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Chen T, Liu T, Li T, Zhao H, Chen Q. Exhaled breath analysis in disease detection. Clin Chim Acta 2021; 515:61-72. [PMID: 33387463 DOI: 10.1016/j.cca.2020.12.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/05/2023]
Abstract
Investigating the use of exhaled breath analysis to diagnose and monitor different diseases has attracted much interest in recent years. This review introduces conventionally used methods and some emerging technologies aimed at breath analysis and their relevance to lung disease, airway inflammation, gastrointestinal disorders, metabolic disorders and kidney diseases. One section correlates breath components and specific diseases, whereas the other discusses some unique ideas, strategies, and devices to analyze exhaled breath for the diagnosis of some common diseases. This review aims to briefly introduce the potential application of exhaled breath analysis for the diagnosis and screening of various diseases, thereby providing a new avenue for the detection of non-invasive diseases.
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Affiliation(s)
- Ting Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Tiannan Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Ting Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China.
| | - Hang Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
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2
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Song Q, Hu Z, Xie X, Cai H. Zafirlukast prevented ox-LDL-induced formation of foam cells. Toxicol Appl Pharmacol 2020; 409:115295. [PMID: 33096109 DOI: 10.1016/j.taap.2020.115295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/15/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
Atherosclerosis (AS), a common arterial disease, is one of the main pathological roots of cardiovascular disease. The formation and accumulation of foam cells is an important event in early AS. An imbalance between cholesterol uptake and efflux is the primary cause of foam cell formation. Although research has focused on preventing the formation of foam cells, a safe and effective therapy has to be found. Zafirlukast is a widely useful type 1 cysteinyl leukotriene receptor (CysLT1R) antagonist with a good safety profile. Zafirlukast is the most used for the treatment of asthma and allergic rhinitis. However, the effect of zafirlukast on preventing the formation of foam cells has not been determined. The aim of this study was to investigate whether zafirlukast prevented macrophages from transforming into foam cells. Our data show that zafirlukast reduced the expression of CD36 and lipoprotein receptor-1 (LOX-1), which are responsible for lipid uptake. In addition, zafirlukast enhanced the activity of ATP-Binding Cassette A1 (ABCA1) and ATP-binding cassette transporter G1 (ABCG1), leading to the acceleration of cholesterol efflux. Furthermore, zafirlukast influenced the activity of the phosphatidylinositol-3-kinase (PI3K)/Akt signaling pathway, which mediates the expression of ABCA1 and ABCG1. In summary, our data indicate that zafirlukast might be a potential treatment strategy for AS by mediating lipid metabolism and preventing the formation of foam cells.
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Affiliation(s)
- Qiang Song
- Department of Structural Heart Disease, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shanxi, China
| | - Zhi Hu
- Department of Structural Heart Disease, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shanxi, China
| | - Xinming Xie
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shanxi, China
| | - Hui Cai
- Department of vascular surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shanxi, China.
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3
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Leukotriene D 4 role in allergic asthma pathogenesis from cellular and therapeutic perspectives. Life Sci 2020; 260:118452. [PMID: 32956660 DOI: 10.1016/j.lfs.2020.118452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 01/05/2023]
Abstract
Asthma is a chronic inflammatory and allergic disease that is mainly characterized by reversible airway obstruction and bronchial hyperresponsiveness. The incidence of asthma is increasing with more than 350 million people worldwide are affected. Up to now, there is no therapeutic option for asthma and most of the prescribed drugs aim to ameliorate the symptoms of the disease especially during the acute exacerbations after trigger exposure. Asthma is a heterogonous disease that involves interactions between inflammatory mediators and cellular components within the disease microenvironment including inflammatory and structural cells. Cysteinyl leukotrienes (cys-LTs) are inflammatory lipid mediators that have potent roles in asthma pathogenesis. CysLTs consisting of LTC4, LTD4, and LTE4 are mainly secreted by leukocytes and act through three main G-protein coupled receptors (CysLT1R, CysLT2R, and CysLT3R). LTD4 is the most potent bronchoconstrictor which gives it the priority to be discussed in detail in this review. LTD4 binds with high affinity to CysLT1R and many studies showed that using CysLT1R antagonists such as montelukast has a beneficial effect for asthmatics especially in corticosteroid refractory cases. Since asthma is a heterogeneous inflammatory disease of many cell types involved in the disease pathogenies and LTD4 has a special role in inflammation and bronchoconstriction, this review highlights the role of LTD4 on each cellular component in asthma and the benefits of using CysLT1R antagonists in ameliorating LTD4-induced effects.
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Abstract
There are multiple proinflammatory pathways in the pathogenesis of asthma. These include both innate and adaptive inflammation, in addition to inflammatory and physiologic responses mediated by eicosanoids. An important component of the innate allergic immune response is ILC2 activated by interleukin (IL)-33, thymic stromal lymphopoietin, and IL-25 to produce IL-5 and IL-13. In terms of the adaptive T-lymphocyte immunity, CD4+ Th2 and IL-17-producing cells are critical in the inflammatory responses in asthma. Last, eicosanoids involved in asthma pathogenesis include prostaglandin D2 and the cysteinyl leukotrienes that promote smooth muscle constriction and inflammation that propagate allergic responses.
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Affiliation(s)
- R Stokes Peebles
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, VUMC, T-1218 MCN, 1161 21st Avenue South, Nashville, TN 37232-2650, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, VUMC, T-1218 MCN, 1161 21st Avenue South, Nashville, TN 37232-2650, USA.
| | - Mark A Aronica
- Department of Pathobiology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine, CWRU, 9500 Euclid Avenue, NB2-85, Cleveland, OH 44195, USA
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Kaphalia L, Srinivasan MP, Kakumanu RD, Kaphalia BS, Calhoun WJ. Ethanol Exposure Impairs AMPK Signaling and Phagocytosis in Human Alveolar Macrophages: Role of Ethanol Metabolism. Alcohol Clin Exp Res 2019; 43:1682-1694. [PMID: 31211863 DOI: 10.1111/acer.14131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic alcohol consumption impairs alveolar macrophage's (AM) function and increases risk for developing lung infection and pneumonia. However, the mechanism and metabolic basis of alcohol-induced AM dysfunction leading to lung infection are not well defined, but may include altered ethanol (EtOH) and reactive oxygen species metabolism and cellular energetics. Therefore, oxidative stress, endoplasmic reticulum (ER) stress, the formation of fatty acid ethyl esters [FAEEs, nonoxidative metabolites of EtOH], AMP-activated protein kinase (AMPK) signaling, and phagocytic function were examined in freshly isolated AM incubated with EtOH. METHODS AMs separated from bronchoalveolar lavage fluid samples obtained from normal volunteers were incubated with EtOH for 24 hours. AMPK signaling and ER stress were assessed using Western blotting, FAEEs by GC-MS, oxidative stress by immunofluorescence using antibodies to 4-hydroxynonenal, and phagocytosis by latex beads. Oxidative stress was also measured in EtOH-treated AMs with/without AMPK activator [5-aminoimidazole-4-carboxamide ribonucleotide (AICAR)] or inhibitor (Compound C), and in AMs incubated with FAEEs. mRNA expression for interleukins (IL-6 and IL-8), monocyte chemoattractant protein (MCP)-1, and transforming growth factor (TGF)-β was measured in AM treated with EtOH or FAEEs using RT-PCR. RESULTS EtOH exposure to AM increased oxidative stress, ER stress, and synthesis of FAEEs, decreased phosphorylated AMPK, and impaired phagocytosis. Attenuation or exacerbation of EtOH-induced oxidative stress by AICAR or Compound C, respectively, suggests a link between AMPK signaling, EtOH metabolism, and related oxidative stress. The formation of FAEEs may contribute to EtOH-induced oxidative stress as FAEEs also produced concentration-dependent oxidative stress. An increased mRNA expression of IL-6, IL-8, and MCP-1 by FAEEs is key finding to suggest a metabolic basis of EtOH-induced inflammatory response. CONCLUSIONS EtOH-induced impaired phagocytosis, oxidative stress, ER stress, and dysregulated AMPK signaling are plausibly associated with the formation of FAEEs and may participate in the pathogenesis of nonspecific pulmonary inflammation.
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Affiliation(s)
- Lata Kaphalia
- Division of Pulmonary, Critical Care Medicine, and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.,Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Mukund P Srinivasan
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | - Ramu D Kakumanu
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas
| | | | - William J Calhoun
- Division of Pulmonary, Critical Care Medicine, and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.,Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
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Göbel T, Diehl O, Heering J, Merk D, Angioni C, Wittmann SK, Buscato EL, Kottke R, Weizel L, Schader T, Maier TJ, Geisslinger G, Schubert-Zsilavecz M, Steinhilber D, Proschak E, Kahnt AS. Zafirlukast Is a Dual Modulator of Human Soluble Epoxide Hydrolase and Peroxisome Proliferator-Activated Receptor γ. Front Pharmacol 2019; 10:263. [PMID: 30949053 PMCID: PMC6435570 DOI: 10.3389/fphar.2019.00263] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/04/2019] [Indexed: 02/06/2023] Open
Abstract
Cysteinyl leukotriene receptor 1 antagonists (CysLT1RA) are frequently used as add-on medication for the treatment of asthma. Recently, these compounds have shown protective effects in cardiovascular diseases. This prompted us to investigate their influence on soluble epoxide hydrolase (sEH) and peroxisome proliferator activated receptor (PPAR) activities, two targets known to play an important role in CVD and the metabolic syndrome. Montelukast, pranlukast and zafirlukast inhibited human sEH with IC50 values of 1.9, 14.1, and 0.8 μM, respectively. In contrast, only montelukast and zafirlukast activated PPARγ in the reporter gene assay with EC50 values of 1.17 μM (21.9% max. activation) and 2.49 μM (148% max. activation), respectively. PPARα and δ were not affected by any of the compounds. The activation of PPARγ was further investigated in 3T3-L1 adipocytes. Analysis of lipid accumulation, mRNA and protein expression of target genes as well as PPARγ phosphorylation revealed that montelukast was not able to induce adipocyte differentiation. In contrast, zafirlukast triggered moderate lipid accumulation compared to rosiglitazone and upregulated PPARγ target genes. In addition, we found that montelukast and zafirlukast display antagonistic activities concerning recruitment of the PPARγ cofactor CBP upon ligand binding suggesting that both compounds act as PPARγ modulators. In addition, zafirlukast impaired the TNFα triggered phosphorylation of PPARγ2 on serine 273. Thus, zafirlukast is a novel dual sEH/PPARγ modulator representing an excellent starting point for the further development of this compound class.
