Polymyositis-dermatomyositis-associated interstitial lung disease

We report findings in 70 patients with both diffuse interstitial lung disease and either polymyositis (PM) or dermatomyositis (DM). Initial presentations were most commonly either musculoskeletal (arthralgias, myalgias, and weakness) or pulmonary (cough, dyspnea, and fever) symptoms alone; in only 15 patients (21.4%) did both occur simultaneously. Pulmonary disease usually took the form of acute to subacute antibiotic-resistant community-acquired pneumonia. Chest radiographs and computed tomography most commonly demonstrated bilateral irregular linear opacities involving the lung bases; occasionally consolidation was present. Jo-1 antibody was present in 19 (38%) of 50 patients tested. Synchronous associated malignancy was present in 4 of 70 patients (5.7%). Surgical lung biopsies disclosed nonspecific interstitial pneumonia (NSIP) in 18 of 22 patients (81.8%), organizing diffuse alveolar damage (DAD) in 2, bronchiolitis obliterans organizing pneumonia (BOOP) in 1, and usual interstitial pneumonia (UIP) in 1. Treatment usually included prednisone in 40-60 mg/d dosages for initial control, followed by lower dose prednisone plus an immunosuppressive agent such as azathioprine or methotrexate for disease suppression. Survival was significantly better than that observed for historical control subjects with idiopathic UIP, and was more consistent with survival previously reported in idiopathic NSIP. There was no difference in survival between Jo-1 positive and Jo-1 negative groups.

High short-term mortality following lung biopsy for usual interstitial pneumonia

Usual interstitial pneumonia (UIP) is a specific histological pattern of interstitial pneumonia most often associated with the clinical syndrome of idiopathic pulmonary fibrosis (IPF). There is controversy regarding the use of surgical lung biopsy in the diagnosis of UIP, and the risk of lung biopsy in these patients is largely unknown. This study investigated the 30 day surgical mortality rate in patients undergoing surgical lung biopsy for UIP. Patients undergoing surgical lung biopsy over a 10-yr period from 1986-1995 with the ultimate diagnosis of UIP (with or without underlying connective tissue disease) were identified. Pathology, computed tomography, medical records, and survival were assessed. Ten of sixty patients with usual interstitial pneumonia were found to be dead within 30 days of surgical biopsy. All of these were patients with idiopathic UIP, unassociated with connective tissue disease (clinical condition of IPF). In conclusion, patients with usual interstitial pneumonia of the idiopathic type, who present with atypical features, may be at higher risk for death following surgical biopsy than patients presenting with more typical features or patients with other interstitial illnesses.

Idiopathic pulmonary fibrosis: Impact of oxygen and colchicine, prednisone, or no therapy on survival

The clinical records of 487 patients seen at Mayo Clinic Rochester (MCR) during 1994 through 1996 who were diagnosed as having idiopathic pulmonary fibrosis of the usual interstitial pneumonia type (IPF/UIP) were reviewed. Computed tomography (CT) had been done in 94.7% of patients and surgical open lung biopsy (OLB) in 20.3%. Median survival was 3.2 yr. We compared survival as a function of treatment program, based on intent to treat at the time of the initial contact within the study window. Treatment advised included colchicine alone in 167, no therapy in 157, prednisone at maintenance dosages alone in 54, colchicine plus prednisone in 71, and other programs in 38. Oxygen therapy was advised in 133 patients. By univariate analysis, worse survival was associated with prednisone therapy compared with no therapy, and with oxygen therapy compared with no oxygen therapy. However, on multivariate analysis, worse survival was associated with older age, male gender, lower diffusing capacity for carbon monoxide (DL(CO)), lower alveolar volume (VA), and a history of worsening pulmonary function. When adjustment was made for these factors, there was no significant difference in survival between those patients treated with colchicine or prednisone and those on no therapy, and no difference between those on oxygen therapy and those without oxygen.

Radiation-induced pneumonitis in the "nonirradiated" lung

OBJECTIVE

To describe six cases of radiation-induced organizing pneumonitis occurring outside the direct radiation field and to review clinical, radiologic, and histologic aspects of this entity.

MATERIAL AND METHODS

We present detailed case reports of six women, with a mean age of 62.8 years (range, 50 to 75), who had received radiation therapy (mean dose, 6,560 cGy) for breast cancer.

RESULTS

From 6 to 17 months (mean, 8.8) after the completion of radiotherapy, recurrent and migrating lung infiltrates were detected outside the radiation field in the six study patients. Three patients had pronounced respiratory symptoms, whereas the rest were minimally symptomatic or asymptomatic. Thoracic computed tomography showed dense alveolar infiltrates. Bronchoalveolar lavage in two patients revealed lymphocytosis (25% and 19%), and lung biopsy in five patients demonstrated a histologic pattern consistent with bronchiolitis obliterans organizing pneumonia. Even though the symptomatic patients showed prompt resolution of their symptoms and roentgenographic abnormalities after systemic corticosteroid therapy, the lung infiltrates recurred after corticosteroid therapy was discontinued.

CONCLUSION

These six cases, including their prompt response to corticosteroid therapy, provide additional evidence that irradiation damages lung tissue outside of the direct treatment field and suggest that an immunologically mediated lymphocytic alveolitis may be responsible for the recurrent migratory organizing pneumonitis.

Colchicine versus prednisone in the treatment of idiopathic pulmonary fibrosis. A randomized prospective study. Members of the Lung Study Group

Twenty-six symptomatic subjects with clinical evidence plus either high-resolution computed tomography (HRCT, n = 25) or open-lung biopsy (OLB, n = 1) patterns typical for idiopathic usual interstitial pneumonia (idiopathic UIP) were entered into a randomized prospective treatment trial using high-dose prednisone (n = 12) versus colchicine (n = 14). The minimum dose of prednisone used was 60 mg/d for 1 mo, tapered to 40 mg/d over the second month, tapered to 40 mg every other day during the third month, with subsequent doses adjusted as clinically indicated. The dose of colchicine was 0.6-1.2 mg/d, as tolerated. The presence of a rim of subpleural honeycomb change was present in all of the 25 subjects who had HRCT. Subjects treated with high-dose prednisone alone experienced a higher incidence of serious side effects and also exhibited a trend (not statistically significant, p = 0.391) to more rapid decline of pulmonary function and shortened survival than did those treated with colchicine alone. In most subjects with typical clinical and HRCT features of idiopathic UIP, neither prednisone nor colchicine resulted in objective improvement, and the disease continued to progress in the majority. Colchicine appears to be a safer alternative to a trial of high-dose prednisone but may be no different than no therapy.

