Virus-induced airway hyperresponsiveness and asthma.
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Asthma↗
Biomedical subjects
R Sorkness
Publications and source records attributed to R Sorkness.
Effects of dexamethasone on acute virus-induced airway dysfunction in adult rats.
Respiratory viral infections have been associated with airway obstruction and hyperresponsiveness, and exacerbations of asthma. Although virus-induced asthma is thought to be precipitated by airway inflammation, the clinical efficacy and rationale for using antiinflammatory treatment during such exacerbations remains controversial. The purpose of this study was to use a well characterized animal model of respiratory viral illness to test the hypothesis that the inflammatory response to viral infection is responsible for the development of airway dysfunction. Adult rats were inoculated with either Sendai virus or sterile vehicle and treated with daily injections of dexamethasone or saline. At postinoculation d 4, 5, or 6, rats were evaluated for airway obstruction, hyperresponsivenes, inflammation, and lung viral titers. Saline-treated infected rats had significant airway obstruction (increased resistance, decreased dynamic compliance), hyperresponsiveness (i.v. methacholine), and inflammation (increased bronchoalveolar lavage leukocytes) compared with noninfected controls. In contrast, dexamethasone-treated infected rats had no increase in bronchoalveolar lavage leukocytes and significantly smaller changes in airway physiology, but had increased lung viral titers compared with saline-treated infected rats. We conclude that glucocorticoid suppression of the inflammatory response to respiratory viral infection largely prevents virus-associated airway dysfunction.
Animals↗
Rat eosinophils: isolation and characterization of superoxide production.
Studies with isolated cells are important to the understanding of mechanisms by which eosinophils participate in allergic inflammation. Due to species variability, isolation techniques and cell biology need to be defined for each source. We developed methods to obtain rat eosinophils with purity and viability exceeding 90%, characterized the superoxide anion production of these cells in response to standard activators, and compared these results with those previously obtained in our laboratories with the use of human eosinophils. Rat eosinophils responded vigorously to phorbol myristate acetate and poorly to platelet-activating factor and to N-formyl-methionyl-leucyl-phenylalanine, parallel to the responses of human eosinophils. In contrast, rat eosinophils responded unlike human eosinophils to other activators, having a larger response to calcium ionophore A23187, a smaller response to serum-treated or serum-opsonized zymosan, and a negative rather than positive modulatory effect of cytochalasin B. We conclude that rat eosinophils can be obtained in high purity and with intact responsiveness to a number of different activators.
Animals↗
Attenuation of airway hyperresponsiveness during acute viral infection using the 21-aminosteroid U-83836E in rats.
Respiratory viral infections have been associated with exacerbations of asthma in humans, and are known to produce airway obstruction and hyperresponsiveness in rats. Virus-induced airway dysfunction may result in part from inflammatory cells and their products, and agents that target these mechanisms might therefore attenuate viral airway injury. The 21-aminosteroid class of drugs has been reported to attenuate tissue injury in a variety of models, and we hypothesized that U-83836E, an orally-active aminosteroid, would prevent the development of airway dysfunction during acute viral illness. Adult rats were inoculated with either parainfluenza type 1 (Sendai) virus or sterile vehicle, treated with either U-83836E 20 mg/kg or water by oral gavage twice daily, and studied on postinoculation day 5, 6 or 7. Anesthetized, paralysed, mechanically ventilated rats were placed in a body plethysmograph for measurements of airway obstruction (resistance, dynamic compliance, eucapneic PaO2), and responsiveness to i.v. methacholine; lungs were lavaged to obtain inflammatory cells. The water-treated virus group was significantly different from the non-infected controls for all variables. Virus-induced hyperresponsiveness was attenuated (P = 0.027) by aminosteroid treatment, although airway obstruction and inflammation were not improved by the treatment. We conclude that 21-aminosteroids may protect airways from virus-induced hyperresponsiveness.
Acute Disease↗
Circumsinus branch: a convenient source of baro- and chemoreceptor activity in dogs.
We found a branch of the carotid sinus nerve in 44 of 48 dogs. We propose that this branch be referred to as the "circumsinus" branch of the carotid sinus nerve. Both chemoreceptor and baroreceptor activity were detected in this branch during electrophysiological recording efforts utilizing classic nerve recording techniques. Its convenient location permits whole nerve or single unit recording without having to transect, dissect, or even expose the carotid sinus nerve. Carotid baroreceptor and chemoreceptor activity can be monitored with most of the carotid bifurcation's neural pathways intact.
Animals↗
Effects of airway parasympathetic tone on responses to intravenous bronchoconstrictor agonists in rats.
