Airway hyperresponsiveness to histamine in mycoplasmal infection: role of histamine N-methyltransferase.

To elucidate the modulatory role of histamine-degrading enzymes in airway constrictor responses in mycoplasmal infection, we studied hamster tracheal segments under isometric conditions in vitro. Nasal inoculation with Mycoplasma pneumoniae potentiated the contractile responses to histamine but not to methacholine. Pretreatment of tissues with the histamine N-methyltransferase inhibitor SKF 91488 abolished the infection-induced potentiation, whereas, the diamine oxidase inhibitor aminoguanidine had no effect. The histamine N-methyltransferase but not diamine oxidase activity in tracheal tissues was decreased in infected animals. These results suggest that M. pneumoniae causes airway hyperresponsiveness to histamine probably through a reduction of endogenous histamine N-methyltransferase activity.

[A case of chronic necrotizing pulmonary aspergillosis successfully treated with combination therapy of antifungal drugs and ulinastatin].

A 64-year-old woman with a history of old tuberculosis, had a fungus ball shadow with meniscus sign in the upper right lung field on a chest X-ray film in 1991. Based on the chest X-ray findings, pulmonary aspergilloma was suspected. Because the size of the intracavitary fungus ball increased, the patient was treated with itraconazole over one year in 1995, but there was no improvement. One month later, she was admitted because of fever, hemoptysis and productive cough, and chest X-ray showed an enlargement of intracavitary mass and infiltrative shadow in the right lung. Chronic necrotizing aspergillosis was diagnosed on the basis of her clinical and radiographic features, and positive serological test. Although itraconazol and amphotericin B were given, cavity and intracavitary fungus ball shadow kept growing. Combination therapy of antifungal drugs and ulinastatin markedly improved symptoms and resulted in complete disappearance of the fungus ball on chest CT scan.

5-Hydroxytryptamine inhibits Na absorption and stimulates Cl secretion across canine tracheal epithelial sheets.

BACKGROUND: 5-Hydroxytryptamine (5-HT) can be released from mast cells and platelets through an IgE-dependent mechanism and may play a role in the pathogenesis of allergic bronchoconstriction. However, the effect of 5-HT on ion transport by airway epithelium remains uncertain. OBJECTIVE: To determine whether 5-HT alters electrical and ion transport properties of Cl-secreting epithelia and, if so, what subtype of 5-HT receptors is involved, we studied canine tracheal epithelium under short-circuit conditions in vitro. METHODS: Canine tracheal mucosa was mounted in Lucite half-chambers and the responses of short-circuit current (lsc), transepithelial potential difference (PD) and tissue conductance (G) were measured. In addition, ion fluxes were directly measured using 22Na and 36Cl. RESULTS: Mucosal addition of 5-HT caused a rapid increase in lsc, which was accompanied by the increases in PD and G, whereas submucosal 5-HT had no effect. In the presence of amiloride, 5-HT and its receptor agonists dose-dependently increased lsc, with the rank order of potency being 5-HT > alpha-methyl-5-HT > 2-methyl-5HT > 5-carboxamidotryptamine. The effect of 5-HT was inhibited by ketanserin and spiperone but not by ondansetron. 5-HT increased Cl flux from the submucosa to the mucosa with a slight inhibition of Na flux to the opposite direction. CONCLUSION: 5-HT inhibits airway epithelial Na absorption and stimulates Cl secretion. The latter action predominates the former and is mediated by 5-HT2 receptors. These effects may result in the increase in water movement toward the airway lumen.

Stimulation of airway mucociliary transport and epithelial ciliary motility by the triazolopyridazin derivative TAK-225.

