HMW NAF-heparin (n = 8) was the least effective agent: it attenuated ABR [inhibitory dose causing 50% protection (ID50) = 4 mg/kg] but had no effect on AHR. MMW NAF-heparin (n = 8) showed intermediate efficacy (ABR ID50 = 0.8 mg/kg, AHR ID50 = 1.4 mg/kg), whereas ULMW NAF-heparin (n = 7) was the most effective agent (ABR ID50 = 0.4 mg/kg, AHR ID50 = 0.2 mg/kg). ULMW NAF-heparin was 3.5 times more potent in attenuating antigen-induced AHR when administered "after" antigen challenge and failed to inhibit the bronchoconstrictor response to carbachol and histamine. In 15 additional sheep, segmental antigen challenge caused a marked increase in histamine in bronchoalveolar lavage fluid that was not prevented by any of the inhaled NAF-heparins. These data indicate that antiallergic activity of inhaled heparin is independent of its anticoagulant action and resides in the <2,500 ULMW chains. The antiallergic activity of NAF-heparins is mediated by an unknown biological action and may have therapeutic potential.
Collapse
Affiliation(s)
- C Campo
- Division of Pulmonary Diseases, University of Miami School of Medicine, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA
| | | | | | | |
Collapse
|
15
|
Teuber SS, Vogt PJ. An unproven technique with potentially fatal outcome: provocation/neutralization in a patient with systemic mastocytosis. Ann Allergy Asthma Immunol 1999; 82:61-5. [PMID: 9988209 DOI: 10.1016/s1081-1206(10)62662-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the risks associated with use of an unproven technique, provocation/neutralization, in diagnosis and treatment of a putative "food allergy" in a patient with systemic mastocytosis. METHODS A case report of a 68-year-old woman with mastocytosis is reported. The patient was interviewed, examined, and all medical records were reviewed. Photos were taken, and skin and colonic biopsies were performed. RESULTS The patient was previously diagnosed with urticaria pigmentosa but also had significant diarrhea that was well-controlled by oral cromolyn sodium. She saw a physician who practiced provocation/neutralization and was told that food allergies were the cause of her gastrointestinal symptoms. She was placed on "neutralizing" injections of milk and wheat, but experienced flushing, palpitations, and lightheadedness with syncope upon injections into her thigh, which is a skin area highly involved by visible lesions of cutaneous mastocytosis. Later evaluation revealed increased numbers of mast cells in her colonic mucosa as well as confirmation of cutaneous mastocytosis. CONCLUSIONS The patient's previous history of urticaria pigmentosa, orally communicated by the patient, documented in medical records, and easily visible on physical examination, was discounted by a practitioner of an alternative and unproven medical treatment, provocation/neutralization. She subsequently had potentially life-threatening reactions to "provocative" skin testing and "neutralizing" injections. Patients with systemic mastocytosis are at risk for significant mast cell mediator release during immunotherapy, conventional or alternative.
Collapse
Affiliation(s)
- S S Teuber
- University of California, School of Medicine, Department of Internal Medicine, Davis 95616, USA. ssteuberucdavis.edu
| | | |
Collapse
|
16
|
Molinari JF, Campo C, Shakir S, Ahmed T. Inhibition of antigen-induced airway hyperresponsiveness by ultralow molecular-weight heparin. Am J Respir Crit Care Med 1998; 157:887-93. [PMID: 9517607 DOI: 10.1164/ajrccm.157.3.9708027] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Unfractionated heparin (UF-heparin) has been shown to prevent antigen-induced airway hyperresponsiveness (AHR), but it is ineffective when administered after the antigen challenge. We hypothesized that the failure of UF-heparin to modify postantigen AHR might depend on molecular weight. We therefore studied the effects of UF-heparin and three low-molecular-weight heparin fractions (medium-molecular-weight heparin [MMWH]; low-molecular-weight heparin [LMWH]; and ultralow-molecular-weight heparin [ULMWH]) on antigen-induced AHR and histamine release in bronchoalveolar lavage fluid (BALF). Specific lung resistance (SRL) was measured in 20 allergic sheep before, immediately after, and up to 2 h after challenge with Ascaris suum antigen. Airway responsiveness was expressed as the cumulative provocative dose of carbachol, in breath units, that increased SRL by 400% (PD400). PD400 was determined before and 2 h after antigen, both without and after treatment with aerosolized UF-heparin (1,000 U/kg) and various heparin fractions (0.04 mg/kg to 5 mg/kg) administered after the antigen challenge. Inhaled UF-heparin (n = 4), MMWH (n = 4), and LMWH (n = 6) failed to modify postantigen AHR when administered after the challenge. Only ULMWH (n = 6) inhibited postantigen AHR in a dose-dependent manner (percent protection ranged from 31% to 139%). In eight additional sheep, histamine in BALF was measured with a radioimmunoassay (RIA) before and after the segmental antigen challenge, without and after pretreatment with inhaled UF-heparin, LMWH, or ULMWH. Inhaled UF-heparin and LMWH inhibited antigen-induced histamine release as measured in BALF by 81% and 75%, respectively; whereas ULMWH was ineffective in this respect. We conclude that: (1) modification of antigen-induced AHR by fractionated heparins is molecular-weight dependent; and (2) only ULMWH attenuates AHR when administered after antigen challenge, via an unknown mast-cell-independent action.
Collapse
Affiliation(s)
- J F Molinari
- Division of Pulmonary Diseases, University of Miami School of Medicine, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA
| | | | | | | |
Collapse
|
17
|
Halayko AJ, Rector E, Stephens NL. Airway smooth muscle cell proliferation: characterization of subpopulations by sensitivity to heparin inhibition. THE AMERICAN JOURNAL OF PHYSIOLOGY 1998; 274:L17-25. [PMID: 9458796 DOI: 10.1152/ajplung.1998.274.1.l17] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Growth and maturation state of airway smooth muscle cells (SMCs) are determinants of asthma pathophysiology. Heparin reduces airway SMC proliferation and arterial SMC replication and phenotypic modulation. Distinct arterial SMC subtypes, differing in heparin sensitivity, have been characterized. We assessed the cellular mechanisms underlying the growth and phenotype of heparin-treated canine tracheal myocytes in primary culture. Heparin reduced replication by 40%. Immunoblot assay of myosin, actin, and myosin light chain kinase revealed heparin had no effect on rapid spontaneous phenotypic modulation after the cells were plated. Heparin increased cellular protein and vimentin contents in confluent cultures, suggesting that it may induce hypertrophic growth. Cell cycle analysis revealed that heparin decreased serum-stimulated replicating myocyte number by 40%. Also, G2-M transit was 20% slower for the set of SMCs that proceeded past G1 in the presence of heparin. These data indicate that heparin does not inhibit airway SMC replication by blocking modulation from the contractile state. Moreover, airway smooth muscle is composed of distinct SMC populations differing in mitogen and antiproliferative mediator responsiveness. Identification of functionally divergent subgroups suggests that distinct sets of SMCs may contribute differentially to airway physiology and pathophysiology.
Collapse
Affiliation(s)
- A J Halayko
- Department of Physiology, University of Manitoba, Winnipeg, Canada
| | | | | |
Collapse
|