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1.  Prenatal and Postnatal Polycyclic Aromatic Hydrocarbon Exposure, Airway Hyperreactivity, and Beta-2 Adrenergic Receptor Function in Sensitized Mouse Offspring 
Journal of Toxicology  2013;2013:603581.
Despite data associating exposure to traffic-related polycyclic aromatic hydrocarbons (PAH) in asthma, mechanistic support has been limited. We hypothesized that both prenatal and early postnatal exposure to PAH would increase airway hyperreactivity (AHR) and that the resulting AHR may be insensitive to treatment with a β2AR agonist drug, procaterol. Further, we hypothesized that these exposures would be associated with altered β2AR gene expression and DNA methylation in mouse lungs. Mice were exposed prenatally or postnatally to a nebulized PAH mixture versus negative control aerosol 5 days a week. Double knockout β2AR mice were exposed postnatally only. Prenatal exposure to PAH was associated with reduced β2AR gene expression among nonsensitized mice offspring, but not increases in DNA methylation or AHR. Postnatal exposure to PAH was borderline associated with increased AHR among sensitized wildtype, but not knockout mice. In the first study that delivers PAH aerosols to mice in a relatively physiological manner, small effects on AHR and β2AR gene expression, but not β2AR agonist drug activity, were observed. If confirmed, the results may suggest that exposure to PAH, common ambient urban pollutants, affects β2AR function, although the impact on the efficacy of β2AR agonist drugs used in treating asthma remains uncertain.
PMCID: PMC3876588  PMID: 24454363
2.  Polycyclic Aromatic Hydrocarbons Impair Function of β2-Adrenergic Receptors in Airway Epithelial and Smooth Muscle Cells 
Incomplete combustion produces a pollutant mixture that includes polycyclic aromatic hydrocarbons (PAHs). Previous work by the Columbia Center for Children's Environmental Health (CCCEH) and others linked exposure to PAH with symptoms of asthma and other adverse health effects in young children. Inhaled β2-adrenergic agonists are mainstays in the treatment of reactive airway diseases. These exogenous catecholamines engage membrane-bound β2-adrenergic receptors (β2AR) on airway epithelial and smooth muscle cells to cause airway dilation. We hypothesized that exposure to PAH might similarly interfere with the function of β2AR in airway epithelial or smooth muscle cells, reducing the efficacy of a medication important for the treatment of asthma symptoms. A PAH mixture was devised, based on ambient levels measured prenatally among a cohort of pregnant women participating at the CCCEH. Primary airway epithelial and smooth muscle cells were exposed to varying concentrations of the PAH mixture, and expression, function, and signaling of β2AR were assessed. Murine tracheal epithelial cells and human airway smooth muscle cells, after exposure to a PAH mixture, exhibited reduced expression and function of β2AR. These findings support our hypothesis that environmentally relevant PAHs can impede β2AR-mediated airway relaxation, and suggest a new paradigm where air pollutants not only contribute to the pathogenesis of childhood asthma, but also diminish responsiveness to standard therapy.
PMCID: PMC3262692  PMID: 21617201
polycyclic aromatic hydrocarbons; β2-adrenergic receptors
3.  Vascular Inflammation in Obesity and Sleep Apnea 
Circulation  2010;121(8):1014-1021.
Unrecognized obstructive sleep apnea (OSA) is highly prevalent in obesity. Both obesity and OSA are associated with vascular endothelial inflammation and increased risk for cardiovascular diseases. We investigated directly whether endothelial alterations that are commonly attributed to obesity are in fact related to OSA.
Methods and Results
Seventy-one subjects with body mass index (BMI) ranging from normal to obese underwent attended polysomnography. To assess directly vascular inflammation and oxidative stress, we quantified expression of nuclear factor kappa B (NFκB) and nitrotyrosine by immunofluorescence in freshly harvested venous endothelial cells. To evaluate basal endothelial nitric oxide (NO) production and activity, we quantified expression of endothelial NO synthase (eNOS) and phosphorylated eNOS (P-eNOS). Vascular reactivity was measured by brachial artery flow-mediated dilation (FMD). Expression of eNOS and P-eNOS and FMD were significantly lower whereas expression of nitrotyrosine was significantly greater in OSA patients (n=38) than in OSA-free subjects (n=33) regardless of central adiposity. Expression of NFκB was greater in obese OSA patients than in obese OSA-free subjects (p=0.004). Protein expression and FMD were not significantly affected by increasing BMI or central obesity in OSA patients and in OSA-free subjects. After 4 weeks of continuous positive airway pressure (CPAP) therapy, FMD and expression of eNOS and P-eNOS significantly increased whereas expression of nitrotyrosine and NFκB significantly decreased in OSA patients who adhered with CPAP≥4 hours daily.