To elucidate whether a newly developed antiallergic drug, the triazolopyridazin derivative TAK-225, alters airway mucociliary clearance and, if so, what the mechanism of action is, we measured mucociliary transport in the rabbit tracheal mucosa ex vivo and ciliary motility of the tracheal epithelium in vitro. Mucociliary transport function was determined by the transport rate of Evans blue dye that had been placed on the mucosal surface above the carina. Oral administration of TAK-225 (0.3-30 mg/kg) increased Evans blue transport toward the larynx in a dose-dependent manner. Addition of TAK-225 caused a rapid and sustained increase in the ciliary beat frequency of tracheal epithelium, as assessed by photoelectric method; the maximal increase from the base-line value was 25.1 +/- 4.6% (P < .01), and the concentration required to produce a half-maximal effect (EC50) was 3.1 +/- 0.8 x 10(-7) M. This effect was greatly attenuated by pretreatment with the cAMP antagonist adenosine 3',5'-cyclic monophosphorothioate, but not by Ca++-free medium containing ethylene glycol-bis [3-aminoethyl ether] N,N,N',N'-tetraacetic acid and [1,2-bis(2)aminophenoxy]ethane N,N,N',N'-tetraacetic acid-acetomethoxy ester. Incubation of tracheal epithelium with TAK-225 increased intracellular cAMP contents in a concentration-dependent manner. These results suggest that TAK-225 enhances airway mucociliary clearance probably through cAMP-mediated stimulation of ciliary motility of airway epithelium.

Effect of adenosine on adrenergic neurotransmission and modulation by endothelium in canine pulmonary artery.

To determine the effect of adenosine on adrenergic neurotransmission in pulmonary vasculature and its modulation by endothelial cells, we studied canine pulmonary arteries under isometric conditions in vitro. Adenosine decreased the contractile responses to electrical field stimulation but had no effect on those to norepinephrine. This inhibitory effect was concentration dependent, with a rank order of potency of NECA > 2-chloroadenosine > adenosine >> APNEA (an A3-adenosine-receptor agonist) > CGS-21680 (an A2a agonist) > CCPA (an A1 agonist). Adenosine reduced the electrical field stimulation-evoked 3H overflow in superfused pulmonary artery previously soaked in [3H]norepinephrine. Pretreatment with the adenosine uptake blocker dipyridamole or the adenosine deaminase inhibitor deoxycoformycin enhanced the adenosine action, and this enhancement was not observed in the endothelium-denuded tissues. Adenosine deaminase activity was found in endothelial cells. Therefore, adenosine inhibits norepinephrine release via an A2b-receptor mechanism, an effect that may be modulated by uptake and metabolism by endothelial cells.

Histamine H2 receptor-mediated airway goblet cell secretion and its modulation by histamine-degrading enzymes.

BACKGROUND: Airway goblet cell hypersecretion may contribute to the pathophysiology of asthma. However, it is unknown whether histamine affects goblet cell secretion and, if so, which subtype of histamine receptor is involved and whether endogenous histamine-degrading enzymes modulate these actions. METHODS: We morphometrically assessed goblet cell secretion in the guinea pig trachea stained with alcian blue and periodic acid Schiff stains by measuring the mucus score, which was inversely related to the degree of mucus glycoprotein discharge. RESULTS: Inhalation of histamine caused a dose-dependent decrease in mucus score, an effect that was inhibited by pretreatment with the H2-receptor antagonist cimetidine but not with the H1-receptor antagonist mepyramine or the H3-receptor antagonist thioperamide. Inhaled Dimaprit, a selective H2-receptor agonist, likewise decreased mucus score; whereas stimulation of H1- and H3-receptors with 2-methylhistamine and (R)-alpha-methylhistamine, respectively, had no effect. Pretreatment with the histamine N-methyltransferase inhibitor SKF 91488, but not the diamine oxidase inhibitor aminoguanidine, potentiated the dose-dependent effect of histamine on goblet cell secretion, causing a decrease in the concentration of inhaled histamine required to produce a half-maximal effect from 0.80 +/- 0.12 to 0.48 +/- 0.09 mg/ml (p < 0.01). The histamine methyltransferase activity in the tracheal mucosa was 29 times higher than diamine oxidase activity. CONCLUSION: These findings suggest that histamine stimulates airway goblet cell secretion through H2-receptors and that this effect may be modulated principally by endogenous histamine methyltransferase through a degradation of histamine.

Invasive thymoma with CD4+CD8+ double-positive T cell lymphocytosis.

