Effects of T-helper 2-type cytokines, interleukin-3 (IL-3), IL-4, IL-5, and IL-6 on the survival of cultured human mast cells

Although stem cell factor (SCF) has been identified as a critical cytokine for the development of human mast cells from their progenitors, the effects of other cytokines on human mast cells are less well understood. We examined the effects of several cytokines on the survival of human mast cells of 100% purity generated in suspension cultures of umbilical cord blood mononuclear cells in the presence of 100 ng/mL recombinant human (rh) SCF and interleukin-6 (IL-6). Mast cells suspended in conventional serum-containing medium died over a period of 2 to 6 days after the withdrawal of SCF and IL-6. The cells became pyknotic and underwent DNA fragmentation characteristic of apoptosis. The addition of SCF, IL-3, IL-4, IL-5, or IL-6 to the cultures in both serum-containing and serum-free medium prolonged their survival in a dose-dependent manner. Some other cytokines, such as IL-2, IL-9, IL-10, IL-11, tumor necrosis factor-alpha, transforming growth factor-beta 1, and nerve growth factor, had no survival-promoting effect at 100 ng/mL. Preincubation of mast cells with SCF, IL-4, IL-5, or IL-6 for 24 hours during sensitization with IgE enhanced IgE/anti-IgE antibody-induced histamine release from mast cells, whereas IL-3 showed a negligible effect. Polymerase chain reaction amplification of alpha-chains of IL-3 receptor (R), IL-4 R, IL-5 R, and IL-6 R yielded products of the correct size predicted from the sequence of each receptor. The binding assay using 125I-labeled IL-3 indicated that these mast cells bear receptors for IL-3. These findings suggest that IL-3, Il-4, IL-5, and IL-6, which are mainly produced by T-helper 2 lymphocytes, might regulate the functions of human mast cells in vivo via specific receptors in allergic reactions.

Induction of apoptosis in human eosinophils by anti-Fas antibody treatment in vitro

Fas antigen (CD95) can induce apoptosis of cells such as lymphocytes and neutrophils. To determine whether Fas antigen is involved in eosinophil apoptosis, we examined its expression and function on eosinophils in vitro. Purified human eosinophils expressed low but consistently detectable levels of Fas antigen. Culture of eosinophils in up to 10 ng/mL interleukin-5 (IL-5) prolonged eosinophil survival; incorporation of 1 to 1,000 ng/mL Fas antibody led to significant reductions in IL-5-induced eosinophil viability after 48 to 72 hours of culture. Reductions in survival could not be overcome by IL-5 and also occurred in the absence of exogenous IL-5. Preactivation of eosinophils with platelet-activating factor (PAF) significantly reduced eosinophil viability without altering the survival-reducing effects of Fas antibody treatment. In contrast, RANTES did not affect eosinophil viability or Fas antibody-induced reductions in eosinophil survival. After treatment with Fas antibody, electron microscopy of eosinophils and gel electrophoresis of DNA extracted from eosinophils demonstrated changes consistent with apoptosis. These data demonstrate that Fas antigen can modify eosinophil survival by inducing apoptosis through a pathway that is, at least in part, independent of the survival-promoting effects of IL-5.

Relationship between histamine release and leukotrienes production from human basophils derived from atopic dermatitis donors

Basophils are known to release histamine and to produce leukotrienes (LTs) following both IgE-dependent and -independent stimuli. Although there exist a few reports which examined the relationship between histamine release and LTs production, their conclusions were not always in agreement with each other. In the present study, we examined the relationship between histamine release and LTs production from basophils in the presence or absence of 1 ng/ml of interleukin-3 (IL-3). Normal basophils released a smaller amount of histamine and LTs than atopic determatitis (AD) basophils, when basophils were stimulated with an optimal concentration of anti-IgE antibody. When we examined the relationship of histamine release and LTs production from AD donors induced through Fc epsilon RI, we found a significant exponential correlation between these two mediators (R2 = 0.58 in the absence of IL-3, R2 = 0.83 in the presence of IL-3). Although IL-3 enhanced both histamine release and LTs production from AD donors, the relationship between these two mediators was not affected. In conclusion, there was an exponential correlation between histamine release and LTs production from AD basophils, which was not affected by the pretreatment with IL-3.

