Ann Otol Rhinal Laryngol99: 1990
HISTAMINE STIMULATION OF MUCOCILIARY ACTIVITY IN THE RABBIT MAXILLARY SINUS JAN DOLATA, MD SVEN LINDBERG, MD, PHD
ULF MERCKE, MD, PHD LUND, SWEDEN
The in vivo effect of histamine on mucociliary activity in the rabbit maxillary sinus was investigated by injecting histamine into the maxillary artery and recording the responses with a photoelectric technique. Histamine stimulated the mucociliary activity dosedependently in the dose range 10 to 1,000 JLg/kg. The maximum response was 31.6% ±3.79'0 at a dose of 50 JLg/kg. The histamine-induced stimulation of the mucociliary activity was characterized by a short latency with a peak response within 1 to 2 minutes and a slow decline lasting about 5 minutes. The response displayed tachyphylaxis. Cholinergic blockade with atropine did not affect the response to histamine. Blockade of HI receptors with pyrilamine abolished the response to histamine, whereas blockade of H2 receptors with cimetidine was without effect. The H2 agonist dimaprit failed to stimulate the mucociliary activity. It is concluded that histamine stimulates the mucociliary activity in the rabbit maxillary sinus via HI receptors. KEY WORDS - histamine, mucociliary activity.
ent study reports the in vivo effect on the mucociliary activity in the rabbit maxillary sinus of intra-arterial administration of histamine and its relation to HI, H2, and muscarinic receptors.
INTRODUCTION
The mucociliary system of the respiratory mucosa represents the first line of defense in the airways. This important defense mechanism may malfunction in various pathologic conditions of the respiratory tract. For example, impairment of the mucociliary function in the lower airways has been reported in patients with asthma or chronic bronchitis;':" while a similar mucociliary dysfunction has been found in the upper airways in patients with chronic sinusitis." This impairment can be related to the liberation of inflammatory mediators.v" although it has not been possible to identify the role played by each one individually. One of the putative mediators, histamine, has been studied in various experimental models, but its effect on the mucociliary function is still obscure.
METHODS
The experiments were performed on rabbits of both sexes weighing 1.8 to 3.0 kg. Details of anesthetic and operative techniques have been published previously." The animals were anesthetized with intramuscular urethane 2.0 g/kg as an initial dose, followed by 0.5 g/kg intravenously during the beginning of the operation. The arterial inlet for the test substances was a retrograde cannula in the facial or lingual artery, continuously perfused with saline at 2 mLih. The mucosa in the maxillary sinus was exposed through a trephination hole of about 2 x 8 mm that was covered immediately with an antimist window. The slit between the window and the bone was sealed with bone wax (Ethicon) in order to avoid desiccation of the mucous membrane.
Many in vitro studies have failed to demonstrate an effect of histamine on ciliary activity. S.6 Contrary to these reports, Wanner et al" found that histamine produced modest stimulation of ciliary beat frequency in isolated tracheal cells from ewes, but only in relatively high doses.
The mucociliary activity (visible as flickering light reflections) was observed through a binocular microscope, and the transportation of small particles like mucus clumps and shed cells was the criterion for a working preparation. One of the eyepieces then was switched to a phototransducer, and the mucociliary activity was recorded by a photoelectric technique. The mucociliary wave pattern was monitored continuously on an oscilloscope and recorded on an ink writer during challenges. The recordings were analyzed by a computerized frequency calculator, the mucociliary wave frequency being expressed in waves per minute and calculated every 10 seconds during challenges and at intervals
Histamine is released in response to inflammatory and allergic reactions," both of which occur frequently in the upper airways. However, the effect of histamine has not been studied hitherto on the mucociliary activity in the upper airways. The results obtained from the lower airways are conflicting, and it is doubtful if they can be extrapolated to the upper airways. It is therefore of interest to elucidate the effects of histamine by use of an experimental animal model allowing in vivo study of the mucociliary activity in the upper airways. The pres-
From the Department of Otorhinolaryngology, University Hospital, Lund, Sweden. Supported by grants from the Swedish Medical Research Council (projects 17X-07940, 17P-08451, and 17P-08455), Forenade Liv Mutual Group Life Insurance Company, the Torsten Soderberg and Ragnar Soderberg Foundation, the Swedish Society of Medicine, the Tore Nilson Foundation, and the Medical Faculty of the University of Lund. REPRINTS - Jan Dolata, MD, Dept of Otorhinolaryngology, University Hospital, S-221 85 Lund, Sweden.
