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Biomedical subjects

S T Holgate

Publications and source records attributed to S T Holgate.

At least 235 records · Page 13Linked to original sources
PubMed1997

The effect of a novel orally active selective PDE4 isoenzyme inhibitor (CDP840) on allergen-induced responses in asthmatic subjects.

Recent studies have suggested that theophylline, a nonspecific phospho-diesterase inhibitor, has useful anti-inflammatory actions in asthma. Phosphodiesterase 4 (PDE4) represents the predominant PDE isoenzyme present in inflammatory cells. PDE4 inhibitors might, therefore, have beneficial effects in asthma. Side-effects, specifically nausea, have limited the use of existing agents. CDP840 is an orally active, potent and selective PDE4 inhibitor. We have examined the effect of CDP840 on the allergen-induced asthmatic response, its possible modes of action, and its tolerability at therapeutic doses. A total of 54 patients were recruited to three double-blind, placebo-controlled studies. The first study examined the effect of CDP840 (15 mg b.i.d. for 9.5 days) on the allergen-induced asthmatic response in patients with known dual response to allergen. A second study examined the effect of CDP840 (15 mg b.i.d. for 9.5 days) on airway responsiveness to histamine. A third study examined whether single dose CDP840 (15 and 30 mg) had significant bronchodilatory effects. In all studies, CDP840 was well-tolerated, with no patients reporting nausea. CDP840 did not lead to changes in baseline forced expiratory volume in one second (FEV1) as compared to placebo. The late asthmatic response (LAR) to allergen, expressed as area under the curve at 3-8 h (AUC3-8h), was inhibited by 30% (p=0.016), an effect which persisted to the end of the observation period. The early asthmatic response (EAR) was unaffected, and there was no bronchodilatory effect at the doses used. Treatment with CDP840 did not affect bronchial hyperresponsiveness to histamine. In conclusion, CDP840 significantly attenuated the late asthmatic response to allergen challenge in the absence of any bronchodilatory or histamine antagonist effect. This suggests that CDP840 may exert its effects via an anti-inflammatory mechanism.

Adolescent↗
PubMed1997

Airway endothelin levels in asthma: influence of endobronchial allergen challenge and maintenance corticosteroid therapy.

Endothelins (ETs) are 21 amino acid peptides which, in addition to their other properties, are potent bronchoconstrictors. Whilst there is evidence of the involvement of ET in the pathophysiology of chronic asthma, its contribution to the acute allergic response is undefined. To examine this, we have undertaken segmental bronchoprovocation with allergen and saline at separate sites in six atopic asthmatics receiving treatment with bronchodilators only and six atopic asthmatics additionally receiving treatment with inhaled corticosteroids. Each challenged segment was lavaged 10 min after bronchoprovocation and concentrations of immunoreactive ET were measured in bronchoalveolar lavage fluid. In the non-steroid-treated subjects, there were significantly lower ET levels at the allergen-challenged sites compared to the saline-challenged sites (p<0.05). In the steroid-treated subjects, on the other hand, there was no significant difference between the two sites. Levels of ET at the saline-challenged sites were significantly lower in the steroid-treated subjects compared to the non-steroid-treated subjects (p<0.04). These findings do not support the hypothesis that allergen exposure in asthma results in immediate release of endothelin. However, release at later time-points and a role for endothelin in late-phase bronchoconstriction are not excluded.

Adrenal Cortex Hormones↗
PubMed1997

Allergen-induced release of GM-CSF and IL-8 in vitro by nasal polyp tissue from atopic subjects prolongs eosinophil survival.

Eosinophilia is a feature of nasal polyposis. The aim of this study was to determine the role of cytokines and allergen in maintaining the eosinophilic infiltrate in this condition. Polyp fragments from house dust mite (HDM)-sensitive atopic individuals and nonatopic individuals were cultured in the presence of HDM, or phytohaemagglutinin (PHA) or culture medium alone. Culture supernatants were assayed for interleukins (IL) 3, 5, and 8 and granulocyte macrophage colony stimulating factor (GM-CSF), and eosinophil survival enhancing activity (ESEA) in vitro. Significant ESEA was produced spontaneously. When polyp tissue from atopics, but not from nonatopics, was stimulated with allergen for 2 days there was a further increase in ESEA associated with a median 12 and fourfold increase in IL-8 and GM-CSF, respectively. This increased ESEA was markedly reduced with anti-GM-CSF and, to a lesser extent, anti-IL-8 blocking antibodies. When stimulated with PHA, polyp tissue from atopic subjects also produced increased ESEA, implicating possible T-cell involvement. This was associated with a small (twofold), but significant, increase in IL-8 and a less consistent increase in GM-CSF. However, anti-IL-8 or anti-GM-CSF blocking antibodies failed to reduce the ESEA in these supernatants, suggesting involvement of other mechanisms. This study suggests that in sensitized individuals, allergen may contribute to polyp eosinophilia by stimulating the production of granulocyte/macrophage colony stimulating factor and interleukin 8.

Allergens↗
PubMed1997

Identification of neutrophil chemotactic factors in bronchoalveolar lavage fluid of asthmatic patients.

