Protective efficacy of pirfenidone in rats with pulmonary fibrosis induced by bleomycin

Main Article Content

Baris Demirkol
Sule Gul
Mustafa Cörtük
Neslihan Akanıl Fener
Eminegül Yavuzsan
Ramazan Eren
Kursad Nuri Baydili
Mustafa Baki Çekmen
Erdogan Cetinkaya

Keywords

Bleomycin, Pirfenidone, Pulmonary Fibrosis, Pleuritis

Abstract

Background: Bleomycin causes increased production of reactive oxygen species, leads to pulmonary toxicity, fibroblast activation, and fibrosis.


Objectives: This study aimed to evaluate the protective effect of pirfenidone on bleomycin-induced lung toxicity in rats.


Methods: Twenty-eight adult rats were randomly divided into 3 groups; Bleomycin (B group, n=10), Bleomycin and Pirfenidone (B-PND group, n=13), and the control group (n=5). The bleomycin regimen was administered for 9 weeks. Pirfenidone was administered at 100 mg/kg daily. Total antioxidant level (TAS), total oxidant level (TOS), tumor necrosis factor (TNF-α), transforming growth factor (TGF-β1), matrix metalloproteinase-2 (MMP-2), plasminogen activator inhibitor (PAI) levels were studied. Histopathologically, sections were stained with Hematoxylin-eosin and Masson-trichrome for grading-scoring according to the Ashcroft score.


Results: Stage 3 fibrosis was observed in 50% of the B group rats, stage 3 and higher fibrosis was never detected in the B-PND group and the difference was statistically significant (p=0.003). When evaluating tissue inflammation, the inflammation was higher in the B-PND group than in the other groups (p<0.001). Pleuritis was detected in all rats in group B, while was not observed in B-PND and control group (p<0.001). The TAS level was found to be significantly higher in group B than in group B-PND (p=0.034), while no difference was found between TOS, TNF-α, MMP-2, PAI, TGF-β1.


Conclusions: Pirfenidone had a statistically significant protective effect in bleomycin-induced lung fibrosis and pleuritis in rats.  Despite the presence of inflammation in the tissue, no significant changes were observed in inflammation markers in the peripheral blood. Novel serum biomarkers are needed to indicate the presence of inflammation and fibrosis in the lung.