To test the hypothesis that parasympathetic airway tone may affect airway responsiveness, we measured bronchoconstrictor responses to intravenous bethanechol (BCh) in anesthetized vagotomized rats with and without background vagal nerve stimulation and developed a predictive model based on pharmacological additivity between endogenous and intravenous agonists. A high degree of agreement (r2 = 0.93) between the measured and predicted responses indicated that intravenous BCh and parasympathetic tone had bronchoconstrictor effects that were pharmacologically additive. An expansion of the additive model was used to determine that the percentage of decrease in respiratory system conductance (Grs) would be a measure of airway response independent of background parasympathetic tone. As predicted, the percentage of decrease in Grs after intravenous BCh was minimally affected by background vagal stimulation. However, the percentage of decrease in Grs was augmented by vagal stimulation for intravenous 5-hydroxytryptamine hydrochloride, a known parasympathetic neuromodulator, and for methacholine, an agonist with nicotinic as well as muscarinic activity (P < 0.02 for each agonist). We conclude that airway parasympathetic tone can be a source of variability for airway responsiveness when substances having neuromodulatory activity are involved in the provocative challenge.
Animals↗
Virus-induced airway obstruction and parasympathetic hyperresponsiveness in adult rats.
Viral respiratory infections in humans have been associated with exacerbations of late allergic responses and asthma, as well as with airway abnormalities that persist after resolution of the acute infection. We hypothesized that augmented parasympathetic contractile mechanisms may contribute to postviral airway dysfunction. We studied airway physiology in anesthetized rats at 1 to 8 wk after inoculation with Parainfluenza 1 virus or vehicle. The virus groups had airway obstruction (abnormal lung mechanics, gas exchange and residual volume), and increased sensitivity to intravenous methacholine at 1 to 4 wk, although methacholine hypersensitivity was minimal in vagotomized rats; these abnormalities were absent at 7 to 8 wk after inoculation. Airway responses to vagal parasympathetic nerve stimulation were enhanced markedly at 1 to 4 wk, and significantly at 7 to 8 wk, after viral inoculation. Dysfunction of M2 muscarinic autoreceptors during acute viral infection was indicated by a significant attenuation of gallamine-induced augmentation of airway parasympathetic responses; in contrast, gallamine-augmentation of parasympathetic responses at 2 to 8 wk after viral inoculation was not different from noninfected control animals. We conclude that respiratory virus infection in rats produces airway dysfunction that remains for weeks after resolution of the acute infection, and that is caused in part by parasympathetic hyperresponsiveness, associated both with M2 autoreceptor malfunction and with M2-independent mechanism(s).
Animals↗
Association of mononuclear cells and eosinophils with airway resistance and responsiveness in rat pulmonary inflammatory responses.
To evaluate the association of various leukocytes with pulmonary resistance and methacholine responsiveness, we induced pulmonary eosinophil-rich inflammation in IgE-sensitized (ovalbumin) Sprague Dawley rats. Sensitized rats were challenged with either relevant (OA) or irrelevant antigen by tracheal insufflation a) with no other treatment, b) in conjunction with intravenous Sephadex beads pretreatment, or c) with antigen coupled covalently to Sepharose beads. About 24 h after antigen challenge, respiratory system resistance (Rrs), response to aerosolized methacholine, and pulmonary histopathology were evaluated. Challenge with OA, insufflation with Sepharose, and treatment with i.v. Sephadex all independently increased inflammatory cell infiltrates, but the combination of OA with the other agents did not significantly enhance the inflammatory response over OA alone. Interactive stepwise regression techniques were utilized to identify correlates for Rrs and methacholine responsiveness. Mononuclear cell score was a significant predictor (p < .01) for Rrs, and insufflation of Sepharose had a significant independent effect on Rrs (p = .01) above that predicted by mononuclear cell infiltrates. Conversely, eosinophil score and neutrophil score were not significant predictors for Rrs, and challenges with antigen or Sephadex had no significant independent effect on Rrs beyond that predicted from mononuclear cell infiltrates. Eosinophil score was the only significant histological predictor for methacholine responsiveness (p < .0001). Challenges with Sephadex, antigen and Sepharose did not significantly change methacholine responsiveness independently of the changes associated with eosinophil infiltrates. These findings suggest that mononuclear cells and eosinophils contribute to increases in airway resistance and responsiveness, respectively, following the induction of pulmonary inflammation by both allergic and non-allergic stimuli.
Airway Resistance↗
Anesthetic effects on pulmonary allergic responses in rats: changes in sensitivity to serotonin.
