montelukast and Bronchopulmonary-Dysplasia

This review highlights important advances in paediatric respiratory medicine since 2014, excluding cystic fibrosis. It focuses mainly on the more common conditions, bronchopulmonary dysplasia, bronchiolitis and preschool wheezing, asthma, pneumonia and sleep, and highlights some of the rarer conditions such as primary ciliary dyskinesia and interstitial lung disease (ILD).

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Bronchopulmonary Dysplasia; Ciliary Motility Disorders; Cyclopropanes; Humans; Lung Diseases, Interstitial; Medication Adherence; Pediatrics; Pulmonary Medicine; Quinolines; Saline Solution, Hypertonic; Sleep Apnea, Obstructive; Sulfides

Bronchopulmonary dysplasia (BPD) is a major cause of mortality and morbidity in infants with an extremely low birth weight. Because there is no effective therapy, the mortality of this condition in severely affected patients is high. Therapeutic blocking of the leukotriene system seems to be a logical approach due to the known pathophysiology of BPD.. The aim of this study was to examine the therapeutic effect of montelukast in preterm children suffering from severe BPD.. We performed an unblinded, prospective trial including infants born between 23 and 27 weeks of gestation suffering from severe BPD. The study drug was montelukast (1 mg/kg of body weight as a single dose daily in the 1st week of therapy, increasing to 1.5 mg/kg of body weight in the 2nd week and finally to 2 mg/kg of body weight in the 3rd week). Treatment was continued until the radiological signs and the clinical symptoms of BPD disappeared or the patient was discharged from the hospital. Each patient included in this study was matched for gestational age, birth weight, and pulmonary severity score to a control.. Until March 2014, a total of 22 infants were enrolled into the study. The rates of the primary outcome differed significantly between the montelukast-treated group and the control group. All but 1 of the children in the treatment group survived (91%), whereas 7 of the 11 children in the control group died (survival rate 36%; p = 0.002 using Fisher's exact test). The mean mechanical ventilation time (41.2 ± 25.3 vs. 103.7 ± 90.6 days) was significantly shorter and the mean preterm complication score (3.0 ± 1.7 vs. 5.6 ± 1.4) was significantly lower in treated patients compared to the control group. (p = 0.05 for both items; Wilcoxon's matched-pairs test).. Based on the clinical observations, the statistical results, and the relatively low risk of the study drug montelukast, we recommend using this treatment in severe cases of BPD for infants facing a high risk of death.

Topics: Acetates; Bronchopulmonary Dysplasia; Cyclopropanes; Drug Dosage Calculations; Drug Monitoring; Female; Humans; Infant; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Leukotriene Antagonists; Male; Prospective Studies; Quinolines; Radiography; Receptors, Leukotriene; Respiration, Artificial; Severity of Illness Index; Sulfides; Survival Rate; Treatment Outcome

The present study investigated the role of montelukast (MK) during the progression of bronchopulmonary dysplasia (BPD) and the underlying mechanism of action. A rat model of BPD was induced by hyperoxia and subsequently, the rats were treated with 10 mg/kg MK. On day 14 post‑hyperoxia induction, lung function was assessed by detecting the mean linear intercept (MLI; the average alveolar diameter), the radial alveolar count (RAC; alveolar septation and alveologenesis) and the lung weight/body weight (LW/BW) ratio. Type II alveolar epithelial (AEC II) cells were isolated from normal rats to investigate the mechanism underlying the effect of MK on BPD in vitro. Western blotting and reverse transcription‑quantitative PCR were performed to measure the expression levels of surfactant protein C (SP‑C), E‑cadherin, N‑cadherin, Vimentin, collagen I (Col I), matrix metallopeptidase (MMP)1/3, transforming growth factor (TGF)‑β1 and Smad3. MK significantly reduced the MLI and the LW/BW ratio, and increased the RAC of the BPD group compared with the control group. MK upregulated the expression of SP‑C and E‑cadherin, and downregulated the expression levels of N‑cadherin and Vimentin in the lung tissues of the rat model of BPD, as well as in TGF‑β1‑ and hyperoxia‑induced AEC II cells. In addition, MK reduced the expression of Col I, MMP1, MMP3, TGF‑β1 and Smad3 in the lung tissues of the rat model of BPD, as well as in TGF‑β1‑ and hyperoxia‑induced AEC II cells. The present study demonstrated that MK improved BPD by inhibiting epithelial‑mesenchymal transition via inactivating the TGF‑β1/Smads signaling pathway.