Organizing pneumonia. Features and prognosis of cryptogenic, secondary, and focal variants

BACKGROUND

Organizing pneumonia (OP) is a non-specific response to many types of lung injury. Clinicians frequently encounter pathology reports of OP in patients with no underlying condition (cryptogenic OP, also known as BOOP or bronchiolitis obliterans OP) or in association with drugs or nonpulmonary disease. The goals of this study are to describe the clinical course and outcomes in patients with 3 clinical variants of OP.

METHODS

A retrospective study of patients with OP seen at the Mayo Clinic, Rochester, Minn, from January 1, 1984, through June 30, 1994, was conducted. Initial features were obtained from medical records. Chest radiographs and pathology specimens were reviewed for this study. Resolution, relapse, and survival were obtained from medical records and a follow-up patient questionnaire.

RESULTS

Seventy-four patients had pathologically confirmed OP. Organizing pneumonia was classified into 3 clinical groups: symptomatic cryptogenic OP; symptomatic OP related to underlying hematologic malignant neoplasm, collagen vascular disease, or drugs (secondary OP); and asymptomatic OP presenting as a focal nodule (focal OP). Thirty-seven patients (50%) had cryptogenic OP and 27 patients (36%) had secondary OP. No difference was found between cryptogenic and secondary OP in type or severity of symptoms, signs, laboratory and pulmonary function tests, or radiologic or pathologic findings. Corticosteroids were given at a similar initial dose (prednisone, about 50 mg/d). Resolution of symptoms was more frequent in patients with cryptogenic OP than those with secondary OP. Relapse was infrequent in both of these groups. Five-year survival was higher in patients with cryptogenic OP (73%) than in secondary OP (44%), and respiratory-related deaths were more frequent in patients with secondary OP. Organizing pneumonia was an asymptomatic focal rounded opacity in 10 patients (14%), most often detected on chest radiograph and diagnosed on lung biopsy done for suspicion of lung cancer. Patients with focal OP required no treatment and had no relapse or respiratory-related deaths.

CONCLUSIONS

Clinical classification of OP is useful to predict clinical course and outcome. Cryptogenic OP most often was a symptomatic bilateral lung process that had an overall favorable prognosis with prolonged corticosteroid therapy. Patients with secondary OP had a high mortality rate when the disease was associated with predisposing conditions or drugs. Patients with asymptomatic focal OP had an excellent prognosis.

Colchicine versus prednisone as treatment of usual interstitial pneumonia

OBJECTIVE

To assess the results with colchicine and prednisone as initial single-drug therapy in patients with usual interstitial pneumonia (UIP).

MATERIAL AND METHODS

We reviewed the serial pulmonary function test results in 22 patients with typical clinical and high-resolution computed tomographic features of UIP who were treated with colchicine as initial single-agent therapy and compared them with a group of 22 historical patients with UIP of similar severity diagnosed by open-lung biopsy who were given prednisone as initial single-drug therapy.

RESULTS

No significant difference was detected in the rate of decline of pulmonary function or in the time to "failure" between the two study groups. A trend was suggested for more rapid decline of pulmonary function in the prednisone-treated than in the colchicine-treated group. The design of this study does not allow distinction between a possible beneficial effect of colchicine and a possible adverse effect related to weaning from high-dose prednisone. Colchicine was well tolerated; few side effects other than mild diarrhea were noted in those patients able to take the drug long enough to return for pulmonary function testing at 3 months. In comparison, the side effects of prednisone were more serious and were not always reversible with cessation of therapy.

CONCLUSION

This study lends further support to the assumption that colchicine may be a satisfactory and less hazardous substitute for prednisone in the treatment of patients with UIP.

Both GABAA and GABAB receptors participate in suppression of [CA2+]i pulsing in toad melanotrophs

The receptor mechanisms involved in the inhibitory effect of gamma-aminobutyric acid (GABA) in suppressing spontaneous [Ca2+]i pulsing in melanotrophs of Xenopus laevis were investigated. The selective GABAB receptor agonist, baclofen reversibly arrested [Ca2+]i pulsing. This inhibition was unaffected by the selective GABAA receptor antagonist, bicuculline methiodide, but was blocked by the selective GABAB receptor antagonist, CGP 35348 (3-aminopropyl diethyoxymethyl phosphinic acid). The selective GABAA receptor agonist, muscimol, also arrested [Ca2+]i pulsing after causing a transient rise in [Ca2+]i. This biphasic response to muscimol was unaffected by CGP 35348, but was blocked by bicuculline. The inhibitory effect of GABA was unaffected by either CGP 35348 or bicuculline when given alone, but was blocked by both antagonists given together. In cells pretreated with pertussis toxin, the response to baclofen was completely lost, whereas responses to GABA and muscimol persisted; the response to GABA was blocked by bicuculline alone. Thus, both GABAA and GABAB receptors are involved in the inhibitory effect of GABA in suppressing spontaneous [Ca2+]i pulsing in Xenopus melanotrophs.

Pulmonary venoocclusive disease: CT findings in eight patients

OBJECTIVE

The objective of the study was to describe the CT findings of pulmonary venoocclusive disease.

MATERIALS AND METHODS

Eight patients with CT scans of the thorax and a diagnosis of pulmonary venoocclusive disease were identified from three institutions. The six males and two females had a mean age of 32 years old (range, 5-58 years old). All scans were evaluated with consensus reading by two chest radiologists. Lung parenchyma were assessed for the type and distribution of disease. Bronchi, pleura, hila, mediastina, and chest walls were evaluated for abnormalities. Pathologic specimens from five patients were reviewed and specifically correlated with the radiologic findings.

RESULTS

Seven of the eight patients had interlobular septal thickening. All eight patients had regions of ground-glass opacity. Four of the eight patients had a mosaic pattern of lung attenuation. No enlarged hilar or mediastinal nodes were revealed. Five patients had bilateral pleural effusions.