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Affiliation(s)
- Tamara Göbel
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Olaf Diehl
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan Heering
- Branch for Translational Medicine and Pharmacology, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Frankfurt am Main, Germany
| | - Daniel Merk
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Carlo Angioni
- Faculty of Medicine, Institute of Clinical Pharmacology, Pharmazentrum Frankfurt, ZAFES, Frankfurt am Main, Germany
| | - Sandra K Wittmann
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Estel la Buscato
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ramona Kottke
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lilia Weizel
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Tim Schader
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thorsten J Maier
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gerd Geisslinger
- Branch for Translational Medicine and Pharmacology, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Frankfurt am Main, Germany.,Faculty of Medicine, Institute of Clinical Pharmacology, Pharmazentrum Frankfurt, ZAFES, Frankfurt am Main, Germany
| | | | - Dieter Steinhilber
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ewgenij Proschak
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Astrid S Kahnt
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University Frankfurt, Frankfurt am Main, Germany
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Hwang HJ, Park KS, Choi JH, Cocco L, Jang HJ, Suh PG. Zafirlukast promotes insulin secretion by increasing calcium influx through L-type calcium channels. J Cell Physiol 2018; 233:8701-8710. [PMID: 29797580 DOI: 10.1002/jcp.26750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/18/2018] [Indexed: 01/08/2023]
Abstract
The zafirlukast has been reported to be anti-inflammatory and widely used to alleviate the symptoms of asthma. However, its influence on insulin secretion in pancreatic β-cells has not been investigated. Herein, we examined the effects of zafirlukast on insulin secretion and the potential underlying mechanisms. Among the cysteinyl leukotriene receptor 1 antagonists, zafirlukast, pranlukast, and montelukast, only zafirlukast enhanced insulin secretion in a concentration-dependent manner in both low and high glucose conditions and elevated the level of [Ca2+ ]i , further activating Ca2+ /calmodulin-dependent protein kinase II (CaMKII), protein kinase B (AKT), and extracellular signal-regulated kinase (ERK) signaling. These effects were nearly abolished by the L-type Ca2+ channel antagonist nifedipine, while treatment with thapsigargin, a sarco/endoplasmic reticulum Ca2+ ATPase inhibitor, did not have the same effect, suggesting that zafirlukast primarily induces the entry of extracellular Ca2+ rather than intracellular Ca2+ from the endoplasmic reticulum. Zafirlukast treatment resulting in a significant drop in glucose levels and increased insulin secretion in C57BL/6J mice. These findings will contribute to an improved understanding of the side effects of zafirlukast and potential candidate for a therapeutic intervention in diabetes.
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Affiliation(s)
- Hyeon-Jeong Hwang
- School of Life Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Kyoung-Su Park
- In Vivo Research Center, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Jang Hyun Choi
- School of Life Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea.,Korea Mouse Phenotyping Center, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Lucio Cocco
- Cellular Signaling Laboratory, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Hyun-Jun Jang
- School of Life Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Pann-Ghill Suh
- School of Life Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
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Abstract
Histamine is a pro-inflammatory mediator with a prominent role in allergic diseases. Antagonists at the histamine receptor subtype 1 are central in anti-allergic therapies, with the exception of allergic asthma, where they are clinically without effect. The latest identified histamine receptor subtype 4, which is expressed mainly in hematopoietic cells, now provides a reasonable target for new therapeutic strategies inhibiting histamine function. The pathophysiology of allergy, esp. allergic asthma, and in its context the effects of antagonists at the histamine receptor subtype 4 in preclinical and clinical settings are discussed in this chapter.
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9
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Smith N, Herbeuval JP. Mechanisms underlying plasmacytoid dendritic cell regulation during viral infection. Future Virol 2017. [DOI: 10.2217/fvl-2017-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Nikaïa Smith
- CNRS UMR-8601, Université Paris Descartes, CICB, 45 rue des Saints-Pères, 75006 Paris, France
- Chemistry & Biology, Modeling & Immunology for Therapy, CBMIT
| | - Jean-Philippe Herbeuval
- CNRS UMR-8601, Université Paris Descartes, CICB, 45 rue des Saints-Pères, 75006 Paris, France
- Chemistry & Biology, Modeling & Immunology for Therapy, CBMIT
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Natural amines inhibit activation of human plasmacytoid dendritic cells through CXCR4 engagement. Nat Commun 2017; 8:14253. [PMID: 28181493 PMCID: PMC5309800 DOI: 10.1038/ncomms14253] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 12/08/2016] [Indexed: 01/07/2023] Open
Abstract
Plasmacytoid dendritic cells (pDC) are specialized in secretion of type I interferon in response to pathogens. Here we show that natural monoamines and synthetic amines inhibit pDC activation by RNA viruses. Furthermore, a synthetic analogue of histamine reduces type I interferon production in a mouse model of influenza infection. We identify CXC chemokine receptor 4 (CXCR4) as a receptor used by amines to inhibit pDC. Our study establishes a functional link between natural amines and the innate immune system and identifies CXCR4 as a potential ‘on-off' switch of pDC activity with therapeutic potential. Plasmacytoid dendritic cells produce type I interferons in response to viral sensing. Here the authors show that amines inhibit these plasmacytoid dendritic cell responses through CXCR4 engagement.
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11
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Singh J, Shah R, Singh D. Inundation of asthma target research: Untangling asthma riddles. Pulm Pharmacol Ther 2016; 41:60-85. [PMID: 27667568 DOI: 10.1016/j.pupt.2016.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/11/2016] [Accepted: 09/20/2016] [Indexed: 12/31/2022]
Abstract
Asthma is an inveterate inflammatory disorder, delineated by the airway inflammation, bronchial hyperresponsiveness (BHR) and airway wall remodeling. Although, asthma is a vague term, and is recognized as heterogenous entity encompassing different phenotypes. Targeting single mediator or receptor did not prove much clinical significant, as asthma is complex disease involving myriad inflammatory mediators. Asthma may probably involve a large number of different types of molecular and cellular components interacting through complex pathophysiological pathways. This review covers the past, present, and future therapeutic approaches and pathophysiological mechanisms of asthma. Furthermore, review describe importance of targeting several mediators/modulators and receptor antagonists involved in the physiopathology of asthma. Novel targets for asthma research include Galectins, Immunological targets, K + Channels, Kinases and Transcription Factors, Toll-like receptors, Selectins and Transient receptor potential channels. But recent developments in asthma research are very promising, these include Bitter taste receptors (TAS2R) abated airway obstruction in mouse model of asthma and Calcium-sensing receptor obliterate inflammation and in bronchial hyperresponsiveness allergic asthma. All these progresses in asthma targets, and asthma phenotypes exploration are auspicious in untangling of asthma riddles.
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Affiliation(s)
- Jatinder Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, 147002, Punjab, India
| | - Ramanpreet Shah
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, 147002, Punjab, India
| | - Dhandeep Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, 147002, Punjab, India.
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12
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Swedin L, Saarne T, Rehnberg M, Glader P, Niedzielska M, Johansson G, Hazon P, Catley MC. Patient stratification and the unmet need in asthma. Pharmacol Ther 2016; 169:13-34. [PMID: 27373855 DOI: 10.1016/j.pharmthera.2016.06.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/14/2016] [Indexed: 02/07/2023]
Abstract
Asthma is often described as an inflammatory disease of the lungs and in most patients symptomatic treatment with bronchodilators or inhaled corticosteroids is sufficient to control disease. Unfortunately there are a proportion of patients who fail to achieve control despite treatment with the best current treatment. These severe asthma patients have been considered a homogeneous group of patients that represent the unmet therapeutic need in asthma. Many novel therapies have been tested in unselected asthma patients and the effects have often been disappointing, particularly for the highly specific monoclonal antibody-based drugs such as anti-IL-13 and anti-IL-5. More recently, it has become clear that asthma is a syndrome with many different disease drivers. Clinical trials of anti-IL-13 and anti-IL-5 have focused on biomarker-defined patient groups and these trials have driven the clinical progression of these drugs. Work on asthma phenotyping indicates that there is a group of asthma patients where T helper cell type 2 (Th2) cytokines and inflammation predominate and these type 2 high (T2-high) patients can be defined by biomarkers and response to therapies targeting this type of immunity, including anti-IL-5 and anti-IL-13. However, there is still a subset of T2-low patients that do not respond to these new therapies. This T2-low group will represent the new unmet medical need now that the T2-high-targeting therapies have made it to the market. This review will examine the current thinking on patient stratification in asthma and the identification of the T2-high subset. It will also look at the T2-low patients and examine what may be the drivers of disease in these patients.
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Affiliation(s)
- Linda Swedin
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Tiiu Saarne
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Maria Rehnberg
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Pernilla Glader
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Magdalena Niedzielska
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Gustav Johansson
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Petra Hazon
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Matthew C Catley
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden.
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13
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Lajqi N, Ilazi A, Kastrati B, Islami H. Comparison of Glucocorticoid (Budesonide) and Antileukotriene (Montelukast) Effect in Patients with Bronchial Asthma Determined with Body Plethysmography. Acta Inform Med 2016; 23:347-51. [PMID: 26862243 PMCID: PMC4720827 DOI: 10.5455/aim.2015.23.347-351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: Effect of glucocorticoids-budesonide and antileukotriene–montelukast in patients with bronchial asthma and bronchial increased reactivity was studied in this work. Methods: Parameters of the lung function are determined with Body plethysmography. Raw and ITGV were registered and specific resistance (SRaw) was also calculated. Results: Results of this research, in patients with bronchial asthma, indicate that glucocorticoids – budesonide (Pulmicort; 2 × 2 mg inh) has significant action (p< 0.01) on reduction of the specific resistance (SRaw) of airways, applied to the same patients 3 days after administration of montelukast, at home (2 × 10 mg). Three days after administration of the montelukast, antileukotriene medicine, at home, on the fourth day same patients administered a capsule of montelukast, 10 mg dose per os, and significantly (p < 0.05) reduced the increased bronchomotor tonus; and the effect of the control with salbutamol (beta2-adrenergic agonist) is effective in removal of the increased bronchomotor tonus, causing significant decrease of the resistance (Raw), respectively of the specific resistance (SRaw), (p < 0, 01). Conclusion: This suggests that the bronchodilator effect of glucocorticoids is more powerful than of the leukotriene, because glucocorticoids terminate the early stage of chemical mediator release (prostaglandins PgD2, SRS, and leukotriene LTC4, LTD4, LTE4 and Cytokinins also etc.) as powerful bronchoconstriction substances, whilst antileukotriene substances does not have this feature.