Abstract 590 | PDF Downloads 497

References

1. Noble PW, Barkauskas CE, Jiang D. Pulmonary fibrosis: patterns and perpetrators. J Clin Invest 2012; 122(8): 2756-2762. doi:10.1172/JCI60323.
2. Schelegle ES, Mansoor JK, Giri S. Pirfenidone attenuates bleomycin-induced changes in pulmonary functions in hamsters. Proc Soc Exp Biol Med 1997; 216(3): 392-397. doi:10.3181/00379727-216-44187.
3. Sausville EA, Stein RW, Peisach J, Horwitz SB. Properties and products of the degradation of DNA by bleomycin and iron(II). Biochemistry 1978; 17: 2746-2754. doi:10.1021/bi00607a008.
4. Zitnik RJ. Drug-induced lung disease: cancer chemotherapy agents. J Respir Dis 1995; 16: 855-865.
5. Zhao L, Wang X, Chang Q, et al. Neferine, a bisbenzylisoquinline alkaloid attenuates bleomycin-induced pulmonary fibrosis: European Journal of Pharmacology 2010; 627: 304–312. doi:10.1016/j.ejphar.2009.11.007.
6. Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: Idiopathic pulmonary fibrosis: Evidence‑based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011;183: 788‑824. doi:10.1164/rccm.2009-040GL.
7. Conte E, Gili E, Fagone E, Fruciano M, Iemmolo M, Vancheri C. Effect of pirfenidone on proliferation, TGF-β-induced myofibroblast differentiation and fibrogenic activity of primary human lung fibroblasts. Eur J Pharm Sci 2014; 58:13-9. doi:10.1016/j.ejps.2014.02.014.
8. Iyer SN, Wild JS, Schiedt MJ, Hyde DM, Margolin SB, Giri SN. Dietary intake of pirfenidone ameliorates bleomycin-induced lung fibrosis in hamsters. J Lab Clin Med 1995; 125:779–785.
9. Shimizu T, Kuroda T, Hata S, Fukagawa M, Margolin SB, Kurokawa K. Pirfenidone improves renal function and fibrosis in the post-obstructed kidney. Kidney Int 1998; 54:99–109. doi:10.1046/j.1523-1755.1998.00962.x.
10. Tada S, Nakamuta M, Enjoji M, et al. Pirfenidone inhibits dimethylnitrosamine-induced hepatic fibrosis in rats. Clin Exp Pharmacol Physiol 2001; 28: 522–527. doi:10.1046/j.1440-1681.2001.03481.x.
11. Garcia L, Hernandez I, Sandoval A, et al. Pirfenidone effectively reverses experimental liver fibrosis. J Hepatol 2002; 37: 797–805. doi:10.1016/s0168-8278(02)00272-6.
12. Chaudhary NI, Schnapp A, Park JE. Pharmacologic Differentiation of Inflammation and Fibrosis in the Rat Bleomycin Model. Am J Respir Crit Care Med 2006; 1; 173(7): 769-76. doi:10.1164/rccm.200505-717OC.
13. Oku H, Shimizu T, Kawabata T, et al. Antifibrotic action of pirfenidone and prednisolone: different effects on pulmonary cytokines and growth factors in bleomycin-induced murine pulmonary fibrosis. Eur J Pharmacol 2008; 590(1-3): 400-408. doi:10.1016/j.ejphar.2008.06.046.
14. Iyer SN, Gurujeyalakshmi G, Giri SN. Effects of pirfenidone on procollagen gene expression at the transcriptional level in bleomycin hamster model of lung fibrosis. The Journal of Pharmacology and Experimental Therapeutics 1999; 289(1), 211–218.
15. Ashcroft T, Simpson JM, Timbrell V. Simple method of estimating severity of pulmonary fibrosis on a numerical scale. J Clin Pathol 1988; 41(4): 467-470. doi:10.1136/jcp.41.4.467.
16. Tanino Y, Makita H, Miyamoto K, et al. Role of macrophage migration inhibitory factor in bleomycin-induced lung injury and fibrosis in mice. Am J Physiol Lung Cell Mol Physiol 2002; 283(1): L156-L162. doi:10.1152/ajplung.00155.2001.
17. Sleijfer S. Bleomycin-induced pneumonitis. Chest 2001; 120(2): 617-624. doi:10.1378/chest.120.2.617.
18. Ye Q, Li Y, Jiang H, et al. Prevention of Pulmonary Fibrosis via Trichostatin A (TSA) in Bleomycin Induced Rats. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases 2014; 31(3), 219–226.
19. Claussen CA, Long EC. Nucleic Acid recognition by metal complexes of bleomycin. Chem Rev 1999; 99(9): 2797–2816. doi:10.1021/cr980449z.
20. Grande NR, Peão MND, de Sá CM, Águas AP. Lung fibrosis induced by bleomycin: structural changes and overview of recent advances. Scanning Microscopy 1998; 12(3): 487–494.
21. Lasky J. Pirfenidone. IDrugs 2004; 7: 166–72.
22. Bando M, Yamauchi H, Ogura T, et al. Clinical experience of the long-term use of pirfenidone for idiopathic pulmonary fibrosis. Intern Med 2016; 55: 443–8. doi:10.2169/internalmedicine.55.5272.
23. Antoniu SA. Pirfenidone for the treatment of idiopathic pulmonary fibrosis. Expert Opin Investig Drugs 2006; 15: 823–8. doi:10.1517/13543784.15.7.823.
24. Iyer SN, Hyde DM, Giri SN. Anti-inflammatory effect of pirfenidone in the bleomycin-hamster model of lung inflammation. Inflammation 2000; 24: 477–91. doi:10.1023/a:1007068313370.