Untreated OSA rather than obesity is a major determinant of vascular endothelial dysfunction, inflammation and elevated oxidative stress in obese patients.
PMCID: PMC2864627  PMID: 20159829
obesity; sleep; endothelium; hypoxia
4.  Prenatal allergen and diesel exhaust exposure and their effects on allergy in adult offspring mice 
Multiple studies have suggested that prenatal exposure to either allergens or air pollution may increase the risk for the development of allergic immune responses in young offspring. However, the effects of prenatal environmental exposures on adult offspring have not been well-studied. We hypothesized that combined prenatal exposure to Aspergillus fumigatus (A. fumigatus) allergen and diesel exhaust particles will be associated with altered IgE production, airway inflammation, airway hyperreactivity (AHR), and airway remodeling of adult offspring.
Following sensitization via the airway route to A. fumigatus and mating, pregnant BALB/c mice were exposed to additional A. fumigatus and/or diesel exhaust particles. At age 9-10 weeks, their offspring were sensitized and challenged with A. fumigatus.
We found that adult offspring from mice that were exposed to A. fumigatus or diesel exhaust particles during pregnancy experienced decreases in IgE production. Adult offspring of mice that were exposed to both A. fumigatus and diesel exhaust particles during pregnancy experienced decreases in airway eosinophilia.
These results suggest that, in this model, allergen and/or diesel administration during pregnancy may be associated with protection from developing systemic and airway allergic immune responses in the adult offspring.
PMCID: PMC2875211  PMID: 20459836
5.  Inflammation, Oxidative Stress, and Repair Capacity of the Vascular Endothelium in Obstructive Sleep Apnea 
Circulation  2008;117(17):2270-2278.
Indirect evidence implicates endothelial dysfunction in the pathogenesis of vascular diseases associated with obstructive sleep apnea (OSA). We investigated directly whether dysfunction and inflammation occur in vivo in the vascular endothelium of patients with OSA. The effects of continuous positive airway pressure (CPAP) therapy on endothelial function and repair capacity were assessed.
Methods and Results
Thirty-two patients with newly diagnosed OSA and 15 control subjects were studied. Proteins that regulate basal endothelial nitric oxide (NO) production (endothelial NO synthase [eNOS] and phosphorylated eNOS) and inflammation (cyclooxygenase-2 and inducible NOS) and markers of oxidative stress (nitrotyrosine) were quantified by immunofluorescence in freshly harvested venous endothelial cells before and after 4 weeks of CPAP therapy. Vascular reactivity was measured by flow-mediated dilation. Circulating endothelial progenitor cell levels were quantified to assess endothelial repair capacity. Baseline endothelial expression of eNOS and phosphorylated eNOS was reduced by 59% and 94%, respectively, in patients with OSA compared with control subjects. Expression of both nitrotyrosine and cyclooxygenase-2 was 5-fold greater in patients with OSA than in control subjects, whereas inducible NOS expression was 56% greater. Expression of eNOS and phosphorylated eNOS significantly increased, whereas expression of nitrotyrosine, cyclooxygenase-2, and inducible NOS significantly decreased in patients who adhered to CPAP ≥4 hours daily. Baseline flow-mediated dilation and endothelial progenitor cell levels were lower in patients than in control subjects, and both significantly increased in patients who adhered to CPAP ≥4 hours daily.
OSA directly affects the vascular endothelium by promoting inflammation and oxidative stress while decreasing NO availability and repair capacity. Effective CPAP therapy is associated with the reversal of these alterations.
PMCID: PMC2844329  PMID: 18413499
endothelium; hypoxia; sleep
6.  Endothelial repair capacity and apoptosis are inversely related in obstructive sleep apnea 
To investigate the impact of obstructive sleep apnea (OSA) on endothelial repair capacity and apoptosis in the absence of potentially confounding factors including obesity.
