Search

Background: In asthma and chronic obstructive pulmonary disease (COPD), airway mucus hypersecretion contributes to impaired mucociliary clearance, mucostasis and, potentially, the development of mucus plugging of the airways. Summary: Excess mucus production can be targeted via therapies that focus on inhibition mucin synthesis, via reducing expression of mucin (MUC) genes, and/or inhibition of mucin secretion into the airways. Key Messages: This review discusses a number of therapeutic approaches to reduce airway mucus in asthma and COPD, including the use of synthetic and natural products. In particular, it highlights areas where clinical trials of inhibitors of particular target molecules are lacking. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors are an example of a targeted therapy that has been researched to reduce mucus synthesis, as have inhibitors of EGFR's downstream signalling pathways, for example, mitogen-activated protein kinase-13 and hypoxia inducible factor-1. However, their efficacy and safety profiles are currently not up to the mark. There is clinical potential in Bio-11006, which reduces mucus secretion via the inhibition of myristoylated alanine-rich C-kinase substrate and is currently in Phase IIb trial. more...

Airway mucus hypersecretion is a pathophysiological feature of asthma and chronic obstructive pulmonary disease (COPD). The hypersecretion is associated with phenotypic changes in the airways, notably, increases in the number of surface epithelial goblet cells (hyperplasia) and in the size of the submucosal glands (hypertrophy). The hyperplasia and hypertrophy are associated with increased production of mucin, the gel-forming component of mucus. The excess mucus production contributes to morbidity and mortality in many patients, particularly in those with more severe disease. Although current pharmacotherapy is effective in clinical management of patients with stable asthma, severe asthma is poorly treated and there is no current drug treatment for COPD. In neither disease is there specific, effective pharmacotherapy for the hypersecretion. Consequently, identification of potential drug targets for treatment of hypersecretion in asthma and COPD is warranted. The inflammatory mediators and the associated intracellular signaling pathways underlying upregulation of mucin synthesis and development of goblet cell hyperplasia are gradually being elucidated. These include Th2 cytokines (predominantly IL-9 and IL-13), and IL-1 beta, tumor necrosis factor-alpha (TNF-alpha) and cyclooxygenase (COX)-2. IL-9 may act predominantly via calcium-activated chloride channels (CLCA), IL-13 via STAT-6 and FOXA2, TNF-alpha via NF-kappaB, and IL-1 beta via COX-2. Epidermal growth factor receptor (EGF-R) signaling and FOXA2 appear to be convergent intracellular pathways for a number of inflammatory mediators, with EGF-R upregulated in the airways of asthmatic and COPD patients. Thus, preclinical studies have clearly identified a number of intracellular signaling pathways as possible targets for pharmacotherapy of airway mucus hypersecretion in asthma and COPD. Of these, the EGF-R and Th2 cytokine pathways may have the greatest potential for inhibition of excessive mucus production. However, because these targets are so often intimately involved with different aspects of airway (and systemic) homeostasis, there is potential for development of unwanted side effects with drug intervention. Thus, translation of the promising preclinical studies to the clinic will depend on development of drug moieties with low off-target activity. This may be accomplished by maximizing airway selectivity, which may be facilitated by appropriate delivery device design. more...

Airway mucus hypersecretion is a key pathophysiological feature in many patients with asthma and chronic obstructive pulmonary disease (COPD). Consequently, it is important to develop drugs that inhibit mucus hypersecretion in these susceptible patients. Conventional therapy (anticholinergics, β2-adrenoceoptor agonists, corticosteroids, mucolytics and macrolide antibiotics) has variable efficacy in inhibiting airway mucus hypersecretion, and is less effective in COPD than in asthma. Novel pharmacotherapeutic targets are being investigated, including inhibitors of nerve activity, tachykinin antagonists, epoxygenase inducers, inhibitors of mucin exocytosis, inhibitors of mucin synthesis and goblet cell hyperplasia, inducers of goblet cell apoptosis, and purinoceptor antagonists and agonists to inhibit or hydrate secretions. However, real and theoretical differences differentiate the mucus hypersecretory phenotype in asthma from that in COPD. More information is required on these differences to identify spec... more...

Airway mucus hypersecretion is now recognized as a key pathophysiological feature in many patients with asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis. Consequently, it is important to develop drugs that inhibit mucus hypersecretion in these susceptible patients. Conventional therapies, including anticholinergics, ss2-adrenoceptor agonists, corticosteroids, mucolytics and macrolide antibiotics, have variable efficacy in inhibiting airway mucus hypersecretion, and are less effective in COPD than in asthma. Novel pharmacotherapeutic targets are being investigated, including inhibitors of nerve activity (e.g. large conductance calcium-activated potassium, BKCa, channel activators), tachykinin receptor antagonists, epoxygenase inducers (e.g. benzafibrate), inhibitors of mucin exocytosis (e.g. anti-myristoylated alanine-rich C kinase substrate (MARCKS), peptide and Munc-18B blockers), inhibitors of mucin synthesis and goblet cell hyperplasia (e.g. epidermal growth factor (EGF), receptor tyrosine kinase inhibitors, p38 mitogen-activated protein (MAP), kinase inhibitors, MAP kinase kinase/extracellular signal-regulated kinase (MEK/ERK), inhibitors, human calcium-activated chloride (hCACL2), channel blockers and retinoic acid receptor-a antagonists), inducers of goblet cell apoptosis (e.g. Bax inducers or Bcl-2 inhibitors), and purinoceptor P(2Y2) antagonists to inhibit mucin secretion or P(2Y2) agonists to hydrate secretions. However, real and theoretical differences delineate the mucus hypersecretory phenotype in asthma from that in COPD. More information is required on these differences to identify specific therapeutic targets which, in turn, should lead to rational design of anti-hypersecretory drugs for treatment of airway mucus hypersecretion in asthma and COPD. more...

Often considered an aggravating but otherwise benign component of chronic obstructive pulmonary disease (COPD), airway mucus hypersecretion is now recognised as a potential risk factor for an accelerated loss of lung function in COPD and is a key pathophysiological feature in many patients, particularly those prone to respiratory tract infection. Consequently, it is important to develop drugs that inhibit mucus hypersecretion in these susceptible patients. Conventional therapy including anticholinergics, beta2-adrenoceoptor agonists, alone or in combination with corticosteroids, mucolytics and macrolide antibiotics are not entirely or consistently effective in inhibiting airway mucus hypersecretion in COPD. Novel pharmacotherapeutic targets are being investigated, including inhibitors of nerve activity (e.g., BK(Ca) channel activators), tachykinin receptor antagonists, epoxygenase inducers (e.g., benzafibrate), inhibitors of mucin exocytosis (e.g., anti-MARCKS peptide and Munc-18B blockers), inhibitors of mucin synthesis and goblet cell hyperplasia (e.g., EGF receptor tyrosine kinase inhibitors, p38 MAP kinase inhibitors, MEK/ERK inhibitors, hCACL2 blockers and retinoic acid receptor-alpha antagonists), inducers of goblet cell apoptosis (e.g., Bax inducers or Bcl-2 inhibitors), and purinoceptor P(2Y2) antagonists to inhibit mucin secretion or P(2Y2) agonists to hydrate secretions. However, real and theoretical differences delineate the mucus hypersecretory phenotype in COPD from that in other hypersecretory diseases of the airways. More information is required on these differences to identify therapeutic targets pertinent to COPD which, in turn, should lead to rational design of anti-hypersecretory drugs for specific treatment of airway mucus hypersecretion in COPD. more...