Lymphocytosis in the peripheral blood is a very rare manifestation of thymoma. A 45-year-old man presented with a giant mediastinal mass involving pleural dissemination and peripheral T cell lymphocytosis. Biopsy of the mediastinal mass revealed invasive thymoma, and two-color analysis of peripheral lymphocytes showed a marked increase in CD4+CD8+ double-positive cells. Both thymoma and lymphocytosis were improved by a combination of chemotherapy and mediastinal irradiation.

[Six patients with pneumonitis related to blended Chinese traditional medicines].

We encountered six patients with pneumonitis related to blended chinese traditional medicine (Kampo). The duration of treatment with kampo ranged from 14 to 110 days (mean: 38 days). The most common complaints were dyspnea, fever, and dry coughing. Fine crackles were heard at the bases of both lungs. Abnormal laboratory findings included high values of C-reactive protein and glutamic-oxaloacetic transaminase in all patients, lactate dehydrogenase in 5 patients, and eosinophil count in 1 patient. Chest X-ray films and CT films revealed diffuse reticulo-nodular interstitial shadows with consolidation in both lung fields in 3 patients and pleural effusion in 1 patient. Bronchoalveolar lavage was done in 4 patients; examination of the lavage fluid showed lymphocyte alveolitis, either pure or associated with neutrophilia and eosinophilia in 3 patients. Inverted CD4/CD8 lymphocyte ratios were found in 3 patients. Transbronchial lung biopsy was done in 4 patients and specimens from 3 of those 4 showed organizing pneumonitis with thickening of alveolar septa. Lymphocyte stimulation tests were positive in 4 patients. Discontinuation of the drug (2 patients) or administration of corticosteroids (4 patients) was followed by rapid improvement. Patients being treated with kampo preparations should be observed for signs and symptoms of drug-induced pneumonitis.

Cholinergic control of rabbit tracheal transepithelial potential difference in vivo.

The aim of the present study was to investigate the role of the autonomic nervous system in the regulation of airway epithelial ion transport in vivo. Rabbits were anaesthetized and mechanically-ventilated through a cannula inserted above the carina. The upper tracheal mucosa was exposed, and the electrical potential difference (PD) between the mucosal surface and the submucosal space was continuously measured by a high-impedance voltmeter under open-circuit conditions. Perfusion of the mucosa with atropine caused a rapid decline in PD from -20.1+/-2.0 to -15.2+/-0.9 mV (p<0.01), whereas phentolamine, propranolol, or the tachykinin antagonist, FK224, had no effect. Cutting both cervical vagus nerves decreased PD to the same degree as did atropine. Exogenously applied acetylcholine increased PD in a dose-dependent manner. Topical application of ipratropium bromide reduced the baseline value PD in a dose-dependent manner. The maximal decrease in PD was 43 +/- 0.3 mV (p<0.01), and the dose required to produce a half-maximal effect was 34 microg. Perfusion with either amiloride, a Na channel blocker, and diphenylamine-2-carboxylate, a Cl channel blocker, decreased the baseline PD, and the subsequent application of ipratropium bromide further decreased the PD in each case. We conclude that a cholinergic neural component may play a role in the generation of tracheal potential difference in vivo, probably involving stimulation by endogenously released acetylcholine of both Cl secretion and Na absorption across the airway epithelium.

Effect of ciprofloxacin on ciliary motility of rabbit airway epithelium.

To determine the effect of the new quinolone ciprofloxacin on airway ciliary motility, we studied ciliary beat frequency (CBF) of rabbit tracheal epithelium using an in-vitro microphoto-oscillation method. Incubation of the cells with ciprofloxacin increased CBF in a concentration-dependent manner, the maximal increase from the baseline value and the EC50 being 17.1 +/- 2.0% (P < 0.01) and 10(-7.25) M, respectively. This ciliary stimulatory effect was not affected by propranolol or indomethacin but was nullified by verapamil. These results suggest that ciprofloxacin probably increases airway epithelial ciliary motility by facilitating Ca2+ influx through a voltage-dependent channel.

