Metabolic functions of the lung. Of what clinical relevance?

Circulating serotonin levels in COPD patients: a pilot study

Background

Chronic obstructive pulmonary disease (COPD) is a major and increasing global health problem. Serotonin is a neurotransmitter that participates in several pulmonary functions and it has been involved in oxidative stress, which plays essential roles in the pathogenesis of COPD. The current study aimed at establishing the levels of circulating serotonin in COPD, and investigating eventual relations between serotonin and oxidative stress markers.

Methods

Whole blood serotonin was assessed in 43 consecutive patients with stable COPD and in 43 age and sex-matched healthy controls.

Results

Serotonin blood levels were significantly higher in COPD patients than in controls (median 0.81 μmol/L, IQR: 0.61–4.02 vs 0.65 μmol/L, IQR: 0.53–1.39, p = 0.02). The univariate logistic regression analysis evidenced that serotonin levels are independently associated with presence of COPD (crude OR = 7.29, 95% CI: 1.296–41.05, p = 0.003) and such an association was confirmed also after adjusting for several confounders (OR 21.92, 95% CI 2.02–237.83; p = 0.011).

Conclusions

Our study showed higher levels of circulating serotonin in COPD and an inverse correlation with the worsening of airway obstruction. Future studies are necessary to investigate the clinical utility of this finding.

Case Series of Pulmonary Tumor Embolism and Intravascular Lymphoma: Evaluation of the Usefulness of Pulmonary Microvascular Cytology

Pulmonary tumor embolism (PTE) and intravascular lymphoma cause rapidly progressive deterioration and an antemortem diagnosis is difficult. The usefulness of pulmonary microvascular cytology (PMC) in the diagnosis of these disorders has been reported in sporadic case reports. We retrospectively evaluated the records of 7 patients with tumor cells in the pulmonary microvasculature (4 with PTE and 3 with malignant lymphoma) who underwent pulmonary microvascular cytology. Two of the 4 patients with PTE and 2 of the 3 patients with malignant lymphoma (all 3 had intravascular metastasis) had positive PMC results. These findings suggested that PMC may be useful in the diagnosis of these disorders.

Migraines Linked to Intrapulmonary Right-to-Left Shunt

OBJECTIVE

To determine if there is an association between migraines and intrapulmonary right-to-left shunt.

BACKGROUND

Several studies have described an association between migraines and intracardiac right-to-left shunt.

METHODS

Patients with hereditary hemorrhagic telangiectasia (HHT) were retrospectively recruited from the Toronto Hereditary Hemorrhagic Telangiectasia Center Clinical Database. All patients had been prospectively, systematically asked about a history of migraines and systematically screened for pulmonary and cerebral arteriovenous malformations (AVMs). All patients with a definite diagnosis of HHT, assessed during a 2-year period (February 1997 to April 1999), were included. Univariate analyses and logistic regression were performed, for migraine as the dependent variable and the following independent variables: age, sex, pulmonary AVMs, and cerebral AVMs.

RESULTS

Of the 200 patients assessed during the 2-year period, 124 (62%) had a definite diagnosis of HHT and were included in the analysis. Eighty (65%) were females. Forty-seven (38%) of the HHT patients had a history of migraine, of whom 38 (81%) had migraine with aura. The prevalence of migraine was greater in patients with pulmonary AVMs (46%) compared to patients without pulmonary AVMs (33%), OR = 1.7 (0.8 to 3.6), though this did not reach statistical significance (P = .14). Pulmonary AVMs were significantly associated with migraine (OR = 2.4, 95% CI = 1.1 to 5.5, P = .04), after adjustment for age and sex, using logistic regression.

CONCLUSIONS

There is a significant association between intrapulmonary right-to-left shunt and migraine.

