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Mosaic attenuation in non-fibrotic areas as a predictor of non-usual interstitial pneumonia pathologic diagnosis. Sci Rep 2022; 12:7289. [PMID: 35508493 PMCID: PMC9068629 DOI: 10.1038/s41598-022-10750-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
The new radiological diagnostic criteria for diagnosing idiopathic pulmonary fibrosis (IPF) seek to optimize the indications for surgical lung biopsy (SLB). We applied the new criteria to a retrospective series of patients with interstitial lung disease (ILD) who underwent SLB in order to analyse the correlation between the radiological findings suggestive of another diagnosis (especially mosaic attenuation and its location with respect to fibrotic areas) and the usual interstitial pneumonia (UIP) pathologic diagnosis. Two thoracic radiologists reviewed the HRCT images of 83 patients with ILD and SLB, describing the radiological findings and patterns based on the new criteria. The association of each radiological finding with radiological patterns and histology was analysed. Mosaic attenuation is highly prevalent in both the UIP and non-UIP pathologic diagnosis and with similar frequency (80.0% vs. 78.6%). However, the presence of significant mosaic attenuation (≥ 3 lobes) only in non-fibrotic areas was observed in 60.7% of non-UIP pathologic diagnosis compared to 20.0% in UIP. This finding was associated with other diagnoses different from IPF, mostly connective tissue disease-associated interstitial lung disease (CTD-ILD) and hypersensitivity pneumonitis (HP). In our series of pathologically confirmed ILD, mosaic attenuation in non-fibrotic areas was a predictor of non-UIP pathologic diagnosis, and was associated with other diagnoses different from UIP, mostly CTD-ILD and HP. If confirmed in larger series, this finding could constitute a valuable tool for improving the interpretation of radiological patterns.
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202
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Usual interstitial pneumonia: a clinically significant pattern, but not the final word. Mod Pathol 2022; 35:589-593. [PMID: 35210554 DOI: 10.1038/s41379-022-01054-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 12/13/2022]
Abstract
Usual interstitial pneumonia (UIP) is a concept that is deeply entrenched in clinical practice and the prognostic significance of UIP is well established, but the field continues to suffer from the lack of a true gold standard for diagnosing fibrotic interstitial lung disease (ILD). The meaning and usage of UIP have shifted over time and this term is prone to misinterpretation and poor diagnostic agreement. For pathologists, it is worth reflecting on the limitations of UIP and our true role in the care of patients with ILD, a controversial topic explored in two point-counterpoint editorials published simultaneously in this journal. Current diagnostic guidelines are ambiguous and difficult to apply in clinical practice. Further complicating matters for the pathologist is the paradigm shift that occurred with the advent of anti-fibrotic agents, necessitating increased focus on the most likely etiology of fibrosis rather than simply the pattern of fibrosis when pulmonologists select appropriate therapy. Despite the wealth of information locked in tissue samples that could provide novel insights into fibrotic ILDs, pulmonologists increasingly shy away from obtaining biopsies, likely because pathologists no longer provide sufficient value to offset the risks of a biopsy procedure, and pathologic assessment is insufficiently reliable to meaningfully inform therapeutic decisionmaking. To increase the value of biopsies, pathologists must first recognize the problems with UIP as a diagnostic term. Second, pathologists must realize that the primary goal of a biopsy is to determine the most likely etiology to target with therapy, requiring a shift in diagnostic focus. Third, pathologists must devise and validate new classifications and criteria that are evidence-based, biologically relevant, easy to use, and predictive of outcome and treatment response. Only after the limitations of UIP are understood will pathologists provide maximum diagnostic value from biopsies to clinicians today and advance the field forward.
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203
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Warszawiak D. Usual interstitial pneumonia. Are we "speaking the same language" and "seeing the same things" when analyzing computed tomography scans? Radiol Bras 2022; 55:V-VI. [PMID: 35795598 PMCID: PMC9254704 DOI: 10.1590/0100-3984.2022.55.3e1-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Danny Warszawiak
- Radiologist at DAPI - Diagnóstico Avançado por Imagem/Liga das Senhoras Católicas de Curitiba and at Hospital Erasto Gaertner/Liga Paranaense de Combate ao Câncer, Curitiba, PR, Brazil
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Giménez A, Mazzini S, Franquet T. El informe radiológico en patología intersticial pulmonar. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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205
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Warszawiak D. Pneumonia intersticial usual. Estamos “falando a mesma língua” e “vendo as mesmas coisas” ao analisar a tomografia computadorizada? Radiol Bras 2022. [DOI: 10.1590/0100-3984.2022.55.3e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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206
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Zhang Q, Guo L, Song X, Lv C, Tang P, Li Y, Ding Q, Li M. Serum IL-36 cytokines levels in idiopathic pulmonary fibrosis and connective tissue disease-associated interstitial lung diseases. Clin Chim Acta 2022; 530:8-12. [DOI: 10.1016/j.cca.2022.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
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Raghu G, Remy-Jardin M, Richeldi L, Thomson CC, Inoue Y, Johkoh T, Kreuter M, Lynch DA, Maher TM, Martinez FJ, Molina-Molina M, Myers JL, Nicholson AG, Ryerson CJ, Strek ME, Troy LK, Wijsenbeek M, Mammen MJ, Hossain T, Bissell BD, Herman DD, Hon SM, Kheir F, Khor YH, Macrea M, Antoniou KM, Bouros D, Buendia-Roldan I, Caro F, Crestani B, Ho L, Morisset J, Olson AL, Podolanczuk A, Poletti V, Selman M, Ewing T, Jones S, Knight SL, Ghazipura M, Wilson KC. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2022; 205:e18-e47. [PMID: 35486072 PMCID: PMC9851481 DOI: 10.1164/rccm.202202-0399st] [Citation(s) in RCA: 947] [Impact Index Per Article: 473.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: This American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax guideline updates prior idiopathic pulmonary fibrosis (IPF) guidelines and addresses the progression of pulmonary fibrosis in patients with interstitial lung diseases (ILDs) other than IPF. Methods: A committee was composed of multidisciplinary experts in ILD, methodologists, and patient representatives. 1) Update of IPF: Radiological and histopathological criteria for IPF were updated by consensus. Questions about transbronchial lung cryobiopsy, genomic classifier testing, antacid medication, and antireflux surgery were informed by systematic reviews and answered with evidence-based recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 2) Progressive pulmonary fibrosis (PPF): PPF was defined, and then radiological and physiological criteria for PPF were determined by consensus. Questions about pirfenidone and nintedanib were informed by systematic reviews and answered with evidence-based recommendations using the GRADE approach. Results:1) Update of IPF: A conditional recommendation was made to regard transbronchial lung cryobiopsy as an acceptable alternative to surgical lung biopsy in centers with appropriate expertise. No recommendation was made for or against genomic classifier testing. Conditional recommendations were made against antacid medication and antireflux surgery for the treatment of IPF. 2) PPF: PPF was defined as at least two of three criteria (worsening symptoms, radiological progression, and physiological progression) occurring within the past year with no alternative explanation in a patient with an ILD other than IPF. A conditional recommendation was made for nintedanib, and additional research into pirfenidone was recommended. Conclusions: The conditional recommendations in this guideline are intended to provide the basis for rational, informed decisions by clinicians.
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Evaluation of interstitial lung disease: An algorithmic review using ILD-RADS. Clin Imaging 2022; 88:45-52. [DOI: 10.1016/j.clinimag.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
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209
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Comes A, Wong AW, Fisher JH, Morisset J, Johannson KA, Farrand E, Fell CD, Kolb M, Manganas H, Cox G, Gershon AS, Halayko AJ, Hambly N, Khalil N, Sadatsafavi M, Shapera S, To T, Wilcox PG, Collard HR, Ryerson CJ. Association of BMI and Change in Weight With Mortality in Patients With Fibrotic Interstitial Lung Disease. Chest 2022; 161:1320-1329. [PMID: 34788669 DOI: 10.1016/j.chest.2021.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mortality risk assessment in interstitial lung disease (ILD) is challenging. Our objective was to determine the prognostic significance of BMI and change in weight in the most common fibrotic ILD subtypes. RESEARCH QUESTION Could BMI and weight loss over time be reliable prognostic indicators in patients with fibrotic ILD? STUDY DESIGN AND METHODS This observational retrospective multicenter cohort study enrolled patients with fibrotic ILD from the six-center CAnadian REgistry for Pulmonary Fibrosis (CARE-PF, derivation) and the ILD registry at the University of California, San Francisco (UCSF, validation). Patients were subcategorized as underweight (BMI < 18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), or obese (BMI > 30). Annual change in weight was calculated for all years of follow-up as the slope of best fit using the least square method based on every available measurement. Separate multivariable analyses evaluated the associations of BMI and change in weight with mortality, adjusting for common prognostic variables. RESULTS The derivation and validation cohorts included 1,786 and 1,779 patients, respectively. Compared with patients with normal BMI, mortality was highest in patients who were underweight (hazard ratio [HR], 3.19; 95% CI, 1.88-5.43; P < .001) and was lowest in those who were overweight (HR, 0.52; 95% CI, 0.36-0.75; P < .001) or obese (HR, 0.55; 95%CI, 0.37-0.83; P < .001) in the analysis adjusted for the ILD-GAP (gender, age, physiology) Index. Patients who had a weight loss of at least 2 kg within 1 year had increased risk of death in the subsequent year (HR, 1.41; 95% CI, 1.01-1.97; P = .04) after adjustment for the ILD-GAP Index and baseline BMI category, with a plateau in risk for patients with greater weight loss. Consistent results were observed in the validation cohort. INTERPRETATION Both BMI and weight loss are independently associated with 1-year mortality in fibrotic ILD. BMI and weight loss may be clinically useful prognostic indicators in fibrotic ILD.
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Affiliation(s)
- Alessia Comes
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.
| | - Alyson W Wong
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julie Morisset
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Erica Farrand
- Department of Medicine, University of California San Francisco, CA
| | - Charlene D Fell
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Hélène Manganas
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Gerard Cox
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Andrea S Gershon
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrew J Halayko
- Departments of Internal Medicine and Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB, Canada
| | - Nathan Hambly
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Shane Shapera
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Pearce G Wilcox
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Harold R Collard
- Department of Medicine, University of California San Francisco, CA
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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210
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Besutti G, Monelli F, Schirò S, Milone F, Ottone M, Spaggiari L, Facciolongo N, Salvarani C, Croci S, Pattacini P, Sverzellati N. Follow-Up CT Patterns of Residual Lung Abnormalities in Severe COVID-19 Pneumonia Survivors: A Multicenter Retrospective Study. Tomography 2022; 8:1184-1195. [PMID: 35645383 PMCID: PMC9149852 DOI: 10.3390/tomography8030097] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 01/05/2023] Open
Abstract
Prior studies variably reported residual chest CT abnormalities after COVID-19. This study evaluates the CT patterns of residual abnormalities in severe COVID-19 pneumonia survivors. All consecutive COVID-19 survivors who received a CT scan 5–7 months after severe pneumonia in two Italian hospitals (Reggio Emilia and Parma) were enrolled. Individual CT findings were retrospectively collected and follow-up CT scans were categorized as: resolution, residual non-fibrotic abnormalities, or residual fibrotic abnormalities according to CT patterns classified following standard definitions and international guidelines. In 225/405 (55.6%) patients, follow-up CT scans were normal or barely normal, whereas in 152/405 (37.5%) and 18/405 (4.4%) patients, non-fibrotic and fibrotic abnormalities were respectively found, and 10/405 (2.5%) had post-ventilatory changes (cicatricial emphysema and bronchiectasis in the anterior regions of upper lobes). Among non-fibrotic changes, either barely visible (n = 110/152) or overt (n = 20/152) ground-glass opacities (GGO), resembling non-fibrotic nonspecific interstitial pneumonia (NSIP) with or without organizing pneumonia features, represented the most common findings. The most frequent fibrotic abnormalities were subpleural reticulation (15/18), traction bronchiectasis (16/18) and GGO (14/18), resembling a fibrotic NSIP pattern. When multiple timepoints were available until 12 months (n = 65), residual abnormalities extension decreased over time. NSIP, more frequently without fibrotic features, represents the most common CT appearance of post-severe COVID-19 pneumonia.
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Affiliation(s)
- Giulia Besutti
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (G.B.); (L.S.); (P.P.)
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Filippo Monelli
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (G.B.); (L.S.); (P.P.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence:
| | - Silvia Schirò
- Department of Medicine and Surgery (DiMec), University of Parma, 43126 Parma, Italy; (S.S.); (N.S.)
| | - Francesca Milone
- Unit of Scienze Radiologiche, University Hospital of Parma, 43126 Parma, Italy;
| | - Marta Ottone
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Lucia Spaggiari
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (G.B.); (L.S.); (P.P.)
| | - Nicola Facciolongo
- Respiratory Disease Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Stefania Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Pierpaolo Pattacini
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (G.B.); (L.S.); (P.P.)
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMec), University of Parma, 43126 Parma, Italy; (S.S.); (N.S.)