CONCLUSION

The most common CT findings in these eight patients with pulmonary venoocclusive disease were smooth interlobular septal thickening, diffuse multifocal regions of ground-glass opacity, pleural effusions, enlarged central pulmonary arteries, and pulmonary veins of normal caliber. Four patients had a mosaic pattern of lung attenuation on the CT scans. These findings are highly suggestive of pulmonary venoocclusive disease and may be helpful in difficult cases. Definitive diagnosis requires lung biopsy.

Chronic eosinophilic pneumonia and idiopathic bronchiolitis obliterans organizing pneumonia: comparison of eosinophil number and degranulation by immunofluorescence staining for eosinophil-derived major basic protein

OBJECTIVE

To undertake additional assessment of the possible overlap between bronchiolitis obliterans organizing pneumonia (BOOP) and chronic eosinophilic pneumonia (CEP).

DESIGN

We retrospectively reviewed open-lung biopsy specimens from six patients with CEP, five patients with idiopathic BOOP, and four patients with secondary BOOP, encountered during the 5-year period 1986 through 1991, for the presence of eosinophils and extent of eosinophil degranulation.

MATERIAL AND METHODS

Using previously described immunofluorescence methods for detection of intact eosinophils and extracellular deposition of eosinophil-derived major basic protein, we counted the number of eosinophils per x160 microscopic field and evaluated the extent of eosinophil degranulation semiquantitatively.

RESULTS

The median numbers of eosinophils were 221 (range, 26 to 343) in cases of CEP, 7 (range, 1 to 65) in cases of idiopathic BOOP, and 7.5 (range, 1 to 39) in cases of secondary BOOP. More eosinophils were found in CEP than in idiopathic BOOP or all cases of idiopathic and secondary BOOP. We found no differences in the extent of eosinophil degranulation among the three groups, although a tendency for more degranulation was noted in cases of CEP.

CONCLUSION

Even though clinical and histologic overlap may exist between CEP and idiopathic BOOP, the exact relationship and the role of the eosinophil in idiopathic BOOP remain to be determined.

Melanotrophs of Xenopus laevis do respond directly to neuropeptide-Y as evidenced by reductions in secretion and cytosolic calcium pulsing in isolated cells

Neuropeptide-Y (NPY) is present, along with dopamine and gamma-aminobutyric acid, in the neurons innervating the intermediate lobe of the pituitary gland of Xenopus laevis, and all three neurotransmitters have been shown to inhibit melanotroph secretion from isolated neurointermediate lobes. However, unlike dopamine and gamma-aminobutyric acid, NPY has been reported to be without inhibitory effect on secretion from dispersions of intermediate lobe cells. Moreover, binding studies have been taken as indicating that Xenopus melanotrophs lack NPY receptors, although such receptors appear to be present on folliculostellate cells. For these reasons, NPY has been considered to act indirectly on Xenopus melanotrophs; the putative intermediary is supposed to be the folliculo-stellate cell. However, the present experiments show that NPY does strongly inhibit melanotroph secretion from cells dispersed from Xenopus intermediate lobes. In addition, they demonstrate that NPY acts directly on individual Xenopus melanotrophs (immunohistochemically identified and under conditions that preclude any interaction between cells) to inhibit the intermittent rises in cytosolic free Ca (cytosolic Ca pulsing). From these observations, we conclude that NPY does act directly on melanotrophs of Xenopus.

Spontaneous cytosolic calcium pulsing detected in Xenopus melanotrophs: modulation by secreto-inhibitory and stimulant ligands

The purpose of the experiments was to examine the behavior of cytosolic Ca2+ ([Ca2+]i) in individual pituitary melanotrophs and how that is affected by physiological ligands that inhibit or stimulate melanotroph secretion. Melanotrophs were dispersed from neurointermediate lobes of Xenopus laevis adapted to a black background, and [Ca2+]i was measured with fura-2. In basal (unstimulated) conditions, repetitive transient elevations in [Ca2+]i, not hitherto observed in any melanotrophs, were detected in 73% of the cells. These cytosolic Ca pulses occurred at fairly regular intervals (1-10 min) and lasted from a half to several minutes, during which [Ca2+]i rose several-fold. Pulsing was promptly and reversibly arrested by the secreto-inhibitory transmitters, dopamine, neuropeptide-Y (NPY), and gamma-aminobutyric acid (GABA), and also by quinpirole, muscimol, and baclofen. Pertussis toxin eliminated the responses to dopamine, NPY, and GABAB receptor activation, but spared responses to GABAA receptor activation. The responses to the physiological inhibitors and to the Ca channel blocker Ni were close to all or nothing; a mere doubling of an ineffective concentration commonly sufficed to arrest pulsing. Submaximal responses, seen over a narrow concentration range, involved a slowing of the pulsing. Cells not pulsing spontaneously were responsive to dopamine, GABA, and NPY and pulsed in response to the secretagogues CRF and TRH. They are suggested to be melanotrophs not actively secreting. The behavior of [Ca2+]i parallels secretory activity and strengthens the view that spontaneous secretion is driven by spontaneous influx of Ca ions and that secreto-inhibitory transmitters act by suppressing this influx and lowering [Ca2+]i. Cytosolic Ca pulsing may provide an efficient means of sustaining a high rate of spontaneous secretion.

