Effect of PAF-acether inhalation on nonspecific bronchial reactivity and adrenergic response in normal and asthmatic subjects.

Bronchial hyperreactivity, although recognized as a hallmark of asthma, is not totally understood. Mast cell-derived mediators, including histamine, have been shown to cause immediate bronchoconstriction, but until recently, no single mediator has been shown to induce prolonged changes in airway reactivity. Recent reports indicate PAF-acether (PAF) can induce increased nonspecific bronchial reactivity in normal subjects but not in asthmatics. We sought to elucidate the role of PAF in airway hyperreactivity by comparing the effect of inhaled PAF on methacholine and isoproterenol airway responsiveness in six nonasthmatic and six asthmatic subjects. Neither nonspecific airway reactivity nor isoproterenol responsiveness was changed following PAF inhalation in the nonasthmatic subjects in the six days following PAF. Asthmatics had increased airway responsiveness to methacholine at two hours post-PAF, which did not persist. Responsiveness to isoproterenol did not change in the asthmatic subjects. Additional evaluation of the role of PAF in causing changes in airway reactivity is warranted.

The role of fibronectin in bronchoalveolar lavage fluid of asthmatic patients.

Allergic and chronic inflammation of the airway is regarded as the main pathogenesis of bronchial asthma, in which adhesion of inflammatory cells requires the expression of adhesion molecules. Thus, to clarify the role of fibronectin (FN) in the airway inflammation of bronchial asthma, FN levels in plasma and bronchoalveolar lavage fluid (BALF) from bronchial asthmatics were determined. FN concentrations in plasma and BALF were measured by enzyme-linked immunosorvent assay (ELISA) in 17 asthmatic patients and 10 healthy controls to elucidate the role of FN in allergic inflammation. The mean FN/albumin (Alb) level in the BALF of asthmatic patients was 2.973 micrograms/mg, which was significantly higher than that of healthy controls (0.727 microgram/mg). Non-atopic asthmatics showed a significantly higher level of FN in their BALF in comparison with atopic asthmatics, although the ratio of FN to albumin showed no significant difference. FN levels in BALF correlated significantly with total cell density (r = 0.71, P < 0.05) and alveolar macrophage density (r = 0.64, P < 0.05). FN levels in plasma did not correlate with those in BALF. In conclusion, increased FN in BALF, which was produced locally in the airways of asthmatic patients, is actively involved in the regulation of allergic inflammation.

Plasma fibronectin in asthmatic patients and its relation to asthma attack.

This study investigated the relation between asthma attacks and levels of plasma fibronectin (FN) and serum eosinophilic cationic protein (ECP) in patients with bronchial asthma in order to clarify the role of FN in the airway inflammation of bronchial asthma. Plasma levels of FN were significantly higher (P < 0.025) in patients with bronchial asthma than in healthy controls. They were also significantly higher (P < 0.05) in non-atopic asthmatics than in atopic asthmatics. Furthermore, plasma FN was lower during the attack than the non-attack stage (P < 0.025), and a significant increase of plasma FN was noted (P < 0.05) in asthmatics who had more severe and more frequent attacks. Serum levels of ECP were significantly higher during the attack than the non-attack stage (P < 0.005). An increase of plasma FN in the non-attack stage after attacks showed a significant correlation (P < 0.05) with a decrease of serum ECP. These observations clearly indicate that the decrease in plasma FN associated with attacks is closely related to aggravation of airway inflammation, and that the increase in plasma FN in the non-attack stage reflects chronic airway inflammation. These results suggest that the fluctuation in plasma levels of FN may be one of the factors affecting allergic inflammation and attacks in bronchial asthma.

[A case report of pulmonary infiltration with eosinophilia syndrome induced by Candida albicans].

A sixty six-year-old female who had been treated for bronchial asthma for about 25 years was admitted to the hospital with complaints of episodes of dyspnea, eosinophilia and infiltrative shadows in the chest X-ray film. An infiltrative shadow appeared to move from the left to the right lung field and finally formed a shadow of atelectasis in the middle field of the right lung. A sputum culture showed only Candida albicans. Allergic and immunologic examination revealed high IgE serum levels with specific IgE against Candida albicans in high titer, and Aspergillus fumigatus in low titer. The precipitating antibody was shown only against Candida antigen. Additionally, the blastogenic response to Candida antigen was high in comparison with other fungal antigens including Aspergillus fumigatus. The clinical features and laboratory findings of this patient were found to satisfy Rosenberg's criteria for allergic bronchopulmonary aspergillosis (ABPA), except for the existence of Candida albicans in place of Aspergillus species as the causative antigen. The pathogenesis of PIE syndrome has been studied and various allergic mechanisms against many antigens reported. In this patient Candida albicans could be playing the crucial role in the formation of PIE syndrome, which might be best described as allergic bronchopulmonary candidiasis (ABPC).

[Pulmonary Nocardia otitidiscaviarum infection in an immunocompetent host].