[T-kinin-induced increase in airway vascular permeability and its modulation by angiotensin-converting enzyme].

We studied the effect of T-kinin on airway vascular permeability and its modulation by endogenous peptidases in anesthetized rats in vivo, Vascular permeability was assessed by photometric measurement of extravasated Evans blue dye after formamide extraction. Intravenous injection of T-kinin increased dye extravasation in the trachea and main bronchi in a dose-dependent manner. Plasma extravasation evoked by T-kinin was inhibited by Hoe 140, a B2 receptor but-not by des Arg9-Leu8-bradykinin, a B1 receptor antagonist. Treatment with captopril, an angiotensin-converting enzyme inhibitor, potentiated the T-kinin-induced plasma extravasation, whereas phosphoramidon, a neutral endopeptidase inhibitor, had no effect. These results suggest that T-kinin increases airway vascular permeability via stimulation of B2 receptors, and that this effect is modulated by endogenous angiotensin-converting enzyme.

[Regulation of cyclooxygenase activity in airway epithelium by endogenous nitric oxide].

The role of nitric oxide (NO) in the activity of cyclooxygenase (COX) in cultured canine tracheal epithelium was studied. Tracheal epithelium spontaneously released prostaglandin E2 (PGE2), which is a product of COX. The release of PGE2 was increased by bradykinin and was decreased by two NO synthase inhibitors: NG-nitro-L-arginine methyl ester and NG-monomethyl-L-arginine. That decrease was reversed in the presence of L-arginine. Chrolpromadin, but not aminoguanidine, inhibited PGE2 production, which suggests that constitutive NO synthase is involved. Two stable NO donors, sodium nitroprusside and S-nitroso-N-acetyl DL-penicillamine, also increased the production of PGE2. These effects were abolished by coincubation with hemoglobin, which binds and inactivates NO, but not by methylene blue, an inhibitor of soluble guanylate cyclase. NADPH diaphorase histochemistry of cultured tracheal cells revealed activity in the periphery of the cytoplasm. These results suggest that, in cultured canine tracheal epithelium, NO directly interacts with COX to regulate PGE2 production.

Effect of 5-hydroxytryptamine on bioelectric properties of airway epithelial cells in culture.

To elucidate whether 5-hydroxytryptamine (5-HT) affects airway epithelial electrolyte transport and, if so, what the mechanism of action is, we studied the bioelectric properties of canine cultured tracheal epithelium under short-circuit conditions in vitro. Mucosal addition of 5-HT dose-dependently increased short-circuit current (Isc), which was accompanied by increases in transepithelial potential difference and cell conductance. In contrast, 5-HT had no effect on bioelectric properties when it was added to the submucosal side. Pretreatment of cells with amiloride potentiated the increase in Isc produced by 5-HT. In the presence of diphenylamine-2-carboxylate or Cl-free medium, 5-HT decreased Isc from the baseline level. Incubation with BAPTA-AM but not dibutyryl cAMP greatly attenuated the 5-HT-induced increase in amiloride-insensitive portion of Isc. These results suggest that 5-HT inhibits Na absorption and stimulates Cl secretion across canine tracheal epithelium and that the Cl secretion may be associated with elevation of intracellular Ca2+ contents.

Stimulation of opioid mu-receptors potentiates beta adrenoceptor-mediated relaxation of canine airway smooth muscle.