Airway mucus hypersecretion is a clinical feature of a number of childhood diseases, including asthma and bronchitis-associated conditions. However, compared with adults, there is relatively scarce information concerning mucus pathophysiology in respiratory diseases in children. The available evidence indicates many similarities between adult and childhood respiratory hypersecretory conditions, including goblet-cell hyperplasia and submucosal gland hypertrophy, and airway mucus plugging in asthma. Consequently, it is likely that treatments that are effective in adults would be effective in children. Numerous therapeutic targets are linked to the pathophysiology of airway mucus hypersecretion in experimental models and adults with respiratory disease. Whether or not these same targets are relevant in children is for the most part unclear. These targets include the inflammatory cells mediating the inflammatory response that generates the hypersecretory phenotype, and highly specific cellular elements such as epidermal growth factor receptor tyrosine kinase and calcium-activated chloride (CACL) channels. Identification of these factors is linked with the development of different classes of pharmacotherapeutic molecules directed at these targets. Compounds with a broader spectrum of anti-inflammatory activity are likely to be more effective than compounds with restricted activity. However, certain highly specific targets, such as human CACL1 channels, appear to be strongly associated with the development of an airway hypersecretory phenotype. Data from current clinical trials in adults with blockers of these specific targets are awaited with great interest. The hope is that, if effective, pediatric trials with these compounds could be initiated with a view to alleviation of the clinical impact of airway mucus hypersecretion in children. A significant challenge to the therapeutic progression of these new compounds is effective delivery to the airways in children, with the research effort into development of new compounds matched by advances in inhaler design. more...

Background: In cystic fibrosis (CF), genetic mutations in the CF transmembrane conductance regulator (CFTR) gene cause reduced chloride efflux from ciliated airway epithelial cells. This results in a reduction in periciliary liquid (PCL) depth of the airway surface liquid due to associated reduced water efflux. PCL layer dehydration reduces mucociliary clearance (MCC), leading to airway obstruction (reduced airflow and inflammation due to pathogen invasion) with mucus plug formation. Summary: Rehydrating mucus increases MCC. Mucus hydration can be achieved by direct hydration (administering osmotic agents to set up an osmotic gradient), using CFTR modulators to correct dysfunctional CFTR, or it can be achieved pharmacologically (targeting other ion channels on airway epithelial cells). Key Messages: The molecular mechanisms of several therapies are discussed in the context of pre-clinical and clinical trial studies. Currently, only the osmotic agent 7% hypertonic saline and the CFTR ‘potentiator' VX-770 (ivacaftor) are used clinically to hydrate mucus. Emerging therapies include the osmotic agent mannitol (Bronchitol), the intracellular Ca2+-raising agent Moli1901/lancovutide, the CFTR potentiator sildenafil [phosphodiesterase type 5 (PDE5) inhibitor] and the CFTR ‘corrector' VX-809 (lumacaftor). Other CFTR correctors (e.g. ‘chemical chaperones') are also showing pre-clinical promise. more...

Activation of nerves increases airway mucus secretion. The mucus derives from submucosal glands and epithelial goblet cells. Depending upon species and airway level, innervation comprises parasympathetic (cholinergic), sympathetic (adrenergic) and 'sensory-efferent' pathways. In all species studied, cholinergic mechanisms predominate, particularly in human airways. Muscarinic M3 receptors on the secretory cells mediate the cholinergic response. Tachykinins (substance P and neurokinin A) mediate the sensory-efferent response, acting via tachykinin NK1 receptors. Endogenous mechanisms regulate the magnitude of neurogenic secretion, including enzymes (degrade neurotransmitters), nitric oxide (NO) and vasoactive intestinal peptide (VIP) (regulate stimulated secretion), and muscarinic M2 autoreceptors (inhibit acetylcholine release). Exogenous opioids also inhibit neurogenic secretion prejunctionally. Both VIP and opioids act by opening large conductance, calcium-activated potassium (BK(Ca)) channels. Present understanding of neural control of mucus secretion in animal airways requires translation into human data. This information should lead to rational development of drugs for bronchial diseases in which neurogenic mucus hypersecretion contributes to pathophysiology, including chronic bronchitis and asthma. more...

We investigated the effect of MEN 11467 ((1R,2S)-2-N[1(H)indol-3-yl-carbonyl]-1-N-{Nα(p-tolylacetyl)-Nα(methyl)-D-3-(2-naphthyl)alanyl}diaminocyclohexane) on tachykinin-induced mucus secretion in ferret trachea in vitro and determined its effect on secretion by tracheae from allergic ferrets in response to allergen challenge. Repeated administration of [Sar9,Met(O2)11]-substance P ([Sar9]SP, 1 μM) maintained mucus output above control values for at least 1.75 h. MEN 11467 inhibited secretion in a concentration-dependent manner with maximal inhibition at 10 μM and an approximate IC50 of 0.3 μM. Inhibition by MEN 11467 (0.1 – 10 μM) was maintained, to varying degree, for at least 1.75 h after washout in the continued presence of [Sar9]SP. In electrically stimulated tracheae, tachykininergic neural secretion was virtually abolished by 1 μM MEN 11467. In tracheae from ovalbumin-sensitised animals, repeated administration of ovalbumin maintained mucus output above controls for 1.5 h. MEN 11467 inhibited ovalbumin-induced secretion in a concentration-dependent manner, with complete inhibition at 1 μM. Inhibition by MEN 11467 (1 and 10 μM) was maintained, to varying degree, after drug washout for the 1.5 h of ovalbumin stimulation. MEN 11467 1 μM did not affect secretion induced by either acetylcholine or histamine, whereas 10 μM MEN 11467 did inhibit agonist-induced secretion. We conclude that, in ferret trachea in vitro, MEN 11467 at concentrations of 0.1 – 1 μM is a long acting and selective inhibitor of tachykininergic-induced mucus secretion, and may have therapeutic potential for bronchial hypersecretion associated with allergic conditions, for example in asthma. Keywords: Airway, allergy, asthma, mucin, mucus, MEN 11467, respiratory tract, sensitisation, tachykinin receptor, tachykinin receptor antagonist Introduction Mucus secretion is a vital component of airway homeostasis, providing the ‘front-line' barrier to inhaled irritants. The rate of secretion is controlled by both humoral and neuronal mechanisms. In mammalian airways, the dominant neural control is cholinergic (Rogers, 2000a). Adrenergic neural mechanisms contribute little to control, particularly in human airways. Capsaicin-sensitive ‘sensory-efferent' nerves also control secretion, although their relative contribution varies with species (Rogers, 2000a). Asthma and chronic obstructive pulmonary disease (COPD) are two severe respiratory conditions that are associated with airway mucus hypersecretion (Liu et al., 1998a; Rogers, 2000b). In both conditions, abnormalities in neural control are implicated in pathophysiology. Consequently, investigation of the neural control of airway secretion is linked to design of therapeutic drugs for bronchial mucus hypersecretion. Preclinical test systems have, therefore, been developed to assess compounds with potential to inhibit neurogenic secretion. One such system is the in vitro ferret trachea. Neurogenic secretion in ferret trachea is mediated via cholinergic nerves and capsaicin-sensitive ‘sensory-efferent' nerves (Rogers, 2000a). Tachykinin receptor agonist studies (Geppetti et al., 1993; Meini et al., 1993) and tachykinin receptor antagonist studies using a range of peptide and non-peptide compounds (Ramarine et al., 1994; Khawaja et al., 1999) show that the sensory-efferent secretory response is mediated exclusively via tachykinin NK1 receptors. Thus, mucus secretion from the in vitro ferret trachea is a useful experimental system for investigating drugs acting at tachykinin NK1 receptors. Allergy is one component of asthma. Consequently, antigen-sensitized animals are commonly employed as models of allergic asthma (Chung, 1995). In guinea-pigs, the later-phase of antigen-induced tracheal plasma exudation is mediated via tachykinin interaction with tachykinin NK1 receptors (Bertrand et al., 1993a). The involvement of tachykininergic pathways in antigen-induced airway mucus secretion is not reported. In the present study, we used the pseudopeptide tachykinin NK1 receptor antagonist, MEN 11467 ((1R,2S)-2-N[1(H)indol-3-yl-carbonyl]-1-N-{Nα(p-tolylacetyl)-Nα (methyl)-D-3-(2-naphthyl) alanyl}diaminocyclohexane) (Cirillo et al., 1998), to study tachykininergic involvement in antigen-induced mucus secretion in ferret trachea in vitro. We used this antagonist because its long duration of action was required if antigen-induced neurogenic secretory responses were late in onset (Bertrand et al., 1993a). Firstly, we determined the inhibitory profile and duration of action of MEN 11467 against secretion induced by the selective tachykinin NK1 receptor agonist [Sar9,Met(O2)11]-substance P ([Sar9]SP). Secondly, we examined inhibition by MEN 11467 of electrically stimulated tissue in the presence of adrenoceptor and cholinoceptor blockade (i.e. tachykininergic neural secretion). Thirdly, we assessed the inhibitory profile and duration of action of MEN 11467 in tracheae from ovalbumin-sensitised animals challenged with ovalbumin (‘allergic' secretion). Finally, the selectivity of MEN 11467 for tachykininergic-induced mucus secretion was assessed using acetylcholine and histamine to induce secretion. We used 35SO4 as a mucus marker because it localises to secretory structures and is released upon stimulation (Gashi et al., 1987), and the released material has a molecular weight and buoyant density characteristic of a mucus glycoprotein (Davies et al., 1990). more...

