Search

Objectives Small molecule tyrosine kinase inhibitors [smTKI, comprising mostly of Janus kinase (JAK) and to a lesser extent, spleen tyrosine kinase (SyK) inhibitors] modulate the cytokine receptor-mediated intracellular signal cascade, and are an effective treatment for autoimmune diseases and malignancies. As smTKI are novel, long-term safety is uncertain. Due to increasing use, characterization of their true adverse event profile is critical. Methods We performed a systematic review and meta-analysis of all published trial data on the pulmonary and serious adverse effects of smTKIs in autoimmune disease. EMBASE, MEDLINE, CENTRAL and Pneumotox databases were searched up to April 2019 for randomized controlled trials, observational studies and post marketing surveillance, comparing any smTKI with placebo or another therapy, or as monotherapy at different doses. Primary outcomes comprised of any respiratory complications including upper and lower respiratory tract infections (URTI, LRTI), influenza, pneumonia, opportunistic respiratory infections, drug-induced interstitial lung disease, pulmonary embolism and lung neoplasm. Results We identified 4667 citations for screening, and selected 319 studies for full text review. Seventy-nine studies were analysed, including 47 randomized controlled trials, 25 observational studies and seven post-marketing surveillance studies, comprising 159 652 participants. There were significantly increased risks of URTI [risk difference (RD) 0.03; 95% CI: 0.01, 0.05; P  = 0.00; 36 studies, 14 724 participants], LRTI (RD 0.01; 95% CI: 0.00, 0.02; P  = 0.02; 24 studies, 12 302 participants), influenza (RD 0.01; 95% CI: 0.00, 0.01; P  = 0.04; 22 studies, 10 684 participants), and pneumonia (RD 0.00; 95% CI: 0.00, 0.01; P  = 0.02; 33 studies, 15 511 participants). No increased risk was found for other respiratory complications, including pulmonary embolism. Conclusion SmTKI increases the risk of non-opportunistic respiratory infections compared with placebo. The risk of any serious pulmonary adverse events is low. [ABSTRACT FROM AUTHOR]

Many constituents of tobacco smoke (TS) require bioactivation to exert toxic effects; however, few studies have examined the role of bioactivation enzymes in the adverse effects of TS exposure. This knowledge gap is a major source of uncertainty for risk assessment and chemoprevention efforts. Our aim is to test the hypothesis that cytochrome P450 (P450) enzyme-mediated bioactivation is essential to the development of TS exposure-induced lung toxicity, by determining the contributions of P450 enzymes in the mouse Cyp2abfgs gene subfamilies to environmental tobacco smoke (ETS)-induced lung inflammation. Adult female wildtype (WT) and Cyp2abfgs -null mice (both on C57BL/6J background) were exposed to filtered air or ETS, intermittently, for 1 or 2 weeks. Lung inflammation was assessed by quantification of inflammatory cells, cytokines, chemokines, and proteins in bronchoalveolar lavage fluid (BALF) and histopathological analysis. Glutathione (GSH) conjugates of 2 ETS constituents, naphthalene (NA), and 3-methylindole (3MI), were measured in mice exposed to ETS for 4 h. Persistent macrophagic and neutrophilic lung inflammation was observed in ETS-exposed WT mice; the extent of which was significantly reduced in ETS-exposed Cyp2abfgs -null mice. Levels of proinflammatory cytokines and chemokines, along with the total protein concentration, were increased in cell-free BALF from ETS-exposed WT mice, but not Cyp2abfgs -null mice. Additionally, GSH conjugates of NA and 3MI were detected in the lungs of WT, but not Cyp2abfgs -null, mice following ETS exposure. These results provide the first in vivo evidence that the mouse Cyp2abfgs gene cluster plays an important role in ETS-induced lung inflammation. [ABSTRACT FROM AUTHOR]

Inhalation of waterproofing spray products has on several occasions caused lung damage, which in some cases was fatal. The present study aims to elucidate the mechanism of action of a nanofilm spray product, which has been shown to possess unusual toxic effects, including an extremely steep concentration-effect curve. The nanofilm product is intended for application on non-absorbing flooring materials and contains perfluorosiloxane as the active film-forming component. The toxicological effects and their underlying mechanisms of this product were studied using a mouse inhalation model, by in vitro techniques and by identification of the binding interaction. Inhalation of the aerosolized product gave rise to increased airway resistance in the mice, as evident from the decreased expiratory flow rate. The toxic effect of the waterproofing spray product included interaction with the pulmonary surfactants. More specifically, the active film-forming components in the spray product, perfluorinated siloxanes, inhibited the function of the lung surfactant due to non-covalent interaction with surfactant protein B, a component which is crucial for the stability and persistence of the lung surfactant film during respiration. The active film-forming component used in the present spray product is also found in several other products on the market. Hence, it may be expected that these products may have a toxicity similar to the waterproofing product studied here. Elucidation of the toxicological mechanism and identification of toxicological targets are important to perform rational and cost-effective toxicological studies. Thus, because the pulmonary surfactant system appears to be an important toxicological target for waterproofing spray products, study of surfactant inhibition could be included in toxicological assessment of this group of consumer products. [ABSTRACT FROM PUBLISHER]

