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Kleinman MT, Bhalla DK, Mautz WJ, Phalen RF. Cellular and Immunologic Injury with PM-10 Inhalation. Inhal Toxicol 2008. [DOI: 10.3109/08958379509014467] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wells UM, Duneclift S, Widdicombe JG. H2O2 increases sheep tracheal blood flow, permeability, and vascular response to luminal capsaicin. J Appl Physiol (1985) 1997; 82:621-31. [PMID: 9049746 DOI: 10.1152/jappl.1997.82.2.621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Exogenous hydrogen peroxide (H2O2) causes airway epithelial damage in vitro. We have studied the effects of luminal H2O2 in the sheep trachea in vivo on tracheal permeability to low-molecular-weight hydrophilic (technetium-99m-labeled diethylenetriamine pentaacetic acid; 99mTc-DTPA) and lipophilic ([14C]antipyrine; [14C]AP) tracers and on the tracheal vascular response to luminal capsaicin, which stimulates afferent nerve endings. A tracheal artery was perfused, and tracheal venous blood was collected. H2O2 exposure (10 mM) reduced tracheal potential difference (-42.0 +/- 6.4 mV) to zero. It increased arterial and venous flows (56.7 +/- 6.1 and 57.3 +/- 10.0%, respectively; n = 5, P < 0.01, paired t-test) but not tracheal lymph flow (unstimulated flow 5.0 +/- 1.2 microliters.min-1.cm-1, n = 4). During H2O2 exposure, permeability to 99mTc-DTPA increased from -2.6 to -89.7 x 10(-7) cm/s (n = 5, P < 0.05), whereas permeability to [14C]AP (-3,312.6 x 10(-7) cm/s, n = 4) was not altered significantly (-2,565 x 10(-7) cm/s). Luminal capsaicin (10 microM) increased tracheal blood flow (10.1 +/- 4.1%, n = 5) and decreased venous 99mTc-DTPA concentration (-19.7 +/- 4.0, P < 0.01), and these effects were significantly greater after epithelial damage (28.1 +/- 6.0 and -45.7 +/- 4.3%, respectively, P < 0.05, unpaired t-test). Thus H2O2 increases the penetration of a hydrophilic tracer into tracheal blood and lymph but has less effect on a lipophilic tracer. It also enhances the effects of luminal capsaicin on blood flow and tracer uptake.
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Affiliation(s)
- U M Wells
- Department of Physiology, St. George's Hospital Medical School, London, United Kingdom
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Smith BL, Jones JH, Hornof WJ, Miles JA, Longworth KE, Willits NH. Effects of road transport on indices of stress in horses. Equine Vet J 1996; 28:446-54. [PMID: 9049493 DOI: 10.1111/j.2042-3306.1996.tb01616.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Stress associated with road transport is believed to be a significant contributor to the pathogenesis of post transport respiratory disease in horses. To determine the effects of road transport on pulmonary function, pulmonary aerosol clearance rates were measured in 4 horses 24 h before, and immediately after, 24 h of road transport by delivering aerosolised 99mtechnetium-labelled diethylenetriaminepentacetate (99mTc-DTPA) to the lungs and monitoring its washout. Each horse was transported twice, once while the trailer was equipped with a leaf-spring suspension and bias-ply tyres (trailer's original equipment, smooth ride) and once while the trailer was equipped with a torsion-bar suspension and normal pressure radial tyres (rough ride) in order to generate different ride characteristics. Before transport, blood was drawn from each horse for haematology and measurement of serum cortisol concentration; 24 h rates of hay and water intake and faecal output were recorded for each horse. Horses were then transported, 2 at a time, over a 128 km circular route of predominantly rural freeways at a constant speed of 72 km/h for 24 h. Horses were rested by stopping the trailer every 3.75 h for 0.25 h. During transport, heart rates (continuous 1 min averages), rates of hay and water intake and rates of faecal output were measured. Ammonia (NH3) and carbon monoxide (CO) concentrations were measured within the trailer and temperatures (wet bulb [WB], dry bulb [DB] and black globe [BG]) within the trailer were recorded each minute. Immediately after each experiment blood was drawn for haematology and measurement of pulmonary aerosol clearance rates were measured. For control studies, horses were housed in their stalls while heart rates were measured for 24 h. Slopes calculated from the 99mTc-DTPA clearance curves for pretransport horses were not significantly different from post transport clearance slopes. Pretransport mean 99mTc-DTPA clearance half-lives (T50, left lung mean +/- s.d. 41.7 +/- 15.8 min, right lung 44.6 +/- 19.1 min) were not significantly different from post transport T50 (left lung 53.5 +/- 14.0 min, right lung 52.0 +/- 11.6 min). Heart rates during transport were not affected by suspension type or trip order (the horse's first or second transport experiment) and were not significantly different from stall controls after the first 120 min of the experiment. Horses had increased red blood cell count, packed cell volume, haemoglobin, plasma protein and cortisol concentrations, and decreased body weights immediately post transport, indicating slight dehydration. Water and hay intake rates were significantly lower during transport than pretransport. Temperatures within the trailer were highest in the midafternoon and lowest in the early morning hours, but all temperatures measured in the trailer were within the comfort zone for large homeotherms. Ammonia and CO concentrations in the trailer during the transport period were within acceptable limits for human exposure. However, respirable articulates in the atmosphere were elevated above safe concentrations for human exposure.