We investigated whether vasoactive intestinal peptide (VIP) and its related peptides, pituitary adenylate cyclase activating peptide (PACAP) and secretin, regulate cholinergic neural mucus secretion in ferret trachea in vitro, using 35SO4 as a mucus marker. We also studied the interaction between VIP and secretin on cholinergic mucus output. VIP (1 and 10 μM) increased secretion, whereas neither PACAP1–27, PACAP1–38 nor secretin (up to 10 μM) increased mucus output. In contrast, VIP, PACAP1–27 and PACAP1–38 concentration-dependently inhibited cholinergic neural secretion, with an order of potency of VIP>PACAP 1–38>PACAP1–27. Neither PACAP1–27 nor PACAP1–38 altered the secretion induced by acetylcholine (ACh). Secretin increased cholinergic neural secretion with a maximal increase of 190% at 1 μM. This potentiation was blocked by VIP or atropine. Similarly, secretin (1 μM) potentiated VIP (1 μM)-induced mucus output by 160%. Secretin did not alter exogenous ACh-induced secretion. VIP vs secretin competition curves suggested these two peptides were competing reversibly for the same receptor. We conclude that, in ferret trachea in vitro, VIP and PACAPs inhibit cholinergic neural secretion via pre-junctional modulation of cholinergic neurotransmission. VIP and secretin compete for the same receptor, possibly a VIP1 receptor, at which secretin may be a receptor antagonist. British Journal of Pharmacology (1999) 128, 1353–1359; doi:10.1038/sj.bjp.0702942 more...

1. Muscarinic receptor subtypes mediating neurogenic mucus secretion in ferret trachea were characterized in vitro and in vivo using 35SO4 as a label for secreted mucus, and the muscarinic receptor antagonists telenzepine for the M1 receptor subtype, methoctramine for the M2 subtype and 4-diphenylacetoxy-N-methylpiperidine methobromide (4-DAMP) for the M3 receptor. We also performed receptor binding and mapping studies. 2. Each muscarinic antagonist displaced [N-methyl-3H]scopolamine binding with high-affinity binding constant (KH) values of 1.9, 2.7 and 5.0 nM for telenzepine, methoctramine and 4-DAMP, respectively. Muscarinic M1 and M3 receptors localized to submucosal glands, whereas M2 receptors did not. 3. In vitro, electrical stimulation (50 V, 10 Hz, 0.5 ms for 5 min) increased 35SO4 output by 160%. Telenzepine did not inhibit the neurogenic secretory response at concentrations two-or twentyfold its KH value, nor did it inhibit secretion induced by acetylcholine (ACh). 4-DAMP inhibited neurogenic secretion by 80 and 95%, respectively, at concentrations two-and twentyfold its KH value, and also inhibited ACh-induced secretion. Methoctramine potentiated neurogenic secretion induced at 2.5 Hz (50 V, 0.5 ms for 5 min) in a dose-related (5.4-100 nM) manner with increases of 33-451% above electrically stimulated values. Methoctramine did not potentiate secretion induced at 10 Hz and did not have any effect on ACh-induced secretion. 4. In vivo, vagal stimulation (10 V, 10 Hz, 2 ms for 8 min) increased output of 35SO4 by approximately 120%. Telenzepine had no significant effect on neurogenic secretion. Methoctramine approximately doubled the stimulated response, whereas 4-DAMP abolished the stimulated secretory response. 5. We conclude that in ferret trachea, cholinergic nerve stimulation increases mucus secretion via muscarinic M3 receptors on the submucosal glands. The magnitude of the secretory response is regulated by neuronal M2 muscarinic receptors. The muscarinic M1 receptors localized to the submucosal glands do not appear to be involved with mucus secretion. more...

Trimellitic anhydride is a cause of occupational asthma in humans. We have previously found that tracheal instillation of trimellitic anhydride conjugated to guinea pig serum albumin induces acute bronchoconstriction and airway plasma exudation in sensitised animals, responses mediated primarily via histamine release. In the present study, neural mechanisms mediating bronchoconstriction and goblet cell secretion were determined in trimellitic anhydride-sensitised guinea pigs using the ganglionic blocker hexamethonium to eliminate efferent reflex mechanisms, pretreatment with capsaicin to eliminate afferent mechanisms, or cimetidine and mepyramine to eliminate histamine-mediated mechanisms. The magnitude of secretion of intracellular mucus from tracheal goblet cells was quantified morphometrically as a mucus score which is inversely related to the degree of discharge. Guinea pigs were injected intradermally either with 0.1 ml 0.3% trimellitic anhydride in corn oil or with corn oil alone as control. Fourteen to eighteen days later all sensitised animals had developed specific immunoglobulin (Ig) G1 antibodies whereas the controls had not. Tracheal instillation of conjugated trimellitic anhydride in anaesthitised animals significantly increased airway lung resistance ( R L ) 24-fold in sensitised guinea pigs (34.3 ± 7.9 cm H 2 O · ml −1 · s) compared with controls (1.4 ± 0.1 cm H 2 O · ml −1 · s). Mucus score was significantly reduced by 51% (indicating goblet cell secretion) in sensitised guinea pigs (183 ± 22 mucus score units) compared with controls (372 ± 41 mucus score units). The antihistamines significantly inhibited conjugated trimellitic anhydride-induced bronchoconstriction by 89%, but did not significantly affect goblet cell discharge. Hexamethonium alone did not significantly affect conjugated trimellitic anhydride-induced bronchoconstriction or goblet cell secretion. Capsaicin pretreatment (in combination with hexamethonium) significantly inhibited golet cell discharge (by 80%) but had no significant effect on bronchoconstriction. We conclude that conjugated trimellitic anhydride challenge of trimellitic anhydride-sensitised guinea pigs induces goblet cell discharge and bronchoconstriction via different mechanisms with activation of capsaicin-sensitive sensory nerves responsible for secretion and histamine release responsible for airway constriction. The guinea pig model of trimellitic anhydride-induced occupational asthma may prove useful in examination of mechanisms of goblet cell secretion in allergic diseases. more...