The role of 5-hydroxytryptamine in the control of pulmonary vascular tone in a rabbit model of pulmonary hypertension secondary to left ventricular dysfunction

The role of 5-hydroxytryptamine (5-HT) in a rabbit model of pulmonary hypertension (PHT) secondary to left ventricular dysfunction was investigated. Following pulmonary artery catheterisation under anaesthesia, 5-HT (1-400 microg kg(-1) i.v.) was administered before and after either 5-HT(2A) receptor antagonism with ketanserin (0.5 mg kg(-1)) or infusion of the nitric oxide synthase inhibitor, l-NAME (30 micromol min(-1)). Eight week coronary artery ligated rabbits demonstrate increased mean pulmonary arterial pressure (PAP) compared to controls (17.0+/-0.5 versus 12.0+/-0.5 mmHg, P<0.001) accompanied by right ventricular hypertrophy. 5-HT alone produced a greater pulmonary pressor response in rabbits with PHT (increase of 7.5+/-1.2, n=12 c.f. 3.5+/-0.4 mmHg in shams, n=12, P<0.01). Ketanserin had no effect on basal PAP in either PHT or control rabbits but inhibited the response to 5-HT in both groups. The response to 5-HT following l-NAME was increased in both groups and was greater in rabbits with PHT (an increase of 20.1+/-2.9, n=6 c.f. 11.4+/-1.8 mmHg, n=6, P<0.05). These results suggest that the difference shown in the in vivo pulmonary response to exogenous 5-HT is mediated largely through 5-HT(2A) receptors in this model. However, activity of endogenous 5-HT at the 5-HT(2A) receptors is not responsible for maintaining the raised basal PAP through vasoconstriction in PHT rabbits once PHT has developed.

Neuroadrenergic denervation of the lung in type I diabetes mellitus complicated by autonomic neuropathy

STUDY OBJECTIVE

To verify whether autonomic neuropathy (AN) complicating type I, insulin-dependent diabetes mellitus affected neuroadrenergic bronchopulmonary innervation.

PATIENTS

Twenty nonsmoking diabetic patients without respiratory diseases were studied: 11 patients with AN (group AN) and 9 patients without AN (control; group C) diagnosed by standardized criteria.

DESIGN

Patients underwent respiratory function tests and ventilatory scintigraphies with (123)I-metaiodobenzylguanidine (MIBG) and with (99m)Tc-diethylenetriaminepenta-acetic acid (DTPA) to assess both bronchopulmonary neuroadrenergic innervation and also permeability of the alveolar-capillary barrier to water-soluble tracers. Rates of pulmonary clearance of the two tracers were computed, and correlates were identified by nonparametric statistics.

SETTING

University hospital.

RESULTS

The AN and C groups had normal respiratory function test results and comparable duration of diabetes and quality of metabolic control. (99m)Tc-DTPA clearance did not distinguish the groups. (123)I-MIBG clearance was faster in the AN group than in the C group (mean +/- SD half-time of the radiotracer time-activity curve [T(1/2)], 116.1 +/- 22.8 min in the AN group vs 139.5 +/- 18.3 min in the C group, p = 0.022), which is consistent with neuroadrenergic denervation in the AN group. (123)I-MIBG clearance was independent from (99m)Tc-DTPA clearance. Faster (123)I-MIBG clearance was significantly associated with worse performance in three of the four autonomic tests.

CONCLUSIONS

Neuroadrenergic bronchopulmonary denervation may occur in diabetic patients with AN despite normal clinical and respiratory function findings. Further research is needed to identify clinical and prognostic implications of these findings.