Subsequent to observations that pulmonary responses to antigen challenge are of different magnitudes in sensitized rats that are anesthetized with different drugs, we conducted studies to test whether the alterations in responses were due to changes in airway responsiveness to cholinergic or serotonergic challenge, opioid-receptor mediated events, or changes in mast cell mediator release. Immunoglobulin E-sensitized rats anesthetized with ketamine/urethan had larger changes in lung resistance and plasma histamine after pulmonary antigen challenge compared with rats anesthetized with fentanyl-droperidol. Blockade of opioid receptors with naloxone did not affect the responses. In unsensitized rats, airway responses to aerosolized methacholine were similar for the two anesthetics, indicating unchanged smooth muscle responsiveness; however, airway responses to intravenous serotonin were enhanced by ketamine and ablated by droperidol. We conclude that ketamine- and droperidol-induced alterations of pulmonary allergic responses are due to changes in sensitivity to serotonin and in mast cell mediator release. We speculate that mast cell mediator release may be modulated by a serotonin receptor-linked mechanism.
Airway Resistance↗
Persistent airway hyperresponsiveness after neonatal viral bronchiolitis in rats.
Viral bronchiolitis in human infants has been associated with permanent changes in small airways and gas exchange and an increased incidence of hyperresponsive airways later in life. Respiratory infection by Sendai virus in neonatal rats also has been reported to cause permanent changes in lung morphology and increased numbers of bronchiolar mast cells and eosinophils. We evaluated pulmonary mechanics, gas exchange, and airway responsiveness in rats at 7 and 13-16 wk after neonatal Sendai virus infection. Rats from the virus group had lower arterial PO2 and increased total lung resistance compared with controls. There were no significant differences between groups for arterial PCO2, dynamic lung compliance, quasi-static respiratory system compliance, or vital capacity. Rats from the infected group were significantly more sensitive to aerosolized methacholine than were controls, although both virus and control groups became less sensitive with age. We conclude that neonatal Sendai virus infection in rats results in persistent alterations in lung function and airway responsiveness. This phenomenon may be valuable for the study of the relationships among airway inflammation, lung morphology, and airway hyperresponsiveness, and it may be relevant to human airway disease.
Airway Resistance↗
Late pulmonary allergic responses in actively but not passively IgE-sensitized rats.
Previous studies suggested that although rats that were passively sensitized [monoclonal murine immunoglobulin E (IgE)] would respond to pulmonary antigen challenge with an immediate increase in resistance, they exhibited no late increases in resistance, unlike late changes in rats actively sensitized to preferentially produce IgE antibody. We hypothesized that passively sensitized rats also would not develop antigen-induced pulmonary inflammation. In a blinded protocol we compared immediate responses and pulmonary resistance and inflammation at 8, 19 and 24 h after challenge with placebo antigen, with dinitrophenol-bovine serum albumin (DNP-BSA) to elicit a passively sensitized response, or with ovalbumin (OA) to elicit an actively sensitized response. Despite similar immediate responses to OA and DNP-BSA, only the rats challenged with OA had marked inflammatory changes and a significant incidence of late elevations in resistance. Inflammation scores and lung resistance were significantly correlated only in the OA group. We also observed that anesthesia with fentanyl/droperidol significantly attenuated the immediate but not the late responses to antigen challenge, compared with rats anesthetized with ketamine. We conclude that IgE-mediated immediate responses to pulmonary antigen challenge are insufficient, and may be unnecessary, to initiate antigen-induced late inflammatory changes.
Airway Resistance↗
Contribution of upper airways to antigen-induced late airway obstructive responses in guinea pigs.
The pathogenesis of the late asthmatic response has been of interest due to the fact that its development has been associated with airway obstruction, airway inflammation, and airway hyperresponsiveness: all features of chronic asthma. In order to study more precisely late responses, a number of animal models have been developed. Previous reports have described alterations in airway mechanics at both 3 to 6 and 17 h after antigen challenge in sensitized guinea pigs. In these experiments, however, animals were challenged through the nose with aerosolized antigen, and airway conductance was measured using whole body plethysmography while the animals breathed through the upper airways. In rats similarly challenged, the predominant immediate change in resistance occurs in the upper airways. The purpose of this study, therefore, was to evaluate the contribution made by both the upper and lower airways to late changes after allergen challenge in guinea pigs. Outbred female Hartley guinea pigs were actively or passively sensitized (IgG1 antibody response) to three different antigens and challenged either by direct tracheal insufflation (sheep gamma globulin [SGG] or oxazolone-human serum albumin [OX-HSA]) or by aerosolization (ovalbumin [OA]). Lung resistance (RL) and dynamic compliance (Cdyn) were measured in anesthetized guinea pigs through a tracheostomy tube, and specific airway conductance (SGaw) was measured in unanesthetized, nose-breathing guinea pigs using a whole body plethysmograph. Late responses were defined as a RL greater than the mean + 2 SD RL or as a decrease in SGaw from baseline greater than 2 SD from the placebo-challenged (bovine serum albumin) group.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Pulmonary antigen challenge in rats passively sensitized with a monoclonal IgE antibody induces immediate but not late changes in airway mechanics.
