ABSTRACT
BACKGROUND: Leukotriene B4 (LTB4), a potent chemokinetic mediator for neutrophils, is enhanced by interleukin-8 (IL-8) and may play a key role in the inflammatory response of asthma. OBJECTIVE: The aim of the present study was to investigate whether zileuton, a 5-lipoxygenase antagonist known to inhibit LTB4 production and recruitment of eosinophils/neutrophils in bronchoalveolar fluid, could affect the production of LTB4 and IL-8 by allergen-stimulated peripheral blood mononuclear cells in vitro from patients with asthma and/or allergic rhinitis. METHODS: Peripheral blood mononuclear cells were isolated using Ficoll-Hypaque density gradient from 14 subjects (2 with asthma, 11 with asthma and allergic rhinitis, and 1 with allergic rhinitis) and were stimulated by selected allergens (grass, tree, mite, and mold) in the absence or presence of 1 and 10 microM of zileuton. Supernatants were collected and assayed for LTB4 and IL-8 levels using RIA and ELISA, respectively. RESULTS: Levels of LTB4 were significantly elevated in peripheral blood mononuclear cells stimulated with mold, grass, and tree compared with the unstimulated control group (P<.05). Levels of IL-8 were significantly elevated in all allergen-stimulated peripheral blood mononuclear cells, except mold, compared with the unstimulated control group (P<.05). Zileuton significantly reduced production of LTB4 by mold and tree-stimulated peripheral blood mononuclear cells. By contrast, no effect of zileuton on IL-8 production was observed in allergen-stimulated peripheral blood mononuclear cells. CONCLUSIONS: The zileuton-induced attenuation of LTB4 production by allergen-stimulated peripheral blood mononuclear cells from patients with asthma and/or allergic rhinitis occurs independently from the allergen-stimulated IL-8 production.
Subject(s)
Asthma/metabolism , Hydroxyurea/analogs & derivatives , Interleukin-8/metabolism , Leukotriene B4/metabolism , Lipoxygenase Inhibitors/pharmacology , Rhinitis, Allergic, Perennial/metabolism , Rhinitis, Allergic, Seasonal/metabolism , Adult , Aged , Allergens/pharmacology , Female , Humans , Hydroxyurea/pharmacology , Leukocytes, Mononuclear/metabolism , Male , Middle AgedABSTRACT
BACKGROUND: Nitric oxide (NO), a reactive free radical synthesized from L-arginine by the enzyme NO synthase (NOS), may play a role in many pathophysiologic conditions, including asthma. OBJECTIVE: The aim of this study was to investigate whether peripheral blood mononuclear cells (PBMCs) from asthmatics would spontaneously produce NO. A second objective was to ascertain whether commonly used asthma medications would modulate the production of NO. METHODS: PBMCs were isolated from 24 subjects (10 with asthma, 4 with allergic rhinitis and 10 healthy controls) and were incubated either alone or in the presence of an RNA polymerase inhibitor (actinomycin D, 1 microg/mL), a NOS inhibitor (L-NG-nitroarginine methyl ester [L-NAME], 1 mM), and L-NAME plus L-arginine (5 mM). Furthermore, PBMCs were incubated with or without addition of therapeutic concentrations of hydrocortisone (15 microg/mL), theophylline (15 microg/mL), albuterol (15 microg/mL) and ipratropium bromide (12 microg/mL). Culture supernatants were collected and assayed for NO production. RESULTS: NO production was significantly elevated in asthmatics compared with the control group (1.39+/-0.21 microM versus 0.46+/-0.01 microM; P < .05). L-NAME significantly reduced NO production in asthmatics (0.83+/-0.06 microM; P < .05), an effect completely reversed by L-arginine. Theophylline blocked NO production in asthmatics (1.39+/-0.21 microM to 0.92+/-0.11; P < .05). There was no significant effect with any of the other medications. CONCLUSION: This study suggests that theophylline may be antiinflammatory by inhibiting the L-arginine-dependent production of NO in patients with asthma.
Subject(s)
Anti-Inflammatory Agents/pharmacology , Asthma/drug therapy , Leukocytes, Mononuclear/metabolism , Nitric Oxide/biosynthesis , Theophylline/pharmacology , Adult , Asthma/metabolism , Female , Humans , Male , Middle Aged , Theophylline/therapeutic useABSTRACT
BACKGROUND: We describe a child and an adult infected with the human immunodeficiency virus (HIV) who developed cerebral lesions consistent with toxoplasmosis. A biopsy in the child and IgG ELISA in both patients confirmed the diagnosis of Toxoplasma gondii. The patients were initially treated with pyrimethamine, however, computerized tomography studies (CT scan) revealed progression of a left frontal and temporoparietal lesion. Therapy in the child was changed to pyrimethamine, clindamycin, and azithromycin. Repeat CT scan showed further disease progression and therapy was changed to high-dose pyrimethamine (3 mg/kg/d) and azithromycin. A subsequent CT scan disclosed further radiologic progression with increasing edema. The adult patient developed a maculopapular rash during attempted treatment with pyrimethamine. METHODS: Introduction of 2 (trans-4[4 chlorophenol] cyclohexy[3-hydroxy-1, 4 naphthoquinone] (HNPQ) an experimental antiparasitic compound previously used only in adult HIV clinical trials, was instituted in the child and rapid oral desensitization to pyrimethamine was initiated in the adult patient. RESULTS: HNPQ resulted in resolution of the cerebral lesion in the child and rapid oral desensitization to pyrimethamine produced an excellent clinical response in the adult. To our knowledge, these are the first cases of childhood and adult cerebral toxoplasmosis treated successfully with HNPQ and rapid oral desensitization to pyrimethamine. CONCLUSION: HNPQ and pyrimethamine desensitization should be considered as alternate modes of therapy in patients who become intolerant or fail to respond to traditional therapy for toxoplasmosis.