A rare case of pulmonary Nocardia otitidiscaviarum (N. otitidiscaviarum) was encountered in an immunocompetent host. A 74-year-old man was admitted to our hospital with a high fever and a productive cough. His chest radiograph and CT scan revealed infiltrative shadows in the right middle and lower lung fields. Although several antibiotics (third-generation cephalosporin, minocycline, imipenem) were administered, the fever and cough persisted, and C-reactive protein remained elevated. Repeated sputum cultures showed normal flora, so a transbronchial lung biopsy and bronchoalveolar lavage (BAL) were performed bronchoscopically at the right S5. The BAL fluid contained acid-fast, branching filamentous structures. The microorganism was identified as N. otitidiscaviarum by the Research Center for Pathogenic Fungi and Microbial Toxicoses (Chiba University). Trimethoprim-sulfamethoxazole was therefore administered, but the fever continued to rise daily, and C-reactive protein remained elevated. This isolated N. otitidiscaviarum showed resistance to multiple antimicrobial agents in vitro when examined by the disk diffusion method, and so, on the basis of the antibiogram, the patient was treated with clarithromycin (oral, 600 mg/day) plus amikacin (400 mg/day), which proved successful. Testing for pulmonary nocardiosis should be added to the differential diagnosis procedures for refractory pneumonia as an opportunistic infection and for community-acquired pneumonia.

[The cellular kinetics in BAL fluid of hypersensitivity pneumonitis and pulmonary function].

The cellular components of bronchoalveolar lavage (BAL) fluid of patients with hypersensitivity pneumonitis were analyzed in regard to the inhalation period of antigen in the environment before BAL procedure. BAL fluid in early phase of antigen inhalation contained increased percent of neutrophils as well as lymphocytes while low percent of neutrophils and prominent increase of lymphocytes in chronic antigen inhalation. Furthermore, the increased neutrophils in BAL fluid decreased rapidly after admission as cessation of antigen inhalation while the lymphocyte percent decreased gradually. In relation to respiratory function the lymphocyte percent showed statistically significant negative correlation with %TLC, %VC and %DLco. On the other hand the percent of neutrophils showed some relationship with the airway damage and inflammatory changes in early phase of this disease.

The effect of WEB 2086 on PAF-induced eosinophil chemotaxis and LTC4 production from eosinophils.

We investigated the effect of WEB 2086, a selective platelet-activating factor (PAF) receptor antagonist, on PAF-induced eosinophil chemotaxis and LTC4 production. WEB 2086 inhibited PAF-induced eosinophil chemotaxis in normals and asthmatics. To further determine if WEB 2086 is a selective PAF receptor antagonist, we examined the effect of WEB 2086 against formyl-methionyl-leucyl-phenylalanine (fMLP)-induced or eosinophil chemotactic factor of anaphylaxis (ECF-A)-induced eosinophil chemotaxis. WEB 2086 did not have a significant inhibition against fMLP or ECF-A-induced eosinophil chemotaxis. These results suggest that WEB 2086 is a selective and potent inhibitor of PAF-induced eosinophil chemotaxis and LTC4 production from eosinophils, due to its antagonism of PAF-receptors.

The effect of ketotifen on eosinophils as measured at LTC4 release and by chemotaxis.

We examined the effect of ketotifen on calcium ionophore (A23187)-induced leukotriene C4 (LTC4) release from eosinophils, and platelet activating factor (PAF)-induced eosinophil chemotaxis to estimate the mechanism of the antiasthmatic property of ketotifen. Purified eosinophil suspensions were obtained from eight atopic asthmatic subjects and eight normals. Twenty microM of ketotifen significantly inhibited A23187-induced LTC4 release from eosinophils, and 10 microM of ketotifen significantly inhibited PAF-induced eosinophil chemotaxis. These findings may demonstrate the antiallergic pharmacological properties of ketotifen.

Inhibitory effect of terfenadine on mediator release from human blood basophils and eosinophils.

The effect of terfenadine on histamine release from human basophils and LTC4 production and release from human eosinophils was evaluated. Eosinophils and basophils were obtained by discontinuous gradient centrifugation of the peripheral blood of atopic asthma patients who were off medication. Anti-IgE-induced histamine release from human basophils was significantly inhibited by terfenadine. Maximum inhibition was obtained at 1 x 10(-5) M terfenadine (percentage inhibition = 57.0 +/- 20.1; P less than 0.05). However, only the highest dose of terfenadine used in this study, i.e. 2 x 10(-5) M, significantly inhibited calcium ionophore (A23187)-induced histamine release from human basophils (percentage inhibition = 40.0 +/- 14.6; P less than 0.05), and LTC4 production from human eosinophils (percentage inhibition = 59.8 +/- 9.9; P less than 0.05. These findings demonstrate that terfenadine, in addition to its known antihistamine property, also has an inhibitory effect on chemical mediator release.

Effect of terfenadine on pulmonary function, histamine release, and bronchial challenges with nebulized water and cold-air hyperventilation.