Background Therapeutic intervention in the pathophysiology of airway mucus hypersecretion is clinically important. Several types of drugs are available with different possible modes of action. We examined the effects of guaifenesin (GGE), N-acetylcysteine (NAC) and ambroxol (Amb) on differentiated human airway epithelial cells stimulated with IL-13 to produce additional MUC5AC. Methods After IL-13 pre-treatment (3 days), the cultures were treated with GGE, NAC or Amb (10–300 μM) in the continued presence of IL-13. Cellular and secreted MUC5AC, mucociliary transport rates (MTR), mucus rheology at several time points, and the antioxidant capacity of the drugs were assessed. Results IL-13 increased MUC5AC content (~25%) and secretion (~2-fold) and decreased MTR, but only slightly affected the G’ (elastic) or G” (viscous) moduli of the secretions. GGE significantly inhibited MUC5AC secretion and content in the IL-13-treated cells in a concentration-dependent manner (IC50s at 24 hr ~100 and 150 μM, respectively). NAC or Amb were less effective. All drugs increased MTR and decreased G’ and G” relative to IL-13 alone. Cell viability was not affected and only NAC exhibited antioxidant capacity. Conclusions Thus, GGE effectively reduces cellular content and secretion of MUC5AC, increases MTR, and alters mucus rheology, and may therefore be useful in treating airway mucus hypersecretion and mucostasis in airway diseases. more...

1. We characterized the tachykinin receptor(s) mediating 'sensory-efferent' neural control of release of 35SO4-labelled macromolecules (mucus) from ferret trachea in vitro in Ussing chambers using selective tachykinin antagonists. Secretion was induced by substance P (SP), neurokinin A (NKA), capsaicin, the NK1 tachykinin receptor agonist [Sar9, Met(O2)11]substance P ([Sar9]SP), or acetylcholine (ACh), or by electrical stimulation of nerves. Antagonists used were FK888 and L-668,169, selective for the NK1 receptor, SR 48968, selective for the NK2 receptor, and FK224, a dual antagonist at NK1 and NK2 receptors. The selectivity of FK888 and SR 48968 was examined on NKA-induced contraction of ferret tracheal smooth muscle in vitro. 2. SP (1 microM) increased mucus secretion by 695% above vehicle controls. FK888 (0.1 microM-30 microM) inhibited SP-induced secretion in a dose-dependent manner, with complete inhibition at 10 microM and an IC50 of 1 microM. L-668,169 (1 microM) also completely inhibited SP-induced secretion. 3. NKA (1 microM) significantly increased mucus secretion by 271% above baseline, a response which was completely inhibited by FK888 (10 microM) or L-668,169 (microM). Secretion induced by ACh (10 microM: 317% above baseline) was not inhibited by FK888 but was inhibited by atropine. Capsaicin (10 microM)-induced secretion (456% above vehicle controls) was significantly inhibited by FK888 and by L-668,169 (111% and 103% inhibition respectively). 4. Electrical stimulation (50 V, 10 Hz, 0.5 ms, 5 min) increased mucus output above baseline (increased by 12 to 26 fold), a response blocked by tetrodotoxin (0.1 microM). FK888 (10 microM) inhibited the increase in secretion due to electrical stimulation by 47%. Atropine, propranolol and phentolamine in combination(APP) inhibited the response to electrical stimulation by 48%. The remaining NANC response, i.e. in the presence of APP, was further reduced by 66% with FK888. FK224 (10 microM) inhibited neurally evoked secretion by 73%. SR 48968 (0.1 fLM) had no effect on electrically-stimulated or [Sar9]SP-induced secretion.5. NKA (10nM- 1O microM: in the presence of DMSO control vehicle) induced tracheal smooth muscle contraction in a concentration-dependent manner with a maximal contraction of 30% of the maximal response to ACh (10 mM) and an ECm of 0.3 JAM. SR 48968 (0.1 microM in DMSO) inhibited the NKA induced contraction whereas FK888 did not. Neither antagonist had any inhibitory effect on ACh induced contraction.6. We conclude that 'sensory-efferent' neurogenic mucus secretion in ferret trachea in vitro is mediated via tachykinin NK, receptors with no involvement of NK2 receptors. Potent and selective tachykinin antagonists may have therapeutic potential in bronchial diseases such as asthma and chronic bronchitis in which neurogenic mucus hypersecretion may be aetiologically important. more...

Baseline and agonist-stimulated secretion of fucose, hexose, and protein (markers of mucus secretion) was investigated in vitro in 45 bronchial segments from 14 patients with cystic fibrosis (CF) (three after heart-lung transplant, the remainder < 4.5 h after autopsy), in 51 segments from 26 patients with carcinoma (24 resection, 2 after autopsy), and in 4 segments from 3 patients with bronchiectasis (resection). Basal rates of secretion of each mucus marker by CF bronchi were not significantly different from those by carcinoma bronchi bronchiectatic bronchi. However, rates of secretion of each marker in response to the cholinomimetic methacholine (10 microM; n = 11-18, depending on marker) and the beta 2-adrenoceptor agonist terbutaline (10 microM; n = 9-11) were significantly (p < .05) increased in carcinoma bronchi (by 50-117% above basal), but not in CF airways (n = 11-14). The secretory response to the sensory neuropeptide substance P (1 nM to 10 microM; n = 5-7) was also reduced in CF compared with carcinoma bronchi. Physiological and morphological data indicated that the reduced response by CF tissue could not be accounted for by inclusion of autopsy tissue in the study. These data suggest a defect in autonomic control of bronchial secretion in CF, not in the basal rate of secretion, but in its response to receptor stimulation. more...

Gross pathology, histological and ultrastructural observations and analysis of sputum and lavage fluid indicate that plasma exudation from the bronchial microvasculature and the formation of tissue oedema are characteristic features of asthma. Appropriate mediators for the induction of plasma exudation are generated in the blood and airways of asthmatic patients and when administered experimentally will cause plasma leakage and oedema. Plasma exudate may not only contribute directly to the thickened bronchial walls and mucus plugs in the airways of asthmatics, but may also play a role in epithelial shedding, thickening of the basement membrane, hypertrophy of the smooth muscle, inducing mucus secretion and in thickening the secreted mucus. The beneficial effect of corticosteroids in asthma may be due to an anti-leakage action. Development of drugs with a broad spectrum of action against mediator release may have therapeutic advantage over specific receptor antagonist drugs. more...