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Dolata et al, Histamine & Mucociliary Activity
of 1 minute otherwise. The induced frequency changes were expressed as percentages of the mucociliary wave frequency (frequency zero level) at the time of the administration of the tested substances. The dose-response and time-course curves were plotted from the maximum mucociliary wave frequency change during the first 5 minutes after each challenge. Electrocardiographic activity and rectal temperature were monitored. Body temperature was maintained at 37°C to 38.5°C by a heating pad. Respiration was sensed by a Hewlett Packard Toccotransducer 15278 B placed on the thorax and was recorded simultaneously with the mucociliary activity. The following drugs were used: histamine dihydrochloride (Sigma, USA), pyrilamine maleate (mepyramine; Sigma, USA), cimetidine (Tagamet; SK&F, Belgium), and atropine sulfate (ACO, Sweden). Dimaprit (dimethylamino-propyl-isothiourea) was a generous gift from Dr J. Skidmore, SK&F Research Ltd, England. Doses are expressed as concentrations of the respective salt. All substances were dissolved in saline. The intra-arterial route for administration of histamine was chosen for the following reasons. Although topical administration of histamine minimizes general side effects and mimics the release of histamine from mucosal mast cells, this method of application carries some disadvantages for mucociliary studies. Local administration causes tactile stimulation that increases the ciliary beat frequency.:" The rheologic properties of mucus are influenced by the applied solution, and this in turn could interfere with the mucociliary activity. Moreover, intra-arterial histamine has been used in other studies of airway physiology. II
Experimental Procedure. Histamine was given as a bolus injection of 0.2 mL in all experiments. 1. The effect of increasing doses of histamine was investigated in 16 rabbits, and a log dose-response curve was plotted in the interval 0.01 to 1,000 j.tg/kg (corresponding to 54.3 pmollkg to 5.43 j.tmollkg histamine dihydrochloride). The time lapse between challenges was 30 to 60 minutes. 2. In order to investigate if there was any tachyphylaxis to histamine, six rabbits were challenged with three consecutive 50-j.tg/kg injections of histamine at l-hour intervals. 3. The effect of a 50-j.tg/kg histamine dose during cholinergic blockade by atropine was investigated in six rabbits. Atropine was given at a dose of 0.2 mg/kg as an intra-arterial bolus injection of 0.2 mL. The rabbits were challenged with histamine 2 minutes after the atropine injection. 4. The effect of histamine at 50 j.tg/kg during HI receptor blockade by pyrilamine was investigated in six rabbits. Pyrilamine (mepyramine) 4 mg/kg was
667
Frequency change (%)
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(]) (12)
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15 (9)
10
(4)
5
0
, 0.01 0.1
i
1.0
,
10 50100 1000
Dose ~g/k9)
Fig 1. Effect of histamine on mucociliary activity in dose range 0.01 to 1,000 JLg/kg (corresponding to 54.3 pmollkg to 5.43 JLmol/kg). Figures in parentheses refer to number of experiments performed at each dose. Results are expressed as means ± SEM. The correlation coefficient for raw data was r = 0.66 (n = 16). Frequency zero level was 1,234 ± 21 waves/min.
given as an intravenous infusion of 1 mL over 1 minute. The rabbits were challenged with histamine 10 to 15 minutes after the pyrilamine infusion. 5. The effect of histamine at 50 j.tg/kg during H2 receptor blockade by cimetidine was investigated in six rabbits. Cimetidine at 5 mg/kg was given as an intravenous infusion of 1 mL over 1 minute. The rabbits were challenged with histamine 10 to 15 minutes after the cimetidine infusion. 6. Five rabbits were challenged with the H2 receptor agonist dimaprit at 10, 50, and 250 j.tg/kg given as bolus doses of 0.2 mL. The time lapse between challenges was 20 to 30 minutes. Six rabbits received histamine (50 j.tg/kg) only, as a control. The doses of the antagonists and the time intervals between the antagonists and the subsequent injections of histamine were chosen in accordance with results of previous investigations using the same experimental model'" and in vivo experiments performed by other research groupS.13-15 The results are expressed as means and standard error of the mean (SEM). The maximum response and the area under the curve were subjected to a parametric t test, except for the experiments with cimetidine, in which the Mann-Whitney U test was used. Only p values smaller than .05 were considered significant.
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Dolata et al, Histamine & Mucociliary Activity change (%)
Frequency
Frequency change (%)
35
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Fig 2. Effect of histamine on mucociliary activity in one rabbit in doses 1.0, 10, and 100 ltg/kg. Results are expressed as percentages of basal mucociliary level. Frequency zero levels were 1,083, 1,077, and 970, respectively.
~
~ II
I~ III
Injection
Fig 3. Maximum response of mucociliary activity after three consecutive injections of histamine at dose of 50 ltg/kg at intervals of 1 hour. Two-way analysis of variance revealed significant difference between three injections (p< .05). Linear regression of raw data displayed slope of - 8.0 and correlation coefficient of r = 0.55.
sponse with or without atropine was almost identical.
RESULTS
Injections of saline, used to dissolve all the tested substances, did not influence the mucociliary activity. Histamine stimulated the mucociliary activity dose-dependently in the dose interval 10 to 1,000 J.!g/kg (corresponding to 54.3 nmol/kg to 5.43 J.!mol! kg); the maximum response was 31.6% ±3.7170 for a dose of 50 J.!g/kg. The dose-response relationship is illustrated in Fig 1, which summarizes the results obtained from 53 experiments in 16 rabbits. The histamine-induced stimulation of the rnucociliary activity is characterized by a short latency with a peak response within 1 to 2 minutes and a slow decline of about 5 minutes. The higher the dose given, the longer the duration of the effect. Figure 2 shows the results from one rabbit challenged with three consecutive but different doses of histamine in ascending order. In six rabbits challenged with three consecutive injections of histamine at a dose of 50 J.!g/kg, tachyphylaxis was found (Fig 3). Cholinergic blockade by atropine (0.2 mg/kg intra-arterially) did not affect the stimulating effect of histamine on the mucociliary activity (Fig 4A). The maximum response (p> .5) and the areas under the curves (p> .5) were not significantly different from those of the control experiments. It is also evident from Fig 4A that the time-course of the re-
Pretreatment with the HI receptor antagonist pyrilamine (4 mg/kg intravenously) abolished the response to histamine (Fig 4B). Both the maximum responses (p< .001) and the area under the curve (p< .05) were reduced significantly. Pretreatment with the H2 receptor antagonist cimetidine (5 mg/kg intravenously) did not affect the response to histamine (Fig 4C). There is no statistically significant difference between the results obtained with and without cimetidine, neither for maximum responses (p = .067) nor for the area under the curve (p = .41). The H2 receptor agonist dimaprit failed to stimulate the mucociliary activity at the doses of 10, 50, and 250 J.!g/kg. Maximum responses and the area under the curve did not differ statistically from those of saline control experiments. The HI receptor antagonist pyrilamine stimulated the mucociliary activity per se, whereas the H2 receptor antagonists cimetidine and atropine were without effect. The pyrilamine-induced stimulation was characterized by a longer latency than that for histamine, no stimulation of the mucociliary activity occurring during the first minute. The maximum response, 18.5% ±2.5170 (n = 6), was noted after more than 2 minutes. The duration of the response was less than 10 minutes, and the baseline level was regained before the challenge
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Dolata et al, Histamine & Mucociliary Activity Frequency
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ATROPINE
change (:1:)
Fig 4. Time course for effect of histamine at dose of 50 jlg/kg. Results are expressed as means±SEM (n=6 in each group). A) After blockade of cholinergic muscarinic receptors by atropine (... 0"'), and control experiments with histamine (- • -). Frequency zero level was 1,327 ±24 in control group and 1,213±63 in blocking experiments. B) After HI blockade by pyrilamine (... 0"'), and control experiments with histamine (- • -). Frequency zero level was 1,327±24 in control group and 1,430±45 in blocking experiments. C) After H2 blockade by cimetidine (... 0'''), and control experiments with histamine (- • -). Frequency zero level was 1,327 ± 24 in control group and 1,420 ± 80 in blocking experiments.