Diagnosis of pulmonary microvascular metastases by cytologic evaluation of pulmonary artery catheter-derived blood specimens

Pulmonary microvascular tumor embolization is a recognized cause of respiratory distress in cancer patients that is rarely diagnosed antemortem. Previous studies with relatively few patients have reported high diagnostic yield using wedged pulmonary artery catheter-derived blood samples to evaluate dyspneic cancer patients for possible microembolization. From 1991 to 1993, 21 cancer patients with respiratory distress of relatively acute onset and varying severity who required pulmonary artery catheterization for hemodynamic monitoring were evaluated using this technique. Pulmonary microvascular cytology (PMC) was interpreted as positive for malignant cells in nine of 21 patients presenting with a range of tumor types, including carcinomas of the breast, colon, and pancreas as well as non-Hodgkin's lymphoma. In 11 patients the PMC was interpreted as negative. One case was considered nondiagnostic. Megakaryocytes, noted in most PMC specimens as well as in several samples of simultaneously drawn peripheral blood, may mimic epithelial tumor cells. Immunocytochemical stains for factor VIII and cytokeratins were used to resolve occasional diagnostic dilemmas. Clinical and/or pathologic follow-up information was available for all patients. Diagnostic accuracy was highest for epithelial malignancies. Two false-negative results occurred in patients with metastatic choriocarcinoma and breast carcinoma. Circulating malignant cells in the peripheral blood of a patient with non-Hodgkin's lymphoma led to one false-positive diagnosis. Benign lymphoid elements in PMC generally have a reactive and variable appearance that should not be misinterpreted as lymphoma. We conclude that PMC is a useful tool in the evaluation of dyspneic cancer patients requiring pulmonary artery catheterization for hemodynamic monitoring and its use potentially avoids additional diagnostic procedures.

Lipid peroxidation, protein thiol oxidation and DNA damage in hydrogen peroxide-induced injury to endothelial cells: role of activation of poly(ADP-ribose)polymerase

These experiments are a continuation of work investigating the mechanism of oxidant-induced damage to cultured bovine pulmonary artery endothelial cells (BPEC). Earlier experiments implicated DNA strand breakage and activation of poly(ADP-ribose)polymerase as critical steps in cell injury. In the current report, a better defined model of oxidant stress was used to investigate DNA damage, lipid peroxidation and protein thiol oxidation in BPEC following oxidant stress. The dose and time response of LDH release following exposure to H2O2 were established. H2O2 was metabolized rapidly by BPEC (t1/2 = 20 min). Hydrogen peroxide-induced increases in thiobarbituric acid (TBA) reactive material were prevented by pretreatment with the lipophilic antioxidant diphenylphenylinediamine (DPPD). However, DPPD did not decrease LDH release. Conversely, pretreatment with 5 mM 3-aminobenzamide (3AB), a competitive inhibitor of poly(ADP-ribose)polymerase, prevented LDH release from BPEC following H2O2 treatment. Dithiothreitol (DTT), a sulfhydryl reducing agent, also prevented LDH release. The effects of 3AB and DTT on H2O2-induced changes in DNA strand breaks and NAD+ and ATP levels were investigated as well as the effect of H2O2 on soluble and protein-bound thiols. As DPPD inhibited peroxidation without preventing LDH release, lipid peroxidation does not appear to play a role in the loss of BPEC viability in response to oxidant stress. As protein thiol oxidation was not caused by H2O2, it does not appear to play a causative role in cytotoxicity, although DTT may protect via maintenance of soluble thiols. H2O2 induces DNA strand breaks, which activate poly(ADP-ribose)polymerase, leading to depletion of cellular NAD+ and ATP and loss in cell viability. This supports earlier studies implicating the activation of poly(ADP-ribose)polymerase in oxidant injury to cultured endothelial cells.