Airway mucus hypersecretion is a pathophysiological feature of asthma and, in many patients, contributes to morbidity and mortality. Although current pharmacotherapy is effective in patients with stable disease, severe asthma is poorly treated, and there is no specific treatment for the hypersecretion. Consequently, identification of potential targets for pharmacotherapy of hypersecretion in asthma is warranted. This review identifies intracellular signalling pathways as rational targets for treatment of excessive airway mucus production.The inflammatory mediators and the associated intracellular signalling pathways underlying development of goblet cell hyperplasia, an index of mucus hypersecretion, are becoming ever clearer, and include T-helper type 2 (Th2) cytokines, in particular interleukin (IL)-9 and IL-13, as well as IL-1beta, tumour necrosis factor (TNF)-alpha and cyclooxygenase (COX)-2. IL-9 may act predominantly via calcium-activated chloride channels (CLCAs), IL-13 via STAT-6 and FOXA2, TNF-alpha via nuclear factor (NF)-kappaB, and IL-1beta via COX-2. Epidermal growth factor receptor (EGF-R) and FOXA2 appear to be convergent pathways for a number of mediator signals, with EGF-R up-regulated in the airways of asthmatic patients.Although many potential intracellular signalling pathways have been identified as possible targets for pharmacotherapy of airway mucus hypersecretion in asthma, the EGF-R and Th2 cytokine pathways offer the greatest potential for inhibition of excessive mucus production. more...

Publisher Summary The chapter addresses the above issues by discussion of similarities and differences in the pulmonary inflammatory “profile” between asthma and chronic obstructive pulmonary disease (COPD) and how these may relate to the generation of the airway mucus hypersecretory state in the two conditions. It begins with consideration of sputum, airway mucus, and mucins, followed by an outline of the characteristics of mucus hypersecretion in asthma and COPD, emphasizing differences between the two conditions and the theoretical requirements for drugs aimed at effectively inhibiting airway mucus hypersecretion. Patients with asthma or COPD invariably exhibit characteristics of airway mucus hypersecretion, comprising sputum production, excessive mucus in the airway lumen, goblet cell hyperplasia, and submucosal gland hypertrophy. The pathophysiological sequelae of mucus hypersecretion are airway obstruction, airflow limitation, ventilation-perfusion mismatch, and impairment of gas exchange. The association of airway mucus hypersecretion with asthma and COPD is not necessarily cause and effect. The excess mucus may merely be a result of the inflammatory processes causing the disease. Consequently, treating the mucus problem will not inevitably treat the disease, especially if the changes that have led to increased mucus production are irreversible. Production of airway mucus is a vital homeostatic mechanism that protects the respiratory tract from a barrage of inhaled insult. However, abnormal production of mucus can contribute to respiratory disease. Airway obstruction by mucus is a common feature of a number of severe respiratory conditions, including asthma and COPD. At present, there is considerable interest in inhibitors of EGF receptor tyrosine kinases, MEK/ERK, and CLCA channels to suppress goblet cell hyperplasia, and in molecules to selectively interfere with mucin exocytosis and thereby inhibit airway mucus hypersecretion. more...

Most patients with chronic obstructive pulmonary disease (COPD) exhibit characteristics of airway mucus hypersecretion, namely sputum production, increased luminal mucus, submucosal gland hypertrophy and goblet cell hyperplasia. The clinical consequences of hypersecretion are impaired gas exchange and compromised mucociliary clearance, which encourages bacterial colonization and associated exacerbations. However, the extent of the contribution of mucus to pathophysiology of COPD is controversial. Early epidemiological studies found little evidence for the involvement of mucus in the age-related decline in lung function and mortality associated with COPD and concluded that chronic airflow obstruction and mucus hypersecretion were independent processes. Later studies found positive associations between phlegm production and decline in lung function, hospitalization and death. Thus, although not diagnostic for the condition, mucus hypersecretion contributes to morbidity and mortality in certain groups of patients with COPD. This suggests that it is important to develop drugs that inhibit mucus hypersecretion in these patients. Unfortunately, ambiguity in clinical studies of mucoactive drugs means that mucolytics are not recommended in clinical management. Future research should determine whether there is an intrinsic abnormality in mucus in COPD, which will determine development of appropriate inhibitors, which in turn can be used in 'proof of concept' and in treatment. more...

1. We studied the effect of capsaicin and sensory neuropeptides on tracheal goblet cell secretion in anaesthetized guinea-pigs using a semi-quantitative morphometric technique whereby the magnitude of discharge of stained intracellular mucus, expressed as a mucus score (MS), was related inversely to discharge. 2. Capsaicin (i.v.) induced goblet cell secretion: a decrease of 50% in MS below control (indicative of increased secretion) was maximal at 3.3 x 10(-9) mol/kg. 3. Capsaicin-induced secretion was unaffected either by prior vagus nerve section or by pre-treatment with atropine, propranolol and phentolamine which suggests that local axon reflexes with release of sensory neuropeptides are involved in the response. 4. Intravenous substance P (SP), neurokinin A (NKA), neurokinin B (NKB), and calcitonin gene-related peptide (CGRP) produced dose-related increases in goblet cell secretion, with SP the most potent. Doses (mol/kg) causing a 50% decrease in MS from control were 3.5 x 10(-12) for SP; 72 x 10(-10) for NKA; 1.6 x 10(-9) for NKB; and 1.2 x 10(-8) for CGRP. The maximal increase in goblet cell secretion was 75% of control and occurred with SP at 10(-10) mol/kg. 5. SP-induced mucus discharge was not inhibited by atropine or the histamine receptor antagonists mepyramine or cimetidine. 6. We conclude that in guinea-pig trachea, goblet cell secretion is under the control of capsaicin-sensitive sensory nerves and release of neuropeptides from these nerves may induce mucus discharge via tachykinin receptors of the NK-1 subtype (indicated by an order of potency of SP greater than NKA greater than NKB). more...

We studied the neural control of goblet cell secretion in the lower airways of anesthetized guinea pigs using a semiquantitative morphometric technique. The magnitude of discharge of intracellular mucus was determined in histological sections of the trachea and main bronchi stained for mucus glycoproteins. Bilateral electrical stimulation of the cervical vagus nerves induced goblet cell secretion. The magnitude of the effect was dependent on the frequency, voltage, and pulse width of the stimulus, and the duration of stimulation. At 10 Hz, 5 V, and 5 ms for 3 min, there was a 62% decrease in the amount of intracellular mucus below that with sham stimulation. The secretion was blocked either by atropine or by pretreatment with capsaicin but was not significantly inhibited by idazoxan, an alpha-adrenoceptor antagonist. The magnitude of goblet cell discharge in animals pretreated with propranolol was intermediate between that in controls and that with nerve stimulation, although not significant to either. These results demonstrate that goblet cell secretion is under neural control in guinea pig airways and suggest that cholinergic, nonadrenergic-noncholinergic, and possibly adrenergic neural pathways, may contribute to the secretion. more...

