Laryngeal receptors responding to transmural pressure, airflow and local muscle activity

The larynx has a rich sensory supply which is the main source of several respiratory reflexes. These reflexes, that influence both the patency of the upper airway and the pattern of breathing, are related to transmural pressure and/or airflow in the upper airway. Yet hardly any information is available on the response of laryngeal mechanoreceptors to transmural pressure and airflow. We recorded action potentials from single fibers separated from the superior laryngeal nerve of anesthetized dogs, breathing spontaneously either through a tracheostomy or the upper airway. The airway could be occluded above or below the larynx. On the basis of their behavior during tracheostomy breathing, upper airway breathing, tracheal occlusion and upper airway occlusion, laryngeal mechanoreceptors were classified as pressure receptors, flow receptors or 'drive' receptors (stimulated by the respiratory activity of upper airway muscles). Pressure receptors were encountered most frequently, representing 63.6% of our sample of 110 receptors, 'drive' receptors constituted 21.8% and flow receptors the remaining 14.6%. Our findings indicate that, even though the three types of receptors differ in sensory modality, they concur in exhibiting a predominant activity during inspiration. In fact, 65% of all receptors are active during eupneic inspiration. Moreover, their activity increases markedly during upper airway obstruction.

Influence of upper airway pressure changes on genioglossus muscle respiratory activity

The effects of change in pharyngeal airway pressure on electromyographic (EMG) activity of a pharyngeal dilating muscle (genioglossus) were investigated in 20 anesthetized rabbits. In vagotomized animals, upper airway loading maneuvers (nasal occlusion) increased the peak inspiratory activity of the genioglossus (GG) muscle on the first occluded breath. In contrast, "unloading" maneuvers (switching from nose to tracheostomy breathing) decreased GG activity. To further characterize the GG response, sustained pressure changes were produced within the isolated upper airway. Negative pressure increased GG activity; positive pressure decreased it. A poststimulus effect consisting of increased GG activity compared with control was seen following both negative- and positive-pressure stimuli. Cyclical pressure changes applied to the isolated upper airway increased the GG activity. These observations indicate the presence of reflex pathways that regulate GG muscle activity in response to upper airway pressure loads. This reflex system appears to play a role in regulating GG activity during tidal breathing and could be important in ensuring pharyngeal airway patency.

Genioglossus muscle responses to upper airway pressure changes: afferent pathways

The afferent pathway of an upper airway reflex in which genioglossus muscle electromyographic (GG EMG) activity is influenced by pharyngeal pressure changes was investigated in 20 anesthetized rabbits. We took advantage of the fact that the upper airway was separated into two compartments by pharyngeal closure occurring when the animals breathe through a tracheostomy. This allowed pressure to be delivered selectively either to the nose and nasopharynx or to the larynx and hypopharynx. Midcervical vagotomy did not eliminate the GG EMG response to pressure stimuli. On the other hand high cervical vagotomy or superior laryngeal nerve section eliminated the response in the laryngeal compartment, but not in the nasopharyngeal compartment. Topical anesthesia of the mucosa of the nose, pharynx, and larynx abolished the response in both compartments. Therefore we conclude that more than one afferent pathway exists for this upper airway pressure reflex; the primary afferent pathway from the laryngeal compartment is the superior laryngeal branch of the vagus nerve, whereas the primary afferent pathway for the nasopharynx is nonvagal. Trigeminal nerve, glossopharyngeal nerve, and/or nervus intermedius carry nonvagal afferents from the nasopharynx and nose. The topical anesthetic and nerve section studies suggest that superficial receptors mediate this response. The occurrence of swallowing in response to upper airway pressure changes and its elimination by topical anesthesia or superior mechanoreceptors may mediate both genioglossus respiratory responses and swallowing responses.