To elucidate the effect of an opioid on airway smooth muscle relaxant responses and its mechanism of action, we studied canine bronchial segments under isometric conditions in vitro. Addition of the opioid mu-receptor-specific agonist DAMGO (10(-5) M) or Tyr-D-Arg-phe-Lys-NH2 (10(-5) M) did not alter the resting tension or the contractile responses to Ach but augmented the relaxation induced by isoproterenol: the concentrations of isoproterenol required to produce a half-maximal effect were decreased from 1.9 +/- 0.6 x 10(-6) to 3.1 +/- 1.0 x 10(-7) M (P < .01) by DAMGO and from 2.1 +/- 0.4 x 10(-6) M to 4.3 +/- 0.7 x 10(-7) M (P < .01), by Tyr-D-Arg-phe-Lys-NH2. This effect of DAMGO was concentration-dependent and was abolished by naloxone or Cys2, Tyr3, Orn5, Pen7-amide, a mu-receptor antagonist. DAMGO likewise caused a leftward displacement of concentration-response curves for forskolin but was without effect on those for 3-isobutyl-3-methylxanthine and 8-bromo-cAMP. Also, DAMGO did not affect the relaxant responses to verapamil, nitroprusside or 8-bromo-cGMP. Incubation of bronchial smooth muscle with DAMGO (10(-5) M) potentiated the intracellular accumulation of cAMP induced by isoproterenol (10(-6) M) from 258 +/- 22 pmol/g tissue wt. to 420 +/- 27 pmol/g tissue wt. (P < .01), an effect that was abolished by naloxone. These results suggest that stimulation of opioid mu-receptors specifically augments beta adrenoceptor-mediated bronchodilation probably by acting at the site proximal to adenylate cyclase in the cAMP-dependent pathway.

Cyclic adenosine monophosphate-mediated release of nitric oxide from canine cultured tracheal epithelium.

Nitric oxide (NO) may play a part in pulmonary vascular regulation and bronchomotor control and has been detected in exhaled air. We report the release of NO from airway epithelial cells and its regulation by cyclic adenosine monophosphate (cAMP). To directly measure NO release, a highly specific amperometric sensor for NO made of Pt/Ir alloy coated with a three-layered membrane consisting of KCI, NO-selective resin, and normal silicon resin was developed. Immersion of this sensor in the medium containing canine cultured tracheal epithelium detected baseline levels of NO at 9.6 +/- 1.6 nM (mean +/- SE), which was reduced by NG-nitro-L-arginine methylester (L-NAME) but not by D-NAME. This inhibition was reversed by L-arginine. Addition of isoproterenol, 3-isobutyl-1-methylxanthine, and forskolin caused a rapid increase in NO, an effect that was not altered by Ca(2+)-free medium in the presence of the intracellular Ca2+ chelator BAPTA-AM and the calmodulin antagonist W-7. Bradykinin, ionomycin, and ATP were without effect on NO release. The forskolin-induced NO release was accompanied by intracellular accumulation of cAMP and Ca2+. In contrast, bradykinin increased intracellular Ca2+ but not cAMP levels. Cytochemistry of cultured tracheal epithelium showed a positive staining with NADPH diaphorase activity. These results suggest that airway epithelial cells spontaneously release NO and that the release may be stimulated specifically through cAMP-dependent mechanism.

Effect of T-kinin on microvascular permeability and its modulation by peptidases in rat airways.

T-kinin (Ile-Ser-bradykinin), the product of T-kininogen, has been found in rat plasma during systemic inflammation, but the effect of this kinin on airway inflammatory response is unknown. We examined the effect of T-kinin on vascular permeability in airways of anesthetized rats in vivo by using photometric measurement of the extravasated Evans blue. Intravenous injection of T-kinin (0.1-10 mumol/kg) increased dye extravasation in a dose-dependent manner, with 134% for trachea and 117% for bronchi by 1 mumol/kg. Pretreatment with bradykinin B2-receptor antagonist Hoe-140 (100 nmol/kg), but not the B1-receptor antagonist des-Arg9-Leu8-bradykinin (5 mg/kg), abolished plasma extravasation evoked by T-kinin (1 mumol/kg). NK1 tachykinin-receptor antagonist CP-99994 (4 mg/kg) did not affect T-kinin-induced vascular leakage. Pretreatment with captopril (2.5 mg/kg), angiotensin-converting enzyme inhibitor, potentiated T-kinin (100 nmol/kg)-induced plasma extravasation, whereas phosphoramidon (2.5 mg/kg), a neutral endopeptidase inhibitor, had no effect. We conclude that T-kinin produces airway vascular extravasation via stimulation of B2 receptors. The effect is modulated by endogenous angiotensin-converting enzyme and is not mediated via activation of sensory nerve.