Study of liver function in infants with atopic dermatitis using the 13C-methacetin breath test

Serum glutamic-oxaloacetic transaminase (GOT) levels were determined in 214 infants (133 males and 81 females) with atopic dermatitis during their first visit to the Department of Allergy, National Children's Hospital, Tokyo, Japan. Compared with the normal hospital range, their levels were found to be significantly higher, a tendency which was more conspicuous in lower age groups. We carried out a 13C-methacetin breath test (MBT), administering the stable-isotope-labeled compound to 11 children with higher serum GOT values and 5 within the normal range to investigate hepatic metabolism of methacetin in infants with atopic dermatitis. 13C-methacetin was given orally, and the 13CO2 level in the breath was determined immediately before and after administration, by mass spectrometry. Compared to the normal controls, the atopic infants demonstrated significantly lower 13CO2 peak excretion and delayed peak time. The clearance rate of 13CO2 was also decreased. These results suggest some relationship between atopic dermatitis and liver function in infants.

Characterization of cord-blood-derived human mast cells cultured in the presence of Steel factor and interleukin-6

We generated > 10(7) mast cells by culturing 10(7) cord blood mononuclear cells for > 10 weeks in the presence of Steel factor, interleukin-6 and prostaglandin E2. 99% of the cultured cells had tryptase-positive granules, while 18% had chymase-positive granules. Cultured mast cells contained 3.6 micrograms histamine and 3.5 micrograms tryptase per 10(6) cells. Cells sensitized with 1 microgram/ml human IgE released 58.5% histamine and 1.55 ng tumor necrosis factor (TNF)-alpha per 10(6) cells when challenged with 1 microgram/ml antihuman IgE, whereas the control cells spontaneously released 3.7% histamine and 0.18 ng TNF-alpha. Analysis for surface antigens revealed that cultured mast cells expressed the following CD molecules: 9, 13, 14, 29, 33, 38, 43, 44, 45RA, 45RB, 46, 47, 48, 49d, 50, 51, 53, 54, 55, 58, 59, 60, 61 and 117 (c-Kit). Taken together, these cultured cells seem to be functionally mature mast cells.

[Investigation into the therapeutic efficacy of continuous isoproterenol inhalation in relation to respiratory infections in asthmatic children]

In our Department, continuous isoproterenol inhalation therapy has been conducted on status asthmatics over the last 10 years. In the present study, we investigated whether there are any differences in the therapeutic efficacy of continuous inhalation of isoproterenol in the presence or absence of respiratory infections which may induce or aggravate asthma attacks. The treatment period was significantly longer in patients with pneumonia. Further prolongation of the treatment period was noted in patients with atelectasis. However, there were no apparent differences in therapeutic efficacy according to age or the severity of attacks. These findings suggest that continuous inhalation of isoproterenol is very effective for status asthmatics if respiratory infections are thoroughly controlled.

Pharmacokinetics and pharmacodynamics of the tulobuterol patch, HN-078, in childhood asthma

BACKGROUND

Recently, a novel percutaneous adhesive tulobuterol preparation, HN-078, has been developed and tests using healthy adult subjects have indicated it to be effective for controlling exacerbations early in the morning if applied at bedtime. In children, percutaneous application is very important to eliminate side effects, including abdominal pain and appetite loss.

OBJECTIVE

We report the pharmacokinetics and pharmacodynamics of tulobuterol patch, HN-078, in the treatment of childhood asthma.

METHODS

Single applications of HN-078 were applied transdermally in six children with asthma who had been admitted to a hospital. Subjects weighing less than 30 kg received 1 mg of tulobuterol while subjects weighing 30 kg or above received 2 mg on the chest for 24 hours. Serum tulobuterol levels and peak expiratory flow rate were determined before and after each application.

