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Pedersen F, Holz O, Lauer G, Quintini G, Kiwull-Schöne H, Kirsten AM, Magnussen H, Rabe KF, Goldmann T, Watz H. Multi-analyte profiling of inflammatory mediators in COPD sputum – The effects of processing. Cytokine 2015; 71:401-4. [DOI: 10.1016/j.cyto.2014.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 08/15/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
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102
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Tangedal S, Aanerud M, Persson LJP, Brokstad KA, Bakke PS, Eagan TM. Comparison of inflammatory markers in induced and spontaneous sputum in a cohort of COPD patients. Respir Res 2014; 15:138. [PMID: 25398249 PMCID: PMC4237726 DOI: 10.1186/s12931-014-0138-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/26/2014] [Accepted: 10/24/2014] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Sputum induction is a non-invasive method for obtaining measurements of inflammation in the airways. Whether spontaneously sampled sputum can be a valid surrogate is unknown. The aim of this study was to compare levels of six inflammatory markers in sputum pairs consisting of induced and spontaneous sputum sampled on the same consultation either in a stable state or during exacerbations of chronic obstructive pulmonary disease (COPD). METHODS 433 COPD patients aged 40-76, Global initiative for chronic Obstructive Lung Disease (GOLD) stage II-IV were enrolled in 2006/07 and followed every six months for three years. 356 patients were followed for potential exacerbations. Interleukin-6, interleukin-8, interleukin-18, interferon gamma-inducible protein-10, monokine induced by gamma interferon and tumor necrosis factor-alpha (IL-6, IL-8, IL-18, IP-10, MIG and TNF-α) were measured by bead based multiplex immunoassay in 60 paired sputum samples from 45 patients. Albumin was measured by enzyme immunoassay, for concentration correction. Culturing for bacterial growth was performed on 24 samples. Bland-Altman plots were used to assess agreement. The paired non-parametric Wilcoxon signed-rank test, the non-parametric Spearman's rank correlation test and Kruskal-Wallis test were used for statistical analyses. For all analyses, a p-value < 0.05 was considered significant. RESULTS Agreement between the two measurements was generally low for all six markers. TNF-α was significantly higher in spontaneous sputum at exacerbations (p = 0.002) and trending higher at the steady state (p = 0.06). Correlation coefficients between the levels of markers in induced and spontaneous sputum varied between 0.58 (IL-18) to 0.83 (IP-10). In spontaneous sputum IL-18 and MIG were higher in ex-smokers (p < 0.05). The levels of all markers were higher in GOLD stage III & IV except for IL-6 in spontaneous sputum and IL-18 in induced sputum, compared with GOLD stage II, although not statistically significant. In spontaneous sputum the levels of IL-6 were significantly higher if Haemophilus influenzae (HI) was not cultured. CONCLUSION We observed a low agreement and significant differences in inflammatory markers between induced and spontaneous sputum, both at steady state and exacerbations. We recommend considering sampling method when reporting on inflammatory markers in sputum.
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Affiliation(s)
- Solveig Tangedal
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Marianne Aanerud
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Louise J P Persson
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Karl A Brokstad
- Institute of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Per S Bakke
- Institute of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Tomas M Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
- Institute of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
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Ravi AK, Khurana S, Lemon J, Plumb J, Booth G, Healy L, Catley M, Vestbo J, Singh D. Increased levels of soluble interleukin-6 receptor and CCL3 in COPD sputum. Respir Res 2014; 15:103. [PMID: 25183374 PMCID: PMC4156958 DOI: 10.1186/s12931-014-0103-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 08/19/2014] [Indexed: 01/10/2023] Open
Abstract
Background COPD patients have increased numbers of macrophages and neutrophils in the lungs. Interleukin-6 (IL-6) trans-signaling via its soluble receptor sIL-6R, governs the influx of innate immune cells to inflammatory foci through regulation of the chemokine CCL3. We hypothesized that there would be enhanced levels of IL-6, sIL-6R and CCL3 in COPD sputum. Methods 59 COPD patients, 15 HNS and 15 S underwent sputum induction and processing with phosphate buffered saline to obtain supernatants for IL-6, sIL-6R and CCL3 analysis. Cytoslides were produced for differential cell counting and immunocytochemistry (COPD; n = 3) to determine cell type surface expression of the CCL3 receptors CCR5 and CCR1. Results COPD patients expressed higher levels (p < 0.05) of sIL-6R and CCL3 compared to controls (sIL-6R medians pg/ml: COPD 166.4 vs S 101.1 vs HNS 96.4; CCL3 medians pg/ml: COPD 117.9 vs S 0 vs HNS 2.7). COPD sIL-6R levels were significantly correlated with sputum neutrophil (r = 0.5, p < 0.0001) and macrophage (r = 0.3, p = 0.01) counts. Immunocytochemical analysis revealed that CCR5 and CCR1 were exclusively expressed on airway macrophages. Conclusion Enhanced airway generation of sIL-6R may promote IL-6 trans-signaling in COPD. Associated upregulation of CCL3 may facilitate the recruitment of macrophages into the airways by ligation of CCR1 and CCR5. Electronic supplementary material The online version of this article (doi:10.1186/s12931-014-0103-4) contains supplementary material, which is available to authorized users.