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Affiliation(s)
- B L Smith
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis 95616, USA
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Ma TY, Hollander D, Tran LT, Nguyen D, Hoa N, Bhalla D. Cytoskeletal regulation of Caco-2 intestinal monolayer paracellular permeability. J Cell Physiol 1995; 164:533-45. [PMID: 7650061 DOI: 10.1002/jcp.1041640311] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
An abnormal increase in intestinal paracellular permeability may be an important pathogenic factor in various intestinal diseases. The intracellular factors and processes that regulate and cause alteration of intestinal paracellular permeability are not well understood. The purpose of this study was to examine some of the intracellular processes involved in cytoskeletal regulation of intestinal epithelial paracellular permeability using the filter-grown Caco-2 intestinal epithelial monolayers. Cytochalasin-b and colchicine were used to disrupt the cytoskeletal elements, actin microfilaments, and microtubules. Cytochalasin-b (5 micrograms/ml) and colchicine (2 x 10(-5) M) at the doses used caused marked depolymerization and disruption of actin microfilaments and microtubules, respectively. Cytochalasin-b-induced disruption of actin microfilaments resulted in perturbation of tight junctions and desmosomes and an increase in Caco-2 monolayer paracellular permeability. The cytochalasin-b-induced disruption of actin microfilaments and subsequent changes in intercellular junctional complexes and paracellular permeability were not affected by inhibitors of protein synthesis (actinomycin-D or cycloheximide) or microtubule function (colchicine), but were inhibited by metabolic energy inhibitors (2,4-dinitrophenol or sodium azide). The cytochalasin-b-induced disturbance in Caco-2 actin microfilaments and intercellular junctional complexes and increase in paracellular permeability were rapidly reversed. The paracellular pathway "re-tightening" following cytochalasin-b removal was not affected by actinomycin-D, cycloheximide, or colchicine, but was inhibited by 2,4-dinitrophenol and sodium azide. The colchicine-induced disruption of microtubules did not have significant effect on actin microfilaments, intercellular junctions, or paracellular permeability. These findings suggest that cytochalasin-b-induced increase in Caco-2 monolayer paracellular permeability was due to actin microfilament mediated perturbation of intercellular junctional complexes. The re-tightening of paracellular pathways (following removal of cytochalasin-b) resulted from energy-mediated re-assembly of pre-existing actin microfilaments and intercellular junctional complexes. This re-closure process did not require protein synthesis or microtubule-mediated shuttling process.
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Affiliation(s)
- T Y Ma
- Department of Medicine, Long Beach Veterans Administration Medical Center, California 90822, USA
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Croxton TL, Takahashi M, Kokia I. Effects of acute ozone exposure on the electrophysiological properties of guinea pig trachea. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH 1994; 43:73-83. [PMID: 8078095 DOI: 10.1080/15287399409531905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Acute ozone (O3) exposures produce an increase in the apparent permeability of the tracheal epithelium, but the mechanism of this response is poorly understood. Comparison of previous studies suggests that qualitative differences may exist between measurements made in vivo or in vitro. To test this possibility we used both in vitro and in vivo electrophysiological techniques to investigate the effects of O3 exposure on guinea pig tracheal epithelium. Male Hartley guinea pigs were exposed to either 1 or 2 ppm O3 or to filtered air for 3 h and were studied 0, 6, or 24 h after exposure. Air-exposed animals had in vitro mean tracheal potential (VT) -32.0 +/- 1.5 mV, conductance (GTL) 2.18 +/- 0.22 mS/cm, short-circuit current (ISCL) 62.6 +/- 3.7 microA/cm, and diameter (D) 2.44 +/- 0.10 mm. In vitro properties after 1 ppm O3 exposure did not differ at any time point from control. Two parts per million O3 increased ISCL, but only at 6 h postexposure. The effect of O3 on ISCL was abolished by amiloride. There were no significant changes in VT, GTL, or D. In vivo tracheal potential under pentobarbital anesthesia was -19.7 +/- 1.7 mV. At 6 h postexposure to 2 ppm O3, but not at 0 or 24 h, in vivo VT was increased. Thus, acute exposure of guinea pigs to a high concentration of O3 caused a delayed increase in Na+ absorption by the trachea with no change in conductance. This indicates that paracellular permeability of guinea pig tracheal epithelium was not substantially increased by acute O3 and suggests that enhanced macromolecular uptake in this species probably occurs transcellularly. Furthermore, the increase of in vivo VT following O3 exposure is consistent with the in vitro response, indicating that in vivo/in vitro differences are not responsible for the discrepancies between previous electrophysiological and "permeability" studies.
