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Ritondo BL, Rogliani P, Facciolo F, Falco S, Vocale A, Calzetta L. Beclomethasone dipropionate and sodium cromoglycate protect against airway hyperresponsiveness in a human ex vivo model of cow's milk aspiration. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100010. [PMID: 34909646 PMCID: PMC8663930 DOI: 10.1016/j.crphar.2020.100010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background Recurrent cow's milk (CM) aspiration is often associated with gastroesophageal reflux in infants and toddlers and it seems to be implicated in the etiology of different inflammatory lung disorders. This study aimed to investigate ex vivo the impact of CM aspiration on human airways and whether treatment with beclomethasone dipropionate (BDP) or sodium cromoglycate (SCG) may prevent the potential CM-induced airway hyperresponsiveness (AHR). Methods Human isolated bronchi were contracted by electrical field stimulation (EFS10Hz) to mimic the contractile tone induced by the parasympathetic activity and challenged with CM, fat/lactose-free CM, or human breast milk (HM). The effect of pre-treatment with beclomethasone dipropionate (BDP) and sodium cromoglycate (SCG) was also investigated on the AHR induced by CM. Results After a 60 min-challenge with CM 1:10 v/v and fat/lactose-free CM 1:10 v/v, ASM significantly (P < 0.05) increased compared to control (+67.04 ± 17.08% and +77.91 ± 1.34%, respectively), a condition that remained stable for 150 min post-treatment, whereas HM did not alter ASM contractility. BDP 1 μM and 10 μM significantly (P < 0.05) reduced the AHR elicited by CM (−52.49 ± 10.97% and −66.98 ± 7.90%, respectively vs. control). At the same manner, SCG 1 μM and 10 μM significantly (P < 0.05) inhibited the CM-induced AHR (−59.03 ± 9.24% and −73.52 ± 7.41%, respectively vs. control). Conclusion CM induces AHR in human ASM by eliciting an increased parasympathetic contractile response. Preventive treatment with nebulized SCG may be indicated in infants or toddlers fed with CM, rather than with BDP due to a superior safety profile. Cow's milk aspiration seems to be associated with some inflammatory lung diseases. Cow's milk aspiration induces human airway hyperresponsiveness. Beclomethasone and sodium cromoglycate protect against cow's milk hyperresponsiveness in vitro. Inhaled sodium cromoglycate might be suitable in children at risk of cow's milk aspiration.
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Affiliation(s)
- Beatrice Ludovica Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Silvia Falco
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Aurora Vocale
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Via Rasori 10, 43126, Parma, Italy
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Silva FMDCE, de Oliveira EE, Ambrósio MGE, Ayupe MC, de Souza VP, Menegati LM, Reis DRDL, Machado MA, Macedo GC, Ferreira AP. Disodium cromoglycate treatment reduces T H2 immune response and immunohistopathological features in a murine model of Eosinophilic Esophagitis. Int Immunopharmacol 2020; 83:106422. [PMID: 32251959 DOI: 10.1016/j.intimp.2020.106422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/28/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
Eosinophilic esophagitis (EoE) is an emergent chronic disease of the esophagus. The immunopathological process in EoE is characterized by Th2 immune response and prominent eosinophilic influx, in response to common food allergens. The classical treatment consists of allergen elimination diet and systemic/topical corticosteroid therapy. Nevertheless, patients do not always comply to treatment, and the prolonged corticosteroid therapy can cause side effects, therefore, there is an immediate need for new therapeutic approach for EoE. Disodium cromoglicate (DSCG) is a substance broadly used in allergic asthma treatment, and a well-known mast cell activation stabilizer. However, its effect in EoE have not been evaluated yet. This study aimed to assess the effects of DSCG treatment in an EoE experimental model. Male Balb/C mice were subcutaneously sensitized for five days with OVA, and subsequently orally OVA-challenged, DSCG administration was performed between the OVA-challenges. DSCG treatment not only reduced eosinophilic and mast cell influx, as well as reduced fibrosis. In addition, tslp, GATA3, IL-5, FoxP3 and IL-10 mRNA expression were reduced in esophageal mucosa, associated with lower Th2 (CD3+CD4+GATA3+IL4+) and B cells (CD19+CD40+) number in peripheral lymphoid organs. In conclusion, the data demonstrate DSCG treatment was effective in reducing mast cell activation and Th2 immune response, important immunopathological EoE features. Therefore, the use of DSCG as an EoE treatment can be considered a promising therapeutic approach to treat this disease.