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PYRILAMINE
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CIMETIDINE
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B with histamine. The frequency zero level was 1,344 ± 51 before the pyrilamine infusion and 1,430 ± 45 before the subsequent histamine challenge (p = .23, n=6). Adverse respiratory effects were seen at the highest doses of histamine, probably reflecting its bronchoconstrictor action. These effects were characterized by a tachypnea starting 18 to 30 seconds after the injection. Two of six rabbits died of apnea preceded by a short period of tachypnea when given a dose of 1,000 JLg/kg. The respiratory effects of histamine were blocked by pyrilamine, whereas pretreatment with atropine or cimetidine had no effect. Pyrilamine per se induced a transient tachypnea in four of six rabbits. DISCUSSION
Earlier reports concerning the effects of histamine on the mucociliary system have been contradictory. Older in vitro studies failed to demonstrate any effect of histamine on mucociliary function,":" whereas Wanner et al," using an in vitro technique on epithelial cells from the trachea of sheep, re-
ported that histamine had a modest stimulatory effect on the ciliary beat frequency in relatively high concentrations. Contrary to these results, the present investigation shows that histamine has a distinct accelerating effect on mucociliary activity, and that there is a clear dose-response relationship (Figs 1 and 2). A possible explanation for these conflicting results is that the earlier methods were semiquantitative and mainly recorded the occurrence of ciliostasis on in vitro preparations. It is also possible that histamine exerts its effect indirectly via mediators or via neurogenic mechanisms demonstrable only in intact animals. 15 A detrimental influence on mucociliary function probably triggered by released inflammatory mediators, including histamine, has been described by Chevance;" who found that local application of horse serum or pollen in the nose of sensitized rabbits and guinea pigs produced transient stimulation of ciliary activity followed by a decrease or a cessation of ciliary motility. A similar influence has been reported by Iravani and Melville;" who in an in vitro investigation of a preparation from the bronchial tree of rats found ciliary incoordination after
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Dolata et al, Histamine & Mucociliary Activity
the administration of high concentrations of histamine. However, no such effect of histamine could be verified in the present investigation, in which supraphysiologic doses like 1,000 J.(g/kg, while certainly having adverse effects on the respiratory function, still accelerated the mucociliary activity. "Classic" antihistamines, ie, HI receptor antagonists, possess additional pharmacologic properties such as anticholinergic and local anesthetic effects. 18 HI receptor antagonists per se have been reported to depress ciliary motility in vitro.":" However, in the present model, methacholine, a cholinergic receptor agonist, still stimulated the mucociliary activity after blockade by pyrilamine (Dolata, unpublished observations), thereby excluding the possibility that pyrilamine exerts its effect through an unspecific mechanism. The effect of histamine was not affected by atropine (Fig 4A), thus excluding a cholinergic pathway for the histamine-evoked mucociliaryacceleration.
The experiments with consecutive injections of histamine at a dose of 50 J.(g/kg (Fig 3) revealed tachyphylaxis to histamine. Experiments by Bradley and Russell " have shown that tachyphylaxis to histamine can be dose-dependent; high concentrations of histamine led to the development of tachyphylaxis with respect to the capability to contract airway smooth muscles, while lower concentrations did not. In the present investigation tachyphylaxis developed with a dose of histamine that induced maximum stimulation of mucociliary activity. Histamine develops tachyphylaxis in the upper airways of humans with respect to tickling, sneezing, and hypersecretion;" ie, symptoms mediated by trigeminal sensory nerve fibers. Since stimulation of sensory C fibers in our experimental model enhances mucociliary activity,25.26 sensory nerve fibers might be involved in the histamine-induced stimulation of mucociliary activity. Experiments using capsaicin are necessary to evaluate this possibility further.
Pyrilamine per se stimulated mucociliary activity slightly and elicited a transient tachypnea in four of six rabbits. An analogous situation has been described by Bradley and Russell;" who reported that pyrilamine contracted smooth muscle strips from the lower airways but also blocked the histamineinduced contractions of the smooth muscles in the same experimental model, indicating that pyrilamine may possess not only an antagonistic effect on HI receptors but also an agonistic effect (ie, intrinsic activity).
There are reports that histamine via HI receptors induces net fluxes of Na" and CI- toward the luminal side of the mucosa." This will affect the water content of both the periciliary fluid and the mucus, thereby interfering with the mucociliary system. 27.28 One may therefore speculate that the accelerating effect of histamine is due to its action on ion fluxes over the respiratory epithelium. The animal model used here does not permit us to investigate whether the apparent stimulation of mucociliary activity by histamine reflects such ion-flux changes.