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Affiliation(s)
- T L Croxton
- Department of Environmental Health Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205
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Abstract
This study determined the interactive effects of O3 and enzymatically-generated oxidants and antioxidants in the lung. Rats treated with dimethylthiourea (DMTU) or H2O2, generated by glucose/glucose oxidase, were exposed for 2 h to 0.6 or 0.8 ppm O3. A significant increase in the flux of total albumin in the bronchoalveolar lavage (BAL) and a concomitant elevation in the transport of 99mTc-diethylenetriaminepentaacetate (99mTc-DTPA) from trachea to blood occurred after O3 exposure. Pretreatment of rats with DMTU prevented the albumin flux in the BAL. Intratracheal instillation of glucose/glucose oxidase produced a localized response in trachea, but it did not affect the broncho-alveolar permeability. The results demonstrate an additive effect of O3 and an enzymatically-generated oxidant, and an antagonistic effect of an antioxidant in rats exposed to O3. The observations support the suggestion that a balance of oxidant-antioxidant system may be critical in maintaining respiratory integrity following O3 exposure.
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Bhat M, Toledo-Velasquez D, Wang L, Malanga CJ, Ma JK, Rojanasakul Y. Regulation of tight junction permeability by calcium mediators and cell cytoskeleton in rabbit tracheal epithelium. Pharm Res 1993; 10:991-7. [PMID: 8378262 DOI: 10.1023/a:1018906504944] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The present study investigates the mechanisms controlling tight junction permeability of the tracheal epithelium, with an emphasis on the regulatory role of intra- and extracellular calcium as well as the cell cytoskeleton. The tracheas were isolated from rabbits and their junctional permeability barrier was investigated in vitro by means of transepithelial electrical resistance measurements and flux measurements of the radiolabeled paracellular tracer, 14C-mannitol. The effects of intra- and extracellular calcium were studied using the calcium ionophore A 23187 and EGTA, and that of the cytoskeleton was investigated using cytochalasin B. Intracellular calcium of the tracheal epithelium was monitored microfluorometrically using the specific calcium indicator, Fura-2 AM (acetoxymethyl ester). The results indicate that the tight junction permeability of the trachea was significantly increased upon treatment with all three of the test compounds, as evidenced by a substantial decrease in transepithelial electrical resistance and an increase in transepithelial flux of 14C-mannitol. The effects of EGTA and cytochalasin B on the tight junction permeability are fully reversible upon removal of the compounds from the bathing media. On the other hand, tissues treated with the calcium ionophore demonstrate a partial or no recovery in membrane permeability, depending on the intracellular calcium levels. Moderate and transient increases in intracellular calcium caused a partial reversibility of the membrane resistance, while high and sustained intracellular calcium levels induce a complete irreversibility of the membrane resistance.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Bhat
- School of Pharmacy, West Virginia University, Morgantown 26506
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Fouke JM, Wolin AD, McFadden ER. Effects of ozone on lung mechanics and cyclooxygenase metabolites in dogs. PROSTAGLANDINS 1991; 42:343-53. [PMID: 1796149 DOI: 10.1016/0090-6980(91)90083-r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To determine if acute exposure to ozone can cause changes in the production of cyclooxygenase metabolites of arachidonic acid (AA) in the lung which are associated with changes in lung mechanics, we exposed mongrel dogs to 0.5 ppm ozone for two hours. We measured pulmonary resistance (RL) and dynamic compliance (Cdyn) and obtained methacholine dose response curves and bronchoalveolar lavagate (BAL) before and after the exposures. We calculated the provocative dose of methacholine necessary to increase RL 50% (PD50) and analyzed the BAL for four cyclooxygenase metabolites of AA: a stable hydrolysis product of prostacyclin, 6-keto-prostaglandin F1 alpha (6-keto-PgF1 alpha); prostaglandin E2 (PgE2); a stable hydrolysis product of thromboxane A2, thromboxane B2 (TxB2); and prostaglandin F2 alpha (PgF2 alpha). Following ozone exposure, RL increased from 4.75 +/- 1.06 to 6.08 +/- 1.3 cm H2O/L/sec (SEM) (p less than 0.05), Cdyn decreased from 0.0348 +/- 0.0109 TO .0217 +/- .0101 L/cm H2O (p less than 0.05), and PD50 decreased from 4.32 +/- 2.41 to 0.81 +/- 0.49 mg/cc (p less than 0.05). The baseline metabolite levels were as follows: 6-keto PgF1 alpha: 96.1 +/- 28.8 pg/ml; PgE2: 395.8 +/- 67.1 pg/ml; TxB2: 48.5 +/- 11.1 pg/ml; PgF2 alpha: 101.5 +/- 22.6 pg/ml. Ozone had no effect on any of these prostanoids. These studies quantify the magnitude of cyclooxygenase products of AA metabolism in BAL from dog lungs and demonstrate that changes in their levels are not prerequisites for ozone-induced changes in lung mechanics or airway reactivity.
