Protection of the lungs from acid during aspiration

Effros, Richard M.; Hogan, Genevieve; Hoagland, Kelly; Olson, L. Karl; Lin, Wen

doi:10.1016/s0002-9343(01)00822-1

Cited by 10 publications

(8 citation statements)

References 5 publications

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“…BA should not be detectable in the lung under normal circumstances and this has been recently confirmed by our group [106]. The presence of BA in the alveoli can lower the alveolar pH leading to the damage of enzymatic activities in type II pneumocytes [102,122,123]. A similar and probably most important mechanism of action is the BA capacity to disrupt cellular membranes in the alveoli increasing the cellular cationic permeability [89,124].…”

Section: Future Perspectivesmentioning

confidence: 57%

Intrahepatic Cholestasis of Pregnancy and Bile Acids Induced Lung Injury in Newborn Infants

Zecca¹,

Luca²,

Marras³

et al. 2007

CPR

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Intrahepatic cholestasis of pregnancy (ICP) is a clinical syndrome of unknown pathophysiology, occurring during the second half of pregnancy and persisting until delivery. The incidence of ICP varies from 0.1% to 1.5% of pregnancies in Europe, North America and Australia and from 9.2% to 15.6% in South American countries such as Bolivia and Chile. This syndrome has been associated with increased foetal distress, intrauterine death, premature delivery, perinatal mortality and, more recently, with the occurrence of respiratory distress syndrome in the newborn infant. Bile acids (BA) are supposed to be the main mediators for these complications because ICP seriously impairs the placental clearance of foetal BA leading to a dangerous accumulation of these compounds within the foetus and the newborn. Cholestatic pregnancies have to be considered high risk ones, recent reports showing that BA can interfere with surfactant metabolism and are particularly harmful for the developing lung.This review summarizes existing literature data on this topic with particular emphasis on bile acids-induced lung injury. The authors discuss possible mechanisms of lung damage and highlight future research perspectives in this field.

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Section: Future Perspectivesmentioning

confidence: 57%

Intrahepatic Cholestasis of Pregnancy and Bile Acids Induced Lung Injury in Newborn Infants

Zecca¹,

Luca²,

Marras³

et al. 2007

CPR

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“…Of the various components of the duodeno-GER, the acid per se may play a limited role in the injury related to chronic, silent aspiration (40,41). Bile acids are barrier breakers of the gastric mucosa, disrupting its protective surfactant phospholipid layer (42,43).…”

Section: Discussionmentioning

confidence: 99%

“…Bile aspiration has been associated with pulmonary injury (36)(37)(38)(39) with dose-dependent cytotoxicity ranging from alteration of cellular cationic permeability to disruption of the cellular membrane as observed in type II pneumocytes (40). Of the various components of the duodeno-GER, the acid per se may play a limited role in the injury related to chronic, silent aspiration (40,41). Bile acids are barrier breakers of the gastric mucosa, disrupting its protective surfactant phospholipid layer (42,43).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, at low levels there appears to be a stimulatory effect on the SP-A production suggesting an irritant/stimulatory effect from low bile acids levels and a noxious effect at high levels on the type II pneumocytes (the major source of surfactant proteins within the pulmonary parenchyma). Bile acids have been shown to induce intracellular cAMP, and in turn cAMP has been shown to induce surfactant protein A gene expression (45,51) although at high doses, they disrupt cell membranes and induce apoptosis (40,52,53).…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Reflux and Bile Acid Aspiration on the Lung Allograft and Its Surfactant and Innate Immunity Molecules SP-A and SP-D

D’Ovidio

Mura

Ridsdale

et al. 2006

American Journal of Transplantation

171

116

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Gastro-esophageal reflux and related pulmonary bile acid aspiration were prospectively investigated as possible contributors to postlung transplant bronchiolitis obliterans syndrome (BOS). We also studied the impact of aspiration on pulmonary surfactant collectin proteins SP-A and SP-D and on surfactant phospholipids-all important components of innate immunity in the lung. Proximal and distal esophageal 24-h pH testing and broncho-alveolar lavage fluid (BALF) bile acid assays were performed prospectively at 3-month posttransplant in 50 patients. BALF was also assayed for SP-A, SP-D and phospholipids expressed as ratio to total lipids: phosphatidylcholine; dipalmitoylphosphatidylcholine; phosphatidylglycerol (PG); phosphatidylinositol; sphingomyelin (SM) and lysophosphatidylcholine. Actuarial freedom from BOS was assessed.Freedom from BOS was reduced in patients with abnormal (proximal and/or distal) esophageal pH findings or BALF bile acids (Log-rank Mantel-Cox p < 0.05). Abnormal pH findings were observed in 72% (8 of 11) of patients with bile acids detected within the BALF. BALF with high levels of bile acids also had significantly lower SP-A, SP-D, dipalmitoylphosphatidylcholine; PG and higher SM levels (Mann-Whitney, p < 0.05). Duodeno-gastro-esophageal reflux and consequent aspiration is a risk factor for the development of BOS postlung transplant. Bile acid aspiration is associated with impaired lung allograft innate immunity manifest by reduced surfactant collectins and altered phospholipids.

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“…We measured the BALF pH, because BA could lower the alveolar pH, damaging type II pneumocyte enzymatic activities. 9,17,18 BA could also disrupt cellular membranes in the alveoli, increasing cationic permeability and intracellular Ca ϩϩ concentration, leading to apoptosis. 5,19,20 BALF pH was not different among our groups, probably because BAs are weak acid compounds.…”

Section: Discussionmentioning

confidence: 99%

Bile Acid-Induced Lung Injury in Newborn Infants: A Bronchoalveolar Lavage Fluid Study

Zecca

Luca²,

Baroni³

et al. 2008

Pediatrics

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Protection of the lungs from acid during aspiration

Cited by 10 publications

References 5 publications

Intrahepatic Cholestasis of Pregnancy and Bile Acids Induced Lung Injury in Newborn Infants

Intrahepatic Cholestasis of Pregnancy and Bile Acids Induced Lung Injury in Newborn Infants

The Effect of Reflux and Bile Acid Aspiration on the Lung Allograft and Its Surfactant and Innate Immunity Molecules SP-A and SP-D

Bile Acid-Induced Lung Injury in Newborn Infants: A Bronchoalveolar Lavage Fluid Study

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