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Affiliation(s)
- Njomza Lajqi
- Trifarm, Laboratory of Pharmaceutical Company, Fushe Kosove, Kosova
| | - Ali Ilazi
- Kosovo Occupational Health Institute, Clinical Centre N.N., Gjakova, Kosova
| | - Bashkim Kastrati
- Department of Pharmacy, Faculty of Medicine. University of Prishtina. Clinical Centre, Mother Theresa Str., Prishtina. Kosova
| | - Hilmi Islami
- Department of Pharmacology, Faculty of Medicine. University of Prishtina. Clinical Centre, Mother Theresa Str., Prishtina. Kosova
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14
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Morina N, Boçari G, Iljazi A, Hyseini K, Halac G. Maximum Time of the Effect of Antileukotriene - Zileuton in Treatment of Patients with Bronchial Asthma. Acta Inform Med 2016; 24:16-9. [PMID: 27046942 PMCID: PMC4789724 DOI: 10.5455/aim.2016.24.16-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 01/16/2016] [Indexed: 11/26/2022] Open
Abstract
Objective: Maximum time of the effect of antileukotriene substances - Zileuton in the treatment of patients with bronchial asthma and increased bronchial reactivity and of the salbutamol as agonist of the beta2 adrenergic receptor studied in this work. Methods: Parameters of the lung function are determined with Body plethysmography. Raw and ITGV were registered and specific resistance (SRaw) was calculated. Zileuton (Zyflo, tbl. 600 mg), producer Cornerstone Therapeutics, USA was used in the research. Results: Results of this research, in patients with bronchial asthma, indicate that antileukotriene substances–Zileuton administered in a dose of 600 mg first day (oral route of administration 4 × 1 tbl.) has not caused significant decrease of the specific resistance of the airways (SRaw) (p value 0.1 > Alpha 0.05), whereas Zileuton administered two days in a row, in a dose of 600 mg (4 × 1 tbl. a day), has caused significant decrease of the specific resistance of the airways (SRaw) (P value 0.03 < Alpha 0.05). Effect of the control with salbutamol (beta2-adrenergic receptor agonist) is efficient in the removal of the increased bronchomotor tone, causing significant decrease of the resistance (Raw), respectively of the specific resistance (SRaw), (p value 0.05 = Alpha 0.05). Conclusion: Formation of leukotrienes depends on the lypoxygenation of the arachidonic acid by 5-lypoxygenase. Zileuton is an active and powerful inhibitor of the activity of 5- lypoxygenase and as such inhibits generation of its products. Consequently, besides inhibition of cys-LTs’, zileuton also inhibits the formation of leukotriene B4 (LTB4), which is a powerful chemotactic of other eicosanoids too, which depend on the synthesis of lekotriene A4 (LTA4). This suggests that the effect of antileukotrienes (Zileuton) is not immediate after oral administration, but the powerful effect of the Zileuton seen only after two days of inhibition of cys-LTs’, and inhibition of leukotriene B4 (LTB4) and A4 (LTA4).
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Affiliation(s)
- Naim Morina
- Department of Pharmacy, Faculty of Medicine. University of Prishtina. Clinical Centre, Mother Theresa Str., Prishtina. Kosova
| | - Gëzim Boçari
- Department of Pharmacology, Faculty of Medicine. University of Tirana, Albania
| | - Ali Iljazi
- Kosovo Occupational Health Institute, Clinical Centre N.N., Gjakova, Kosova
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15
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Bao W, Liu P, Qiu Z, Yu L, Hang J, Gao X, Zhou X. Efficacy of add-on montelukast in nonasthmatic eosinophilic bronchitis: the additive effect on airway inflammation, cough and life quality. Chin Med J (Engl) 2015; 128:39-45. [PMID: 25563311 PMCID: PMC4837817 DOI: 10.4103/0366-6999.147805] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The efficacy of montelukast (MONT), a cysteinyl leukotriene receptor antagonist, in nonasthmatic eosinophilic bronchitis (NAEB), especially its influence on cough associated life quality is still indefinite. We evaluated the efficacy of MONT combined with budesonide (BUD) as compared to BUD monotherapy in improving life quality, suppressing airway eosinophilia and cough remission in NAEB. Methods: A prospective, open-labeled, multicenter, randomized controlled trial was conducted. Patients with NAEB (aged 18-75 years) were randomized to inhaled BUD (200 μg, bid) or BUD plus oral MONT (10 μg, qn) for 4 weeks. Leicester cough questionnaire (LCQ) life quality scores, cough visual analog scale (CVAS) scores, eosinophil differential ratio (Eos), and eosinophil cationic protein (ECP) in induced sputum were monitored and compared. Results: The control and MONT groups contained 33 and 32 patients, respectively, with similar baseline characteristics. Significant with-in group improvement in CVAS, LCQ scores, Eos, and ECP was observed in both groups during treatment. After 2-week treatment, add-on treatment of MONT was significantly more effective than BUD monotherapy for CVAS decrease and LCQ scores improvement (both P < 0.05). Similar results were seen at 4-week assessment (both P < 0.05). 4-week add-on therapy of MONT also resulted in a higher percentage of patients with normal sputum Eos (<2.5%) and greater decrease of ECP (both P < 0.05). Conclusions: MONT combined with BUD was demonstrated cooperative effects in improvement of life quality, suppression of eosinophilic inflammation, and cough remission in patients with NAEB.
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Affiliation(s)
| | | | | | | | | | | | - Xin Zhou
- Department of Respiratory Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
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16
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Hartwig C, Munder A, Glage S, Wedekind D, Schenk H, Seifert R, Neumann D. The histamine H4 -receptor (H4 R) regulates eosinophilic inflammation in ovalbumin-induced experimental allergic asthma in mice. Eur J Immunol 2015; 45:1129-40. [PMID: 25501767 DOI: 10.1002/eji.201445179] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/18/2014] [Accepted: 12/09/2014] [Indexed: 01/05/2023]
Abstract
Via the histamine H4 -receptor (H4 R), histamine promotes the pathogenesis of experimental allergic asthma in mice. Application of H4 R antagonists during sensitization as well as during provocation reduces the severity of the disease. However, the specific cell types functionally expressing H4 R in experimental allergic asthma have not been well characterized in vivo. In this study, we identified the cell type(s) responsible for H4 R activity in experimental asthma and related physiological mechanisms. Using H4 R-deficient mice, we studied the role of H4 R in the sensitization and effector phase. DCs lacking H4 R expression during the in vitro sensitization reaction resulted in effector T cells unable to induce an entire eosinophilic inflammation in the lung upon adoptive transfer in vivo. Recipient mice lacking H4 R expression, which were adoptively transferred with H4 R(+/+) T cells polarized in the presence of H4 R(+/+) DCs, showed reduced signs of inflammation and ameliorated lung function. Here, we provide in vivo evidence that in experimental asthma in mice the H4 R specifically regulates activation of DCs during sensitization, while in the effector phase the H4 R is active in cells involved in the activation of eosinophils, and possibly other cells. A putative therapy targeting the H4 R may be an option for asthma patients developing IL-5-dependent eosinophilia.
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Affiliation(s)
- Christina Hartwig
- Institute of Pharmacology, Hannover Medical School, Hannover, Germany
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17
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Kiykac Altinbas S, Tapisiz OL, Cavkaytar S, Simsek G, Oguztuzun S, Goktolga U. Is montelukast effective in regression of endometrial implants in an experimentally induced endometriosis model in rats? Eur J Obstet Gynecol Reprod Biol 2014; 184:7-12. [PMID: 25462212 DOI: 10.1016/j.ejogrb.2014.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 10/10/2014] [Accepted: 10/22/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Montelukast, a selective antagonist of Type 1 cysteinyl leukotriene receptors (CysLT1Rs), antagonizes the proinflammatory and proasthmatic activities of CysLT1Rs. We investigated the effect of montelukast on a surgically induced endometriosis rat model. STUDY DESIGN Thirty-two sexually mature, cycling, female Wistar-Albino rats, in which endometriotic implants were surgically induced, were randomly divided into three groups. Group I [Montelukast (M), 10 rats)] was given 1.6 mg/kg/day of oral montelukast sodium. Group II [Leuprolide acetate (L), 11 rats] was given 1 mg/kg single dose of s.c.leuprolide acetate. Group III [Control (C), 11 rats] received saline solution through an orogastric tube and served as controls. After a 3-weeks medication, the rats were sacrificed to investigate the endometriotic implants for size and morphological and histological characteristics, including immunoreactivity of MMP-2 and VEGF. RESULTS The mean area of implants decreased from 48.2 ± 24.7 to 29.3 ± 15.8mm(2) in Group I (M) (P = 0.008) and from 62 ± 32.1 to 39.9 ± 18.1mm(2) in Group II (L) (P=0.003). In Group III (C), the mean area increased from 41.1 ± 31.1 to 60.4 ± 37.1mm(2) (P = 0.025). Histopathological analysis showed statistically significant lower scores in rats treated with montelukast compared to leuprolide and controls. MMP H scores were not different between the groups in both epithelial and stromal MMP-2 immunostaining. VEGF H scores were statistically lower in Group 1 (M) in epithelial VEGF immunostaining when compared to Group II (L) and Group III (C) (P=0.006). CONCLUSION(S) Montelukast may effectively cause a significant decrease in the area of endometriotic implants.
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Affiliation(s)
- Sadiman Kiykac Altinbas
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Omer Lutfi Tapisiz
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Sabri Cavkaytar
- Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Gulcin Simsek
- Kecioren Education and Research Hospital, Department of Pathology, Ankara, Turkey
| | - Serpil Oguztuzun
- Kirikkale University School of Medicine, Department of Biology, Kirikkale, Turkey
| | - Umit Goktolga
- Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
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Ikeda G, Miyahara N, Koga H, Fuchimoto Y, Waseda K, Kurimoto E, Taniguchi A, Tanimoto Y, Kataoka M, Tanimoto M, Kanehiro A. Effect of a cysteinyl leukotriene receptor antagonist on experimental emphysema and asthma combined with emphysema. Am J Respir Cell Mol Biol 2014; 50:18-29. [PMID: 23937413 DOI: 10.1165/rcmb.2012-0418oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The incidence of overlapping bronchial asthma and chronic obstructive pulmonary disease has increased in recent years. Cysteinyl leukotrienes (CysLTs) play an important role in asthma, and the type 1 CysLT receptor (CysLT1R) is expressed by many inflammatory cells. We evaluated the effect of montelukast, a CysLT1R antagonist, on mouse models of asthma, porcine pancreatic elastase (PPE)-induced emphysema, and asthma combined with emphysema. Mice were sensitized with ovalbumin (OVA) on Days 0 and 14 and subsequently challenged with OVA on Days 28, 29, and 30. Pulmonary emphysema was induced by intratracheal instillation of PPE on Day 25. Mice were treated subcutaneously with montelukast or vehicle from Day 25 to Day 31. Airway hyperresponsiveness (AHR), static compliance; the number of inflammatory cells, the levels of cytokines, chemokines, LTs, and perforin in the bronchoalveolar lavage fluid, and the quantitative morphometry of lung sections were analyzed on Day 32. Treatment with montelukast significantly attenuated the AHR and eosinophilic airway inflammation in OVA-sensitized and OVA-challenged mice. Administration of montelukast significantly reduced the AHR, static compliance, and neutrophilic airway inflammation, while attenuating emphysematous lung changes, in PPE-treated mice. In PPE-treated mice subjected to allergen sensitization and challenges, montelukast significantly suppressed the AHR, static compliance, and eosinophilic and neutrophilic airway inflammation in addition to the development of experimentally induced emphysema in the lungs. Our data suggest that CysLT1R antagonists may be effective in ameliorating the consequences of PPE-induced lung damage and the changes that follow allergen sensitization and challenges.
