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Jin P, Zhao LS, Zhang TQ, Di H, Guo W. Establishment of a Mouse Model of Mycoplasma pneumoniae-Induced Plastic Bronchitis. Microorganisms 2024; 12:1132. [PMID: 38930514 PMCID: PMC11205551 DOI: 10.3390/microorganisms12061132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Plastic bronchitis (PB) constitutes a life-threatening pulmonary disorder, predominantly attributed to Mycoplasma pneumoniae (MP) infection. The pathogenic mechanisms involved remain largely unexplored, leading to the absence of reliable approaches for early diagnosis and clear treatment. Thus, the present investigation aimed to develop an MP-induced mouse model of PB, thereby enhancing our understanding of this complex condition. In the first stage, healthy BALB/c mice were utilized to investigate the optimal methods for establishing PB. This involved the application of nebulization (15-20 min) and intratracheal administration (6-50 μL) with 2-chloroethyl ethyl sulfide (CEES) concentrations ranging from 4.5% to 7.5%. Subsequently, the MP model was induced by administering an MP solution (2 mL/kg/day, 108 CFU/50 μL) via the intranasal route for a duration of five consecutive days. Ultimately, suitable techniques were employed to induce plastic bronchitis in the MP model. Pathological changes in lung tissue were analyzed, and immunohistochemistry was employed to ascertain the expression levels of vascular endothelial growth factor receptor 3 (VEGFR-3) and the PI3K/AKT/mTOR signaling pathway. The administration of 4.5% CEES via a 6 µL trachea was the optimal approach to establishing a PB model. This method primarily induced neutrophilic inflammation and fibrinous exudate. The MP-infected group manifested symptoms indicative of respiratory infection, including erect hair, oral and nasal secretions, and a decrease in body weight. Furthermore, the pathological score of the MP+CEES group surpassed that of the groups treated with MP or CEES independently. Notably, the MP+CEES group demonstrated significant activation of the VEGFR-3 and PI3K/AKT/mTOR signaling pathways, implying a substantial involvement of lymphatic vessel impairment in this pathology. This study successfully established a mouse model of PB induced by MP using a two-step method. Lymphatic vessel impairment is a pivotal element in the pathogenetic mechanisms underlying this disease entity. This accomplishment will aid in further research into treatment methods for patients with PB caused by MP.
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Affiliation(s)
- Peng Jin
- Department of Respiratory Medicine, Tianjin University Children’s Hospital (Tianjin Children’s Hospital), Tianjin 300134, China; (P.J.)
- Clinical School of Pediatrics, Tianjin Medical University, Tianjin 300070, China
| | - Lin-Sheng Zhao
- Department of Respiratory Medicine, Tianjin University Children’s Hospital (Tianjin Children’s Hospital), Tianjin 300134, China; (P.J.)
| | - Tong-Qiang Zhang
- Department of Respiratory Medicine, Tianjin University Children’s Hospital (Tianjin Children’s Hospital), Tianjin 300134, China; (P.J.)
| | - Han Di
- Department of Respiratory Medicine, Tianjin University Children’s Hospital (Tianjin Children’s Hospital), Tianjin 300134, China; (P.J.)
- Clinical School of Pediatrics, Tianjin Medical University, Tianjin 300070, China
| | - Wei Guo
- Department of Respiratory Medicine, Tianjin University Children’s Hospital (Tianjin Children’s Hospital), Tianjin 300134, China; (P.J.)
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2
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Nick HJ, Johnson CA, Stewart AR, Christeson SE, Bloomquist LA, Appel AS, Donkor AB, Veress LA, Logue BA, Bratcher PE, White CW. Mesna Improves Outcomes of Sulfur Mustard Inhalation Toxicity in an Acute Rat Model. J Pharmacol Exp Ther 2024; 388:576-585. [PMID: 37541763 PMCID: PMC10801720 DOI: 10.1124/jpet.123.001683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023] Open
Abstract
Inhalation of high levels of sulfur mustard (SM), a potent vesicating and alkylating agent used in chemical warfare, results in acutely lethal pulmonary damage. Sodium 2-mercaptoethane sulfonate (mesna) is an organosulfur compound that is currently Food and Drug Administration (FDA)-approved for decreasing the toxicity of mustard-derived chemotherapeutic alkylating agents like ifosfamide and cyclophosphamide. The nucleophilic thiol of mesna is a suitable reactant for the neutralization of the electrophilic group of toxic mustard intermediates. In a rat model of SM inhalation, treatment with mesna (three doses: 300 mg/kg intraperitoneally 20 minutes, 4 hours, and 8 hours postexposure) afforded 74% survival at 48 hours, compared with 0% survival at less than 17 hours in the untreated and vehicle-treated control groups. Protection from cardiopulmonary failure by mesna was demonstrated by improved peripheral oxygen saturation and increased heart rate through 48 hours. Additionally, mesna normalized arterial pH and pACO2 Airway fibrin cast formation was decreased by more than 66% in the mesna-treated group at 9 hour after exposure compared with the vehicle group. Finally, analysis of mixtures of a mustard agent and mesna by a 5,5'-dithiobis(2-nitrobenzoic acid) assay and high performance liquid chromatography tandem mass spectrometry demonstrate a direct reaction between the compounds. This study provides evidence that mesna is an efficacious, inexpensive, FDA-approved candidate antidote for SM exposure. SIGNIFICANCE STATEMENT: Despite the use of sulfur mustard (SM) as a chemical weapon for over 100 years, an ideal drug candidate for treatment after real-world exposure situations has not yet been identified. Utilizing a uniformly lethal animal model, the results of the present study demonstrate that sodium 2-mercaptoethane sulfonate is a promising candidate for repurposing as an antidote, decreasing airway obstruction and improving pulmonary gas exchange, tissue oxygen delivery, and survival following high level SM inhalation exposure, and warrants further consideration.
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Affiliation(s)
- Heidi J Nick
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
| | - Carly A Johnson
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
| | - Amber R Stewart
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
| | - Sarah E Christeson
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
| | - Leslie A Bloomquist
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
| | - Amanda S Appel
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
| | - Abigail B Donkor
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
| | - Livia A Veress
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
| | - Brian A Logue
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
| | - Preston E Bratcher
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
| | - Carl W White
- Department of Pediatrics, National Jewish Health, Denver, Colorado (H.J.N., S.E.C., P.E.B.); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado (H.J.N., C.A.J., A.R.S., S.E.C., L.A.B., L.A.V., P.E.B., C.W.W.); and Department of Chemistry and Biochemistry, South Dakota State University, Brookings, South Dakota (A.S.A., A.B.D., B.A.L.)
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3
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Khazdair MR, Boskabady MH. Possible Treatment Approaches of Sulfur Mustard-Induced Lung Disorders, Experimental and Clinical Evidence, an Updated Review. Front Med (Lausanne) 2022; 9:791914. [PMID: 35572987 PMCID: PMC9106304 DOI: 10.3389/fmed.2022.791914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/12/2022] [Indexed: 12/04/2022] Open
Abstract
Sulfur mustard (SM) is one of the major potent chemical warfare that caused the death of victims in World War I and the Iraq-Iran conflict (1980-1988). The respiratory system is the main target of SM exposure and there are no definitive therapeutic modalities for SM-induced lung injury. The effects of the new pharmaceutical drugs on lung injury induced by SM exposure were summarized in this review. Literature review on PubMed, ScienceDirect, and Google Scholar databases was performed to find papers that reported new treatment approach on SM-exposure-induced injury in the respiratory system until October 2019. The search was restricted to sulfur mustard AND induced injury (in vitro studies, animal experiments, and clinical trials) AND respiratory system OR lung, AND treatment in all fields. Two hundred and eighty-three relevant articles were identified that 97 retrieved articles were eligible and were included in the review. Some new pharmaceutical drugs have shown therapeutic potential in controlling various characteristics of lung injury due to SM exposure. Recent studies showed therapeutic effects of mucolytic drugs, non-steroidal drugs, and antibiotics on reducing lung inflammation, oxidative stress responses, and modulating of the immune system as well as improving of respiratory symptoms and pulmonary function tests. Studies on the therapeutic effects of new agents with amelioration or treatment of SM-induced lung injury were reviewed and discussed.
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Affiliation(s)
- Mohammad Reza Khazdair
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohammad Hossein Boskabady
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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4
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Naeimi Kararoudi M, Alsudayri A, Hill CL, Elmas E, Sezgin Y, Thakkar A, Hester ME, Malleske DT, Lee DA, Neal ML, Perry MR, Harvilchuck JA, Reynolds SD. Assessment of Beta-2 Microglobulin Gene Edited Airway Epithelial Stem Cells as a treatment for Sulfur Mustard Inhalation. Front Genome Ed 2022; 4:781531. [PMID: 35199100 PMCID: PMC8859869 DOI: 10.3389/fgeed.2022.781531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Respiratory system damage is the primary cause of mortality in individuals who are exposed to vesicating agents including sulfur mustard (SM). Despite these devastating health complications, there are no fielded therapeutics that are specific for such injuries. Previous studies reported that SM inhalation depleted the tracheobronchial airway epithelial stem cell (TSC) pool and supported the hypothesis, TSC replacement will restore airway epithelial integrity and improve health outcomes for SM-exposed individuals. TSC express Major Histocompatibility Complex (MHC-I) transplantation antigens which increases the chance that allogeneic TSC will be rejected by the patient’s immune system. However, previous studies reported that Beta-2 microglobulin (B2M) knockout cells lacked cell surface MHC-I and suggested that B2M knockout TSC would be tolerated as an allogeneic graft. This study used a Cas9 ribonucleoprotein (RNP) to generate B2M-knockout TSC, which are termed Universal Donor Stem Cells (UDSC). Whole genome sequencing identified few off-target modifications and demonstrated the specificity of the RNP approach. Functional assays demonstrated that UDSC retained their ability to self-renew and undergo multilineage differentiation. A preclinical model of SM inhalation was used to test UDSC efficacy and identify any treatment-associated adverse events. Adult male Sprague-Dawley rats were administered an inhaled dose of 0.8 mg/kg SM vapor which is the inhaled LD50 on day 28 post-challenge. On recovery day 2, vehicle or allogeneic Fisher rat UDSC were delivered intravenously (n = 30/group). Clinical parameters were recorded daily, and planned euthanasia occurred on post-challenge days 7, 14, and 28. The vehicle and UDSC treatment groups exhibited similar outcomes including survival and a lack of adverse events. These studies establish a baseline which can be used to further develop UDSC as a treatment for SM-induced airway disease.