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Affiliation(s)
- J M Fouke
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
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Bhalla DK, Rasmussen RE, Tjen S. Interactive effects of O3, cytochalasin D, and vinblastine on transepithelial transport and cytoskeleton in rat airways. Am J Respir Cell Mol Biol 1990; 3:119-29. [PMID: 2378746 DOI: 10.1165/ajrcmb/3.2.119] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cytoskeletal perturbations and associated changes in transepithelial transport in rat airways were analyzed after in vivo treatment with cytochalasin D or vinblastine or exposure to ozone (O3). Exposure of O3 or cytochalasin D, but not vinblastine, increased permeability in the bronchoalveolar region. Combined treatment with cytochalasin D and O3 did not increase the effect seen with each agent alone. However, treatment with vinblastine plus 0.8 ppm O3 resulted in a slight enhancement of permeability over that seen with O3 alone. This enhancement was not seen with 2 ppm O3. When cytochalasin and vinblastine treatment were combined, a synergistic effect on bronchoalveolar permeability was seen, suggesting participation of both microfilamentous and microtubular cytoskeletal elements in maintaining the integrity of the bronchoalveolar epithelium. Potentially harmful effects of O3 on cytoskeletal elements were confirmed in rat lung epithelial cells in culture. O3 exposure produced reversible changes in microfilamentous structures comparable to those produced by cytochalasin D. The results of these studies support the hypotheses that the cytoskeleton has a central role in maintenance of respiratory epithelial integrity and that a target for O3 toxicity may be the components of cytoskeleton. These results, however, do not rule out the possibility that treatment with cytoskeleton destabilizing drugs leads to the release of mediators, which in turn contribute to the airway epithelial dysfunction and increased permeability.
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Affiliation(s)
- D K Bhalla
- Department of Community and Environmental Medicine, University of California, Irvine 92717
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Alpert SE, Kramer CM, Hayes MM, Dennery PA. Morphologic injury and lipid peroxidation in monolayer cultures of rabbit tracheal epithelium exposed in vitro to ozone. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH 1990; 30:287-304. [PMID: 2388300 DOI: 10.1080/15287399009531430] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Numerous reports have documented airway epithelial damage and lipid peroxidation in the lungs of animals exposed to ozone. However, the response of isolated tracheal epithelial (TE) cells to ozone has not been extensively studied. To assess ozone-induced injury in cultured TE cells, an in vitro exposure system was developed in which cells were maintained at gas-fluid interface analogous to in vivo conditions. Confluent monolayer cultures of rabbit TE cells were exposed for 30 min to atmospheres of 5% CO2/air containing 0.05, 0.1, 0.5, 1, 2, 4, 6, or 8 ppm ozone. Morphologic injury was assessed by phase-contrast microscopy and by determination of TE cell number and viability (trypan blue dye exclusion) pre- and postexposure, and the lipid peroxide content of TE cells was measured as thiobarbituric acid (TBA) reactive substances. Exposure to 5% CO2/air alone did not affect monolayer morphology, cell number of viability. Cultures exposed to 0.05 or 0.1 ppm ozone demonstrated no consistent light microscopic changes, whereas exposure to 0.5 ppm and higher ozone concentrations caused distortion of monolayer morphology, cytoplasmic vacuolization, and decreased viability. Exposure to 0.5 or 1 ppm resulted primarily in cytoplasmic vacuolization while exposure to 2, 4, 6, or 8 ppm induced more pronounced cellular injury associated with cell necrosis (viability post 8 ppm ozone 75.0 +/- 7.0%, vs. 95.9 +/- 2.6% for 5% CO2/air controls). Ozone exposure also caused changes in cell shape, which on occasion resulted in loss of cell-to-cell contact. Increased production of TBA-reactive substances was detected in TE cells following ozone exposure, including exposure to 0.05 and 0.1 ppm. The morphologic changes induced by in vitro ozone exposure in the cultured TE cells were similar to those described in the tracheal epithelium of ozone-exposed animals and occurred independent of recruited inflammatory cells or extravasated circulating mediators.
