Local Effects of Two Intravenous Formulations of Pulmonary Vasodilators on Airway Epithelium

• Published in: Respiratory care 2020-10, Vol.65 (10), p.1427-1432
• Main Authors: Kuch, Bradley A, Linssen, Rosalie, Yoshikawa, Hiroki, Smallwood, Craig D, Davis, Michael D
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Analysis; Antihypertensive Agents - adverse effects; Care and treatment; Cell death; Epithelium; Epoprostenol; Epoprostenol - therapeutic use; Glycine; Humans; Hypertension; Hypertension, Pulmonary - drug therapy; Nitric oxide; Nitric Oxide - therapeutic use; RNA; Vasodilation; Vasodilator Agents
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.07938

Intravenous formulations of epoprostenol are frequently delivered via nebulizer to treat pulmonary hypertension in acutely ill patients. Although their efficacy as pulmonary vasodilators has been shown to be comparable to inhaled nitric oxide, the local effects of these formulations within the airways have not been determined. We hypothesized that the alkaline diluents of these compounds would lead to increased airway epithelial cell death and ciliary cessation. Human bronchial epithelial cells were exposed to epoprostenol in glycine and arginine diluents or control fluid. Ciliary beat frequency, lactate dehydrogenase, and total RNA levels were measured before and after exposure. Results were compared between exposure and control groups. Ciliary beat frequency ceased immediately after exposure to epoprostenol with both diluents. Lactate dehydrogenase levels increased by 200% after exposure to epoprostenol and glycine diluent ( = .002). Total RNA levels were undetectable after exposure to epoprostenol and arginine, indicating complete cell death and lysis ( = .015). Ciliary beat frequency ceased after 30 s of exposure to epoprostenol and glycine ( = .008). There was no difference between cells exposed to epoprostenol and those exposed only to diluent. Exposure to intravenous formulations of epoprostenol in glycine and arginine caused increased cell death and ciliary cessation in bronchial epithelial cells. These findings suggest that undesired local effects may occur when these compounds are delivered as inhaled aerosols to patients.