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Affiliation(s)
- Genyo Ikeda
- 1 Department of Hematology, Oncology, Allergy and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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19
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Kahnt AS, Rörsch F, Diehl O, Hofmann B, Lehmann C, Steinbrink SD, Angioni C, Geisslinger G, Grösch S, Steinhilber D, Maier TJ. Cysteinyl leukotriene-receptor-1 antagonists interfere with PGE2 synthesis by inhibiting mPGES-1 activity. Biochem Pharmacol 2013; 86:286-96. [PMID: 23684692 DOI: 10.1016/j.bcp.2013.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/07/2013] [Accepted: 05/07/2013] [Indexed: 01/28/2023]
Abstract
Because of their favourable safety profile and beneficial anti-inflammatory properties, the CysLT1 receptor antagonists (LTRA), montelukast, zafirlukast and pranlukast are approved for the treatment of asthma and are frequently prescribed as add-on therapeutics to reduce the amount of inhaled glucocorticoids and β2-agonists. There is evidence that some of these anti-inflammatory properties might be of a secondary nature and therefore, unrelated to the CysLT1 antagonism. Here, we show that LTRA inhibit PGE2 formation in cytokine-stimulated Hela and A549 carcinoma cells and in lipopolysaccharide (LPS)-stimulated human leukocyte preparations (IC50∼20μM). Neither expression of enzymes involved in PGE2 synthesis nor arachidonic acid release and COX activities were inhibited by the compounds. In contrast, mPGES-1 activity was suppressed at low micromolar levels (IC50 between 2 and 4μM). This suppression was specific for PGE2 synthesis, since PGD2 and PGI2 levels in LPS-stimulated leukocyte preparations were not negatively affected. PGF2α levels were concomitantly inhibited, probably due to its direct synthesis from PGE2. Several major conclusions can be drawn from this study: (A) clinical trials investigating elevated doses of the compounds are helpful to confirm suppression of PGE2 synthesis in vivo; (B) studies investigating the role of CysLTs in cell culture or animal models of inflammation and cancer have to be reassessed carefully, if higher doses of LTRA were applied or serum levels in cell culture assays were low; and (C) LTRA may serve as new scaffolds for the development of potent, selective and well tolerated mPGES-1 inhibitors.
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Affiliation(s)
- Astrid Stefanie Kahnt
- Goethe-University, Institute of Pharmaceutical Chemistry, ZAFES, Max-von-Laue-Str. 9, D-60438 Frankfurt/Main, Germany.
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20
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Neuronal modulation of airway and vascular tone and their influence on nonspecific airways responsiveness in asthma. J Allergy (Cairo) 2012; 2012:108149. [PMID: 23150736 PMCID: PMC3485909 DOI: 10.1155/2012/108149] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 09/28/2012] [Indexed: 01/08/2023] Open
Abstract
The autonomic nervous system provides both cholinergic and noncholinergic neural inputs to end organs within the airways, which includes the airway and vascular smooth muscle. Heightened responsiveness of the airways to bronchoconstrictive agents is a hallmark feature of reactive airways diseases. The mechanisms underpinning airways hyperreactivity still largely remain unresolved. In this paper we summarize the substantial body of evidence that implicates dysfunction of the autonomic nerves that innervate smooth muscle in the airways and associated vasculature as a prominent cause of airways hyperresponsiveness in asthma.
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21
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Wenzel SE. Tissue-based and bronchoalveolar lavage-based biomarkers in asthma. Immunol Allergy Clin North Am 2012; 32:401-11. [PMID: 22877618 DOI: 10.1016/j.iac.2012.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In this article, tissue and bronchoalveolar lavage biomarkers of asthma are evaluated for their use in asthma and evaluated in the context of the phenotype that they may best represent. It is hoped that studies that better link biomarkers to specific phenotypes will eventually improve the ability to evaluate genetic features, diagnose, measure progression, and tailor treatments. Although some biomarkers may only be associated with disease, it is also likely that some may be mechanistically involved. Some of these biomarkers may then also become targets for specific treatment.
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Affiliation(s)
- Sally E Wenzel
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, Asthma Institute, University of Pittsburgh Medical Center, Montefiore Hospital, PA 15213, USA.
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22
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Abstract
Asthma is an inflammatory disease characterized by airways obstruction, airways hyperresponsiveness, excessive mucous secretion and cough. Guinea pig airways display many anatomical, physiological and pharmacological attributes of human airways, making this species ideal for modeling the asthmatic condition. This unit provides an overview of animal models of asthma, including definitions, descriptions of available animal models, and discussion of numerous critical issues to consider before designing a model to study this complex disease.
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23
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Kazani S, Sadeh J, Bunga S, Wechsler ME, Israel E. Cysteinyl leukotriene antagonism inhibits bronchoconstriction in response to hypertonic saline inhalation in asthma. Respir Med 2010; 105:667-73. [PMID: 21169002 DOI: 10.1016/j.rmed.2010.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 11/21/2010] [Accepted: 11/23/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND In asthma, cysteinyl leukotrienes (CysLTs) play varying roles in the bronchomotor response to multiple provocative stimuli. The contribution of CysLTs on the airway's response to hypertonic saline (HS) inhalation in asthma is unknown. Whether polymorphisms in the leukotriene biosynthetic pathway affect the contribution of CysLTs to this response is also unknown. METHODS In a prospective, randomized, double-blind, placebo-controlled cross-over study, mild and moderate asymptomatic asthmatics underwent inhaled 3% HS challenge by doubling the duration of nebulization (0.5, 1, 2, 4, and 8 min) 2 h after one dose of montelukast (a CysLT receptor 1 [CysLTR1] antagonist) or placebo, and after three-week courses. We examined the effect of the leukotriene C(4) synthase (LTC(4)S) polymorphism (A-444C) on the efficacy of montelukast against HS inhalation in an exploratory manner. RESULTS In 37 subjects, 2 h after administration of montelukast, the mean provocative dose of HS required to cause a 20% drop in FEV(1) (HS-PD(20)) increased by 59% (9.17 ml after placebo vs. 14.55 ml after montelukast, p=0.0154). Three weeks of cysLTR1 antagonism increased the HS-PD(20) by 84% (10.97 vs. 20.21 ml, p=0.0002). Three weeks of CysLTR1 antagonism appeared to produce greater effects on blocking bronchial hyper-responsiveness (2 h vs. three-week HS-PD(20) values 14.55 vs. 20.21 ml respectively, p=0.0898). We did not observe an effect of the LTC(4)S polymorphism on the response to CysLTR1 antagonism in this cohort. CONCLUSIONS A significant proportion of HS-induced bronchoconstriction is mediated by release of leukotrienes as evidenced by substantial acute inhibition with a CysLTR1 antagonist. There was a trend toward greater inhibition of bronchial responsiveness with three weeks of therapy as opposed to acute CysLTR1 antagonism. Clinicaltrials.gov registration number NCT00116324.
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Affiliation(s)
- Shamsah Kazani
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, PBB Clinics 3, 75 Francis Street, Boston, MA 02115, USA.
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24
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Han J, Jia Y, Takeda K, Shiraishi Y, Okamoto M, Dakhama A, Gelfand EW. Montelukast during primary infection prevents airway hyperresponsiveness and inflammation after reinfection with respiratory syncytial virus. Am J Respir Crit Care Med 2010; 182:455-63. [PMID: 20442434 PMCID: PMC2937239 DOI: 10.1164/rccm.200912-1811oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 04/28/2010] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Respiratory syncytial virus (RSV) bronchiolitis in infants may be followed by the development of asthma-like symptoms. Age at first infection dictates consequences upon reinfection. Reinfection of mice initially exposed as neonates to RSV enhanced development of airway hyperresponsiveness (AHR), eosinophilic inflammation, and mucus hyperproduction. RSV lower respiratory tract disease is associated with activation of the leukotriene pathway. OBJECTIVES To determine the effects of montelukast (MK), a cysteinyl leukotriene (cysLT) receptor antagonist, in primary and secondary RSV-infected newborn and adult mice. METHODS BALB/c mice were infected with RSV at 1 week (neonate) or 6 to 8 weeks (adult) of age and reinfected 5 weeks later. MK was administered 1 day before the initial infection and through Day 6 after infection. Seven days after primary or secondary infection, airway function was assessed by lung resistance to increasing doses of inhaled methacholine; lung inflammation, goblet cell metaplasia, and cytokine levels in bronchoalveolar lavage fluid were monitored. MEASUREMENTS AND MAIN RESULTS RSV infection induced cysLT release in bronchoalveolar lavage fluid. MK decreased RSV-induced AHR, airway inflammation, and increased IFN-gamma production in primary infected adult and neonatal mice. MK, administered during initial infection of neonates but not during secondary infection, prevented subsequent enhancement of AHR, airway eosinophilia, and mucus hyperproduction upon reinfection. CONCLUSIONS MK attenuated the initial responses to primary RSV infection in both age groups and altered the consequences of RSV reinfection in mice initially infected as neonates. These data support an important role for cysLT in RSV-induced AHR and inflammation.
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Affiliation(s)
- Junyan Han
- Division of Cell Biology, Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Yi Jia
- Division of Cell Biology, Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Katsuyuki Takeda
- Division of Cell Biology, Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Yoshiki Shiraishi
- Division of Cell Biology, Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Masakazu Okamoto
- Division of Cell Biology, Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Azzeddine Dakhama
- Division of Cell Biology, Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Erwin W. Gelfand
- Division of Cell Biology, Department of Pediatrics, National Jewish Health, Denver, Colorado
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25
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Djukanović R, Wilson SJ, Moore WC, Koenig SM, Laviolette M, Bleecker ER, Davis WB, Doherty DE, Olivenstein R, Israel E, Kavuru MS, Kleerup E, Reilly DS, Yancey SW, Edwards LD, Stauffer JL, Dorinsky PM, Jarjour NN. Montelukast added to fluticasone propionate does not alter inflammation or outcomes. Respir Med 2010; 104:1425-35. [PMID: 20709517 DOI: 10.1016/j.rmed.2010.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 03/22/2010] [Accepted: 04/05/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Airway inflammation is a key pathological feature of asthma which underlies its clinical presentation. OBJECTIVES To examine whether adding a leukotriene modifier to an inhaled corticosteroid produces further clinical and/or anti-inflammatory benefits in patients symptomatic on short-acting beta(2)-agonists. METHODS Patients uncontrolled on short-acting beta(2)-agonists were treated for 12 weeks with either fluticasone propionate (100mcg BD) or fluticasone propionate (100mcg BD) and montelukast (10mg QD) in a randomized, double-blind, parallel group study. Bronchoscopy with endobronchial biopsy and bronchoalveolar lavage (BAL) was performed before and after treatment to compare effects on airway inflammation. RESULTS Of 103 subjects enrolled, 89 subjects completed treatment and 82 subjects had matched pair biopsy samples. Submucosal eosinophil counts, the primary endpoint, and asthma control improved to similar extents after both treatments (p<or=0.008). Both treatments significantly reduced submucosal mast cell, CD3+, CD4+, CD8+ and CD25+ cell counts. Submucosal mast cell reduction was greater in the fluticasone propionate plus montelukast group. There were no differences between treatments in BAL markers of inflammation or thickness of sub-epithelial collagen. CONCLUSIONS Low-dose fluticasone propionate significantly improves clinical disease control and reduces airway inflammation in asthma patients uncontrolled with short-acting beta(2)-agonists without further improvement when montelukast is added to low-dose fluticasone propionate.