OBJECTIVES Isolated lung perfusion with gemcitabine is an effective technique for the treatment of lung metastases in an experimental model. In clinical studies, increased toxicity has been observed when combining intravenous gemcitabine with radiotherapy (RT). The goal of our study was to determine whether RT in combination with isolated lung perfusion increases lung toxicity. METHODS Rodents were randomized into eight groups: sham group, RT, intravenous gemcitabine, intravenous gemcitabine combined with RT, isolated lung perfusion with hydroxyethyl starch (HES) or gemcitabine, isolated lung perfusion with HES or gemcitabine combined with RT. Gemcitabine was administered in a dose of 40 mg/kg and RT as a single fraction of 8 Gy. The effect on lung tissue was evaluated by % fibrosis in a haematoxylin–eosin stain and by % alveoli that contained siderophages on Perls stain. A total of 36 slices were made per treatment and per stain. The results of different groups were compared using logistic regression. RESULTS There were no significant differences between treatment with intravenous gemcitabine and RT. Isolated lung perfusion with gemcitabine showed significant more histopathologic changes compared with intravenous gemcitabine (P < 0.0001). When RT was added, there was no fibrosis after intravenous gemcitabine and mild-to-moderate haemosiderosis. After isolated lung perfusion with gemcitabine combined with RT, there was moderate to severe fibrosis and mild to severe haemosiderosis. Adding RT to isolated lung perfusion with gemcitabine showed no significant difference compared to isolated lung perfusion alone. CONCLUSIONS Combination of isolated lung perfusion and RT is feasible in an experimental model. No additional toxicity of RT was observed compared to isolated lung perfusion alone. Further studies are necessary to determine efficacy of this combined treatment. [ABSTRACT FROM AUTHOR]

Abstract: Immunomodulator therapy with the thiopurine analogues azathioprine (AZA) or 6-mercaptopurine (6-MP) is commonly prescribed for maintenance of remission in inflammatory bowel disease (IBD). Ten to twenty-five percent of patients have to withdraw from AZA or 6-MP due to adverse events that are partly explained by the relative activity of the drug metabolizing enzymes. Most of the potential major adverse events (myelosuppression, hepatotoxicity and pancreatitis) are well known. Pulmonary toxicity is rare but severe and may lead to respiratory insufficiency and even death. We describe a case of a young woman with ulcerative colitis (UC) who developed respiratory symptoms and fever combined with nodular densities and ground glass areas in both lungs on CT scan. An infection was ruled out and the diagnosis azathioprine induced pneumonitis was made. The drug was stopped and within one week her fever and respiratory symptoms resolved. Clinicians should be alert to this serious adverse event when treating patients with thiopurines. [Copyright &y& Elsevier]

The aims of this study were to assess in rats, using a well-developed, short-term pulmonary bioassay, the acute pulmonary toxicity of intratracheally instilled triethoxyoctylsilane (OTES)-coated (i.e. hydrophobic) pigment-grade TiO2 particles relative to uncoated, hydrophilic TiO2 particle control samples and to bridge the results of these instillation studies with data previously generated from inhalation studies with uncoated, pigment-grade TiO2 particles, using these uncoated pigment-grade TiO2 particles as the inhalation/instillation bridge material. Rats were intratracheally instilled with 2 or 10 mg/kg of the following TiO2 particle types: TiO2 with OTES, TiO2 with Tween 80, or TiO2 with OTES and Tween 80. Saline-instilled rats served as controls. The lungs of sham and exposed rats were evaluated by bronchoalveolar lavage and histopathology at 24 h, 1 week, 1 month and 3 months post-exposure. The results demonstrated that only the high dose (10 mg/kg) pigment-grade TiO2 particles and those with Tween 80 produced a transient pulmonary inflammatory response, and this reached control levels within 1 month post-exposure. We conclude that the OTES coating on the pigment-grade TiO2 particle does not cause significant pulmonary toxicity. [ABSTRACT FROM AUTHOR]

The aims of this study were to assess in rats, using a well-developed, short-term pulmonary bioassay, the acute pulmonary toxicity of intratracheally instilled triethoxyoctylsilane (OTES)-coated (i.e. hydrophobic) pigment-grade TiO2 particles relative to uncoated, hydrophilic TiO2 particle control samples and to bridge the results of these instillation studies with data previously generated from inhalation studies with uncoated, pigment-grade TiO2 particles, using these uncoated pigment-grade TiO2 particles as the inhalation/instillation bridge material. Rats were intratracheally instilled with 2 or 10 mg/kg of the following TiO2 particle types: TiO2 with OTES, TiO2 with Tween 80, or TiO2 with OTES and Tween 80. Saline-instilled rats served as controls. The lungs of sham and exposed rats were evaluated by bronchoalveolar lavage and histopathology at 24 h, 1 week, 1 month and 3 months post-exposure. The results demonstrated that only the high dose (10 mg/kg) pigment-grade TiO2 particles and those with Tween 80 produced a transient pulmonary inflammatory response, and this reached control levels within 1 month post-exposure. We conclude that the OTES coating on the pigment-grade TiO2 particle does not cause significant pulmonary toxicity. [ABSTRACT FROM AUTHOR]