Spontaneous cytosolic calcium pulses in Xenopus melanotrophs are due to calcium influx during phasic increases in the calcium permeability of the cell membrane

We recently discovered that melanotrophs of Xenopus laevis exhibit spontaneous pulse-like rises in cytosolic free calcium ([Ca2+]i) and that this cytosolic Ca pulsing is inhibited by the secreto-inhibitory transmitters dopamine, gamma-aminobutyric acid, and neuropeptide-Y and stimulated by the secretagogues CRF and TRH. Here we provide evidence for the factors responsible for the individual cytosolic Ca pulse and the repetitive behavior. Isolated melanotrophs of Xenopus were loaded with fura-2, and fluorescence was recorded from perifused single cells to measure [Ca2+]i and assess the patency of divalent cation channels by Mn quenching of fluorescence. Cytosolic Ca pulsing was arrested by omission of Ca and by the Ca channel blockers Ni and Co, but was unaffected by tetrodotoxin. Mn (0.3 mM) caused phasic quenching, each "quench" being synchronous with the rising phase of a cytosolic Ca pulse. Quenching was blocked by Ni, but was unaffected by tetrodotoxin. When introduced during the course of an individual Ca pulse, Ni aborted the pulse and [Ca2+]i collapsed. Extracellular K+ (10 mM) or K channel block with tetraethylammonium stimulated Ca pulsing. Threshold concentrations of Ni slowed Ca pulsing without reducing the amplitude of the individual pulses. The overshoots in quenching and Ca pulsing observed after exposure to Ni, dopamine, or baclofen are interpreted as off responses. It is concluded that each cytosolic Ca pulse is attributable, probably quantitatively, to Ca influx during a spontaneous increase in Ca permeability independent of Na-mediated action potentials, and that the pacemaker for the repetitive phenomenon is voltage sensitive and may involve Ca currents active around basal membrane potential.

Colchicine in the treatment of pulmonary fibrosis

There is no standard or known optimal treatment for idiopathic pulmonary fibrosis. Corticosteroids have been used with widely variable benefit. Colchicine has been reported to suppress fibroblast growth factors and to inhibit collagen deposition. A potential role has been proposed for colchicine in the treatment of fibrotic pulmonary diseases. We retrospectively assessed the outcome of 23 patients with idiopathic pulmonary fibrosis in whom colchicine was used as empiric treatment. Eighteen patients had received prior corticosteroid therapy. By clinical and pulmonary function criteria, five patients (22 percent) improved following colchicine, nine (39 percent) remained stable, and nine (39 percent) worsened. The average duration of follow-up was 22 months. Despite limitations of this retrospective analysis, colchicine may be of benefit in pulmonary fibrosis and should be considered for further clinical trials.

Indications from Mn-quenching of Fura-2 fluorescence in melanotrophs that dopamine and baclofen close Ca channels that are spontaneously open but not those opened by high [K+]O; and that Cd preferentially blocks the latter

In unstimulated melanotrophs, which secrete spontaneously, Mn caused a progressive quenching of Fura-2 fluorescence (F360) which was: (a) unaffected by tetrodotoxin to suppress spontaneous Na-action potentials; (b) slowed by lowering temperature to 23 degrees C; and (c) arrested by the Ca channel blocker, Ni. Mn quenching slowed on lowering [K+]O from 5 to 2 mM to hyperpolarize (indicating Mn entry through voltage-dependent channels) and accelerated on raising [K+]O to 50 or 100 mM to strongly depolarize (indicating recruitment of high threshold channels). The secreto-inhibitor, dopamine, arrested spontaneous Mn quenching and so, too, did the GABAB agonist, baclofen; and these effects like those of the two agonists on secretion and [Ca2+]i were blocked by the specific D2 and GABAB antagonists, sulpiride and CGP 35348, respectively, and were lost following exposure to pertussis toxin. By contrast, neither dopamine nor baclofen prevented Mn quenching in response to high K, although this was arrested by Ni. A second Ca channel blocker, Cd, in concentrations that inhibited the response to high K, failed to inhibit spontaneous entry of Mn. This preferential effect offers an explanation for observations made with Cd that have been interpreted as contrary to the notion of Ca-regulated secretion in the melanotroph. The results we have obtained are interpreted to mean that in the melanotroph secreting spontaneously some voltage-dependent Ca channels are in the open state; that this open state is not dependent on any Na spiking activity; and that these channels are preferentially closed by dopamine and baclofen which are without effect on Ca channels opened by strongly depolarizing concentrations of K.

Calcium channels in rat melanotrophs are permeable to manganese, cobalt, cadmium, and lanthanum, but not to nickel: evidence provided by fluorescence changes in fura-2-loaded cells

Cobalt (Co), nickel (Ni), manganese (Mn), cadmium (Cd), and lanthanum (La) are commonly used as calcium (Ca) channel blockers, but some of them, besides reducing Ca entry, also traverse Ca channels and can exert effects intracellularly that confound interpretation of functional responses. Because of this and our need to use Ca channel blockers in an ongoing analysis of Ca channel activity in the regulation of the cytosolic free Ca concentration ([Ca2+]i) and secretion in melanotrophs, we assessed whether the cations mentioned enter these cells. This was done by incorporating the fluorescence for changes that would signal the presence of the cations in the cytosol. In cell-free solution, where the probe and cations can interact freely, Mn, Co, and Ni all quench fluorescence, whereas Cd and La act in a Ca-like manner. When tested on fura-2-loaded melanotrophs in basal (unstimulated) conditions, Mn, Co, and Cd each yielded corresponding signals, thereby showing that they had penetrated the cells. By contrast, Ni caused no quenching of fluorescence even in melanotrophs exposed to 100 mM K+ to recruit additional Ca channels. Ni, therefore, did not penetrate the cells. However, as expected, Ni quenched fluorescence when given artificial access to the cytoplasm by ionomycin. Ni blocked spontaneous entry of Mn, Co, and Cd. It also lowered [Ca2+]i in unstimulated melanotrophs, consistent with blockade of spontaneous Ca entry. Like Ni, La lowered basal [Ca2+]i in unstimulated melanotrophs without penetrating the cells; however, unlike Ni, it penetrated when the melanotrophs were exposed to high potassium. We conclude that Ni is the most specific of the Ca channel blockers tested and that results obtained with Mn, Co, Cd, and La must be interpreted with reserve.

High-resolution CT of the lungs: findings in various pulmonary diseases

High-resolution CT (HRCT) is a technique that optimizes the spatial resolution of conventional scanners. HRCT shows exquisite detail of both normal and diseased lung. The findings seen with HRCT of the lung correlate well with the microscopic and gross pathologic findings. In this review, we describe the technical features of HRCT and discuss the HRCT findings in various lung diseases.