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Fujiwara H, Konno R, Netsu S, Odagiri K, Taneichi A, Takamizawa S, Ohwada M, Suzuki M. Efficacy of montelukast, a leukotriene receptor antagonist, for the treatment of dysmenorrhea: A prospective, double-blind, randomized, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 2010; 148:195-8. [DOI: 10.1016/j.ejogrb.2009.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 09/03/2009] [Accepted: 10/30/2009] [Indexed: 10/20/2022]
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O'Byrne PM, Gauvreau GM, Murphy DM. Efficacy of leukotriene receptor antagonists and synthesis inhibitors in asthma. J Allergy Clin Immunol 2009; 124:397-403. [PMID: 19608262 DOI: 10.1016/j.jaci.2009.05.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 05/14/2009] [Indexed: 11/16/2022]
Abstract
Cysteinyl leukotrienes are important mediators of asthmatic responses. They are the most potent bronchoconstrictors known; their release is triggered by exposure to inhaled allergens after exercise and after aspirin ingestion by subjects with aspirin-sensitive asthma. The cysteinyl leukotrienes promote inflammatory cell migration into the airways, as well as bone marrow eosinophilopoiesis after allergen inhalation. Leukotriene inhibitors are effective at attenuating asthmatic responses to all of these stimuli and are also effective at treating persistent asthma. These drugs are a viable alternative to low-dose inhaled corticosteroid (ICS) treatment but should be reserved for patients who cannot or will not use ICSs, often because of concerns about potential side effects of ICS treatment, which limits their use, particularly in children. Leukotriene receptor antagonists are also alternatives to long-acting inhaled beta(2)-agonists as add-on therapy to ICSs, but their efficacy together with ICSs is less than that of ICS/long-acting inhaled beta(2)-agonist combinations. Leukotriene receptor antagonists have an excellent safety profile.
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Affiliation(s)
- Paul M O'Byrne
- Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Ontario, Canada.
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28
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Ramsay CF, Sullivan P, Gizycki M, Wang D, Swern AS, Barnes NC, Reiss TF, Jeffery PK. Montelukast and bronchial inflammation in asthma: a randomised, double-blind placebo-controlled trial. Respir Med 2009; 103:995-1003. [PMID: 19249198 DOI: 10.1016/j.rmed.2009.01.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 01/19/2009] [Accepted: 01/19/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Examination of bronchoalveolar lavage, induced sputum, and peripheral blood indicate that cysteinyl leukotriene receptor blockers decrease inflammatory cells in asthma but these do not examine airway tissue per se. OBJECTIVES Our objective was to determine the effect of montelukast, a leukotriene receptor antagonist, on airway tissue inflammatory cells by direct bronchoscopic examination of the bronchial mucosa. METHODS Adult subjects with mild asthma (pre-bronchodilator FEV(1)> or =70% predicted; PC(20) of < or =4 mg/mL) were given 10mg/day oral montelukast (N=38) or placebo (N=37) for 6 weeks. Bronchial mucosal eosinophils and mast cells were identified and counted. RESULTS Change from baseline in numbers of biopsy EG2+ ("activated") eosinophils was the primary endpoint; numbers of total (chromotrope 2R+) eosinophils and (tryptase+) mast cells were secondary. Unexpectedly, there were many patients with zero EG2+ eosinophils at baseline. There was a within-group decrease in EG2+ cells, from 13.54 cells/mm (at baseline) to 0.79 cells/mm at 6 weeks in the montelukast group (LS mean change; 95% confidence interval=-13.59 [-25.45, -1.74]cells/mm; P<0.05), a change not observed in the placebo group (-1.17 [-13.26, 10.91]cells/mm; NS). The zero-inflated Poisson statistical model demonstrated that montelukast significantly reduced post-treatment EG2+ cells by 80% compared with placebo (95% CI [70.6-86.8%]; P<0.0001). The data for total eosinophils showed similar changes. The reduction in mast cell numbers was 12% (95% CI [7.9, 16.0]; P<0.0001). CONCLUSION Direct examination of airway tissue confirms that montelukast decreases the number of eosinophils and mast cells in asthma.
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Affiliation(s)
- C F Ramsay
- Department of Respiratory Medicine, Royal London Hospital, London, UK
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Jeffery PK. The roles of leukotrienes and the effects of leukotriene receptor antagonists in the inflammatory response and remodelling of allergic asthma. ACTA ACUST UNITED AC 2008. [DOI: 10.1046/j.1472-9725.2001.00028.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Spinozzi F, de Benedictis D, de Benedictis FM. Apoptosis, airway inflammation and anti-asthma therapy: from immunobiology to clinical application. Pediatr Allergy Immunol 2008; 19:287-95. [PMID: 18179617 DOI: 10.1111/j.1399-3038.2007.00668.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
T lymphocyte apoptosis is essential for maintaining immune system homeostasis. Experimental evidence suggests apoptosis control mechanisms may be impaired in inflammatory conditions, particularly airway Th2-type allergic diseases. This review briefly examines the mucosal immune system homeostasis and common apoptotic pathways and discusses impaired apoptosis, allergy, airway inflammation, remodelling and fibrosis. Finally, the paper presents an update on pharmacological targeting of apoptosis to control airway inflammation in patients with allergic asthma.
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Affiliation(s)
- Fabrizio Spinozzi
- Department of Clinical and Experimental Medicine, University of Perugia, Italy
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31
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Zhang JY, Wenzel SE. Tissue and BAL based biomarkers in asthma. Immunol Allergy Clin North Am 2008; 27:623-32; vi. [PMID: 17996580 DOI: 10.1016/j.iac.2007.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Asthma is a heterogeneous disease with multiple phenotypes. There are no tissue or bronchoalveolar lavage biomarkers that are "specific" for asthma. Markers associated with eosinophilic, neutrophilic, and paucigranulocytic asthma are discussed here, and those for remodeling. Efforts are to compare tissue and lavage biomarkers with less invasive measures, such as sputum, serum, or exhaled breath, to improve the treatment and management of asthma.
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Affiliation(s)
- June Y Zhang
- Allergy/Immunology Section, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA.
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Amaral MM, Davio C, Ceballos A, Salamone G, Cañones C, Geffner J, Vermeulen M. Histamine improves antigen uptake and cross-presentation by dendritic cells. THE JOURNAL OF IMMUNOLOGY 2007; 179:3425-33. [PMID: 17785776 DOI: 10.4049/jimmunol.179.6.3425] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Previous studies have shown that histamine is able to modulate the function of dendritic cells (DCs). Histamine seems to be required for the normal differentiation of DCs. Moreover, it is capable of stimulating the chemotaxis of immature DCs and of promoting the differentiation of T CD4+ cells into a Th2 profile. In this study, we analyzed whether histamine was able to modulate endocytosis and cross-presentation mediated by immature DCs. Our results show that both functions are stimulated by histamine. Endocytosis of soluble HRP and FITC-OVA and cross-presentation of soluble OVA were markedly increased by histamine. Interestingly, stimulation of endocytosis and cross-presentation appeared to be mediated through different histamine receptors. In fact, the enhancement of endocytosis was prevented by the histamine2 receptor (H2R) antagonist cimetidine, whereas the stimulation of cross-presentation was prevented by the H3R/H4R antagonist thioperamide. Of note, contrasting with the observations made with soluble Ags, we found that histamine did not increase either the uptake of OVA-attached to latex beads, or the cross-presentation of OVA immobilized on latex beads. This suggests that the ability of histamine to increase endocytosis and cross-presentation is dependent on the Ag form and/or the mechanisms through which the Ag is internalized by DCs. Our results support that histamine may favor cross-presentation of soluble allergens by DCs enabling the activation of allergen-specific T CD8+ cells, which appears to play an important role in the development of allergic responses in the airway.
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Affiliation(s)
- Maria Marta Amaral
- Institute of Hematologic Research, National Academy of Medicine and National Reference Center for AIDS, Department of Microbiology, Buenos Aires University School of Medicine, Buenos Aires, Argentina
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Landgraf RG, Nossi DF, Sirois P, Jancar S. Prostaglandins, leukotrienes and PAF selectively modulate lymphocyte subset and eosinophil infiltration into the airways in a murine model of asthma. Prostaglandins Leukot Essent Fatty Acids 2007; 77:163-72. [PMID: 17923399 DOI: 10.1016/j.plefa.2007.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 08/03/2007] [Accepted: 08/13/2007] [Indexed: 10/22/2022]
Abstract
The effects of inhibitors of prostaglandins synthesis, indomethacin and nimesulide, or of receptor antagonists of cysteinyl-leukotrienes, MK571 or of platelet activating factor (PAF), WEB2170, were studied on the infiltration of lymphocytes (Tgammadelta, NKT, CD4, CD8 and B cells) and eosinophils into the bronchoalveolar lavage fluid (BALF) in two mouse strains (C57Bl/6 and BALB/c) as well as on bronchial hyperreactivity and mucus production. It was found that indomethacin and nimesulide strongly reduced the number of all cell types analyzed in both mouse strains. MK571 did not affect Tgammadelta or CD4 lymphocytes but reduced the other populations. WEB2170 reduced all lymphocyte subpopulations in both mouse strains. Moreover, the relative numbers of the lymphocyte subsets in the airways and their response to PAF antagonist were strain-dependent. The intensity of bronchoconstriction and mucus production did not correlate with BALF cell types or numbers. The cysteinyl-leukotriene receptor antagonist inhibited eosinophil infiltration and bronchial hyperreactivity, without affecting the Tgammadelta cell subset. Since Tgammadelta cells play a major role in mucosa protection and resolution of lung inflammation, this would represent an additional benefit of cysteinyl-leukotrienes antagonism in asthma.
