Background: Amiodarone (AM) is a widely used anti-arrhythmic medication. Its utility is, however, limited by adverse side effects. The mechanism of amiodarone-induced toxicity (APT) in the lungs is attributed primarily to stimulation of the angiotensin enzyme system leading to lung cell apoptosis and cell death. This mechanism has been demonstrated by in vitro and in vivo experimental animal studies. To date, however, no in vivo human studies have confirmed this mechanism for APT. Purpose: This study was undertaken to determine whether angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) offer a protective effect against APT in humans. Demonstration of a protective effect of an ACE-I or ARB would suggest that stimulation of the angiotensin enzyme system may be a key process in APT. Design: An 8-year retrospective analysis of all patients on AM therapy at the James H. Quillen Veterans Affairs Medical Center was undertaken. Results: A total of 1000 patients on AM were identified. One-hundred-and-seventeen were excluded from the study. Five-hundred-and-twenty-four patients were simultaneously on an ACE-I or ARB. The remaining 359 patients were not. Pulmonary toxicity attributed to AM was identified in five and 14 patients with and without concomitant ACE-I or ARB therapy, respectively. The APT rate for the entire patient sample was 2.2%. APT occurred in 1% of patients on an ACE-I or ARB and in 3.9% of patients not taking an ACE-I or ARB. This observed difference in percentage of APT was statistically significant. Conclusion: The concomitant use of ACE-I or ARB in patients taking AM appears to offer a protective effect against APT. This observation suggests that the stimulation of the angiotensin enzyme system may play an important role in APT in humans.

Les nanoparticules (NPs) représentent un danger potentiel pour la santé des travailleurs et du grand public, notamment en cas d’exposition par voie respiratoire. Si une NP est évaluée in vivo comme toxique chez l’animal, cela peut inciter à prendre des mesures pour réduire l’exposition de l’Homme à celle-ci, avant qu’il y ait des conséquences sanitaires graves. Les études in vivo sont donc d’une importance capitale afin de diminuer les potentiels risques sanitaires des NPs pour l’Homme. Néanmoins, dans un contexte de réduction du nombre d’animaux utilisés et compte tenu du nombre important de NPs existantes et de leur grande diversité physico-chimique, la toxicologie a besoin de modèles alternatifs, comme le in vitro, permettant de prédire de manière fiable les potentiels effets pulmonaires chez l’Homme. Des progrès importants ont été faits pour développer des modèles in vitro pulmonaires plus physiologiques et des méthodes d’exposition permettant de simuler l’inhalation de NPs in vitro. Cependant, des incertitudes existent quant à la capacité de ces nouveaux modèles in vitro à prédire les réponses observées in vivo dans les poumons après exposition à des NPs. Dans ce contexte, l’objectif de ce travail a été d’évaluer la capacité de plusieurs méthodes in vitro, de complexité différente, à prédire les effets toxiques observés in vivo chez le rat après exposition aiguë (24h) pulmonaire à des NPs métalliques faiblement solubles de TiO2 et de CeO2. Dans un premier temps, des expérimentations in vitro ont été effectuées afin d’évaluer si exposer des cellules alvéolaires à l’interface air-liquide (ALI) à des aérosols de NPs de TiO2 et de CeO2, générait des résultats différents par rapport à des expositions classiques à des suspensions en submergé. Dans un second temps, des expérimentations in vivo par aspiration intratrachéale ont été réalisées afin de comparer les réponses toxiques pulmonaires in vitro avec celles obtenues in vivo. Pour comparer les réponses pulmonaires in vivo et in vitro, des référentiels de dose similaires, notamment la masse par unité de surface ou par macrophage, ont été utilisés. Après 24h d’exposition, des réponses biologiques significatives (inflammation principalement) ont été observées in vitro à des doses inférieures à l’ALI par rapport au submergé. Nous avons par ailleurs souligné la nécessité de prendre en compte les doses réellement déposées sur les cellules ainsi que le débit de dose pour effectuer les comparaisons entre les deux méthodes d’exposition in vitro utilisées. Nous avons ensuite comparé les résultats in vitro avec ceux obtenus in vivo. Nous avons constaté que la méthode ALI générait des résultats plus prédictifs du in vivo, en termes de niveau d’activation des réponses toxiques à 24h. Finalement, nous avons établi un classement des quatre NPs utilisées dans notre étude et