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Affiliation(s)
| | | | | | - Ezgi Elmas
- Nationwide Children’s Hospital, Columbus, OH, United States
- Molecular, Cellular, and Developmental Biology Graduate Program, The Ohio State University, Columbus, OH, United States
| | - Yasemin Sezgin
- Nationwide Children’s Hospital, Columbus, OH, United States
| | - Aarohi Thakkar
- Nationwide Children’s Hospital, Columbus, OH, United States
| | - Mark E. Hester
- Nationwide Children’s Hospital, Columbus, OH, United States
| | | | - Dean A. Lee
- Nationwide Children’s Hospital, Columbus, OH, United States
| | | | - Mark R. Perry
- Battelle Memorial Institute, Columbus, OH, United States
| | | | - Susan D. Reynolds
- Nationwide Children’s Hospital, Columbus, OH, United States
- *Correspondence: Susan D. Reynolds,
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5
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Liptzin DR, McGraw MD, Houin PR, Veress LA. Fibrin airway cast obstruction: Experience, classification, and treatment guideline from Denver. Pediatr Pulmonol 2022; 57:529-537. [PMID: 34713989 DOI: 10.1002/ppul.25746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Plastic bronchitis (PB) is a condition characterized by the formation of thick airway casts leading to acute and often life-threatening airway obstruction. PB occurs mainly in pediatric patients with congenital heart disease (CHO) who have undergone staged surgical palliation (Glenn, Fontan), but can also occur after chemical inhalation, H1N1, severe COVID-19, sickle cell disease, severe asthma, and other diseases. Mortality risk from PB can be up to 40%-60%, and no treatment guideline exist. The objectives herein are to develop a standardized evaluation, classification, and treatment guideline for PB patients presenting with tracheobronchial casts, based on our experience with PB at the Children's Hospital of Colorado in Denver. METHODS We describe 11 patients with CHO-associated PB (post-Fontan [n = 9], pre-Fontan [n = 2]) who presented with their initial episodes. We utilized histopathological analysis of tracheobronchial casts to guide treatment in these patients, utilizing our hospital-wide guideline document and classification system. RESULTS We found that 100% of post-Fontan PB patients had fibrinous airway casts, while pre-Fontan PB casts were fibrinous only in one of two patients (50%). Utilizing histopathology as a guide to therapy, PB patients with fibrin airway casts were treated with airway-delivered fibrinolytics and anticoagulants, as well as aggressive airway clearance and other supportive care measures. These therapies resulted in successful cast resolution and improved survival in post-Fontan PB patients. CONCLUSION We have shown an improved outcome in PB patients whose treatment plan was based on Denver's PB classification schema and standardized treatment guideline based on tracheobronchial cast histopathology.
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Affiliation(s)
- Deborah R Liptzin
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Denver (Primary Research Site), Aurora, Colorado, USA
| | - Matthew D McGraw
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Denver (Primary Research Site), Aurora, Colorado, USA
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Paul R Houin
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Denver (Primary Research Site), Aurora, Colorado, USA
| | - Livia A Veress
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Denver (Primary Research Site), Aurora, Colorado, USA
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6
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Cruz-Hernandez A, Mendoza RP, Nguyen K, Harder A, Evans CM, Bauer AK, Tewari-Singh N, Brown JM. Mast Cells Promote Nitrogen Mustard-Mediated Toxicity in the Lung Associated With Proinflammatory Cytokine and Bioactive Lipid Mediator Production. Toxicol Sci 2021; 184:127-141. [PMID: 34453837 DOI: 10.1093/toxsci/kfab107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sulfur mustard (SM) has been widely used as a chemical warfare agent including most recently in Syria. Mice exposed to SM exhibit an increase in pro-inflammatory cytokines followed by immune cell infiltration in the lung, however, the mechanisms leading to these inflammatory responses has not been completely elucidated. Mast cells are one of the first responding innate immune cells found at the mucosal surfaces of the lung and have been reported to be activated by SM in the skin. Therefore, we hypothesized that nitrogen mustard (NM: a surrogate for SM) exposure promotes activation of mast cells causing chronic respiratory inflammation. To assess the role of mast cells in NM-mediated pulmonary toxicity, we compared the effects of NM exposure between C57BL/6 and B6.Cg-KitW-sh/HNihrJaeBsmJ (KitW-sh; mast cell deficient) mice. Lung injury was observed in C57BL/6J mice following NM exposure (0.125 mg/kg) at 72 h, which was significantly abrogated in KitW-sh mice. Although both strains exhibited damage from NM, C57BL/6J mice had higher inflammatory cell infiltration and more elevated prostaglandin D2 (PGD2) present in bronchoalveolar lavage fluid compared with KitW-sh mice. Additionally, we utilized murine bone marrow-derived mast cells to assess NM-induced early and late activation. Although NM exposure did not result in mast cell degranulation, we observed an upregulation in PGD2 and IL-6 levels following exposure to NM. Results suggest that mast cells play a prominent role in lung injury induced by NM and may contribute to the acute and potentially long-term lung injury observed caused by SM.
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Affiliation(s)
- Angela Cruz-Hernandez
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Ryan P Mendoza
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Kathleen Nguyen
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Anna Harder
- Division of Pulmonary Sciences and Critical Care Medicine, The University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Christopher M Evans
- Division of Pulmonary Sciences and Critical Care Medicine, The University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Alison K Bauer
- Department of Environmental and Occupational Health, Colorado School of Public Health, The University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Neera Tewari-Singh
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan 48824, USA
| | - Jared M Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
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7
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Perry MR, Neal M, Hawks R, Pressburger D, Satola J, Triplett C, Reed B, Andrews M, Harvilchuck JA, Nealy MS, Platoff GE, Yeung DT. A novel sulfur mustard (HD) vapor inhalation exposure model of pulmonary toxicity for the efficacy evaluation of candidate medical countermeasures. Inhal Toxicol 2021; 33:221-233. [PMID: 34396872 DOI: 10.1080/08958378.2021.1951401] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To develop a novel inhalation exposure system capable of delivering a controlled inhaled HD dose through an endotracheal tube to anesthetized rats to investigate the lung pathophysiology and evaluate potential medical countermeasures. MATERIALS AND METHODS Target HD vapor exposures were generated by a temperature-controlled vapor generator, while concentration was monitored near real-time by gas chromatography. Animal breathing parameters were monitored real-time by in-line EMKA/SciReq pulmonary analysis system. Individual exposures were halted when the target inhaled doses were achieved. Animals were observed daily for clinical observations and lethality with scheduled termination at 28 days post-exposure. Upon scheduled or unscheduled death, animals underwent a gross necropsy and lung and trachea were collected for histopathology. RESULTS Controlled HD concentrations ranged from 60 to 320 mg/m3. Delivered inhaled doses range from 0.3 to 3.20 mg/kg with administered doses within 3% of the target. The 28-day inhaled LD50 is 0.80 mg/kg (95% CI = 0.42-1.18 mg/kg). Post exposure respiratory abnormalities were observed across all dose levels though the higher dose levels had earlier onset and higher frequency of occurrence. Histopathologic alterations were not qualitatively altered in accordance with dose but instead showed a relationship to an animals' time of death, with early deaths demonstrating acute damage and later deaths displaying signs of repair. DISCUSSION/CONCLUSION This novel exposure system administers targeted HD inhaled doses to generate a small animal model that can be used to evaluate physiological toxicities of inhaled HD on the lungs and for evaluation of potential medical countermeasure treatments.
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Affiliation(s)
| | - Matthew Neal
- Biomedical Research Center, Battelle, West Jefferson, OH, USA
| | - Roger Hawks
- Biomedical Research Center, Battelle, West Jefferson, OH, USA
| | | | - Jan Satola
- Biomedical Research Center, Battelle, West Jefferson, OH, USA
| | - Cheryl Triplett
- Biomedical Research Center, Battelle, West Jefferson, OH, USA
| | - Beth Reed
- Biomedical Research Center, Battelle, West Jefferson, OH, USA
| | | | | | - Michael S Nealy
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Gennady E Platoff
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - David T Yeung
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
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8
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Masjoan Juncos JX, Shakil S, Bradley WE, Wei CC, Zafar I, Powell P, Mariappan N, Louch WE, Ford DA, Ahmad A, Dell'Italia LJ, Ahmad S. Chronic cardiac structural damage, diastolic and systolic dysfunction following acute myocardial injury due to bromine exposure in rats. Arch Toxicol 2021; 95:179-193. [PMID: 32979061 PMCID: PMC7855670 DOI: 10.1007/s00204-020-02919-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022]
Abstract
Accidental bromine spills are common and its large industrial stores risk potential terrorist attacks. The mechanisms of bromine toxicity and effective therapeutic strategies are unknown. Our studies demonstrate that inhaled bromine causes deleterious cardiac manifestations. In this manuscript we describe mechanisms of delayed cardiac effects in the survivors of a single bromine exposure. Rats were exposed to bromine (600 ppm for 45 min) and the survivors were sacrificed at 14 or 28 days. Echocardiography, hemodynamic analysis, histology, transmission electron microscopy (TEM) and biochemical analysis of cardiac tissue were performed to assess functional, structural and molecular effects. Increases in right ventricular (RV) and left ventricular (LV) end-diastolic pressure and LV end-diastolic wall stress with increased LV fibrosis were observed. TEM images demonstrated myofibrillar loss, cytoskeletal breakdown and mitochondrial damage at both time points. Increases in cardiac troponin I (cTnI) and N-terminal pro brain natriuretic peptide (NT-proBNP) reflected myofibrillar damage and increased LV wall stress. LV shortening decreased as a function of increasing LV end-systolic wall stress and was accompanied by increased sarcoendoplasmic reticulum calcium ATPase (SERCA) inactivation and a striking dephosphorylation of phospholamban. NADPH oxidase 2 and protein phosphatase 1 were also increased. Increased circulating eosinophils and myocardial 4-hydroxynonenal content suggested increased oxidative stress as a key contributing factor to these effects. Thus, a continuous oxidative stress-induced chronic myocardial damage along with phospholamban dephosphorylation are critical for bromine-induced chronic cardiac dysfunction. These findings in our preclinical model will educate clinicians and public health personnel and provide important endpoints to evaluate therapies.
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MESH Headings
- Animals
- Bromine
- Calcium-Binding Proteins/metabolism
- Cardiomegaly/chemically induced
- Cardiomegaly/metabolism
- Cardiomegaly/pathology
- Cardiomegaly/physiopathology
- Cardiotoxicity
- Diastole
- Disease Models, Animal
- Fibrosis
- Male
- Mitochondria, Heart/metabolism
- Mitochondria, Heart/ultrastructure
- Myocardium/metabolism
- Myocardium/ultrastructure
- NADPH Oxidase 2/metabolism
- Natriuretic Peptide, Brain/metabolism
- Oxidative Stress/drug effects
- Peptide Fragments/metabolism
- Phosphorylation
- Protein Phosphatase 1/metabolism
- Rats, Sprague-Dawley
- Sarcoplasmic Reticulum Calcium-Transporting ATPases/metabolism
- Systole
- Time Factors
- Troponin I/metabolism
- Ventricular Dysfunction, Left/chemically induced
- Ventricular Dysfunction, Left/metabolism
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/chemically induced
- Ventricular Dysfunction, Right/metabolism
- Ventricular Dysfunction, Right/pathology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Ventricular Remodeling
- Rats
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Affiliation(s)
- Juan Xavier Masjoan Juncos
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Shazia Shakil
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Wayne E Bradley
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Chih-Chang Wei
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Iram Zafar
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Pamela Powell
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Nithya Mariappan
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - William E Louch
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- Center for Heart Failure Research, KG Jebsen Cardiac Research Center, University of Oslo, Oslo, Norway
| | - David A Ford
- Department of Biochemistry and Molecular Biology and Center for Cardiovascular Research, Saint Louis University, St. Louis, MO, USA
| | - Aftab Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Louis J Dell'Italia
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Shama Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, #322 BMRII, 901 19th St. South, Birmingham, AL, 35294, USA.
