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Original Research: SLEEP MEDICINE |

Leukotriene Pathways and In Vitro Adenotonsillar Cell Proliferation in Children With Obstructive Sleep Apnea

Ehab Dayyat, MD; Laura D. Serpero, PhD; Leila Kheirandish-Gozal, MD; Julie L. Goldman, MD; Ayelet Snow, MD; Rakesh Bhattacharjee, MD; David Gozal, MD, FCCP
Author and Funding Information

*From the Departments of Pediatrics (Drs. Dayyat, Serpero, Kheirandish-Gozal, Goldman, Snow, Bhattacharjee, and Gozal) and Surgery (Dr. Goldman), Division of Sleep Medicine and Kosair Children's Hospital Research Institute, University of Louisville, Louisville, KY.

Correspondence to: David Gozal, MD, FCCP, Professor and Chair, Department of Pediatrics, Physician-in-Chief, Comer Children's Hospital, The University of Chicago, 5721 S Maryland Ave, MC 8000, Suite K-160, Chicago, IL 60637; e-mail: dgozal@peds.bsd.uchicago.edu


None of the authors have any conflict of interest to declare.

Dr. Gozal is supported by National Institutes of Health grants Nos. HL-065270, HL-086662, and HL-083075, the Commonwealth of Kentucky Research Challenge for Excellence Trust Fund, and the Children's Foundation Endowment for Sleep Research. Dr. Kheirandish-Gozal is supported by an investigator-initiated grant from the Merck Company. Dr. Bhattacharjee is supported by a fellowship from Jazz Pharmaceuticals.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(5):1142-1149. doi:10.1378/chest.08-2102
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Introduction:  The abundant expression of leukotrienes (LTs) and their receptors in adenotonsillar tissues of children with obstructive sleep apnea (OSA) suggest that LT antagonists could be useful in treating OSA.

Methods:  The effects of LTD4 and of LT receptor antagonists zileuton, montelukast, and BAY u9773 were examined on mixed cell cultures prepared from dissociated tonsils or adenoids harvested intraoperatively from children with polysomnographically diagnosed OSA. Proliferation was assessed by 3[H]-thymidine incorporation, and inflammatory cytokine production (tumor necrosis factor [TNF]-α, interleukin [IL]-6, IL-8, IL-10, and IL-12) was assessed in supernatants using enzyme-linked immunosorbent assay.

Results:  LTD4 elicited dose-dependent increases in adenotonsillar cell proliferation (p < 0.001; n = 12). All LT antagonists exhibited dose-dependent reductions in adenotonsillar cellular proliferation rates, with montelukast more than BAY u9773 more than zileuton (n = 14/group; p < 0.001). However, BAY u9773 showed partial agonist effects and increased cellular proliferation at higher concentrations (10−4 mmol/L; p < 0.01; n = 12). LTD4 effects were partially blocked by montelukast and BAY u9773 but not by zileuton. All three antagonists reduced TNF-α, IL-6, and IL-12 concentrations, with selective changes in IL-8 and no effects on IL-10 levels.

Conclusions:  LT pathways mediate intrinsic proliferative and inflammatory signaling pathways in adenotonsillar tissues from children with OSA, and targeted pharmacologic disruption of these pathways may provide nonsurgical alternatives for prevention and treatment of this disease.

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