How does lobeline injected intravenously produce a cough?

In order to examine, whether the lobeline-induced cough is a true reflex or a voluntary effort to get rid of its irritating sensations in the upper respiratory tract, we systematically studied the cough response to lobeline, of subjects who were unable to make conscious discriminations i.e. were either comatose (n=4) or anaesthetized (n=5). 8 microg/kg lobeline injected into the right atrium of one and 29 microg/kg intravenously (i.v.) into another evenly and spontaneously breathing comatose subject produced a cough after 4s and 12s, respectively. Cough was repeatable and showed a dose response relationship i.e., its latency decreasing and its duration/intensity increasing with the dose. In a third subject, capable only of weak spontaneous respiration, a relatively high dose injected into the right atrium (44 microg/kg) generated a pronounced cough-like respiratory movement superimposed on the artificial ventilation and also during the apnoea after disconnecting the pump. No respiratory response was evoked in a fourth subject who had no evidence of brainstem reflexes. In five normals, cough was elicited with a mean dose of 35+/-5 microg/kg i.v. (latency 14+/-2 s; duration 10+/-3 s). After thiopental anaesthesia, injecting 41+/-7 microg/kg produced a cough within 13+/-2 s that lasted for 12+/-2 s. It may be noted that neither the later dose nor the latency or duration of cough that it produced were significantly different from the pre anaesthesia values (P>0.05). These two sets of results show unequivocally that the lobeline-induced cough is evoked reflexly; its magnitude in the conscious state could vary by subjective influences. We discuss the likelihood of its origin from juxtapulmonary capillary receptors.

Presence of lobeline-like sensations in exercising patients with left ventricular dysfunction.

Since there is evidence that lobeline-induced sensations, associated with discomfort in the mouth, throat and chest arise by stimulating juxtapulmonary or J receptors, we were interested in investigating if similar sensations are felt by patients with left ventricular dysfunction (LVD) in whom a natural stimulation of these receptors would occur by transient interstitial oedema or during augmentation of the stimulus, by increased pulmonary blood flow during exercise. Threshold doses of lobeline produced three or more respiratory sensations simultaneously in 9 out of 10 patients, which was greater than the response of the controls (P < 0.01). With mild exercise, a greater number of patients (7) than controls (1) reported feeling two or more sensations (P < 0.01); in fact half the controls did not express a respiratory sensation with equivalent exercise (P < 0.05). The predominant lobeline-like sensations reported by patients with exercise were a feeling of heat or burning and pressure in the throat or chest (P < 0.05). The presence of cough in three patients and in none of the controls was noteworthy. The mean latency with which sensations appeared during exercise in patients (4.4 +/- 0.3 min) was almost half that in controls (7.4 +/- 0.2 min) (P < 0.005). Since, respiratory sensations in response to lobeline and exercise were intensified in patients compared to controls and since both lobeline and exercise-induced sensations were similar (P < 0.05), we speculate that a common origin exists. Despite important caveats, that we discuss, in our view these respiratory sensations and cough arise from stimulation of J receptors.

Changes in respiratory sensations induced by lobeline after human bilateral lung transplantation.

1. The sensations evoked by the injection of lobeline into the right antecubital vein were studied in 8 subjects after bilateral lung transplantation and 10 control subjects. In control subjects, two distinct sensations were experienced. There was an early noxious sensation (onset approximately 10 s) followed by a late sensation of breathlessness (onset approximately 26 s) associated with involuntary hyperventilation. The early sensation was accompanied by respiratory and cardiovascular changes. 2. In contrast to control subjects, the early respiratory events and the noxious sensations evoked by injections of lobeline (18-60 microg kg(-1)) did not occur in subjects with recent bilateral lung transplantation. This suggests that the early respiratory sensations are mediated by the discharge of receptors in the lungs. 3. The late hyperventilation and the accompanying sensation of breathlessness occurred in both transplant and control subjects and are therefore likely to be mediated by receptors elsewhere in the body, presumably systemic arterial chemoreceptors stimulated by lobeline. 4. In control subjects, but not transplant subjects, there was a consistent decrease in mean arterial pressure associated with the lobeline injection. This suggests that pulmonary afferents mediate the hypotension. 5. For transplant subjects studied more than a year after transplantation, there was some evidence that the noxious respiratory sensations evoked by lobeline had returned. This suggests that some functional reinnervation of pulmonary afferents may occur.