The observation that the histamine-induced effect was blocked by the HI receptor antagonist pyrilamine indicates the existence of HI receptors in the upper respiratory epithelium and/or in effector nerves. Secher et aPl indirectly suggested the existence of HI receptors in the sensory trigeminal nerve fibers in humans, and by using a radioligand-binding technique Ishibe et aP2 showed the existence of binding sites for HI receptor ligands in the nasal mucosa in both humans and guinea pigs. If sensory C fibers are involved in the HI-mediated effect on mucociliary activity, this can be elucidated further by pretreatment with capsaicin, a substance that depletes neuropeptides in sensory nerve endings. 23
The bolus doses of histamine used in the present study are high enough to cause changes in systemic blood pressure'"" that in turn also will affect the local blood flow in the maxillary sinus. Moreover, in vivo and in vitro studies have indicated the existence of HI and H2 receptors on nasal blood vessels with a distribution that varies among different species.21.30.31 It therefore could be hypothesized that the effect of histamine on mucociliary activity is in fact the result of changes in the vascular bed of the ciliated mucous membrane. However, measurement of the blood flow with a laser-Doppler flowmeter showed that a single intra-arterial injection of 100 J.(g/kg of histamine depressed the local blood flow in the maxillary sinus approximately 90 % , the effect lasting 10 to 15 minutes (Dolata, unpublished observations). The same dose of histamine increased mucociliary activity by more than 30 % (Fig 1). These results are in accordance with those of Cervin et al ," who did not find any correlation between mucociliary activity and local blood flow measured by the laser-Doppler flowmeter.
The time-course of the histamine response after H2 blockade with cimetidine showed a tendency toward suppression of mucociliary activity compared with that obtained after histamine alone, but there is not a statistically significant difference. However, an Hz-mediated effect definitely can be excluded, because rabbits challenged with dimaprit did not increase their mucociliary activity. Dimaprit is a highly specific H2 receptor agonist, having 17 % to 70 % of the potency of histamine on H2 receptors for similar maximal responses but less than 0.0001 % of the activity of histamine on HI receptors.:"
In conclusion, histamine is capable of stimulating the mucociliary activity in the rabbit maxillary sinus in a dose-dependent fashion. The effect is mediated by HI receptors and not by H2 or cholinergic muscarinic receptors.
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REFERENCES 1. Santa Cruz R, Landa L Hirsch I, Sackner MA. Tracheal mucous velocity in normal man and patients with obstructive lung disease; effects of terbutaline. Am Rev Respir Dis 1974; 109:458-63. 2. Mezey RJ, Cohn MA, Fernandez RJ, Ja~uszkie~icz A~, Wanner A. Mucociliary transport in allergic patients With antigen-induced bronchospasm. Am Rev Respir Dis 1978;118:677-84. 3. Sakakura Y, Ukai K, Majima Y, Murai S, Harada T, Miyoshi Y. Nasal mucociliary clearance under various conditions. Acta Otolaryngol (Stockh) 1983;96:167-73. 4. Wanner A, Zarzecki S, Hirsch J, Epstein S. Tracheal mucous transport in experimental canine asthma. J Appl Physiol 1975;39:950-7. 5. Ballenger JJ. A study of ciliary activity in the respiratory tract of animals. Ann Otol Rhinol Laryngol 1949;58:351-69. 6. Scudi JV, Kimura ET, Reinhard JF. Study of drug action on mammalian ciliated epithelium. J Pharmacol Exp Ther 1951; 102:132-7. 7. Wanner A, Maurer D, Abraham WM, Szepfalusi A, Sielczak M. Effects of chemical mediators of anaphylaxis on ciliary function. J Allergy Clin ImmunoI1983;72:663-7. 8. Naclerio RM, Meier HL, Adkinson NF Jr, et al. In vivo demonstration of inflammatory mediator release following nasal challenge with antigen. Eur J Respir Dis [Suppl] 1983;64(suppl 128):26-32. 9. Hybbinette J-C, Mercke U. A method for ~~aluatin~ t~e e.ffects of pharmacological substances on rnucociliary activity in vivo. Acta Otolaryngol (Stockh) 1982;93:151-9. 10. Sanderson MJ, Dirksen ER. Mechanosensitivity of cultured ciliated cells from the mammalian respiratory tract: implications for the regulation of mucociliary transport. Proc Natl Acad Sci USA 1986;83:7302-6. 11. Leff AR, Munoz NM, Hendrix SG. Comparative distribution of smooth muscle postsynaptic contractile responses in canine trachea and bronchus in vivo. J Pharmacol Exp Ther 1983;224: 259-64. 12. Hybbinette J-C, Mercke U. Effects of the parasympathomimetic drug methacholine and its antagonist atropine on mucociliary activity. Acta Otolaryngol (Stockh) 1982;93:465-73. 13. Bentley AI, Jackson RT. Changes in the patency of the upper nasal passage induced by histamine and antihistamines. Laryngoscope 1970;80:1859-70. 14. Stajniak A, Pruszynski JP, Maslinski S. Histamine and gastric acid secretion in rabbits: mechanism of inhibition. Agents Actions 1982;12:179-80. 15. Carson SA, Chopra SK, Tashkin DP. Effect of intravenous cimetidine on mucociliary transport in anesthetized dogs. Eur J Respir Dis 1982;63:310-5. 16. Chevance LG. The first stages of the nasal anaphylactic shock. Acta Otolaryngol (Stockh) 1957;47:480-8. 17. Iravani I, Melville GN. Wirkung von Ph arm aka und ~ili euanderungen auf die Flimmertatlgkeit der Atemwege. Respira-