Topics: Acetates; Alveolar Epithelial Cells; Animals; Bronchopulmonary Dysplasia; Cell Hypoxia; Cyclopropanes; Disease Models, Animal; Epithelial-Mesenchymal Transition; Gene Expression Regulation; Quinolines; Rats; Signal Transduction; Smad Proteins; Sulfides; Transforming Growth Factor beta1

BACKGROUND Bronchopulmonary dysplasia (BPD) is a chronic lung disease common in preterm infants. Montelukast, an effective cysteinyl leukotriene (cysLT) receptor antagonist, has a variety of pharmacological effects and has protective effects against a variety of diseases. Currently, the efficacy and safety of montelukast sodium in treating BPD has been revealed, however, the precise molecular mechanism of the effect of montelukast on BPD development remain largely unclear. Therefore, this study aimed to investigate the effect and mechanism of montelukast on BPD in vivo and in vitro. MATERIAL AND METHODS A mouse BPD model and hyperoxia-induced lung cell injury model were established and treated with montelukast. Then mean linear intercept (MLI), radial alveolar count (RAC), lung weight/body weight (LW/BW) ratio, pro-inflammatory factors, and oxidative stress-related factors in lung tissues were determined. Cell viability and apoptosis were detected using MTT assay and flow cytometer respectively. RESULTS The results showed that montelukast treatment relieved mouse BPD, evidenced by increased RAC and decreased MLI and LW/BW ratios. We also found that montelukast treatment reduced pro-inflammatory factors (TNF-alpha, IL-6, and IL-1ß) production, enhanced superoxide dismutase (SOD) activity, and reduced malondialdehyde (MDA) content in the lung tissues of BPD mice. Besides, montelukast eliminated the reduced cell viability and enhanced cell apoptosis induced by hyperoxia exposure in vitro. Moreover, the upregulated pro-inflammatory factors production and p-p65 protein level in lung cells caused by hyperoxia were decreased by montelukast treatment. CONCLUSIONS Montelukast protected against mouse BPD induced by hyperoxia through inhibiting inflammation, oxidative stress, and lung cell apoptosis.

Topics: Acetates; Animals; Animals, Newborn; Apoptosis; Bronchopulmonary Dysplasia; Cyclopropanes; Disease Models, Animal; Hyperoxia; Interleukin-1beta; Interleukin-6; Lung; Lung Injury; Mice; Mice, Inbred C57BL; Oxidative Stress; Quinolines; Receptors, Leukotriene; Sulfides; Tumor Necrosis Factor-alpha

We aimed to assess the efficiency of clarithromycin, montelukast, and pentoxifylline treatments, alone and in combination, in reducing hyperoxic lung injury at the histopathologic level.. The experiment was carried out with 47 newborn rat pups divided into six groups during postnatal days 3 to 13. The rats belonging to group 1 were designated as the control group and kept in room air without exposure to hyperoxia. Group 2 (clarithromycin), group 3 (montelukast), group 4 (pentoxifylline), group 5 (clarithromycin + montelukast + pentoxifylline combination), and group 6 (placebo) were kept in plexiglass chamber and exposed to hyperoxia (88-92%) throughout the experiment. Alveolar surface area percentage, fibrosis, and smooth muscle actin expression were assessed in the lungs, which were resected by thoracotomy on postnatal day 14.. Drug treatments, when used separately, were not detected to be superior to placebo with regard to mean alveolar surface area, fibrosis, and smooth muscle actin expression. Combination treatment resulted in significantly higher mean lung area percentages and lower actin scores with respect to the placebo treatment group (64.0% vs. 50.2%, p=0.002; 0 (0-1) vs. 7 (2-12), p=0.005, respectively).. It was determined that clarithromycin, montelukast, and pentoxifylline combination treatment is superior to placebo treatment in the newborn rat hyperoxic lung injury model. The present study indicates that combination therapy might be successful in bronchopulmonary dysplasia, which has complex pathophysiologic processes and lacks established efficient treatment strategies.

Topics: Acetates; Animals; Animals, Newborn; Anti-Inflammatory Agents, Non-Steroidal; Bronchopulmonary Dysplasia; Clarithromycin; Cyclopropanes; Disease Models, Animal; Drug Therapy, Combination; Humans; Infant, Newborn; Leukotriene Antagonists; Oxygen Inhalation Therapy; Pentoxifylline; Quinolines; Rats; Sulfides