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104
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Rossall MRW, Cadden PA, Molphy SD, Plumb J, Singh D. Repeatability of induced sputum measurements in moderate to severe asthma. Respir Med 2014; 108:1566-8. [PMID: 25195138 DOI: 10.1016/j.rmed.2014.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/31/2014] [Accepted: 08/05/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Novel therapies are being developed for patients with moderate to severe asthma. These patients may have neutrophilic airway inflammation. Induced sputum is commonly used as an endpoint in clinical trials of asthma therapies. We have performed repeated induced sputum sampling in moderate to severe asthma patients to understand the variability of cell counts, including neutrophils, and performed power calculations for studies in this group of patients. METHODS Nineteen patients with moderate to severe asthma with evidence of airflow obstruction (FEV1 ≤ 80% predicted) and suboptimal control (ACQ ≥ 1) performed repeated induced sputum separated by 1 month. RESULTS The Ri of neutrophil percentage and absolute eosinophil count demonstrated good (0.61) and moderate (0.56) repeatability respectively, but there was a poor level of agreement for eosinophil percentage and absolute neutrophil counts. The within subject SD for sputum neutrophil percentage was 15.8. In cross over studies, sample sizes of n = 14 and n = 54 are required to detect changes in neutrophil percentages by 20 and 10 % respectively at 90% power. CONCLUSIONS Sputum neutrophil percentage has good reproducibility in patients with moderate to severe asthma.
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Affiliation(s)
| | - Paul Aidan Cadden
- University of Manchester, Medicines Evaluation Unit, The Langley Building, Southmoor Road, Manchester, M23 9QZ, UK
| | - Stephanie Dawn Molphy
- University of Manchester, Medicines Evaluation Unit, The Langley Building, Southmoor Road, Manchester, M23 9QZ, UK
| | - Jonathan Plumb
- University of Manchester, Medicines Evaluation Unit, The Langley Building, Southmoor Road, Manchester, M23 9QZ, UK
| | - Dave Singh
- University of Manchester, Medicines Evaluation Unit, The Langley Building, Southmoor Road, Manchester, M23 9QZ, UK
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Ghebre MA, Bafadhel M, Desai D, Cohen SE, Newbold P, Rapley L, Woods J, Rugman P, Pavord ID, Newby C, Burton PR, May RD, Brightling CE. Biological clustering supports both "Dutch" and "British" hypotheses of asthma and chronic obstructive pulmonary disease. J Allergy Clin Immunol 2014; 135:63-72. [PMID: 25129678 PMCID: PMC4282726 DOI: 10.1016/j.jaci.2014.06.035] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 06/15/2014] [Accepted: 06/18/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous diseases. OBJECTIVE We sought to determine, in terms of their sputum cellular and mediator profiles, the extent to which they represent distinct or overlapping conditions supporting either the "British" or "Dutch" hypotheses of airway disease pathogenesis. METHODS We compared the clinical and physiological characteristics and sputum mediators between 86 subjects with severe asthma and 75 with moderate-to-severe COPD. Biological subgroups were determined using factor and cluster analyses on 18 sputum cytokines. The subgroups were validated on independent severe asthma (n = 166) and COPD (n = 58) cohorts. Two techniques were used to assign the validation subjects to subgroups: linear discriminant analysis, or the best identified discriminator (single cytokine) in combination with subject disease status (asthma or COPD). RESULTS Discriminant analysis distinguished severe asthma from COPD completely using a combination of clinical and biological variables. Factor and cluster analyses of the sputum cytokine profiles revealed 3 biological clusters: cluster 1: asthma predominant, eosinophilic, high TH2 cytokines; cluster 2: asthma and COPD overlap, neutrophilic; cluster 3: COPD predominant, mixed eosinophilic and neutrophilic. Validation subjects were classified into 3 subgroups using discriminant analysis, or disease status with a binary assessment of sputum IL-1β expression. Sputum cellular and cytokine profiles of the validation subgroups were similar to the subgroups from the test study. CONCLUSIONS Sputum cytokine profiling can determine distinct and overlapping groups of subjects with asthma and COPD, supporting both the British and Dutch hypotheses. These findings may contribute to improved patient classification to enable stratified medicine.