celles-ci ont été classées similairement in vivo et in vitro et quelle que soit la méthode utilisée in vitro. Nous avons par ailleurs montré l’importance de considérer la surface active des NPs pour établir ce classement. En conclusion, notre approche nous a permis de mieux évaluer le fossé existant entre le in vivo et le in vitro. Nos résultats soulignent l’intérêt d’utiliser des méthodes in vitro plus réalistes et plus proches de la physiologie humaine dans le but de modéliser les potentiels effets indésirables des NPs pour l’Homme. Cela ouvre des perspectives quant à l’utilisation et au développement de méthodologies in vitro de plus en plus représentatives des conditions d’exposition in vivo. / Nanoparticles (NPs) represent a potential danger for workers and public, especially after inhalation. When a NP is shown toxic for the lungs in vivo in animals, this can incite regulators to implement measures to reduce human exposure risks. The in vivo studies are thus of utmost importance in reducing the potential health risks for humans. However, in a context of a diminution in the number of animals used in experimentations and considering the high number of NPs used and their physicochemical diversity, there is an urgent need for alternative methods, like the in vitro, which could be used to predict the potential health effects of NPs in human. Many progresses have been made recently to develop more physiological cell models and exposure methods simulating the inhalation of NPs in vitro. Nevertheless, uncertainties remain regarding the capacity of these new in vitro methods to predict the biological responses observed in vivo into the lungs after exposure to NPs. In this context, the aim of our study was to assess the ability of several in vitro methods, differing in complexity, to predict the adverse responses observed in vivo in rat lungs after acute exposure (24h) to several metallic and poorly soluble TiO2 and CeO2 NPs. For this, in vitro experimentations were first performed to assess if exposing alveolar cells in monoculture or in co-culture at the ALI interface to aerosols of NPs, generated different results compared to classic exposure in submerged conditions to suspensions. In a second step, rats were exposed by intratracheal aspiration of NP suspensions to compare the biological responses in vitro to those obtained in vivo. To compare the pulmonary responses in vivo and in vitro, similar dose metrics were selected, including the mass per surface unit or per macrophage. After 24h of exposure, significant biological responses (mostly inflammation) were observed at lower doses at the ALI compared to in submerged conditions. Moreover, we highlighted the necessity to take into account the deposited dose on the cells and the timing of the dose delivery in order to compare the two exposure methods used in vitro. When we compared the responses in vitro to those observed in vivo, we noticed that the ALI methods generated more predictive results than the submerged one, in term of biological activation levels after 24h of exposure. Finally, a ranking of the four NPs used in our study was provided and the NPs were ranked similarly both in vivo and in vitro and whatever the exposure method used in vitro. We also showed the importance of the surface area when ranking the poorly soluble NPs. In conclusion, the gap existing between the in vivo and the in vitro has been evaluated in our study. Our results highlighted the relevance of using more realistic in vitro exposure methods to model the potential adverse effects of NPs for human. This brings perspectives about using and developing in vitro methods mimicking more closely the in vivo exposure conditions.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Polymeric nanocapsules have been studied extensively for drug delivery by various routes of administration. Currently, the nanoencapsulation of drugs is considered the most efficient means of ensuring controlled release, specific targeting and reduction of adverse effects. In this context, the aim of this work was to develop polymeric nanocapsules for pulmonary delivery of beclomethasone dipropionate (BD). Nanocapsules have been prepared from 2 polymers, poly(-caprolactone) (PCL) and ethyl cellulose (EC). To quantify the drug in the nanostructures, the analytical method was developed and validated. This method showed to be specific, linear, precise, accurate and robust. Nanocapsules were prepared by interfacial deposition of preformed polymers and were evaluated as to pH, particle diameter, polydispersity index, drug content, encapsulation efficiency and zeta potential. All