Upper airway negative-pressure effects on respiratory activity of upper airway muscles

Influence of upper airway negative-pressure change on the respiratory activity of various upper airway muscles was investigated in 13 anesthetized rabbits. Phasic inspiratory activity increased or appeared during virtually all negative-pressure trials in nasolabial, cricothyroid, and posterior cricoarytenoid muscles. No phasic inspiratory activity was seen in the sternothyroid (ST) and sternohyoid (SH) muscles before negative-pressure applications but appeared during 80% of trials in ST and 62% of trials in SH. During maintained negative pressure, a gradual decline in activity was often observed in the nasolabial and laryngeal muscles, whereas a rapid decline in activity was seen in the cervical strap muscles. Reflex effects of negative pressure was markedly reduced or abolished by sectioning the internal branch of the superior laryngeal nerve bilaterally. Reflex augmentation of upper airway muscle activity reported here may have functional significance in the maintenance of upper airway patency. It could prevent upper airway collapse when negative pressure swings in the upper airway increase or facilitate recovery when large negative pressure swings are produced by obstructed inspiratory efforts.

Laryngeal cold receptors

We have previously demonstrated the presence of specific laryngeal 'flow' receptors activated independently of transmural pressure. This study considers the operational characteristics of these endings. In 15 anesthetized dogs we recorded single unit action potentials from the peripheral cut end of the internal branch of the superior laryngeal nerve. All the 30 laryngeal 'flow' receptors studied showed an inspiratory modulation when the dog was breathing room air at 26 degrees C and 55% relative humidity (laryngeal temperature approximately equal to 34 degrees C) through the upper airway. All the receptors became silent when the temperature of the inspired air was raised to 36-40 degrees C, 100% relative humidity (laryngeal temperature between 35 and 38 degrees C) and increased their activity when the temperature in the larynx was decreased either by lowering the temperature or the humidity of the inspired air. Fourteen laryngeal 'flow' receptors were tested with a steady flow of air, directed through the isolated in vivo larynx, at different temperatures and saturated with water vapor. Their discharge rate was found to be inversely related to laryngeal temperature (from 35 to 25 degrees C) and independent of airflow. Their rate of adaptation indicates a high dynamic sensitivity. In the isolated larynx preparation these receptors were activated by airflow in both inspiratory and expiratory directions provided that laryngeal temperature was lower than 35 degrees C. We conclude that the previously described laryngeal 'flow' receptors operate as thermoreceptors activated by cooling.

Butyrate, an HDAC inhibitor, stimulates interplay between different posttranslational modifications of histone H3 and differently alters G1-specific cell cycle proteins in vascular smooth muscle cells

HDACs and HATs regulate histone acetylation, an epigenetic modification that controls chromatin structure and through it, gene expression. Butyrate, a dietary HDAC inhibitor, inhibits VSMC proliferation, a crucial factor in atherogenesis, and the principle mechanism in arterial and in-stent restenosis. Here, the link between antiproliferation action of butyrate and the portraits of global covalent modifications of histone H3 that it induces are characterized to understand the mechanics of butyrate-arrested VSMC proliferation. Analysis of histone H3 modifications specific to butyrate arrested VSMC proliferation display induction of histone H3-Lysine9 acetylation, inhibition of histone H3-Serine10 phosphorylation, reduction of histone H3-Lysine9 dimethylation and stimulation of histone H3-Lysine4 di-methylation, which is linked to transcriptional activation, cell cycle/mitosis, transcriptional suppression and activation, respectively. Conversely, untreated VSMCs exhibit inhibition of H3-Lysine9 acetylation, induction of H3-Serine10 phosphorylation, stimulation of H3-Lysine9 di-methylation and reduction in H3-Lysine4 di-methylation. Butyrate's cooperative effects on H3-Lysine9 acetylation and H3-Serine10 phosphorylation, and contrasting effects on di-methylation of H3-Lysine9 and H3-Lysine4 suggests that the interplay between these site-specific modifications cause distinct chromatin alterations that allow cyclin D1 and D3 induction, G1-specific cdk4, cdk6 and cdk2 downregulation, and upregulation of cdk inhibitors, p15INK4b and p21Cip1. Regardless of butyrate's effect on D-type cyclins, downregulation of G1-specific cdks and upregulation of cdk inhibitors by butyrate prevents cell cycle progression by failing to inactivate Rb. Overall, through chromatin remodeling, butyrate appears to differentially alter G1-specific cell cycle proteins to ensure proliferation arrest of VSMCs, a crucial cellular component of blood vessel wall.