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Affiliation(s)
- Flávia Márcia de Castro E Silva
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, MG, Brazil
| | - Erick Esteves de Oliveira
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, MG, Brazil
| | | | - Marina Caçador Ayupe
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, MG, Brazil
| | - Viviane Passos de Souza
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, MG, Brazil
| | - Laura Machado Menegati
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, MG, Brazil
| | | | | | - Gilson Costa Macedo
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, MG, Brazil
| | - Ana Paula Ferreira
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, MG, Brazil.
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Mannitol and the mechanisms behind bronchoconstriction. J Allergy Clin Immunol 2019; 144:931-932. [PMID: 31472165 DOI: 10.1016/j.jaci.2019.06.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/19/2019] [Indexed: 01/03/2023]
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4
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Stanek F, Stodulski M. Mild and efficient organocatalytic method for the synthesis of flavones. Tetrahedron Lett 2016. [DOI: 10.1016/j.tetlet.2016.07.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rundell KW, Anderson SD, Sue-Chu M, Bougault V, Boulet LP. Air quality and temperature effects on exercise-induced bronchoconstriction. Compr Physiol 2016; 5:579-610. [PMID: 25880506 DOI: 10.1002/cphy.c130013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is exaggerated constriction of the airways usually soon after cessation of exercise. This is most often a response to airway dehydration in the presence of airway inflammation in a person with a responsive bronchial smooth muscle. Severity is related to water content of inspired air and level of ventilation achieved and sustained. Repetitive hyperpnea of dry air during training is associated with airway inflammatory changes and remodeling. A response during exercise that is related to pollution or allergen is considered EIB. Ozone and particulate matter are the most widespread pollutants of concern for the exercising population; chronic exposure can lead to new-onset asthma and EIB. Freshly generated emissions particulate matter less than 100 nm is most harmful. Evidence for acute and long-term effects from exercise while inhaling high levels of ozone and/or particulate matter exists. Much evidence supports a relationship between development of airway disorders and exercise in the chlorinated pool. Swimmers typically do not respond in the pool; however, a large percentage responds to a dry air exercise challenge. Studies support oxidative stress mediated pathology for pollutants and a more severe acute response occurs in the asthmatic. Winter sport athletes and swimmers have a higher prevalence of EIB, asthma and airway remodeling than other athletes and the general population. Because of fossil fuel powered ice resurfacers in ice rinks, ice rink athletes have shown high rates of EIB and asthma. For the athlete training in the urban environment, training during low traffic hours and in low traffic areas is suggested.
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Affiliation(s)
- Kenneth W Rundell
- Department of The Basic Sciences, The Commonwealth Medical College, Scranton, PA, USA
| | - Sandra D Anderson
- Clinical Professor Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Malcolm Sue-Chu
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Randolph C. Pediatric exercise-induced bronchoconstriction: contemporary developments in epidemiology, pathogenesis, presentation, diagnosis, and therapy. Curr Allergy Asthma Rep 2014; 13:662-71. [PMID: 23925985 DOI: 10.1007/s11882-013-0380-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Exercise-induced bronchoconstriction is transient narrowing of the airways following strenuous exercise. It is the earliest sign of asthma and the last to resolve. EIB is found in 90 % of asthmatics and reflects underlying control of asthma. This review is focused on the contemporary developments in pediatric EIB: the epidemiology, pathogenesis, presentation, diagnosis and management. Proper diagnosis by objective pulmonary function and/or exercise challenge and therapy should allow the pediatric asthmatic to enjoy a healthy lifestyle including participation in the chosen sport.