- Unit of Scienze Radiologiche, University Hospital of Parma, 43126 Parma, Italy;
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211
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Hoffman TW, van der Vis JJ, Biesma DH, Grutters JC, van Moorsel CHM. Extrapulmonary manifestations of a telomere syndrome in patients with idiopathic pulmonary fibrosis are associated with decreased survival. Respirology 2022; 27:959-965. [PMID: 35419815 DOI: 10.1111/resp.14264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/11/2022] [Accepted: 04/04/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Idiopathic pulmonary fibrosis (IPF) is a heterogenous disease with a median survival of 3-4 years. Patients with mutations in telomere-related genes exhibit extrapulmonary signs and symptoms. These patients represent a distinct phenotype of IPF with worse survival. As genetic analyses are not available for most patients with IPF, we sought to determine the predictive value of extrapulmonary signs and symptoms of a telomere syndrome in patients with IPF. METHODS We retrospectively studied 409 patients with IPF. Clinical characteristics, laboratory results and family history suggestive of a telomere syndrome were related to leukocyte telomere length measured by quantitative PCR and patient outcomes. RESULTS The cohort included 293 patients with sporadic IPF and 116 patients with a background of familial pulmonary fibrosis. Any or a combination of a clinical history (haematological disease, liver disease, early greying of hair, nail dystrophy, skin abnormalities), a family history or haematological laboratory abnormalities (macrocytosis, anaemia, thrombopenia or leukopenia) suggestive of a telomere syndrome was present in 27% of IPF patients and associated with shorter leukocyte telomere length and shorter survival (p = 0.002 in a multivariate model). In sporadic IPF, having either a clinical history, family history or haematological laboratory abnormalities was not significantly associated with decreased survival (p = 0.07 in a multivariate model). CONCLUSION Taking a careful clinical and family history focused on extrapulmonary manifestations of a telomere syndrome can provide important prognostic information in patients with IPF, as this is associated with shorter survival.
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Affiliation(s)
- Thijs W Hoffman
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Joanne J van der Vis
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Clinical Chemistry, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Douwe H Biesma
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Internal Medicine, University Medical Centre, Utrecht, The Netherlands
| | - Jan C Grutters
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Division of Heart and Lungs, University Medical Centre, Utrecht, The Netherlands
| | - Coline H M van Moorsel
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Division of Heart and Lungs, University Medical Centre, Utrecht, The Netherlands
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Angiogenic T Cells: Potential Biomarkers for the Early Diagnosis of Interstitial Lung Disease in Autoimmune Diseases? Biomedicines 2022; 10:biomedicines10040851. [PMID: 35453601 PMCID: PMC9026324 DOI: 10.3390/biomedicines10040851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: We explored, for the first time, the contribution of angiogenic T cells (TAng) in interstitial lung disease associated to autoimmune disease (AD-ILD+) as potential biomarkers of the disease, evaluating their role in the underlying vasculopathy and lung fibrosis. Additionally, the relationship of TAng with clinical manifestations and cellular and molecular endothelial dysfunction-related biomarkers was assessed. (2) Methods: We included 57 AD-ILD+ patients (21 with rheumatoid arthritis (RA)-ILD+, 21 with systemic sclerosis (SSc)-ILD+ and 15 with other AD-ILD+) and three comparative groups: 45 AD-ILD− patients (25 RA-ILD− and 20 SSc-ILD−); 21 idiopathic pulmonary fibrosis (IPF) patients; 21 healthy controls (HC). TAng were considered as CD3+CD184+CD31+ by flow cytometry. (3) Results: A similar TAng frequency was found between AD-ILD+ and IPF, being in both cases lower than that observed in AD-ILD− and HC. A lower TAng frequency was associated with negative Scl-70 status and lower FEV1/FVC ratio in SSc-ILD+, as well as with men in RA-ILD+ and non-specific interstitial pneumonia radiological pattern in other AD-ILD+. No relationship between TAng and endothelial progenitor cells, endothelial cells and vascular endothelial growth factor gene expression and protein levels was disclosed. (4) Conclusions: Our findings suggest TAng as potential biomarkers for the early diagnosis of ILD in AD.
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Farquhar H, Beckert L, Edwards A, Matteson EL, Thiessen R, Ganly E, Stamp LK. Rheumatoid interstitial lung disease in Canterbury New Zealand: prevalence, risk factors and long-term outcomes-protocol for a population-based retrospective study. BMJ Open 2022; 12:e050934. [PMID: 35383056 PMCID: PMC8983996 DOI: 10.1136/bmjopen-2021-050934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) affects approximately 0.5%-1% of the general population. Clinically significant interstitial lung diseases (ILD) develops in just under 10% of people with RA, and subclinical disease is more common. Little is known about RA-ILD in New Zealand (NZ), or the number of persons with RA in Canterbury, NZ. This study aims to determine: (1) incidence and prevalence of RA, (2) incidence and prevalence of RA-ILD, (3) clinical characteristics and risk factors for the development of RA-ILD, (4) long-term outcomes of RA-ILD, in the population resident within the Canterbury District Health Board (CDHB) catchment area. METHODS AND ANALYSIS Persons aged 18 years of age and older, and resident in the region covered by the CDHB with RA as well as RA-ILD will be identified by retrospective review of medical records. Prevalent as well as incident cases of RA between 1 January 2006 and 31 December 2008 and between 1 January 2011 and 31 December 2013 will be identified, and followed until 30 June 2019. Existing as well as incident cases of RA-ILD during this time will be identified. The association between the development of ILD and clinical characteristics and environmental exposures will be examined using Cox-proportional hazard models. Kaplan-Meier methods will be used to estimate survival rates for patients with RA-ILD. Mortality for people with RA and RA-ILD will also be compared with the general population of the CDHB. ETHICS AND DISSEMINATION Data will be obtained by retrospective review of medical records. Deidentified patient data will be stored in a secure online database. Data on individual patients will not be released, and all results will only be published in aggregate. Ethical approval has been obtained from the University of Otago Human Research Ethics Committee (REF HD18/079). Results will be published in peer-reviewed medical journals and presented at conferences. TRIAL REGISTRATION NUMBER ACTRN12619001310156; Pre-results.
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Affiliation(s)
- Hamish Farquhar
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Adrienne Edwards
- Respiratory Department, Christchurch Hospital, Christchurch, New Zealand
| | - Eric L Matteson
- Division of Rheumatology and Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Rennae Thiessen
- Radiology Department, Christchurch Hospital, Christchurch, New Zealand
| | - Edward Ganly
- Radiology Department, Christchurch Hospital, Christchurch, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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214
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Chiu YH, Chu CC, Lu CC, Liu FC, Tang SE, Chu SJ, Kuo SY, Chen HC. KL-6 as a Biomarker of Interstitial Lung Disease Development in Patients with Sjögren Syndrome: A Retrospective Case–Control Study. J Inflamm Res 2022; 15:2255-2262. [PMID: 35422651 PMCID: PMC9005069 DOI: 10.2147/jir.s352085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Krebs von den Lungen-6 (KL-6) is expressed on regenerating type II pneumocytes and has been recognized as biomarkers in interstitial lung disease (ILD). We aim to identify the role of the serum KL-6 level in patients with newly diagnosed Sjögren syndrome (SS), as well as the correlation between the immunoassays. Methods Patients with newly diagnosed SS and receiving HRCT for clinical reason during follow-up were included. Baseline KL-6 level was measured via enzyme-linked immunosorbent assay (ELISA) and latex particle-enhanced turbidimetric immunoassay (LETIA). Results Of the 39 patients, 21 (53.85%) developed interstitial lung disease (ILD) by the conclusion of the follow-up period. The median time to diagnosis of ILD was 2.24 years (IQR 1.15–4.34) in the ILD group. The median serum KL-6 level, measured using ELISA, was 1232 U/mL (IQR 937–2242) and 764.5 U/mL (IQR 503.25–1035.75) in the ILD group and the non-ILD group, respectively (p = 0.001). The median LETIA for serum KL-6 was 329 U/mL (IQR 235–619) and 245 U/mL (IQR 215.25–291) in the ILD group and the non-ILD group, respectively (p = 0.074). Conclusion Serum KL-6 levels were higher in newly diagnosed SS patients with ILD diagnosis during follow-up. Thus, the serum KL-6 level can serve as a valuable biomarker to identify hidden ILD in patients with newly diagnosed SS patients. However, the immunoassay procedure may influence the efficacy of the prediction and its clinical association.
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Affiliation(s)
- Yu-Hsiang Chiu
- Division of Rheumatology/Immunology/Allergies, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Chen-Chih Chu
- Division of Rheumatology/Immunology/Allergies, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Chi Lu
- Division of Rheumatology/Immunology/Allergies, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Feng-Cheng Liu
- Division of Rheumatology/Immunology/Allergies, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shin-En Tang
- Division of Thoracic Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shi-Jye Chu
- Division of Rheumatology/Immunology/Allergies, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - San-Yuan Kuo
- Division of Rheumatology/Immunology/Allergies, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsiang-Cheng Chen
- Division of Rheumatology/Immunology/Allergies, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Correspondence: Hsiang-Cheng Chen, Division of Rheumatology/Immunology/Allergy, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec, 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan, R.O.C, Tel +886 2 87927135, Fax +886 2 87927136, Email
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Predicting Usual Interstitial Pneumonia Histopathology From Chest CT Imaging With Deep Learning. Chest 2022; 162:815-823. [DOI: 10.1016/j.chest.2022.03.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/27/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
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Cottin V, Tomassetti S, Valenzuela C, Walsh S, Antoniou K, Bonella F, Brown KK, Collard HR, Corte TJ, Flaherty K, Johannson KA, Kolb M, Kreuter M, Inoue Y, Jenkins G, Lee JS, Lynch DA, Maher TM, Martinez FJ, Molina-Molina M, Myers J, Nathan SD, Poletti V, Quadrelli S, Raghu G, Rajan SK, Ravaglia C, Remy-Jardin M, Renzoni E, Richeldi L, Spagnolo P, Troy L, Wijsenbeek M, Wilson KC, Wuyts W, Wells AU, Ryerson C. Integrating Clinical Probability into the Diagnostic Approach to Idiopathic Pulmonary Fibrosis: An International Working Group Perspective. Am J Respir Crit Care Med 2022; 206:247-259. [PMID: 35353660 DOI: 10.1164/rccm.202111-2607pp] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND When considering the diagnosis of idiopathic pulmonary fibrosis (IPF), experienced clinicians integrate clinical features that help to differentiate IPF from other fibrosing interstitial lung diseases, thus generating a "pre-test" probability of IPF. The aim of this international working group perspective was to summarize these features using a tabulated approach similar to chest HRCT and histopathologic patterns reported in the international guidelines for the diagnosis of IPF, and to help formally incorporate these clinical likelihoods into diagnostic reasoning to facilitate the diagnosis of IPF. METHODS The committee group identified factors that influence the clinical likelihood of a diagnosis of IPF, which was categorized as a pre-test clinical probability of IPF into "high" (70-100%), "intermediate" (30-70%), or "low" (0-30%). After integration of radiological and histopathological features, the post-test probability of diagnosis was categorized into "definite" (90-100%), "high confidence" (70-89%), "low confidence" (51-69%), or "low" (0-50%) probability of IPF. FINDINGS A conceptual Bayesian framework was created, integrating the clinical likelihood of IPF ("pre-test probability of IPF") with the HRCT pattern, the histopathology pattern when available, and/or the pattern of observed disease behavior into a "post-test probability of IPF". The diagnostic probability of IPF was expressed using an adapted diagnostic ontology for fibrotic interstitial lung diseases. INTERPRETATION The present approach will help incorporate the clinical judgement into the diagnosis of IPF, thus facilitating the application of IPF diagnostic guidelines and, ultimately improving diagnostic confidence and reducing the need for invasive diagnostic techniques.