BACKGROUND: Although neutrophils have been implicated in bronchial asthma, the mechanism(s) which bring these cells into the airways is poorly understood. OBJECTIVE: To investigate the presence and identity of neutrophil chemotactic factors in bronchoalveolar lavage (BAL) fluid from atopic asthmatic subjects. METHOD: BAL fluid was obtained from 13 subjects (seven asthmatics and six normals), aged 19 to 60 yr, at bronchoscopy. Separation of neutrophil chemotactic activity (NCA) was achieved by FPLC cation exchange chromatography. Fractions were collected and assayed for chemotaxis in multiwell micro-chemotaxes chambers using polycarbonate filters, for the complement peptide C5a/C5a des Arg by radioimmunoassay (RIA) and for interleukin-8 (IL-8) by ELISA. RESULTS: NCA was found in FPLC fractions of BAL samples in four out of seven asthmatics and each of these subjects had at least three similar peaks of NCA. The major peak of NCA was found to contain immunoreactive C5a/C5a des Arg and chemotaxis. In response to this NCA could be blocked by desensitization of the neutrophils with recombinant C5a. Purified serum derived C5a/C5a des Arg was found to have altered chromatographic properties when added to BAL fluid; this suggested that BAL fluid contained proteins which interacted with the C5a/C5a des Arg. Immunoreactive IL-8 (iIL-8) was also detected but its concentration or chemical form was insufficient to induce neutrophil chemotaxis. CONCLUSION: This study demonstrates that bronchial asthmatic lavage fluid contains C5a/ C5a des/Arg and IL-8, together with other as yet unidentified factors which may contribute to neutrophil recruitment in this disease.

Adolescent↗
PubMed1997

[Respiratory inflammation].

Respiratory virus are the most frequent cause of asthma attacks, and are responsible for more than 80% of episodes of wheezing in children. Atopic subjects have a higher risk of respiratory virus infections, benign or severe, than healthy persons. In children older than 8 years, most respiratory infections are caused by rhinovirus (RV). RV colonizes the respiratory epithelium and provokes a symptomatic rhinitis by non-inflammatory routes (with non involvement of leucocytes). In the nose the most importance of these routes are nerves. In the lower respiratory airways, infection with RV causes an inflammatory reaction with persistence of eosinophils. IL-8 and the other cytokines produced by the infected epithelium extend the action of eosinophils and the inflammatory reaction. The viral/inflammatory pathway is an important new target for development of strategies for the prevention of asthma.

Adult↗
PubMed1997

Candidate locus approach for studying the genetics of asthma and atopy.

Insights into the complex genetic factors underlying asthma and atopy have arisen from investigating genes whose functions are likely to be involved in the pathogenesis of these disorders. Candidate genes have now been studied on 13 human autosomes, and genetic linkage analysis and association studies have identified potentially important genes on chromosomes 5, 6, 11 and 14. However, these four regions do not account for all the heritability of these disorders, and additional regions are now being identified by systematic searches of the whole genome.

Asthma↗
PubMed1997

Immunolocalization of cytokines to mast cells in normal and allergic conjunctiva.

BACKGROUND: Recently, the potential role of mast cells in allergic reactions has been extended by the discovery that these cells synthesize, store and secrete multifunctional cytokines. Seasonal allergic conjunctivitis is characterized as an immediate hypersensitivity reaction, in which allergen binds to specific IgE on mast cells, leading to release of pre-formed and newly synthesized inflammatory mediators. OBJECTIVE: In this study we aimed to localize the cytokines IL-4, IL-5, IL-6, IL-8 and TNF alpha to conjunctival mast cells and to examine the relationship between mast cell-associated cytokines and allergic conjunctivitis. METHODS: Immunohistochemistry was performed on serial sections of conjunctival biopsies from patients with seasonal allergic conjunctivitis, in and out of the hay fever season, as well as from non-allergic volunteers. RESULTS: IL-4, IL-5, IL-6 and TNF alpha were localized to mast cells in normal and allergic conjunctiva. IL-8 was localized to mast cells in two patients with seasonal allergic conjunctivitis, one during and the other outside the pollen season. Using the monoclonal antibody 3H4, which identifies the secreted form of IL-4, biopsies from patients with active seasonal allergic conjunctivitis contained a significantly higher proportion of mast cells positive for IL-4, than those from out-of-season patients (P=<0.016). There was no difference between the two groups in the number of mast cells immunostained by the antibody 4D9 which identifies the stored form of IL-4. CONCLUSIONS: These results suggest that conjunctival mast cells can store a range of multifunctional cytokines and release IL-4 during active disease, which may give them an important role in upregulating allergic inflammation in the conjunctiva.

Adult↗
PubMed1996

Molecular mediators of asthma: current insights.

With advances in molecular biology, the complex inflammatory events that underlie asthma are being unraveled. The players are diverse, involving two populations each of mast cells and helper T cells, eosinophils, bronchial endothelial and epithelial cells, and an array of vasoactive and bronchoactive mediators. The clinical message is already clear: Treat the inflammation early.

Asthma↗
PubMed1996

Production of IL-8 and IL-4 by positively and negatively selected CD4+ and CD8+ human T cells following a four-step cell separation method including magnetic cell sorting (MACS).