tion 1975;32:157-64. 18. Burland WL, Mills JG. The pathophysiological role of histamine and potential therapeutic uses of HI and H2 antihistamines. In: Ganellin CR, Parsons ME, eds. Pharmacology of histamine receptors. Bristol, England: Wright PSG, 1982:436-81. 19. Van de Donk HJM, Zuidema I, Merkus FWHM. The effects of nasal drops on the ciliary beat frequency of chicken embryo tracheas. Rhinology 1981;19:215-30. 20. Bradley SL, Russell JA. Distribution of histamine receptors in isolated canine airways. J Appl PhysioI1983;54:693-700. 21. Secher C, Kirkegaard I, Borum P, Maansson A, Osterhammel P, Mygind N. Significance of HI and H.2 recept.o~s in ~he human nose: rationale for topical use of combined antihistamine preparations. J Allergy Clin ImmunoI1982;70:211-8. 22. Ishibe T, Kubo N, Kumazawa H, Yamashita T, Kamazawa T. Histamine HI receptors and affinity analyses in human nasal mucosa in cases of nasal allergy. Ann Otol Rhinol Laryngol 1985;94: 186-90. 23. Gamse R, Holzer P, Lembeck F. Decrease of substance P in primary afferent neurones and impairment of neurogenic plasma extravasation by capsaicin. Br J PharmacoI1980;68:207-13. 24. Ganellin CR. Chemistry and structure-activity relationships of drugs acting at histamine receptors. In: Ganellin CR, Parsons ME, eds. Pharmacology of histamine receptors. Bristol, England: Wright PSG, 1982:10-102. 25. Lindberg S, Mercke U. Capsaicin stimulates mucociliary activity by releasing substance P and acetylcholine. Eur J Respir Dis 1986;68:96-106. 26. Lindberg S, Mercke U. Antidromic nerve stimulation accelerates mucociliary activity in rabbit maxillary sinus. Acta Otolaryngol (Stockh) 1986;101 :484-93. 27. Marin MG, Davis B, Nadel JA. Effect of histamine on electrical and ion transport properties of tracheal epithelium. J Appl PhysioI1977;42:735-8. 28. Nadel JA, Davis B. Regulation of Na' and Cl: transport and mucous gland secretion in airway epithelium. In: Porter R, Rivers J, O'Connor M, eds. Respiratory tract mucus. CIBA Foundation Symposium 54 (new series). Amsterdam: Elsevier/Excerpta Medica, 1978:133-47. 29. Levi R, Owen DAA, Trzeciakowski H. Actions of histamine on the heart and vasculature. In: Ganellin CR, Parsons ME, eds. Pharmacology of histamine receptors. Bristol, England: Wright PSG, 1982:236-97. 30. Hiley CR, Wilson H, Yates MS. Identification of /3-adrenoceptors and histamine receptors in the cat nasal vasculature. Acta Otolaryngol (Stockh) 1978;85:444-8. 31. Ichlrnura K, Jackson RT. HI and H2 histamine receptors in the in vitro nasal mucosa. Acta Otolaryngol (Stockh) 1985; 99:610-9. 32. Cervin A, Bende M, Lindberg S, Mercke U, Olsson P. Relations between blood flow and mucociliary activity in the rabbit maxillary sinus. Acta Otolaryngol (Stockh) 1988;105:350-6.
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HISTAMINE STIMULATION OF MUCOCILIARY ACTIVITY IN THE RABBIT MAXILLARY SINUS JAN DOLATA, MD SVEN LINDBERG, MD, PHD
ULF MERCKE, MD, PHD LUND, SWEDEN
The in vivo effect of histamine on mucociliary activity in the rabbit maxillary sinus was investigated by injecting histamine into the maxillary artery and recording the responses with a photoelectric technique. Histamine stimulated the mucociliary activity dosedependently in the dose range 10 to 1,000 JLg/kg. The maximum response was 31.6% ±3.79'0 at a dose of 50 JLg/kg. The histamine-induced stimulation of the mucociliary activity was characterized by a short latency with a peak response within 1 to 2 minutes and a slow decline lasting about 5 minutes. The response displayed tachyphylaxis. Cholinergic blockade with atropine did not affect the response to histamine. Blockade of HI receptors with pyrilamine abolished the response to histamine, whereas blockade of H2 receptors with cimetidine was without effect. The H2 agonist dimaprit failed to stimulate the mucociliary activity. It is concluded that histamine stimulates the mucociliary activity in the rabbit maxillary sinus via HI receptors. KEY WORDS - histamine, mucociliary activity.
ent study reports the in vivo effect on the mucociliary activity in the rabbit maxillary sinus of intra-arterial administration of histamine and its relation to HI, H2, and muscarinic receptors.
INTRODUCTION
The mucociliary system of the respiratory mucosa represents the first line of defense in the airways. This important defense mechanism may malfunction in various pathologic conditions of the respiratory tract. For example, impairment of the mucociliary function in the lower airways has been reported in patients with asthma or chronic bronchitis;':" while a similar mucociliary dysfunction has been found in the upper airways in patients with chronic sinusitis." This impairment can be related to the liberation of inflammatory mediators.v" although it has not been possible to identify the role played by each one individually. One of the putative mediators, histamine, has been studied in various experimental models, but its effect on the mucociliary function is still obscure.
METHODS
The experiments were performed on rabbits of both sexes weighing 1.8 to 3.0 kg. Details of anesthetic and operative techniques have been published previously." The animals were anesthetized with intramuscular urethane 2.0 g/kg as an initial dose, followed by 0.5 g/kg intravenously during the beginning of the operation. The arterial inlet for the test substances was a retrograde cannula in the facial or lingual artery, continuously perfused with saline at 2 mLih. The mucosa in the maxillary sinus was exposed through a trephination hole of about 2 x 8 mm that was covered immediately with an antimist window. The slit between the window and the bone was sealed with bone wax (Ethicon) in order to avoid desiccation of the mucous membrane.
