Near-fatal classic heat stroke is associated with multiorgan dysfunction. A high percentage of patients had infection at presentation. A high mortality rate was observed during acute hospitalization and at 1 year. In addition, substantial functional impairment at discharge persisted 1 year. The degree of functional disability correlated highly with survival at 1 year.

Airway smooth muscle proliferation may contribute to the airway wall remodeling seen in asthma. In this study we tested for the presence of airway smooth muscle mitogenic activity in bronchoalveolar lavage (BAL) fluid obtained from 12 atopic asthmatics before and serially after segmental allergen challenge, and from four normal subjects who did not undergo allergen challenge. Mitogenic effect was assessed by coincubating BAL fluid with human airway smooth muscle cells, and measuring its effect on (3)[H]thymidine incorporation and cell number. Induction of ERK phosphorylation and cyclin D(1) protein abundance were also assessed. Compared with serum-free medium alone, BAL fluid obtained from normal subjects increased thymidine incorporation, cell number, ERK phosphorylation, and cyclin D(1) abundance. BAL fluid from asthmatic subjects prior to allergen challenge induced even greater increases in all measures, except for cell number, which was similar to that observed with normal subjects' BAL fluid. Incubation with lavage fluid obtained 48 h after segmental allergen challenge in atopic asthmatics caused yet further increases in thymidine incorporation, cell number, and cyclin D(1) protein abundance. Molecular sieving of prechallenge BAL fluid from three asthmatic subjects demonstrated that mitogenic activity was present exclusively in the > 10 kD fraction. These results provide the first direct demonstration that fluid lining the airways of asthmatics contains excess mitogenic activity for human airway smooth muscle, and that this activity increases further after allergen challenge.

We assessed the effect of prostaglandin (PG) E2 on tone of guinea pig tracheal smooth muscle (TSM) strips in vitro. In the presence of spontaneous tone [ST; i.e., no indomethacin (-Indo)], exogenous PGE2 caused a significant relaxation of ST at concentrations > 10(-6) M [to -127 +/- 40.8% electric field stimulation (EFS); P = 0.001 vs. baseline ST] and at concentrations < 10(-6) M caused a variable change in contractile force (51.6 +/- 29.6% EFS; P = NS vs. baseline ST). In the absence of ST (i.e., +Indo) 10(-10) to 10(-7) M PGE2 elicited contraction of TSM to 126.3 +/- 10.5% EFS (P = 0.001 vs. baseline) and no relaxation. Addition of prostanoid EP1 receptor antagonist (either AH-6809 or SC-19220) to Indo-treated TSM caused a substantial rightward shift and attenuation of contraction in response to PGE2 (55.9 +/- 16.8% EFS for 10(-5) MAH-6809; P = 0.007 vs. +Indo alone, and 80.5 +/- 12.7% EFS for 10(-5) M SC-19220, P = 0.03 vs. +Indo alone). We further assessed the effect of EP1 and EP4 receptor antagonism on the ST of guinea pig TSM strips. Concentration-response curves to the EP1 receptor-specific antagonists AH-6809 or SC-19220 and the EP4 receptor-specific antagonist AH-23848B were generated (10(-7) to 10(-5) M); AH-6809 caused relaxation of ST to 11.4 +/- 2.9% ST (P = 0.001 vs. initial ST) and SC-19220 caused relaxation to 31.0 +/- 12.7% ST (P = 0.02 vs. initial ST). However, AH-23848B did not significantly affect ST (to 60.9 +/- 7.7% ST; P = 0.07 vs. initial ST). Furthermore, AH-6809 specifically inhibited contraction elicited by the EP1 receptor agonist Iloprost but had no effect on contraction elicited by the EP3 receptor agonist Enprostil. We demonstrate that in the presence of ST (-Indo), exogenous PGE2 elicits a biphasic response in guinea pig TSM in which relaxation predominates. In the absence of ST (+Indo), exogenous PGE2 elicits contraction of guinea pig TSM strips that is inhibited by EP1 receptor-specific antagonism. Spontaneous tone of guinea pig TSM strips also is inhibited by EP1 receptor antagonism. Our data suggest that both PGE2-elicited contraction and ST of guinea pig TSM are mediated through activation of EP1 prostanoid receptors.