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Affiliation(s)
- Christopher Randolph
- Center for Allergy, Asthma & Immunology, 1389 West Main Street Suite 205, Waterbury, CT, 06708, USA,
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Porsbjerg C, Sverrild A, Backer V. The usefulness of the mannitol challenge test for asthma. Expert Rev Respir Med 2014; 7:655-63. [DOI: 10.1586/17476348.2013.847370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Anderson SD. The prevention of exercise-induced bronchoconstriction: what are the options? Expert Rev Respir Med 2013; 6:355-7. [PMID: 22971059 DOI: 10.1586/ers.12.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Chuang DW, El-Shazly M, Balaji D. B, Chung YM, Chang FR, Wu YC. Synthesis of Flavones and γ-Benzopyranones Using Mild Sonogashira Coupling and 18-Crown-6 Ether Mediated 6-endoCyclization. European J Org Chem 2012. [DOI: 10.1002/ejoc.201200529] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
This article reviews the diagnostic challenge methods-both exercise and surrogate-for diagnosis of exercise-induced bronchoconstriction (EIB) and EIB with known asthma. Indirect challenges that release the entire repertoire of mediators representative of EIB and asthma are more specific for diagnosis and are recommended over direct challenges such as methacholine challenge, which are sensitive but nonspecific. Self-reported history and empiric therapeutic trials are not adequate for diagnosis of EIB with or without known asthma. Objective pulmonary function documentation with bronchodilator reversibility or exercise or surrogate challenge are optimal for diagnosis of EIB or EIB with known asthma. Such objective pulmonary function documentation is optimal for the proper management and healthy lifestyle of the exercising athlete or individual.
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Affiliation(s)
- Christopher Randolph
- Department of Pediatrics/Medicine, Division of Allergy/Immunology Center for Allergy, Asthma, and Immunology, Yale University, Waterbury, CT 06708, USA.
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Netzer NC, Küpper T, Voss HW, Eliasson AH. The actual role of sodium cromoglycate in the treatment of asthma--a critical review. Sleep Breath 2012; 16:1027-32. [PMID: 22218743 DOI: 10.1007/s11325-011-0639-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 10/30/2011] [Accepted: 12/15/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite international consensus and clearly written guidelines urging wider use of corticosteroids or combinations of inhaled short- and long-acting β-agonists (SABA and LABA) and corticosteroids in persistent asthma, prescribing patterns and compliance rates fall far short of recommendations. OBJECTIVES The failure to use steroids more aggressively is due, in part, to their side effects, even with inhaled forms of the drug. There is a role for expanded use of sodium cromolyn in asthma. Its potent anti-inflammatory effects, lack of side effects, and acceptable dosing and method of delivery, as well as its special role in exercise-induced asthma, make it a very suitable choice in the initial therapy for control of asthma. CONCLUSION Compared to SABA and LABA, cromoglycates alone are unsuspicious of being used to enhance physical performance.
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Affiliation(s)
- Nikolaus C Netzer
- Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Paracelsus Medical University, Salzburg, Austria.
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Sverrild A, Porsbjerg C, Backer V. The use of inhaled mannitol in the diagnosis and management of asthma. Expert Opin Pharmacother 2011; 13:115-23. [PMID: 22118547 DOI: 10.1517/14656566.2012.638917] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Airway hyperresponsiveness (AHR) is a key feature of asthma and can be assessed by the use of bronchial provocation tests. A test using inhaled dry powder mannitol for diagnosing asthma is now regulatory approved in 20 countries. AREAS COVERED This paper reviews the literature on inhaled mannitol from the first publication in 1997 until present (October 2011). It discusses the current knowledge on the clinical usefulness as a tool for diagnosing and managing asthma. EXPERT OPINION Inhaled mannitol can be regarded as a safe, standardized, specific, but less sensitive, tool for the diagnosis of asthma in both children and adults. Discomfort, in terms of cough, during the test occurs in 85.3% of subjects, but rarely (1.3%) leads to discontinuation. Headache (6.1%), pharyngolaryngeal pain (2.6%) and cough (1.3%) are the most frequent adverse events that occur on the day of the test. The test holds several advantages compared with existing tests; there is no need for additional equipment (i.e., a nebulizer) besides a spirometer; it requires no cleaning and has only one standard operating protocol. In a new study using mannitol for monitoring mild and moderate persistent asthma in primary care, the number of mild exacerbations was reduced.
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Affiliation(s)
- Asger Sverrild
- University Hospital of Copenhagen, Department of Respiratory Medicine, Bispebjerg, 2400 Copenhagen NV, Denmark.