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Affiliation(s)
- Vincent Cottin
- Louis Pradel University Hospital, Respiratory Medicine, Lyon, France;
| | | | - Claudia Valenzuela
- Servicio de Neumología, Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Madrid, Spain
| | - Simon Walsh
- Imperial College London, 4615, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Katerina Antoniou
- Medical School, University of Crete, Heraklion, Greece, Department of Thoracic Medicine, Laboratory of Molecular and Cellular Pneumonology, Heraklion, Greece.,University Hospital of Heraklion, Heraklion, Greece, Department of Thoracic Medicine, Heraklion, Greece
| | | | - Kevin K Brown
- National Jewish Health, 2930, Denver, Colorado, United States
| | - Harold R Collard
- University of California, San Francisco, Department of Medicine, San Francisco, California, United States
| | - Tamera J Corte
- Royal Prince Alfred Hospital, Department of Respiratory Medicine, Sydney, New South Wales, Australia.,University of Sydney, 4334, Medical School, Sydney, New South Wales, Australia
| | - Kevin Flaherty
- University of Michigan, Division of Pulmonary and Critical Care Medicine, Ann Arbor, Michigan, United States
| | | | - Martin Kolb
- McMaster University, Hamilton, Ontario, Canada
| | - Michael Kreuter
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research Germany, Heidelberg, Germany
| | - Yoshikazu Inoue
- National Hospital Organization, Kinki-Chuo Chest Medical Center, Clinical Research Center, Osaka, Japan
| | - Gisli Jenkins
- Imperial College London, 4615, National Heart & Lung Institute, London, United Kingdom of Great Britain and Northern Ireland.,NIHR Nottingham Biomedical Research Centre, 574111, Respiratory Research Unit, Nottingham, United Kingdom of Great Britain and Northern Ireland.,University of Nottingham School of Medicine, 170718, Division of Respiratory Medicine, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Joyce S Lee
- University of Colorado, School of Medicine, Department of Medicine, Aurora, Colorado, United States
| | - David A Lynch
- National Jewish Health, Radiology, Denver, Colorado, United States
| | - Toby M Maher
- University of Southern California Keck School of Medicine, 12223, PCCSM, Los Angeles, California, United States
| | | | - Maria Molina-Molina
- Pneumology, ILD Unit. University Hospital of Bellvitge, Hospitalet de Llobregat, Spain
| | - Jeff Myers
- University of Michigan, Division of Anatomic Pathology, Ann Arbor, Michigan, United States
| | - Steven D Nathan
- Inova Fairfax Hospital, 23146, Advanced Lung Disease and Transplant Program, Falls Church, Virginia, United States
| | - Venerino Poletti
- GB MORGAGNI HOSPITAL, Department of Diseases of the Thorax, FORLI, Italy
| | - Silvia Quadrelli
- Sanatorio Guemes, 62948, Pulmonary Medicine, Buenos Aires, Argentina
| | - Ganesh Raghu
- University of Washington Medical Center, 21617, Division of Pulmonary and Critical Care Medicine, Seattle, Washington, United States
| | - Sujeet K Rajan
- Bombay Hospital Institute f Medical Sciences and Bhatia Hospital, Mumbai, India
| | | | | | - Elisabetta Renzoni
- Royal Brompton Hospital, Interstitial Lung Disease Unit, London, United Kingdom of Great Britain and Northern Ireland
| | - Luca Richeldi
- Universita Cattolica del Sacro Cuore Sede di Roma, 96983, Pulmonary Medicine, Roma, Italy
| | - Paolo Spagnolo
- Canton Hospital Baselland, and University of Basel, Medical University Clinic, Liestal, Switzerland
| | - Lauren Troy
- Royal Prince Alfred Hospital, 2205, Respiratory Medicine, Sydney, New South Wales, Australia
| | - Marlies Wijsenbeek
- Erasmus University Rotterdam, 6984, Rotterdam, Zuid-Holland, Netherlands
| | - Kevin C Wilson
- American Thoracic Society, 44197, Documents Department, New York, New York, United States.,Boston University, Medicine, Boston, Massachusetts, United States
| | - Wim Wuyts
- K U Leuven, respiratory medicine, Leuven, Belgium
| | - Athol U Wells
- Royal Brompton Hospital, Interstitial Lung Disease Unit, London, United Kingdom of Great Britain and Northern Ireland
| | - Christopher Ryerson
- University of British Columbia, Medicine, Vancouver, British Columbia, Canada
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Blood KL-6 predicts prognosis in primary Sjögren’s syndrome-associated interstitial lung disease. Sci Rep 2022; 12:5343. [PMID: 35351939 PMCID: PMC8964755 DOI: 10.1038/s41598-022-09283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractInterstitial lung disease associated with primary Sjögren’s syndrome (SJS-ILD) has a variable clinical course. We aimed to investigate the role of blood biomarkers in predicting prognosis for SJS-ILD. Clinical data of 46 SJS-ILD patients were retrospectively reviewed. Plasma biomarker levels, including Krebs von den Lungen-6 (KL-6), CC chemokine ligand 18 (CCL18), chitinase-3-like-1 (YKL-40), interleukin-4 receptor alpha (IL-4Ra), and matrix metalloproteinase-7 (MMP-7) were measured using the multiplex Luminex assays (R&D Systems, Minneapolis, USA). The median follow-up period was 69.0 months. The mean age of the patients was 59.4 years; 17.4% were men. The KL-6 level was significantly higher in non-survivors (n = 12; 119.6 vs. 59.5 pg/mL, P = 0.037) than survivors (n = 34), while the levels of the other biomarkers did not differ. Receiver operating characteristic analysis indicated that KL-6 shows the best performance for predicting survival (area under the curve = 0.705, P = 0.037; best cut-off value = 53.5 pg/mL). Multivariable Cox analysis that was adjusted by age and diffusing capacity for carbon monoxide suggested a high KL-6 level (> 53.5 pg/mL) as an independent prognostic factor for survival (hazard ratio = 5.939, 95% confidence interval 1.312–26.881, P = 0.021). Our results suggest that blood KL-6 might be a useful in predicting the prognosis for patients with SJS-ILD.
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Moui A, Dirou S, Sagan C, Liberge R, Defrance C, Arrigoni PP, Morla O, Kandel-Aznar C, Cellerin L, Cavailles A, Eschapasse E, Morio F, Gourraud PA, Goronflot T, Tissot A, Blanc FX. Immune alveolitis in interstitial lung disease: an attractive cytological profile in immunocompromised patients. BMC Pulm Med 2022; 22:79. [PMID: 35247991 PMCID: PMC8897721 DOI: 10.1186/s12890-022-01871-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Bronchoalveolar lavage (BAL) is a major diagnostic tool in interstitial lung disease (ILD). Its use remains largely quantitative, usually focused on cell differential ratio. However, cellular morphological features provide additional valuable information. The significance of the “immune alveolitis” cytological profile, characterized by lymphocytic alveolitis with activated lymphocytes and macrophages in epithelioid transformation or foamy macrophages desquamating in cohesive clusters with lymphocytes, remains unknown in ILD. Our objective was to describe patients’ characteristics and diagnoses associated with an immune alveolitis profile in undiagnosed ILD. Methods We performed a monocentric retrospective observational study. Eligible patients were adults undergoing diagnostic exploration for ILD and whose BAL fluid displayed an immune alveolitis profile. For each patient, we collected clinical, radiological and biological findings as well as the final etiology of ILD. Results Between January 2012 and December 2018, 249 patients were included. Mean age was 57 ± 16 years, 140 patients (56%) were men, and 65% of patients were immunocompromised. The main etiological diagnosis was Pneumocystis pneumonia (PCP) (24%), followed by drug-induced lung disease (DILD) (20%), viral pneumonia (14%) and hypersensitivity pneumonitis (HP) (10%). All PCP were diagnosed in immunocompromised patients while HP was found in only 8% of this subgroup. DILD and viral pneumonia were also commonly diagnosed in immunocompromised patients (94% and 80%, respectively). Conclusion Our study highlights the additional value of BAL qualitative description in ILD. We suggest incorporating the immune alveolitis profile for the diagnosis and management of ILD, especially in immunocompromised patients, since it guides towards specific diagnoses. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01871-w.
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Cottin V, Bonniaud P, Cadranel J, Crestani B, Jouneau S, Marchand-Adam S, Nunes H, Wémeau-Stervinou L, Bergot E, Blanchard E, Borie R, Bourdin A, Chenivesse C, Clément A, Gomez E, Gondouin A, Hirschi S, Lebargy F, Marquette CH, Montani D, Prévot G, Quetant S, Reynaud-Gaubert M, Salaun M, Sanchez O, Trumbic B, Berkani K, Brillet PY, Campana M, Chalabreysse L, Chatté G, Debieuvre D, Ferretti G, Fourrier JM, Just N, Kambouchner M, Legrand B, Le Guillou F, Lhuillier JP, Mehdaoui A, Naccache JM, Paganon C, Rémy-Jardin M, Si-Mohamed S, Terrioux P. [French practical guidelines for the diagnosis and management of IPF - 2021 update, short version]. Rev Mal Respir 2022; 39:275-312. [PMID: 35304014 DOI: 10.1016/j.rmr.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Since the previous French guidelines were published in 2017, substantial additional knowledge about idiopathic pulmonary fibrosis has accumulated. METHODS Under the auspices of the French-speaking Learned Society of Pulmonology and at the initiative of the coordinating reference center, practical guidelines for treatment of rare pulmonary diseases have been established. They were elaborated by groups of writers, reviewers and coordinators with the help of the OrphaLung network, as well as pulmonologists with varying practice modalities, radiologists, pathologists, a general practitioner, a head nurse, and a patients' association. The method was developed according to rules entitled "Good clinical practice" in the overall framework of the "Guidelines for clinical practice" of the official French health authority (HAS), taking into account the results of an online vote using a Likert scale. RESULTS After analysis of the literature, 54 recommendations were formulated, improved, and validated by the working groups. The recommendations covered a wide-ranging aspects of the disease and its treatment: epidemiology, diagnostic modalities, quality criteria and interpretation of chest CT, indication and modalities of lung biopsy, etiologic workup, approach to familial disease entailing indications and modalities of genetic testing, evaluation of possible functional impairments and prognosis, indications for and use of antifibrotic therapy, lung transplantation, symptom management, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION These evidence-based guidelines are aimed at guiding the diagnosis and the management in clinical practice of idiopathic pulmonary fibrosis.
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Affiliation(s)
- V Cottin
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France; UMR 754, IVPC, INRAE, Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France; Membre d'OrphaLung, RespiFil, Radico-ILD2, et ERN-LUNG, Lyon, France.
| | - P Bonniaud
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares, centre hospitalo-universitaire de Bourgogne et faculté de médecine et pharmacie, université de Bourgogne-Franche Comté, Dijon ; Inserm U123-1, Dijon, France
| | - J Cadranel
- Service de pneumologie et oncologie thoracique, centre de référence constitutif des maladies pulmonaires rares, assistance publique-hôpitaux de Paris (AP-HP), hôpital Tenon, Paris ; Sorbonne université GRC 04 Theranoscan, Paris, France
| | - B Crestani
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - S Jouneau
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Pontchaillou, Rennes ; IRSET UMR1085, université de Rennes 1, Rennes, France
| | - S Marchand-Adam
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, hôpital Bretonneau, service de pneumologie, CHRU, Tours, France
| | - H Nunes
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie, AP-HP, hôpital Avicenne, Bobigny ; université Sorbonne Paris Nord, Bobigny, France
| | - L Wémeau-Stervinou
- Centre de référence constitutif des maladies pulmonaires rares, Institut Cœur-Poumon, service de pneumologie et immuno-allergologie, CHRU de Lille, Lille, France
| | - E Bergot
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie et oncologie thoracique, hôpital Côte de Nacre, CHU de Caen, Caen, France
| | - E Blanchard
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Haut Levêque, CHU de Bordeaux, Pessac, France
| | - R Borie
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - A Bourdin
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, département de pneumologie et addictologie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, Montpellier ; Inserm U1046, CNRS UMR 921, Montpellier, France
| | - C Chenivesse
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et d'immuno-allergologie, hôpital Albert Calmette ; CHRU de Lille, Lille ; centre d'infection et d'immunité de Lille U1019 - UMR 9017, Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, Lille, France
| | - A Clément
- Centre de ressources et de compétences de la mucoviscidose pédiatrique, centre de référence des maladies respiratoires rares (RespiRare), service de pneumologie pédiatrique, hôpital d'enfants Armand-Trousseau, CHU Paris Est, Paris ; Sorbonne université, Paris, France
| | - E Gomez
- Centre de compétence pour les maladies pulmonaires rares, département de pneumologie, hôpitaux de Brabois, CHRU de Nancy, Vandoeuvre-les Nancy, France
| | - A Gondouin
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Jean Minjoz, Besançon, France
| | - S Hirschi
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, Nouvel Hôpital civil, Strasbourg, France
| | - F Lebargy
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Maison Blanche, Reims, France
| | - C-H Marquette
- Centre de compétence pour les maladies pulmonaires rares, FHU OncoAge, département de pneumologie et oncologie thoracique, hôpital Pasteur, CHU de Nice, Nice cedex 1 ; Université Côte d'Azur, CNRS, Inserm, Institute of Research on Cancer and Aging (IRCAN), Nice, France
| | - D Montani
- Centre de compétence pour les maladies pulmonaires rares, centre national coordonnateur de référence de l'hypertension pulmonaire, unité pneumologie et soins intensifs pneumologiques, AP-HP, DMU 5 Thorinno, Inserm UMR S999, CHU Paris-Sud, hôpital de Bicêtre, Le Kremlin-Bicêtre ; Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
| | - G Prévot
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Larrey, Toulouse, France
| | - S Quetant
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et physiologie, CHU Grenoble Alpes, Grenoble, France
| | - M Reynaud-Gaubert
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, AP-HM, CHU Nord, Marseille ; Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - M Salaun
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, oncologie thoracique et soins intensifs respiratoires & CIC 1404, hôpital Charles Nicole, CHU de Rouen, Rouen ; IRIB, laboratoire QuantiIF-LITIS, EA 4108, université de Rouen, Rouen, France
| | - O Sanchez
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et soins intensifs, hôpital européen Georges Pompidou, AP-HP, Paris, France
| | | | - K Berkani
- Clinique Pierre de Soleil, Vetraz Monthoux, France
| | - P-Y Brillet
- Université Paris 13, UPRES EA 2363, Bobigny ; service de radiologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - M Campana
- Service de pneumologie et oncologie thoracique, CHR Orléans, Orléans, France
| | - L Chalabreysse
- Service d'anatomie-pathologique, groupement hospitalier est, HCL, Bron, France
| | - G Chatté
- Cabinet de pneumologie et infirmerie protestante, Caluire, France
| | - D Debieuvre
- Service de Pneumologie, GHRMSA, hôpital Emile Muller, Mulhouse, France
| | - G Ferretti
- Université Grenoble Alpes, Grenoble ; service de radiologie diagnostique et interventionnelle, CHU Grenoble Alpes, Grenoble, France
| | - J-M Fourrier
- Association Pierre Enjalran Fibrose Pulmonaire Idiopathique (APEFPI), Meyzieu, France
| | - N Just
- Service de pneumologie, CH Victor Provo, Roubaix, France
| | - M Kambouchner
- Service de pathologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - B Legrand
- Cabinet médical de la Bourgogne, Tourcoing ; Université de Lille, CHU Lille, ULR 2694 METRICS, CERIM, Lille, France
| | - F Le Guillou
- Cabinet de pneumologie, pôle santé de l'Esquirol, Le Pradet, France
| | - J-P Lhuillier
- Cabinet de pneumologie, La Varenne Saint-Hilaire, France
| | - A Mehdaoui
- Service de pneumologie et oncologie thoracique, CH Eure-Seine, Évreux, France
| | - J-M Naccache
- Service de pneumologie, allergologie et oncologie thoracique, GH Paris Saint-Joseph, Paris, France
| | - C Paganon
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France
| | - M Rémy-Jardin
- Institut Cœur-Poumon, service de radiologie et d'imagerie thoracique, CHRU de Lille, Lille, France
| | - S Si-Mohamed
- Département d'imagerie cardiovasculaire et thoracique, hôpital Louis Pradel, HCL, Bron ; Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France
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Westphalen SS, Torres FS, Tonetto MS, Zampieri JF, Torri GB, Garcia TS. Interobserver agreement regarding the Fleischner Society diagnostic criteria for usual interstitial pneumonia patterns on computed tomography. Radiol Bras 2022; 55:71-77. [PMID: 35414738 PMCID: PMC8993175 DOI: 10.1590/0100-3984.2021.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/02/2021] [Indexed: 12/30/2022] Open
Abstract
Objective To assess interobserver agreement among radiologists regarding the current
Fleischner Society diagnostic criteria for usual interstitial pneumonia
(UIP) patterns on computed tomography (CT). Materials and Methods Using the Fleischner Society criteria for UIP CT patterns, five raters,
working independently, categorized the high-resolution CT (HRCT) scans of 44
patients with interstitial lung disease who underwent lung biopsy. The
raters also evaluated the presence, extent, and distribution of the most
relevant imaging findings, as well as indicating their level of confidence
in the most likely diagnosis and in up to three diagnostic hypotheses. Results There was moderate to substantial interobserver agreement regarding the UIP
patterns on HRCT—kappa statistic (κ) = 0.59-0.61. Interobserver
agreement for the binary scores was substantial (κ = 0.77-0.79),
whereas that for the presence of honeycombing was almost perfect (κ =
0.81-0.96). There was agreement regarding at least one of the three
diagnostic hypotheses in only 36.4% of the cases. For the level of
confidence in the most likely diagnosis, there was only slight to fair
agreement (κ = 0.19-0.21). Conclusion Interobserver agreement regarding the current Fleischner Society CT criteria
for UIP was moderate to substantial among raters with varying levels of
experience. There was only slight to fair agreement regarding the diagnostic
hypotheses and for the level of confidence in the most likely diagnosis.