Many in vitro studies have failed to demonstrate an effect of histamine on ciliary activity. S.6 Contrary to these reports, Wanner et al" found that histamine produced modest stimulation of ciliary beat frequency in isolated tracheal cells from ewes, but only in relatively high doses.
The mucociliary activity (visible as flickering light reflections) was observed through a binocular microscope, and the transportation of small particles like mucus clumps and shed cells was the criterion for a working preparation. One of the eyepieces then was switched to a phototransducer, and the mucociliary activity was recorded by a photoelectric technique. The mucociliary wave pattern was monitored continuously on an oscilloscope and recorded on an ink writer during challenges. The recordings were analyzed by a computerized frequency calculator, the mucociliary wave frequency being expressed in waves per minute and calculated every 10 seconds during challenges and at intervals
Histamine is released in response to inflammatory and allergic reactions," both of which occur frequently in the upper airways. However, the effect of histamine has not been studied hitherto on the mucociliary activity in the upper airways. The results obtained from the lower airways are conflicting, and it is doubtful if they can be extrapolated to the upper airways. It is therefore of interest to elucidate the effects of histamine by use of an experimental animal model allowing in vivo study of the mucociliary activity in the upper airways. The pres-
From the Department of Otorhinolaryngology, University Hospital, Lund, Sweden. Supported by grants from the Swedish Medical Research Council (projects 17X-07940, 17P-08451, and 17P-08455), Forenade Liv Mutual Group Life Insurance Company, the Torsten Soderberg and Ragnar Soderberg Foundation, the Swedish Society of Medicine, the Tore Nilson Foundation, and the Medical Faculty of the University of Lund. REPRINTS - Jan Dolata, MD, Dept of Otorhinolaryngology, University Hospital, S-221 85 Lund, Sweden.
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Dolata et al, Histamine & Mucociliary Activity
of 1 minute otherwise. The induced frequency changes were expressed as percentages of the mucociliary wave frequency (frequency zero level) at the time of the administration of the tested substances. The dose-response and time-course curves were plotted from the maximum mucociliary wave frequency change during the first 5 minutes after each challenge. Electrocardiographic activity and rectal temperature were monitored. Body temperature was maintained at 37°C to 38.5°C by a heating pad. Respiration was sensed by a Hewlett Packard Toccotransducer 15278 B placed on the thorax and was recorded simultaneously with the mucociliary activity. The following drugs were used: histamine dihydrochloride (Sigma, USA), pyrilamine maleate (mepyramine; Sigma, USA), cimetidine (Tagamet; SK&F, Belgium), and atropine sulfate (ACO, Sweden). Dimaprit (dimethylamino-propyl-isothiourea) was a generous gift from Dr J. Skidmore, SK&F Research Ltd, England. Doses are expressed as concentrations of the respective salt. All substances were dissolved in saline. The intra-arterial route for administration of histamine was chosen for the following reasons. Although topical administration of histamine minimizes general side effects and mimics the release of histamine from mucosal mast cells, this method of application carries some disadvantages for mucociliary studies. Local administration causes tactile stimulation that increases the ciliary beat frequency.:" The rheologic properties of mucus are influenced by the applied solution, and this in turn could interfere with the mucociliary activity. Moreover, intra-arterial histamine has been used in other studies of airway physiology. II
Experimental Procedure. Histamine was given as a bolus injection of 0.2 mL in all experiments. 1. The effect of increasing doses of histamine was investigated in 16 rabbits, and a log dose-response curve was plotted in the interval 0.01 to 1,000 j.tg/kg (corresponding to 54.3 pmollkg to 5.43 j.tmollkg histamine dihydrochloride). The time lapse between challenges was 30 to 60 minutes. 2. In order to investigate if there was any tachyphylaxis to histamine, six rabbits were challenged with three consecutive 50-j.tg/kg injections of histamine at l-hour intervals. 3. The effect of a 50-j.tg/kg histamine dose during cholinergic blockade by atropine was investigated in six rabbits. Atropine was given at a dose of 0.2 mg/kg as an intra-arterial bolus injection of 0.2 mL. The rabbits were challenged with histamine 2 minutes after the atropine injection. 4. The effect of histamine at 50 j.tg/kg during HI receptor blockade by pyrilamine was investigated in six rabbits. Pyrilamine (mepyramine) 4 mg/kg was
667
Frequency change (%)
40 (5)
(]) (12)
35
30
25
20
15 (9)
10
(4)
5
0
, 0.01 0.1
i
1.0
,
10 50100 1000
Dose ~g/k9)
Fig 1. Effect of histamine on mucociliary activity in dose range 0.01 to 1,000 JLg/kg (corresponding to 54.3 pmollkg to 5.43 JLmol/kg). Figures in parentheses refer to number of experiments performed at each dose. Results are expressed as means ± SEM. The correlation coefficient for raw data was r = 0.66 (n = 16). Frequency zero level was 1,234 ± 21 waves/min.
given as an intravenous infusion of 1 mL over 1 minute. The rabbits were challenged with histamine 10 to 15 minutes after the pyrilamine infusion. 5. The effect of histamine at 50 j.tg/kg during H2 receptor blockade by cimetidine was investigated in six rabbits. Cimetidine at 5 mg/kg was given as an intravenous infusion of 1 mL over 1 minute. The rabbits were challenged with histamine 10 to 15 minutes after the cimetidine infusion. 6. Five rabbits were challenged with the H2 receptor agonist dimaprit at 10, 50, and 250 j.tg/kg given as bolus doses of 0.2 mL. The time lapse between challenges was 20 to 30 minutes. Six rabbits received histamine (50 j.tg/kg) only, as a control. The doses of the antagonists and the time intervals between the antagonists and the subsequent injections of histamine were chosen in accordance with results of previous investigations using the same experimental model'" and in vivo experiments performed by other research groupS.13-15 The results are expressed as means and standard error of the mean (SEM). The maximum response and the area under the curve were subjected to a parametric t test, except for the experiments with cimetidine, in which the Mann-Whitney U test was used. Only p values smaller than .05 were considered significant.