RESULTS

Cmax of tulobuterol was determined to be 1.33 +/- 0.21 ng/mL, Tmax was 14.0 +/- 2.0 hours, and AUCO-t was 27.1 +/- 4.2 ng.hr/mL. These pharmacokinetic parameters per body surface area of children were nearly equivalent to those of adults obtained in other studies. Peak expiratory flow rate values obtained after application of HN-078 significantly increased in comparison to those obtained before application. No significant changes were observed in pulse rate or blood pressure, and no side effects were found with regard to the subjective symptoms and skin conditions.

CONCLUSIONS

These results suggest that the patch formulation of tulobuterol, HN-078, will be very useful for the treatment of pediatric asthma. It is especially significant that no side effects were observed.

Increase in respiratory resistance after exercise in conscious guinea pigs. As a model for exercise-induced asthma

We have developed an experimental model for exercise-induced asthma (EIA) using conscious guinea pigs. Respiratory resistance (Rrs) was measured before and after exercise (running). When a 0.05% lipopolysaccharide (LPS) was inhaled by guinea pigs which had been pretreated with a corticosteroid biosynthesis inhibitor metyrapone (50 mg/kg, i.v.), Rrs significantly increased 24 h after exercise. Metyrapone had no effect, however, on the LPS-induced increase in the numbers of macrophages, eosinophils, neutrophils and lymphocytes in bronchoalveolar lavage fluid (BALF). In order to examine the role of airway inflammation, the effects of murine recombinant interleukin-5 (mrIL-5) and platelet activating factor (PAF) were investigated in guinea pigs. The exercise-elicited increase in Rrs was observed 24 h later than the treatment with mrIL-5 in metyrapone-treated animals. The number of macrophages, eosinophils and neutrophils increased in the BALF of mrIL-5-treated animals. In contrast, a 0.05% PAF aerosol caused an increased number of eosinophils in BALF, but did not affect Rrs after exercise in either metyrapone-treated or non-treated animals. Moreover, to evaluate the value of this model as a pharmacological tool, the effect of ketotifen and prednisolone on the exercise-induced increase in Rrs was investigated. Prior administration of ketotifen and prednisolone showed a tendency to prevent, or clearly inhibited, the exercise-induced increase in Rrs in animals treated with the combination with LPS and metopyrone.

[On the antibacterial effect of hinokitiol against Staphylococcus aureus showing double zone phenomenon]

We studied the antibacterial effect of Hinokitiol against Staphylococcus aureus. As reference, we studied also the antibacterial effects of the oil and water from Thujopsis dolablata var. hondai Makino which contains Hinokitiol an important element of its antibacterial effect. Interestingly, Hinokitiol showed the double zone phenomenon, i.e., minimum inhibitory concentration of hinokitiol against MSSA was 15-125 micrograms/ml and against MSSA was 125 micrograms/ml. But when the concentration of Hinokitiol was diluted to 1.87-0.94 micrograms/ml, then the growth of MSSA was inhibited (Table 1 and Fig. 1). This phenomenon was observed the study on antibacterial effect using disk containing Hinokitiol (Fig/3). Similar phenomenon were observed also in the study using water from Thujopsis dolablata (Table 2 & Fig. 2). We deduce that Hinokitiol has a strong antibacterial effect against S. aureus. But this effect shows double zone effect. The antibacterial effect of Hinokitiol is more prominent against MRSA than MSSA.