Effectiveness of GABAB antagonists in inhibiting baclofen-induced reductions in cytosolic free Ca concentration in isolated melanotrophs of rat

1. The purpose of the present experiments was to assess the activities of GABAB receptor antagonists in mammalian isolated melanotrophs. 2. Cytosolic free Ca concentration ([Ca2+]i) in rat melanotrophs in primary culture was monitored with the fluorescent probe, fura-2. 3. (-)-Baclofen lowered [Ca2+]i in a concentration-dependent manner with an EC50 of 0.96 microM. The reduction in [Ca2+]i produced by (-)-baclofen at a maximally effective concentration (100 microM) was similar to that produced by the classic transmitter inhibitory to melanotroph secretion, dopamine, at a corresponding concentration (100 nM), or by perifusion with a nominally Ca-free solution. 4. The GABAB receptor antagonists, 3-aminopropyl(diethoxymethyl)phosphinic acid (CGP 35348), 2-hydroxy saclofen, phaclofen and 4-amino-3-(5-methoxybenzo[b]furan-2-yl) butanoic acid (9H), had inhibitory effects on the reduction in [Ca2+]i produced by (-)-baclofen (3 microM). Of the antagonists tested, CGP 35348 was the most potent with an IC50 of 60 microM, compared to 120 to 400 microM for the others. CGP 35348 acted competitively. 5. CGP 35348 alone had no effect on basal [Ca2+]i, or on the changes in [Ca2+]i produced by dopamine (10 nM) or the specific GABAA receptor agonist, muscimol (10 microM). 6. The evidence indicates that of the antagonists tested, CGP 35348 offers the greatest promise for pharmacological analysis of the functional significance of the GABAB receptors in melanotrophs.

Upper lobe pulmonary parenchymal calcification in a patient with AIDS and Pneumocystis carinii pneumonia receiving aerosolized pentamidine

In patients with AIDS-related Pneumocystis carinii infection occurring during aerosolized pentamidine prophylaxis, roentgenographic findings may be atypical. Pulmonary parenchymal calcification due to P carinii is rare. In this case, extensive upper lobe pulmonary parenchymal, splenic, and nodal calcifications occurred after two years of monthly treatments with aerosolized pentamidine.

Why are several inhibitory transmitters present in the innervation of pituitary melanotrophs? Actions and interactions of dopamine, GABA and neuropeptide Y on secretion from neurointermediate lobes of Xenopus laevis

The aim of the present experiments was to determine whether some rationale for the presence of the several inhibitory neurotransmitters in the innervation to the toad melanotroph might be found in differences in their individual effects or in possible cooperative interactions affecting secretion. Measurements of peptide release from isolated, perifused neurointermediate lobes of the toad Xenopus laevis showed that each of the three identified inhibitory transmitters, dopamine, GABA and NPY, was able to inhibit secretion profoundly and no less effectively than omission of Ca. Moreover, the inhibitory effects were rather similar in onset, duration and recovery. Furthermore, there was no evidence of any cooperative interactions when the transmitters were given in various combinations. And finally, the inhibitory response to each of the transmitters was abolished by pretreatment with pertussis toxin. While not excluding differential postsynaptic effects on other parameters of melanotroph function, the similarities observed have encouraged alternative speculations on the significance of the apparent redundancy of inhibitory transmitters.

Studies on pituitary melanotrophs reveal the novel GABAB antagonist CGP 35-348 to be the first such compound effective on endocrine cells

One obstacle to understanding the action and physiological significance of the responsiveness of various endocrine cells to gamma-aminobutyric acid (GABA) has been that previously available substances, all active as GABAB antagonists in the nervous system, are ineffective on endocrine cells. The introduction of a potent new member of this class, CGP 35-348, of very different chemical structure, encouraged us to examine its effect on endocrine cells. For this purpose, we studied melanotroph secretion from pituitary neurointermediate lobes. We found that CGP 35-348, in contrast to previously available members of this class, suppressed completely, in rat and toad, secretory responses to baclofen, the classic GABAB agonist. Analysis, in toad, showed CGP 35-348 did not affect responses to GABAA agonists (muscimol; isoguvacine), dopamine, or neuropeptide Y. When tested against GABA, the physiological ligand present in the innervation of melanotrophs (along with dopamine and neuropeptide Y), CGP 35-348 completely suppressed the secretory response, which, in toad, is purely inhibitory and unaffected by bicuculline, the specific GABAA antagonist. In addition, CGP 35-348 unmasked a stimulant effect that bicuculline blocked. In CGP 35-348, we thus have a new tool with which to analyse responses to GABA and their physiological involvement in endocrine cells.

Dopamine (D2) or gamma-aminobutyric acid (GABAB) receptor activation hyperpolarizes rat melanotrophs and pertussis toxin blocks these responses and the accompanying fall in [Ca2+]i

The effects, on membrane potential, of dopamine (DA) and gamma-aminobutyric acid (GABA), transmitters present in the secreto-inhibitor innervation to the melanotrophs, were monitored in primary cultures of rat melanotrophs with bis-oxonol. DA and GABA, acting through D2 and GABAB receptors, hyperpolarized the melanotrophs. Hyperpolarization was not suppressed by tetrodotoxin but was prevented by pertussis toxin and may thus be due to a G protein mediated mechanism. Pertussis toxin also blocked the effects mediated by the two receptors to reduce intracellular free Ca2+ ([Ca2+]i).

Cytosolic Ca2+ in melanotrophs: pharmacological insights into regulatory influences of electrical activity and ion channels

The concentration of intracellular free Ca2+ ([Ca2+]i) was measured in melanotrophs, the characteristic endocrine cells of the pars intermedia of the rat pituitary gland, using the fluorescent Ca indicator fura-2. The resting [Ca2+]i was 211 +/- 8 nM and was little affected by tetrodotoxin (TTX; 5 or 10 microM), which inhibits the spontaneous action potentials that occur in these cells. Removal of extracellular Ca2+ (by chelation with EGTA) or addition of the Ca channel blocker nimodipine (1 microM) produced a rapid fall in [Ca2+]i, which occurred whether TTX was present or not. Excess K+ (60 mM), veratridine (10 or 100 microM) and BAY K 8644 (1 microM) each caused a rapid rise in [Ca2+]i, which was blocked or truncated by EGTA or nimodipine. TTX blocked or truncated the increases in [Ca2+]i induced by veratridine, but not those induced by either excess K+ or BAY K 8644. The results show that manipulations that increase or decrease hormone output increase or decrease [Ca2+]i. Furthermore, the resting [Ca2+]i appears to depend importantly on Ca influx, since it is rapidly and markedly reduced by removal of extracellular Ca2+ or addition of a Ca channel blocker.