Mucus secretion is the first-line defense against the barrage of irritants that inhalation of approximately 500 L of air an hour brings into the lungs. The inhaled soot, dust, microbes, and gases can all damage the airway epithelium. Consequently, mucus secretion is extremely rapid, occurring in tens of milliseconds. In addition, mucus is held in cytoplasmic granules in a highly condensed state in which high concentrations of Ca(2+) nullify the repulsive forces of the highly polyanionic mucin molecules. Upon initiation of secretion and dilution of the Ca(2+), the repulsion forces of the mucin molecules cause many-hundred-fold swelling of the secreted mucus, to cover and protect the epithelium. Secretion is a highly regulated process, with coordination by several molecules, including soluble N-ethyl-maleimide-sensitive factor attachment protein receptor (SNARE) proteins, myristoylated alanine-rich C kinase substrate (MARCKS), and Munc proteins, to dock the mucin granules to the secretory cell membrane prior to exocytosis. Because mucus secretion appears to be such a fundamental airway homeostatic process, virtually all regulatory and inflammatory mediators and interventions that have been investigated increase secretion acutely. When given longer-term, many of these same mediators also increase mucin gene expression and mucin synthesis, and induce goblet cell hyperplasia. These responses induce (in contrast to the protective effects of acute secretion) long-term, chronic hypersecretion of airway mucus, which contributes to respiratory disease. In this case the homeostatic, protective function of airway mucus secretion is lost, and, instead, mucus hypersecretion contributes to pathophysiology of a number of severe respiratory conditions, including asthma, chronic obstructive pulmonary disease, and cystic fibrosis. more...

Airway mucus hypersecretion is a feature of a number of severe respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF). However, each disease has a different airway inflammatory response, with consequent, and presumably linked, mucus hypersecretory phenotype. Thus, it is possible that optimal treatment of the mucus hypersecretory element of each disease should be disease-specific. Nevertheless, mucoactive drugs are a longstanding and popular therapeutic option, and numerous compounds (eg, N-acetylcysteine, erdosteine, and ambroxol) are available for clinical use worldwide. However, rational recommendation of these drugs in guidelines for management of asthma, COPD, or CF has been hampered by lack of information from well-designed clinical trials. In addition, the mechanism of action of most of these drugs is unknown. Consequently, although it is possible to categorize them according to putative mechanisms of action, as expectorants (aid and/or induce cough), mucolytics (thin mucus), mucokinetics (facilitate cough transportability), and mucoregulators (suppress mechanisms underlying chronic mucus hypersecretion, such as glucocorticosteroids), it is likely that any beneficial effects are due to activities other than, or in addition to, effects on mucus. It is also noteworthy that the mucus factors that favor mucociliary transport (eg, thin mucus gel layer, "ideal" sol depth, and elasticity greater than viscosity) are opposite to those that favor cough effectiveness (thick mucus layer, excessive sol height, and viscosity greater than elasticity), which indicates that different mucoactive drugs would be required for treatment of mucus obstruction in proximal versus distal airways, or in patients with an impaired cough reflex. With the exception of mucoregulatory agents, whose primary action is unlikely to be directed against mucus, well-designed clinical trials are required to unequivocally determine the effectiveness, or otherwise, of expectorant, mucolytic, and mucokinetic agents in airway diseases in which mucus hypersecretion is a pathophysiological and clinical issue. It is noteworthy that, of the more complex molecules in development, it is simple inhaled hypertonic saline that is currently receiving the greatest attention as a mucus therapy, primarily in CF. more...

Airway mucus hypersecretion is a feature of many patients with asthma. It is indicative of poor asthma control and contributes to morbidity and mortality. Excess mucus not only obstructs airways but also contributes to airway hyperresponsiveness. Furthermore, asthma might have a specific mucus hypersecretory phenotype. Goblet cell hyperplasia and submucosal gland hypertrophy are shared with other hypersecretory diseases, such as chronic obstructive pulmonary disease; however, some features are different, including mucus plugging, mucus "tethering" to goblet cells, plasma exudation, and increased amounts of a low charge glycoform of mucin (MUC)5B and the presence of MUC2 in secretions. Experimentally, most of the inflammatory mediators and neural mechanisms implicated in the pathophysiology of asthma impact upon the mucus hypersecretory phenotype. There is currently huge research interest in identifying targets involved in inducing mucus abnormalities, which should lead to the rational design of anti-hypersecretory drugs for treatment of airway mucus hypersecretion in asthma. more...

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. COPD comprises multiple components which, as well as a systemic component, include pulmonary inflammation, airway remodelling and mucociliary dysfunction. The latter features contribute to the development of chronic, progressive airflow limitation. The mucociliary dysfunction component of COPD is due to mucus hypersecretion coupled with a decrease in mucus transport, and represents an important pathophysiological feature requiring appropriate treatment. Current international guidelines do not recommend the use of mucolytics in the treatment of stable COPD. In contrast, bronchodilators are central to symptomatic management of COPD, and include β 2 -adrenoceptor agonists, anti-cholinergics and methylxanthines. Interestingly, long-acting β 2 -agonists (LABAs), rather than short-acting β 2 -agonists, have the potential to improve the mucociliary component of COPD, in addition to providing symptomatic treatment by their bronchodilator action. Combination therapy with a LABA and an inhaled corticosteroid has the potential to more fully address the multicomponent nature of COPD by providing important anti-inflammatory activity, which may indirectly further improve mucociliary clearance. Theoretically, anti-cholinergics are likely to have mixed effects on mucociliary function, but clinically these effects have been difficult to demonstrate. Finally, a number of novel targets for the treatment of airway mucociliary dysfunction have been identified, and targeting agents are currently in development. more...

Airway mucus hypersecretion is a cardinal feature of chronic obstructive pulmonary disease (COPD) (Fig. 1). Or is it? In fact, mucus hypersecretion, implicit in the term chronic bronchitis, is one of three pathophysiological entities comprising COPD, the other two being chronic bronchiolitis (small airways disease) and emphysema (alveolar destruction). The relative contribution of each component to pathophysiology varies between patients, with the impact of mucus hypersecretion on morbidity and mortality varying accordingly. Thus, although previously included in definitions of COPD [1], the term “mucus hypersecretion” is omitted from current definitions [2]. Nevertheless, there are many patients in whom hypersecretion has clinical significance, for example patients prone to chest infections [3]. Consequently, it is important to understand the mechanisms underlying mucus hypersecretion in COPD. This in turn should allow identification of pathophysiological targets and rational development of pharmacotherapeutic drugs. The present chapter: 1) assesses the role of airway mucus hypersecretion in the pathophysiology of the “bronchitic” component of COPD, 2) considers the clinical impact of mucus hypersecretion in COPD, and 3) discusses potential novel therapy for this condition. The chapter begins with a brief overview of airway mucus and mucins. more...

Hypersecretion of airway mucus is characteristic of several severe lung diseases, particularly those involving chronic inflammation such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) (1). Mucins are the major macromolecular component of mucus and play a fundamental role in the pathophysiology of these diseases by determining the viscoelastic properties of mucus and its ability to interact with the cilia of the respiratory tract during mucociliary clearance. more...

Mucus hypersecretion is a prominent feature of allergic rhinitis and asthma. Biologic targets for suppression of hypersecretion range from the inflammatory cells that initiate airway inflammation, to specific cellular elements such as calcium-activated chloride (CLCA) channels, epidermal growth factor receptor tyrosine kinase, and antiapoptotic factors (eg, Bcl-2). Identification of these targets is driving development of new pharmacotherapeutic compounds. Aside from specific instances in which a single mediator has a major impact on hypersecretion--for example, histamine in rhinitis--it is likely that compounds with broad-spectrum anti-inflammatory activity are more effective than compounds with restricted activity. However, certain highly specific targets, such as CLCA channels, seem to be intimately associated with development of a hypersecretory phenotype. Data from clinical trials with blockers of these targets are awaited with great interest, not only for disease management but also to determine the clinical benefit of selective inhibition of airway hypersecretion. more...