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Affiliation(s)
- Stephanie Sander Westphalen
- Hospital de Clínicas de Porto Alegre (HCPA), Brazil; Hospital Moinhos de Vento, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | | | - Mateus Samuel Tonetto
- Hospital de Clínicas de Porto Alegre (HCPA), Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | | | | | - Tiago Severo Garcia
- Hospital de Clínicas de Porto Alegre (HCPA), Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
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Challenges in the Diagnosis and Management of Patients with Fibrosing Interstitial Lung Disease. Case Rep Pulmonol 2022; 2022:9942432. [PMID: 35211349 PMCID: PMC8863484 DOI: 10.1155/2022/9942432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 01/22/2023] Open
Abstract
Interstitial lung diseases (ILDs) are heterogeneous in their clinical presentation. Making a differential diagnosis of ILD requires a thorough medical history, clinical examination, serologies, high-resolution computed tomography (CT) scan, and, in some cases, bronchoalveolar lavage or surgical lung biopsy. Multidisciplinary discussion is recommended to improve diagnostic confidence. ILDs have a variable and unpredictable clinical course. Patients should be closely monitored to ensure that progression of ILD is detected promptly. This involves regular assessment of symptoms, lung function, and, where appropriate, high-resolution CT. Patients with some fibrosing ILDs may respond well to immunosuppressants, but even patients who respond well to immunosuppressants initially may later show deterioration despite appropriate management. The tyrosine kinase inhibitor nintedanib has been approved for the treatment of idiopathic pulmonary fibrosis, other chronic fibrosing ILDs with a progressive phenotype, and systemic sclerosis-associated ILD. The three case studies described in this article illustrate the challenges in the diagnosis and management of patients with fibrosing ILDs and the importance of taking a multidisciplinary and individualized approach to care, including regular monitoring and consideration of whether a patient's drug regimen needs to be changed when there is evidence of disease progression.
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He J, Li X. Identification and Validation of Aging-Related Genes in Idiopathic Pulmonary Fibrosis. Front Genet 2022; 13:780010. [PMID: 35211155 PMCID: PMC8863089 DOI: 10.3389/fgene.2022.780010] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/19/2022] [Indexed: 12/13/2022] Open
Abstract
Aging plays a significant role in the occurrence and development of idiopathic pulmonary fibrosis (IPF). In this study, we aimed to identify and verify potential aging-associated genes involved in IPF using bioinformatic analysis. The mRNA expression profile dataset GSE150910 available in the Gene Expression Omnibus (GEO) database and R software were used to identify the differentially expressed aging-related genes involved in IPF. Hub gene expression was validated by other GEO datasets. Gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed on differentially expressed aging-related genes. Subsequently, aging-related genes were further screened using three techniques (least absolute shrinkage and selection operator (LASSO) regression, support vector machine, and random forest), and the receiver operating characteristic curves were plotted based on screening results. Finally, real-time quantitative polymerase chain reaction (qRT-PCR) was performed to verify the RNA expression of the six differentially expressed aging-related genes using the blood samples of patients with IPF and healthy individuals. Sixteen differentially expressed aging-related genes were detected, of which the expression of 12 were upregulated and four were downregulated. GO and KEGG enrichment analyses indicated the presence of several enriched terms related to senescence and apoptotic mitochondrial changes. Further screening by LASSO regression, support vector machine, and random forest identified six genes (IGF1, RET, IGFBP2, CDKN2A, JUN, and TFAP2A) that could serve as potential diagnostic biomarkers for IPF. Furthermore, qRT-PCR analysis indicated that among the above-mentioned six aging-related genes, only the expression levels of IGF1, RET, and IGFBP2 in patients with IPF and healthy individuals were consistent with the results of bioinformatic analysis. In conclusion, bioinformatics analysis identified 16 potential aging-related genes associated with IPF, and clinical sample validation suggested that among these, IGF1, RET, and IGFBP2 might play a role in the incidence and prognosis of IPF. Our findings may help understand the pathogenesis of IPF.
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Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, China.,Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xiaoyan Li
- Clinical Medical College of Chengdu Medical College, Chengdu, China.,Department of Endocrinology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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Xu F, Wang Q, Jiang L, Zhu F, Yang L, Zhang S, Song X. Evaluation of Nitric Oxide Fluctuation Via a Fast, Responsive Fluorescent Probe in Idiopathic Pulmonary Fibrosis Cells and Mice Models. Anal Chem 2022; 94:4072-4077. [PMID: 35194985 DOI: 10.1021/acs.analchem.1c05643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fatal interstitial pneumonia with unknown pathogenesis. Early diagnosis and therapeutic intervention are essential for improving the prognosis of patients with IPF. The level of nitric oxide upregulates in the alveoli of IPF patients, which is correlated with the severity of the disease. Herein, we report a fluorescent probe DCM-nitric oxide (NO) to detect IPF by monitoring the concentration changes of NO. This probe displays a fast response time and a good linear response to NO in vitro. Fluorescence imaging experiments with probe DCM-NO revealed that the level of intracellular NO increases in the pulmonary fibrosis cells and IPF mice models. Probe DCM-NO displayed a strong red fluorescence in IPF mice models. However, a declining fluorescence was evidenced in the OFEV-treated IPF mice, implying that DCM-NO is capable of evaluating the therapeutic effects on IPF. Thus, probe DCM-NO can quickly predict the progression of pulmonary fibrosis at an early stage and thus help improve the effective treatment.
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Affiliation(s)
- Feifei Xu
- Collaborative Innovation Center of Tumor Marker Detection Technology, Equipment and Diagnosis-Therapy Integration in Universities of Shandong, Shandong Provincial Key Laboratory of Detection Technology for Tumor Markers, College of Chemistry and Chemical Engineering, Linyi University, Linyi 276005, China
| | - Qing Wang
- Collaborative Innovation Center of Tumor Marker Detection Technology, Equipment and Diagnosis-Therapy Integration in Universities of Shandong, Shandong Provincial Key Laboratory of Detection Technology for Tumor Markers, College of Chemistry and Chemical Engineering, Linyi University, Linyi 276005, China
| | - Ling Jiang
- Collaborative Innovation Center of Tumor Marker Detection Technology, Equipment and Diagnosis-Therapy Integration in Universities of Shandong, Shandong Provincial Key Laboratory of Detection Technology for Tumor Markers, College of Chemistry and Chemical Engineering, Linyi University, Linyi 276005, China
| | - Fawei Zhu
- Collaborative Innovation Center of Tumor Marker Detection Technology, Equipment and Diagnosis-Therapy Integration in Universities of Shandong, Shandong Provincial Key Laboratory of Detection Technology for Tumor Markers, College of Chemistry and Chemical Engineering, Linyi University, Linyi 276005, China
| | - Lei Yang
- Collaborative Innovation Center of Tumor Marker Detection Technology, Equipment and Diagnosis-Therapy Integration in Universities of Shandong, Shandong Provincial Key Laboratory of Detection Technology for Tumor Markers, College of Chemistry and Chemical Engineering, Linyi University, Linyi 276005, China
| | - Shusheng Zhang
- Collaborative Innovation Center of Tumor Marker Detection Technology, Equipment and Diagnosis-Therapy Integration in Universities of Shandong, Shandong Provincial Key Laboratory of Detection Technology for Tumor Markers, College of Chemistry and Chemical Engineering, Linyi University, Linyi 276005, China
| | - Xiangzhi Song
- College of Chemistry & Chemical Engineering, Central South University, Changsha, Hunan 410083, China
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Saleh M, Fotook Kiaei SZ, Kavianpour M. Application of Wharton jelly-derived mesenchymal stem cells in patients with pulmonary fibrosis. Stem Cell Res Ther 2022; 13:71. [PMID: 35168663 PMCID: PMC8845364 DOI: 10.1186/s13287-022-02746-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/26/2022] [Indexed: 12/12/2022] Open
Abstract
Pulmonary fibrosis is a devastating disease that eventually leads to death and respiratory failure. Despite the wide range of drugs, including corticosteroids, endothelin antagonist, and pirfenidone, there is no effective treatment, and the only main goal of treatment is to alleviate the symptoms as much as possible to slow down the progression of the disease and improve the quality of life. Lung transplantation may be a treatment option for a few people if pulmonary fibrosis develops and there is no established treatment. Pulmonary fibrosis caused by the COVID19 virus is another problem that we face in most patients despite the efforts of the international medical communities. Therefore, achieving alternative treatment for patients is a great success. Today, basic research using stem cells on pulmonary fibrosis has published promising results. New stem cell-based therapies can be helpful in patients with pulmonary fibrosis. Wharton jelly-derived mesenchymal stem cells are easily isolated in large quantities and made available for clinical trials without causing ethical problems. These cells have higher flexibility and proliferation potential than other cells isolated from different sources and differentiated into various cells in laboratory environments. More clinical trials are needed to determine the safety and efficacy of these cells. This study will investigate the cellular and molecular mechanisms and possible effects of Wharton jelly-derived mesenchymal stem cells in pulmonary fibrosis.
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Affiliation(s)
- Mahshid Saleh
- Department of Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyedeh Zahra Fotook Kiaei
- Department of Pulmonary and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maria Kavianpour
- Department of Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Kamp JC, Neubert L, Stark H, Hinrichs JB, Boekhoff C, Seidel AD, Ius F, Haverich A, Gottlieb J, Welte T, Braubach P, Laenger F, Hoeper MM, Kuehnel MP, Jonigk DD. Comparative Analysis of Gene Expression in Fibroblastic Foci in Patients with Idiopathic Pulmonary Fibrosis and Pulmonary Sarcoidosis. Cells 2022; 11:cells11040664. [PMID: 35203313 PMCID: PMC8870272 DOI: 10.3390/cells11040664] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Fibroblastic foci (FF) are characteristic features of usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) and one cardinal feature thought to represent a key mechanism of pathogenesis. Hence, FF have a high impact on UIP/IPF diagnosis in current guidelines. However, although less frequent, these histomorphological hallmarks also occur in other fibrotic pulmonary diseases. Currently, there is therefore a gap in knowledge regarding the underlying molecular similarities and differences of FF in different disease entities. Methods: In this work, we analyzed the compartment-specific gene expression profiles of FF in IPF and sarcoidosis in order to elucidate similarities and differences as well as shared pathomechanisms. For this purpose, we used laser capture microdissection, mRNA and protein expression analysis. Biological pathway analysis was performed using two different gene expression databases. As control samples, we used healthy lung tissue that was donated but not used for lung transplantation. Results: Based on Holm Bonferroni corrected expression data, mRNA expression analysis revealed a significantly altered expression signature for 136 out of 760 genes compared to healthy controls while half of these showed a similar regulation in both groups. Immunostaining of selected markers from each group corroborated these results. However, when comparing all differentially expressed genes with the fdr-based expression data, only 2 of these genes were differentially expressed between sarcoidosis and IPF compared to controls, i.e., calcium transport protein 1 (CAT1) and SMAD specific E3 ubiquitin protein ligase 1 (SMURF1), both in the sarcoidosis group. Direct comparison of sarcoidosis and IPF did not show any differentially regulated genes independent from the statistical methodology. Biological pathway analysis revealed a number of fibrosis-related pathways pronounced in IPF without differences in the regulatory direction. Conclusions: These results demonstrate that FF of end-stage IPF and sarcoidosis lungs, although different in initiation, are similar in gene and protein expression, encouraging further studies on the use of antifibrotic agents in sarcoidosis.
