Cough reflex sensitivity in adolescents with diabetic autonomic neuropathy.

OBJECTIVE: Diabetic autonomic neuropathy (DAN) is one of the chronic complications of diabetes mellitus which can involve one or more organ systems. DAN without apparent symptoms is more often in childhood and adolescence. While heart rate variability (HRV) and Ewing's battery of cardiovascular tests are regarded as a gold standard for the diagnosis of DAN, the examination of cough reflex sensitivity (CRS) is another possibility. The aim of this study was to compare HRV and CRS in children with diabetes mellitus. MATERIAL AND METHODS: Sixty one patients (37 girls, 24 boys) aged 15-19 suffering from diabetes mellitus type 1 completed the study. Based on HRV, patients were divided into 2 groups - with DAN (n=25) and without DAN (n=32), 4 patients were excluded because of ambiguous results. CRS was studied in each patient by inhalation of gradually increasing concentration of capsaicin. RESULTS: Subjects with DAN required a significantly higher concentration of capsaicin needed to evoke 2 coughs (median 625 micromol/l, IQR 68.4-625.0 micromol/l vs. median 29.3 micromol/l, IQR 9.8-156.3 micromol/l, P<0.001) and 5 coughs (median 2500.0 micromol/l, IQR 1250.0-2500.0 micromol/l vs. median 312.5 micromol/l, IQR 117.2-625.0 micromol/l, P<0.001) compared with those without DAN. Moreover, a strong negative correlation between HRV and CRS was established. CONCLUSION: Diabetes mellitus lowers the cough response. Cough reflex sensitivity appears to be another sensitive method for the evaluation of DAN in diabetes.

Cough reflex sensitivity in various phenotypes of childhood asthma.

Cough is a major symptom in some children with asthma, but the relationship between cough and the severity of asthma is defined insufficiently. As cough represents common problem of pediatrics, several objective methods for its assessment were developed. Cough reflex sensitivity (CRS) test with capsaicin is one of the most important tools for studying cough. In the present study, we aimed to study the CRS in various phenotypes of childhood asthma. We found that, in general, CRS was increased in asthmatic children compared with controls. The most evident increase of CRS was observed during acute asthma exacerbation, in children suffering from asthma with concomitant allergic rhinitis, and in atopic asthmatics. Interestingly, we noted a significant decline in lung function after capsaicin CRS. Various laboratory and clinical characteristics of asthmatic children influence cough sensitivity to a different extent. Cough reflex sensitivity measurement can add valuable information beside the commonly used spirometric and inflammometric methods in the management of asthmatic children.

Carvedilol--a beta-blocker with considerable antiaggregatory effect on human blood platelets.

BACKGROUND: Activated blood platelets play a key role in the genesis of many pathological states. Several studies have documented that beta-blockers can influence platelet aggregation. Carvedilol, a third generation non-selective agent with vasodilatory properties, is successfully used in pathological states accompanied with platelet hyperreactivity, however information on its antiplatelet activity is lacking. OBJECTIVES: The aim of this study was to analyse the in vitro effect of carvedilol on aggregation of human blood platelets, to compare this effect with the effect of propranolol and atenolol, and to determine whether its suggested antiaggregatory effect was accompanied with reduced thromboxane B2 formation. Moreover, some physico-chemical parameters of the drugs tested were calculated and compared. METHODS: Platelets were isolated by differential centrifugation and platelet aggregation was measured by the turbidimetric method. The amount of thromboxane B2 was measured by the radioimmunoassay method. Physico-chemical parameters of the drugs tested were calculated using the computer programme Hyperchem. RESULTS: Carvedilol and propranolol inhibited platelet aggregation in the rank order of stimuli: PMA > thrombin > A23187 > epinephrine. The reduction was accompanied by inhibition of thromboxane B2 formation. In comparison to propranolol, carvedilol was more effective, with the exception for aggregation stimulated with ADP. Atenolol did not affect any platelet function tested. From the drugs studied, the molecule of carvedilol was found to possess the highest partition coefficient, the highest index of molar refractivity, and the lowest dipole moment. CONCLUSION: Our study found carvedilol to be more potent than propranolol and atenolol in inhibiting platelet aggregation and thromboxane B2 production. This may be due to the different structure and more convenient physico-chemical parameters of the carvedilol molecule.