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Affiliation(s)
- Michael A Ghebre
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, University of Leicester, Leicester, United Kingdom; NIHR Respiratory Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom; Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Mona Bafadhel
- Department of Respiratory Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Headington, Oxford, United Kingdom
| | - Dhananjay Desai
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, University of Leicester, Leicester, United Kingdom; NIHR Respiratory Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom
| | - Suzanne E Cohen
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, United Kingdom
| | - Paul Newbold
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, United Kingdom
| | - Laura Rapley
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, United Kingdom
| | - Jo Woods
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, United Kingdom
| | - Paul Rugman
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, United Kingdom
| | - Ian D Pavord
- Department of Respiratory Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Headington, Oxford, United Kingdom
| | - Chris Newby
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, University of Leicester, Leicester, United Kingdom; NIHR Respiratory Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom; Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Paul R Burton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Richard D May
- MedImmune Ltd, Milstein Building, Granta Park, Cambridge, United Kingdom
| | - Chris E Brightling
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, University of Leicester, Leicester, United Kingdom; NIHR Respiratory Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom.
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Fu JJ, McDonald VM, Gibson PG, Simpson JL. Systemic Inflammation in Older Adults With Asthma-COPD Overlap Syndrome. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 6:316-24. [PMID: 24991455 PMCID: PMC4077958 DOI: 10.4168/aair.2014.6.4.316] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 06/03/2013] [Accepted: 07/18/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE The role of systemic inflammation on asthma-COPD overlap syndrome is unknown. This study aimed to examine systemic inflammation in asthma-COPD overlap syndrome, and to identify associations between clinical characteristics and inflammatory mediators in asthma-COPD overlap syndrome. METHODS In 108 adults older than 55 years comprising healthy controls (n=29), asthma (n=16), COPD (n=21) and asthma-COPD overlap syndrome (n=42), serum high sensitivity C-reactive protein and Interleukin 6 (IL-6) were assayed. Spirometry, induced sputum, quality of life, comorbidities and medications were assessed, and their associations with asthma-COPD overlap syndrome were analyzed using logistic regression. Associations between systemic inflammatory mediators and clinical characteristics were tested in multivariate linear regression models. RESULTS Patients with asthma-COPD overlap syndrome had significantly elevated IL-6 levels compared with healthy controls and asthmatics. Age, comorbidity index and IL-6 level were independently associated with asthma-COPD overlap syndrome. FEV1% predicted was inversely associated with IL-6 level, and cardiovascular disease was associated with an increased IL-6 level. Systemic markers were not associated with airway inflammation. CONCLUSIONS Systemic inflammation is commonly present in asthma-COPD overlap syndrome, and asthma-COPD overlap syndrome resembled COPD in terms of systemic inflammation. IL-6 is a pivotal inflammatory mediator that may be involved in airflow obstruction and cardiovascular disease and may be an independent treatment target.
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Affiliation(s)
- Juan-Juan Fu
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China. ; Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle; Hunter Medical Research Institute, Newcastle, NSW, Australia. ; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia
| | - Vanessa M McDonald
- Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle; Hunter Medical Research Institute, Newcastle, NSW, Australia. ; School of Nursing and Midwifery, Faculty of Health, University of Newcastle, NSW, Australia. ; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia
| | - Peter G Gibson
- Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle; Hunter Medical Research Institute, Newcastle, NSW, Australia. ; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia. ; Woolcock Institute of Medical Research, Sydney NSW, Australia
| | - Jodie L Simpson
- Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle; Hunter Medical Research Institute, Newcastle, NSW, Australia. ; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia
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107
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Makiya MA, Herrick JA, Khoury P, Prussin CP, Nutman TB, Klion AD. Development of a suspension array assay in multiplex for the simultaneous measurement of serum levels of four eosinophil granule proteins. J Immunol Methods 2014; 411:11-22. [PMID: 24914990 DOI: 10.1016/j.jim.2014.05.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 04/28/2014] [Accepted: 05/31/2014] [Indexed: 12/18/2022]
Abstract
The concentrations of major basic protein (MBP), eosinophil cationic protein (ECP), eosinophil derived neurotoxin (EDN) and eosinophil peroxidase (EPO) have been associated with eosinophilic disease severity. Whereas a variety of techniques have been used to measure individual eosinophil granule protein concentration, none of these methods efficiently measures MBP, ECP, EDN and EPO simultaneously. A multiplex suspension array system was developed to simultaneously measure the concentrations of MBP, ECP, EDN and EPO in serum. The assay showed excellent inter- and intra-assay reliability, and serum levels of MBP, ECP and EDN from eosinophilic subjects analyzed by ELISA and multiplex were highly correlated (r=0.8579; P<0.0001, r=0.6356; P=0.0006 and r=0.8600; P<0.0001, respectively, Spearman rank correlation). Moreover, the multiplex assay required 500-fold less serum than a single ELISA to achieve comparable sensitivity. Absolute eosinophil count and eosinophil surface expression of the activation marker, CD69, were significantly correlated with concentrations of MBP, EDN and EPO, but not ECP, in serum from eosinophilic subjects. Furthermore, subjects with eosinophilic gastrointestinal disorder and normal peripheral absolute eosinophil counts (<0.5×10(9)/l) had significantly increased concentrations of MBP (P<0.0001), ECP (P<0.0001), EDN (P=0.0001) and EPO (P<0.0001) compared to normal donors. In summary, the eosinophil granule protein multiplex assay provides a rapid and reliable way to measure eosinophil granule protein levels and should prove useful in assessing patterns of degranulation in patients with eosinophilic disorders.