Pulmonary microvascular cytology in the diagnosis of lymphangitic carcinomatosis

The diagnosis of lymphangitic spread of carcinoma in the lungs is sometimes difficult. We studied the cytologic characteristics of blood drawn through a wedged pulmonary-artery catheter from eight patients in whom lymphangitic carcinomatosis was confirmed by subsequent autopsy, lung biopsy, or clinical evaluation. The sites of the primary tumors were the prostate, breast, esophagus, and lung. Malignant cells were found in seven of the eight patients. Cytologic findings were normal in 16 of 17 patients with cancer but without pulmonary metastases and in 22 of 23 patients with nonmalignant pulmonary disorders. In a patient with cancer with tumor embolism to the lungs, the findings were positive, probably because of extensive intravascular tumor in large hepatic veins. One false positive finding occurred in a patient with extensive pulmonary infarction. Megakaryocytes, which are present in large numbers in the pulmonary capillary bed, are the hallmark of a satisfactory pulmonary vascular blood sample for pulmonary microvascular cytologic study. Familiarity with the cytologic characteristics of these cells in Papanicolaou preparations is essential to avoid mistakenly identifying them as malignant. Although transbronchial lung biopsy remains the diagnostic procedure of choice in this disorder, our findings suggest that the presence of malignant cells in pulmonary microvascular-cytology preparations in patients with cancer and unexplained dyspnea constitutes presumptive evidence of lymphangitic carcinomatosis. Pulmonary microvascular cytology may be particularly valuable when lung biopsy is refused or is thought to be too hazardous.

The lung as a metabolic organ

Recently, the lung has received increasing attention as a metabolic organ. In this role, the lung modulates the composition of the arterial blood by several mechanisms: removing active substances from the plasma, releasing substances into the plasma, temporarily holding substances from circulation, and activating or inactivating substances that pass through the lungs. In this report, the procedures proposed by different investigators for in vivo noninvasive assessment of the lung metabolic functions are reviewed. Most procedures are based on an estimation of the clearance of plasma amines by the lung endothelial cells. This clearance is assessed by measuring the lung uptake or the extraction fraction of an intravenously (IV) injected radiolabeled amine. Our own procedure, which assesses the number of free pulmonary endothelial amine receptors, is discussed in detail. In our procedure, the number of receptors was computed using the number of injected molecules of amine and determining the lung extraction fraction of the amine during its first pass through the lungs. In goats, using N-isopropyl-p-iodoamphetamine labeled with 123I as the radiopharmaceutical, the total number of endothelial lung amine receptors was found to be 1.589 X 10(20). The methods for studying the lung metabolic functions, which are discussed in this report can be applied in humans to evaluate either physiological or pathological conditions.

Effects of halothane on transport of 5-hydroxytryptamine by platelet membranes

Na+-dependent uptake of 5-HT (5-hydroxytryptamine) into plasma membrane vesicles derived from bovine blood platelets and ATP-dependent 5-HT uptake into storage vesicles in platelet lysates were measured. Na+-dependent uptake was temperature-dependent, inhibited by imipramine and exhibited Michaelis-Menten kinetics (apparent Km, 0.12 +/- 0.02 microM; Vmax. 559 +/- 54 pmol/min per mg of protein. Halothane had no effect on Na+-dependent transport of 5-HT in plasma-membrane vesicles. ATP-dependent 5-HT transport into storage granules also exhibited Michaelis-Menten kinetics (apparent Km 0.34 +/- 0.03 microM; Vmax. 34.3 +/- 1.7 pmol/min per mg of protein) and was inhibited by noradrenaline (norepinephrine), but not by imipramine. Exposure of the granules to halothane resulted in a progressive decrease in Vmax. The results demonstrate a possible site for disruption of platelet function by anaesthetics.

Effect of contrast media on the formation of prostacyclin in isolated rat lungs

The synthesis of prostacyclin (PGI2) was studied in isolated perfused rat lungs during the infusion of radiographic contrast media into the pulmonary circulation. At the same molar concentration, diatrizoate, iopamidol, and NaCl fairly equally stimulated the generation of PGI2. A bolus injection of histamine also enhanced the formation of PGI2. A high dose of ionic diatrizoate and hypertonic saline (0.4 mol/l) caused considerable pulmonary edema, which was less marked with non-ionic iopamidol. Experiments with 125I-labeled contrast media indicated rapid efflux of contrast media from the lungs. The present investigation indicates that different contrast media stimulate the synthesis of prostacyclin mainly because of chemical irritation of the pulmonary endothelium. The enhanced formation of endothelium-derived prostacyclin may mediate some systemic and local side effects seen temporarily during intravascular contrast medium examinations.