[A comparative evaluation of three commercially available peak flowmeters before and after being used 1000 times]

The differences in values, accuracy, reproducibility and interdevice variability of three models of portable peak flowmeters (standard and low range of Assess, mini-Wright, Pulmo-Graph) before use and after they had been used 1000 times. A computerized standard flow generator was used to evaluate. Standard range; The three models showed differences in values before and after 100 uses of less than 3 percent at flow rates below 480 L/min. However, the used flowmeters, especially the Assess, showed higher values compared with the new ones at higher flow ranges. There was no significant difference in accuracy between the new and used mini-Wright and Pulmo-Graph models. The used Assess, howevers, showed higher values at higher ranges, thus demonstrating improved accuracy over the new ones. The reproducibilities of the three models deteriorated at high flow rates. The interdevice variability of the used Pulmo-Graph flowmeter was better than that the new one. No significant changes were observed in the mini-Wright, while the Assess showed deteriorated interdevice variability. Low range; The three models showed no significant differences in values, accuracy, reproducibility or interdevice variability before and after use.

[Adrenocortical function in children with near fatal asthma]

The adrenal function of children with near fatal asthma was evaluated by a modified rapid ACTH test. The rapid ACTH tests, which were performed within six months of each life-threatening asthmatic episode, showed extremely low responsiveness. The response in the subjects was significantly lower than that of patients who had received high dose of corticosteroid therapy. It was suggested that the adrenocortical function of children with near fatal asthma had been already suppressed and that adrenal suppression could easily occur in such patients. We advocate the following measures: (1) environmental control, education of patients and their families, physical training accurate medication should be supplied to reduce the use of corticosteroids, (2) sufficient doses of corticosteroids should, however be given to patients with acute exacerbation, (3) not only lung function tests or allergic examinations, but also adrenocortical function tests should be performed on severe asthmatic patients.

Histamine and tryptase levels in allergic conjunctivitis and vernal keratoconjunctivitis

Tryptase is useful as a specific and accurate indicator of mast cell activation, whereas histamine, a mast cell's major mediator, also exists in basophils. The aim of this study is to investigate histamine and tryptase levels in allergic conjunctiva. We measured histamine and tryptase levels in conjunctival epithelial cell suspension of children with allergic conjunctivitis (AC) and vernal kerato-conjunctivitis (VKC), and controls, and we evaluated correlations with clinical observations. Both the histamine and tryptase levels in VKC were significantly higher than controls (p < 0.05, p < 0.01), and histamine levels in VKC was also greater than AC (p < 0.05). The histamine/tryptase (H/T) ratios were 0.03 +/- 0.04 in AC, 0.08 +/- 0.09 in VKC and 0.006 +/- 0.006 in controls. The H/T ratios in VKC were significantly higher than controls (p < 0.05) and AC (p < 0.05), and were also found to correlate with the superficial punctate keratopathy (SPK) score (r2 = 0.89). Analyzing the histamine and tryptase levels in conjunctival epithelium may be useful in evaluating the allergic ocular surface, especially in the cases with SPK, where the increase in the histamine levels is not accompanied by an increase in tryptase levels. This suggests an important role for inflammatory cells such as basophils infiltrating into the conjunctival epithelium in allergic reactions.

[Changes in histamine levels in skin chambers. Application for clinical evaluation of atopic dermatitis--report 2]

We measured changes in histamine levels in fluids from children with moderate or severe atopic dermatitis by the skin chamber method and evaluated the correlation with clinical symptoms. Skin chambers were applied to the forearm skin which had been scratched with a needle, and extract of Dermatophagoides farinae (mite antigen) at 50 microns filters as a challenge. We measured the concentrations of histamine 2, 6, 12 and 24 hr after challenge. The skin chamber test was performed before and after beach camp therapy or hospitalization therapy. We treated 26 children with beach camp therapy, and compared the effects with hospitalization in Tokyo (20 children). All the children in both groups showed results of mediator releasability in skin chamber was different in the two groups. The histamine levels were dramatically increased 24 hr after challenge with mite antigen. The levels of histamine in the chambers 24 hr after challenge decreased with treatment along with improvements in skin condition. A marked increase in histamine levels in the skin chamber fluids was observed after 24 hours, whereas no increase was observed when they were challenged with vehicle saline. After 7 days of beach camp therapy, challenge with mite antigen produced only a very small increase in histamine levels even after 24 hours, which was significantly lower than the levels before therapy. In the cases involving hospitalization in Tokyo, histamine was observed to be increased at 24 hr (24.9 +/- 8.0 ng/ml SEM), similarly to the beach campgroup (19.0 +/- 7.3 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