Effects of BAY K 8644 on Ca-channel currents and electrical activity in mouse melanotrophs

The effects of BAY K 8644 on both evoked and spontaneous electrical activity were studied in mouse melanotrophs. The action potential in these cells consisted of both a Na and a Ca component. BAY K 8644 greatly increased the duration of the evoked action potential apparently by enhancing the Ca component since this prolongation remained when the Na component was blocked by tetrodotoxin but was diminished by the Ca-channel antagonists Co2+ or nimodipine. In addition to its effects on the evoked action potential, BAY K 8644 sometimes caused action potentials of long duration to occur in otherwise quiescent melanotrophs, even in the presence of tetrodotoxin. These action potentials appeared to be triggered by small, depolarizing prepotentials. Voltage-clamp experiments suggested the existence of 3 types of Ca-channel currents in these cells: one low-threshold current and two high-threshold currents, one of which rapidly inactivated and another which did not. BAY K 8644 caused a shift in the I-V relation for Ca-channel current to more negative values and reduced or abolished the hump in the initial part of the I-V curve produced by the low-threshold current suggesting that BAY K 8644 selectively affects high-threshold Ca current. The action of BAY K 8644 to initiate trains of long-lasting Ca spikes and thereby increase Ca influx, might explain its secretagogue effect on the unstimulated melanotroph.

Silo-filler's disease

Between 1955 and 1987, 17 patients were examined at the Mayo Clinic shortly after exposure to silo gas. All exposures had occurred in conventional top-unloading silos. Acute lung injury occurred in 11 patients, 1 of whom died; early diffuse alveolar damage with hyaline membranes and hemorrhagic pulmonary edema and acute edema of the airways were found at autopsy. In one patient, hypoxemia and transient obstruction of the airways developed, but no pulmonary infiltrates were noted. One patient had symptoms for 5 weeks and diffuse confluent pulmonary infiltrates; many years later, chronic obstructive pulmonary disease developed (he had, however, been a heavy smoker before exposure). Bronchiolitis obliterans was not observed in the other patients, probably because of less severe exposure or early corticosteroid therapy. Prophylactic corticosteroid therapy is advised for workers who have been exposed to silo gas. The management of patients with established acute lung injury is reviewed. Previously unreported patterns of exposure to silo gas in conventional silos are described, and recommendations for avoiding exposure are suggested.

Role of bronchoalveolar lavage in the assessment of opportunistic pulmonary infections: utility and complications

We prospectively evaluated the diagnostic role of bronchoalveolar lavage in the assessment of opportunistic pulmonary infections and the incidence of associated complications in 100 immunocompromised patients during a 9-month period. Bronchoalveolar lavage was useful in detecting the presence of Pneumocystis carinii, viruses, fungi, bacteria, and mycobacteria in the lower respiratory tract. P. carinii was diagnosed by bronchoalveolar lavage in 17 patients and by open-lung biopsy in 1. Other organisms detected by lavage, lung biopsy, or both included viruses (eight patients), fungi (four patients), bacteria (six patients), and mycobacteria (three patients). Of the 100 patients studied, 33 had infectious agents detected in the lung; in 6 of these patients, more than one organism was present. Bronchoalveolar lavage detected the infectious organisms in 30 of the patients, in many of whom an open-lung biopsy was likely avoided because of the lavage studies. Although no major complications of bronchoalveolar lavage were noted in this critically ill population, five patients did require short-term mechanical ventilation after bronchoscopy. When correctly used, bronchoalveolar lavage is a safe and useful procedure for the assessment of immunocompromised subjects with suspected opportunistic pulmonary infections.

Electrical stimulation of neurointermediate lobes of mice elicits calcium-dependent output of melanocyte-stimulating hormone

Current pulses applied to isolated neurointermediate lobes of mice increased output of melanocyte-stimulating hormone. This response was dependent on extracellular calcium over a wide range of stimulus intensities and thus appears to be a true secretory response from the melanotrophs. Since substantial responses persisted in the presence of tetrodotoxin, much of the effect seems to be independent of Na spiking.

Effects of Bay K 8644 and other dihydropyridines on basal and potassium-evoked output of MSH from mouse melanotrophs in vitro

Dihydropyridines that have been shown in studies on other tissues either to facilitate Ca influx (BAY K 8644) or depress it (nimodipine and nifedipine) were examined for their effects on the secretory activity of the melanotrophs. Isolated mouse neurointermediate lobes, cultured for a week or longer to allow the nerves to degenerate, were perifused and output of MSH activity was measured by bioassay. The Ca-channel agonist BAY K 8644 augmented secretion under basal conditions and potentiated secretion evoked by 30 mM K+, a submaximally depolarizing concentration. The stimulant effect on secretion under basal conditions persisted in the presence of tetrodotoxin (which blocks the action potentials, Na spikes, in the melanotrophs) but was lost when Ca2+ was omitted or nimodipine added. The results are considered to support the view that the prominent basal secretory activity in these cells, as well as that evoked by excess K+, involve the inward flux of Ca2+ through dihydropyridine-sensitive Ca channels. If the stimulant and inhibitory effects of the dihydropyridines on basal secretion are to be attributed to actions on voltage-regulated Ca channels, as the results from other tissues would suggest, then such channels in the melanotrophs are different from those previously described in other tissues.

Amiodarone pulmonary toxicity. Assessment by bronchoalveolar lavage

Bronchoalveolar lavage was used to demonstrate morphologic changes in alveolar macrophages characteristic of amiodarone effect in lung tissue obtained by biopsy. This procedure may be useful in the assessment of abnormal chest x-ray findings in patients suspected to have amiodarone toxicity.

Survival in adult respiratory distress syndrome caused by blastomycosis infection

A 32-year-old man with diabetes had rapid development of acute respiratory failure and severe hypoxemia. Radiologic and hemodynamic evaluation confirmed the clinical diagnosis of adult respiratory distress syndrome, and open-lung biopsy disclosed blastomycosis as the etiologic agent. The survival of this patient, after amphotericin therapy, to our knowledge is the first reported recovery from substantiated adult respiratory distress syndrome secondary to blastomycosis.