Breathing patterns of preterm infants during bottle feeding: role of milk flow

Milk flow achieved during feeding may contribute to the ventilatory depression observed during nipple feeding. One of the important determinants of milk flow is the size of the feeding hole. In the first phase of the study, investigators compared the breathing patterns of 10 preterm infants during bottle feeding with two types of commercially available (Enfamil) single-hole nipples: one type designed for term infants and the other for preterm infants. Reductions in ventilation, tidal volume, and breathing frequency, compared with prefeeding control values, were observed with both nipple types during continuous and intermittent sucking phases; no significant differences were observed for any of the variables. Unlike the commercially available, mechanically drilled nipples, laser-cut nipple units showed a markedly lower coefficient of variation in milk flow. In the second phase of the study, two sizes of laser-cut nipple units, low and high flow, were used to feed nine preterm infants. Significantly lower sucking pressures were observed with high-flow nipples as compared with low-flow nipples. Decreases in minute ventilation and breathing frequency were also significantly greater with high-flow nipples. These results suggest that milk flow contributes to the observed reduction in ventilation during nipple feeding and that preterm infants have limited ability to self-regulate milk flow.

Sucking and breathing patterns during breast- and bottle-feeding in term neonates. Effects of nutrient delivery and composition

We attempted to determine whether differences in milk composition or flow rate are the primary determinants in altering breathing pattern during nipple-feeding. In the first phase of the study, 15 neonates were studied during breast-feeding and bottle-feeding; in the second phase, 15 were evaluated during bottle-feeding of expressed human milk and formula. A reduction in inspiratory duration was observed with all feeding regimens. Moreover, significant prolongation in expiratory duration and reduction in breathing frequency were observed during bottle-feeding of formula and expressed human milk (compared with control); these effects were greater with formula feeding. Higher sucking frequency was observed during breast-feeding compared with bottle-feeding; no difference in suckling frequency or sucking pressure was observed between bottle-feeding of expressed human milk and formula. We conclude that most of the differences in sucking and breathing patterns between breast- and bottle-feeding can be attributed to nutrient delivery rather than nutrient composition.

Failure of daily lumbar punctures to prevent the development of hydrocephalus following intraventricular hemorrhage

A prospective study of 48 infants with periventricular-intraventricular hemorrhage was carried out to evaluate the role of daily lumbar punctures, instituted from the time of diagnosis of the hemorrhage, in prevention of posthemorrhagic hydrocephalus and improvement in immediate outcome. The data lead to the following conclusions: (1) minor hemorrhage (Grade I) is associated with minimal risk of death or hydrocephalus; (2) moderate hemorrhage (Grade II) is associated with low risk of death and intermediate risk of hydrocephalus, and serial lumbar punctures do not reduce these risks; and (3) severe hemorrhage (Grade III) is associated with high risks of death or hydrocephalus or both, and serial lumbar punctures also do not reduce these risks.

Pharyngeal airway obstruction in preterm infants during mixed and obstructive apnea

The site of upper airway obstruction during mixed and obstructive apnea was investigated in nine preterm infants with clinical apnea. The level of obstruction was determined using a saline-filled pharyngeal catheter that detects respiratory pressure changes. High pharyngeal obstruction was found in 87 of 94 spells. These data suggest that the mechanism of upper airway obstruction in infants with apnea may be similar to that seen in older children and adults with obstructive sleep apnea.