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9
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Sadeghi S, Tapak M, Ghazanfari T, Mosaffa N. A review of Sulfur Mustard-induced pulmonary immunopathology: An Alveolar Macrophage Approach. Toxicol Lett 2020; 333:115-129. [PMID: 32758513 DOI: 10.1016/j.toxlet.2020.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/27/2022]
Abstract
Despite many studies investigating the mechanism of Sulfur Mustard (SM) induced lung injury, the underlying mechanism is still unclear. Inflammatory and subsequent fibroproliferative stages of SM-toxicity are based upon several highly-related series of events controlled by the immune system. The inhalation of SM gas variably affects different cell populations within the lungs. Various studies have shown the critical role of macrophages in triggering a pulmonary inflammatory response as well as its maintenance, resolution, and repair. Importantly, macrophages can serve as either pro-inflammatory or anti-inflammatory populations depending on the present conditions at any pathological stage. Different characteristics of macrophages, including their differentiation, phenotypic, and functional properties, as well as interactions with other cell populations determine the outcomes of lung diseases and the extent of long- or short-term pulmonary damage induced by SM. In this paper, we summarize the current state of knowledge regarding the role of alveolar macrophages and their mediators in the pathogenesis of SM in pulmonary injury. Investigating the specific cells and mechanisms involved in SM-lung injury may be useful in finding new target opportunities for treatment of this injury.
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Affiliation(s)
- Somaye Sadeghi
- Student Research Committee, Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahtab Tapak
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tooba Ghazanfari
- Immunoregulation Research Center, Shahed University, Tehran, Iran; Department of Immunology, Shahed University, Tehran, Iran.
| | - Nariman Mosaffa
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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10
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Juncos JXM, Shakil S, Ahmad A, Aishah D, Morgan CJ, Dell'Italia LJ, Ford DA, Ahmad A, Ahmad S. Circulating and tissue biomarkers as predictors of bromine gas inhalation. Ann N Y Acad Sci 2020; 1480:104-115. [PMID: 32645215 DOI: 10.1111/nyas.14422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
Abstract
The threat from deliberate or accidental exposure to halogen gases is increasing, as is their industrial applications and use as chemical warfare agents. Biomarkers that can identify halogen exposure, diagnose victims of exposure or predict injury severity, and enable appropriate treatment are lacking. We conducted these studies to determine and validate biomarkers of bromine (Br2 ) toxicity and correlate the symptoms and the extent of cardiopulmonary injuries. Unanesthetized rats were exposed to Br2 and monitored noninvasively for clinical scores and pulse oximetry. Animals were euthanized and grouped at various time intervals to assess brominated fatty acid (BFA) content in the plasma, lung, and heart using mass spectrometry. Bronchoalveolar lavage fluid (BALF) protein content was used to assess pulmonary injury. Cardiac troponin I (cTnI) was assessed in the plasma to evaluate cardiac injury. The blood, lung, and cardiac tissue BFA content significantly correlated with the clinical scores, tissue oxygenation, heart rate, and cardiopulmonary injury parameters. Total (free + esterified) bromostearic acid levels correlated with lung injury, as indicated by BALF protein content, and free bromostearic acid levels correlated with plasma cTnI levels. Thus, BFAs and cardiac injury biomarkers can identify Br2 exposure and predict the severity of organ damage.
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Affiliation(s)
- Juan Xavier Masjoan Juncos
- Department of Anesthesiology and Perioperative Medicine, the University of Alabama at Birmingham, Birmingham, Alabama
| | - Shazia Shakil
- Department of Anesthesiology and Perioperative Medicine, the University of Alabama at Birmingham, Birmingham, Alabama
| | - Aamir Ahmad
- Department of Anesthesiology and Perioperative Medicine, the University of Alabama at Birmingham, Birmingham, Alabama
| | - Duha Aishah
- Department of Anesthesiology and Perioperative Medicine, the University of Alabama at Birmingham, Birmingham, Alabama
| | - Charity J Morgan
- Department of Biostatistics, the University of Alabama at Birmingham, Birmingham, Alabama
| | - Louis J Dell'Italia
- Division of Cardiovascular Disease, Department of Medicine, the University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham VA Medical Center, Birmingham, Alabama
| | - David A Ford
- Department of Biochemistry and Molecular Biology and Center for Cardiovascular Research, Saint Louis University, St. Louis, Missouri
| | - Aftab Ahmad
- Department of Anesthesiology and Perioperative Medicine, the University of Alabama at Birmingham, Birmingham, Alabama
| | - Shama Ahmad
- Department of Anesthesiology and Perioperative Medicine, the University of Alabama at Birmingham, Birmingham, Alabama
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11
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McGraw MD, Kim SY, White CW, Veress LA. Acute cytotoxicity and increased vascular endothelial growth factor after in vitro nitrogen mustard vapor exposure. Ann N Y Acad Sci 2020; 1479:223-233. [PMID: 32408394 DOI: 10.1111/nyas.14367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022]
Abstract
Nitrogen mustard (NM) is a highly toxic alkylating agent. Inhalation exposure can cause acute and chronic lung injury. This study's aims were to develop an in vitro coculture model of mustard-induced airway injury and to identify growth factors contributing to airway pathology. Primary human bronchial epithelial cells cultured with pulmonary endothelial cells were exposed to NM (25, 50, 100, 250, or 500 μM) or PBS (control) for 1 hour. Lactate dehydrogenase (LDH) and transepithelial electrical resistance (TEER) were measured before and 24 h after NM exposure. Fixed cultures were stained for hematoxylin and eosin or live/dead staining. Culture media were analyzed for 11 growth factors. A 1-h vapor exposure to greater than or equal to 50 μM NM increased supernatant LDH, decreased TEER, and caused airway epithelial cell detachment. Endothelial cell death occurred at 500 μM NM. Vascular endothelial growth factor A (VEGF-A) and placental growth factor (PlGF) expression increased in 500 μM NM-exposed cultures compared with PBS-exposed control cultures. NM vapor exposure causes differential cytotoxicity to airway epithelial and endothelial injury in culture. Increased VEGF-A and PlGF expression occurred acutely in airway cocultures. Future studies are required to validate the role of VEGF signaling in mustard-induced airway pathology.
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Affiliation(s)
- Matthew D McGraw
- Department of Pediatric Pulmonology, University of Rochester Medical Center, Rochester, New York.,Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York
| | - So-Young Kim
- Department of Pediatric Pulmonology, University of Rochester Medical Center, Rochester, New York
| | - Carl W White
- Department of Pediatrics, Pulmonology Section, Pediatric Airway Research Center, University of Colorado Denver, Aurora, Colorado
| | - Livia A Veress
- Department of Pediatrics, Pulmonology Section, Pediatric Airway Research Center, University of Colorado Denver, Aurora, Colorado
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12
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Nick HJ, Rioux JS, Veress LA, Bratcher PE, Bloomquist LA, Anantharam P, Croutch CR, Tuttle RS, Peters E, Sosna W, White CW. Alleviation of methyl isocyanate-induced airway obstruction and mortality by tissue plasminogen activator. Ann N Y Acad Sci 2020; 1479:134-147. [PMID: 32233099 DOI: 10.1111/nyas.14344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/23/2022]
Abstract
Methyl isocyanate (MIC, "Bhopal agent") is a highly reactive, toxic industrial chemical. Inhalation of high levels (500-1000 ppm) of MIC vapor is almost uniformly fatal. No therapeutic interventions other than supportive care have been described that can delay the onset of illness or death due to MIC. Recently, we found that inhalation of MIC caused the appearance of activated tissue factor in circulation with subsequent activation of the coagulation cascade. Herein, we report that MIC exposure (500 ppm for 30 min, nose-only) caused deposition of fibrin-rich casts in the conducting airways resulting in respiratory failure and death within 24 h in a rat model (LC90-100 ). We thus investigated the effect of airway delivery of the fibrinolytic agent tissue plasminogen activator (tPA) on mortality and morbidity in this model. Intratracheal administration of tPA was initiated 11 h post MIC exposure and repeated every 4 h for the duration of the study. Treatment with tPA afforded nearly 60% survival at 24 h post MIC exposure and was associated with decreased airway fibrin casts, stabilization of hypoxemia and respiratory distress, and improved acidosis. This work supports the potential of airway-delivered tPA therapy as a useful countermeasure in stabilizing victims of high-level MIC exposure.
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Affiliation(s)
- Heidi J Nick
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jacqueline S Rioux
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Livia A Veress
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Preston E Bratcher
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Division of Cell Biology, Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Leslie A Bloomquist
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | | | | | | | - Carl W White
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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13
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Etemad L, Moshiri M, Balali-Mood M. Advances in treatment of acute sulfur mustard poisoning - a critical review. Crit Rev Toxicol 2020; 49:191-214. [PMID: 31576778 DOI: 10.1080/10408444.2019.1579779] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sulfur mustard (SM) is a blistering chemical warfare agent that was used during the World War I and in the Iraq-Iran conflict. The aim of this paper is to discuss and critically review the published results of experiments on the treatment of SM poisoning based on our clinical and research experience. The victims must remove from the contaminated zone immediately. The best solution for decontamination is large amounts of water, using neutral soap and 0.5% sodium hypochlorite. Severely intoxicated patients should be treated according to advanced life support protocols and intensive care therapy for respiratory disorders and the chemical burn. Sodium thiosulfate infusion (100-500 mg/kg/min) should be started up to 60 min after SM exposure. However, N-acetyle cysteine (NAC) is recommended, none of them acts as specific or effective antidote. The important protective and conservative treatment of SM-induced pulmonary injuries include humidified oxygen, bronchodilators, NAC as muculytic, rehydration, mechanical ventilation, appropriate antibiotics and respiratory physiotherapy as clinically indicated. Treatment of acute SM ocular lesions start with topical antibiotics; preferably sulfacetamide eye drop, continue with lubricants, and artificial tears. Treatment for cutaneous injuries include: moist dressing; preferably with silver sulfadiazine cream, analgesic, anti-pruritic, physically debridement, debridase, Laser debridement, followed by skin autologous split-thickness therapy as clinically indicated. The new suggested medications and therapeutic approaches include: anti-inflammatory agents, Niacinamide, Silibinin, Calmodulin antagonists, Clobetasol, full-thickness skin grafting for skin injuries; Doxycycline; Bevacizumab, and Colchicine for ocular injuries. Recommended compounds based on animal studies include Niacinamide, Aprotinin, des-aspartate-angiotensin-I, Gamma-glutamyltransferase, vitamin E, and vitamin D. In vitro studies revealed that Dimethylthiourea, L-nitroarginine, Methyl-ester, Sodium pyruvate, Butylated hydroxyanisole, ethacrynic acid, and macrolide antibiotics are effective. However, none of them, except macrolide antibiotics have been proved clinically. Avoidance of inappropriate polypharmacy is advisable.