Pharmacological and ionic features of gamma-aminobutyric acid receptors influencing electrical properties of melanotrophs isolated from the rat pars intermedia

Characteristics of the gamma-aminobutyric acid receptors on melanotrophs of the rat pars intermedia were studied by intracellular recording. Muscimol and 3-amino-1-propanesulfonic acid, but not baclofen or glycine, mimicked the depolarization and conductance increase produced by gamma-aminobutyric acid on the melanotrophs. These effects appeared to be due to an increase in chloride ion conductance since the null potentials for all three drugs were the same and were affected by changes in external or internal chloride ion concentration but not by changes in the concentrations of other ions present in the recording solution or by the addition of the calcium-channel blocker cobalt. Bicuculline abolished the effect of muscimol. Picrotoxin reduced the effect of gamma-aminobutyric acid; so too did furosemide. Muscimol mimicked the ability of gamma-aminobutyric acid to reduce the depolarization produced by excess potassium and this effect was also blocked by bicuculline. Rat melanotrophs thus appear to possess gamma-aminobutyric acid receptor-ionophore complexes similar to the classical sort found in neurons in the mammalian central nervous system. Furthermore, the parallels between the electrical responses observed and secretory effects previously noted, reinforce the view that electrical activity may participate in stimulus-secretion coupling in melanotrophs.

Effects of veratridine, tetrodotoxin and other drugs that alter electrical behaviour on secretion of melanocyte-stimulating hormone from melanotrophs of the pituitary pars intermedia

Since melanotrophs are electrically active and exhibit spontaneous Na spikes, a study was made of the effects, on melanotroph secretion, of drugs known to influence electrical properties. The output of melanocyte-stimulating hormone was measured from perifused neurointermediate lobes of mice or melanotrophs dispersed from such lobes of mice or rats. Veratridine (200 microM), which is known to increase Na permeability in a variety of cells, caused a large, although transient, increase in secretion from the melanotrophs that required extracellular Ca2+ and was blocked by the Na-channel blocker tetrodotoxin (1 microM). Tetraethylammonium (10 mM), which blocks K channels and thus prolongs the duration of the action potential in many cells, also stimulated secretion in the melanotrophs in a Ca-dependent manner. This response was not, however, blocked by tetrodotoxin, and is thus not attributable to prolongation of Na spikes in these cells. Moreover, tetrodotoxin did not inhibit basal secretion. The stimulant effect of veratridine on secretion in melanotrophs and its suppression by tetrodotoxin suggests that voltage-dependent Na channels can participate in the regulation of hormone output in these cells of the pituitary pars intermedia. However, the apparent lack of effect of tetrodotoxin on basal secretion suggests that the spontaneous Na spikes previously observed in these cells are not required for promoting the Ca influx which other evidence shows is important for basal secretion.

Electrical activity in adenohypophyseal cells and effects of hypophyseotropic substances

Normal endocrine cells isolated from adenohypophyses of the rat, lizard, and fish, and maintained in short-term culture, produce action potentials spontaneously or in response to depolarizing current pulses or stimulant hypophyseotropic substances. Thyrotropin-releasing hormone elicited action potentials in a fraction of a mixed population of rat pars distalis cells. Dopamine, which inhibits basal secretion from rat melanotrophs and teleostean prolactin cells, inhibited action potential discharge in both these cell types. 5-Hydroxytryptamine, which stimulates secretion from lizard pars intermedia cells, stimulated action potentials in these cells. gamma-Aminobutyric acid, recently found in nerves to the rat pars intermedia and shown to have both stimulant and inhibitory effects on secretion, depolarized rat melanotrophs. The effect involved an increase in Cl conductance, which could be blocked by bicuculline and potentiated by diazepam. A Ca component that indicates inward Ca flux was present in the action potentials in each of the cell types examined, although its contribution varied with species and gland region. Electrical activity may therefore participate in secretory control in adenohypophyseal cells. Attention is drawn to some unexpected electrical responses to agents that are likely to be used in attempts to examine the correlation between the electrical events and secretion.

Calmodulin, phospholipase, and exocytosis. p-Bromophenacyl bromide inhibits but mepacrine stimulates secretion in rat mast cells

p-Bromophenacyl bromide (10-50 microM), a reagent that reacts with and inhibits phospholipase A2, completely suppressed exocytotic responses in rat serosal mast cells elicited by A23187. In contrast, mepacrine (0.01-0.1 mM), an antimalarial drug which has likewise been reported to inhibit phospholipase and additionally calmodulin, did not inhibit exocytosis elicited by concanavalin A (con A) or ionophore A23187. Rather, mepacrine (0.1-0.5 mM) alone increased histamine release up to 70%. Light microscopic observations following ruthenium red staining demonstrated the mepacrine-induced response to be exocytosis. Like the response to compound 48/80, that elicited by mepacrine was maximal within 40 s and was inhibited by phosphatidylserine. In the absence of extracellular calcium, secretion elicited by mepacrine and by con A was inhibited by 87 and 90%, respectively, whereas that elicited by 48/80 was unaffected. Incubation of mast cells in the presence of 2 mM EDTA for 2 h inhibited responses to 48/809 by 76% and nearly abolished those to mepacrine and to con A. 5,8,11,14-Eicosatetraynoic acid (50 and 100 microM) inhibited secretion elicited by con A but not that evoked by mepacrine or polymyxin B. The phenothiazines thioridazine (10-50 microM) and chlorpromazine (25-125 microM) inhibited secretory responses to mepacrine, to 48/80 and to con A. Both phenothiazines inhibited secretion elicited by con A more effectively than that elicited by mepacrine or 48/80. The results indicate that mepacrine, like con A, elicits exocytosis in mast cells by drawing on extracellular sources of calcium, but the early events of secretion initiated by these two secretagogues are pharmacologically distinct.(ABSTRACT TRUNCATED AT 250 WORDS)

Secretagogue effect of barium on output of melanocyte-stimulating hormone from pars intermedia of the mouse pituitary