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Affiliation(s)
- Michelle A Makiya
- Eosinophil Pathology Unit, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States.
| | - Jesica A Herrick
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Paneez Khoury
- Eosinophil Pathology Unit, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Calman P Prussin
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Thomas B Nutman
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Amy D Klion
- Eosinophil Pathology Unit, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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108
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Caramori G, Adcock IM, Di Stefano A, Chung KF. Cytokine inhibition in the treatment of COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:397-412. [PMID: 24812504 PMCID: PMC4010626 DOI: 10.2147/copd.s42544] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cytokines play an important part in many pathobiological processes of chronic obstructive pulmonary disease (COPD), including the chronic inflammatory process, emphysema, and altered innate immune response. Proinflammatory cytokines of potential importance include tumor necrosis factor (TNF)-α, interferon-γ, interleukin (IL)-1β, IL-6, IL-17, IL-18, IL-32, and thymic stromal lymphopoietin (TSLP), and growth factors such as transforming growth factor-β. The current objectives of COPD treatment are to reduce symptoms, and to prevent and reduce the number of exacerbations. While current treatments achieve these goals to a certain extent, preventing the decline in lung function is not currently achievable. In addition, reversal of corticosteroid insensitivity and control of the fibrotic process while reducing the emphysematous process could also be controlled by specific cytokines. The abnormal pathobiological process of COPD may contribute to these fundamental characteristics of COPD, and therefore targeting cytokines involved may be a fruitful endeavor. Although there has been much work that has implicated various cytokines as potentially playing an important role in COPD, there have been very few studies that have examined the effect of specific cytokine blockade in COPD. The two largest studies that have been reported in the literature involve the use of blocking antibody to TNFα and CXCL8 (IL-8), and neither has provided benefit. Blocking the actions of CXCL8 through its CXCR2 receptor blockade was not successful either. Studies of antibodies against IL-17, IL-18, IL-1β, and TSLP are currently either being undertaken or planned. There is a need to carefully phenotype COPD and discover good biomarkers of drug efficacy for each specific target. Specific groups of COPD patients should be targeted with specific anticytokine therapy if there is evidence of high expression of that cytokine and there are features of the clinical expression of COPD that will respond.
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Affiliation(s)
- Gaetano Caramori
- Dipartimento di Scienze Mediche, Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-correlate (CEMICEF; formerly Centro di Ricerca su Asma e BPCO), Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Ferrara, Italy
| | - Ian M Adcock
- Airway Diseases Section, National Heart and Lung Institute, Imperial College London, UK
- Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Antonino Di Stefano
- Divisione di Pneumologia e Laboratorio di Citoimmunopatologia dell’Apparato Cardio-Respiratorio, Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy
| | - Kian Fan Chung
- Airway Diseases Section, National Heart and Lung Institute, Imperial College London, UK
- Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
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109
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Bastarache JA, Koyama T, Wickersham NE, Ware LB. Validation of a multiplex electrochemiluminescent immunoassay platform in human and mouse samples. J Immunol Methods 2014; 408:13-23. [PMID: 24768796 DOI: 10.1016/j.jim.2014.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/31/2014] [Accepted: 04/14/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite the widespread use of multiplex immunoassays, there are very few scientific reports that test the accuracy and reliability of a platform prior to publication of experimental data. Our laboratory has previously demonstrated the need for new assay platform validation prior to use of biologic samples from large studies in order to optimize sample handling and assay performance. METHODS In this study, our goal was to test the accuracy and reproducibility of an electrochemiluminescent multiplex immunoassay platform (Meso Scale Discovery, MSD®) and compare this platform to validated, singleplex immunoassays (R&D Systems®) using actual study subject (human plasma and mouse bronchoalveolar lavage fluid (BAL) and plasma) samples. RESULTS We found that the MSD platform performed well on intra- and inter-assay comparisons, spike and recovery and cross-platform comparisons. The mean intra-assay CV% and range for MSD were 3.49 (0.0-10.4) for IL-6 and 2.04 (0.1-7.9) for IL-8. The correlation between values for identical samples measured on both MSD and R&D was R=0.97 for both analytes. The mouse MSD assay had a broader range of CV% with means ranging from 9.5 to 28.5 depending on the analyte. The range of mean CV% was similar for single plex ELISAs at 4.3-23.7 depending on the analyte. Regardless of species or sample type, CV% was more variable at lower protein concentrations. CONCLUSIONS In conclusion, we validated a multiplex electrochemiluminescent assay system and found that it has superior test characteristics in human plasma compared to mouse BALF and plasma. Both human and MSD assays compared favorably to well-validated singleplex ELISAs.