1 We determined the eect of cyclosporine A (CsA) treatment on mast cell degranulation and lung resistance (R L ) in vivo, and tracheal smooth muscle (TSM) contraction ex vivo after antigen challenge in sensitized cats. We also determined the direct eects of addition of CsA to the tissue bath on antigeninduced responses of TSM in vitro. 2 Cats (n=10) were sensitized by i.m. injection of Ascaris suum antigen (AA); 5 cats (CsA+) received CsA twice daily for 2 weeks before acute antigen challenge in doses sucient to suppress interleukin-2 secretion from feline peripheral blood mononuclear cells ex vivo. 3 Lung resistance increased comparably within 10 min of exposure to AA (P50.03). Histamine content in bronchoalveolar lavage¯uid from both groups increased comparably within 30 min of antigen challenge, from undetectable levels to 542+74 pg ml 71 post AA for CsA+ and from 74+19 pg ml 71 at baseline, to 970+180 pg ml 71 post AA CsA7 (P50.05; P=NS vs CsA+). 4 In excised TSM, active tension elicited by exposure to AA in vitro was 107+38% KCl in the CsA+ group vs 144+56% KCl in the CsA7 group (P=NS). However, contraction of TSM (n=4) harvested from both groups was abolished or greatly diminished after AA challenge when tissues were preincubated with 1 mM CsA in vitro (8+8% KCl, P50.05 vs CsA+ and CsA7). This was associated with inhibited release of 5-hydroxytryptamine into the organ bath¯uid of tissues treated with CsA in vitro only. 5 We demonstrated that CsA treatment in vivo does not inhibit the early phase asthmatic response or mast cell degranulation following antigen challenge in sensitized cats. Additionally, the eects of CsA on mast cell function ex vivo do not re¯ect lack of eects of CsA on mast cell function in vivo in this animal model of atopic asthma.

We examined the relationship between eosinophil migration into the bronchoalveolar space and change in FEV(1) after endobronchial allergen challenge (EBAC) in atopic asthmatic (AA) and atopic nonasthmatic (ANA) subjects. The purpose of this study was to obtain continuous, intrasubject controlled assessment of the relationship between cell migration in control and allergen-challenged segments in the same individuals over 96 h. In AA subjects, the eosinophil (Eos) count in the bronchoalveolar lavage fluid (BALF) increased from a baseline of 7,896 +/- 3,865 to 416,476 +/- 231,012 Eos/ml by 72 h (p = 0.001) in the challenged segment post-EBAC. For ANA subjects, the postsegmental challenge count was 29,874 +/- 474 Eos/ml (p = 0.03 versus baseline and p < 0.05 AA peak versus ANA peak). In both groups, there was a comparable decrease in peripheral blood eosinophil count beginning 5 h after challenge, which resolved at 24 h. In AA subjects, 416,476 +/- 231,012 Eos/ml was obtained from the allergen-challenged segment and 23,522 +/- 8,298 Eos/ml was obtained from the sham-challenged segment (p < 0.001) at 72 h. In contrast, there was no difference in the Eos count obtained from the BALF between the antigen- and sham-challenged segments of ANA subjects. We also found that increased airway neutrophils were present in equal numbers in allergen-challenged and sham-challenged segments in both AA and ANA subjects. We conclude that augmented eosinophil migration after EBAC is a characteristic of atopic asthma and is not present in atopic subjects who do not have asthma. We find that BAL eosinophilia in ANA patients as well as neutrophilia in both ANA and AA subjects are nonspecific consequences of bronchoscopy. Finally, we find no relationship between specific airway eosinophil migration into the BALF and FEV(1) < 72 h after challenge; however, at 96 h, there is a substantial decrease in FEV(1) that accompanies BALF eosinophilia.