Pulmonary antigen challenge in sensitized individuals results in isolated immediate, isolated late, or dual reactions consisting of both an immediate and late change in airway function. The immediate response appears to be dependent on the presence of IgE antibody and mast cell mediator release. Although the late phase of dual responses is considered to be related to or a continuum of the immediate hypersensitivity response, its precise pathogenesis remains to be determined. To increase both the sensitivity and specificity of analyzing the pathogenesis of IgE-dependent pulmonary responses, we have used a Sprague-Dawley rat model system in which rats are passively sensitized with a murine monoclonal IgE anti-dinitrophenol (DNP) antibody prior to challenge with DNP-bovine serum albumin (DNP-BSA). Pathogen-free rats were injected with IgE or saline in a randomized blinded protocol, and in 24 to 48 h were anesthetized with urethane (1.2 g/kg intraperitoneally) and instrumented to measure lung resistance (RL) and dynamic compliance (Cdyn). Rats were then challenged with aerosolized DNP-BSA (10 mg/ml), and RL and Cdyn monitored through 7 h after challenge. Both RL (0.30 +/- 0.10 versus 0.13 +/- 0.02 cm H2O/ml.sec-1) and Cdyn (0.41 +/- 0.10 versus 0.25 +/- 0.08 ml/cm H2O) were significantly different (p less than 0.05) in sensitized rats compared to control rats immediately after challenge. No late changes were observed in either the treated or control animals.(ABSTRACT TRUNCATED AT 250 WORDS)
Airway Resistance↗
Reflex effects of isocapnic changes in ventilation on tracheal tone in awake dogs.
We studied the effects of passive, isocapnic changes in ventilation on tracheal smooth muscle tone in 3 awake and 6 anesthetized dogs. Ventilation was altered using mechanical ventilation under hyperoxic conditions, and tracheal tone was measured using the pressure within a water-filled balloon in an isolated segment of trachea. Hypocapnia was prevented at increased VA by increasing FICO2. When f and VT were changed reciprocally, keeping VA constant, tracheal tone did not change. However, when either for VT was changed independently, tracheal tone decreased with an increase in VA. This effect was abolished following thoracic vagotomy. We conclude that tracheal tone is reflexly decreased during an increase in VA.
Animals↗
Multiple systems organ failure: I. The basal state.
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Acute Kidney Injury↗
Multiple systems organ failure: II. The effect of infusion of amino acids and glucose.
Amino acids and dextrose infusion were given for short periods of time to a young man whose basal state is characterized in the previous paper in this series, and their effects were documented in terms of plasma concentrations and splanchnic extraction. The basal state measurements show in the acute trauma state and its subsequent starvation state a largely balanced splanchnic extraction of amino acids but at a decreasing rate. Amino acid (FreAmine) infusion at low rates on this background produced a large increase in extraction of a largely balanced mixture of amino acids but a minimal change in glucose release. The septic state is characterized in both the basal and amino acid infusion state by splanchnic extraction of an unbalanced mixture of amino acids which is deficient in branched-chain amino acids and in relative excess of glucogenic amino acids with increased glucose release and increased utilization of amino acids for gluconeogenesis. In early sepsis this state can largely be repaired by exogenous amino acid infusion but in late sepsis can only be partially repaired. The data suggest that the patient in late sepsis should have a branched-chain rich amino acid mixture and that the hepatic failure of sepsis is strongly associated with peripheral release of an unbalanced mixture of amino acids secondary to enhanced branched-chain catabolism. Infused glucose produces a large increase in the plasma glucose but also improves the balance of the splanchnic amino acids extracted. The statistical validity of the preceding statements are examined in detail in the manuscript.
Amino Acids↗
Therapeutics bibliography for clinical pharmacists: infectious disease.
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Bibliographies as Topic↗
Therapeutic problem solving: a systematic approach.
A systematic approach to therapeutic problem solving is discussed. Therapeutic problem solving includes defining the problem, assessing possible solutions to the problem and choosing the best solution (therapy). The thought processes specific to drug therapy include: (1) choice of agent, (2) evaluation of benefit versus risk ratios, and (3) determination of dosage. Once treatment has been initiated, the problem-solving process shifts to reassessing the patient, monitoring and readjusting therapy, and anticipating new problems related to therapy. An algorithm is provided to demonstrate a thought sequence for solving therapeutic problems. To assure that no important consideration has been neglected, it is useful to develop a pattern of thought that may be applied to each therapeutic situation.
Drug Administration Schedule↗