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Affiliation(s)
- Jan C. Kamp
- Department of Respiratory Medicine, Hannover Medical School, 30625 Hannover, Germany; (J.G.); (T.W.); (M.M.H.)
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
- Correspondence:
| | - Lavinia Neubert
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
- Institute for Pathology, Hannover Medical School, 30625 Hannover, Germany; (C.B.); (A.D.S.)
| | - Helge Stark
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
- Institute for Pathology, Hannover Medical School, 30625 Hannover, Germany; (C.B.); (A.D.S.)
| | - Jan B. Hinrichs
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, 30625 Hannover, Germany
| | - Caja Boekhoff
- Institute for Pathology, Hannover Medical School, 30625 Hannover, Germany; (C.B.); (A.D.S.)
| | - Allison D. Seidel
- Institute for Pathology, Hannover Medical School, 30625 Hannover, Germany; (C.B.); (A.D.S.)
| | - Fabio Ius
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Axel Haverich
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, 30625 Hannover, Germany; (J.G.); (T.W.); (M.M.H.)
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, 30625 Hannover, Germany; (J.G.); (T.W.); (M.M.H.)
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
| | - Peter Braubach
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
- Institute for Pathology, Hannover Medical School, 30625 Hannover, Germany; (C.B.); (A.D.S.)
| | - Florian Laenger
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
- Institute for Pathology, Hannover Medical School, 30625 Hannover, Germany; (C.B.); (A.D.S.)
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, 30625 Hannover, Germany; (J.G.); (T.W.); (M.M.H.)
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
| | - Mark P. Kuehnel
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
- Institute for Pathology, Hannover Medical School, 30625 Hannover, Germany; (C.B.); (A.D.S.)
| | - Danny D. Jonigk
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), 30625 Hannover, Germany; (L.N.); (H.S.); (J.B.H.); (F.I.); (A.H.); (P.B.); (F.L.); (M.P.K.); (D.D.J.)
- Institute for Pathology, Hannover Medical School, 30625 Hannover, Germany; (C.B.); (A.D.S.)
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Ultrasonographic detection of enthesitis and its relation to clinical manifestations among Egyptian systemic sclerosis patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [PMCID: PMC8824779 DOI: 10.1186/s43166-021-00099-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Systemic sclerosis is a complex multi-systemic autoimmune disease with a wide range of its clinical manifestations; many systemic sclerosis (SSc) patients develop musculoskeletal manifestations during their course of illness. The aim of the study is to assess the prevalence of sonographically detected entheseal alterations in a case-control study of systemic sclerosis patients and to evaluate the relationship between the presence of these alterations and the clinical systemic manifestations. Patients and controls were evaluated using B mode and power Doppler ultrasonography to detect presence of enthesitis and were scored using Madrid Sonography Enthesitis Index (MASEI).
Results
In SSc patients, the MASEI score was significantly higher than in control (P < 0.0001). Enthesitis was more prevalent among SSc patients compared to healthy controls, SSc patients with enthesitis had significantly more prevalence of diffuse subtypes (P < 0.001).SSc patients had significantly more prevalence of interstitial pulmonary fibrosis (IPF) (P < 0.001), digital ulcers (P < 0.001), pulmonary hypertension (P < 0.001), and arthralgia and arthritis (P < 0.001). Regarding nailfold capillaroscopy pattern, late pattern was significantly more prevalent among patients with enthesitis (P = 0.008). Age, ESR level, and modified Rodnan skin score were predictors for MASEI score.
Conclusions
Ultrasound features of enthesopathy were frequently presented in systemic sclerosis patients. The enthesopathy was correlated with inflammation and disease complications.
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227
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Glass DS, Grossfeld D, Renna HA, Agarwala P, Spiegler P, DeLeon J, Reiss AB. Idiopathic pulmonary fibrosis: Current and future treatment. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:84-96. [PMID: 35001525 PMCID: PMC9060042 DOI: 10.1111/crj.13466] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/21/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
Objectives Idiopathic pulmonary fibrosis (IPF) is a chronic fibrotic lung disease characterized by dry cough, fatigue, and progressive exertional dyspnea. Lung parenchyma and architecture is destroyed, compliance is lost, and gas exchange is compromised in this debilitating condition that leads inexorably to respiratory failure and death within 3–5 years of diagnosis. This review discusses treatment approaches to IPF in current use and those that appear promising for future development. Data Source The data were obtained from the Randomized Controlled Trials and scientific studies published in English literature. We used search terms related to IPF, antifibrotic treatment, lung transplant, and management. Results Etiopathogenesis of IPF is not fully understood, and treatment options are limited. Pathological features of IPF include extracellular matrix remodeling, fibroblast activation and proliferation, immune dysregulation, cell senescence, and presence of aberrant basaloid cells. The mainstay therapies are the oral antifibrotic drugs pirfenidone and nintedanib, which can improve quality of life, attenuate symptoms, and slow disease progression. Unilateral or bilateral lung transplantation is the only treatment for IPF shown to increase life expectancy. Conclusion Clearly, there is an unmet need for accelerated research into IPF mechanisms so that progress can be made in therapeutics toward the goals of increasing life expectancy, alleviating symptoms, and improving well‐being.
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Affiliation(s)
- Daniel S Glass
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, New York, USA
| | - David Grossfeld
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Heather A Renna
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Priya Agarwala
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Peter Spiegler
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Joshua DeLeon
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Allison B Reiss
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, New York, USA
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Dhanaliwala AH, Sood S, Olivias C, Simpson S, Galperin-Aisenberg M, Torigian D, Zigmund B, Johnson CR, Patterson K, Miller WT. A CT Algorithm Can Elevate the Differential Diagnosis of Interstitial Lung Disease by Non-specialists to Equal That of Specialist Thoracic Radiologists. Acad Radiol 2022; 29 Suppl 2:S181-S190. [PMID: 34429261 DOI: 10.1016/j.acra.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnosis of diffuse parenchymal lung diseases (DPLD) on high resolution CT (HRCT) is difficult for non-expert radiologists due to varied presentation for any single disease and overlap in presentation between diseases. RATIONALE AND OBJECTIVES To evaluate whether a pattern-based training algorithm can improve the ability of non-experts to diagnosis of DPLD. MATERIALS AND METHODS Five experts (cardiothoracic-trained radiologists), and 25 non-experts (non-cardiothoracic-trained radiologists, radiology residents, and pulmonologists) were each assigned a semi-random subset of cases from a compiled database of DPLD HRCTs. Each reader was asked to create a top three differential for each case. The non-experts were then given a pattern-based training algorithm for identifying DPLDs. Following training, the non-experts were again asked to create a top three differential for each case that they had previously evaluated. Accuracy between groups was compared using Chi-Square analysis. RESULTS A total of 400 and 1450 studies were read by experts and non-experts, respectively. Experts correctly placed the diagnosis as the first item on the differential versus having the correct diagnosis as one of their top three diagnoses at an overall rate of 48 and 64.3%, respectively. Pre-training, non-experts achieved a correct diagnosis/top three of 32.5 and 49.7%, respectively. Post-training, non-experts demonstrated a correct diagnosis/top three of 41.2 and 65%, a statistically significant increase (p < 0.0001). In addition, post training, there was no difference between non-experts and experts in placing the correct diagnosis within their top three differential. CONCLUSION The diagnosis of DPLDs by HRCT imaging alone is relatively poor. However, use of a pattern-based teaching algorithm can improve non-expert interpretation and enable non-experts to include the correct diagnosis within their differential diagnoses at a rate comparable to expert cardiothoracic trained radiologists.
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Affiliation(s)
- Ali H Dhanaliwala
- University of Pennsylvania Health System, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Silverstein 1, 3400 Spruce St, Philadelphia, PA 19104
| | - Shweta Sood
- University of Pennsylvania Health System, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Silverstein 1, 3400 Spruce St, Philadelphia, PA 19104
| | - Christina Olivias
- Department of Radiology, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Scott Simpson
- University of Pennsylvania Health System, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Silverstein 1, 3400 Spruce St, Philadelphia, PA 19104
| | - Maya Galperin-Aisenberg
- University of Pennsylvania Health System, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Silverstein 1, 3400 Spruce St, Philadelphia, PA 19104
| | - Drew Torigian
- University of Pennsylvania Health System, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Silverstein 1, 3400 Spruce St, Philadelphia, PA 19104
| | - Beth Zigmund
- Department of Radiology, University of Vermont, Burlington, Vermont
| | - Cheilonda R Johnson
- University of Pennsylvania Health System, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Silverstein 1, 3400 Spruce St, Philadelphia, PA 19104
| | - Karen Patterson
- University of Pennsylvania Health System, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Silverstein 1, 3400 Spruce St, Philadelphia, PA 19104; Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom
| | - Wallace T Miller
- University of Pennsylvania Health System, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Silverstein 1, 3400 Spruce St, Philadelphia, PA 19104.
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Soffer S, Morgenthau AS, Shimon O, Barash Y, Konen E, Glicksberg BS, Klang E. Artificial Intelligence for Interstitial Lung Disease Analysis on Chest Computed Tomography: A Systematic Review. Acad Radiol 2022; 29 Suppl 2:S226-S235. [PMID: 34219012 DOI: 10.1016/j.acra.2021.05.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVES High-resolution computed tomography (HRCT) is paramount in the assessment of interstitial lung disease (ILD). Yet, HRCT interpretation of ILDs may be hampered by inter- and intra-observer variability. Recently, artificial intelligence (AI) has revolutionized medical image analysis. This technology has the potential to advance patient care in ILD. We aimed to systematically evaluate the application of AI for the analysis of ILD in HRCT. MATERIALS AND METHODS We searched MEDLINE/PubMed databases for original publications of deep learning for ILD analysis on chest CT. The search included studies published up to March 1, 2021. The risk of bias evaluation included tailored Quality Assessment of Diagnostic Accuracy Studies and the modified Joanna Briggs Institute Critical Appraisal checklist. RESULTS Data was extracted from 19 retrospective studies. Deep learning techniques included detection, segmentation, and classification of ILD on HRCT. Most studies focused on the classification of ILD into different morphological patterns. Accuracies of 78%-91% were achieved. Two studies demonstrated near-expert performance for the diagnosis of idiopathic pulmonary fibrosis (IPF). The Quality Assessment of Diagnostic Accuracy Studies tool identified a high risk of bias in 15/19 (78.9%) of the studies. CONCLUSION AI has the potential to contribute to the radiologic diagnosis and classification of ILD. However, the accuracy performance is still not satisfactory, and research is limited by a small number of retrospective studies. Hence, the existing published data may not be sufficiently reliable. Only well-designed prospective controlled studies can accurately assess the value of existing AI tools for ILD evaluation.
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Compagnone N, Palumbo D, Cremona G, Vitali G, De Lorenzo R, Calvi MR, Del Prete A, Baiardo Redaelli M, Calamarà S, Belletti A, Steidler S, Conte C, Zangrillo A, De Cobelli F, Rovere‐Querini P, Monti G. Residual lung damage following ARDS in COVID-19 ICU survivors. Acta Anaesthesiol Scand 2022; 66:223-231. [PMID: 34758108 PMCID: PMC8652634 DOI: 10.1111/aas.13996] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Coronavirus disease 2019 acute respiratory distress syndrome (COVID-19 ARDS) is a disease that often requires invasive ventilation. Little is known about COVID-19 ARDS sequelae. We assessed the mid-term lung status of COVID-19 survivors and investigated factors associated with pulmonary sequelae. METHODS All adult COVID-19 patients admitted to the intensive care unit from 25th February to 27th April 2020 were included. Lung function was evaluated through chest CT scan and pulmonary function tests (PFT). Logistic regression was used to identify predictors of persisting lung alterations. RESULTS Forty-nine patients (75%) completed lung assessment. Chest CT scan was performed after a median (interquartile range) time of 97 (89-105) days, whilst PFT after 142 (133-160) days. The median age was 58 (52-65) years and most patients were male (90%). The median duration of mechanical ventilation was 11 (6-16) days. Median tidal volume/ideal body weight (TV/IBW) was 6.8 (5.71-7.67) ml/Kg. 59% and 63% of patients showed radiological and functional lung sequelae, respectively. The diffusion capacity of carbon monoxide (DLCO ) was reduced by 59%, with a median per cent of predicted DLCO of 72.1 (57.9-93.9) %. Mean TV/IBW during invasive ventilation emerged as an independent predictor of persistent CT scan abnormalities, whilst the duration of mechanical ventilation was an independent predictor of both CT and PFT abnormalities. The extension of lung involvement at hospital admission (evaluated through Radiographic Assessment of Lung Edema, RALE score) independently predicted the risk of persistent alterations in PFTs. CONCLUSIONS Both the extent of lung parenchymal involvement and mechanical ventilation protocols predict morphological and functional lung abnormalities months after COVID-19.