samples showed encapsulation efficiency greater than 98%, negative zeta potential, pH value in the range of neutrality and drug contents close to their theoretical values. The size distribution was nanometric (158-270 nm) with polydispersity index lower than 0.2. The results of the photodegradation study showed that polymeric nanocapsules were able to protect BD from UVC radiation when compared to the free drug solution. In vitro release experiments were performed using the dialysis bag technique, which showed, for all formulations, a prolonged drug release mediated by anomalous transport and first order kinetics. Free drug in solution took between 24 and 36 h to reach 100% of release, whereas nanocapsules were able to control the drug release for up to 108 h, depending on the polymer employed. Nanocapsules of EC and PCL were evaluated for in vitro and in vivo toxicity and the results suggest that the proposed formulations are safe. In the final stage of the work, pullulan was proposed as stabilizer agent for PCL nanocapsules and the results obtained for the zeta potential and the drug content suggested that these formulations have become more stable. Thus, the nanocapsules developed in this work represent a promising alternative for the pulmonary delivery of BD in the treatment of asthma and other respiratory disorders. / Nanocápsulas poliméricas vem sendo estudadas extensivamente para liberação de fármacos por diversas vias de administração. Atualmente a nanoencapsulação de fármacos é considerada o meio mais eficiente de assegurar liberação controlada, direcionamento específico e redução dos efeitos adversos. Neste contexto, o objetivo do presente trabalho foi desenvolver nanocápsulas poliméricas para a liberação pulmonar do dipropionato de beclometasona (DB). Nanocápsulas foram preparadas a partir de 2 polímeros, a poli(-caprolactona) (PCL) e a etilcelulose (EC). Para a quantificação do fármaco nas nanoestruturas, o método analítico foi desenvolvido e validado. Este mostrou ser específico, linear, preciso, exato e robusto. As nanocápsulas foram preparadas por deposição interfacial do polímero pré-formado e avaliadas quanto ao pH, diâmetro de partícula, índice de polidispersão, teor, eficiência de encapsulamento e potencial zeta. Todas as amostras apresentaram eficiência de encapsulamento maior que 98%, valor de potencial zeta negativo, valor de pH na faixa da neutralidade e teores próximos aos teóricos. A distribuição de tamanho foi nanométrica (158-270 nm) com índice de polidispersão menor que 0,2. Os resultados do estudo de fotodegradação mostraram que as nanocápsulas poliméricas foram capazes de proteger o DB da radiação UVC quando comparadas com uma solução do fármaco. Os experimentos de liberação in vitro foram realizados empregando a técnica de sacos de diálise, a qual mostrou, para todas as formulações, uma liberação prolongada do DB, mediada por transporte anômalo e cinética de primeira ordem. A solução etanólica de DB levou entre 24 e 36 h para alcançar 100% de liberação, enquanto que as nanocápsulas foram capazes de controlar a liberação do fármaco por até 108 h, dependendo do polímero empregado. Nanocápsulas de EC e PCL foram avaliadas quanto à toxicidade in vitro e in vivo e os resultados obtidos sugerem que as formulações propostas são seguras. Na etapa final do trabalho, o pullulan foi proposto como agente estabilizador de nanocápsulas de PCL e os resultados obtidos para o potencial zeta e o teor de fármaco sugerem que estas formulações tornaram-se mais estáveis. Desta forma, as nanocápsulas desenvolvidas neste trabalho representam uma alternativa promissora para a liberação pulmonar do DB no tratamento da asma e de outras desordens do trato respiratório.

En raison de leur petite taille, les nanoparticules (NP) (< 100 nm) peuvent coaguler très rapidement ce qui favorise leur pénétration dans l’organisme sous forme d’agglomérats. L’objectif de cette recherche est d’étudier l’influence de l’état d’agglomération de NP de dioxyde de titane (TiO2) de trois tailles de départ différentes, 5, 10-30 ou 50 nm sur la toxicité pulmonaire chez le rat mâle (F344) exposé à des aérosols de 2, 7 ou 20 mg/m3 pendant 6 heures. Dans une chambre d’inhalation, six groupes de rats (n = 6 par groupe) ont été exposés par inhalation aiguë nez-seulement à des aérosols ayant une taille primaire de 5 nm, mais produits sous forme faiblement (< 100 nm) ou fortement (> 100 nm) agglomérée à 2, 7 et 20 mg/m3. De façon similaire, quatre autres groupes de rats ont été exposés à 20 mg/m3 à des aérosols ayant une taille primaire de 10-30 et 50 nm. Les différents aérosols ont été