Laryngeal pressure receptors

We studied the response characteristics of laryngeal pressure receptors in anesthetized dogs, breathing through a tracheal cannula, by recording single unit action potentials from the peripheral cut end of the internal branch of the superior laryngeal nerve. The larynx, with the rest of the upper airway, was isolated and cannulated separately for the application of distending and collapsing pressures. We identified receptors responding to either negative or positive pressure and a few responding to both. All these receptors showed a marked dynamic sensitivity and had the characteristics of slowly adapting mechanoreceptors. The majority of pressure receptors were active at zero transmural pressure and the gain of their response to pressure was higher at lower values, suggesting a role for these receptors in eupnea. Reflex alterations in breathing pattern and upper airway muscle activity during upper airway pressure changes, previously reported, are presumably mediated by the receptors described here. Moreover, these receptors may play a role in certain pathological states, such as obstructive sleep apnea, in which the upper airway is transiently subjected to large collapsing pressure.

Laryngeal influences on breathing pattern and posterior cricoarytenoid muscle activity

Receptors responding to transmural pressure, airflow, and contraction of laryngeal muscles have been previously identified in the larynx. To assess the relative contribution of these three types of receptors to the reflex changes in breathing pattern and upper airway patency, we studied diaphragmatic (DIA) and posterior cricoarytenoid muscle (PCA) activity in anesthetized dogs during spontaneous breathing and occluded efforts with and without bypassing the larynx. Inspiratory duration (TI) was longer, mean inspiratory slope (peak DIA/TI) was lower, and PCA activity was greater with upper airway occlusion than with tracheal occlusion (larynx bypassed). Bilateral section of the superior laryngeal nerves eliminated these differences. When respiratory airflow was diverted from the tracheostomy to the upper airway the only change attributable to laryngeal afferents was an increase in PCA activity. These results confirm the importance of the superior laryngeal nerves in the regulation of breathing pattern and upper airway patency and suggest a prevalent role for laryngeal negative pressure receptors.

Apnea of prematurity: pathogenesis and management strategies

Apnea of prematurity (AOP) is a significant clinical problem manifested by an unstable respiratory rhythm reflecting the immaturity of respiratory control systems. This review will address the pathogenesis of and treatment strategies for AOP. Although the neuronal mechanisms leading to apnea are still not well understood, recent decades have provided better insight into the generation of the respiratory rhythm and its modulation in the neonate. Ventilatory responses to hypoxia and hypercarbia are impaired and inhibitory reflexes are exaggerated in the neonate. These unique vulnerabilities predispose the neonate to the development of apnea. Treatment strategies attempt to stabilize the respiratory rhythm. Caffeine remains the primary pharmacological treatment modality and is presumed to work through blockade of adenosine receptors A(1) and A(2). Recent evidences suggest that A(2A) receptors may have a greater role than previously thought. AOP typically resolves with maturation suggesting increased myelination of the brainstem.

Influence of upper airway pressure changes on respiratory frequency

Influences of pressure changes within the upper airway on respiratory frequency were studied in anesthetized rabbits. These reflex effects were investigated in two ways: (1) by applying sustained negative or positive pressures to isolated upper airway in vagally intact animals during tracheostomy breathing, and (2) by briefly occluding the nasal airways of vagotomized animals at end expiration. Negative pressure applied to isolated upper airway decreased the respiratory frequency (P less than 0.01). Decrease in respiratory frequency correlated with magnitude of pressure change. In contrast, positive pressures produced an increase in respiratory frequency (P less than 0.05). But, the increase in frequency correlated poorly with magnitude of positive pressure change. A post-stimulus effect lasting several breaths was seen following the release of both negative and positive pressures (P less than 0.01). Nasal occlusion in vagotomized animals was associated with an increase in Ti and Ttot of the first nasally occluded breath (P less than 0.05). Increase in Ti was not associated with an increase in peak diaphragmatic activity. This would result in decreased inspiratory load on the upper airway patency maintaining muscles by reducing the mean inspiratory pressure. Hence, these reflex responses to airway pressure could play a functional role in the maintenance of upper airway patency.