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Affiliation(s)
- Richardt G Landgraf
- Universidade de São Paulo, Instituto de Ciências Biomédicas, Departamento de Imunologia, Av. Prof. Lineu Prestes, 1730, CEP 05508-000, São Paulo-SP, Brazil
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Capra V, Thompson MD, Sala A, Cole DE, Folco G, Rovati GE. Cysteinyl-leukotrienes and their receptors in asthma and other inflammatory diseases: critical update and emerging trends. Med Res Rev 2007; 27:469-527. [PMID: 16894531 DOI: 10.1002/med.20071] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cysteinyl-leukotrienes (cysteinyl-LTs), that is, LTC4, LTD4, and LTE4, trigger contractile and inflammatory responses through the specific interaction with G protein-coupled receptors (GPCRs) belonging to the purine receptor cluster of the rhodopsin family, and identified as CysLT receptors (CysLTRs). Cysteinyl-LTs have a clear role in pathophysiological conditions such as asthma and allergic rhinitis (AR), and have been implicated in other inflammatory conditions including cardiovascular diseases, cancer, atopic dermatitis, and urticaria. Molecular cloning of human CysLT1R and CysLT2R subtypes has confirmed most of the previous pharmacological characterization and identified distinct expression patterns only partially overlapping. Interestingly, recent data provide evidence for the immunomodulation of CysLTR expression, the existence of additional receptor subtypes, and of an intracellular pool of CysLTRs that may have roles different from those of plasma membrane receptors. Furthermore, genetic variants have been identified for the CysLTRs that may interact to confer risk for atopy. Finally, a crosstalk between the cysteinyl-LT and the purine systems is being delineated. This review will summarize and attempt to integrate recent data derived from studies on the molecular pharmacology and pharmacogenetics of CysLTRs, and will consider the therapeutic opportunities arising from the new roles suggested for cysteinyl-LTs and their receptors.
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MESH Headings
- Adult
- Animals
- Asthma/drug therapy
- Asthma/physiopathology
- Cardiovascular Diseases/physiopathology
- Child
- Child, Preschool
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/etiology
- Female
- Humans
- Hydroxyurea/adverse effects
- Hydroxyurea/analogs & derivatives
- Leukotriene Antagonists/adverse effects
- Leukotriene Antagonists/therapeutic use
- Leukotriene C4/physiology
- Leukotriene D4/physiology
- Leukotriene E4/physiology
- Membrane Proteins/drug effects
- Membrane Proteins/genetics
- Membrane Proteins/physiology
- Pharmacogenetics
- Receptors, Leukotriene/drug effects
- Receptors, Leukotriene/genetics
- Receptors, Leukotriene/physiology
- Receptors, Purinergic/physiology
- Recombinant Proteins/pharmacology
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/physiopathology
- SRS-A/biosynthesis
- Tissue Distribution
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Affiliation(s)
- Valérie Capra
- Department of Pharmacological Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy.
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Yoshino T, Ishikawa J, Ohga K, Morokata T, Takezawa R, Morio H, Okada Y, Honda K, Yamada T. YM-58483, a selective CRAC channel inhibitor, prevents antigen-induced airway eosinophilia and late phase asthmatic responses via Th2 cytokine inhibition in animal models. Eur J Pharmacol 2007; 560:225-33. [PMID: 17307161 DOI: 10.1016/j.ejphar.2007.01.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 12/25/2006] [Accepted: 01/08/2007] [Indexed: 11/30/2022]
Abstract
T cells play a regulatory role in the pathogenesis of various immune and allergic diseases, including human asthma. Recently, it was reported that a pyrazole derivative, YM-58483 (BTP2), potently inhibits Ca(2+) release-activated Ca(2+) (CRAC) channels and interleukin (IL)-2 production in T cells. We investigated the effects of YM-58483 on T helper type 2 (Th2) cytokine production in vitro and antigen-induced airway asthmatic responses in vivo. YM-58483 inhibited IL-4 and IL-5 production in a conalbumine-stimulated murine Th2 T cell clone (D10.G4.1), and IL-5 production in phytohemagglutinin-stimulated human whole blood cells with IC(50) values comparable to those reported for its CRAC channel inhibition (around 100 nM). YM-58483 inhibited antigen-induced eosinophil infiltration into airways, and decreased IL-4 and cysteinyl-leukotrienes content in inflammatory airways induced in actively sensitized Brown Norway rats. Furthermore, orally administered YM-58483 prevented antigen-induced late phase asthmatic bronchoconstriction and eosinophil infiltration in actively sensitized guinea pigs. These data suggest that the inhibition of Ca(2+) influx through CRAC channel leads to the prevention of antigen-induced airway inflammation, probably via the inhibition of Th2 cytokine production and inflammatory mediators release. YM-58483 may therefore be useful for treating airway inflammation in bronchial asthma.
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Affiliation(s)
- Taiji Yoshino
- Pharmacology Research Laboratories, Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba-shi, Ibaraki 305-8585, Japan.
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Shirasaki H, Kanaizumi E, Seki N, Kikuchi M, Watanabe K, Konno N, Himi T. Distribution of specific binding sites for cysteinyl leukotriene 1 receptor antagonist in human nasal mucosa. Acta Otolaryngol 2006; 126:948-51. [PMID: 16864492 DOI: 10.1080/00016480500540493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONCLUSION The high density of [3H]-pranlukast binding sites on the local leukocytes in human nasal mucosa suggests that CysLT1 receptor antagonists may directly modulate cellular function of the local leukocytes through binding to CysLT1 receptor on allergic nasal mucosa. OBJECTIVES The cysteinyl leukotrienes (CysLTs) are lipid mediators that have been implicated in the pathogenesis of allergic diseases. Pharmacological studies using CysLTs indicate that two classes of receptors named CysLT1 and CysLT2 receptor exist. The former is sensitive to the CysLT1 receptor antagonist currently used to treat asthma and allergic rhinitis. To confirm the binding sites of CysLT1 receptor antagonist in human nasal mucosa, the autoradiographic distribution of CysLT1 receptor was studied in human nasal inferior turbinates. MATERIALS AND METHODS Cryostat sections were incubated with [3H]-pranlukast for autoradiography. Nonspecific binding was determined by adding unlabelled pranlukast. RESULTS Autoradiograms indicated [3H]-pranlukast densely labeled on the interstitial cells. Blood vessels were sparsely labeled. There was no specific labeling in the submucosal glands or epithelium. These results support our previous report from in situ hybridization and immunohistochemistry of CysLT1 receptor.
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Affiliation(s)
- Hideaki Shirasaki
- Department of Otolaryngology, Sapporo Medical University, School of Medicine, Sapporo, Japan.
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Fullmer JJ, Khan AM, Elidemir O, Chiappetta C, Stark JM, Colasurdo GN. Role of cysteinyl leukotrienes in airway inflammation and responsiveness following RSV infection in BALB/c mice. Pediatr Allergy Immunol 2005; 16:593-601. [PMID: 16238585 DOI: 10.1111/j.1399-3038.2005.00248.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cysteinyl leukotrienes (CysLTs) contribute to the development of airway obstruction and inflammation in asthma; however little information is available on the role of these molecules in the pathophysiology of respiratory syncytial virus (RSV) bronchiolitis. This study was designed to evaluate the effects of RSV infection on CysLTs production in a well-established mouse infection model. Furthermore, we assessed the effect of anti-inflammatory agents (a leukotriene receptor antagonist, MK-571, and dexamethasone) on the functional and immune changes induced by RSV infection. Six to 8-wk-old BALB/c mice were infected with human RSV (strain A2). Measurements of airway function were performed using whole body plethysmography. Lung inflammation was assessed by cell counts, measurement of cytokines and CysLTs in bronchoalveolar lavage fluid (BALF) in the absence and presence of treatment with MK-571 or dexamethasone. RSV infection produced a marked increase in CysLTs in the BALF and lung tissue, recruitment of neutrophils and lymphocytes into the airways, increased IFN-gamma levels and airway hyperresponsiveness (AHR). Treatment with MK-571 decreased RSV-induced AHR without affecting the cellular and inflammatory responses to RSV. Dexamethasone decreased AHR and markedly reduced the recruitment of inflammatory cells and production of IFN-gamma. Our findings suggest CysLTs play an important role in the pathogenesis of RSV-induced airway dysfunction. Treatment with MK-571 decreases RSV-induced AHR but does not appear to alter the lung inflammatory responses to RSV. In contrast, dexamethasone decreases RSV-induced AHR but interferes with recruitment of inflammatory cells, resulting in decreased Th1 cytokines (a potentially Th2-prone environment) in this model. These studies support recent reports on the beneficial effects of CysLT receptor antagonist in human trials and provide a model for investigating the role of CysLTs in RSV bronchiolitis.
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Affiliation(s)
- Jason J Fullmer
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
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Cakmak G, Demir T, Gemicioglu B, Aydemir A, Serdaroglu E, Donma O. The effects of add-on zafirlukast treatment to budesonide on bronchial hyperresponsiveness and serum levels of eosinophilic cationic protein and total antioxidant capacity in asthmatic patients. TOHOKU J EXP MED 2005; 204:249-56. [PMID: 15572850 DOI: 10.1620/tjem.204.249] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mild persistent asthma is most effectively controlled with inhaled corticosteroids. Leukotriene receptor antagonists have complementary effects to corticosteroids on inflammation control. The additional effect of a leukotriene receptor antagonist, zafirlukast, was investigated in stable asthma patients under control with inhaled budesonide. We conducted a randomised, double-blind, placebo-controlled, single center trial to investigate the effects of add-on zafirlukast treatment to budesonide, on symptom score, pulmonary function, bronchial responsiveness, and serum levels of eosinophilic cationic protein (ECP) and antioxidant capacity in stable asthmatic patients under control with inhaled budesonide. The present study included 21 mild or moderate asthmatic patients (8 males and 13 females), who were stable at least for 6 weeks with inhaled budesonide (400 microg/day). Serum total antioxidant capacity (TAC) and ECP levels were measured, and symptom scoring, spirometry, and bronchial provocation with methacholine were performed. Then, the patients were randomised to use either placebo or oral zafirlukast (40 mg/day) in addition to budesonide for 6 weeks. At the 6th week, symptom scoring, spirometry, and bronchial provocation tests were repeated and serum TAC and ECP levels were measured again. After add-on zafirlukast treatment to budesonide, forced expiratory volume in 1 second (FEV(1)), TAC and ECP values did not change significantly (p > 0.05) but bronchial hyperresponsiveness and symptom score decreased significantly (p = 0.022) compared to baseline. Thus, in stable asthmatic patients, add-on zafirlukast treatment to budesonide improves symptoms and decreases bronchial hyperresponsiveness.
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Affiliation(s)
- Gulfidan Cakmak
- Department of Pulmonary Diseases, Istanbul University Cerrahpasa Medical of Faculty, Turkey.