générés par nébulisation à partir de suspensions ou par dispersion à sec. Pour chaque concentration massique, un groupe de rats témoins (n = 6 par groupe) a été exposé à de l’air comprimé dans les mêmes conditions. Les animaux ont été sacrifiés 16 heures après la fin de l’exposition et les lavages broncho-alvéolaires ont permis de doser des marqueurs d’effets inflammatoires, cytotoxiques et de stress oxydant. Des coupes histologiques de poumons ont également été analysées. L’influence de l’état d’agglomération des NP de TiO2 n’a pu être discriminée à 2 mg/m3. Aux concentrations massiques de 7 et 20 mg/m3, nos résultats montrent qu’une réponse inflammatoire aiguë est induite suite à l'exposition aux aérosols fortement agglomérés. En plus de cette réponse, l’exposition aux aérosols faiblement agglomérés à 20 mg/m3 s’est traduite par une augmentation significative de la 8-isoprostane et de la lactate déshydrogénase. À 20 mg/m3, les effets cytotoxiques étaient plus importants suite à l’exposition aux NP de 5 nm faiblement agglomérées. Ces travaux ont montré dans l'ensemble que différents mécanismes de toxicité pulmonaire peuvent être empruntés par les NP de TiO2 en fonction de la taille de départ et de l’état d’agglomération. / Given their small size, nanoparticles (NP) (< 100 nm) can coagulate quickly, which promotes their entry into the body in the form of agglomerates. The objective of this study is to evaluate the influence of the agglomeration state of three different primary particle sizes (5, 10-30 and 50 nm) of titanium dioxide (TiO2) NP on the pulmonary toxicity of male rats (F344) exposed to aerosols at 2, 7 or 20 mg/m3 for 6 hours. In an inhalation chamber, six groups of rats (n = 6 per group) were acutely exposed by nose-only inhalation to aerosols with a 5-nm primary particle size, produced in the form of small agglomerates (< 100 nm) (SA) or large agglomerates (> 100 nm) (LA) at 2, 7 and 20 mg/m3. Similarly, four other groups of rats were exposed to aerosols at 20 mg/m3 with a primary particle size of 10-30 and 50 nm. The different aerosols were generated by nebulization of suspensions or by dry dispersion. For each mass concentration, one group of control rats (n = 6 per group) was exposed to compressed air under the same conditions. The animals were sacrificed 16 hours after the end of exposure, and analysis of the bronchoalveolar lavage fluids was used to measure markers of inflammatory, cytotoxicity and oxidative stress effects. Lung sections were also analyzed for histopathology. The influence of the agglomeration state of TiO2 NP (5 nm) could not be determined at 2 mg/m3. For mass concentrations of 7 and 20 mg/m3, our results showed that an acute inflammatory response was induced following exposure to LA aerosols. In addition to this response, exposure to SA aerosols resulted in a significant increase in 8-isoprostane and lactate dehydrogenase. At 20 mg/m3, the cytotoxic effects were greater after exposure to the 5-nm NP in the SA aerosol. This study showed that TiO2 NP use different mechanisms to induce their pulmonary toxicity as a function of their primary particle size and their agglomeration state.

En raison de leur petite taille, les nanoparticules (NP) (< 100 nm) peuvent coaguler très rapidement ce qui favorise leur pénétration dans l’organisme sous forme d’agglomérats. L’objectif de cette recherche est d’étudier l’influence de l’état d’agglomération de NP de dioxyde de titane (TiO2) de trois tailles de départ différentes, 5, 10-30 ou 50 nm sur la toxicité pulmonaire chez le rat mâle (F344) exposé à des aérosols de 2, 7 ou 20 mg/m3 pendant 6 heures. Dans une chambre d’inhalation, six groupes de rats (n = 6 par groupe) ont été exposés par inhalation aiguë nez-seulement à des aérosols ayant une taille primaire de 5 nm, mais produits sous forme faiblement (< 100 nm) ou fortement (> 100 nm) agglomérée à 2, 7 et 20 mg/m3. De façon similaire, quatre autres groupes de rats ont été exposés à 20 mg/m3 à des aérosols ayant une taille primaire de 10-30 et 50 nm. Les différents aérosols ont été générés par nébulisation à partir de suspensions ou par dispersion à sec. Pour chaque concentration massique, un groupe de rats témoins (n = 6 par groupe) a été exposé à de l’air comprimé dans les mêmes conditions. Les animaux ont été sacrifiés 16 heures après la fin de l’exposition et les lavages broncho-alvéolaires ont permis de doser des marqueurs d’effets inflammatoires, cytotoxiques et de stress oxydant. Des coupes histologiques de poumons ont également été analysées. L’influence de l’état d’agglomération des NP de TiO2 n’a pu être discriminée à 2 mg/m3. Aux