Blood platelets decrease concentration of reactive oxygen species produced by polymorphonuclear leukocytes.

BACKGROUND: Reactive oxygen species produced by polymorphonuclear leukocytes (PMNL) participate substantially in vascular injury induced by ischaemia and reperfusion. Blood platelets, accumulated simultaneously with PMNL may modulate this process. OBJECTIVE: To compare effects of resting and completely stimulated platelets on PMNL-derived oxidants. METHODS: Autologous human platelets and PMNL were co-incubated in the physiological cell ratio 50:1, and the formation of reactive oxygen species was detected by luminol- and isoluminol-enhanced chemiluminescence methods. To compare effects of platelets at different degrees of their activation, FMLP (selective PMNL stimulus) and Ca2+-ionophore A23187 (activates both PMNL and platelets) were used as chemiluminescence stimuli. The liberation of serotonin from platelets was estimated fluorometrically. RESULTS: Both stimulated and non-stimulated platelets inhibited PMNL chemiluminescence. However, while the decreasing effect of resting platelets disappeared at increased extracellular peroxidase concentration, the inhibition of chemiluminescence by activated platelets became even more pronounced after the addition of peroxidase and was accompanied by liberation of serotonin. The concentrations of serotonin released from platelets were sufficiently high to inhibit PMNL chemiluminescence. CONCLUSION: The obtained data indicate that by interference of platelets with peroxidase liberation from PMNL and the scavenging effect of platelet serotonin, resting and stimulated platelets might be respectively operative in inhibiting chemiluminescence. Since the presence of blood platelets in the proximity of PMNL effectively decreased the concentration of reactive oxygen species, platelets may represent a unique protective mechanism, active only in case of emergency and selectively at sites exposed to toxic effects of reactive oxygen species. (Tab. 1, Fig. 4, Ref. 42.).

Antiplatelet activity of carvedilol in comparison to propranolol.

The non-selective vasodilating beta-blocker carvedilol was found to inhibit platelet aggregation as well as thromboxane B(2) formation more effectively than propranolol. The antiaggregatory activity of carvedilol decreased, depending on the stimulus used, in the following rank order of potency (in parentheses the respective mean inhibitory concentrations of carvedilol and propranolol are given in micromol/l): PMA (19 and 34) > thrombin (55 and 77) > Ca(2+)-ionophore A23187 (58 and 81) > epinephrine (86 and 118). However, aggregation of platelets activated with ADP was not affected by carvedilol in concentrations up to 100 micromol/l. In platelets stimulated with thrombin, carvedilol (10 micromol/l) reduced thromboxane B(2) formation by 64%, whereas propranolol was ineffective at this concentration. Moreover, A23187-induced formation of thromboxane B(2), not affected by propranolol, was completely blocked by 100 micromol/l carvedilol. In comparison to propranolol, the molecule of carvedilol is more lipophilic and possesses lower dipole moment and higher molar refractivity, thus penetrating into platelet membranes readily and in large quantities. The antiplatelet effect was assumed to result from interactions of carvedilol with membrane macromolecules (phospholipids, ion channels, enzymes, etc.) rather than from blockade of alpha- and beta-adrenergic receptors.

Monoclonal antibodies suitable for type-specific identification of herpes simplex viruses by a rapid culture assay.

Eight monoclonal antibodies (MAbs) to herpes simplex viruses 1 and/or 2 (HSV-1, HSV-2) were tested for their reactivity with 190 previously typed HSV-positive clinical specimens in order to determine their suitability for use as type-specific reagents. Using a rapid culture assay we found that two MAbs (T51 and T96) identified HSV-1 in all the 94 specimens, previously found HSV-1-positive, but did not react with the 96 specimens, previously found HSV-2-positive. In contrast, one MAb (303) confirmed the presence of HSV-2 in all the specimens, previously found HSV-2-positive, but did not react with any of the 94 specimens, previously found HSV-1-positive. These three type-specific MAbs allow for a rapid type-specific identification of HSV in infected cultures. One type-common MAb (T111) reacted with all HSV-positive cultures. This MAb can be used as an excellent reagent for detection of HSV infection.

Monoclonal antibodies to the distinct antigenic sites on glycoproteins C and B and their protective abilities in herpes simplex virus infection.