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Affiliation(s)
- Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Mahdi Balali-Mood
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences , Birjand , Iran
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14
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Mariappan N, Husain M, Zafar I, Singh V, Smithson KG, Crowe DR, Pittet JF, Ahmad S, Ahmad A. Extracellular nucleic acid scavenging rescues rats from sulfur mustard analog-induced lung injury and mortality. Arch Toxicol 2020; 94:1321-1334. [PMID: 32157350 DOI: 10.1007/s00204-020-02699-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/02/2020] [Indexed: 01/08/2023]
Abstract
Sulfur mustard (SM) is a highly toxic war chemical that causes significant morbidity and mortality and lacks any effective therapy. Rats exposed to aerosolized CEES (2-chloroethyl ethyl sulfide; 10% in ethanol), an analog of SM, developed acute respiratory distress syndrome (ARDS), which is characterized by increased inflammation, hypoxemia and impaired gas exchange. We observed elevated levels of extracellular nucleic acids (eNA) in the bronchoalveolar lavage fluid (BALF) of CEES-exposed animals. eNA can induce inflammation, coagulation and barrier dysfunction. Treatment with hexadimethrine bromide (HDMBr; 10 mg/kg), an eNA neutralizing agent, 2 h post-exposure, reduced lung injury, inhibited disruption of alveolar-capillary barrier, improved blood oxygenation (PaO2/FiO2 ratio), thus reversing ARDS symptoms. HDMBr treatment also reduced lung inflammation in the CEES-exposed animals by decreasing IL-6, IL-1A, CXCL-1 and CCL-2 mRNA levels in lung tissues and HMGB1 protein in BALF. Furthermore, HDMBr treatment also reduced levels of lung tissue factor and plasminogen activator inhibitor-1 indicating reduction in clot formation and increased fibrinolysis. Fibrin was reduced in BALF of the HDMBr-treated animals. This was further confirmed by histology that revealed diminished airway fibrin, epithelial sloughing and hyaline membrane in the lungs of HDMBr-treated animals. HDMBr completely rescued the CEES-associated mortality 12 h post-exposure when the survival rate in CEES-only group was just 50%. Experimental eNA treatment of cells caused increased inflammation that was reversed by HDMBr. These results demonstrate a role of eNA in the pathogenesis of CEES/SM-induced injury and that its neutralization can serve as a potential therapeutic approach in treating SM toxicity.
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Affiliation(s)
- Nithya Mariappan
- Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Maroof Husain
- Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Iram Zafar
- Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Vinodkumar Singh
- Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Kenneth G Smithson
- Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th St. South, Birmingham, AL, 35294, USA
| | - David R Crowe
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jean-Francois Pittet
- Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Shama Ahmad
- Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th St. South, Birmingham, AL, 35294, USA
| | - Aftab Ahmad
- Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th St. South, Birmingham, AL, 35294, USA.
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15
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McGraw MD, Dysart MM, Hendry-Hofer TB, Houin PR, Rioux JS, Garlick RB, Loader JE, Smith R, Paradiso DC, Holmes WW, Anderson DR, White CW, Veress LA. Bronchiolitis Obliterans and Pulmonary Fibrosis after Sulfur Mustard Inhalation in Rats. Am J Respir Cell Mol Biol 2019; 58:696-705. [PMID: 29314868 DOI: 10.1165/rcmb.2017-0168oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Inhalation of powerful chemical agents, such as sulfur mustard (SM), can have debilitating pulmonary consequences, such as bronchiolitis obliterans (BO) and parenchymal fibrosis (PF). The underlying pathogenesis of disorders after SM inhalation is not clearly understood, resulting in a paucity of effective therapies. In this study, we evaluated the role of profibrotic pathways involving transforming growth factor-β (TGF-β) and platelet-derived growth factor (PDGF) in the development of BO and PF after SM inhalation injury using a rat model. Adult Sprague-Dawley rats were intubated and exposed to SM (1.0 mg/kg), then monitored daily for respiratory distress, oxygen saturation changes, and weight loss. Rats were killed at 7, 14, 21, or 28 days, and markers of injury were determined by histopathology; pulmonary function testing; and assessment of TGF-β, PDGF, and PAI-1 concentrations. Respiratory distress developed over time after SM inhalation, with progressive hypoxemia, respiratory distress, and weight loss. Histopathology confirmed the presence of both BO and PF, and both gradually worsened with time. Pulmonary function testing demonstrated a time-dependent increase in lung resistance, as well as a decrease in lung compliance. Concentrations of TGF-β, PDGF, and PAI-1 were elevated at 28 days in lung, BAL fluid, and/or plasma. Time-dependent development of BO and PF occurs in lungs of rats exposed to SM inhalation, and the elevated concentrations of TGF-β, PDGF, and PAI-1 suggest involvement of these profibrotic pathways in the aberrant remodeling after injury.
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Affiliation(s)
| | | | - Tara B Hendry-Hofer
- 2 Department of Emergency Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado; and
| | | | | | | | | | | | - Danielle C Paradiso
- 3 Medical Toxicology Branch, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland
| | - Wesley W Holmes
- 3 Medical Toxicology Branch, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland
| | - Dana R Anderson
- 3 Medical Toxicology Branch, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland
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16
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Ahmad S, Masjoan Juncos JX, Ahmad A, Zaky A, Wei CC, Bradley WE, Zafar I, Powell P, Mariappan N, Vetal N, Louch WE, Ford DA, Doran SF, Matalon S, Dell'Italia LJ. Bromine inhalation mimics ischemia-reperfusion cardiomyocyte injury and calpain activation in rats. Am J Physiol Heart Circ Physiol 2018; 316:H212-H223. [PMID: 30379573 DOI: 10.1152/ajpheart.00652.2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Halogens are widely used, highly toxic chemicals that pose a potential threat to humans because of their abundance. Halogens such as bromine (Br2) cause severe pulmonary and systemic injuries; however, the mechanisms of their toxicity are largely unknown. Here, we demonstrated that Br2 and reactive brominated species produced in the lung and released in blood reach the heart and cause acute cardiac ultrastructural damage and dysfunction in rats. Br2-induced cardiac damage was demonstrated by acute (3-24 h) increases in circulating troponin I, heart-type fatty acid-binding protein, and NH2-terminal pro-brain natriuretic peptide. Transmission electron microscopy demonstrated acute (3-24 h) cardiac contraction band necrosis, disruption of z-disks, and mitochondrial swelling and disorganization. Echocardiography and hemodynamic analysis revealed left ventricular (LV) systolic and diastolic dysfunction at 7 days. Plasma and LV tissue had increased levels of brominated fatty acids. 2-Bromohexadecanal (Br-HDA) injected into the LV cavity of a normal rat caused acute LV enlargement with extensive disruption of the sarcomeric architecture and mitochondrial damage. There was extensive infiltration of neutrophils and increased myeloperoxidase levels in the hearts of Br2- or Br2 reactant-exposed rats. Increased bromination of sarco(endo)plasmic reticulum Ca2+-ATPase (SERCA) and increased phosphalamban after Br2 inhalation decreased cardiac SERCA activity by 70%. SERCA inactivation was accompanied by increased Ca2+-sensitive LV calpain activity. The calpain-specific inhibitor MDL28170 administered within 1 h after exposure significantly decreased calpain activity and acute mortality. Bromine inhalation and formation of reactive brominated species caused acute cardiac injury and myocardial damage that can lead to heart failure. NEW & NOTEWORTHY The present study defines left ventricular systolic and diastolic dysfunction due to cardiac injury after bromine (Br2) inhalation. A calpain-dependent mechanism was identified as a potential mediator of cardiac ultrastructure damage. This study not only highlights the importance of monitoring acute cardiac symptoms in victims of Br2 exposure but also defines calpains as a potential target to treat Br2-induced toxicity.
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Affiliation(s)
- Shama Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Juan Xavier Masjoan Juncos
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Aftab Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Ahmed Zaky
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Chih-Chang Wei
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.,Department of Veterans Affairs Medical Center , Birmingham, Alabama
| | - Wayne E Bradley
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.,Department of Veterans Affairs Medical Center , Birmingham, Alabama
| | - Iram Zafar
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Pamela Powell
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.,Department of Veterans Affairs Medical Center , Birmingham, Alabama
| | - Nithya Mariappan
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Nilam Vetal
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - William E Louch
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo , Oslo , Norway.,KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - David A Ford
- Department of Biochemistry and Molecular Biology and Center for Cardiovascular Research, Saint Louis University , St. Louis, Missouri
| | - Stephen F Doran
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Sadis Matalon
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Louis J Dell'Italia
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.,Department of Veterans Affairs Medical Center , Birmingham, Alabama
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17
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Surasarang SH, Sahakijpijarn S, Florova G, Komissarov AA, Nelson CL, Perenlei E, Fukuda S, Wolfson MR, Shaffer TH, Idell S, Williams RO. Nebulization of Single-Chain Tissue-Type and Single-Chain Urokinase Plasminogen Activator for Treatment of Inhalational Smoke-Induced Acute Lung Injury. J Drug Deliv Sci Technol 2018; 48:19-27. [PMID: 30123328 DOI: 10.1016/j.jddst.2018.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Single-chain tissue-type plasminogen activator (sctPA) and single-chain urokinase plasminogen activator (scuPA) have attracted interest as enzymes for the treatment of inhalational smoke-induced acute lung injury (ISALI). In this study, the pulmonary delivery of commercial human sctPA and lyophilized scuPA and their reconstituted solution forms were demonstrated using vibrating mesh nebulizers (Aeroneb® Pro (active) and EZ Breathe® (passive)). Both the Aeroneb® Pro and EZ Breathe® vibrating mesh nebulizers produced atomized droplets of protein solution of similar size of less than about 5 μm, which is appropriate for pulmonary delivery. Enzymatic activities of scuPA and of sctPA were determined after nebulization and both remained stable (88.0% and 93.9%). Additionally, the enzymatic activities of sctPA and tcuPA were not significantly affected by excipients, lyophilization or reconstitution conditions. The results of these studies support further development of inhaled formulations of fibrinolysins for delivery to the lungs following smoke-induced acute pulmonary injury.
