montelukast and Acute-Lung-Injury

To explore the therapeutic role of a single dose combination of montelukast (MON) and dexamethasone (DXM) through intra-peritoneal route against paraquat (PQ)-intoxicated experimental Wistar rats.. Results of survival rate and levels of lungs parameters indicated therapeutic potential of combination treatment of MON and DXM. Protective activity on lungs was reflected in chest imaging and histopathological investigations. Moreover, combination treatment exhibited significant increased levels of all anti-oxidant parameters. Significant decrease in the levels of IL-1β; IL-6; TGF-β1 and TNF-α was also observed with the combination treatment of MON and DXM. Evidence of significant down regulation of NF-kB and phospho-NF-kB was also found with the combination treatment of MON and DXM.. Given the advantage of therapeutic synergism activity of MON and DXM, it may be used in the prophylaxis of PQ-intoxication following clinical trials.

Topics: Acetates; Acute Lung Injury; Administration, Inhalation; Animals; Anti-Inflammatory Agents; Catalase; Cyclopropanes; Cytokines; Dexamethasone; Drug Therapy, Combination; Glutathione Peroxidase; Herbicides; Lung; Male; NF-kappa B; Paraquat; Quinolines; Rats, Wistar; Respiratory Function Tests; Sulfides; Superoxide Dismutase

Bleomycin has progressively been used to treat low-flow vascular malformations in children. No significant systemic side effects have been reported in large series after low doses, but some authors are still concerned about its use. We report a case of a severe acute lung toxicity after a low dose of a second bleomycin intralesional injection in a 5-year-old girl. She had no risk factors and presented a cervical low-flow venous malformation. Twenty-four hours after this second administration, she presented with fever and respiratory distress. A chest radiograph showed bilateral opacities and computerized tomography revealed extensive and diffuse lung ground-glass opacities. The patient started to receive intravenous methylprednisolone, but she experienced progressively increased dyspnea, and montelukast was added. She improved and was discharged from the hospital without oxygen support, with montelukast and prednisolone for tapering doses during months. Five months after onset, the patient is developing well, is active, and walks and talks without dyspnea. A new low-dose computed tomography shows improvement in radiologic findings. This is the second case of pulmonary toxicity observed in a child after bleomycin intralesional administration, and the first reported after the lowest dose of this drug to date (7 mg: 0.28 mg/kg; 10 U: 0.4 U/kg). A delay in the diagnosis and treatment of this complication can be fatal. Any physician who treats these patients must be alert and consider this complication in children with respiratory symptoms after bleomycin sclerotherapy. Early detection of pulmonary toxicity would allow prompt therapy and could avoid pulmonary damage.

Topics: Acetates; Acute Lung Injury; Bleomycin; Child, Preschool; Cyclopropanes; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Injections, Intralesional; Methylprednisolone; Quinolines; Risk Assessment; Sclerotherapy; Sulfides; Tomography, X-Ray Computed; Treatment Outcome; Vascular Malformations

The aim of this study was to assess the possible protective effect of montelukast against haemorrhagic shock-induced acute lung injury by interfering with inflammatory and oxidative pathways. Acute lung injury following haemorrhagic shock/resuscitation is an important contributor to late morbidity and mortality in trauma patients. Haemorrhagic shock (HS), followed by resuscitation, is considered to be an insult that frequently induces systemic inflammatory response syndrome and oxidative stress, resulting in multiple-organ dysfunction syndrome, including microvascular changes and microscopic damage termed acute lung paraynchymal injury. Montelukast is a cysteinyl leukotriene receptor antagonist that exerts an anti-inflammatory and antioxidant influence.. Eighteen adult albino rats were assigned to three groups of six. In Group I, the 'sham' group, rats underwent all the surgical procedures but neither haemorrhagic shock nor resuscitation was carried out. Group II--the 'HS' induced, untreated group--was the control and underwent HS for one hour before being resuscitated with Ringer's lactate for one hour. Group III--the 'montelukast' group--underwent HS and treatment with montelukast (7 mg/kg i.p. injection) 30 min before the induction of HS, with the same dose repeated just before the reperfusion period. At the end of the experiment, two hours after completion of resuscitation, blood samples were collected for measurement of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). The trachea was then isolated and bronchoalveolar lavage was carried out for measurement of leukotriene B(4) (LTB(4)), leukotriene C(4) (LTC(4)) and total protein. The lungs were harvested and the left lung was homogenized for measurement of malondialdehyde (MDA) and reduced glutathione (GSH) and the right lung was fixed in 10% formalin for histological examination.. Montelukast treatment (Group III) significantly reduced the total lung injury score, compared with the HS group (Group II) (P < 0.05). Montelukast also significantly decreased serum TNF-α and IL-6; lung MDA; bronchoalveolar lavage fluid (BALF) LTB(4), LTC(4) & total protein compared with the HS group (P < 0.05). Montelukast treatment significantly inhibited decrease in the lung GSH levels, compared with the HS group (P < 0.05).. The results of the present study reveal that montelukast may ameliorate lung injury in shocked rats by interfering with inflammatory and oxidative pathways, implicating the role of leukotrienes in the pathogenesis of haemorrhagic shock-induced lung inflammation.

Topics: Acetates; Acute Lung Injury; Animals; Bronchoalveolar Lavage Fluid; Cyclopropanes; Glutathione; Interleukin-6; Leukotriene Antagonists; Leukotrienes; Male; Malondialdehyde; Oxidative Stress; Proteins; Quinolines; Rats; Shock, Hemorrhagic; Sulfides; Tumor Necrosis Factor-alpha