The relative importance of the humoral immune response to various antigenic sites on the glycoproteins C and B (gC, gB) of herpes simplex virus (HSV) was evaluated in BALB/c and DBA/2 mice passively immunized with monoclonal antibodies (MoAbs) and then challenged with lethal dose of infectious virus. Eight MoAbs to three topographically distinct antigenic sites on gC and eight MoAbs to two distinct antigenic sites on gB were selected. The results indicated that any antigenic site on gC and gB contains epitopes for the protective immunity. However, individual MoAbs to different epitopes of the same antigenic site (i.e. antigenic site III on gC, and antigenic site II on gB) varied extremely in their protective ability. The protection did not correlate with the virus neutralization in vitro whereas it correlated significantly with the immune cytolysis in the presence of complement. The information about protective epitopes is essential for understanding the immunology of HSV infection at molecular level and may have implications for the design of HSV vaccine.

Inhibition of blood platelet functions by cationic amphiphilic drugs in relation to their physico-chemical properties.

The effects of bromadryl, dithiaden, chloroquine and propranolol on thrombin-stimulated rat platelet aggregation (measured turbidimetrically) and thromboxane B2 generation (detected by an RIA method) were compared with four selected physico-chemical parameters of these drugs. Platelet aggregation was inhibited in the rank order of potency: bromadryl > dithiaden > propranolol > chloroquine, which corresponded with the decrease in the net charge of the terminal methyl-(or ethyl-) groups in the side chain and with the increase of the dipole moment of drug molecules. On the other hand, the rank order of potency in which the drugs tested inhibited thromboxane B2 formation (chloroquine > dithiaden > bromadryl > propranolol) correlated well with the decline in molar refractivity of the drugs. No relationship was found between inhibitory effects of drugs and their partition coefficients. The results presented indicate that inhibition of platelet functions might consist of several types of drug-cell interactions, depend on the structure and physico-chemical properties of the drugs and cannot be estimated simply on the basis of partition coefficients.

Modification of layered atelocollagen: enzymatic degradation and cytotoxicity evaluation.

Two kinds of layered atelocollagen materials cross-linked with hexamethylene diisocyanate (HMDIC), starch dialdehyde and glyoxal were enzymatically treated by bacterial collagenase. Evaluating collagenase digestion assay for these material showed progressive differences, particularly in the group of samples cross-linked with HMDIC. This should offer the possibility of programmed enzymatic degradation. These materials may be toxicologically acceptable as proven by the short-term test used for cytotoxicity evaluation.

Chloroquine inhibits stimulated platelets at the arachidonic acid pathway.

Chloroquine inhibited arachidonic acid liberation from membrane phospholipids of thrombin- and A23187- stimulated platelets. In addition, it dose-dependently inhibited stimulated malondialdehyde formation and thromboxane B2 generation in the same platelets. The linear correlation between the inhibition of arachidonic acid liberation and malondialdehyde formation indicated that chloroquine inhibited activated phospholipase A2 in thrombin-stimulated platelets, similarly as it does in different cells and tissues. Yet, the nonlinear relationship between arachidonic acid liberation along with malondialdehyde formation and thromboxane generation as well as aggregation suggest that phospholipase A2 does not seem to be the only site of chloroquine action. Rather, it may affect platelets either at other levels of the arachidonic acid cascade too, or at some different stimulatory pathways, like intraplatelet calcium mobilisation, phosphoinositide cycle, calmodulin and protein kinase C activation.

[The effect of antihistamines on stimulated blood platelet functions]. / Ovplyvnenie stimulovaných funkcií krvných dosticiek antihistaminikami.

The histamine receptor H1-antagonists of cationic amphiphilic drug (CAD) structure BromadrylR (BRO) and DithiadenR (DIT) were investigated on stimulated functions of blood platelets in vitro. Both drugs dose-dependently decreased platelet aggregation. BRO significantly decreased aggregation in concentrations of 20 and 200 mumol/l in thrombin and ADP stimulated platelets, respectively. DIT was 10 times less active as compared with BRO. A dose-dependent inhibitory effect of BRO and DIT was demonstrated on thrombin stimulated production of malondialdehyde (MDA) and thromboxane (TXB2) generation in platelets. A significant decrease in MDA production and TXB2 generation was measured with BRO and DIT in 10 mumol/l concentration. Results showed that the antihistaminic drugs BRO and DIT inhibited stimulated aggregation in relation to membrane phospholipid peroxidation and arachidonic cascade activation in platelets. These data, along with results from studies on the effect of other CAD on platelets, revealed that antihistaminic drugs interfere with stimulated aggregation by inhibiting phospholipase A2 rather than the intraplatelet histamine receptor.