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Affiliation(s)
- Nicola Compagnone
- Vita‐Salute San Raffaele UniversityMilanItaly
- Division of Immunology, Transplantation and Infectious DiseasesIRCCS San Raffaele HospitalMilanItaly
| | - Diego Palumbo
- Vita‐Salute San Raffaele UniversityMilanItaly
- Clinical and Experimental Radiology UnitExperimental Imaging CenterIRCCS San Raffaele Scientific InstituteMilanItaly
| | - George Cremona
- Unit of Respiratory MedicineIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Giordano Vitali
- Division of Immunology, Transplantation and Infectious DiseasesIRCCS San Raffaele HospitalMilanItaly
| | - Rebecca De Lorenzo
- Vita‐Salute San Raffaele UniversityMilanItaly
- Division of Immunology, Transplantation and Infectious DiseasesIRCCS San Raffaele HospitalMilanItaly
| | - Maria Rosa Calvi
- Department of Anesthesia and Intensive CareIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Andrea Del Prete
- Clinical and Experimental Radiology UnitExperimental Imaging CenterIRCCS San Raffaele Scientific InstituteMilanItaly
| | | | - Sabrina Calamarà
- Clinical and Experimental Radiology UnitExperimental Imaging CenterIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Alessandro Belletti
- Department of Anesthesia and Intensive CareIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Stephanie Steidler
- Clinical and Experimental Radiology UnitExperimental Imaging CenterIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Caterina Conte
- Division of Immunology, Transplantation and Infectious DiseasesIRCCS San Raffaele HospitalMilanItaly
| | - Alberto Zangrillo
- Vita‐Salute San Raffaele UniversityMilanItaly
- Department of Anesthesia and Intensive CareIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Francesco De Cobelli
- Vita‐Salute San Raffaele UniversityMilanItaly
- Clinical and Experimental Radiology UnitExperimental Imaging CenterIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Patrizia Rovere‐Querini
- Vita‐Salute San Raffaele UniversityMilanItaly
- Division of Immunology, Transplantation and Infectious DiseasesIRCCS San Raffaele HospitalMilanItaly
| | | | - Giacomo Monti
- Department of Anesthesia and Intensive CareIRCCS San Raffaele Scientific InstituteMilanItaly
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231
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Qian W, Xia S, Yang X, Yu J, Guo B, Lin Z, Wei R, Mao M, Zhang Z, Zhao G, Bai J, Han Q, Wang Z, Luo Q. Complex Involvement of the Extracellular Matrix, Immune Effect, and Lipid Metabolism in the Development of Idiopathic Pulmonary Fibrosis. Front Mol Biosci 2022; 8:800747. [PMID: 35174208 PMCID: PMC8841329 DOI: 10.3389/fmolb.2021.800747] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background and objective: Idiopathic pulmonary fibrosis (IPF) is an aggressive fibrotic pulmonary disease with spatially and temporally heterogeneous alveolar lesions. There are no early diagnostic biomarkers, limiting our understanding of IPF pathogenesis. Methods: Lung tissue from surgical lung biopsy of patients with early-stage IPF (n = 7), transplant-stage IPF (n = 2), and healthy controls (n = 6) were subjected to mRNA sequencing and verified by real-time quantitative PCR (RT-qPCR), immunohistochemistry, Western blot, and single-cell RNA sequencing (scRNA-Seq). Results: Three hundred eighty differentially expressed transcripts (DETs) were identified in IPF that were principally involved in extracellular matrix (ECM) remodeling, lipid metabolism, and immune effect. Of these DETs, 21 (DMD, MMP7, POSTN, ECM2, MMP13, FASN, FADS1, SDR16C5, ACAT2, ACSL1, CYP1A1, UGT1A6, CXCL13, CXCL5, CXCL14, IL5RA, TNFRSF19, CSF3R, S100A9, S100A8, and S100A12) were selected and verified by RT-qPCR. Differences in DMD, FASN, and MMP7 were also confirmed at a protein level. Analysis of scRNA-Seq was used to trace their cellular origin to determine which lung cells regulated them. The principal cell sources of DMD were ciliated cells, alveolar type I/II epithelial cells (AT cells), club cells, and alveolar macrophages (AMs); MMP7 derives from AT cells, club cells, and AMs, while FASN originates from AT cells, ciliated cells, and AMs. Conclusion: Our data revealed a comprehensive transcriptional mRNA profile of IPF and demonstrated that ECM remodeling, lipid metabolism, and immune effect were collaboratively involved in the early development of IPF.
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Affiliation(s)
- Weiping Qian
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Shu Xia
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xiaoyun Yang
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaying Yu
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bingpeng Guo
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Zhengfang Lin
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rui Wei
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Mengmeng Mao
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ziyi Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Gui Zhao
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Junye Bai
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Qian Han
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
- *Correspondence: Qian Han, ; Zhongfang Wang, ; Qun Luo,
| | - Zhongfang Wang
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Qian Han, ; Zhongfang Wang, ; Qun Luo,
| | - Qun Luo
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- National Clinical Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
- *Correspondence: Qian Han, ; Zhongfang Wang, ; Qun Luo,
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Sato Y, Baba T, Kitamura H, Niwa T, Komatsu S, Hagiwara E, Iwasawa T, Okudela K, Takemura T, Ogura T. Usefulness and safety of transbronchial lung cryobiopsy for reassessment of treatment in the clinical course of diffuse parenchymal lung disease. BMC Pulm Med 2022; 22:46. [PMID: 35086515 PMCID: PMC8793241 DOI: 10.1186/s12890-022-01838-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background The usefulness and safety of transbronchial lung cryobiopsy (TBLC) for reassessment of diffuse parenchymal lung disease (DPLD) with progression is still unknown. Our purpose was to clarify the usefulness and safety of TBLC for reassessment of DPLD with progression. Methods This retrospective study included 31 patients with DPLD diagnosed by surgical lung biopsy who progressed in the clinical course and underwent TBLC for reassessment between January 2017 and September 2019 at Kanagawa Cardiovascular & Respiratory Center. Two pulmonologists independently selected the clinical diagnosis, treatment strategy, and confidence level of the treatment strategy based on clinical and radiological information with and without pathological information from TBLC. A consensus was reached among the pulmonologists regarding the clinical diagnosis, treatment strategy, and confidence level of the treatment strategy. Complications of TBLC were also examined. Results Seven (22.6%), 5 (16.1%), and 6 (19.4%) of clinical diagnosis was changed after TBLC for Pulmonologist A, for Pulmonologist B, and for consensus, respectively. The treatment strategy was changed in 7 (22.6%), 8 (25.9%), and 6 (19.4%) cases after TBLC for Pulmonologist A, for Pulmonologist B and for consensus, respectively. The definite or high confidence level of the consensus treatment strategy was 54.8% (17/31) without TBLC and 83.9% (26/31) with TBLC. There were 6 cases of moderate bleeding, but no other complications were noted. Conclusions Pathological information from TBLC may contribute to decision-making in treatment strategies for the progression of DPLD, and it may be safely performed. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01838-x.
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Affiliation(s)
- Yozo Sato
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama-City, Kanagawa, 236-0051, Japan.
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama-City, Kanagawa, 236-0051, Japan
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama-City, Kanagawa, 236-0051, Japan
| | - Takashi Niwa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama-City, Kanagawa, 236-0051, Japan
| | - Shigeru Komatsu
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama-City, Kanagawa, 236-0051, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama-City, Kanagawa, 236-0051, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama-City, Kanagawa, Japan
| | - Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama-City, Kanagawa, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama-City, Kanagawa, 236-0051, Japan
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233
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Renaud A, Pautre R, Morla O, Achille A, Durant C, Espitia O, Frampas E, Agard C. Thoracic lymphadenopathies in diffuse systemic sclerosis: an observational study on 48 patients using computed tomography. BMC Pulm Med 2022; 22:44. [PMID: 35078448 PMCID: PMC8788097 DOI: 10.1186/s12890-022-01837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Thoracic multidetector computed tomography (MDCT) is essential for the detection of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc). Thoracic MDCT assessment can reveal the presence of thoracic lymphadenopathies (LAP) whose signification remains uncertain. The purpose of the study was to describe the characteristics and to assess the significance of thoracic LAP in patients with diffuse SSc.
Methods
We conducted a monocentric observational study on adult patients with diffuse SSc, and collected general patient and first thoracic MDCT characteristics, PET-CT and outcome data. Comparisons were made between patients with and without thoracic LAP.
Results
Forty-eight patients were included. There were 30 patients (62.5%) with an ILD and 23 (48%) with at least one thoracic LAP on the first MDCT assessment. Median number per patient of thoracic LAP was 3 [1–8], with a mean size of 11.7 ± 1.7 mm, mainly located in right para-tracheal area (22.8% of the total number of LAP), right hilar area (20.3%), left hilar area (6.5%), and sub-carinal area (15.2%). PET-CT showed lymph node hypermetabolism in 11/15 patients (73.3%) with mean SUVmax at 4 ± 1.3. There were significantly more males (p = 0.002) and more patients exposed to silica (p = 0.001) in patients with thoracic LAP. ILD was significantly more extended according to Goh score (p = 0.03), and using semi-quantitative score for mixed ground-glass reticulation (p = 0.01) and global abnormalities (p = 0.03) in patients with thoracic LAP and ILD. Thirteen patients (27.1%) died during follow-up without significant difference according to the presence or not of thoracic LAP (p = 0.15). There was also no significant difference concerning immunosuppressive treatment initiation (p = 0.17).
Conclusions
Thoracic LAP are common in diffuse SSc and are generally multiple, not bulky, moderately hypermetabolic, and located at the base of the mediastinum lymph node chains. Their presence correlates with the extent of ILD. In absence of ILD, thoracic LAP presence seems to be often explained by silica exposure.
Trial Registration: NA.
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234
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Morrow LE, Hilleman D, Malesker MA. Management of patients with fibrosing interstitial lung diseases. Am J Health Syst Pharm 2022; 79:129-139. [PMID: 34608488 PMCID: PMC8881211 DOI: 10.1093/ajhp/zxab375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This article summarizes the appropriate use and pharmacology of treatments for fibrosing interstitial lung diseases, with a specific focus on the antifibrotic agents nintedanib and pirfenidone. SUMMARY The interstitial lung diseases are a heterogenous group of parenchymal lung disorders with a common feature-infiltration of the interstitial space with derangement of the normal capillary-alveolar anatomy. Diseases characterized by fibrosis of the interstitial space are referred to as the fibrosing interstitial lung diseases and often show progression over time: idiopathic pulmonary fibrosis is the most common fibrotic interstitial lung disease. Historically, therapies for fibrosing lung diseases have been limited in number, questionable in efficacy, and associated with potential harms. Food and Drug Administration (FDA) approval of the antifibrotic agents nintedanib and pirfenidone for idiopathic pulmonary fibrosis in 2014 heralded an era of reorganization of therapy for the fibrotic interstitial lung diseases. Subsequent investigations have led to FDA approval of nintedanib for systemic sclerosis-associated interstitial lung disease and interstitial lung diseases with a progressive phenotype. Although supportive care and pulmonary rehabilitation should be provided to all patients, the role(s) of immunomodulators and/or immune suppressing agents vary by the underlying disease state. Several agents previously used to treat fibrotic lung diseases (N-acetylcysteine, anticoagulation, and pulmonary vasodilators) lack efficacy or cause harm. CONCLUSION With the introduction of effective pharmacotherapy for fibrosing interstitial lung disease, pharmacists have an increasingly important role in the interdisciplinary team managing these patients.
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Affiliation(s)
- Lee E Morrow
- Creighton University School of Medicine, Omaha, NE
- Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Daniel Hilleman
- Creighton University School of Pharmacy and Health Professions, Omaha, NE
- Creighton University School of Medicine, Omaha, NE, USA
| | - Mark A Malesker
- Creighton University School of Pharmacy and Health Professions, Omaha, NE
- Creighton University School of Medicine, Omaha, NE, USA
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Popmihajlov Z, Sutherland DJ, Horan GS, Ghosh A, Lynch DA, Noble PW, Richeldi L, Reiss TF, Greenberg S. CC-90001, a c-Jun N-terminal kinase (JNK) inhibitor, in patients with pulmonary fibrosis: design of a phase 2, randomised, placebo-controlled trial. BMJ Open Respir Res 2022; 9:9/1/e001060. [PMID: 35058236 PMCID: PMC8783810 DOI: 10.1136/bmjresp-2021-001060] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/18/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Idiopathic pulmonary fibrosis (IPF) is a progressive and often fatal interstitial lung disease (ILD); other ILDs have a progressive, fibrotic phenotype (PF-ILD). Antifibrotic agents can slow but not stop disease progression in patients with IPF or PF-ILD. c-Jun N-terminal kinases (JNKs) are stress-activated protein kinases implicated in the underlying mechanisms of fibrosis, including epithelial cell death, inflammation and polarisation of profibrotic macrophages, fibroblast activation and collagen production. CC-90001, an orally administered (PO), one time per day, JNK inhibitor, is being evaluated in IPF and PF-ILD. Methods and analysis This is a phase 2, randomised, double-blind, placebo-controlled study evaluating efficacy and safety of CC-90001 in patients with IPF (main study) and patients with PF-ILD (substudy). Both include an 8-week screening period, a 24-week treatment period, up to an 80-week active-treatment extension and a 4-week post-treatment follow-up. Patients with IPF (n=165) will be randomised 1:1:1 to receive 200 mg or 400 mg CC-90001 or placebo administered PO one time per day; up to 25 patients/arm will be permitted concomitant pirfenidone use. Forty-five patients in the PF-ILD substudy will be randomised 2:1 to receive 400 mg CC-90001 or placebo. The primary endpoint is change in per cent predicted forced vital capacity from baseline to Week 24 in patients with IPF. Ethics and dissemination This study will be conducted in accordance with Good Clinical Practice guidelines, Declaration of Helsinki principles and local ethical and legal requirements. Results will be reported in a peer-reviewed publication. Trial registration number NCT03142191.
