Recent advances in the management of chronic obstructive pulmonary disease

Cryptotanshinone alleviates lipopolysaccharide and cigarette smoke-induced chronic obstructive pulmonary disease in mice via the Keap1/Nrf2 axis

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity worldwide. Cigarette smoking, which leads to abnormalities in the airways or alveoli and persistent obstruction of the airway's flow, is a significant risk factor of COPD. Cryptotanshinone (CTS) is the active ingredient in Salvia miltiorrhiza (Danshen) and has many pharmacological properties including anti-inflammatory, antitumor, and antioxidant properties, but its impact on COPD is uncertain. In the present study, the potential effect of CTS on COPD was investigated in a modified COPD mice model induced with cigarette smoke (CS) and lipopolysaccharide (LPS) exposure. CTS significantly reversed the decline in lung function, emphysema, inflammatory cell infiltration, small airway remodeling, pulmonary pathological damage, and airway epithelial cell proliferation in CS- and LPS-exposed mice. Additionally, CTS decreased inflammatory cytokines such as tumor necrosis factor α (TNF α), interleukins IL-6 and IL-1β, and keratinocyte chemoattractant (KC), increased the activities of superoxide dismutase (SOD), Catalase (CAT) and L-Glutathione (GSH), and repressed the expression of protein hydrolases matrix metalloprotein (MMP)- 9 and - 12 in pulmonary tissue and bronchoalveolar lavage fluid (BALF). The protective effects of CTS were also observed in human bronchial epithelial cell line BEAS-2B simulated with cigarette smoke condensate (CSC) and LPS. Mechanistically, CTS can repress the protein level of Keap1, resulting to activation of erythroid 2-related factor (Nrf2), finally alleviating COPD. In summary, the present findings demonstrated that CTS dramatically ameliorates COPD induced by CS and LPS via activating Keap1/Nrf2 pathway.

Protective effect of Palmijihwanghwan in a mouse model of cigarette smoke and lipopolysaccharide-induced chronic obstructive pulmonary disease

Background

Palmijihwanghwan (PJH) is a traditional medicine and eight constituents derived from PJH possess anti-inflammatory activities. However, the scientific evidence for its potential as a therapeutic agent for inflammatory lung disease has not yet been studied. In this study, we examined the protective effect of PJH in a mouse model of chronic obstructive pulmonary disease (COPD) induced by cigarette smoke (CS) with lipopolysaccharide (LPS).

Methods

Mice received CS exposure for 8 weeks and intranasal instillation of LPS on weeks 1, 3, 5 and 7. PJH (100 and 200 mg/kg) was administrated daily 1 h before CS treatment for the last 4 weeks.

Results

Compared with CS plus LPS-exposed mice, mice in the PJH-treated group showed significantly decreased inflammatory cells count and reduced inflammatory cytokines including interleukin-1 beta (IL-1β), IL-6 and tumor necrosis factor alpha (TNF-α) levels in broncho-alveolar lavage fluid (BALF) and lung tissue. PJH also suppressed the phosphorylation of nuclear factor kappa B (NF-κB) and extracellular signal-regulated kinase1/2 (ERK1/2) caused by CS plus LPS exposure. Furthermore, CS plus LPS induced increases in matrix metallopeptidase (MMP)-7, MMP-9, and transforming growth factor-β (TGF-β) expression and collagen deposition that were inhibited in PJH-treated mice.

Conclusions

This study demonstrates that PJH prevents respiratory inflammation and airway remodeling caused by CS with LPS exposure suggesting potential therapy for the treatment of COPD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-021-03453-5.

Role of chitosan based nanomedicines in the treatment of chronic respiratory diseases

Chitosan-loaded nanomedicines provide a greater opportunity for the treatment of respiratory diseases. Natural biopolymer chitosan and its derivatives have a large number of proven pharmacological actions like antioxidant, wound healing, immuno-stimulant, hypocholesterolemic, antimicrobial, obesity treatment, anti-inflammatory, anticancer, bone tissue engineering, antifungal, regenerative medicine, anti-diabetic and mucosal adjuvant, etc. which attracted its use in the pharmaceutical industry. As compared to other polysaccharides, chitosan has excellent mucoadhesive characteristics, less viscous, easily modified into the chemical and biological molecule and gel-forming property due to which the drugs retain in the respiratory tract for a longer period of time providing enhanced therapeutic action of the drug. Chitosan-based nanomedicines would have the greatest effect when used to transport poor water soluble drugs, macromolecules like proteins, and peptides through the lungs. In this review, we highlight and discuss the role of chitosan and its nanomedicines in the treatment of chronic respiratory diseases such as pneumonia, asthma, COPD, lung cancer, tuberculosis, and COVID-19.

