Investigation of the neutrophil-directed anti-inflammatory properties of the cysteinyl leukotriene receptor antagonist, montelukast

Abstract

Montelukast (ML) is primarily an antagonist of type 1 cysteinyl leukotriene receptors (CysLT1R), an activity which underpins its therapeutic efficacy in bronchial asthma. However, ML has also been reported to be useful in the treatment of acute and chronic inflammatory disorders of both infective and non-infective origin in which CysLTs are unlikely to be the predominant mediators of harmful inflammatory responses. These include conditions such as chronic obstructive pulmonary disease and cystic fibrosis in which the neutrophil is believed to be the primary offender, suggesting that ML may possess neutrophil-targeted, CysLT1R-independent mechanisms of anti-inflammatory activity. Accordingly, the laboratory research presented in this thesis was designed with the primary objectives of characterizing possible CysLT1R-dependent and – independent neutrophil-targeted anti-inflammatory activities of ML in vitro, and consisted of 3 phases. These were investigation of: i) the effects of the CysLTs, LTC4 and LTD4 (in the absence and presence of ML) on mobilization of intracellular Ca2+ stores, generation of reactive oxygen species (ROS) and release of primary and secondary granule proteinases; ii) the effects of ML on a series of pro-inflammatory activities of neutrophils following activation of the cells with the chemoattractants FMLP and platelet-activating factor (PAF); and iii) the interactive, anti-inflammatory effects on neutrophils of ML in combination with the long-acting beta-2 agonist, formoterol. In addition to the aforementioned activities, measurement of the production and expression of CR3, as well as generation of inositol triphosphate (IP3), cyclic AMP, and activities of the enzymes cAMP- and cGMP-phosphodiesterases (PDEs) in isolated neutrophil cytosol and membrane fractions, were also included. The following assays were used: i) chemiluminescence procedures for the detection of ROS; ii) a colourimetric procedure for the detection of elastase; iii) ELISA procedures for the detection of the matrix metalloproteinases (MMPs) 8- and -9, LTB4, and cyclic AMP; iv) fura-2-based spectrofluorimetry and a radiometric procedure for monitoring cytosolic Ca2+ fluxes; v) flow cytometry for CR3; and vi) radioassays for IP3 and activity of cAMP- and cGMP-PDEs. Exposure of neutrophils to LTD4, but not LTC4, activated a very modest and transient increase in cytosolic Ca2+, but failed to initiate the generation of ROS or release of elastase or MMP-8. However, brief pre-treatment with either LTC4 or LTD4 sensitized the cells for increased production of ROS and release of granule proteinases following activation with FMLP, which was partially attenuated by inclusion of ML. In the second part of the study, pre-treatment of neutrophils with ML, at therapeutically relevant concentrations, resulted in dose-related inhibition of the FMLP- or PAF-activated generation of ROS and LTB4, as well as the release of elastase, with the former being unaffected by an inhibitor of 5-lipoxygenase (MK886), compatible with a CysLT1R-independent mechanism of anti-inflammatory activity. From a mechanistic perspective, these interactions of ML with neutrophils were associated with accelerated clearance of Ca2+ from the cytosol of the cells which could not be attributed to inhibition of production of IP3, but was, however, associated with increased levels of cAMP, apparently as a consequence of non- specific inhibition of cyclic nucleotide phosphodiesterases. In the third part of the study, combining ML with formoterol caused (in most cases) additive inhibitory effects on the generation of ROS and LTB4, release of granule proteinases, as well as expression of CR3, which again were associated with elevations in cAMP and interference with Ca2+ mobilization. In conclusion, ML appears to attenuate neutrophil activation by CysLT1R-dependent and –independent mechanisms. In the case of the former by interfering with the modest sensitizing (priming) interactions of LTC4 and LTD4 with neutrophils, and in the latter by inhibition of PDEs, leading a to sustained elevation in cAMP, resulting in rapid clearance of Ca2+ from the cytosol and decreased uptake of the cation from the extracellular milieu.