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Peters-Golden M, Henderson WR. The role of leukotrienes in allergic rhinitis. Ann Allergy Asthma Immunol 2005; 94:609-18; quiz 618-20, 669. [PMID: 15984591 DOI: 10.1016/s1081-1206(10)61317-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review the role of cysteinyl leukotrienes (cysLTs) in allergic rhinitis and the scientific rationale for therapy with leukotriene receptor antagonists (LTRAs). DATA SOURCES Relevant basic science and clinical articles were identified by a search of the PubMed database for articles published from 1984 to 2004 using the following keywords: allergic rhinitis; nose; immune response; allergen challenge; leukotrienes C, D, and E; cysteinyl leukotriene; cysteinyl leukotriene receptor; cytokine; leukocyte; montelukast; zafirlukast; and pranlukast. STUDY SELECTION The authors' expert opinion was used to select studies for inclusion in this review. RESULTS CysLTs are synthesized via 5-lipoxygenase metabolism of arachidonic acid by mast cells and basophils during the early-phase response to antigen and by eosinophils and macrophages during the late phase. The cysLT levels in nasal secretions are elevated after short-term allergen instillation and in allergy season in patients with allergic rhinitis. These lipid mediators act locally and systemically by interacting with receptors, particularly the cysLT1 receptor, on target cells. Evidence derived from topical application of cysLTs in the nose and from the effects of LTRAs indicates that cysLTs contribute to nasal mucous secretion, congestion, and inflammation. CysLTs promote allergic inflammation by enhancing immune responses and the production, adhesion, migration, and survival of inflammatory cells such as eosinophils. They also increase the generation of an array of other proinflammatory mediators, such as cytokines, which in turn increase the production of and receptors for cysLTs. Clinical trials have demonstrated that LTRAs have significant but modest efficacy as single agents but additive efficacy when used with other classes of agents. CONCLUSIONS CysLTs fulfill the criteria for relevant mediators of allergic rhinitis via their diverse effects on immune, inflammatory, and local structural components of disease. By blocking the cysLT1 receptor responsible for most of these effects, LTRAs represent a useful approach to treatment of this important and prevalent disorder.
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Affiliation(s)
- Marc Peters-Golden
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109-0642, USA.
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Riccioni G, Di Ilio C, D'Orazio N. An update of the leukotriene modulators for the treatment of asthma. Expert Opin Investig Drugs 2005; 13:763-76. [PMID: 15212617 DOI: 10.1517/13543784.13.7.763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bronchial asthma is a chronic inflammatory airway disease involving many cells and mediators. Chronic inflammation constitutes an important predisposing condition for airway remodelling with secondary irreversible airflow obstruction. Current approaches for asthma treatment involve many classes of drugs, adequate patient education for their correct use, environmental exposure control and daily monitoring of pulmonary function. Unfortunately, the use of multiple therapies complicates treatment regimens, thus leading to a reduced compliance to therapy. Available evidence from randomised clinical trials and real-word experience derived from managing patients with asthma justifies a broader role for leukotriene receptor antagonist drugs in asthma management than that recommended in the National Asthma Education and Prevention Programme and National Health Lung and Blood Institute Treatment Guidelines. While a low dose of inhaled corticosteroids remains the reference drug as a controller in mild-to-moderate persistent asthma, oral therapy with an leukotriene-receptor antagonist drug represents a good option providing the clinical efficacy requested in common clinical practice. For this reason the recent Global Initiative for Asthma Guidelines allocate this drug to the second and third steps of asthma treatment.
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Affiliation(s)
- Graziano Riccioni
- G D'Annunzio University, Department of Biomedical Science, Via dei Vestini 66013, 66100 Chieti, Italy.
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Busse WW, Wanner A, Adams K, Reynolds HY, Castro M, Chowdhury B, Kraft M, Levine RJ, Peters SP, Sullivan EJ. Investigative bronchoprovocation and bronchoscopy in airway diseases. Am J Respir Crit Care Med 2005; 172:807-16. [PMID: 16020805 PMCID: PMC2718402 DOI: 10.1164/rccm.200407-966ws] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Basic and clinical research strategies used for many lung diseases have depended on volunteer subjects undergoing bronchoscopy to establish access to the airways to collect biological specimens and tissue, perhaps with added bronchoprovocation in asthma syndromes. These procedures have yielded a wealth of important scientific information. Since the last critical review more than a decade ago, some of the techniques and applications have changed, and untoward events have occurred, raising safety concerns and increasing institutional review scrutiny. OBJECTIVES AND METHODS To reappraise these investigational methods in the context of current knowledge, the National Heart, Lung, and Blood Institute and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health convened a working group to review these procedures used for airway disease research, emphasizing asthma and chronic obstructive pulmonary disease. MAIN RESULTS The group reaffirmed the scientific importance of investigative bronchoscopy and bronchoprovocation, even as less invasive technologies evolve. The group also considered the safety of bronchoscopy and bronchoprovocation with methacholine and antigen to be acceptable for volunteer subjects and patients, but stressed the need to monitor this closely and to emphasize proper training of participating medical research personnel. Issues were raised about vulnerable volunteers, especially children who need surrogates for informed consent. CONCLUSION This review of investigative bronchoscopy and bronchoprovocation could serve as the basis for future guidelines for the use of these procedures in the United States.
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Spinozzi F, Russano AM, Piattoni S, Agea E, Bistoni O, de Benedictis D, de Benedictis FM. Biological effects of montelukast, a cysteinyl-leukotriene receptor-antagonist, on T lymphocytes. Clin Exp Allergy 2005; 34:1876-82. [PMID: 15663562 DOI: 10.1111/j.1365-2222.2004.02119.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Montelukast (MNT), a cysteinyl-leukotriene receptor (Cys-LTR) antagonist, has anti-inflammatory activity in the treatment of allergic diseases. If this effect is due only to blocking leukotrienes or also owing to inhibiting proliferation and survival of inflammatory cells, is actually unknown. OBJECTIVE Testing the hypothesis that MNT could influence T lymphocyte functional behaviour in vitro. METHODS Normal T lymphocytes were analysed for surface expression of Cys-LTR(1) and Cys-LTR(2) by means of monoclonal antibodies (mAbs), in the resting state and after activation with T helper type 2 cytokine or T cell receptor (TcR) stimulation. Proliferative activity, as well as IL-4 andIFN-gamma production, were simultaneously determined in samples exposed to molar concentrations of MNT from 10(-8) to 10(-5). Programmed cell death in cultured samples was evaluated by means of propidium iodide and fluorescein isothiocyanate-conjugated anti-Annexin V mAb staining. The complementary DNA microarray technique was adopted to identify gene products involved in apoptosis induction. RESULTS Resting T cells expressed low levels of Cys-LTR. Upon anti-CD3 mAb activation, a progressive increase in Cys-LTR(1) and -LTR(2) expression was observed. Exposure to MNT reduced proliferative response to TcR engagement, increased IFN-gamma production and led to apoptosis at minimal concentrations of 10(-6) M. A progressive loss in BAD and B cell lymphoma/leukaemia-2 activities, and an increase in the expression of CD27, TRAF3, TRAIL, p53 and Fas genes were also observed. CONCLUSIONS Biological effects of MNT delineate a complex picture of gene activation and repression, probably induced by Cys-LTR blockade. The induction of apoptosis in allergen-specific T cell population, as a final result, appears fundamental in the treatment of asthma.
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Affiliation(s)
- F Spinozzi
- Laboratory of Experimental Immunology and Allergy, Department of Clinical and Experimental Medicine, University of Perugia, I-06122 Perugia, Italy.
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Rouhani FN, Meitin CA, Kaler M, Miskinis-Hilligoss D, Stylianou M, Levine SJ. Effect of tumor necrosis factor antagonism on allergen-mediated asthmatic airway inflammation. Respir Med 2005; 99:1175-82. [PMID: 16085220 DOI: 10.1016/j.rmed.2005.02.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess whether tumor necrosis factor (TNF) antagonism can attenuate eosinophilic airway inflammation in patients with mild-to-moderate allergic asthma. DESIGN Randomized, double-blind, placebo-controlled trial. SETTING National Institutes of Health (NIH) Clinical Center. PATIENTS Twenty-six patients with mild-to-moderate allergic asthma, receiving only inhaled beta-2-agonists, who demonstrated both an early and late phase response to inhalational allergen challenge. INTERVENTION Injection of a soluble TNF receptor (TNFR:Fc, etanercept, Enbrel) or placebo, 25mg subcutaneously, twice weekly for 2 weeks, followed by a bronchoscopic segmental allergen challenge. MEASUREMENTS The primary outcome measure was whether TNFR:Fc can access the lung and inhibit TNF bioactivity. Secondary outcome measures included pulmonary eosinophilia, Th2-type cytokines, and airway hyperresponsiveness. RESULTS Anti-TNF therapy was associated with transient hemiplegia in one patient, which resulted in suspension of the study. Data from the 21 participants who completed the study were analyzed. Following treatment, patients receiving anti-TNF therapy had significantly increased TNFR2 levels in epithelial lining fluid (ELF) (P<0.001), consistent with delivery of TNFR:Fc to the lung. TNF antagonism did not attenuate pulmonary eosinophilia and was associated with an increase in ELF IL-4 levels (P=0.033) at 24h following segmental allergen challenge. TNF antagonism was not associated with a change in airway hyperresponsiveness to methacholine. CONCLUSIONS TNF antagonism may not be effective for preventing allergen-mediated eosinophilic airway inflammation in mild-to-moderate asthmatics. Transient hemiplegia, which may mimic an evolving stroke, may be a potential toxicity of anti-TNF therapy.
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Affiliation(s)
- Farshid N Rouhani
- Pulmonary-Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 6D03, MSC 1590, Bethesda, MD 20892-1590, USA
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Laitinen A, Lindqvist A, Halme M, Altraja A, Laitinen LA. Leukotriene E(4)-induced persistent eosinophilia and airway obstruction are reversed by zafirlukast in patients with asthma. J Allergy Clin Immunol 2005; 115:259-65. [PMID: 15696079 DOI: 10.1016/j.jaci.2004.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND We have shown that inhalation of leukotriene (LT) E 4 contributes to specific recruitment of eosinophils to the airway mucosa in patients with asthma at the time of maximal decrease in airway-specific conductance. OBJECTIVE We examined the ability of the cysteinyl LT 1 receptor antagonist, zafirlukast, to improve or prevent LT-mediated eosinophilia and airway obstruction in asthma. METHODS Bronchial biopsies were taken and pulmonary function was measured before and 4 to 6 hours after the dose of inhaled LTE 4 causing a > or =15% fall in FEV 1 at baseline both at week 0 and after 6-week randomly assigned treatment with a high dose of zafirlukast, 80 mg twice daily. RESULTS Leukotriene E 4 inhalation at week 0 doubled the number of eosinophils in the airway mucosa in 21 of 25 patients with mild asthma, increased the numbers of neutrophils and lymphocytes, and decreased FEV 1 (-17%). Zafirlukast reduced both airway eosinophilia and obstruction in FEV 1 , whereas with a double-blind placebo treatment, the effect of LTE 4 on both parameters persisted for 6 weeks. On repeat LTE 4 inhalation challenge after 6 weeks, zafirlukast treatment prevented further airway eosinophilia and decrease in FEV 1 seen in the placebo group. CONCLUSION Persistent LTE 4 -induced airway eosinophilia may form the basis of an amplification mechanism for further eosinophil recruitment. Zafirlukast prevents LTE 4 -induced eosinophilic airway inflammation in mild asthma.