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Affiliation(s)
- J A Bastarache
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, T-1218 MCN, Nashville, TN 37232-2650, United States.
| | - T Koyama
- Department of Biostatistics, Vanderbilt University School of Medicine, T-1218 MCN, Nashville, TN 37232-2650, United States
| | - N E Wickersham
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, T-1218 MCN, Nashville, TN 37232-2650, United States
| | - L B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, T-1218 MCN, Nashville, TN 37232-2650, United States
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Drozdovszky O, Barta I, Antus B. Sputum eicosanoid profiling in exacerbations of chronic obstructive pulmonary disease. Respiration 2014; 87:408-15. [PMID: 24714447 DOI: 10.1159/000358099] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/09/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Eicosanoids are small lipid molecules with diverse biological functions in the airways. OBJECTIVES The aim of this study was to investigate changes in leukotriene B4 (LTB4), 8-isoprostane, prostaglandin E2 (PGE2) and cysteinyl-leukotriene (cys-LT) levels in the sputum of patients with chronic obstructive pulmonary disease (COPD) at the onset of a severe exacerbation and during the course of recovery. METHODS Thirty-seven ex-smoker COPD patients suffering an episode of acute exacerbation were enrolled. Samples were taken (i) on hospital admission and (ii) after regular treatment. Twenty-five stable ex-smoker COPD patients served as controls. Eicosanoids were determined by enzyme immunoassay. RESULTS Sputum PGE2 [39.8 (13.3-103.3) vs. 5.05 (2.3-12.1) pg/ml, p < 0.001], 8-isoprostane [89.5 (36.9-184.7) vs. 29.7 (13.8-68.8) pg/ml, p < 0.01] and LTB4 [587.7 (252.9-774.8) vs. 276.1 (105.4-594.7) pg/ml, p < 0.05] levels were increased in patients with exacerbation compared to stable subjects. After treatment only PGE2 levels decreased significantly [at discharge: 19.6 (4.6-52.5) pg/ml, p < 0.01], the levels of other eicosanoids remained elevated (p = NS). Sputum cys-LT levels were similar in stable patients and in those with exacerbation and treatment did not influence cys-LTs either. There was a significant correlation between PGE2 and sputum neutrophil and lymphocyte cell counts in patients with exacerbation. CONCLUSIONS Our results suggest that 8-isoprostane, LTB4 and PGE2 but not cys-LTs may be involved in exacerbation-associated inflammatory processes in the airways of patients with COPD. Validation of PGE2 for use as a biomarker of recovery from an exacerbation requires further studies.
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Affiliation(s)
- Orsolya Drozdovszky
- Department of Pathophysiology, National Koranyi Institute of TB and Pulmonology, Budapest, Hungary
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Gold DL, Dawson M, Yang H, Parker J, Gossage DL. Clinical trial simulation to assist in COPD trial planning and design with a biomarker-based diagnostic: when to pull the trigger? COPD 2013; 11:226-35. [PMID: 24111823 DOI: 10.3109/15412555.2013.836170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease with a wide range of clinical phenotypes that vary from predominantly airway disease (chronic bronchitis) to predominantly parenchymal disease (emphysema). Current advances for the treatment of COPD are increasingly focused on targeted treatments and development of novel biomarker-based diagnostics (Dx)'s to select the patients most likely to benefit. Clinical trial planning and design with biomarkers includes additional considerations beyond those for conventional trials in un-selected populations, e.g., the heterogeneity of COPD phenotypes in the population, the ability of a biomarker to predict clinically meaningful phenotypes that are differentially associated with the response to a targeted treatment, and the data needed to make Go/No Go decisions during clinical development. We developed the Clinical Trial Object Oriented Research Application (CTOORA), a computer-aided clinical trial simulator of COPD patient outcomes, to inform COPD trial planning with biomarkers. CTOORA provides serial projections of trial success for a range of hypothetical and plausible scenarios of interest. In the absence of data, CTOORA can identify characteristics of a biomarker-based Dx needed to provide a meaningful advantage when used in a clinical trial. We present a case study in which CTOORA is used to identify the scenarios for which a biomarker may be used successfully in clinical development. CTOORA is a tool for robust clinical trial planning with biomarkers, to guide early-to-late stage development that is positioned for success.