Effect of upper airway negative pressure on respiratory timing

The effects of upper airway negative pressure on respiratory timing and respiratory muscle activity were investigated in 13 urethane-pentobarbital anesthetized adult rabbits. Diaphragm and upper airway muscle EMGs were recorded with fine wire electrodes. The upper airway was converted into a closed system and negative pressure changes were made at will with a syringe attached to a laryngeal cannula. Both inspiratory and expiratory durations (Ti and Te) were prolonged during the negative pressure trials. Maximal prolongation occurred on the first experimental breath for Te and on second breath for Ti. Decreased effects were seen during maintained negative pressures. Peak diaphragm EMG and average slope of diaphragm EMG decreased during these trials. Diaphragmatic apnea (Te greater than or equal to 5 sec) occurred in 15% of trials. In some of these trials apnea lasted as long as the negative pressure stimulus whereas in others spontaneous breathing resumed after a period of apnea. Phasic upper airway muscle activity occurred during diaphragmatic apnea in most of these trials. The superior laryngeal nerve section markedly reduced the effects of negative pressure, indicating that its afferents primarily mediate this response. Our results suggest that upper airway negative pressure acts centrally on both inspiratory and expiratory timing as well as on the motor output of thoracic and upper airway respiratory muscles.

Breathing pattern and ventilation during oral feeding in term newborn infants

The effect of oral feeding on breathing pattern and ventilation was studied in 19 healthy term neonates in the semiupright supine position. Ventilation was measured with a nasal flowmeter, and sucking pressure via a modified nipple that permitted milk delivery. The feeding pattern in these infants consisted of an initial period of continuous sucking followed by intermittent sucking for the remainder of the feed. A significant reduction in minute ventilation (P less than 0.01) was observed during continuous sucking, and resulted entirely from a reduction in breathing frequency (P less than 0.01). Tidal volume did not change (P greater than 0.05), but prolongation of expiration (P less than 0.01) and shortening of inspiration (P less than 0.05) were also observed. During intermittent sucking, the minute ventilation was similar to that of the control period. However, smaller but significant changes in breathing frequency and in duration of inspiration and expiration persisted during intermittent sucking. Our results document a significant reduction in ventilation during the initial part of oral feeding in term neonates, and subsequent recovery with continued feeding. Depending on the magnitude of this reduction in ventilation, cyanosis and bradycardia may develop in some infants during oral feeding.

Respiratory control during nipple feeding in preterm infants

The present study was designed to investigate the development of respiratory control during feeding in premature infants. Cardiorespiratory disturbances during feeding were evaluated with polygraphic monitoring in 24 premature infants within 1 week of beginning nipple feeds. During the initial study, 15 infants exhibited one or more episodes of short apnea (greater than or equal to 10 sec) and three infants exhibited prolonged apnea (greater than or equal to 20 sec). Bradycardia developed in seven infants; apnea and decreases in oxygen saturation invariably preceded the development of bradycardia. In contrast, short apnea occurred during sleep in five infants and associated bradycardia developed in four infants. Occurrence of apnea during sleep was significantly lower than that observed during feeding (P less than 0.05). Subsequently, 18 of these infants were reevaluated 7-10 days later. Seven infants developed one or more episodes of short apnea, five developed prolonged apnea, and four developed bradycardia. These occurrences were not significantly different from those observed during the initial study (P greater than 0.05). Short apnea persisted during sleep in four infants during reevaluation. Most of the apneic episodes in both studies were mixed apnea. The high frequency of cardiorespiratory disturbances during the first 2 weeks of nipple feeding indicates that in most preterm infants respiratory control during feeding is still immature at the postconceptional age of 35-36 weeks.