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Affiliation(s)
- Soraya Hengsawas Surasarang
- The University of Texas at Austin, College of Pharmacy, Division of Molecular Pharmaceutics and Drug Delivery, Austin, TX, USA
| | - Sawittree Sahakijpijarn
- The University of Texas at Austin, College of Pharmacy, Division of Molecular Pharmaceutics and Drug Delivery, Austin, TX, USA
| | - Galina Florova
- The University of Texas Health Science Center at Tyler, School of Medical Biological Sciences, Tyler, TX, USA
| | - Andrey A Komissarov
- The University of Texas Health Science Center at Tyler, School of Medical Biological Sciences, Tyler, TX, USA
| | - Christina L Nelson
- The University of Texas Medical Branch, Translational Intensive Care Unit, Galveston, TX, USA
| | - Enkhbaatar Perenlei
- The University of Texas Medical Branch, Translational Intensive Care Unit, Galveston, TX, USA
| | - Satoshi Fukuda
- The University of Texas Medical Branch, Translational Intensive Care Unit, Galveston, TX, USA
| | - Marla R Wolfson
- Lewis Katz School of Medicine at Temple University, Departments of Physiology, Thoracic Medicine and Surgery, Pediatrics, Philadelphia, PA, USA
| | - Thomas H Shaffer
- Lewis Katz School of Medicine at Temple University, Departments of Physiology, Thoracic Medicine and Surgery, Pediatrics, Philadelphia, PA, USA.,Jefferson Medical College/Thomas Jefferson University, Department of Pediatrics, Philadelphia, PA, USA
| | - Steven Idell
- The University of Texas Health Science Center at Tyler, School of Medical Biological Sciences, Tyler, TX, USA
| | - Robert O Williams
- The University of Texas at Austin, College of Pharmacy, Division of Molecular Pharmaceutics and Drug Delivery, Austin, TX, USA
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18
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Joslyn LR, Pienaar E, DiFazio RM, Suliman S, Kagina BM, Flynn JL, Scriba TJ, Linderman JJ, Kirschner DE. Integrating Non-human Primate, Human, and Mathematical Studies to Determine the Influence of BCG Timing on H56 Vaccine Outcomes. Front Microbiol 2018; 9:1898. [PMID: 30177934 PMCID: PMC6110197 DOI: 10.3389/fimmu.2018.01898] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/31/2018] [Indexed: 12/21/2022] Open
Abstract
Background Acute lung injury (ALI) is characterized by suppressed fibrinolytic activity in bronchoalveolar lavage fluid (BALF) attributed to elevated plasminogen activator inhibitor-1 (PAI-1). Restoring pulmonary fibrinolysis by delivering tissue-type plasminogen activator (tPA), urokinase plasminogen activator (uPA), and plasmin could be a promising approach. Objectives To systematically analyze the overall benefit of fibrinolytic therapy for ALI reported in preclinical studies. Methods We searched PubMed, Embase, Web of Science, and CNKI Chinese databases, and analyzed data retrieved from 22 studies for the beneficial effects of fibrinolytics on animal models of ALI. Results Both large and small animals were used with five routes for delivering tPA, uPA, and plasmin. Fibrinolytics significantly increased the fibrinolytic activity both in the plasma and BALF. Fibrin degradation products in BALF had a net increase of 408.41 ng/ml vs controls (P < 0.00001). In addition, plasma thrombin–antithrombin complexes increased 1.59 ng/ml over controls (P = 0.0001). In sharp contrast, PAI-1 level in BALF decreased 21.44 ng/ml compared with controls (P < 0.00001). Arterial oxygen tension was improved by a net increase of 15.16 mmHg, while carbon dioxide pressure was significantly reduced (11.66 mmHg, P = 0.0001 vs controls). Additionally, fibrinolytics improved lung function and alleviated inflammation response: the lung wet/dry ratio was decreased 1.49 (P < 0.0001 vs controls), lung injury score was reduced 1.83 (P < 0.00001 vs controls), and BALF neutrophils were lesser (3 × 104/ml, P < 0.00001 vs controls). The mortality decreased significantly within defined study periods (6 h to 30 days for mortality), as the risk ratio of death was 0.2-fold of controls (P = 0.0008). Conclusion We conclude that fibrinolytic therapy may be effective pharmaceutic strategy for ALI in animal models.
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Affiliation(s)
- Louis R Joslyn
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, United States.,Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Elsje Pienaar
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, United States.,Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Robert M DiFazio
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Sara Suliman
- South African Tuberculosis Vaccine Initiative and Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Benjamin M Kagina
- South African Tuberculosis Vaccine Initiative and Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - JoAnne L Flynn
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Thomas J Scriba
- South African Tuberculosis Vaccine Initiative and Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Jennifer J Linderman
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Denise E Kirschner
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
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19
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Fukuda S, Enkhbaatar P, Nelson C, Cox RA, Wolfson MR, Shaffer TH, Williams RO, Surasarang SH, Sawittree S, Florova G, Komissarov AA, Koenig K, Sarva K, Ndetan HT, Singh KP, Idell S. Lack of durable protection against cotton smoke-induced acute lung injury in sheep by nebulized single chain urokinase plasminogen activator or tissue plasminogen activator. Clin Transl Med 2018; 7:17. [PMID: 29916009 PMCID: PMC6006005 DOI: 10.1186/s40169-018-0196-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/10/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Airway fibrin casts are clinically important complications of severe inhalational smoke-induced acute lung injury (ISIALI) for which reliable evidence-based therapy is lacking. Nebulized anticoagulants or a tissue plasminogen activator; tPA, has been advocated, but airway bleeding is a known and lethal potential complication. We posited that nebulized delivery of single chain urokinase plasminogen activator, scuPA, is well-tolerated and improves physiologic outcomes in ISIALI. To test this hypothesis, we nebulized scuPA or tPA and delivered these agents every 4 h to sheep with cotton smoke induced ISIALI that were ventilated by either adaptive pressure ventilation/controlled mandatory ventilation (APVcmv; Group 1, n = 14) or synchronized controlled mandatory ventilation (SCMV)/limited suctioning; Group 2, n = 32). Physiologic readouts of acute lung injury included arterial blood gas analyses, PaO2/FiO2 ratios, peak and plateau airway pressures, lung resistance and static lung compliance. Lung injury was further assessed by histologic scoring. Biochemical analyses included determination of antigenic and enzymographic uPA and tPA levels, plasminogen activator and plasminogen activator inhibitor-1 activities and D-dimer in bronchoalveolar lavage (BAL). Plasma levels of uPA, tPA antigens, D-dimers and α-macroglobulin-uPA complex levels were also assessed. RESULTS In Group 1, tPA at the 2 mg dose was ineffective, but at 4 mg tPA or scuPA, the PaO2/FiO2 ratios, peak/plateau pressures improved during evolving injury (p < 0.01) without significant differences at 48 h. To improve delivery of the interventions, the experiments were repeated in Group 2 with limited suctioning/SCMV, which generally increased PAs in (BAL). In Group 2, tPA was ineffective, but scuPA (4 or 8 mg) improved physiologic outcomes (p < 0.01) and plateau pressures remained lower at 48 h. Airway bleeding occurred at 8 mg tPA. BAL plasminogen activator (PA) levels positively correlated with physiologic outcomes at 48 h. CONCLUSIONS Physiologic outcomes improved in sheep in which better delivery of the PAs occurred. The benefits of nebulized scuPA were achieved without airway bleeding associated with tPA, but were transient and largely abrogated at 48 h, in part attributable to the progression and severity of ISIALI.
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Affiliation(s)
- Satoshi Fukuda
- Translational Intensive Care Unit, Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Perenlei Enkhbaatar
- Translational Intensive Care Unit, Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Christina Nelson
- Translational Intensive Care Unit, Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Robert A Cox
- Translational Intensive Care Unit, Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Marla R Wolfson
- Department of Physiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Center for Inflammation, Translational and Clinical Lung Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- CENTRe: Collaborative for Environmental and Neonatal Therapeutics Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Temple Lung Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Thomas H Shaffer
- Center for Pediatric Lung Research, Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Robert O Williams
- Molecular Pharmaceutics and Drug Delivery, The University of Texas at Austin, Austin, TX, USA
| | | | - Sahakijpijarn Sawittree
- Molecular Pharmaceutics and Drug Delivery, The University of Texas at Austin, Austin, TX, USA
| | - Galina Florova
- The Department of Cellular and Molecular Biology and the Texas Lung Institute, The University of Texas Health Science Center at Tyler, 11927 US HWY 271, Tyler, TX, 75708, USA
| | - Andrey A Komissarov
- The Department of Cellular and Molecular Biology and the Texas Lung Institute, The University of Texas Health Science Center at Tyler, 11927 US HWY 271, Tyler, TX, 75708, USA
| | - Kathleen Koenig
- The Department of Cellular and Molecular Biology and the Texas Lung Institute, The University of Texas Health Science Center at Tyler, 11927 US HWY 271, Tyler, TX, 75708, USA
| | - Krishna Sarva
- The Department of Cellular and Molecular Biology and the Texas Lung Institute, The University of Texas Health Science Center at Tyler, 11927 US HWY 271, Tyler, TX, 75708, USA
| | - Harrison T Ndetan
- The Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11927 US HWY 271, Tyler, TX, 75708, USA
| | - Karan P Singh
- The Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11927 US HWY 271, Tyler, TX, 75708, USA
| | - Steven Idell
- The Department of Cellular and Molecular Biology and the Texas Lung Institute, The University of Texas Health Science Center at Tyler, 11927 US HWY 271, Tyler, TX, 75708, USA.
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20
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Miao Y, Jing JC, Desai V, Mahon SB, Brenner M, Veress LA, White CW, Chen Z. Automated 3D segmentation of methyl isocyanate-exposed rat trachea using an ultra-thin, fully fiber optic optical coherence endoscopic probe. Sci Rep 2018; 8:8713. [PMID: 29880863 PMCID: PMC5992171 DOI: 10.1038/s41598-018-26389-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/03/2018] [Indexed: 02/06/2023] Open
Abstract
Development of effective rescue countermeasures for toxic inhalational industrial chemicals, such as methyl isocyanate (MIC), has been an emerging interest. Nonetheless, current methods for studying toxin-induced airway injuries are limited by cost, labor time, or accuracy, and only provide indirect or localized information. Optical Coherence Tomography (OCT) endoscopic probes have previously been used to visualize the 3-D airway structure. However, gathering such information in small animal models, such as rat airways after toxic gas exposure, remains a challenge due to the required probe size necessary for accessing the small, narrow, and partially obstructed tracheas. In this study, we have designed a 0.4 mm miniature endoscopic probe and investigated the structural changes in rat trachea after MIC inhalation. An automated 3D segmentation algorithm was implemented so that anatomical changes, such as tracheal lumen volume and cross-sectional areas, could be quantified. The tracheal region of rats exposed to MIC by inhalation showed significant airway narrowing, especially within the upper trachea, as a result of epithelial detachment and extravascular coagulation within the airway. This imaging and automated reconstruction technique is capable of rapid and minimally-invasive identification of airway obstruction. This method can be applied to large-scale quantitative analysis of in vivo animal models.