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668
Dolata et al, Histamine & Mucociliary Activity change (%)
Frequency
Frequency change (%)
35
30 30 -
I
25
20 20
15
T
,o~
10
5
0
-5
#I
t L...!.,O "
o
t
10
t
100
----I,
I I
}lg/kg 'I-Time (min)
1 min
Fig 2. Effect of histamine on mucociliary activity in one rabbit in doses 1.0, 10, and 100 ltg/kg. Results are expressed as percentages of basal mucociliary level. Frequency zero levels were 1,083, 1,077, and 970, respectively.
~
~ II
I~ III
Injection
Fig 3. Maximum response of mucociliary activity after three consecutive injections of histamine at dose of 50 ltg/kg at intervals of 1 hour. Two-way analysis of variance revealed significant difference between three injections (p< .05). Linear regression of raw data displayed slope of - 8.0 and correlation coefficient of r = 0.55.
sponse with or without atropine was almost identical.
RESULTS
Injections of saline, used to dissolve all the tested substances, did not influence the mucociliary activity. Histamine stimulated the mucociliary activity dose-dependently in the dose interval 10 to 1,000 J.!g/kg (corresponding to 54.3 nmol/kg to 5.43 J.!mol! kg); the maximum response was 31.6% ±3.7170 for a dose of 50 J.!g/kg. The dose-response relationship is illustrated in Fig 1, which summarizes the results obtained from 53 experiments in 16 rabbits. The histamine-induced stimulation of the rnucociliary activity is characterized by a short latency with a peak response within 1 to 2 minutes and a slow decline of about 5 minutes. The higher the dose given, the longer the duration of the effect. Figure 2 shows the results from one rabbit challenged with three consecutive but different doses of histamine in ascending order. In six rabbits challenged with three consecutive injections of histamine at a dose of 50 J.!g/kg, tachyphylaxis was found (Fig 3). Cholinergic blockade by atropine (0.2 mg/kg intra-arterially) did not affect the stimulating effect of histamine on the mucociliary activity (Fig 4A). The maximum response (p> .5) and the areas under the curves (p> .5) were not significantly different from those of the control experiments. It is also evident from Fig 4A that the time-course of the re-
Pretreatment with the HI receptor antagonist pyrilamine (4 mg/kg intravenously) abolished the response to histamine (Fig 4B). Both the maximum responses (p< .001) and the area under the curve (p< .05) were reduced significantly. Pretreatment with the H2 receptor antagonist cimetidine (5 mg/kg intravenously) did not affect the response to histamine (Fig 4C). There is no statistically significant difference between the results obtained with and without cimetidine, neither for maximum responses (p = .067) nor for the area under the curve (p = .41). The H2 receptor agonist dimaprit failed to stimulate the mucociliary activity at the doses of 10, 50, and 250 J.!g/kg. Maximum responses and the area under the curve did not differ statistically from those of saline control experiments. The HI receptor antagonist pyrilamine stimulated the mucociliary activity per se, whereas the H2 receptor antagonists cimetidine and atropine were without effect. The pyrilamine-induced stimulation was characterized by a longer latency than that for histamine, no stimulation of the mucociliary activity occurring during the first minute. The maximum response, 18.5% ±2.5170 (n = 6), was noted after more than 2 minutes. The duration of the response was less than 10 minutes, and the baseline level was regained before the challenge
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Dolata et al, Histamine & Mucociliary Activity Frequency
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ATROPINE
change (:1:)
Fig 4. Time course for effect of histamine at dose of 50 jlg/kg. Results are expressed as means±SEM (n=6 in each group). A) After blockade of cholinergic muscarinic receptors by atropine (... 0"'), and control experiments with histamine (- • -). Frequency zero level was 1,327 ±24 in control group and 1,213±63 in blocking experiments. B) After HI blockade by pyrilamine (... 0"'), and control experiments with histamine (- • -). Frequency zero level was 1,327±24 in control group and 1,430±45 in blocking experiments. C) After H2 blockade by cimetidine (... 0'''), and control experiments with histamine (- • -). Frequency zero level was 1,327 ± 24 in control group and 1,420 ± 80 in blocking experiments.