Effect of the antihistaminic drug Bromadryl on ex vivo platelet functions during gestation in rats.

The effect of the antihistaminic drug Bromadryl on stimulated platelet aggregation was studied in pregnant rats. Bromadryl was administered orally in doses 1, 5 and 10 mg/kg from day 2 to day 19 of gestation. On day 20 of gestation blood samples were taken and the aggregation of platelets was measured after stimulation with 9 different concentrations of ADP in the concentration range 0.2 to 100 mumol/l. During gestation, platelet aggregation was significantly increased in comparison to non-pregnant controls. This was indicated in pregnant rats by the increased maximum amplitude of the aggregation curve as well as by the decreased mean effective concentration of ADP. The treatment of dams with Bromadryl during pregnancy resulted in decreased platelet aggregation. The dose-dependent inhibitory effect of the drug was more pronounced at higher stimulus concentrations. The presented results confirmed the antiplatelet activity of Bromadryl observed previously in vitro.

Antihistaminic drug bromadryl and stimulated platelet aggregation.

The H1-receptor antagonist bromadryl dose-dependently inhibited stimulated rat platelet aggregation in vitro. Bromadryl was 10 times more effective on the secondary aggregation of thrombin-stimulated platelets compared with its inhibition of ADP-stimulated primary platelet aggregation in plasma. The inhibition of aggregation was accompanied by a dose-dependent inhibition of thrombin-stimulated malondialdehyde formation and thromboxane B2 production. The results indicate that bromadryl may interfere intracellularly with membrane phospholipid peroxidation and the arachidonic acid metabolism of stimulated platelets. Bromadryl, like other cationic amphiphilic drugs, may inhibit stimulated platelet functions by decreasing the stimulus-induced activation of phospholipase A2. Our results support the possible interference of bromadryl with histamine as an intraplatelet messenger responsible for aggregation.

On the inhibitory effect of chloroquine on blood platelet aggregation.

Chloroquine inhibited aggregation of rat blood platelets in a dose-dependent way. The inhibitory effect decreased, depending on the aggregation stimulus used, in the rank order of potency: ADP > thrombin > A23187. Effect of 1 millimolar chloroquine on A23187-stimulated aggregation was significantly decreased or completely abolished by addition of Ca2+ ions in the concentration of 0.1 or 1 mmol/l, respectively. For thrombin-stimulated aggregation the effect of chloroquine was partially decreased by corresponding isomolar calcium; platelet aggregation induced by ADP was not changed in the presence of extracellular Ca2+ ions. Addition of chloroquine during aggregation resulted in disaggregation of ADP-stimulated platelets and inhibition of thrombin- and A23187-induced aggregation.

The role of intracellular calcium in A-23187 stimulated and beta-adrenoceptor blocking drug treated blood platelets.

A significant concentration-dependent difference was found between beta-adrenoceptor blocking drugs in their ability to inhibit A23187-induced isolated platelet aggregation. In the absence of extracellular calcium ions the following rank order of potency to inhibit calcium ionophore stimulated platelet aggregation was shown: propranolol > bevantolol > alprenolol > metipranolol > oxprenolol > atenolol > pindolol > metoprolol approximately sotalol approximately practolol. The interruption of induced aggregation, as well as inhibition of aggregation, in the absence of extracellular calcium ions indicated interference of inhibitory beta-adrenoceptor blocking drugs with intramembrane or intraplatelet calcium pools activated with A23187. This suggestion was supported by the reversal of the inhibitory effect of beta-adrenoceptor blocking drugs in the presence of extracellular calcium ions. The effect was dose dependent and occurred within 30 sec after calcium administration. The results indicated that inhibitory beta-adrenoceptor blocking drugs, possessing a cationic amphiphilic structure, suppressed calcium mobilization in A23187-stimulated platelets, most probably after entering platelets. This explains why lipophilic drugs are more effective than hydrophilic ones in calcium ionophore A23187-stimulated platelets.