Assessment of pharyngeal airway stability in normal and micrognathic infants

A current hypothesis for obstructive sleep apnea states that 1) negative airway pressure during inspiration can collapse the pharyngeal airway, and 2) neural control of pharyngeal airway-dilating muscles is important in preventing this collapse. To test this hypothesis we performed nasal mask occlusions to increase negative pharyngeal airway pressures during inspiration in eight normal and five micrognathic infants. Both groups developed midinspiratory pharyngeal obstruction, but obstruction was more frequent in micrognathic infants and varied in some infants with sleep state. The airway usually reopened with the subsequent expiration. The occasional failure to reopen was presumably due to pharyngeal wall adhesion. If airway obstruction occurred in sequential breaths during multiple-breath nasal mask occlusions in normal infants, there was a breath-by-breath change in the airway pressure associated with airway closure (airway closing pressure); the airway closing pressure became progressively more negative. Micrognathic infants showed less ability to improve the airway closing pressure, but this ability increased with age. These findings suggest that nasal mask occlusion can test the competence of the neuromuscular mechanisms that maintain pharyngeal airway patency in infants. Micrognathic infants had spontaneous midinspiratory pharyngeal airway obstructions during snoring. Their episodes of obstructive apnea began with midinspiratory pharyngeal obstruction similar to that seen during snoring and nasal mask occlusions. These findings imply a similar pathophysiology for snoring, spontaneous airway obstruction, and obstruction during snoring.

Water-responsive laryngeal receptors in the dog are not specialized endings

The primary purpose of this study was to ascertain whether laryngeal receptors activated by water are specialized endings or whether they also respond to other stimuli, such as pressure, temperature and laryngeal motion as they occur during the breathing cycle. In 35 anesthetized mongrel dogs, breathing spontaneously through a lower cervical tracheostomy, water and other test solutions at approximately 37 degrees C were injected into the functionally isolated larynx with a small catheter. Of the 130 receptors studied, none of the cold receptors (N = 13) responded to water, whereas approximately 60% of all laryngeal mechanoreceptors (72 of 117) responded with either a short delay, short duration or a long delay, long duration response. In general the former pattern of response was exhibited by nonrespiratory-modulated receptors, whereas the latter was typical of respiratory-modulated receptors. The specific nature of the stimulus (hypotonicity or lack of chloride ion) of the water response was further studied in 53 receptors with isoosmotic solutions of dextrose and sodium gluconate. The long delay, long duration response was dependent on a decreased osmolality, while the short delay, short duration response was dependent on the lack of chloride ion of the test solutions. All water-responsive receptors tested (N = 17) were blocked within 50 sec by topically applied 2% lidocaine and thus presumed to be superficial. However, 10 receptors which did not respond to water were also blocked within 50 sec, suggesting that not all superficial receptors are stimulated by water. Based on these observations, we propose that changes in osmolality or ionic composition of the laryngeal surface liquid could play an important role in modifying reflexes involved in the maintenance of upper airway patency.

Effect of upper airway pressure pulses on breathing pattern

Importance of the time of application of upper airway pressure pulses on breathing pattern was investigated in 19 anesthetized, spontaneously breathing rabbits. The upper airway was functionally isolated into a closed system. A servo-respirator, triggered by the inspiratory activity of the diaphragm, was used to apply pressure pulses to the isolated upper airway. Negative pressure pulses of -5, -10, and -15 cm H2O when applied in early inspiration (within the first half) produced a reversible inhibition of inspiration in most trails (86.2%). This resulted in a prolongation of inspiratory duration (TI) and a decrease in mean inspiratory drive (P.Dia/TI) whereas peak diaphragm (P.Dia) activity and expiratory duration (TE) remained largely unaffected. In the remaining 13.8% of trials, an irreversible inhibition with short TI and reduced P.Dia activity was observed. In contrast, with late application of negative pressure pulses the only significant change was a shortening of TI. When positive pressure pulses were applied during expiration, no significant change in TE occurred with either early or late application. A significant prolongation of subsequent TI was seen irrespective of the time of positive pressure application. These results indicate that time of application during the respiratory cycle is an important variable in determining the response to upper airway pressure pulses.