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Affiliation(s)
- Yusi Miao
- Beckman Laser Institute, University of California Irvine, Irvine, 92612, California, USA.,Department of Biomedical Engineering, University of California Irvine, Irvine, 92697, California, USA
| | - Joseph C Jing
- Beckman Laser Institute, University of California Irvine, Irvine, 92612, California, USA.,Department of Biomedical Engineering, University of California Irvine, Irvine, 92697, California, USA
| | - Vineet Desai
- Beckman Laser Institute, University of California Irvine, Irvine, 92612, California, USA
| | - Sari B Mahon
- Beckman Laser Institute, University of California Irvine, Irvine, 92612, California, USA
| | - Matthew Brenner
- Beckman Laser Institute, University of California Irvine, Irvine, 92612, California, USA
| | - Livia A Veress
- Department of Pediatrics, University of Colorado Denver, Denver, 80204, Colorado, USA
| | - Carl W White
- Department of Pediatrics, University of Colorado Denver, Denver, 80204, Colorado, USA
| | - Zhongping Chen
- Beckman Laser Institute, University of California Irvine, Irvine, 92612, California, USA. .,Department of Biomedical Engineering, University of California Irvine, Irvine, 92697, California, USA.
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21
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Advanced biotherapy for the treatment of sulfur mustard poisoning. Chem Biol Interact 2018; 286:111-118. [DOI: 10.1016/j.cbi.2018.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/09/2018] [Accepted: 03/19/2018] [Indexed: 01/09/2023]
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22
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McGraw MD, Rioux JS, Garlick RB, Rancourt RC, White CW, Veress LA. From the Cover: ImpairedProliferation and Differentiation of the Conducting Airway Epithelium Associated With Bronchiolitis Obliterans After Sulfur Mustard Inhalation Injury in Rats. Toxicol Sci 2018; 157:399-409. [PMID: 28402575 DOI: 10.1093/toxsci/kfx057] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sulfur mustard (SM) is a chemical warfare agent that causes chronic airway remodeling. This study's objective was to assess for changes to the bronchiolar epithelium after SM exposure to explain its contribution to chronic airway remodeling. Materials and methods Adult male rats were exposed to a sublethal dose of SM inhalation (1.0-1.2 mg/kg) for 50 min. Histological sections of the bronchiolar epithelium were analyzed for changes using hematoxylin and eosin, trichrome, and immunofluorescent staining for acetylated tubulin (AT) and club cell secretory protein (CCSP). CCSP in bronchoalveolar lavage fluid was assessed using western blot. A bromodeoxyuridine (BRDU) assay was used to assess for epithelial proliferation, and real-time PCR measured changes in Notch mRNA expression. Results SM caused significant proximal bronchiolar epithelial injury with epithelial denudation, loss of acetylated tubulin and CCSP staining, and reduced bronchoalveolar lavage fluid CCSP levels. bromodeoxyuridine (BRDU) + staining of proximal bronchiolar epithelial cells was not increased, but staining was increased in the distal bronchiolar epithelium. One month after injury, the proximal bronchiolar epithelium was not fully repaired. Significant collagen deposition surrounded proximal bronchioles with luminal obstruction, consistent with bronchiolitis obliterans. These changes corresponded with a downregulation of Notch1, Notch3, and Hes1 mRNA expressions. Conclusions This study demonstrates that SM exposure resulted in severe proximal airway epithelial injury, persistent morphological changes, impaired epithelial proliferation and, ultimately, bronchiolitis obliterans. These changes occurred at the same time that the Notch signaling genes were downregulated. Thus, the lung epithelium and the Notch signaling pathway may be worthy targets for the prevention of chronic airway remodeling after SM inhalation injury.
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Affiliation(s)
- Matthew D McGraw
- Department of Pediatric Pulmonology, University of Colorado Denver, Aurora, Colorado, USA.,Pediatric Pulmonary Division, The Breathing Institute at Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jaqueline S Rioux
- Department of Pediatric Pulmonology, University of Colorado Denver, Aurora, Colorado, USA
| | - Rhonda B Garlick
- Department of Pediatric Pulmonology, University of Colorado Denver, Aurora, Colorado, USA
| | - Raymond C Rancourt
- Department of Pediatric Pulmonology, University of Colorado Denver, Aurora, Colorado, USA
| | - Carl W White
- Department of Pediatric Pulmonology, University of Colorado Denver, Aurora, Colorado, USA.,Pediatric Pulmonary Division, The Breathing Institute at Children's Hospital Colorado, Aurora, Colorado, USA
| | - Livia A Veress
- Department of Pediatric Pulmonology, University of Colorado Denver, Aurora, Colorado, USA.,Pediatric Pulmonary Division, The Breathing Institute at Children's Hospital Colorado, Aurora, Colorado, USA
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23
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Okponyia OC, McGraw MD, Dysart MM, Garlick RB, Rioux JS, Murphy AL, Roe GB, White CW, Veress LA. Oxygen Administration Improves Survival but Worsens Cardiopulmonary Functions in Chlorine-exposed Rats. Am J Respir Cell Mol Biol 2018; 58:107-116. [PMID: 28846437 DOI: 10.1165/rcmb.2016-0223oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Chlorine is a highly reactive gas that can cause significant injury when inhaled. Unfortunately, its use as a chemical weapon has increased in recent years. Massive chlorine inhalation can cause death within 4 hours of exposure. Survivors usually require hospitalization after massive exposure. No countermeasures are available for massive chlorine exposure and supportive-care measures lack controlled trials. In this work, adult rats were exposed to chlorine gas (LD58-67) in a whole-body exposure chamber, and given oxygen (0.8 FiO2) or air (0.21 FiO2) for 6 hours after baseline measurements were obtained. Oxygen saturation, vital signs, respiratory distress and neuromuscular scores, arterial blood gases, and hemodynamic measurements were obtained hourly. Massive chlorine inhalation caused severe acute respiratory failure, hypoxemia, decreased cardiac output, neuromuscular abnormalities (ataxia and hypotonia), and seizures resulting in early death. Oxygen improved survival to 6 hours (87% versus 42%) and prevented observed seizure-related deaths. However, oxygen administration worsened the severity of acute respiratory failure in chlorine-exposed rats compared with controls, with increased respiratory acidosis (pH 6.91 ± 0.04 versus 7.06 ± 0.01 at 2 h) and increased hypercapnia (180.0 ± 19.8 versus 103.2 ± 3.9 mm Hg at 2 h). In addition, oxygen did not improve neuromuscular abnormalities, cardiac output, or respiratory distress associated with chlorine exposure. Massive chlorine inhalation causes severe acute respiratory failure and multiorgan damage. Oxygen administration can improve short-term survival but appears to worsen respiratory failure, with no improvement in cardiac output or neuromuscular dysfunction. Oxygen should be used with caution after massive chlorine inhalation, and the need for early assisted ventilation should be assessed in victims.
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Affiliation(s)
| | - Matthew D McGraw
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Marilyn M Dysart
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Rhonda B Garlick
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Jacqueline S Rioux
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Angela L Murphy
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Gates B Roe
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Carl W White
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Livia A Veress
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
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24
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Florova G, Azghani AO, Karandashova S, Schaefer C, Yarovoi SV, Declerck PJ, Cines DB, Idell S, Komissarov AA. Targeting plasminogen activator inhibitor-1 in tetracycline-induced pleural injury in rabbits. Am J Physiol Lung Cell Mol Physiol 2017; 314:L54-L68. [PMID: 28860148 DOI: 10.1152/ajplung.00579.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Elevated active plasminogen activator inhibitor-1 (PAI-1) has an adverse effect on the outcomes of intrapleural fibrinolytic therapy (IPFT) in tetracycline-induced pleural injury in rabbits. To enhance IPFT with prourokinase (scuPA), two mechanistically distinct approaches to targeting PAI-1 were tested: slowing its reaction with urokinase (uPA) and monoclonal antibody (mAb)-mediated PAI-1 inactivation. Removing positively charged residues at the "PAI-1 docking site" (179RHRGGS184→179AAAAAA184) of uPA results in a 60-fold decrease in the rate of inhibition by PAI-1. Mutant prourokinase (0.0625-0.5 mg/kg; n = 12) showed efficacy comparable to wild-type scuPA and did not change IPFT outcomes ( P > 0.05). Notably, the rate of PAI-1-independent intrapleural inactivation of mutant uPA was 2 times higher ( P < 0.05) than that of the wild-type enzyme. Trapping PAI-1 in a "molecular sandwich"-type complex with catalytically inactive two-chain urokinase with Ser195Ala substitution (S195A-tcuPA; 0.1 and 0.5 mg/kg) did not improve the efficacy of IPFT with scuPA (0.0625-0.5 mg/kg; n = 11). IPFT failed in the presence of MA-56A7C10 (0.5 mg/kg; n = 2), which forms a stable intrapleural molecular sandwich complex, allowing active PAI-1 to accumulate by blocking its transition to a latent form. In contrast, inactivation of PAI-1 by accelerating the active-to-latent transition mediated by mAb MA-33B8 (0.5 mg/kg; n = 2) improved the efficacy of IPFT with scuPA (0.25 mg/kg). Thus, under conditions of slow (4-8 h) fibrinolysis in tetracycline-induced pleural injury in rabbits, only the inactivation of PAI-1, but not a decrease in the rate of its reaction with uPA, enhances IPFT. Therefore the rate of fibrinolysis, which varies in different pathologic states, could affect the selection of PAI-1 inhibitors to enhance fibrinolytic therapy.
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Affiliation(s)
- Galina Florova
- Texas Lung Injury Institute, The University of Texas Health Science Center at Tyler , Tyler, Texas
| | - Ali O Azghani
- Department of Biology, The University of Texas at Tyler, Tyler, Texas
| | - Sophia Karandashova
- Texas Lung Injury Institute, The University of Texas Health Science Center at Tyler , Tyler, Texas
| | - Chris Schaefer
- Texas Lung Injury Institute, The University of Texas Health Science Center at Tyler , Tyler, Texas
| | - Serge V Yarovoi
- Department of Pathology and Laboratory Medicine, Perelman-University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - Paul J Declerck
- Laboratory for Therapeutic and Diagnostic Antibodies, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Leuven , Belgium
| | - Douglas B Cines
- Department of Pathology and Laboratory Medicine, Perelman-University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania
| | - Steven Idell
- Texas Lung Injury Institute, The University of Texas Health Science Center at Tyler , Tyler, Texas
| | - Andrey A Komissarov
- Texas Lung Injury Institute, The University of Texas Health Science Center at Tyler , Tyler, Texas
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25
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Summerhill EM, Hoyle GW, Jordt SE, Jugg BJ, Martin JG, Matalon S, Patterson SE, Prezant DJ, Sciuto AM, Svendsen ER, White CW, Veress LA. An Official American Thoracic Society Workshop Report: Chemical Inhalational Disasters. Biology of Lung Injury, Development of Novel Therapeutics, and Medical Preparedness. Ann Am Thorac Soc 2017; 14:1060-1072. [PMID: 28418689 PMCID: PMC5529138 DOI: 10.1513/annalsats.201704-297ws] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This report is based on the proceedings from the Inhalational Lung Injury Workshop jointly sponsored by the American Thoracic Society (ATS) and the National Institutes of Health (NIH) Countermeasures Against Chemical Threats (CounterACT) program on May 21, 2013, in Philadelphia, Pennsylvania. The CounterACT program facilitates research leading to the development of new and improved medical countermeasures for chemical threat agents. The workshop was initiated by the Terrorism and Inhalational Disasters Section of the Environmental, Occupational, and Population Health Assembly of the ATS. Participants included both domestic and international experts in the field, as well as representatives from U.S. governmental funding agencies. The meeting objectives were to (1) provide a forum to review the evidence supporting current standard medical therapies, (2) present updates on our understanding of the epidemiology and underlying pathophysiology of inhalational lung injuries, (3) discuss innovative investigative approaches to further delineating mechanisms of lung injury and identifying new specific therapeutic targets, (4) present promising novel medical countermeasures, (5) facilitate collaborative research efforts, and (6) identify challenges and future directions in the ongoing development, manufacture, and distribution of effective and specific medical countermeasures. Specific inhalational toxins discussed included irritants/pulmonary toxicants (chlorine gas, bromine, and phosgene), vesicants (sulfur mustard), chemical asphyxiants (cyanide), particulates (World Trade Center dust), and respirable nerve agents.