Highly enriched CD4+ and CD8+ human T cells were obtained from peripheral blood using a relatively simple and inexpensive method consisting of four steps: separation of mononuclear cells on Lymphoprep, removal of adherent monocytes by incubation in plastic petri dishes, removal of B cells, NK cells and further depletion of nonadherent monocytes by panning with anti-CD19, -CD16, -CD14, -CD11b and -CD33 mAb, and separation of CD4+ and CD8+ T lymphocytes by magnetic cell sorting (MACS). Cell culture for up to 48 h showed preservation of function by both positively and negatively selected cells as determined by production of IL-8. Although the cell separation procedure had no effect on interleukin-2 receptor (IL-2R, CD25) expression, it induced production of IL-4 by both T cell subsets selected positively, implying cell activation by ligation of CD4 and CD8 molecules. Irrespective of the mode of separation, CD8+ T cells produced more IL-4, a cytokine which is associated with a Th2-type cytokine profile of CD4+ T cells. We conclude that our method for separating T cells into their CD4+ and CD8+ subsets results in high cell purities with preservation of function, as determined by cytokine generation. If enriched cells are to be used for functional studies we recommend isolation by negative selection which has less effect on cell function. The relevance of the finding that CD8+ T cells can be an important source of IL-4 remains to be elucidated.

CD4-Positive T-Lymphocytes↗
PubMed1996

Aetiology of asthma: how public health and molecular medicine work together.

Asthma is recognized as the most common treatable chronic disease of the lung, afflicting over 100 million people of all age groups yet, despite therapeutic advances, there has been little impact on the rising morbidity and mortality from the disease. This article discusses ways in which molecular medicine can inform public health policy and clinical practice in the management of asthma. It focuses on the recognition that asthma is an inflammatory disorder, and that the public health burden of the disease can be reduced by identifying environmental factors that may trigger asthma in genetically susceptible individuals.

Adult↗
PubMed1996

Leukotriene antagonists and synthesis inhibitors: new directions in asthma therapy.

This article briefly reviews the advances in our understanding of asthma with a particular focus on the role of inflammation, before providing a concise overview of current knowledge of leukotrienes in the pathophysiology of the disease. The development of leukotriene receptor antagonists and synthesis inhibitors in briefly described; and acute exercise, allergen, and aspirin challenge studies with these agents are reviewed. Clinical studies with leukotriene antagonists and inhibitors have confirmed the central role of leukotrienes in asthma pathophysiology. In conclusion, we suggest that the new generation of leukotriene receptor antagonists may be suitable as first-line therapy in patients with mild to moderate asthma. Further studies are required to determine whether the leukotriene synthesis inhibitors will be equally effective or provide any additional antiinflammatory benefit.

Anti-Asthmatic Agents↗
PubMed1996

Cellular and mediator responses twenty-four hours after local endobronchial allergen challenge of asthmatic airways.

The effects of acute allergen exposure on bronchoalveolar lavage cells and mediators and mucosal inflammatory cells were evaluated in 10 subjects with atopic asthma who underwent lavage and biopsy 24 hours after segmental endobronchial allergen challenge. Increased numbers of bronchoalveolar lavage eosinophils were retrieved from the allergen-challenged sites compared with the saline-challenged sites (mean 21.4 vs 1.5 x 10(3) cells/ml; p < 0.02). Numbers of neutrophils and proportions of CD4+, CD8+, CD25+, and HLA-DR+ T cells were similar at the saline- and allergen-challenged sites. In contrast to the bronchoalveolar lavage findings, eosinophil numbers were not increased in the bronchial submucosa or epithelium. There was also no significant difference in neutrophils, mast cells, CD3+, CD4+, or CD8+ T cells in the submucosa after allergen challenge, but the number of activated (CD25+) T lymphocytes in the mucosa did increase after allergen challenge. Allergen challenge did not induce any significant change in endothelial expression of P-selectin, E-selectin, intercellular adhesion molecule-1, or vascular cell adhesion molecule-1. CD11a+ and very late antigen-4+ cell numbers were similar in the saline- and allergen-challenged sites. This study suggests that in patients with very mild asthma, local allergen challenge induces persistent bronchoalveolar lavage eosinophilia, but the recruitment process seems to have diminished or ceased by 24 hours.

Adult↗
PubMed1996

Assessment of deposition of inhaled aerosol in the respiratory tract of man using three-dimensional multimodality imaging and mathematical modeling.

Multimodality medical imaging enables measurement of the three-dimensional spatial distribution of a radiolabeled aerosol within the lung. Using a conceptual spatial morphological model these data may be transformed to provide information on deposition per airway generation. This methodology has been used to study the intrapulmonary deposition patterns of two formulations of a metered dose inhaler and two nebulizers in control subjects. The nebulizer study has also been stimulated using a computer model of deposition. The comparison between derived experimental results and those from computer modeling shows areas of agreement, although there are also areas of discrepancy. The new methodology has considerable potential value in the fields of inhalation therapy and deposition modeling, although more detailed validation is still required.

Administration, Inhalation↗