Airway mucus hypersecretion is a clinical and pathophysiological feature of a number of severe respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD). The importance of mucus hypersecretion to the morbidity and mortality of asthma is acknowledged, whereas in COPD it appears to affect only certain groups of patients, particularly the elderly and those prone to chest infections. Treatment with compounds that alter mucus is perceived as a therapeutic option, in particular in continental Europe, and numerous compounds have been developed and are available for clinical use worldwide. However, acceptance (or otherwise) of these drugs in guidelines for management of asthma or COPD has been hampered by lack of information from well designed clinical trials. In addition, the mechanism of action of most of these drugs is unknown and is it likely that any beneficial effects are due to activities other than, or in addition to, effects on mucus. Current information indicates that the most effective use of mucolytic drugs is long-term therapy for reduction of exacerbations of COPD. Cost-effective treatment would be in patients with poor lung function who have frequent or prolonged exacerbations or are repeatedly admitted to hospital. more...

Secretory elements in the airways have a parasympathetic (cholinergic) supply, and activation of cholinergic nerves or administration of cholinomimetic drugs induces marked increases in secretion. In health, secreted high molecular weight glycoproteins (mucins) comprise a small proportion (~ 1%) of the thin layer of aqueous liquid (often termed “mucus”) which overlies the surface epithelium of the airways. The liquid also contains electrolytes, immunoglobulins, plasma-derived proteins (for example albumin), lipids, enzymes, anti-enzymes, antibacterials, cell products and mediators. The relative contribution of each component to the normal functioning of the liquid is comparatively unknown, and the relevance of the liquid to airway homeostasis is, for the most part, only theoretical [1]. Mucins possess viscoelastic properties which confer upon the liquid the ability to be transported on the tips of beating cilia. Airborne particles are trapped in the liquid and are removed from the airways by mucociliary clearance. In disease, changes in the amount of liquid, or its viscoelasticity, or in the relative proportion of its components, convert a normally protective mechanism into a pathophysiological one. The altered mucus is difficult to clear and accumulates in the airways. The resulting airflow limitation contributes to morbidity and mortality in bronchial diseases such as asthma, chronic bronchitis and cystic fibrosis (CF). more...

Neural mechanisms contribute to control of mucus secretion in the airways. Fenspiride is a non-steroidal antiinflammatory agent which has a variety of actions, including inhibition of neurogenic bronchoconstriction. The effect of fenspiride on neurally-mediated mucus secretion was investigated in vitro in electrically-stimulated ferret trachea, using(35)SO(4)as a mucus marker. Cholinergic secretory responses were isolated using adrenoceptor and tachykinin receptor antagonists. Tachykinin responses were isolated using cholinoceptor and adrenoceptor antagonists. Electrical stimulation increased cholinergic secretion by;90% and tachykininergic secretion by;40%. Fenspiride (1 microM-1 mM) tended to inhibit cholinergic secretion in a concentration-dependent manner, although only at 1 mM was inhibition (by 87%) significant. Inhibition by fenspiride of tachykininergic secretion was not concentration-dependent, and again significant inhibition (by 85%) was only at 1 mM. Inhibition was not due to loss of tissue viability, as assessed by restitution of secretory response after washout. Fenspiride also inhibited secretion induced by acetylcholine, but did not inhibit substance P-induced secretion. Histamine receptor antagonists increased basal secretion by 164%, whereas fenspiride did not affect basal secretion. We conclude that, in ferret trachea in vitro, fenspiride inhibits neurally-mediated mucus secretion, with antimuscarinic action the most plausible mechanism of action, but not necessarily the only mechanism. more...

There are many in vivo animal models for studying airway mucus secretion and hypersecretion, each with advantages and disadvantages. Use of a particular test system will depend upon the aspect of secretion to be modelled. Airway hypersecretory diseases exhibit chronic mucus hypersecretion, of which the clinical impact is predominantly in the distal airways. The majority of documented test preparations study acute secretion, invariably using tracheal preparations, but have been invaluable in elucidating the normal physiology of airway mucus secretion. Chronic models of the hypersecretory state in the distal airways have been developed, but are predominantly histologic in nature (for example quantification of increased goblet cell number). There are few investigations of mucus hypersecretion. Examination of the 'antisecretory' potential of pharmaceutical compounds has been investigated predominantly in chronic histologic models with the drug being given 'prophylactically' rather than 'therapeutically'. Refinement of chronic hypersecretory models should lead to elucidation of the connection between airway irritation, inflammation, MUC gene expression, mucous cell hyperplasia/metaplasia, airway hypersecretion and bronchial hypersecretory disease. more...

1. Airway Surface Liquid: Concepts and Measurements.- 2. Structure and Biochemistry of Human Respiratory Mucins.- 3. Airway Mucin Genes and Gene Products.- 4. The Microanatomy of Airway Mucus Secretion.- 5. Mechanisms Controlling Airway Ciliary Activity.- 6. Rheological Properties and Hydration of Airway Mucus.- 7. Goblet Cells: Physiology and Pharmacology.- 8. Airway Submucosal Glands: Physiology and Pharmacology.- 9. Mucus-Bacteria Interactions.- 10. Experimental Induction of Goblet Cell Hyperplasia In Vivo 227.- 11. Mucus Hypersecretion and Its Role in the Airway Obstruction of Asthma and Chronic Obstructive Pulmonary Disease.- 12. Mucus and Airway Epithelium Alterations in Cystic Fibrosis.- 13. Drug-Mucus Interactions.- 14. Therapeutic Approaches to the Lung Problems in Cystic Fibrosis.- 15. Therapeutic Approaches to Airway Mucous Hypersecretion. more...

Despite the importance of mucus secretion in airway physiology and pathophysiology, our understanding of the functional microanatomy of mucus release in mammalian airways is rudimentary. It is not clear how many different types of secretory granule may be present within the different mucus-producing cells (the goblet cells of the surface epithelium and the mucous and serous cells of the submucosal glands), or whether different pathways for granule release exist. There is no clear understanding of the sequence of intracellular events leading to basal secretion of a mucin granule, of the intracellular mechanisms involved or of the effect of secretagogues upon degranulation. The culmination of these events is generally considered to be fusion of the cytoplasmic mucin granule membrane with the plasma membrane, the process of exocytosis, with complete incorporation of the granule membrane into the apical plasma membrane. However, ultrastructural support for this proposal has been surprisingly sparse, and it has been particularly difficult to find changes that can be quantitatively correlated with secretagogue action. The reasons for this are most probably associated with the investigative methods. In order to understand the functional morphology of mucin secretion, it is vital to appreciate what occurs during specimen preparation. more...