The present status of the mechanical hypothesis for chemoreceptor stimulation.

Reasons are given to show why the transmitter based hypothesis for the stimulation of chemoreceptors needs to be reviewed. On the other hand evidence is presented to show that chemoreceptors can be stimulated by various mechanical stimuli and how the local PO2 can be sensed by the type II cell which by getting mechanically deformed causes this cell to shrink. This shrinkage is transmitted to the generator region of the nerve terminal thereby leading to the production of propagated impulses at the regenerative region thus making the whole process of generation of information about the local PO2, similar to the generation of sensory information by other sensory receptors.

Sensory origin of lobeline-induced sensations: a correlative study in man and cat.

1. Intravenous injections of lobeline HCl into twenty-six normal young male human volunteers produced sensations of choking, pressure or fumes in the throat and upper chest at a mean threshold dose of 12 micrograms kg-1. 2. Reflex changes in breathing pattern usually appeared just before the sensations. Increasing the dose of lobeline increased the intensity of the sensations gradually until a dry cough appeared at a mean threshold dose of 24.3 micrograms kg-1. At these doses there was a mean difference of 0.3s in the latencies for sensation and respiratory reflex; in four subjects there was no difference at all. 3. In cats anaesthetized with 35 mg kg-1 sodium pentobarbitone, injecting 25-67 micrograms kg-1 lobeline into the right atrium sensitized thirteen out of seventeen rapidly adapting receptors (RARs). In three out of four cats lobeline had no excitatory effect on the RARs in the absence of normal activity (i.e. when it was injected while artificial respiration was suspended), but on restarting the respiration the activity increased greatly. After injecting lobeline, the activity increased during inflation or deflation or in both phases of the respiratory cycle. It also increased greatly during deflation produced by suction of air from the lungs after lobeline. Such presumed increased activity in the RARs of man produced by forced expiration to residual volume at the time lobeline-induced sensations were expected did not enhance the sensations in any subject. 4. In all the subjects tested, forced expiration alone, which should stimulate RARs, never produced a dry cough or sensations similar to those produced by lobeline.(ABSTRACT TRUNCATED AT 250 WORDS)

Some recent advances in studies on J receptors.

While describing recent advances in studies on J receptors it was shown that the discovery of the principle of the relative dilution of multiple solutes in flowing fluids paved the way for developing a new method for measuring in vivo the concentration of injected drugs in the blood of the pulmonary artery. This led to the finding that excitatory solutes move out of the capillaries through a process of diffusion not through filtration. Increase in the permeability of the capillaries causes a marked increase in the responses of the J receptors to excitants by causing greater movement of the excitants to the receptors. This information is likely to yield a method for distinguishing permeability edema from hamodynamic edema in man. The most recent advance relates to the evidence showing conclusively that the sensations and dry cough produced by injecting lobeline intravenouly in man is due to the stimulation of the J receptors. The slowly and rapidly adapting receptors play little or no role in this. The nature of the sensations felt is somewhat variable, most commonly it is choking and pressure localised in the throat and upper chest. Similar sensations are felt by subjects with high altitude pulmonary edema (HAPE). From this data it is extrapolated that the same kinds of sensations that accompany breathlessness after moderate or severe exercise at sea level are also J receptor induced.

Mechanisms underlying enhanced responses of J receptors of cats to excitants in pulmonary oedema.