concentrations massiques de 7 et 20 mg/m3, nos résultats montrent qu’une réponse inflammatoire aiguë est induite suite à l'exposition aux aérosols fortement agglomérés. En plus de cette réponse, l’exposition aux aérosols faiblement agglomérés à 20 mg/m3 s’est traduite par une augmentation significative de la 8-isoprostane et de la lactate déshydrogénase. À 20 mg/m3, les effets cytotoxiques étaient plus importants suite à l’exposition aux NP de 5 nm faiblement agglomérées. Ces travaux ont montré dans l'ensemble que différents mécanismes de toxicité pulmonaire peuvent être empruntés par les NP de TiO2 en fonction de la taille de départ et de l’état d’agglomération. / Given their small size, nanoparticles (NP) (< 100 nm) can coagulate quickly, which promotes their entry into the body in the form of agglomerates. The objective of this study is to evaluate the influence of the agglomeration state of three different primary particle sizes (5, 10-30 and 50 nm) of titanium dioxide (TiO2) NP on the pulmonary toxicity of male rats (F344) exposed to aerosols at 2, 7 or 20 mg/m3 for 6 hours. In an inhalation chamber, six groups of rats (n = 6 per group) were acutely exposed by nose-only inhalation to aerosols with a 5-nm primary particle size, produced in the form of small agglomerates (< 100 nm) (SA) or large agglomerates (> 100 nm) (LA) at 2, 7 and 20 mg/m3. Similarly, four other groups of rats were exposed to aerosols at 20 mg/m3 with a primary particle size of 10-30 and 50 nm. The different aerosols were generated by nebulization of suspensions or by dry dispersion. For each mass concentration, one group of control rats (n = 6 per group) was exposed to compressed air under the same conditions. The animals were sacrificed 16 hours after the end of exposure, and analysis of the bronchoalveolar lavage fluids was used to measure markers of inflammatory, cytotoxicity and oxidative stress effects. Lung sections were also analyzed for histopathology. The influence of the agglomeration state of TiO2 NP (5 nm) could not be determined at 2 mg/m3. For mass concentrations of 7 and 20 mg/m3, our results showed that an acute inflammatory response was induced following exposure to LA aerosols. In addition to this response, exposure to SA aerosols resulted in a significant increase in 8-isoprostane and lactate dehydrogenase. At 20 mg/m3, the cytotoxic effects were greater after exposure to the 5-nm NP in the SA aerosol. This study showed that TiO2 NP use different mechanisms to induce their pulmonary toxicity as a function of their primary particle size and their agglomeration state.

<p>  </p> <p>Inhalation is a primary route of environmental and occupational exposures. Inhalation toxicology studies have thoroughly demonstrated the efficacy and adverse effects of a large number of chemicals, metals, pharmaceuticals, and agrochemicals. With the rapid development of new technologies and emergence of prominent subpopulations, some emerging exposure issues have arisen. To better protect public health, it is necessary to address these numerous emerging issues related to inhalation toxicology including 1) exposures to complex and unknown chemical emissions generated as we resolve infrastructure needs, 2) real-world exposure scenarios such as nanoparticle (NP) mixtures that may induce unique toxicity, and 3) variations in toxicity responses that occur in vulnerable and prevalent subpopulations following exposures. We designed three aims 1) to characterize differential representative composite manufacturing emissions (CMEs) and toxicity assessment of inhalation exposure to CMEs, 2) to examine the contribution of variable iron and manganese NP components in welding fumes to pulmonary toxicity, and 3) to evaluate metabolic syndrome (MetS)-induced variations in NP-Biocorona (NP-BC) composition following inhalation and modulation of pulmonary toxicity. Overall, this proposal aimed to characterize the emerging and complex exposures occurring in the real world and elucidate the mechanisms of differential pulmonary toxicity and susceptibility associated with CMEs, different metal NP components in welding fumes, and underlying diseases such as MetS. The conclusions from this project can help to improve the application of water infrastructure repairing technology and the utilization of welding and understand the mechanism of susceptibility to NP exposure among individuals with underlying diseases. Furthermore, the findings from these evaluations have supported and improved worldwide regulation, which promotes a safer utilization of novel materials, newly developed medicines, and complex chemicals.</p>