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26
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McElroy CS, Min E, Huang J, Loader JE, Hendry-Hofer TB, Garlick RB, Rioux JS, Veress LA, Smith R, Osborne C, Anderson DR, Holmes WW, Paradiso DC, White CW, Day BJ. From the Cover: Catalytic Antioxidant Rescue of Inhaled Sulfur Mustard Toxicity. Toxicol Sci 2016; 154:341-353. [PMID: 27605419 DOI: 10.1093/toxsci/kfw170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Sulfur mustard (bis 2-chloroethyl ethyl sulfide, SM) is a powerful bi-functional vesicating chemical warfare agent. SM tissue injury is partially mediated by the overproduction of reactive oxygen species resulting in oxidative stress. We hypothesized that using a catalytic antioxidant (AEOL 10150) to alleviate oxidative stress and secondary inflammation following exposure to SM would attenuate the toxic effects of SM inhalation. Adult male rats were intubated and exposed to SM (1.4 mg/kg), a dose that produces an LD50 at approximately 24 h. Rats were randomized and treated via subcutaneous injection with either sterile PBS or AEOL 10150 (5 mg/kg, sc, every 4 h) beginning 1 h post-SM exposure. Rats were euthanized between 6 and 48 h after exposure to SM and survival and markers of injury were determined. Catalytic antioxidant treatment improved survival after SM inhalation in a dose-dependent manner, up to 52% over SM PBS at 48 h post-exposure. This improvement was sustained for at least 72 h after SM exposure when treatments were stopped after 48 h. Non-invasive monitoring throughout the duration of the studies also revealed blood oxygen saturations were improved by 10% and clinical scores were reduced by 57% after SM exposure in the catalytic antioxidant treatment group. Tissue analysis showed catalytic antioxidant therapy was able to decrease airway cast formation by 69% at 48 h post-exposure. To investigate antioxidant induced changes at the peak of injury, several biomarkers of oxidative stress and inflammation were evaluated at 24 h post-exposure. AEOL 10150 attenuated SM-mediated lung lipid oxidation, nitrosative stress and many proinflammatory cytokines. The findings indicate that catalytic antioxidants may be useful medical countermeasure against inhaled SM exposure.
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Affiliation(s)
- Cameron S McElroy
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado 80045.,Department of Medicine, National Jewish Health, Denver, Colorado 80206
| | - Elysia Min
- Department of Medicine, National Jewish Health, Denver, Colorado 80206
| | - Jie Huang
- Department of Medicine, National Jewish Health, Denver, Colorado 80206
| | - Joan E Loader
- Department of Pediatrics, University of Colorado, Aurora, Colorado 80045
| | | | - Rhonda B Garlick
- Department of Pediatrics, University of Colorado, Aurora, Colorado 80045
| | - Jackie S Rioux
- Department of Pediatrics, University of Colorado, Aurora, Colorado 80045
| | - Livia A Veress
- Department of Pediatrics, University of Colorado, Aurora, Colorado 80045
| | - Russell Smith
- Department of Pediatrics, University of Colorado, Aurora, Colorado 80045
| | - Chris Osborne
- Department of Pediatrics, University of Colorado, Aurora, Colorado 80045
| | - Dana R Anderson
- Analytical Toxicology Division, Proving Grounds United States Army Medical Research Institute of Chemical Defense (USAMRICD), Aberdeen, Maryland 21010
| | - Wesley W Holmes
- Analytical Toxicology Division, Proving Grounds United States Army Medical Research Institute of Chemical Defense (USAMRICD), Aberdeen, Maryland 21010
| | - Danielle C Paradiso
- Analytical Toxicology Division, Proving Grounds United States Army Medical Research Institute of Chemical Defense (USAMRICD), Aberdeen, Maryland 21010
| | - Carl W White
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado 80045.,Department of Pediatrics, University of Colorado, Aurora, Colorado 80045
| | - Brian J Day
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado 80045 .,Department of Medicine, National Jewish Health, Denver, Colorado 80206
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27
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Weinberger B, Malaviya R, Sunil VR, Venosa A, Heck DE, Laskin JD, Laskin DL. Mustard vesicant-induced lung injury: Advances in therapy. Toxicol Appl Pharmacol 2016; 305:1-11. [PMID: 27212445 PMCID: PMC5119915 DOI: 10.1016/j.taap.2016.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/18/2016] [Indexed: 01/17/2023]
Abstract
Most mortality and morbidity following exposure to vesicants such as sulfur mustard is due to pulmonary toxicity. Acute injury is characterized by epithelial detachment and necrosis in the pharynx, trachea and bronchioles, while long-term consequences include fibrosis and, in some instances, cancer. Current therapies to treat mustard poisoning are primarily palliative and do not target underlying pathophysiologic mechanisms. New knowledge about vesicant-induced pulmonary disease pathogenesis has led to the identification of potentially efficacious strategies to reduce injury by targeting inflammatory cells and mediators including reactive oxygen and nitrogen species, proteases and proinflammatory/cytotoxic cytokines. Therapeutics under investigation include corticosteroids, N-acetyl cysteine, which has both mucolytic and antioxidant properties, inducible nitric oxide synthase inhibitors, liposomes containing superoxide dismutase, catalase, and/or tocopherols, protease inhibitors, and cytokine antagonists such as anti-tumor necrosis factor (TNF)-α antibody and pentoxifylline. Antifibrotic and fibrinolytic treatments may also prove beneficial in ameliorating airway obstruction and lung remodeling. More speculative approaches include inhibitors of transient receptor potential channels, which regulate pulmonary epithelial cell membrane permeability, non-coding RNAs and mesenchymal stem cells. As mustards represent high priority chemical threat agents, identification of effective therapeutics for mitigating toxicity is highly significant.
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Affiliation(s)
- Barry Weinberger
- Division of Neonatal and Perinatal Medicine, Hofstra Northwell School of Medicine, Cohen Children's Medical Center of New York, New Hyde Park, NY 11040, USA.
| | - Rama Malaviya
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA
| | - Vasanthi R Sunil
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA
| | - Alessandro Venosa
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA
| | - Diane E Heck
- Department of Environmental Health Science, New York Medical College, School of Public Health, Valhalla, NY 10595, USA
| | - Jeffrey D Laskin
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
| | - Debra L Laskin
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA
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McElroy CS, Day BJ. Antioxidants as potential medical countermeasures for chemical warfare agents and toxic industrial chemicals. Biochem Pharmacol 2016; 100:1-11. [PMID: 26476351 PMCID: PMC4744107 DOI: 10.1016/j.bcp.2015.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/01/2015] [Indexed: 12/18/2022]
Abstract
The continuing horrors of military conflicts and terrorism often involve the use of chemical warfare agents (CWAs) and toxic industrial chemicals (TICs). Many CWA and TIC exposures are difficult to treat due to the danger they pose to first responders and their rapid onset that can produce death shortly after exposure. While the specific mechanism(s) of toxicity of these agents are diverse, many are associated either directly or indirectly with increased oxidative stress in affected tissues. This has led to the exploration of various antioxidants as potential medical countermeasures for CWA/TIC exposures. Studies have been performed across a wide array of agents, model organisms, exposure systems, and antioxidants, looking at an almost equally diverse set of endpoints. Attempts at treating CWAs/TICs with antioxidants have met with mixed results, ranging from no effect to nearly complete protection. The aim of this commentary is to summarize the literature in each category for evidence of oxidative stress and antioxidant efficacy against CWAs and TICs. While there is great disparity in the data concerning methods, models, and remedies, the outlook on antioxidants as medical countermeasures for CWA/TIC management appears promising.
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Affiliation(s)
- Cameron S McElroy
- Department of Medicine, National Jewish Health, Denver, CO 80206, United States; Department of Pharmaceutical Sciences, University of Colorado Denver, Aurora, CO 80045, United States
| | - Brian J Day
- Department of Medicine, National Jewish Health, Denver, CO 80206, United States; Department of Medicine, University of Colorado Denver, Aurora, CO 80045, United States; Department of Immunology, University of Colorado Denver, Aurora, CO 80045, United States; Department of Environmental & Occupational Health Sciences, University of Colorado Denver, Aurora, CO 80045, United States; Department of Pharmaceutical Sciences, University of Colorado Denver, Aurora, CO 80045, United States.
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Houin PR, Veress LA, Rancourt RC, Hendry-Hofer TB, Loader JE, Rioux JS, Garlick RB, White CW. Intratracheal heparin improves plastic bronchitis due to sulfur mustard analog. Pediatr Pulmonol 2015; 50:118-26. [PMID: 24692161 PMCID: PMC4182164 DOI: 10.1002/ppul.23043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/04/2014] [Accepted: 03/04/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Inhalation of sulfur mustard (SM) and SM analog, 2-chloroethyl ethyl sulfide (CEES), cause fibrinous cast formation that occludes the conducting airways, similar to children with Fontan physiology-induced plastic bronchitis. These airway casts cause significant mortality and morbidity, including hypoxemia and respiratory distress. Our hypothesis was that intratracheal heparin, a highly cost effective and easily preserved rescue therapy, could reverse morbidity and mortality induced by bronchial cast formation. METHODS Sprague-Dawley rats were exposed to 7.5% CEES via nose-only aerosol inhalation to produce extensive cast formation and mortality. The rats were distributed into three groups: non-treated, phosphate-buffered saline (PBS)-treated, and heparin-treated groups. Morbidity was assessed with oxygen saturations and clinical distress. Blood and bronchoalveolar lavage fluid (BALF) were obtained for analysis, and lungs were fixed for airway microdissection to quantify the extent of airway cast formation. RESULTS Heparin, given intratracheally, improved survival (100%) when compared to non-treated (75%) and PBS-treated (90%) controls. Heparin-treated rats also had improved oxygen saturations, clinical distress and airway cast scores. Heparin-treated rats had increased thrombin clotting times, factor Xa inhibition and activated partial thromboplastin times, indicating systemic absorption of heparin. There were also increased red blood cells (RBCs) in the BALF in 2/6 heparin-treated rats compared to PBS-treated control rats. CONCLUSIONS Intratracheal heparin 1 hr after CEES inhalation improved survival, oxygenation, airway obstruction, and clinical distress. There was systemic absorption of heparin in rats treated intratracheally. Some rats had increased RBCs in BALF, suggesting a potential for intrapulmonary bleeding if used chronically after SM inhalation.