[An evaluation of three commercially available peak flowmeters]

The accuracy, reproducibility and interdevice variability of three models of portable peak flowmeters (standard and low range) were evaluated by using a computerized standard flow generator. Standard range; The mini-Wright peak flow meter generally overestimated peak flow from 120 L/min to 540 L/min and the Assess peak flowmeter underestimated peak flow at full range. The Pulmo-Graph peak flowmeter showed a similar pattern to the mini-Wright but with more accuracy. The Assess showed the best linearity. The reproducibilities of the three models deteriorated over 20 L/min at high flow rates. The interdevice variability of the mini-Wright was better than those of the Assess or the Pulmo-Graph. Low range: The accuracy and interdevice variability of the Pulmo-Graph were better than those of the Assess or the mini-Wright. The reproducibility of Assess seemed to be inferior to the other's. The measured flow from the low ranges was not the same as that of the standard ranges. The three peak flowmeter models have different spring mechanisms for their readings, and the measured flows by one model should not be compared with other models.

[Three cases of typical cryptomeria pollen asthma]

We treated three asthmatic children diagnosed as typical cryptomeria pollen asthma (Cryptomeria japonica). Wheezing started from one to four years after onset of pollinosis. Asthmatic attacks occurred one or several days after pollen counts increased. We could find asthmatic attacks in the years when the pollen counts were higher than in average years. In the laboratory findings, only specific IgE antibody to cryptomeria with its high titer of over 17.5 PRU/ml was detected in these three cases. Allergen inhalation tests were performed with positive results in the two cases, suggesting that these three cases were typical child cryptomeria pollen asthma.

Comparison of bronchial reactivity to ultrasonically nebulized distilled water, exercise and methacholine challenge test in asthmatic children

We studied the responses to ultrasonically nebulized distilled water (UNDW) challenge, exercise challenge and methacholine challenge in asthmatic children. Fifty-four asthmatic and fourteen nonasthmatic control children participated in this study. The UNDW inhalation test was by the methodology described by Anderson. The average output of water was approximately 3.0 mL/min (SD = .1) and inhalation times were 30 seconds, one minute, two minutes and four minutes. Some subjects performed exercise challenge on a bicycle ergometer and methacholine challenge by an Astrograph technique. Twenty-three of 54 asthmatic patients (42.6%) and none of the controls showed a fall in FEV1 greater than 20% with UNDW challenge. The fall in FEV1 with UNDW correlated with that induced by exercise challenge (r = .89) and Log Dmin, which may reflect bronchial sensitivity (r = .70). Our method is not sensitive enough for detecting bronchial hyperresponsiveness in all asthmatic children. Bronchoconstriction induced by UNDW has a similar mechanism of action as exercise and methacholine.

[Does clinical stage have any influence on the results of provocation tests in allergic children? I. The best clinical stage for food provocation tests]

To investigate the best clinical stage for food provocation tests, twenty allergic patients who had early allergic reactions induced by any kind of food were tested. The patients were classified into two groups. Group I; open-food challenge tests were performed on eleven patients within 48 hours of admission. Group II; the tests were performed on nine patients seven or more days after admission. In these food provocation tests, there were nine positive results in Group II (p < 0.05). The percentage of eosinophils in the blood was higher in cases of positive provocation than in cases of negative provocation (p < 0.05). Moreover the percentage of eosinophils decreased after admission day by day in the provocation-negative patients of Group II, but there was no change in the provocation-positive patients. These results suggest that individual sensitivity to food decreased after admission. Therefore, in order to assess the actual sensitivity of allergic children it is necessary that food provocation tests be performed within two days of admission or before admission.