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112
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Abstract
Neutrophils are central to the pathogenesis of COPD, releasing a range of pro-inflammatory and tissue destructive mediators. Sputum neutrophil numbers are elevated in COPD patients compared to healthy controls. We critically appraise the potential of sputum neutrophils as a biomarker in COPD. We show that there is insufficient evidence to support the use of this biomarker to define a phenotype of patients with more severe disease characteristics or a different prognosis. However, sputum neutrophil measurements can be used to measure the effects of anti-inflammatory drugs for the treatment of COPD.
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Affiliation(s)
- Vandana Gupta
- University of Manchester, Medicines Evaluation Unit, University Hospital Of South Manchester Foundation Trust, Manchester, M23 9QZ, UK.
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Fu JJ, Gibson PG, Simpson JL, McDonald VM. Longitudinal changes in clinical outcomes in older patients with asthma, COPD and asthma-COPD overlap syndrome. ACTA ACUST UNITED AC 2013; 87:63-74. [PMID: 24029561 DOI: 10.1159/000352053] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 05/13/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The progression of obstructive airway diseases (OADs) including asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome in older adults is not well understood. OBJECTIVE To examine the prognosis of OADs and to identify potential determinants for longitudinal changes in clinical outcomes. METHODS We consecutively recruited 99 older adults (>55 years) with OADs who underwent a multidimensional assessment at baseline and 4 years which involved spirometry, 6-min walk distance (6MWD), assessments of health status (Saint George's Respiratory Questionnaire, SGRQ), comorbidity, and serum and sputum biomarkers. All-cause mortality and respiratory hospitalisation during the follow-up period were recorded. Clinical outcomes were compared between basal and final visits, and changes in clinical outcomes were compared among asthma, COPD and asthma-COPD overlap groups. Associations between clinical parameters, biomarkers and prognosis were examined. RESULTS After a median follow-up of 4.2 years, outcome data were available for 75 (75.8%) patients. There were 16 (16.2%) deaths. The BODE index predicted all-cause mortality in older people with OADs. While spirometry, 6MWD and SGRQ deteriorated significantly over the 4 years, there was significant heterogeneity in the longitudinal changes in these clinical outcomes. Participants with COPD had a significant decline in FEV1 (p = 0.003), SGRQ (p = 0.030) and 6MWD [decline of 75.5 (93.4) m, p = 0.024]. The change in 6MWD was lower in the asthma-COPD overlap group. Airflow reversibility was associated with a reduced decline in 6MWD. CONCLUSION COPD patients had a poor prognosis compared with asthma and asthma-COPD overlap patients. The BODE index is a useful prognostic indicator in older adults with OADs. Both airway disease diagnosis and BODE index warrant specific attention in clinical practice.
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Affiliation(s)
- Juan-Juan Fu
- Priority Research Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, University of Newcastle, Newcastle, N.S.W., Australia
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114
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Barnes PJ. New anti-inflammatory targets for chronic obstructive pulmonary disease. Nat Rev Drug Discov 2013; 12:543-59. [PMID: 23977698 DOI: 10.1038/nrd4025] [Citation(s) in RCA: 285] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with chronic inflammation of the peripheral airways and lung parenchyma, which leads to progressive obstruction of the airways. Current management with long-acting bronchodilators does not reduce disease progression, and there are no treatments that effectively suppress chronic inflammation in COPD. An increased understanding of the inflammatory processes that are involved in the pathophysiology of COPD has identified several new therapeutic targets. This Review discusses some of the most promising of these targets, including new antioxidants, kinase inhibitors and drugs that target cellular senescence, microbial colonization, epigenetic regulation of inflammatory gene expression and corticosteroid resistance.
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Affiliation(s)
- Peter J Barnes
- National Heart and Lung Institute, Imperial College School of Medicine, Dovehouse Street, London SW3 6LY, UK.
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115
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Jiang D, Wenzel SE, Wu Q, Bowler RP, Schnell C, Chu HW. Human neutrophil elastase degrades SPLUNC1 and impairs airway epithelial defense against bacteria. PLoS One 2013; 8:e64689. [PMID: 23741370 PMCID: PMC3669426 DOI: 10.1371/journal.pone.0064689] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/17/2013] [Indexed: 12/13/2022] Open
Abstract
Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a significant cause of mortality of COPD patients, and pose a huge burden on healthcare. One of the major causes of AECOPD is airway bacterial (e.g. nontypeable Haemophilus influenzae [NTHi]) infection. However, the mechanisms underlying bacterial infections during AECOPD remain poorly understood. As neutrophilic inflammation including increased release of human neutrophil elastase (HNE) is a salient feature of AECOPD, we hypothesized that HNE impairs airway epithelial defense against NTHi by degrading airway epithelial host defense proteins such as short palate, lung, and nasal epithelium clone 1 (SPLUNC1). Methodology/Main Results Recombinant human SPLUNC1 protein was incubated with HNE to confirm SPLUNC1 degradation by HNE. To determine if HNE-mediated impairment of host defense against NTHi was SPLUNC1-dependent, SPLUNC1 protein was added to HNE-treated primary normal human airway epithelial cells. The in vivo function of SPLUNC1 in NTHi defense was investigated by infecting SPLUNC1 knockout and wild-type mice intranasally with NTHi. We found that: (1) HNE directly increased NTHi load in human airway epithelial cells; (2) HNE degraded human SPLUNC1 protein; (3) Recombinant SPLUNC1 protein reduced NTHi levels in HNE-treated human airway epithelial cells; (4) NTHi levels in lungs of SPLUNC1 knockout mice were increased compared to wild-type mice; and (5) SPLUNC1 was reduced in lungs of COPD patients. Conclusions Our findings suggest that SPLUNC1 degradation by neutrophil elastase may increase airway susceptibility to bacterial infections. SPLUNC1 therapy likely attenuates bacterial infections during AECOPD.