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Affiliation(s)
- Annika Laitinen
- Institute of Biomedicine, Department of Anatomy, University of Helsinki, Helsinki, Finland
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Hoshino M. Impact of inhaled corticosteroids and leukotriene receptor antagonists on airway remodeling. Clin Rev Allergy Immunol 2005; 27:59-64. [PMID: 15347851 DOI: 10.1385/criai:27:1:059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Asthma is a chronic inflammatory disease of the airways that is characterized by the presence of inflammatory cells and remodeling, a term used to define complex morphological changes involving all the structures of the bronchial wall (e.g., goblet cell hyperplasia of the epithelium, thickening of reticular basement membrane, increases of airway smooth muscle[ASM], and blood vessels). An important factor in the pathophysiology of asthma is the recognition that airway inflammation and airway remodeling are linked, as they are in other chronic inflammatory diseases. First-line therapy of persistent asthma involves the use of inhaled corticosteroids to control the underlying inflammation of the airways. Because remodeling of the airway wall is thought to be a result of chronic inflammation within the bronchial wall, it follows that because steroids reduce or reverse inflammation, they may also prevent or modulate remodeling. It has been revealed that steroids improve the subepithelial fibrosis and also significantly reduce airway vascularity. The cysteinyl leukotrienes receptor antagonists may also be helpful regarding the targeting of the inflammation and remodeling in asthma. However,long-term studies were needed to appreciate the prevention and treatment of remodeling by drug therapies.
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Affiliation(s)
- Makoto Hoshino
- Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan; 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
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Overbeek SE, O'Sullivan S, Leman K, Mulder PGH, Hoogsteden HC, Prins JB. Effect of montelukast compared with inhaled fluticasone on airway inflammation. Clin Exp Allergy 2005; 34:1388-94. [PMID: 15347371 DOI: 10.1111/j.1365-2222.2004.02041.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inhaled corticosteroids are currently regarded as the gold standard in anti-inflammatory therapy, however, leukotriene receptor antagonists have been ascribed anti-inflammatory properties. OBJECTIVE We directly compared the anti-inflammatory effects of inhaled fluticasone propionate (FP, 100 microg Diskus, twice daily) and oral montelukast (MON 10 mg, nocte) in bronchial biopsies of patients with asthma in a double-blind, double-dummy, parallel-group design. METHODS Bronchial biopsies, serum and urine samples were collected from 36 atopic asthmatics before and after 8 weeks of treatment. Activated T cells (CD25+), eosinophils (MBP+) and mast cells (tryptase+) were analysed by immunohistochemistry. Serum eosinophil cationic protein (ECP) and IL-5 were analysed by radio and enzyme immunoassay (EIA), respectively. Urinary 9alpha-11beta-PGF2 and leukotriene E4 (LTE4) were measured by EIA. RESULTS A comparison of changes from baseline [FP/MON ratio (95% confidence interval)] of activated T cells was not different when subjects were treated with FP compared to treatment with MON [1.00 (0.18-4.86); P=0.924]. Following treatment, mast cells in the FP group were significantly lower than in the group treated with MON [0.39 (0.16-0.97); P=0.041]. There was no difference in the number of eosinophils in the lamina propria following either treatment [0.54 (0.05-2.57); P=0.263]. However, treatment with FP resulted in a significantly greater decrease in serum ECP, compared to treatment with MON [0.37 (0.25-0.71); P=0.002]. CONCLUSIONS FP appears to be superior to MON as an anti-inflammatory therapy in mild asthmatics.
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Affiliation(s)
- S E Overbeek
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Kim JH, Lee SY, Kim HB, Kim BS, Shim JY, Hong TJ, Hong SJ. Prolonged effect of montelukast in asthmatic children with exercise-induced bronchoconstriction. Pediatr Pulmonol 2005; 39:162-6. [PMID: 15633203 DOI: 10.1002/ppul.20156] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Accumulating evidence shows that cysteinyl leukotrienes are the most important mediators in exercise-induced bronchoconstriction (EIB). In contrast to several studies in adults, there are few long-term studies of leukotriene receptor antagonists (LTRAs) in children with EIB. The aim of this study was to assess the prolonged clinical and bronchoprotective effects of montelukast in asthmatic children with EIB. We randomly assigned 64 asthmatic children with EIB. Forty subjects received montelukast (5 mg/day), and 24 subjects received placebo once daily for 8 weeks. Exercise challenge was performed before and after 8 weeks of treatment. Of the 40 patients in the montelukast group, 28 patients crossed over after 8 weeks. The response was measured as asthma symptom score, maximum percent fall in forced expiratory volume in 1 sec (FEV(1)) from pre-exercise baseline, and time to recovery of FEV(1) to within 10% of pre-exercise baseline (time to recovery). Following 8 weeks of treatment with montelukast, the montelukast group compared with placebo showed significant improvements in all endpoints, including asthma symptom score, maximum percent fall in FEV(1) after exercise, and time to recovery. In the cross-over group, even 8 weeks after stopping montelukast treatment, all endpoints were significantly and persistently improved. These results indicate that montelukast provides clinical protection from airway hyperresponsiveness in asthmatic children with EIB, and suggest that LTRAs may be useful for the long-term management of asthmatic children with EIB.
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Affiliation(s)
- Ja-Hyung Kim
- Department of Pediatrics, Ulsan University Hospital, Ulsan, Korea
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Kurowski M, Kuna P, Górski P. Montelukast plus cetirizine in the prophylactic treatment of seasonal allergic rhinitis: influence on clinical symptoms and nasal allergic inflammation. Allergy 2004; 59:280-8. [PMID: 14982509 DOI: 10.1046/j.1398-9995.2003.00416.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The aim of our study was to investigate effects of 6-week pretreatment of seasonal allergic rhinitis (AR) with cetirizine, and montelukast, alone and in combination. Antihistamine/antileukotriene treatment is effective in AR. Antihistamines may prevent AR symptoms while prophylactic activity of antileukotrienes remains unclear. METHODS Sixty AR patients, aged 18-35 years, were randomized to receive placebo, montelukast only, cetirizine only, or montelukast plus cetirizine, 6 weeks prior and 6 weeks after the beginning of grass pollen season. Mean self-recorded in-season symptom scores and mean weekly all-symptom scores were analyzed. In 31 patients, nasal lavages were performed before treatment, and at the end of the study, i.e. 12 weeks after the treatment initiation. Eosinophil and basophil counts, eosinophil cationic protein (ECP), and mast cell tryptase (MCT) levels were evaluated in lavage samples. RESULTS Combined montelukast/cetirizine pretreatment significantly reduced in-season symptom score for sneezing, eye itching, nasal itching, rhinorrhea, and congestion. Montelukast plus cetirizine were more effective than cetirizine alone in preventing eye itching, rhinorrhea, and nasal itching. Moreover, combined pretreatment with montelukast and cetirizine delayed appearance of AR symptoms. Eosinophil nasal lavage fluid counts were significantly increased during pollen season in placebo and montelukast-only groups. No differences were observed in basophil counts. The in-season ECP level was significantly increased in all groups except montelukast-plus-cetirizine group. In-season MCT levels were not increased. CONCLUSION Combined antihistamine and antileukotriene treatment started 6 weeks before the pollen season is effective in preventing AR symptoms and reduces allergic inflammation in nasal mucosa during natural allergen exposure.
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Affiliation(s)
- M Kurowski
- Division of Pneumonology and Allergology, Department of Medicine, Medical University of Łódź, Łódź, Poland
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Kemp JP. Recent advances in the management of asthma using leukotriene modifiers. ACTA ACUST UNITED AC 2004; 2:139-56. [PMID: 14720013 DOI: 10.1007/bf03256645] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Asthma is a chronic inflammatory disease of the airways that affects approximately 100 million people worldwide. In order to reduce symptoms, improve pulmonary function, and decrease morbidity, current treatment guidelines emphasize the importance of controlling the underlying inflammation in patients with asthma. Leukotrienes are leukocyte-generated lipid mediators that promote airway inflammation. Recognition of the importance of leukotrienes in the pathogenesis of asthma has led to the development of leukotriene modifiers, the first new class of drugs for the treatment of asthma to become available in 25 years. Controlled clinical trials with the four currently used leukotriene modifiers (montelukast, zafirlukast, and zileuton in the US and pranlukast in Japan) have established their efficacy in improving pulmonary function, reducing symptoms, decreasing night-time awakenings, and decreasing the need for rescue medications. They exert anti-inflammatory effects that attenuate cellular infiltration and bronchial hyperresponsiveness and complement the anti-inflammatory properties of inhaled corticosteroids. In patients with moderate and severe asthma, they permit tapering of the corticosteroid dose. In patients with exercise-induced asthma, leukotriene modifiers limit the decline in and quicken the recovery of pulmonary functions without the tolerance issues seen with chronic long-acting beta(2)-adrenoceptor agonist use. In patients with aspirin (acetylsalicylic acid)-induced asthma, they improve pulmonary function and shift the dose response curve to the right, reducing the patient's response to aspirin. In patients with seasonal allergic rhinitis, with or without concomitant asthma, they improve nasal, eye, and throat symptoms as well as quality of life. Leukotriene modifiers are generally safe and well tolerated with adverse effect profiles similar to that of placebo. The one safety issue raised with leukotriene modifiers, Churg-Strauss Syndrome, appears to be the unmasking of an already present syndrome that is manifested when the leukotriene modifiers permit corticosteroid doses to be reduced. Although current treatment guidelines recommend their use in patients with mild persistent asthma, these guidelines were developed just as leukotriene modifiers were coming to the market, before much of the clinical efficacy data were published. Because asthma is a heterogeneous disease, the different asthma phenotypes respond differently to therapies; consequently asthma therapy needs to be individualized. Leukotriene modifiers increase the therapeutic options for patients with asthma and, based on recent data, it is expected that future guidelines will describe expanded uses for these agents in clinical circumstances where these drugs are effective.
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Affiliation(s)
- James P Kemp
- Department of Pediatrics, University of California School of Medicine, San Diego, California 92123, USA.
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