Ultrastructural analysis of peripheral eosinophils in children with bronchial hyperresponsiveness

To investigate the condition of peripheral eosinophils in patients with bronchial hyperresponsiveness, we examined density distribution profiles and ultrastructure of peripheral eosinophils obtained before and after exercise challenge test. Following exercise challenge test, the number of hypodense eosinophils (< 1.0825 g/ml) was significantly higher in the EIA-positive than in the EIA-negative subjects. Regarding ultrastructural analysis, the ratio of the area of specific granules to the area of cytoplasm (SG/C) per cell was significantly higher in the EIA-negative than in the EIA-positive patients. The ratio of the degranulated area to the area of cytoplasm (D/C) per cell was significantly higher in the EIA-positive than in the EIA-negative subjects. These data suggested that activation of eosinophils in the patients with bronchial hyperresponsiveness occurs during the preinflammatory phase.

[Dermal reactions in children with atopic dermatitis--changes in histamine/tryptase levels in skin chambers. Report 1]

In the present study, we used the skin chamber method to determine histamine and tryptase released by continuous loading of a single antigen on the skin in order to evaluate dermal reactions produced and thereby obtain greater insight into the role of type I allergic reactions in children with atopic dermatitis. The subjects were 46 children, 23 males and 23 females aged 10.6 +/- 4.3 years on the average, who were being treated at the National Children's Hospital for moderate or severer atopic dermatitis. Mite antigen stimulation was carried out by the skin chamber method upon admission and histamine and tryptase levels in collected antigen solution were determined. Histamine levels in the chamber were increased significantly at 6, 12 and 24 hrs after stimulation compared to the control levels (p < 0.01). Tryptase levels were increased 2 hrs after stimulation but decreased with time thereafter. Histamine and tryptase levels were significantly correlated 2 hrs after stimulation, with a correlation coefficient of 0.954 (p < 0.01). No significant correlation was observed 24 hrs after stimulation. These findings indicate that children with severe atopic dermatitis have great skin reactivity and very sensitive to stimulation by antigens. Mast cells and basophils are thought to be involved in immediate and delayed type reactions, respectively.

[A comparison of two delivery devices on the bronchodilatory effects of procaterol from a metered dose inhaler]

The bronchodilatory response to procaterol delivery by a metered dose inhaler with a spacer device (Volumatic) and a corniced extension tube was studied in a double blind manner in 18 asthmatic children, who were brought to our emergency room with acute attacks. The mean percent increase in forced expiratory volume in 1 second (FEV1) with the Volumatic was 55.6 +/- 39.3%, and 46.2 +/- 37.4% with the extension tube. There were no significant differences in the mean percent increase in FEV1, forced vital capacity (FVC), maximal flow rate at 50% of vital capacity (V50), maximal flow rate at 25% of vital capacity (V25) and peak expiratory flow rate (PEFR) between the two devices. It is concluded that there is no difference in the bronchodilatory effects of the two devices. The corniced extension tube has the advantage of being less expensive and more convenient to carry around.

[The influence of indoor environmental factors on the onset of allergic disease]

To predict and prevent the onset of allergic diseases, we studied the effects of indoor environmental factors, such as diet, on pregnant women and carried out follow-up studies on their infants. Blood samples were collected at random from women who were diagnosed as pregnant (n = 2045). Umbilical cord blood was collected at delivery (n = 1453). To evaluate the efficacy of food guidance, the pregnant women were divided into two groups--one receiving simple diet guidance starting in the later stages of pregnancy, and one receiving no guidance whatsoever. A follow-up survey on allergic symptoms was done on their two-year-old infants, revealing a lower incidence of symptomatic manifestations in the diet guidance group (p < 0.001). Respiratory symptoms (p < 0.05) were associated with maternal smoking and outside work during pregnancy. A study on food guidance in combination with environmental factors revealed that the incidence of respiratory symptoms in two-year-old infants whose mothers received diet guidance in a good indoor environment was held down to around 36.1%, while the incidence in infants whose mothers received diet guidance in a poor indoor environment was 48.1%.