A prospective observational study on acute exacerbation of chronic obstructive pulmonary disease in pulmonology department of tertiary care hospital

Background

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gasses. An acute exacerbation of COPD refers to a flare up or episode where a person breathing becomes worse than normal. An acute exacerbation of COPD refers to a flare up or episode where a person breathing becomes worse than normal. Acute exacerbation in COPD (AECOPD) is frequent in the course of the illness and is the most common reason for medical visits, hospital admissions, and mortality among these patients. Exacerbations of COPD are associated with increased morbidity and mortality. To assess the exposure and severity of acute exacerbations of COPD with COPD Assessment Test (CAT Scale) and mMRC (modified Medical Research Council) Dyspnea scale. Study design was a hospital-based prospective observational study. Study site was conducted at Pulmonology Department of Government General Hospital, Vijayawada.

Results

The total patients were 197. Out of which, 119 were from In-patient Department (IPD) and 78 were from Out-patient Department (OPD). In this study, males were 167 (85%), among which, IPD were 97 (49%), OPD were 70 (36%), and females were 30 (15%), among which, IPD were 22 (11%), OPD were 8 (4%).

Conclusion

The morbidity and mortality of COPD have been increased in recent years. This study concludes that there is a relation between risk of acute exacerbations in COPD with habitual history and occupational history. Increase in exposure to occupational hazards, smoking habit leads to an increase in risk of acute exacerbations in COPD patients. The level of severity was more in smokers and the patients who had biomass, organic dust, and mineral exposure. When severity was observed, group D severity is more observed in population according to CAT scale and mMRC dyspnea scale.

Effects of cannabis oil extract on immune response gene expression in human small airway epithelial cells (HSAEpC): implications for chronic obstructive pulmonary disease (COPD)

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is commonly associated with both a pro-inflammatory and a T-helper 1 (Th1) immune response. It was hypothesized that cannabis oil extract can alleviate COPD symptoms by eliciting an anti-inflammatory Th2 immune response. Accordingly, the effects of cannabis oil extract on the expression of 84 Th2 and related immune response genes in human small airways epithelial cells (HSAEpC) were investigated.

METHODS

HSAEpC from a single donor were treated with three dilutions of a standardized cannabis oil extract (1:400, 1:800 and 1:1600) along with a solvent control (0.25% [2.5 ul/ml] ethanol) for 24 h. There were four replicates per treatment dilution, and six for the control. RNA isolated from cells were employed in pathway-focused quantitative polymerase chain reaction (qPCR) microarray assays.

RESULTS

The extract induced significant (P < 0.05) changes in expression of 37 tested genes. Six genes (CSF2, IL1RL1, IL4, IL13RA2, IL17A and PPARG) were up-regulated at all three dilutions. Another two (CCL22 and TSLP) were up-regulated while six (CLCA1, CMA1, EPX, LTB4R, MAF and PMCH) were down-regulated at the 1:400 and 1:800 dilutions. The relationship of differentially-expressed genes of interest to biologic pathways was explored using the Database for Annotation, Visualization and Integrated Discovery (DAVID).

CONCLUSIONS

This exploratory investigation indicates that cannabis oil extract may affect expression of specific airway epithelial cell genes that could modulate pro-inflammatory or Th1 processes in COPD. These results provide a basis for further investigations and have prompted in vivo studies of the effects of cannabis oil extract on pulmonary function.

TRIAL REGISTRATION

NONE (all in vitro experiments).

Toll-like receptors-mediated pathways activate inflammatory responses in the esophageal mucosa of adult eosinophilic esophagitis

Objectives

Esophageal microbiota and regulation of adaptive immunity are increasingly being investigated in eosinophilic esophagitis (EoE). Toll-like receptors (TLRs) play a central role in the initiation and maintenance of innate immune activity. Our objective was to characterize the esophageal and duodenal innate immune response in EoE and its modulation by dietary therapy.

Methods

Esophageal and duodenal biopsy samples were collected from 10 adults with untreated EoE, before and after effective treatment with a six-food elimination diet (SFED), and 10 controls with normal esophagus. In all cases, bacterial load (by mRNA expression of 16S), TLRs, mucins, transcription factors, interleukins, components of the NKG2D system, and innate immunity effectors were assessed by qPCR. Protein expression of TLRs were also determined by immunofluorescence.

Results

Bacterial load and TLR1, TLR2, TLR4, and TLR9 were overexpressed on biopsies with active EoE compared with controls. Muc1 and Muc5B genes were downregulated while Muc4 was overexpressed. Upregulation of MyD88 and NFκB was found together with IL-1β, IL-6, IL-8, and IL-10 mediators and PER-1, iNOS, and GRZA effectors. NG-K2D components (KLRK1, IL-15, MICB) were also upregulated. In all cases, changes in active EoE were normalized following SFED and mucosal healing. Duodenal samples also showed increased expressions of TLR-1, TLR-2, and TLR-4, but not 16S or any other mediators nor effectors of inflammation.

Conclusions

Esophageal TLR-dependent signaling pathways in EoE support the potential implication of microbiota and the innate immune system in the pathogenesis of this disease.