Regulation of airway cholinergic neurotransmission by Ca(2+)-activated K+ channel and Na(+)-K+ adenosinetriphosphatase.

Stimulation of Ca(2+)-activated K+ channel and Na(+)-K(+)-ATPase may play an important role in the relaxant responses of airway smooth muscle to certain bronchodilators. To test whether cholinergic neuroeffector transmission can be modulated by Ca(2+)-activated K+ channel and Na(+)-K(+)-ATPase, canine airway smooth muscle was studied under isometric conditions in vitro. Addition of charybdotoxin (10(-7) M) did not alter the contractile responses to acetylcholine but augmented electrical field stimulation-induced contractions at 1-10 Hz (p < .01), whereas apamin and glibenclamide were without effect. This effect of charybdotoxin was dose dependent, with the maximal increase being 36.8 +/- 5.3% (p < .001). Ouabain (10(-7) M) increased contractions induced by both electrical field stimulation and acetylcholine. The magnitude of the increase in contractile responses to electrical field stimulation was similar to that of acetylcholine at an ouabain concentration of up to 3 x 10(-7) M, but the former was significantly greater at 10(-6) M ouabain (p < .05). These results suggest that both Ca(2+)-activated K+ channel and Na(+)-K(+)-ATPase may be operative in the regulation of cholinergic neurotransmission by inhibiting the exocytotic release of acetylcholine from the vagal nerve terminals.

Effect of saiboku-to, an antiasthmatic herbal medicine, on nitric oxide generation from cultured canine airway epithelial cells.

The effect of Saiboku-to (TJ-96), an antiasthmatic Kampo medicine, on the generation of nitric oxide (NO) from cultured canine tracheal epithelium was investigated using a highly specific amperometric sensor for this molecule in vitro. Immersion of the NO-selective electrode in the medium containing tracheal epithelial cells detected the baseline current of 16.8-57.0 pA, which corresponded to an NO concentration ([NO]) of 39.7 +/- 8.1 nM. Addition of TJ-96 increased [NO] in a concentration-dependent manner, the maximal increase from the baseline level and the concentration of TJ-96 required to produce a half-maximal effect (EC50) being 127.5 +/- 20.1 nM (P < 0.001) and 86 +/- 9 micrograms/ml, respectively. Pretreatment of cells with NG-nitro-L-arginine methylester (L-NAME) greatly inhibited the TJ-96-induced increase in [NO], whereas NG-nitro-D-arginine methylester (D-NAME) had no effect, and this inhibition was reversed by L-arginine but not by D-arginine. Cytochemical staining of the epithelial cells showed marked reactivity of NADPH diaphorase activity. These results suggest that NO is spontaneously released by the airway epithelium and that TJ-96 stimulates the epithelial NO generation.

Isoproterenol increases Cl diffusion potential difference of rabbit trachea through nitric oxide generation.

To determine whether nitric oxide (NO) formation is involved in Cl secretion across airway mucosa in response to beta adrenergic agonists, we studied the effect of isoproterenol (ISO) on the Cl diffusion potential difference of rabbit tracheal mucosa and measured NO formation by a highly specific electrode for this molecule in vivo. Perfusion of ISO on the tracheal mucosal surface increased the Cl diffusion potential difference, as determined in the presence of amiloride, in a dose-dependent fashion, the maximal increase from the base-line value being 12.1 +/- 1.7 mV (P < .001). Application of NG-nitro-L-arginine methylester (10(-3) M) decreased the Cl diffusion potential difference by itself and attenuated the subsequent response to ISO, causing a rightward displacement of ISO concentration-response curves, whereas NG-nitro-D-arginine methylester had no effect. This inhibitory effect of NG-nitro-L-arginine methyl-ester was reversed by L-arginine but not by D-arginine. Addition of ISO dose-dependently increased polarographic current and, hence, NO concentration in the perfusate, the maximal increase from the base-line levels being 178 +/- 10 nM. Histochemistry for NADPH diaphorase activity showed a strong staining within epithelial cells. These results suggest that NO formation may play a role in the beta adrenoceptor-mediated Cl secretion by tracheal mucosa.