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Mullane K. Asthma translational medicine: report card. Biochem Pharmacol 2011; 82:567-85. [PMID: 21741955 DOI: 10.1016/j.bcp.2011.06.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 06/23/2011] [Accepted: 06/24/2011] [Indexed: 01/21/2023]
Abstract
Over the last 30 years, scientific research into asthma has focused almost exclusively on one component of the disorder - airway inflammation - as being the key underlying feature. These studies have provided a remarkably detailed and comprehensive picture of the events following antigen challenge that lead to an influx of T cells and eosinophils in the airways. Indeed, in basic research, even the term "asthma" has become synonymous with a T helper 2 cell-mediated disorder. From this cascade of cellular activation processes and mediators that have been identified it has been possible to pinpoint critical junctures for therapeutic intervention, leading experimentalists to produce therapies that are very effective in decreasing airway inflammation in animal models. Many of these compounds have now completed early Phase 2 "proof-of-concept" clinical trials so the translational success of the basic research model can be evaluated. This commentary discusses clinical results from 39 compounds and biologics acting at 23 different targets, and while 6 of these drugs can be regarded as a qualified success, none benefit the bulk of asthma sufferers. Despite this disappointing rate of success, the same immune paradigm and basic research models, with a few embellishments to incorporate newly identified cells and mediators, continue to drive target identification and drug discovery efforts. It is time to re-evaluate the focus of these efforts.
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Affiliation(s)
- Kevin Mullane
- Profectus Pharma Consulting, Inc, San Jose, CA 95125, United States.
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Keller M, Schierholz J. Have inadequate delivery systems hampered the clinical success of inhaled disodium cromoglycate? Time for reconsideration. Expert Opin Drug Deliv 2011; 8:1-17. [PMID: 21174604 DOI: 10.1517/17425247.2010.542141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Disodium cromoglycate (DSCG) fits with the perception of a safe drug, but conclusions from questionable meta-analyses reduced its use. In addition, drug delivery aspects, such as hygroscopicity and the poor performance of delivery systems, were not considered to be important determinants of therapeutic failures. AREAS COVERED IN THIS REVIEW Drug delivery aspects and parameters affecting lung deposition and distribution, important parameters for therapeutic efficacy, are addressed. In addition, the distribution and ratio of mast cell tryptase and chymase-positive phenotypes in the lungs and their role in the prostaglandin and leukotriene pathway are discussed. WHAT THE READER WILL GAIN Information on why in vitro data are an excellent tool to understand better therapeutic failures associated with the moisture sensitivity of DSCG and the difficulty in handling and operating DSCG delivery systems in a therapeutically reliable way. TAKE HOME MESSAGE Pharmacological efficacy of DSCG has been demonstrated in animals and humans. If the drug is delivered to the site of inflammation in an effective dose, a reliable therapeutic effect can be expected. DSCG has extra properties and potential unspecific antiviral properties and may offer new therapeutic treatment aspects for asthma and viral-induced bronchiolitis in early childhood.
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Affiliation(s)
- Manfred Keller
- PARI Pharma GmbH, Aerosol Research Institute, Lochhamer Schlag 21, D-82166 Graefelfing, Germany.
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Abstract
PURPOSE OF REVIEW Performing a bronchial provocation test (BPT) using a direct or indirect stimulus to identify bronchial hyper-responsiveness (BHR) reduces the possibility of over and under-diagnosis of asthma based on history and symptoms. This review discusses some long-held beliefs of BPTs to include or exclude a diagnosis of asthma or exercise-induced bronchoconstriction (EIB). RECENT FINDINGS A high frequency of negative methacholine tests has been reported in 240 patients given a diagnosis of asthma at the end of the study, many of whom had documented EIB. This suggests that a negative methacholine test should not be relied upon to rule out asthma. Further, a positive methacholine test alone should be interpreted with caution as it may reflect airway injury rather than asthma or EIB. Mannitol, an indirect stimulus, identified a similar prevalence of BHR to methacholine and identified more patients than a single exercise test in three studies. However, neither mannitol nor methacholine identified all patients with EIB. Mannitol has a higher specificity for a physician diagnosis of asthma than methacholine. SUMMARY It is likely that both a direct test and an indirect test result may be required in some patients in order to confirm or exclude a diagnosis of asthma with certainty.
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