To assess the effectiveness of terfenadine on bronchoconstriction in asthmatics, 12 asthmatic patients between the ages of 19 and 43 were challenged with ultrasonically nebulized distilled water (UNDW) and treated with terfenadine, 120 or 240 mg, or placebo in a three-way crossover double-blind study. A similar study of 12 asthmatics (nine from the UNDW trial) was performed using cold-air hyperventilation challenge (CAHC). In vitro analyses were also made of samples from ten mild asthmatics to determine the effect of terfenadine on basophil histamine release. Terfenadine, 240 mg, showed significant (P = .012) benefit over placebo in improving pulmonary function after UNDW challenge. Modest but significant (P less than .05) bronchodilator benefits were also demonstrated by terfenadine, 240 and 120 mg, after CAHC. Finally, the in vitro study showed significant inhibition by terfenadine of anti-IgE-induced histamine release from human basophils.

Increased hypodense eosinophils after activation with PAF-acether and calcium ionophore in asthmatic subjects.

Eosinophils play a major role in the pathogenesis of bronchial asthma. In this study, we examined the density characteristics of blood eosinophils from 9 normal healthy individuals and 9 allergic asthmatic patients. Furthermore, the effect of platelet-activating factor, a potent mediator of inflammation, and calcium ionophore, A23187, on the density of normodense eosinophils (density > 1.085 g/ml) has also been examined. Initially, asthmatic patients had 27.0 +/- 1.1% eosinophils of lighter density (density < or = 1.081 g/ml), significantly greater than that in the normal individuals (7.5 +/- 0.5%). After exposure to platelet-activating factor (1 microM) or calcium ionophore (A23187, 1 microgram/ml), the normodense eosinophils switched to hypodense in both groups: 16.7 +/- 2.1% and 54.2 +/- 3.7%, respectively, in normal individuals, and 30.6 +/- 5.7% and 77.4 +/- 2.3%, respectively, in asthmatic patients. These data demonstrated that a certain percentage of normodense eosinophils from asthmatics and normal subjects switched to hypodense after activation with platelet-activating factor or calcium ionophore. Furthermore, eosinophils from asthmatics switched to a greater degree than in normal subjects, suggesting that the normodense eosinophils in asthmatics become primed probably by endogenously released mediators.

Elevation of neutrophil chemotactic activity in the human serum and the decreased number of neutrophils after platelet-activating factor inhalation.

We previously reported a significant decrease in neutrophils at 5 min and an increased number of neutrophils at 15 min after PAF-acether inhalation. To investigate the mechanism, we measured the neutrophil chemotactic activity of the sera. Neutrophil chemotactic activity (NCA) of the serum at 5 min was greater than at baseline (p less than 0.01) or at 15 min (p less than 0.05). Furthermore, we investigated the correlation between the change in NCA and decreased number of neutrophils. A significant correlation was found between these two at 5 min (r = 0.751, p less than 0.05). These data suggest that an elevation of NCA may play an important role in the decrease of circulating neutrophils after PAF-acether inhalation.

Fibronectin levels in plasma after platelet-activating factor inhalation.

We evaluated fibronectin levels in plasma and blood leukocyte counts after platelet-activating factor-acether (PAF) inhalation to examine whether PAF may cause pulmonary vascular injury. PAF inhalation challenges were performed on 5 normal subjects and 5 atopic asthmatics. Fibronectin levels in plasma were significantly increased at 5 min (342.5 +/- 36.9 micrograms/ml) after PAF challenge as compared with the baseline values of 277.1 +/- 33.0 micrograms/ml (p less than 0.024). Total white blood cell and neutrophil counts were significantly decreased 5 min after PAF inhalation (WBC from 5,360 +/- 460 to 4,260 +/- 380/mm3, p less than 0.028; neutrophils from 3,113 +/- 441 to 2,214 +/- 344/mm3, p less than 0.043). Our study shows that plasma fibronectin levels transiently increase and that peripheral total WBC counts decrease after PAF inhalation. Elevated fibronectin levels may provide evidence of pulmonary vascular injury due to neutrophils which might be primed and recruited to pulmonary circulation by PAF.

Density distribution and density conversion of neutrophils in allergic subjects.

We investigated the density distribution of neutrophils in peripheral blood of allergic subjects. We divided neutrophils into four groups: fraction 1 (density greater than 1.085), fraction 2 (1.081 less than density less than or equal to 1.085), fraction 3 (1.077 less than density less than or equal to 1.081) and fraction 4 (density less than or equal to 1.077). The percentage of neutrophils in fraction 2 in allergic rhinitis (AR) subjects or asthmatics was lower than that in normals (p less than 0.01). The percentage of neutrophils in fraction 3 and fraction 4 from AR or asthmatics was greater than that in normals (fraction 3, p less than 0.01; fraction 4, p less than 0.05). In neutrophils from AR subjects (fraction 3), chemotaxis to N-formyl-methionyl-leucyl-phenylalanine or platelet-activating factor (PAF) was enhanced compared to fraction 2. PAF (10(-7) M) changed the density of neutrophils (p less than 0.01), which were inhibited by WEB 2086 (p less than 0.05). Furthermore, granulocyte-macrophage colony-stimulating factor changed the density of neutrophils (p less than 0.01). These findings suggest that biological agents may activate neutrophils and convert their density resulting in neutrophils with lower density in allergic subjects.