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Affiliation(s)
| | | | | | | | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, USA
| | - Paul W Noble
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Luca Richeldi
- Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy
| | | | - Steven Greenberg
- Bristol Myers Squibb, Princeton, New Jersey, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University, New York, New York, USA
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The histone methyltransferase DOT1L is a new epigenetic regulator of pulmonary fibrosis. Cell Death Dis 2022; 13:60. [PMID: 35039472 PMCID: PMC8763868 DOI: 10.1038/s41419-021-04365-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 12/17/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with increasing occurrence, high death rates, and unfavorable treatment regimens. The pathogenesis underlying IPF is complex and the epigenetic contributions to IPF are largely unknown. Recent studies have shown that DOT1L (Disruptor of telomeric silencing-1 like), a histone H3K79 methyltransferase, contributes to fibrosis response, but its role in IPF remains unclear. DOT1L, H3K79me3, and the profibrotic proteins levels were upregulated in the pulmonary fibrosis models both in vivo and in vitro. Lentivirus-mediated DOT1L knockdown or DOT1L-specific inhibitor EPZ5676 alleviated the pathogenesis of bleomycin-induced mouse pulmonary fibrosis. Furthermore, heterozygous DOT1L-deficient mice (Dot1l+/−) showed less sensitive to pulmonary fibrosis, as shown by decreased lung fibrosis phenotypes in vivo. Mechanically, DOT1L regulated TGF-β1-induced fibroblasts fibrosis by increasing enrichments of H3K79me3 on the promoter of Jag1 gene (encoding the Notch ligand Jagged1), enhancing the expression of Jagged1, which in turn stimulated exuberant Notch signaling and actuated the fibrosis response. In conclusion, our study confirmed DOT1L to be an epigenetic modifier in the pathogenesis of lung fibrosis, revealed a counterbalancing mechanism governing Jag1 transcription by modulating H3K79 trimethylation at the Jag1 promoter, activating the Notch signaling, and affecting the expression of profibrotic proteins to accelerate the lung fibrosis.
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Kifjak D, Leitner J, Ambros R, Heidinger BH, Milos RI, Beer L, Prayer F, Röhrich S, Prosch H. [Chest radiography findings in diffuse parenchymal lung diseases]. Radiologe 2022; 62:130-139. [PMID: 34997260 PMCID: PMC8740870 DOI: 10.1007/s00117-021-00955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 10/28/2022]
Abstract
CLINICAL ISSUE Diffuse parenchymal lung diseases include a heterogeneous group of diseases of the lung parenchyma, the alveolar spaces, the vessels and the airways, which can be triggered by various pathomechanisms, such as inflammation and fibrotic changes. Since the therapeutic approaches and prognoses differ significantly between the diseases, the correct diagnosis is of fundamental importance. In routine clinical practice, next to the patients' history, the clinical presentation, the laboratory findings and the bronchoscopy, imaging plays a central role in establishing a diagnosis. PRACTICAL RECOMMENDATIONS The diagnosis of diffuse parenchymal lung diseases is an enormous challenge for clinicians, radiologists as well as pathologists and should therefore preferably be carried out in a multidisciplinary setting. Since patients often present with unspecific, respiratory symptoms, chest radiographs are the first imaging method used. Many patterns of diffuse parenchymal lung diseases (e.g., ground-glass opacities and consolidations), their distribution (e.g., cranial-caudal) and the presence of additional findings (e.g., mediastinal lymphadenopathy) are often already detectable on chest X‑rays. However, the imaging reference standard and thus, an integral part of the assessment of diffuse parenchymal lung disease, is the chest HR-CT. In some cases, the pattern of the HR-CT is pathognomonic, in others it is unspecific for a disease, so that further diagnostic steps are necessary.
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Affiliation(s)
- Daria Kifjak
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Johannes Leitner
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Raphael Ambros
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Benedikt H Heidinger
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Lucian Beer
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Florian Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Sebastian Röhrich
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich. .,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Philippot Q, Kannengiesser C, Debray MP, Gauvain C, Ba I, Vieri M, Gondouin A, Naccache JM, Reynaud-Gaubert M, Uzunhan Y, Bondue B, Israël-Biet D, Dieudé P, Fourrage C, Lainey E, Manali E, Papiris S, Wemeau L, Hirschi S, Mal H, Nunes H, Schlemmer F, Blanchard E, Beier F, Cottin V, Crestani B, Borie R. Interstitial lung diseases associated with mutations of poly(A)-specific ribonuclease: A multicentre retrospective study. Respirology 2022; 27:226-235. [PMID: 34981600 DOI: 10.1111/resp.14195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/21/2021] [Accepted: 11/29/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Poly(A)-specific ribonuclease (PARN) mutations have been associated with familial pulmonary fibrosis. This study aims to describe the phenotype of patients with interstitial lung disease (ILD) and heterozygous PARN mutations. METHODS We performed a retrospective, observational, non-interventional study of patients with an ILD diagnosis and a pathogenic heterozygous PARN mutation followed up in a centre of the OrphaLung network. RESULTS We included 31 patients (29 from 16 kindreds and two sporadic patients). The median age at ILD diagnosis was 59 years (range 54 to 63). In total, 23 (74%) patients had a smoking history and/or fibrogenic exposure. The pulmonary phenotypes were heterogenous, but the most frequent diagnosis was idiopathic pulmonary fibrosis (n = 12, 39%). Haematological abnormalities were identified in three patients and liver disease in two. In total, 21 patients received a specific treatment for ILD: steroids (n = 13), antifibrotic agents (n = 11), immunosuppressants (n = 5) and N-acetyl cysteine (n = 2). The median forced vital capacity decline for the whole sample was 256 ml/year (range -363 to -148). After a median follow-up of 32 months (range 18 to 66), 10 patients had died and six had undergone lung transplantation. The median transplantation-free survival was 54 months (95% CI 29 to ∞). Extra-pulmonary features were less frequent with PARN mutation than telomerase reverse transcriptase (TERT) or telomerase RNA component (TERC) mutation. CONCLUSION IPF is common among individuals with PARN mutation, but other ILD subtypes may be observed.
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Affiliation(s)
| | - Caroline Kannengiesser
- INSERM, Unité 1152, Université de Paris, Paris, France.,Laboratoire de Génétique, Hôpital Bichat, APHP, Paris, France
| | - Marie Pierre Debray
- INSERM, Unité 1152, Université de Paris, Paris, France.,Service de Radiologie, Hôpital Bichat, APHP, Paris, France
| | | | - Ibrahima Ba
- Laboratoire de Génétique, Hôpital Bichat, APHP, Paris, France
| | - Margherita Vieri
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Anne Gondouin
- Service de Pneumologie, CHU de Besançon, Besancon, France
| | | | | | | | | | | | - Philippe Dieudé
- INSERM, Unité 1152, Université de Paris, Paris, France.,Service de Rhumatologie, Hôpital Bichat, APHP, Paris, France
| | - Cécile Fourrage
- Service de Génétique Hôpital Necker Enfants Malades, APHP, Paris, France.,Plateforme de Bio-informatique, Institut Imagine, Université de Paris, Paris, France
| | - Elodie Lainey
- Laboratoire d'Hématologie Hôpital Robert Debré, APHP, Paris, France
| | - Effrosyne Manali
- 2nd Pulmonary department, Attikon University Hospital, Athens, Greece
| | - Spyros Papiris
- 2nd Pulmonary department, Attikon University Hospital, Athens, Greece
| | | | | | - Hervé Mal
- INSERM, Unité 1152, Université de Paris, Paris, France.,Service de Pneumologie B, Hôpital Bichat, APHP, Paris, France
| | - Hilario Nunes
- Service de Pneumologie, Hôpital Avicenne, APHP, Bobigny, France
| | - Frédéric Schlemmer
- Unité de Pneumologie, Université Paris-Est Créteil, APHP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | | | - Fabian Beier
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Vincent Cottin
- Coordonnateur OrphaLung, Centre coordonnateur national de référence des maladies pulmonaires rares, Service de Pneumologie, Hôpital Louis Pradel, Université de Lyon, INRAE, member of Radico-ILD, Lyon, France.,RespiFil, ERN-LUNG, Lyon, France
| | - Bruno Crestani
- Service de Pneumologie A, Hôpital Bichat, APHP, Paris, France.,INSERM, Unité 1152, Université de Paris, Paris, France
| | - Raphaël Borie
- Service de Pneumologie A, Hôpital Bichat, APHP, Paris, France.,INSERM, Unité 1152, Université de Paris, Paris, France
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The histologic diagnosis of usual interstitial pneumonia of idiopathic pulmonary fibrosis. Where we are and where we need to go. Mod Pathol 2022; 35:8-14. [PMID: 34465882 PMCID: PMC8695374 DOI: 10.1038/s41379-021-00889-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/19/2021] [Accepted: 07/31/2021] [Indexed: 11/08/2022]
Abstract
In the 50 years since its inception by Dr. Liebow, the diagnosis of usual interstitial pneumonia (UIP) by pathologists has changed significantly. This manuscript reviews the progressive history of the histologic diagnosis of UIP and summarizes the current state of histologic UIP and its relationship to the clinical syndrome idiopathic pulmonary fibrosis (IPF). Fibrotic lung disease mimics of UIP/IPF are reviewed and pearls for distinguishing these diseases from UIP/IPF are provided. Strategies for increasing the value of histologic assessment of biopsies in the setting of pulmonary fibrosis are also discussed.
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240
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Kimbrough BA, Baqir M, Johnson TF, Vasireddy A, Ryu JH. Interstitial Lung Disease in Giant Cell Arteritis: Review of 23 Patients. J Clin Rheumatol 2022; 28:e3-e8. [PMID: 32925448 DOI: 10.1097/rhu.0000000000001566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Giant cell arteritis (GCA) is a large-vessel vasculitis with systemic manifestations. A few case reports have described a possible association of GCA with interstitial lung disease (ILD). The primary aim of the present study was to describe the pattern, severity, and course of ILD in patients with GCA. METHODS This medical records review study evaluated adult patients presenting to Mayo Clinic in Rochester, MN, from January 1, 1997, through December 31, 2018, who had the diagnoses of GCA and ILD. Clinical, laboratory, and radiologic data were analyzed. RESULTS In total, 23 patients were in the study. Median (range) age was 78 (58-93) years, and 14 (61%) were women. Six patients (26%) had a cough at GCA diagnosis. At ILD diagnosis, 15 patients had respiratory symptoms, including dyspnea (n = 12, 52%), dry cough (n = 6, 26%), wheezing (n = 1, 4%), and chest pain (n = 1, 4%). On initial chest computed tomography, the most common pattern of ILD was probable usual interstitial pneumonia (n = 7, 30%), indeterminate for usual interstitial pneumonia (n = 5, 22%), and combined pulmonary fibrosis and emphysema (n = 3, 13%). Airway abnormalities were present in 10 patients: 6 with bronchial wall thickening, 2 with bronchiectasis, and 2 with both. At follow-up computed tomography, 8 patients had ILD progression. Three patients with cough improved after initiation of glucocorticoid therapy. CONCLUSIONS Interstitial lung disease and airway abnormalities may be associated with GCA. Although cough may improve, ILD in some patients with GCA may progress despite immunosuppressive therapy.
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Affiliation(s)
| | - Misbah Baqir
- Division of Pulmonary and Critical Care Medicine
| | | | - Amit Vasireddy
- Department of Internal Medicine, Berkshire Medical Center, Pittsfield, MA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine
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Zheng Q, Cox IA, Campbell JA, Xia Q, Otahal P, de Graaff B, Corte TJ, Teoh AK, Walters EH, Palmer AJ. Mortality and survival in idiopathic pulmonary fibrosis: a systematic review and meta-analysis. ERJ Open Res 2022; 8:00591-2021. [PMID: 35295232 PMCID: PMC8918939 DOI: 10.1183/23120541.00591-2021] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/09/2022] [Indexed: 11/05/2022] Open
Abstract
Background There are substantial advances in diagnosis and treatment for idiopathic pulmonary fibrosis (IPF), but without much evidence available on recent mortality and survival trends. Methods A narrative synthesis approach was used to investigate the mortality trends, then meta-analyses for survival trends were carried out based on various time periods. Results Six studies reported the mortality data for IPF in 22 countries, and 62 studies (covering 63 307 patients from 20 countries) reported survival data for IPF. Age-standardised mortality for IPF varied from ∼0.5 to ∼12 per 100 000 population per year after year 2000. There were increased mortality trends for IPF in Australia, Brazil, Belgium, Canada, Czech Republic, Finland, France, Germany, Hungary, Italy, Lithuania, the Netherlands, Poland, Portugal, Spain, Sweden and UK, while Austria, Croatia, Denmark, Romania and the USA showed decreased mortality trends. The overall 3-year and 5-year cumulative survival rates (CSRs) were 61.8% (95% CI 58.7-64.9; I2=97.1%) and 45.6% (95% CI 41.5-49.7; I2=97.7%), respectively. Prior to 2010, the pooled 3-year CSR was 59.9% (95% CI 55.8-64.1; I2=95.8%), then not significantly (p=0.067) increased to 66.2% (95% CI 62.9-69.5; I2=92.6%) in the 2010s decade. After excluding three studies in which no patients received antifibrotics after year 2010, the pooled 3-year CSRs significantly (p=0.039) increased to 67.4% (95% CI 63.9-70.9; I2=93.1%) in the 2010s decade. Discussion IPF is a diagnosis associated with high mortality. There was no observed increasing survival trend for patients with IPF before year 2010, with then a switch to an improvement, which is probably multifactorial.