25. Liu Y, Lu F, Kang L, Wang Z, Wang Y. Pirfenidone attenuates bleomycin-induced pulmonary fibrosis in mice by regulating Nrf2/Bach1 equilibrium. BMC Pulm Med. 2017; 17(1):63. doi:10.1186/s12890-017-0405-7.
26. Song X, Yu W, Guo F. Pirfenidone suppresses bleomycin-induced pulmonary fibrosis and periostin expression in rats. Exp Ther Med 2018; 16(3): 1800-1806. doi:10.3892/etm.2018.6378.
27. Ayman M. Mousa. Effect of Pirfenidone on Bleomycin Induced Pulmonary Alveolar Fibrosis in Adult Male Rats (Histological, Immunohistochemical, Morphometrical and Biochemical Study). International Journal of Clinical and Developmental Anatomy 2016; 2(3): 17-23.
28. Chua F, Gauldie J, Laurent GJ. Pulmonary fibrosis: searching for model answers. American Journal of Respiratory Cell and Molecular Biology 2005; 33(1), 9–13. doi:10.1165/rcmb.2005-0062TR.
29. Mertens AC, Yasui Y, Liu Y, et al. Pulmonary complications in survivors of childhood and adolescent cancer. Cancer 2002; 95(11): 2431-2441. doi:10.1002/cncr.10978.
30. Reid L. Bullae (The Pathology of Emphysema) Lloyd-Luke Medical Books; London, UK: 1967.
31. Fleischman RW, Baker JR, Thompson GA, et al. Bleomycin induced interstitial pneumonia in dogs. Thorax 1971; 26(6): 675- 681. doi:10.1136/thx.26.6.675.
32. Kim SN, Lee J, Yang HS, et al. Dose-response Effects of Bleomycin on Inflammation and Pulmonary Fibrosis in Mice. Toxicol Res 2010; 26(3): 217-222. doi:10.5487/TR.2010.26.3.217.
33. Talcott JA, Garnick MB, Stomper PC, Godleski JJ, Richie JP. Cavitary lung nodules associated with combination chemotherapy containing bleomycin. J Urol 1987;138(3): 619-20. doi:10.1016/s0022-5347(17)43278-2.
34. Coalson JJ. The ultrastructure of human fibrosing alveolitis. Virchows Arch A Pathol Anat Histol 1982; 395(2): 181–99. doi:10.1007/BF00429611.
35. Corrin B, Jagusch M, Dewar A, et al. Fine structural changes in idiopathic pulmonary haemosiderosis. J. Pathol 1987; 153(3): 249–56. doi:10.1002/path.1711530309.
36. Kasper M, Haroske G. Alterations in the alveolar epithelium after injury leading to pulmonary fibrosis. Histol. Histopathol 1996; 11(2): 463-83.
37. Rennard SI, Bitterman PB, Crystal RG. Response of the lower respiratory tract to injury. Mechanisms of repair of the parenchymal cells of the alveolar wall. Chest 1983; 84(6): 735–39. doi:10.1378/chest.84.6.735.
38. Katzenstein AL. Pathogenesis of “fibrosis” in interstitial pneumonia: an electron microscopic study. Hum. Pathol 1985; 16(10): 1015–24. doi:10.1016/s0046-8177(85)80279-3.
39. Thannickal VJ, Toews GB, White ES, Lynch JP 3rd, Martinez FJ. Mechanisms of pulmonary fibrosis. Annu Rev Med 2004; 55: 395-417. doi:10.1146/annurev.med.55.091902.103810.
40. Di Sario A, Bendia E, Macarri G, et al. The anti-fibrotic effect of pirfenidone in rat liver fibrosis is mediated by downregulation of procollagen alpha1(I), TIMP-1 and MMP-2. Dig Liver Dis 2004; 36(11): 744-751. doi:10.1016/j.dld.2004.05.012.
41. Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998; 9: 1331-1337. doi:10.1023/a:1008407014084.
42. Subramaniam S, Shyama S, Jagadeesan M, Shyamala Devi CS. Oxidant and antioxidant levels in the erythrocytes of breast cancer patients treated with CMF. Med Sci Res 1993; 21: 79-80.
43. Schaefer CJ, Ruhrmund DW, Pan L, Seiwert SD, Kossen K. Antifibrotic activities of pirfenidone in animal models. Eur Respir Rev 2011; 20(120): 85-97. doi:10.1183/09059180.00001111.
44. Dilruba S, Kalayda GV. Platinum-based drugs: past, present and future. Cancer Chemotherapy and Pharmacology 2016; 77(6), 1103–1124. doi:10.1007/s00280-016-2976-z.
45. Chen HHW, Kuo MT. Role of glutathione in the regulation of Cisplatin resistance in cancer chemotherapy. Metal-based Drugs 2010; 430939. doi:10.1155/2010/430939.
46. Taherkhani M, Mahjoub S, Moslemi D, Karkhah A. Three cycles of AC chemotherapy regimen increased oxidative stress in breast cancer patients: a clinical hint. Caspian J Intern Med 2017; 8(4): 264–268. doi:10.22088/cjim.8.4.264.
47. Mohan A, Poulose R, Gupta T, et al. Impact of chemotherapy on symptom profile, oxidant-antioxidant balance and nutritional status in non-small cell Lung Cancer. Lung India 2017; 34(4): 336–340. doi:10.4103/0970-2113.209230.
48. Krawczyk A, Nowak D, Nowak PJ, Padula G, Kwiatkowska S. Elevated exhalation of hydrogen peroxide in patients with non-small cell lung cancer is not affected by chemotherapy. Redox Report 2017; 22(6): 308–14. doi:10.1080/13510002.2016.1229885.
49. Xiang M, Feng J, Geng L, et al. Sera total oxidant/antioxidant status in lung cancer patients. Medicine 2019; 98(37): e17179. doi:10.1097/MD.0000000000017179.