1. The responses of J receptors to certain excitants were recorded during pulmonary oedema produced by phosgene gas (320-1080 p.p.m.) or alloxan, 150 mg kg-1 i.v., in cats anaesthetized with sodium pentobarbitone, 35 mg kg-1 I.P. 2. The responses of fourteen (out of fifteen) J receptors to phenyl diguanide (PDG) were greatly enhanced after phosgene, the enhancement being highly significant (P = < 0.01) in twenty-one out of twenty-six responses. The enhancements were also highly significant after alloxan in the case of another twelve receptors. Similar enhancements were observed in the case of responses to nicotine and capsaicin. This suggests that the enhancement of the responses of J receptors to excitants occurs in a non-specific manner after phosgene and alloxan. 3. The enhanced responses occurred in the absence of any significant increase in the estimated concentration of the excitants in pulmonary artery blood. 4. The enhanced responses to PDG were not closely related to the oedema-induced activity; several occurred during periods of silence of the receptors and in thirteen receptors the enhanced responses occurred before the increase in the oedema-induced activity had begun. 5. A possible role of histamine, 5-HT, prostaglandins and bradykinin in enhancing the responses to PDG after phosgene was excluded. 6. The results therefore suggest that the non-specific enhancement of the responses of the J receptors to excitants must be due to the increased permeability of the capillaries produced by phosgene and alloxan leading to greater movement of the excitants to the J receptors. However, certain unidentified factors may also be involved.

Factors affecting movement of excitatory substances from pulmonary capillaries to type J receptors of anaesthetized cats.

1. Using phenyl diguanide (PDG) as an excitatory substance, the role of certain factors that could influence the movement of such substances across the pulmonary capillaries to the J receptors was studied in cats anaesthetized with sodium pentobarbitone. This was aided by using a new method for estimating continuously in vivo the concentration (C) of PDG in the blood of the pulmonary artery. 2. Reduction of pulmonary blood flow by partial occlusion of the inferior vena cava enhanced the responses of the J receptors to PDG significantly in twelve out of thirteen trials. These effects, which occurred at a time when pulmonary capillary pressure (PCP) had fallen, could be related to the increase in the estimated mean C of PDG over the first 3 s or to the C t (concentration x time) area to 50% of peak C. The responses bore no relation to peak C or rate of rise of C. 3. The responses of the receptors to PDG increased significantly after three out of eight injections of PDG while the PCP was raised by partial occlusion of the mitral orifice; reduced responses were recorded after two injections. These results, showing relatively much weaker stimulation by PDG in spite of the enhanced level of J receptor excitability produced by the raised PCP itself, suggest that movement of PDG out of the capillaries to the J receptors must be influenced primarily by forces governing diffusion, not filtration. 4. In addition to C of PDG there appear to be other factors that influence the responses of the receptors to PDG.

The influence of the sympathetic outflow on aortic chemoreceptors of the cat during hypoxia and hypercapnia.

1. An attempt has been made to reconcile differing observations, made by different groups of investigators, on the responses of aortic chemoreceptors of cats during normoxia, hypoxia and hypercapnia. 2. In cats anaesthetized with sodium pentobarbitone it was observed that during hypoxic stimulation of twelve chemoreceptors, an intravenous injection of about 20 mg sodium pentobarbitone produced hypotension which was accompanied by an initial fall in chemoreceptor activity instead of the expected increase that invariably occurred in all the receptors when hypotension was produced mechanically by distending a balloon in the right atrium (twenty-six during normoxia, eleven during hypoxia and eight during hypercapnia). 3. In twelve receptors a reflex fall in blood pressure produced by injecting 8-25 micrograms veratridine (Bezold-Jarisch reflex) yielded results qualitatively similar to those following injection of sodium pentobarbitone. 4. In sixteen out of twenty-five chemoreceptors it was observed that ventilating the cat with 5.6-6.7% CO2 produced either no or little increase in activity; in nine receptors there was a clear increase in activity, which fell initially or was abolished after injecting a single dose of 20 mg sodium pentobarbitone. 5. In all seven chemoreceptors tested in seven deeply anaesthetized cats it was found that a larger dose (about 50-60 mg) of sodium pentobarbitone had no direct depressant effect on aortic chemoreceptor activity. It followed that the initial depressant effect of the much smaller doses of sodium pentobarbitone observed during hypoxic and hypercapnic stimulation (see above) must be due to reduction in the sympathetic outflow to the aortic bodies. This conclusion was supported by the results following injections of veratridine. 6. By comparing the present results with those reported previously it was concluded that the variations in the responses of aortic chemoreceptors during hypoxia and hypercapnia reported by different investigators could be partly due to variations in the level of sympathetic activity prevailing under different experimental conditions.

