Nonadrenergic inhibitory nervous systems in the airways

Afferent properties and reflex functions of bronchopulmonary C-fibers

Bronchopulmonary C-fiber afferents are characterized by their distinct sensitivity to chemical stimuli in the airways or pulmonary circulation. Responses evoked by activating these afferents are mediated by both central reflex pathways and by local or axon reflexes involving the release of tachykinins from sensory endings. Bronchopulmonary C-fiber stimulation reflexly reduces tidal volume and increases respiratory rate, constricts the airways, increases mucus secretion in the airways, and is associated with coughing. Cardiovascular effects include bradycardia, a fall in cardiac output, and bronchial vasodilation that increases airway blood flow despite systemic hypotension. In animals, C-fiber stimulation inhibits skeletal muscle activity, and in humans, is accompanied by burning and choking sensations in the throat and upper chest. Recent studies have identified additional physiologic and pharmacologic stimuli to these afferents, such as hydrogen ions, adenosine, reactive oxygen species, and hyperosmotic solutions. Furthermore, increasing evidence indicates that the excitability of these afferents is enhanced by the local release of certain autocoids (e.g. PGE2) during airway inflammation. These findings further indicate that vagal C-fiber endings in the lungs and airways play an important role in regulating the cardiopulmonary functions under both normal and abnormal physiologic conditions.

Neural mechanisms and axon reflexes in asthma. Where are we?

For many years, asthma has been classified as a "neural" disease, with an imbalance between constrictor and dilator nerves being responsible for the symptomatology. Although, nowadays, asthma is recognized as an inflammatory disorder of the airways, neural mechanisms remain very important; axon reflexes, in particular, have received a lot of attention in recent years. In this commentary, an overview is given on the innervation of the airways and its relevance in asthma, and potential new insights in airways innervation are discussed. In a second part, the role of axon reflexes is highlighted. Although neuropeptides such as substance P and neurokinin A are present in human airways, where they produce many of the features characteristic of asthma, and although there is an elevation of their content in induced sputum from asthmatics, there is still no clear direct evidence for the existence of operational axon reflexes in human airways. Most of the research focused on this subject is performed in guinea pigs, where such an axon reflex clearly operates in the airways. In these animals, different receptors have been identified on C-fiber endings, which, upon stimulation, cause inhibition of neuropeptide release. Some of these receptors have also been identified on human airway nerves. Therefore, it has been suggested that modulation of axon reflexes could be of potential benefit in asthma treatment. Indeed, some drugs (e.g. sodium cromoglycate, nedocromil sodium, and ketotifen), which have been demonstrated to partially inhibit neuropeptide release in guinea pig airways, have anti-inflammatory effects on neuropeptide release in guinea pig airways, do not seem to have any anti-inflammatory effects in human asthma. Other drugs, however, such as beta2-mimetics, which have a much more pronounced inhibitory effect in asthma. In conclusion, although there is a lot of indirect evidence for the existence of axon reflex mechanisms in human airways, most of the data now available are derived from animal studies. The key question of whether axon reflexes are operational in human airways remains unanswered. Hopefully, the near future will bring a solution to this enigma with the introduction of very potent tachykinin antagonists for the treatment of human asthma.

Interleukin-1 beta stimulates the proliferation of cultured airway smooth muscle cells via platelet-derived growth factor

Bronchoalveolar lavage fluid from symptomatic asthmatics contains elevated levels of several proinflammatory interleukins including interleukin-1 beta (IL-1 beta). Biologic activities of IL-1 beta are considered to be critical in the inflammatory process. Since these characteristics include mitogenic properties, we investigated the effect of IL-1 beta on the proliferation of airway smooth muscle (ASM) cells isolated from guinea pig tracheas. Primary tissue culture of ASM cells was maintained in media containing 0%, 1%, or 10% fetal bovine serum (FBS). Cultures were exposed up to 6 days to human recombinant IL-1 beta (20, 40, or 100 pg/ml) in the presence or absence of indomethacin. The proliferation of ASM cells was assessed with two techniques: a direct counting of cells with a hemocytometer and/or with a [3H]-thymidine incorporation, an established marker of DNA synthesis. The evaluation was done daily, up to the sixth day after exposure of cells to different doses of IL-1 beta. We found that the exposure of ASM cells to human recombinant IL-1 beta significantly (P < 0.01) increased the number of tracheal myocytes as well as the [3H]-thymidine incorporation into ASM cells. These changes were dependent upon the dose of IL-1 beta and the concentration of FBS in the cultured medium. The most active proliferation of ASM cells was observed in medium containing 1% FBS, indomethacin (1 microgram/ml), and IL-1 beta (100 pg/ml). The presence of indomethacin in the culture medium was essential to demonstrate the proliferative effect of IL-1 beta.(ABSTRACT TRUNCATED AT 250 WORDS)

Elevated release of tumor necrosis factor-alpha and interferon-gamma by bronchoalveolar leukocytes from patients with bronchial asthma

Bronchoalveolar lavage (BAL) leukocyte-secreted cytokines are considered to be important mediators of the inflammatory and allergic reactions in the lung. This study examines quantitative changes in the level of tumor necrosis factor-alpha (TNF alpha) and interferon-gamma (IFN gamma) production in BAL cell cultures derived from patients (n = 11) with bronchial asthma. The secretion of TNF alpha and IFN gamma was determined in intact (unstimulated) and phytohemagglutinin/phorbol myristate acetate (PHA + PMA)-stimulated BAL leukocyte cultures and compared with that in control cultures. In all patients studied, the background and PHA + PMA-induced secretion of TNF alpha and IFN gamma was significantly (p < 0.001) higher than that in parallel control cultures. In contrast to BAL cell preparations, the capacity of TNF alpha and IFN gamma secretion by patients' peripheral blood mononuclear cells (PBMC) did not differ from that of control subjects. High spontaneous release of TNF alpha and IFN gamma by patients' BAL leukocytes, but not PBMC, suggest that in the pathophysiology of bronchial asthma, these cytokines may act as local pathogenic agents in the lung.