1. In order to examine the role of nitric oxide (NO) on airway mucus secretion we studied the effects of the nitric oxide synthase (NOS) inhibitor L-N(G)-monomethyl-L-arginine (L-NMMA), a novel nitric oxide donor, (+/-)-(E)-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexeneamide (FK409), and the NO precursor L-arginine on basal mucus secretion in the ferret trachea in vitro in Ussing chambers. We also determined the effects of these agents upon secretion induced by electrical stimulation of nerves or by acetylcholine (ACh). We used 35SO4 as a mucus marker. 2. L-NMMA (0.01-1 mM) increased basal output of 35SO4-labelled macromolecules with a maximal increase above baseline of 248% at 0.1 mM L-NMMA. L-Arginine (1 mM) alone had no significant effect on basal secretion but reversed the potentiating effect of L-NMMA on basal secretion. L-NMMA-induced increases in basal mucus secretion were sustained for at least 30 min in the continuing presence of the NOS inhibitor. In contrast to the potentiating effects of L-NMMA, FK409 (100 nM) reduced basal secretion by 60% (at 1 nM and at 10 nM it was without effect). 3. Electrical stimulation (50 V, 10 Hz, 0.5 ms for 5 min) increased 35SO4 output by 174%. L-NMMA (1 and 10 mM) present during stimulation of tracheal segments resulted in significant potentiations of 214% and 116%, respectively, of the neurogenic response. The potentiated response to 10 mM L-NMMA was reversed by L-arginine (1 mM). At this dose L-arginine had no effect itself on basal secretion. In contrast to the potentiating effects of L-NMMA on neurogenic secretion, FK409 at 10 nM and 100 nM inhibited the neurogenic response by 98% and 99%. 4. At all concentrations tested, neither L-NMMA (0.01 mM-1 mM) nor FK409 (1-100 mM) had any significant effect on ACh-induced mucus secretion. 5. These observations lead us to conclude that nitric oxide, derived from constitutive NO synthase, acts as an endogenous inhibitor of both basal and neurogenic mucus secretion in ferret trachea in vitro. more...

We studied the effect of acute inhalation of middle-tar cigarette smoke on airway goblet cell secretion in anesthetized guinea pigs. Secretion induced by a low dose of smoke (10 breaths diluted 1:10 in air) was blocked by either hexamethonium or by filtering out the particulate phase of the smoke. The response was partially inhibited by atropine but was not inhibited by propranolol, phentolamine, or capsaicin pretreatment. Cutting the nerve supply to the airways did not inhibit the response to low-dose smoke. In contrast, goblet cell secretion induced by a high dose of cigarette smoke (20 breaths undiluted) was inhibited by capsaicin pretreatment but not by autonomic receptor blockade nor by filtering out the particulate phase. Secretion induced by the vapor phase of the high dose of cigarette smoke was blocked by capsaicin pretreatment but was not inhibited by hexamethonium. We conclude that in guinea pig airways the particulate phase of low doses of smoke activates cholinergic nerves via stimulation of parasympathetic ganglia, whereas the vapor phase of high doses of smoke activates capsaicin-sensitive sensory nerves. more...

Basic research into cystic fibrosis (CF) has been hampered by the lack of a suitable animal model. Reserpinized or isoproterenol-treated rats have been proposed as models because they exhibit certain morphological and physiological features characteristic of CF. Recent evidence suggests that abnormal epithelial transport of Na+ [corrected] and Cl- may underlie pathogenesis, defects that may contribute to the markedly more negative transepithelial electrical potential differences (PD) recorded in CF airways compared with controls. To test the models further, we measured tracheal PD in vivo in treated rats (reserpinized - 6.9 mV, SEM 0.7 mV, n = 7; isoproterenol-treated -10.2 mV, SEM 1.5 mV, n = 12) and found it to be no different from that of controls (-8.7 mV, SEM 0.6 mV, n = 25). The animals did, however, demonstrate a reduced gain in body weight as well as increased submaxillary gland weight, which reflected an increased mucus content in the acini. These observations suggest that although the reserpinized or isoproterenol-treated rat may be useful in the study of the pathogenesis of exocrine disturbances in disease, their use as models for the effect of the basic defect of CF in the airways may be limited. more...

1. We studied the effect of platelet activating factor (PAF) on leakage of albumin, and secretion of fucose (a marker for mucus glycoprotein) and protein into the tracheal lumen of the guinea-pig isolated in situ, and on bioelectric properties and fluxes of mannitol in vitro. We also studied the effect of PAF on mucus secretion in human bronchi in vitro. 2. In guinea-pig, intravenous PAF markedly increased the luminal concentration of protein but did not significantly increase fucose concentrations. Increased albumin leakage (274% above controls at a dose of 50 ng/kg PAF) was associated with the increased luminal content of protein (248% above controls at the same dose of PAF). 3. Leakage of albumin was maximal 10 min after PAF, was significantly reduced by 20 min and had returned to baseline by 30 min. This pattern of leakage could be repeated with successive administrations of PAF. 4. PAF induced small but significant biphasic changes in bioelectric properties in vitro. The initial response was rapid in onset and characterized by maximal increases in short-circuit current (Isc) of 6.5% above controls at 7.5 min and in conductance (G) of 7% at 20 min. Both responses were blocked by the PAF receptor antagonist WEB 2086. Amiloride blocked the increase in Isc. Permeability of the tissue to mannitol (Pmann) was unaltered. The delayed response was characterized by maximal increases in Isc and G of 10% above controls at 60-90 min which were not significantly affected by WEB 2086 or amiloride. Pmann was increased by 38% at 90 min. 5. PAF increased fucose secretion in human bronchi in vitro. 6. Lyso-PAF in vitro caused changes similar to those induced by PAF on bioelectric properties and mucus secretion, but had no significant effects in vivo. 7. Light microscopy showed no evidence of epithelial disruption in animals given intravenous PAF at a dose causing significant albumin transudation. 8. We conclude that PAF increases the protein content of guinea-pig tracheal fluid principally by inducing plasma leakage rather than mucus secretion and that the small changes in ion transport and epithelial conductance may reduce the tendency to epithelial disruption during plasma leakage. more...

We examined the effects of mammalian tachykinins on human bronchial secretion in vitro using fucose as an endogenous marker for mucus. Substance P (SP, 10 −9 –10 −5 M) increased secretion in a dose-related manner and was more potent than neurokinin A or neurokinin B. The enkephalinase (endopeptidase 24.11) inhibitor phosphoramidon (10 −5 M) potentiated the effect of SP (10 −7 M). SP is a potent stimulant of secretion in human bronchi and enkephalinase may modulate its effects. more...

The studies presented here describe the involvement of cell proliferation, differentiation and transformation in the epithelial mucous cell increase observed in the airways of experimental animals exposed to tobacco smoke (TS) for 14 days: the inhibitory effect of concurrent administration by injection of non-steroidal and steroidal anti-inflammatory drugs is also presented. In response to T.S. mucous cells arise mainly by self-replication and transformation of existing serous (secretory) cells while the production of ciliated cells appears to be mainly by differentiation of basal cells. Indomethacin inhibits the T.S.-induced mucous cell increase in a dose related way, the extent of which is dependent on the initial degree of response to T.S. and the airway level studied. The steroids dexamethasone, prednisolone and hydrocortisone, whilst effective in their inhibition gave no particular advantage over and above that seen with Indomethacin. more...

1. Mucous secretion and mucosal permeability by the larynx and trachea, isolated in situ, was investigated in normal rats and in those in which ‘chronic bronchitis' was induced by daily exposure to cigarette smoke for 2 weeks. Fucose was used as a specific marker for the secretion of mucus glycoprotein, and hexose and protein were markers both for mucus and plasma-type glycoproteins present in tissue fluid transudate. Albumin was used as an indicator of the contribution of serum to the secretions. 2. After equilibration, the mean basal secretion of fucose (μg/30 min collection) was significantly higher in ‘bronchitic’ rats than in the controls (P < 0.01). Mean values for controls were: fucose 3 (sem 1; n = 9), hexose 41 (sem 9; n = 8), protein 1082 (sem 385; n = 8), albumin 3. In control and bronchitic animals acute administrations of cigarette smoke, blown directly through the laryngo-tracheal segment after equilibration, caused significant (P < 0.05) transient increases in the secretion of fucose, hexose and protein, but not of albumin. more...