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Affiliation(s)
- Di Jiang
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
| | - Sally E. Wenzel
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Qun Wu
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
| | - Russell P. Bowler
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
| | - Christina Schnell
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
| | - Hong Wei Chu
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America
- * E-mail:
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116
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Zhang Y, Cardell LO, Edvinsson L, Xu CB. MAPK/NF-κB-dependent upregulation of kinin receptors mediates airway hyperreactivity: a new perspective for the treatment. Pharmacol Res 2013; 71:9-18. [PMID: 23428345 DOI: 10.1016/j.phrs.2013.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/02/2013] [Accepted: 02/11/2013] [Indexed: 12/30/2022]
Abstract
Airway hyperreactivity (AHR) is a major feature of asthmatic and inflammatory airways. Cigarette smoke exposure, and bacterial and viral infections are well-known environmental risk factors for AHR, but knowledge about the underlying molecular mechanisms on how these risk factors lead to the development of AHR is limited. Activation of intracellular mitogen-activated protein kinase (MAPK)/nuclear factor-kappa B (NF-κB) and their related signal pathways including protein kinase C (PKC), phosphoinositide 3-kinase (PI3K) and protein kinase A (PKA) signaling pathways may result in airway kinin receptor upregulation, which is suggested to play an important role in the development of AHR. Environmental risk factors trigger the production of pro-inflammatory mediators such as tumor necrosis factor-α (TNF-α) and interleukins (ILs) that activate intracellular MAPK- and NF-κB-dependent inflammatory pathways, which subsequently lead to AHR via kinin receptor upregulation. Blockage of intracellular MAPK/NF-κB signaling prevents kinin B₁ and B₂ receptor expression in the airways, resulting in a decrease in the response to bradykinin (kinin B₂ receptor agonist) and des-Arg⁹-bradykinin (kinin B₁ receptor agonist). This suggests that MAPK- and NF-κB-dependent kinin receptor upregulation can provide a novel option for treatment of AHR in asthmatic as well as in other inflammatory airway diseases.
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Affiliation(s)
- Yaping Zhang
- Institute of Basic and Translational Medicine, Xi'an Medical University, Xi'an, Shaanxi 710021, People's Republic of China
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118
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Anderson SE, Khurshid SS, Meade BJ, Lukomska E, Wells JR. Toxicological analysis of limonene reaction products using an in vitro exposure system. Toxicol In Vitro 2013; 27:721-30. [PMID: 23220291 PMCID: PMC4680979 DOI: 10.1016/j.tiv.2012.11.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/23/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
Abstract
Epidemiological investigations suggest a link between exposure to indoor air chemicals and adverse health effects. Consumer products contain reactive chemicals which can form secondary pollutants which may contribute to these effects. The reaction of limonene and ozone is a well characterized example of this type of indoor air chemistry. The studies described here characterize an in vitro model using an epithelial cell line (A549) or differentiated epithelial tissue (MucilAir™). The model is used to investigate adverse effects following exposure to combinations of limonene and ozone. In A549 cells, exposure to both the parent compounds and reaction products resulted in alterations in inflammatory cytokine production. A one hour exposure to limonene+ozone resulted in decreased proliferation when compared to cells exposed to limonene alone. Repeated dose exposures of limonene or limonene+ozone were conducted on MucilAir™ tissue. No change in proliferation was observed but increases in cytokine production were observed for both the parent compounds and reaction products. Factors such as exposure duration, chemical concentration, and sampling time point were identified to influence result outcome. These findings suggest that exposure to reaction products may produce more severe effects compared to the parent compound.
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Affiliation(s)
- Stacey E Anderson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States.