Patients and methods:
Sixteen patients with a body mass index <30 and newly diagnosed OSA and 16 controls were studied. Circulating levels of endothelial progenitor cells, a marker of endothelial repair capacity, and endothelial microparticles, a marker of endothelial apoptosis, were quantified before and after four-week therapy with continuous positive airway pressure (CPAP). Endothelial cell apoptotic rate was also quantified in freshly harvested venous endothelial cells. Vascular reactivity was measured by flow-mediated dilation.
Before treatment, endothelial microparticle levels were greater and endothelial progenitor cell levels were lower in patients with OSA than in controls (P < 0.001 for both). Levels of endothelial microparticles and progenitors cells were inversely related (r = −0.67, P < 0.001). Endothelial progenitor cell levels increased after effective treatment (P = 0.036).
In the absence of any co-morbid conditions including obesity, OSA alone impairs endothelial repair capacity and promotes endothelial apoptosis. These early endothelial alterations may underlie accelerated atherosclerosis and increased cardiovascular risk in OSA.
PMCID: PMC2788596  PMID: 19997572
sleep apnea; endothelium; apoptosis; endothelial repair capacity
7.  Alveolar Epithelial β2-Adrenergic Receptors 
β2-adrenergic receptors are present throughout the lung, including the alveolar airspace, where they play an important role for regulation of the active Na+ transport needed for clearance of excess fluid out of alveolar airspace. β2-adrenergic receptor signaling is required for up-regulation of alveolar epithelial active ion transport in the setting of excess alveolar edema. The positive, protective effects of β2-adrenergic receptor signaling on alveolar active Na+ transport in normal and injured lungs provide substantial support for the use of β-adrenergic agonists to accelerate alveolar fluid clearance in patients with cardiogenic and noncardiogenic pulmonary edema. In this review, we summarize the role of β2-adrenergic receptors in the alveolar epithelium with emphasis on their role in the regulation of alveolar active Na+ transport in normal and injured lungs.
PMCID: PMC2214676  PMID: 17709598
pulmonary edema; acute respiratory distress syndrome; acute lung injury; alveoli; albuterol
8.  Respiratory syncytial virus induces insensitivity to beta-adrenergic agonists in mouse lung epithelium in vivo 
Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in infants and children worldwide. We wished to determine whether intracheal administration of β-agonists improved alveolar fluid clearance (AFC) across the distal respiratory epithelium of RSV infected mice. Following intranasal infection with RSV strain A2, AFC was measured in anesthetized, ventilated BALB/c mice by instillation of 5% BSA into the dependent lung. We found that direct activation of protein kinase A by forskolin or 8-bromo-cAMP increased AFC at day 2 after infection with RSV. In contrast, short- and long-acting β-agonists had no effect at either day 2 or day 4. Insensitivity to β-agonists was not a result of elevated plasma catecholamines, or lung epithelial cell β-adrenergic receptor degradation. Instead, RSV infected mice had significantly higher levels of phosphorylated PKCζ in the membrane fractions of their lung epithelial cells. In addition, insensitivity to β-agonists was mediated in a paracrine fashion by KC (the murine homolog of CXCL8) and reversed by inhibition of either PKCζ or G protein-coupled receptor kinase 2 (GRK2). These results indicate that insufficient response to β-agonists in RSV may be caused, at least in part, by impaired β-adrenergic receptor signaling, as a consequence of GRK2-mediated uncoupling of β-adrenergic receptors from adenylyl cyclase.
PMCID: PMC2084466  PMID: 17435077
Paramyxovirus; Protein kinase C; G protein-coupled receptor kinase 2; CXCL8
9.  Clinical review: Airway hygiene in the intensive care unit 
Critical Care  2008;12(2):209.
Maintenance of airway secretion clearance, or airway hygiene, is important for the preservation of airway patency and the prevention of respiratory tract infection. Impaired airway clearance often prompts admission to the intensive care unit (ICU) and can be a cause and/or contributor to acute respiratory failure. Physical methods to augment airway clearance are often used in the ICU but few are substantiated by clinical data. This review focuses on the impact of oral hygiene, tracheal suctioning, bronchoscopy, mucus-controlling agents, and kinetic therapy on the incidence of hospital-acquired respiratory infections, length of stay in the hospital and the ICU, and mortality in critically ill patients. Available data are distilled into recommendations for the maintenance of airway hygiene in ICU patients.
PMCID: PMC2447567  PMID: 18423061

Results 1-9 (9)