Respiratory afferent activity in the superior laryngeal nerves

This study evaluates the afferent activity in the superior laryngeal nerve (SLN) during breathing as well as during occluded inspiratory efforts. Experiments were performed in 11 anesthetized and spontaneously breathing dogs. Electroneurographic activity was recorded from the peripheral cut end of the SLN and, in 3 dogs, also from the contralateral vagus nerve. A tracheal cannula with a side arm allowed the bypass of the larynx during breathing and occluded efforts. A clear inspiratory modulation was present in all experimental conditions. Both peak and duration of the SLN activity decreased (87% and 89%) when breathing was diverted from the upper airway to the tracheostomy. Peak and duration of the SLN activity (as % of upper airway breathing) increased during occluded efforts; however, the increase was greater when the larynx was not by-passed (peak = 118% vs 208%, duration = 143% vs 178%). Section of the ipsilateral recurrent laryngeal nerve reduced the inspiratory modulation. Vagal afferent activity increased equally during tracheostomy and upper airway breathing and decreased markedly during tracheal and upper airway occlusions. Our results indicate that collapsing pressure in the larynx is the major stimulus in activating laryngeal afferents.

Sucking patterns of neonates during bottle feeding: comparison of different nipple units

The present study was designed to compare the sucking pattern of term and preterm infants during bottle feeding with different types of nipple units (Enfamil single-hole nipple units for term and preterm infants and SMA Nuk nipple units). In addition, the sucking pattern of term neonates during a feeding regimen commonly used in many feeding studies was evaluated (reservoir nipple system). In this system milk flows from a reservoir through a tube and depends on the sucking pressure generated by the infant. Only the Enfamil single-hole nipple units for term and preterm infants were compared in preterm infants. No significant difference in sucking frequency was observed in term neonates with different types of nipple units. Although the mean sucking pressures generated tended to be less among nipple units with higher flow, these differences were not statistically significant. Similarly, no significant difference in total sucking or feeding time was observed among the three nipple units tested. Sucking pressures generated by term infants were significantly less when milk flow was increased markedly utilizing the reservoir system. In preterm infants no differences in sucking frequency, sucking pressure, mean flow, or total feeding time were observed when sucking patterns with term and preterm nipple units were compared. Implications of these findings in feeding neonates are discussed.

Involvement of glutathione/glutathione S-transferase antioxidant system in butyrate-inhibited vascular smooth muscle cell proliferation

Vascular smooth muscle cell (VSMC) proliferation is an important etiological factor in vascular proliferative diseases such as primary atherosclerosis, hypertension, arterial and in-stent restenosis, and transplant vasculopathy. Our studies established that butyrate, a bacterial fermentation product of dietary fiber and a chromatin modulator, is a potent inhibitor of VSMC proliferation. The cardiovascular health benefits of a high-fiber diet, the principle source of butyrate in the body, have been known for a long time, however, very little is known about the antiatherogenic potential of butyrate. Because oxidative stress plays an important role in the pathogenesis of atherosclerosis, we examined involvement of the glutathione/glutathione S-transferase (GST) antioxidant system in butyrate's inhibition of VSMC proliferation. Treatment of proliferating VSMCs with butyrate leads to the induction of several GSTs. Interestingly, our study also demonstrated the nuclear localization of GST-P1 (GST-7-7), which is considered to be a cytosolic protein; this was demonstrated using immunostaining and was corroborated by western blotting. Also, the butyrate-induced antiproliferative action, and the induction of GST-P1 and its nuclear localization are downregulated when butyrate is withdrawn. Furthermore, assessment of intracellular glutathione levels reveals their augmentation by butyrate. Conversely, butyrate treatment reduces the levels of reactive oxygen species in VSMCs. Collectively, the butyrate-treatment-related increase in glutathione content, the reduction in reactive oxygen species, the upregulation of GST and the nuclear localization of GST-P1 in growth-arrested VSMCs imply that butyrate's antiproliferative action involves modulation of the cellular redox state. Thus, induction of the glutathione/GST antioxidant system appears to have other regulatory role(s) besides detoxification and regulation of the cellular redox state, for example, cell-cycle control and cell proliferation, which are both critical to atherogenesis.