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119
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Desai D, Gupta S, Siddiqui S, Singapuri A, Monteiro W, Entwisle J, Visvanathan S, Parmar H, Kajekar R, Brightling CE. Sputum mediator profiling and relationship to airway wall geometry imaging in severe asthma. Respir Res 2013; 14:17. [PMID: 23398985 PMCID: PMC3577477 DOI: 10.1186/1465-9921-14-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/02/2013] [Indexed: 11/24/2022] Open
Abstract
Background Severe asthma is a heterogeneous disease and the relationship between airway inflammation and airway remodelling is poorly understood. We sought to define sputum mediator profiles in severe asthmatics categorised by CT-determined airway geometry and sputum differential cell counts. Methods In a single centre cross-sectional observational study we recruited 59 subjects with severe asthma that underwent sputum induction and thoracic CT. Quantitative CT analysis of the apical segment of the right upper lobe (RB1) was performed. Forty-one mediators in sputum samples were measured of which 21 mediators that were assessable in >50% of samples were included in the analyses. Results Independent of airway geometry, sputum MMP9 and IL-1β were elevated in those groups with a high sputum neutrophil count while sputum ICAM was elevated in those subjects with a low sputum neutrophil count. In contrast, sputum CCL11, IL-1α and fibrinogen were different in groups stratified by both sputum neutrophil count and airway geometry. Sputum CCL11 concentration was elevated in subjects with a low sputum neutrophil count and high luminal and total RB1 area, whereas sputum IL1α was increased in subjects with a high sputum neutrophil count and low total RB1 area. Sputum fibrinogen was elevated in those subjects with RB1 luminal narrowing and in those subjects with neutrophilic inflammation without luminal narrowing. Conclusions We have demonstrated that sputum mediator profiling reveals a number of associations with airway geometry. Whether these findings reflect important biological phenotypes that might inform stratified medicine approaches requires further investigation.
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Affiliation(s)
- Dhananjay Desai
- Institute for Lung Health, NIHR Respiratory Biomedical Research Unit, Department of Infection, Immunity & Inflammation, University of Leicester, Leicester, UK
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120
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Antus B. [Clinical application of induced and spontaneous sputum in asthma and chronic obstructive pulmonary disease]. Orv Hetil 2013; 153:1847-54. [PMID: 23160075 DOI: 10.1556/oh.2012.29494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In recent years induced sputum analysis has become a non-invasive method for the assessment of airway inflammation in obstructive airway diseases. Sputum induction is safe and well tolerated by the patients. The method has been standardized, and this has markedly improved the quality and reproducibility of sputum samples. Identification of sputum eosinophilia has the greatest clinical relevance as it predicts a favorable response to corticosteroids. Treatment strategy aiming normalisation of sputum eosinophil cell count may reduce the rate of exacerbations in asthma. Profiling inflammatory mediators in sputum supernatant provides new insights into the pathogenesis of asthma and chronic obstructive pulmonary disease. Cell type analysis in spontaneous sputum may also provide much information about inflammatory processes in the airways. Based on the results of clinical studies sputum analysis should be more often used in clinical settings in the future.
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Affiliation(s)
- Balázs Antus
- Országos Korányi Tbc- és Pulmonológiai Intézet Budapest.
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121
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Tighe P, Negm O, Todd I, Fairclough L. Utility, reliability and reproducibility of immunoassay multiplex kits. Methods 2013; 61:23-9. [PMID: 23333412 DOI: 10.1016/j.ymeth.2013.01.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022] Open
Abstract
Multiplex technologies are becoming increasingly important in biomarker studies as they enable patterns of biomolecules to be examined, which provide a more comprehensive depiction of disease than individual biomarkers. They are crucial in deciphering these patterns, but it is essential that they are endorsed for reliability, reproducibility and precision. Here we outline the theoretical basis of a variety of multiplex technologies: Bead-based multiplex immunoassays (i.e. Cytometric Bead Arrays, Luminex™ and Bio-Plex Pro™), microtitre plate-based arrays (i.e. Mesoscale Discovery (MSD) and Quantsys BioSciences QPlex), Slide-based Arrays (i.e. FastQuant™) and reverse phase protein arrays. Their utility, reliability and reproducibility are discussed.
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Affiliation(s)
- Paddy Tighe
- COPD Research Group, A Floor, West Block, Queens Medical Centre, The University of Nottingham, Nottingham NG7 2UH, UK
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Goldmann T, Pedersen F, Seehase S, Marwitz S, Lang DS, Kirsten AM, Zabel P, Vollmer E, Magnussen H, Rabe KF, Watz H. The Effect of Dithiothreitol on the Transcriptome of Induced Sputum Cells. Respiration 2013; 86:262-263. [DOI: 10.1159/000348392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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123
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Kroegel C, Bakakos P. The inflammatory effector cell pattern in asthma and chronic obstructive pulmonary disease - what is it good for? ACTA ACUST UNITED AC 2011; 83:17-9. [PMID: 22116055 DOI: 10.1159/000334231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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