The effects of hypoxia on slowly adapting type I (SAI) cutaneous mechanoreceptors in the cat and rat.

In whatever mammalian receptor system Merkel cells are found, they are always associated with a characteristic slowly adapting response. The role of Merkel cells in the transduction process of slowly adapting Type I cutaneous mechanoreceptors (SAI receptors or touch domes) of rats and cats was investigated by mechanical and electrical stimulation of SAI receptors and their afferent fibers in an O2-depleted environment. Circulatory hypoxia was produced either by ventilating animals with N2 or by recirculating venous blood around a limb. In both these experimental preparations, the results obtained were identical. For receptor failure to occur, it was found necessary to have an O2-depleted environment on the limb surface. This was achieved by passing N2 into a gas-tight polythene sock placed over the limb. Replacement of N2 within the polythene sock with O2 was sufficient to bring about receptor recovery, irrespective of arterial blood PO2 levels. There was an inverse linear relationship between receptor response and time when touch domes were stimulated with N2 around the limb. In contrast, the replacement of N2 around the limb with O2 produced an exponential increase in the response with time. Correlated with receptor failure was a significant reduction in the number of dense-cored vesicles normally found in the Merkel cell cytoplasm adjacent to the nerve ending innervating the cell. Receptor recovery was associated with a return in the number of dense-cored vesicles back to that found in control cells. Hypoxia had no effect on the level of electrical stimulation necessary to initiate an action potential in the afferent fiber, even though the response of SAI receptors to mechanical stimulation had ceased. The results indicate that Merkel cell dense-cored vesicles are necessary for the characteristic slowly adapting response of SAI mechanoreceptors and that this may be due to the secretion of a transmitter substance stored within the vesicles.

Reflex effects following selective stimulation of J receptors in the cat.

1. Experiments carried out on anaesthetized cats showed that increasing blood flow, through the lobes of a lung, by 133% (S.E. 33%) generated an average of 0.75 impulses/sec (S.E. 0.3) in ten almost silent J receptors. Equivalent activity was produced by injecting 12-18 micrograms phenyl diguanide/kg into the right atrium. Such activity caused marked reflex effects, i.e. apnoea, rapid shallow breathing and reduction in the knee jerk. 2. The reflex effects of J receptors were studied after blocking the activity from cardiac receptors by intrapericardial injections of xylocaine. This was necessary because left atrial injections of phenyl diguanide produced reflex respiratory effects and inhibition of the knee jerk. 3. Hypoxia, but not hypercapnia, attenuated the reflex effects of J receptors, apnoea being abolished if the Pa,O2 fell below 35 mmHg. This was a central effect as it occurred in spite of increased activity of J receptors following phenyl diguanide, and effects of hypoxia persisted after cutting both carotid nerves. 4. The only invariable reflex effect of J receptors was a reduction in the total number and the average frequency of phrenic impulses in each breath. The changes in inspiratory time (ti) and expiratory time (te) following apnoea were variable although most frequently both were reduced. In about half the observations the first effect before the apnoea was a reduction in ti, in the other half it was a reduction in te. It was concluded that an input from J receptors inhibits inspiratory and expiratory mechanisms directly. 5. In some cats apnoea and rapid shallow breathing produced by J receptors continued after interrupting their activity by vagotomy and this did not diminish the reduction in ti or te; in other cats it did. The reduction in te was at times quite independent of changes in ti, i.e. pulmonary stretch receptor activity. 6. It was concluded that J receptors must be stimulated during moderate exercise to levels that produce marked respiratory reflex effects and inhibition of muscles.