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Affiliation(s)
- Paul R Houin
- Department of Pediatrics, University of Colorado Health Sciences Center, Aurora, Colorado
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Rancourt RC, Ahmad A, Veress LA, Rioux JS, Garlick RB, White CW. Antifibrinolytic mechanisms in acute airway injury after sulfur mustard analog inhalation. Am J Respir Cell Mol Biol 2014; 51:559-67. [PMID: 24796565 DOI: 10.1165/rcmb.2014-0012oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Acute lung injury in response to mustard gas (sulfur mustard [SM]) inhalation results in formation of fibrin casts, which obstruct the airway. The objective of this study was to identify fibrinolytic pathways that could be contributing to the persistence of airway casts after SM exposure. Rats were exposed to the SM analog, 2-chloroethyl ethyl sulfide, via nose-only aerosol inhalation. At 4 and 18 hours after exposure, animals were killed and airway-capillary leak estimated by measuring bronchoalveolar lavage fluid (BALF) protein and IgM content. The fibrin clot-degrading and plasminogen-activating capabilities of BALF were also assessed by activity assays, whereas Western blotting was used to determine the presence and activities of plasminogen activator inhibitor-1, thrombin activatable fibrinolytic inhibitor and α2-antiplasmin. Measurement of tissue-specific steady-state mRNA levels was also conducted for each fibrinolytic inhibitor to assess whether its synthesis occurs in lung or at extrapulmonary sites. The results of this study demonstrate that fibrin-degrading and plasminogen-activating capabilities of the airways become impaired during the onset of 2-chloroethyl ethyl sulfide-induced vascular leak. Findings of functionally active reservoirs of plasminogen activator inhibitor-1, thrombin activatable fibrinolysis inhibitor, and α2-antiplasmin in BALF indicate that airway fibrinolysis is inhibited at multiple levels in response to SM.
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Veress LA, Anderson DR, Hendry-Hofer TB, Houin PR, Rioux JS, Garlick RB, Loader JE, Paradiso DC, Smith RW, Rancourt RC, Holmes WW, White CW. Airway tissue plasminogen activator prevents acute mortality due to lethal sulfur mustard inhalation. Toxicol Sci 2014; 143:178-84. [PMID: 25331496 DOI: 10.1093/toxsci/kfu225] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Sulfur mustard (SM) is a chemical weapon stockpiled today in volatile regions of the world. SM inhalation causes a life-threatening airway injury characterized by airway obstruction from fibrin casts, which can lead to respiratory failure and death. Mortality in those requiring intubation is more than 80%. No therapy exists to prevent mortality after SM exposure. Our previous work using the less toxic analog of SM, 2-chloroethyl ethyl sulfide, identified tissue plasminogen activator (tPA) an effective rescue therapy for airway cast obstruction (Veress, L. A., Hendry-Hofer, T. B., Loader, J. E., Rioux, J. S., Garlick, R. B., and White, C. W. (2013). Tissue plasminogen activator prevents mortality from sulfur mustard analog-induced airway obstruction. Am. J. Respir. Cell Mol. Biol. 48, 439-447). It is not known if exposure to neat SM vapor, the primary agent used in chemical warfare, will also cause death due to airway casts, and if tPA could be used to improve outcome. METHODS Adult rats were exposed to SM, and when oxygen saturation reached less than 85% (median: 6.5 h), intratracheal tPA or placebo was given under isoflurane anesthesia every 4 h for 48 h. Oxygen saturation, clinical distress, and arterial blood gases were assessed. Microdissection was done to assess airway obstruction by casts. RESULTS Intratracheal tPA treatment eliminated mortality (0% at 48 h) and greatly improved morbidity after lethal SM inhalation (100% death in controls). tPA normalized SM-associated hypoxemia, hypercarbia, and lactic acidosis, and improved respiratory distress. Moreover, tPA treatment resulted in greatly diminished airway casts, preventing respiratory failure from airway obstruction. CONCLUSIONS tPA given via airway more than 6 h after exposure prevented death from lethal SM inhalation, and normalized oxygenation and ventilation defects, thereby rescuing from respiratory distress and failure. Intra-airway tPA should be considered as a life-saving rescue therapy after a significant SM inhalation exposure incident.
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Affiliation(s)
- Livia A Veress
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Dana R Anderson
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Tara B Hendry-Hofer
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Paul R Houin
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Jacqueline S Rioux
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Rhonda B Garlick
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Joan E Loader
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Danielle C Paradiso
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Russell W Smith
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Raymond C Rancourt
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Wesley W Holmes
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Carl W White
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
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Perry MR, Benson EM, Kohne JW, Plahovinsak JL, Babin MC, Platoff GE, Yeung DT. A novel sulfur mustard (HD) vapor inhalation exposure system for accurate inhaled dose delivery. J Pharmacol Toxicol Methods 2014; 71:120-8. [PMID: 25291290 DOI: 10.1016/j.vascn.2014.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A custom designed HD exposure system was used to deliver controlled inhaled doses to an animal model through an endotracheal tube. METHODS Target HD vapor challenges were generated by a temperature controlled bubbler/aerosol trap, while concentration was monitored near real-time by gas chromatography. Animal breathing parameters were monitored real-time by an in-line pneumotach, pressure transducer, and Buxco pulmonary analysis computer/software. For each exposure, the challenge atmosphere was allowed to stabilize at the desired concentration while the anesthetized animal was provided humidity controlled clean air. Once the target concentration was achieved and stable, a portion of the challenge atmosphere was drawn past the endotracheal tube, where the animal inhaled the exposure ad libitum. During the exposure, HD vapor concentration and animal weight were used to calculate the needed inhaled volume to achieve the target inhaled dose (μg/kg). The exposures were halted when the inhaled volume was achieved. RESULTS The exposure system successfully controlled HD concentrations from 22.2 to 278mg/m(3) and accurately delivered inhaled doses between 49.3 and 1120μg/kg with actual administered doses being within 4% of the target level. DISCUSSION This exposure system administers specific HD inhaled doses to evaluate physiological effects and for evaluation of potential medical countermeasure treatments.
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Affiliation(s)
- Mark R Perry
- Battelle Biomedical Research Center, Columbus, OH 43201, USA.
| | - Eric M Benson
- Battelle Biomedical Research Center, Columbus, OH 43201, USA
| | | | | | - Michael C Babin
- Battelle Biomedical Research Center, Columbus, OH 43201, USA
| | - Gennady E Platoff
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA
| | - David T Yeung
- National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892, USA
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Keyser BM, Andres DK, Holmes WW, Paradiso D, Appell A, Letukas VA, Benton B, Clark OE, Gao X, Ray P, Anderson DR, Ray R. Mustard Gas Inhalation Injury. Int J Toxicol 2014; 33:271-281. [DOI: 10.1177/1091581814532959] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mustard gas (sulfur mustard [SM], bis-[2-chloroethyl] sulfide) is a vesicating chemical warfare agent and a potential chemical terrorism agent. Exposure of SM causes debilitating skin blisters (vesication) and injury to the eyes and the respiratory tract; of these, the respiratory injury, if severe, may even be fatal. Therefore, developing an effective therapeutic strategy to protect against SM-induced respiratory injury is an urgent priority of not only the US military but also the civilian antiterrorism agencies, for example, the Homeland Security. Toward developing a respiratory medical countermeasure for SM, four different classes of therapeutic compounds have been evaluated in the past: anti-inflammatory compounds, antioxidants, protease inhibitors and antiapoptotic compounds. This review examines all of these different options; however, it suggests that preventing cell death by inhibiting apoptosis seems to be a compelling strategy but possibly dependent on adjunct therapies using the other drugs, that is, anti-inflammatory, antioxidant, and protease inhibitor compounds.
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Affiliation(s)
- Brian M. Keyser
- Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Devon K. Andres
- Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Wesley W. Holmes
- Analytical Toxicology Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Danielle Paradiso
- Analytical Toxicology Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Ashley Appell
- Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Valerie A. Letukas
- Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Betty Benton
- Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Offie E. Clark
- Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Xiugong Gao
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Prabhati Ray
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Dana R. Anderson
- Analytical Toxicology Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Radharaman Ray
- Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
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Rancourt RC, Veress LA, Ahmad A, Hendry-Hofer TB, Rioux JS, Garlick RB, White CW. Tissue factor pathway inhibitor prevents airway obstruction, respiratory failure and death due to sulfur mustard analog inhalation. Toxicol Appl Pharmacol 2013; 272:86-95. [PMID: 23727623 DOI: 10.1016/j.taap.2013.05.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/17/2013] [Accepted: 05/20/2013] [Indexed: 11/25/2022]
Abstract
UNLABELLED Sulfur mustard (SM) inhalation causes airway injury, with enhanced vascular permeability, coagulation, and airway obstruction. The objective of this study was to determine whether recombinant tissue factor pathway inhibitor (TFPI) could inhibit this pathogenic sequence. METHODS Rats were exposed to the SM analog 2-chloroethyl ethyl sulfide (CEES) via nose-only aerosol inhalation. One hour later, TFPI (1.5mg/kg) in vehicle, or vehicle alone, was instilled into the trachea. Arterial O2 saturation was monitored using pulse oximetry. Twelve hours after exposure, animals were euthanized and bronchoalveolar lavage fluid (BALF) and plasma were analyzed for prothrombin, thrombin-antithrombin complex (TAT), active plasminogen activator inhibitor-1 (PAI-1) levels, and fluid fibrinolytic capacity. Lung steady-state PAI-1 mRNA was measured by RT-PCR analysis. Airway-capillary leak was estimated by BALF protein and IgM, and by pleural fluid measurement. In additional animals, airway cast formation was assessed by microdissection and immunohistochemical detection of airway fibrin. RESULTS Airway obstruction in the form of fibrin-containing casts was evident in central conducting airways of rats receiving CEES. TFPI decreased cast formation, and limited severe hypoxemia. Findings of reduced prothrombin consumption, and lower TAT complexes in BALF, demonstrated that TFPI acted to limit thrombin activation in airways. TFPI, however, did not appreciably affect CEES-induced airway protein leak, PAI-1 mRNA induction, or inhibition of the fibrinolytic activity present in airway surface liquid. CONCLUSIONS Intratracheal administration of TFPI limits airway obstruction, improves gas exchange, and prevents mortality in rats with sulfur mustard-analog-induced acute lung injury.
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