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2015 ; 2
(ä): 1463-1472
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Pathology, toxicology, and latency of irritant gases known to cause bronchiolitis
obliterans disease: Does diacetyl fit the pattern?
#MMPMID28962489
Kerger BD
; Fedoruk MJ
Toxicol Rep
2015[]; 2
(ä): 1463-1472
PMID28962489
show ga
Bronchiolitis obliterans (BO) is a rare disease involving concentric bronchiolar
fibrosis that develops rapidly following inhalation of certain irritant gases at
sufficiently high acute doses. While there are many potential causes of
bronchiolar lesions involved in a variety of chronic lung diseases, failure to
clearly define the clinical features and pathological characteristics can lead to
ambiguous diagnoses. Irritant gases known to cause BO follow a similar pathologic
process and time course of disease onset in humans. Studies of inhaled irritant
gases known to cause BO (e.g., chlorine, hydrochloric acid, ammonia, nitrogen
oxides, sulfur oxides, sulfur or nitrogen mustards, and phosgene) indicate that
the time course between causal chemical exposures and development of clinically
significant BO disease is typically limited to a few months. The mechanism of
toxic action exerted by these irritant gases generally involves widespread and
severe injury of the epithelial lining of the bronchioles that leads to acute
respiratory symptoms which can include lung edema within days. Repeated exposures
to inhaled irritant gases at concentrations insufficient to cause marked
respiratory distress or edema may lead to adaptive responses that can reduce or
prevent severe bronchiolar fibrotic changes. Risk of BO from irritant gases is
driven substantially by toxicokinetics affecting concentrations occurring at the
bronchiolar epithelium. Highly soluble irritant gases that cause BO like ammonia
generally follow a threshold-dependent cytotoxic mechanism of action that at
sufficiently high doses results in severe inflammation of the upper respiratory
tract and the bronchiolar epithelium concurrently. This is followed by acute
respiratory distress, pulmonary edema, and post inflammatory concentric fibrosis
that become clinically obvious within a few months. In contrast, irritant gases
with lower solubility like phosgene also follow a threshold-dependent mechanism
of cytotoxicity action but can exhibit more insidious and isolated bronchiolar
tissue damage with a similar latency to fibrosis. To date, animal and human
studies on the highly soluble gas, diacetyl, have not identified a coherent
pattern of pathology and latency that would be expected based on studies of other
known causes of bronchiolitis obliterans disease.