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Tissue Plasminogen Activator Prevents Mortality from Sulfur Mustard Analog-Induced Airway Obstruction

Institution:
1Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA. livia.veress@ucdenver.edu
2Department of Pharmaceutical Sciences, University of Colorado Health Sciences Center, Denver, CO, USA.
Publication Date:
Apr-2013
Journal:
Am J Respir Cell Mol Biol
Volume Number:
48
Issue Number:
4
Pages:
439-47
Citation:
Am J Respir Cell Mol Biol. 2013 Apr;48(4):439-47.
PubMed ID:
23258228
PMCID:
PMC3653605
Keywords:
plastic bronchitis, tissue plasminogen activator, airway obstruction, sulfur mustard, fibrin
Appears in Collections:
NA-MIC
Sponsors:
U54 EB005149/EB/NIBIB NIH HHS/United States
U54 ES015678/ES/NIEHS NIH HHS/United States
Generated Citation:
Veress L.A., Hendry-Hofer T.B., Loader J.E., Rioux J.S., Garlick R.B., White C.W. Tissue Plasminogen Activator Prevents Mortality from Sulfur Mustard Analog-Induced Airway Obstruction. Am J Respir Cell Mol Biol. 2013 Apr;48(4):439-47. PMID: 23258228. PMCID: PMC3653605.
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Sulfur mustard (SM) inhalation causes the rare but life-threatening disorder of plastic bronchitis, characterized by bronchial cast formation, resulting in severe airway obstruction that can lead to respiratory failure and death. Mortality in those requiring intubation is greater than 80%. To date, no antidote exists for SM toxicity. In addition, therapies for plastic bronchitis are solely anecdotal, due to lack of systematic research available to assess drug efficacy in improving mortality and/or morbidity. Adult rats exposed to SM analog were treated with intratracheal tissue plasminogen activator (tPA) (0.15-0.7 mg/kg, 5.5 and 6.5 h), compared with controls (no treatment, isoflurane, and placebo). Respiratory distress and pulse oximetry were assessed (for 12 or 48 h), and arterial blood gases were obtained at study termination (12 h). Microdissection of fixed lungs was done to assess airway obstruction by casts. Optimal intratracheal tPA treatment (0.7 mg/kg) completely eliminated mortality (0% at 48 h), and greatly improved morbidity in this nearly uniformly fatal disease model (90-100% mortality at 48 h). tPA normalized plastic bronchitis-associated hypoxemia, hypercarbia, and lactic acidosis, and improved respiratory distress (i.e., clinical scores) while decreasing airway fibrin casts. Intratracheal tPA diminished airway-obstructive fibrin-containing casts while improving clinical respiratory distress, pulmonary gas exchange, tissue oxygenation, and oxygen utilization in our model of severe chemically induced plastic bronchitis. Most importantly, mortality, which was associated with hypoxemia and clinical respiratory distress, was eliminated.

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