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Affiliation(s)
- S E Alpert
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
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Hornof WJ, Schelegle E, Kammerman M, Gunther RA, Fisher PE, Cross CE. Ozone-induced accelerated lung clearance of 99mTc-DTPA aerosol in conscious sheep. RESPIRATION PHYSIOLOGY 1989; 77:277-90. [PMID: 2506622 DOI: 10.1016/0034-5687(89)90116-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study was initiated to determine the rate and characteristics of 99mTc-DTPA clearance from the lungs of unanesthetized sheep exposed to varying concentrations of O3 for 4 h in a whole-body exposure chamber. Four sheep exposed to 1 ppm O3 had a monoexponential T50 of 274 +/- 81 min (SD), not significantly different from sham exposures (316 +/- 150); 5 sheep exposed to 2 ppm had a T50 of 234 +/- 101 min, not significantly different from sham exposures (364 +/- 131 min). Five additional unanesthetized sheep exposed to 2 ppm for 4 h via a nasotracheal tube had a T50 of 192 +/- 55 min, significantly different from sham exposures (300 +/- 96 min). The results show that the effect of oxidant pollutants on the permeability of alveolobronchiolar epithelium may be assessed in conscious sheep.
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Affiliation(s)
- W J Hornof
- Department of Radiological Sciences, School of Veterinary Medicine, University of California, Davis 95616
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Rasmussen RE, Bhalla DK. Transport across rat trachea in vitro after exposure to cytoskeleton-active drugs in vitro or to ozone in vivo. Exp Lung Res 1989; 15:253-68. [PMID: 2707184 DOI: 10.3109/01902148909087857] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Full-length tracheas from Sprague-Dawley rats were exposed to cytoskeleton-active drugs in short-term organ culture, and the permeability of the tracheal epithelium was measured by instilling radiotracers into the lumen and assay of the radioactivity appearing in the external bathing medium. In vitro treatment with cytochalasin D (cyto D, 2-10 x 10(-6) M) increased the rate of movement of [14C]mannitol across the epithelium. Exposure to vinblastine (VB, 10(-4) M) alone had no significant effect. However, VB in combination with cyto D increased the permeability in a dose-dependent manner. In vivo exposure to ozone (O3, 0.8 or 2.0 ppm, 2 h) had only a slight effect on the rate of movement of the tracer as measured in vitro immediately after exposure. At 24 h postexposure there was no significant difference in permeability between ozone- and air-exposed tracheas. Prior in vivo O3 exposure sensitized the tracheas to the in vitro effects of cyto D; treatment of O3-exposed tracheas with cyto D immediately after O3 exposure produced a greater than additive effect on permeability measured in vitro. VB at concentrations up to 10(-4) M had no enhancing effect on permeability in O3-exposed tracheas. Sham exposure to clean air did not affect permeability compared to untreated (shelf) controls. Electron microscopic studies demonstrated penetration of horseradish peroxidase into intercellular spaces in the tracheas treated in vitro with cyto D or cyto D plus VB. Cyto D is known to affect intracellular microfilaments that have attachments at or near the cell surface, while VB affects microtubules associated with internal cellular structures. Therefore, the synergistic effect on tracheal permeability observed with O3 and cyto D, but not with O3 and VB, suggests that O3 may change cell surface structures associated with the microfilamentous cytoskeleton.
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Affiliation(s)
- R E Rasmussen
- Department of Community and Environmental Medicine, College of Medicine, University of California, Irvine 92717
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