30
20
10
o
o
2
4
3
5
Hme (min)
A Frequency
Frequency
PYRILAMINE
change (:1:)
CIMETIDINE
change (:1:)
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5
Hme (min)
o
---+-- - + - - - - - +--2
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c
B with histamine. The frequency zero level was 1,344 ± 51 before the pyrilamine infusion and 1,430 ± 45 before the subsequent histamine challenge (p = .23, n=6). Adverse respiratory effects were seen at the highest doses of histamine, probably reflecting its bronchoconstrictor action. These effects were characterized by a tachypnea starting 18 to 30 seconds after the injection. Two of six rabbits died of apnea preceded by a short period of tachypnea when given a dose of 1,000 JLg/kg. The respiratory effects of histamine were blocked by pyrilamine, whereas pretreatment with atropine or cimetidine had no effect. Pyrilamine per se induced a transient tachypnea in four of six rabbits. DISCUSSION
Earlier reports concerning the effects of histamine on the mucociliary system have been contradictory. Older in vitro studies failed to demonstrate any effect of histamine on mucociliary function,":" whereas Wanner et al," using an in vitro technique on epithelial cells from the trachea of sheep, re-
ported that histamine had a modest stimulatory effect on the ciliary beat frequency in relatively high concentrations. Contrary to these results, the present investigation shows that histamine has a distinct accelerating effect on mucociliary activity, and that there is a clear dose-response relationship (Figs 1 and 2). A possible explanation for these conflicting results is that the earlier methods were semiquantitative and mainly recorded the occurrence of ciliostasis on in vitro preparations. It is also possible that histamine exerts its effect indirectly via mediators or via neurogenic mechanisms demonstrable only in intact animals. 15 A detrimental influence on mucociliary function probably triggered by released inflammatory mediators, including histamine, has been described by Chevance;" who found that local application of horse serum or pollen in the nose of sensitized rabbits and guinea pigs produced transient stimulation of ciliary activity followed by a decrease or a cessation of ciliary motility. A similar influence has been reported by Iravani and Melville;" who in an in vitro investigation of a preparation from the bronchial tree of rats found ciliary incoordination after
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Dolata et al, Histamine & Mucociliary Activity
the administration of high concentrations of histamine. However, no such effect of histamine could be verified in the present investigation, in which supraphysiologic doses like 1,000 J.(g/kg, while certainly having adverse effects on the respiratory function, still accelerated the mucociliary activity. "Classic" antihistamines, ie, HI receptor antagonists, possess additional pharmacologic properties such as anticholinergic and local anesthetic effects. 18 HI receptor antagonists per se have been reported to depress ciliary motility in vitro.":" However, in the present model, methacholine, a cholinergic receptor agonist, still stimulated the mucociliary activity after blockade by pyrilamine (Dolata, unpublished observations), thereby excluding the possibility that pyrilamine exerts its effect through an unspecific mechanism. The effect of histamine was not affected by atropine (Fig 4A), thus excluding a cholinergic pathway for the histamine-evoked mucociliaryacceleration.
The experiments with consecutive injections of histamine at a dose of 50 J.(g/kg (Fig 3) revealed tachyphylaxis to histamine. Experiments by Bradley and Russell " have shown that tachyphylaxis to histamine can be dose-dependent; high concentrations of histamine led to the development of tachyphylaxis with respect to the capability to contract airway smooth muscles, while lower concentrations did not. In the present investigation tachyphylaxis developed with a dose of histamine that induced maximum stimulation of mucociliary activity. Histamine develops tachyphylaxis in the upper airways of humans with respect to tickling, sneezing, and hypersecretion;" ie, symptoms mediated by trigeminal sensory nerve fibers. Since stimulation of sensory C fibers in our experimental model enhances mucociliary activity,25.26 sensory nerve fibers might be involved in the histamine-induced stimulation of mucociliary activity. Experiments using capsaicin are necessary to evaluate this possibility further.
Pyrilamine per se stimulated mucociliary activity slightly and elicited a transient tachypnea in four of six rabbits. An analogous situation has been described by Bradley and Russell;" who reported that pyrilamine contracted smooth muscle strips from the lower airways but also blocked the histamineinduced contractions of the smooth muscles in the same experimental model, indicating that pyrilamine may possess not only an antagonistic effect on HI receptors but also an agonistic effect (ie, intrinsic activity).
There are reports that histamine via HI receptors induces net fluxes of Na" and CI- toward the luminal side of the mucosa." This will affect the water content of both the periciliary fluid and the mucus, thereby interfering with the mucociliary system. 27.28 One may therefore speculate that the accelerating effect of histamine is due to its action on ion fluxes over the respiratory epithelium. The animal model used here does not permit us to investigate whether the apparent stimulation of mucociliary activity by histamine reflects such ion-flux changes.
The observation that the histamine-induced effect was blocked by the HI receptor antagonist pyrilamine indicates the existence of HI receptors in the upper respiratory epithelium and/or in effector nerves. Secher et aPl indirectly suggested the existence of HI receptors in the sensory trigeminal nerve fibers in humans, and by using a radioligand-binding technique Ishibe et aP2 showed the existence of binding sites for HI receptor ligands in the nasal mucosa in both humans and guinea pigs. If sensory C fibers are involved in the HI-mediated effect on mucociliary activity, this can be elucidated further by pretreatment with capsaicin, a substance that depletes neuropeptides in sensory nerve endings. 23
The bolus doses of histamine used in the present study are high enough to cause changes in systemic blood pressure'"" that in turn also will affect the local blood flow in the maxillary sinus. Moreover, in vivo and in vitro studies have indicated the existence of HI and H2 receptors on nasal blood vessels with a distribution that varies among different species.21.30.31 It therefore could be hypothesized that the effect of histamine on mucociliary activity is in fact the result of changes in the vascular bed of the ciliated mucous membrane. However, measurement of the blood flow with a laser-Doppler flowmeter showed that a single intra-arterial injection of 100 J.(g/kg of histamine depressed the local blood flow in the maxillary sinus approximately 90 % , the effect lasting 10 to 15 minutes (Dolata, unpublished observations). The same dose of histamine increased mucociliary activity by more than 30 % (Fig 1). These results are in accordance with those of Cervin et al ," who did not find any correlation between mucociliary activity and local blood flow measured by the laser-Doppler flowmeter.
The time-course of the histamine response after H2 blockade with cimetidine showed a tendency toward suppression of mucociliary activity compared with that obtained after histamine alone, but there is not a statistically significant difference. However, an Hz-mediated effect definitely can be excluded, because rabbits challenged with dimaprit did not increase their mucociliary activity. Dimaprit is a highly specific H2 receptor agonist, having 17 % to 70 % of the potency of histamine on H2 receptors for similar maximal responses but less than 0.0001 % of the activity of histamine on HI receptors.:"
In conclusion, histamine is capable of stimulating the mucociliary activity in the rabbit maxillary sinus in a dose-dependent fashion. The effect is mediated by HI receptors and not by H2 or cholinergic muscarinic receptors.
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