Ba ions caused an intense and prolonged discharge of melanocyte-stimulating hormone (MSH) from perifused neurointermediate lobes of mouse pituitaries and dispersed pars intermedia cells. The effect persisted in chronically cultured lobes or cells. It did not require Ca, but, like the Ca-dependent response to excess K, was blocked by cyanide combined with glucose lack. The secretagogue effect of Ba was blocked or prevented by Co or by excess Ca, both of which can reduce inward Ba currents through Ca channels. Prior exposure to excess K partially reduced the secretagogue effect of Ba, suggesting that depolarization caused some inactivation of Ba current. In contrast to Ba, excess K elicited secretion that was transient, and prior exposure of preparations to excess K (in the absence of Ca) profoundly suppressed the secretagogue effect of Ca. The evidence is consistent with the view that inward Ca current rapidly inactivates in these cells. It is concluded that Ba ions have a potent and persistent direct secretagogue effect on the melanotrophs that may reflect, in part, their ability to penetrate Ca channels more easily than Ca ions. The strong secretagogue effects of Ba on melanotrophs may be of considerable utility in studies on MSH secretion since a physiological secretagogue has yet to be discovered. Moreover, since the responses of melanotrophs (and other endocrine cells) to Ba can be distinguished from those of various other secretory cells and neurones, it is suggested that Ba may provide a tool for characterizing the distinctive membrane properties of the Ba-responsive endocrine cells.

GABA acts directly on cells of pituitary pars intermedia to alter hormone output

Recent immunohistochemical evidence from the rat, indicating that gamma-aminobutyric acid (GABA)-containing fibres of central nervous origin project to the pars intermedia of the pituitary1,2, prompts inquiry into the function of this innervation. There is electrophysiological evidence that GABA acts directly on melanotrophs isolated from rat, through bicuculline-blockable receptors, to increase Cl- conductance and thereby drive the membrane potential towards the Cl- equilibrium potential in these cells, resulting in depolarization at rest or reduction of the depolarization caused by excess K+ (ref. 3). As voltage-dependent Ca channels can participate in the regulation of secretion in these cells4, we have now examined the effect of GABA on hormone output and find that it first stimulates and then inhibits spontaneous secretion of melanocyte-stimulating hormone (MSH) and inhibits K+-evoked secretion. Moreover, our pharmacological evidence suggests that similar receptors are involved in the secretory and the electrophysiological responses. A function of the GABAergic innervation may therefore be to regulate hormone output by acting directly on the melanotrophs, and this regulation may be affected by the changes in electrical properties induced by GABA.

Lipoxygenase inhibitors exert secretagogue-specific effects on mast cell exocytosis

The lipoxygenase inhibitors HTYA (5,8,11,14-henicosatetraynoic acid, 25-150 microM) and ITYA (4,7,10,13-icosatetraynoic acid, 25-75 microM), inhibited histamine secretion from rat mast cells evoked by concanavalin A but that elicited by compound 48/80 or polymyxin B. Arachidonic acid (100 microM) did not inhibit concanavalin A-induced histamine secretion. The results are consistent with the notion that lipoxygenase inhibitors affect an early stage of stimulus-secretion coupling in the mast cell, peculiar to antibody-directed secretagogues, perhaps that involving calcium influx.

On the calcium receptor activating exocytosis: inhibitory effects of calmodulin-interacting drugs on rat mast cells

1. A series of neuroleptic drugs (five phenothiazines, imipramine, and pimozide) and the smooth muscle relaxant W-7, which all inhibit calcium-calmodulin-activated processes inhibited rat mast cell secretion elicited by antigen, by 48/80, and by the calcium ionophore A23187. 2. Neither the phenothiazines nor W-7 reduced 45Ca uptake in response to A23187. The drugs thus exert an inhibitory action distal to the rise in intracellular Ca ions that activates exocytosis. 3. Chlorpromazine sulphoxide, which shares several membrane-perturbing actions of the phenothiazines but is a weak inhibitor of calmodulin, did not inhibit secretion. Moreover, the inhibitory effects of the phenothiazines were not overcome by a 5- or 10-fold increase in the concentration of calcium, which should counter unspecific membrane effects. 4. The inhibitory effects of the various neuroleptic drugs appeared to be related to their ability to inhibit calmodulin because the individual potencies of these compounds on secretion evoked by 48/80 or A23187 correlated significantly with their reported potencies in inhibiting calmodulin-activated processes. (The greater potency and different rank order of these compounds on secretion evoked by antigen suggests an additional inhibitory action, perhaps involving Ca entry.) 5. These results, which parallel those obtained with drugs of this sort in smooth muscle where calmodulin seemingly functions as the Ca receptor activating contraction, strengthen the view that calmodulin, or some calmodulin-like protein, is the Ca receptor activating exocytosis.

Slowing effects of dopamine and calcium-channel blockers on frequency of sodium spikes in rat pars intermedia cells

1. Spontaneous discharge of action potentials (Na spikes) in cells isolated from rat pars intermedia was slowed or arrested by Co(2+), Ni(2+) or Mn(2+), which block voltage-dependent Ca channels in these cells. The amplitude of persisting spikes was undiminished. The effects resembled those of dopamine.2. Action potential frequency decreased when the Ca(2+) concentration was lowered to 0.1 mM and increased when the Ca(2+) concentration was raised from this level to 1 mM or 2 mM or when Ba(2+) (2 mM) was introduced. These effects, together with those of Co(2+), Ni(2+) and Mn(2+), are consistent with the possibility that Ca(2+) participates in the regulation of spike discharge.3. Verapamil, methoxyverapamil (D600), and nifedipine reduced the amplitude of the individual Na spikes in concentrations that had little effect on voltage-dependent Ca channels. Action potential frequency was comparatively little affected by these drugs.4. K(+) (15 mM) stimulated action potential frequency and this effect too was suppressed by dopamine or Co(2+).5. The effect which dopamine had of slowing spontaneous discharge, like the inhibitory effect on secretion, was blocked by metoclopramide. But otherwise the mechanism is unclear: dopamine blocked voltage-dependent Ca channels in some cells but not in most others.6. The effects of K(+) and Ba(2+) of eliciting spikes, the suppression of Na-spike discharge by Co(2+) and related Ca-channel blocking cations, and the unspecific effects of the organic ;Ca channel blockers', all have implications for the use of these substances as tools to analyse stimulus-secretion coupling.