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Affiliation(s)
- Qiang Zheng
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, Australia
- Dept of Anesthesiology (High-Tech Branch), the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ingrid A. Cox
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, Australia
| | - Julie A. Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Qing Xia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Tamera J. Corte
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, Australia
- Central Clinical School, The University of Sydney, Camperdown, Australia
- Dept of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Alan K.Y. Teoh
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, Australia
- Central Clinical School, The University of Sydney, Camperdown, Australia
- Dept of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - E. Haydn Walters
- School of Medicine, University of Tasmania, Hobart, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- These authors contributed equally
| | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- These authors contributed equally
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242
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Si-Mohamed SA, Nasser M, Colevray M, Nempont O, Lartaud PJ, Vlachomitrou A, Broussaud T, Ahmad K, Traclet J, Cottin V, Boussel L. Automatic quantitative computed tomography measurement of longitudinal lung volume loss in interstitial lung diseases. Eur Radiol 2022; 32:4292-4303. [PMID: 35029730 PMCID: PMC9123030 DOI: 10.1007/s00330-021-08482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/09/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare the lung CT volume (CTvol) and pulmonary function tests in an interstitial lung disease (ILD) population. Then to evaluate the CTvol loss between idiopathic pulmonary fibrosis (IPF) and non-IPF and explore a prognostic value of annual CTvol loss in IPF. METHODS We conducted in an expert center a retrospective study between 2005 and 2018 on consecutive patients with ILD. CTvol was measured automatically using commercial software based on a deep learning algorithm. In the first group, Spearman correlation coefficients (r) between forced vital capacity (FVC), total lung capacity (TLC), and CTvol were calculated. In a second group, annual CTvol loss was calculated using linear regression analysis and compared with the Mann-Whitney test. In a last group of IPF patients, annual CTvol loss was calculated between baseline and 1-year CTs for investigating with the Youden index a prognostic value of major adverse event at 3 years. Univariate and log-rank tests were calculated. RESULTS In total, 560 patients (4610 CTs) were analyzed. For 1171 CTs, CTvol was correlated with FVC (r: 0.86) and TLC (r: 0.84) (p < 0.0001). In 408 patients (3332 CT), median annual CTvol loss was 155.7 mL in IPF versus 50.7 mL in non-IPF (p < 0.0001) over 5.03 years. In 73 IPF patients, a relative annual CTvol loss of 7.9% was associated with major adverse events (log-rank, p < 0.0001) in univariate analysis (p < 0.001). CONCLUSIONS Automated lung CT volume may be an alternative or a complementary biomarker to pulmonary function tests for the assessment of lung volume loss in ILD. KEY POINTS • There is a good correlation between lung CT volume and forced vital capacity, as well as for with total lung capacity measurements (r of 0.86 and 0.84 respectively, p < 0.0001). • Median annual CT volume loss is significantly higher in patients with idiopathic pulmonary fibrosis than in patients with other fibrotic interstitial lung diseases (155.7 versus 50.7 mL, p < 0.0001). • In idiopathic pulmonary fibrosis, a relative annual CT volume loss higher than 9.4% is associated with a significantly reduced mean survival time at 2.0 years versus 2.8 years (log-rank, p < 0.0001).
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Affiliation(s)
- Salim A. Si-Mohamed
- Radiology Department, Department of Cardiovascular and Thoracic Radiology, CHU Cardiologique Louis Pradel, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France ,University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Mouhamad Nasser
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Marion Colevray
- Radiology Department, Hôpital de La Croix-Rousse, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
| | | | - Pierre-Jean Lartaud
- University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | | | - Thomas Broussaud
- University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Kais Ahmad
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Julie Traclet
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Loic Boussel
- University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France ,Radiology Department, Hôpital de La Croix-Rousse, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
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243
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Adams CJ, Shapera S, Ryerson CJ, Assayag D, Johannson KA, Fell CD, Morisset J, Manganas H, Kolb M, Hambly N, Cox G, Khalil N, Marcoux V, Wilcox PG, To T, Sadatsafavi M, Halayko AJ, Gershon A, Garlick K, Fisher JH. Effect of continued antifibrotic therapy after forced vital capacity decline in patients with idiopathic pulmonary fibrosis; a real world multicenter cohort study. Respir Med 2021; 191:106722. [PMID: 34959146 DOI: 10.1016/j.rmed.2021.106722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022]
Abstract
RATIONALE Longitudinal data on the impact of continued, switched or discontinued antifibrotic therapy in patients with idiopathic pulmonary fibrosis (IPF) who have disease progression is needed. OBJECTIVE We hypothesized that ongoing antifibrotic use (versus discontinuation) in the setting of forced vital capacity (FVC) decline would be associated with less future decline and lower likelihood of a composite outcome of FVC decline, lung transplant, or death. METHODS We performed a multicenter cohort study using data from the Canadian Registry for Pulmonary Fibrosis in patients with IPF with FVC decline ≥10% over 6 months on antifibrotic therapy. The association of continued, switched or discontinued therapy with (1) further change in FVC and (2) a composite of FVC decline ≥10%, transplant, or death, in the subsequent 6 months, was assessed using adjusted linear and logistic regression modelling, respectively. Generalized estimating equations accounted for repeated observations per patient. RESULTS 165 patients had a decline in FVC ≥10% over 6 months while receiving antifibrotic therapy. Compared to continued use, antifibrotic discontinuation after FVC decline was associated with greater additional FVC decline (-207 mL 95%CI -353 to -62, p = 0.005) and higher odds of FVC decline ≥10%, transplant, or death (odds ratio 12.2 95%CI 1.2 to 130.5, p = 0.04). There was no difference between continued versus switched antifibrotic therapy. CONCLUSIONS Ongoing antifibrotic therapy in the setting of FVC decline is associated with less future FVC decline and lower odds of FVC decline ≥10%, transplant, or death in a real-world cohort of IPF.
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Affiliation(s)
- Colin J Adams
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shane Shapera
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Charlene D Fell
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Julie Morisset
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Hélène Manganas
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nathan Hambly
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gerard Cox
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Pearce G Wilcox
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrew J Halayko
- Departments of Internal Medicine and Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB, Canada
| | - Andrea Gershon
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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The Impact of the Envisia Genomic Classifier in the Diagnosis and Management of Patients with Idiopathic Pulmonary Fibrosis. Ann Am Thorac Soc 2021; 19:916-924. [PMID: 34889723 DOI: 10.1513/annalsats.202107-897oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The diagnosis of idiopathic pulmonary fibrosis (IPF) remains challenging and can result in delayed or misdiagnosis. IPF diagnosis is based upon the presence of either a radiographic or histologic usual interstitial pneumonia (UIP) pattern in the absence of an identifiable etiology. The Envisia Genomic Classifier is a clinically validated molecular diagnostic test that identifies UIP in transbronchial biopsies. OBJECTIVE To determine the impact of the Envisia Genomic Classifier on physician's clinical decision making in the diagnosis and management of IPF. METHODS This prospective randomized decision impact survey was designed to test the hypothesis that including an Envisia UIP positive (UIP+) result will increase IPF diagnoses, diagnostic confidence levels, and the recommendation for antifibrotic therapy. The survey included patients from the BRAVE study who had an HRCT scan without a typical UIP pattern, an Envisia UIP+ result, and a final diagnosis of IPF by multidisciplinary team discussion. Each case was presented in three different formats: a pre-post cohort where each case is presented initially without and then with Envisia, and two independent cohorts where each case is presented without and with Envisia, respectively. RESULTS U.S. based pulmonologists from community and academic centers in geographically diverse practices were approached for inclusion in this study. 103 (65%) US-based pulmonologists met the inclusion criteria and provided 605 case reviews of 11 patient cases. The number of IPF diagnoses increased with Envisia by an absolute difference of 39% from 47 (30%) pre-Envisia to 107 (69%) post-Envisia in the pre-post cohort and by 13% in the independent cohorts. High confidence (> 90%) of ILD diagnoses was more commonly seen with Envisia in both the pre-post cohort and in the independent cohorts. Recommendation for antifibrotic treatment increased with Envisia by an absolute difference of 36% from 15 (10%) pre-Envisia to 72 (46.4%) post-Envisia in the pre-post cohort and by 11% in the independent cohorts. CONCLUSIONS This decision impact survey suggests the clinical utility of the Envisia Classifier by demonstrating a significant increase in IPF diagnoses, diagnostic confidence, and recommendation for antifibrotic therapies to assist physicians to effectively manage patients to improve outcomes of patients with IPF.
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Special issue on imaging the post cancer-treatment chest: heralding a new definition of an "expert thoracic imager"? Clin Radiol 2021; 77:3-5. [PMID: 34876243 DOI: 10.1016/j.crad.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022]
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246
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Stavri A, Masseau I, Reinero CR. Reversibility of clinical and computed tomographic lesions mimicking pulmonary fibrosis in a young cat. BMC Vet Res 2021; 17:380. [PMID: 34886851 PMCID: PMC8656078 DOI: 10.1186/s12917-021-03081-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background In humans with idiopathic pulmonary fibrosis (IPF), specific thoracic computed tomographic (CT) features in the correct clinical context may be used in lieu of histologic examination. Cats develop an IPF-like condition with similar features to humans. As few cats have invasive lung biopsies, CT has appeal as a surrogate diagnostic, showing features consistent with architectural remodeling supporting “end-stage lung”. Case presentation A 1-year-old female spayed Domestic Shorthair cat presenting with progressive respiratory clinical signs and thoracic CT changes (reticular pattern, parenchymal bands, subpleural interstitial thickening, pleural fissure thickening, subpleural lines and regions of increased attenuation with traction bronchiectasis and architectural distortion) consistent with reports of IPF was given a grave prognosis for long-term survival. The cat was treated with prednisolone, fenbendazole, pradofloxacin and clindamycin. Five months later, while still receiving an anti-inflammatory dose of prednisolone, the cat was re-evaluated with owner-reported absent respiratory clinical signs. Thoracic CT demonstrated resolution of lung patterns consistent with fibrosis. Conclusions Fibrotic lung disease is irreversible. Despite this cat having compatible progressive respiratory signs and associated lung patterns on thoracic CT scan, these abnormalities resolved with non-specific therapy and time, negating the possibility of IPF. While the cause of the distinct CT lesions that ultimately resolved was not determined, infection was suspected. Experimental Toxocara cati infection shows overlapping CT features as this cat and is considered a treatable disease. Improvement of CT lesions months after experimental heartworm-associated respiratory disease in cats has been documented. Reversibility of lesions suggests inflammation rather than fibrosis was the cause of the thoracic CT lesions. This cat serves as a lesson that although thoracic CT has been advocated as a surrogate for histopathology in people with IPF, additional studies in cats are needed to integrate CT findings with signalment, other clinicopathologic features and therapeutic response before providing a diagnosis or prognosis of fibrotic lung disease.
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Affiliation(s)
- Alba Stavri
- Department of Veterinary Medicine and Surgery, University of Missouri, 900 E Campus Dr, Columbia, MO, USA
| | - Isabelle Masseau
- Department of Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, Canada
| | - Carol R Reinero
- Department of Veterinary Medicine and Surgery, University of Missouri, 900 E Campus Dr, Columbia, MO, USA.
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Ruaro B, Baratella E, Confalonieri P, Confalonieri M, Vassallo FG, Wade B, Geri P, Pozzan R, Caforio G, Marrocchio C, Cova MA, Salton F. High-Resolution Computed Tomography and Lung Ultrasound in Patients with Systemic Sclerosis: Which One to Choose? Diagnostics (Basel) 2021; 11:2293. [PMID: 34943531 PMCID: PMC8700001 DOI: 10.3390/diagnostics11122293] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
Imaging plays a pivotal role in systemic sclerosis for both diagnosis management of pulmonary complications, and high-resolution computed tomography (HRCT) is the most sensitive technique for the evaluation of systemic sclerosis-associated interstitial lung disease (SSc-ILD). Indeed, several studies have demonstrated that HRCT helps radiologists and clinicians to make a correct diagnosis on the basis of recognised typical patterns for SSc-ILD. Most SSc patients affected by ILD have a non-specific interstitial pneumonia pattern (NISP) on HRCT scan, whilst a minority of cases fulfil the criteria for usual interstitial pneumonia (UIP). Moreover, several recent studies have demonstrated that lung ultrasound (LUS) is an emergent tool in SSc diagnosis and follow-up, although its role is still to be confirmed. Therefore, this article aims at evaluating the role of LUS in SSc screening, aimed at limiting the use of CT to selected cases.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Paola Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Marco Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Fabio Giuseppe Vassallo
- Department of Pulmonology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy;
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10124 Torino, Italy;
| | - Pietro Geri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Riccardo Pozzan
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Gaetano Caforio
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Cristina Marrocchio
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Francesco Salton
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
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Achaiah A, Rathnapala A, Pereira A, Bothwell H, Dwivedi K, Barker R, Benamore R, Hoyles RK, Iotchkova V, Ho LP. Monocyte and neutrophil levels are potentially linked to progression to IPF for patients with indeterminate UIP CT pattern. BMJ Open Respir Res 2021; 8:8/1/e000899. [PMID: 34799353 PMCID: PMC8606778 DOI: 10.1136/bmjresp-2021-000899] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/07/2021] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with poor prognosis. Identifying patients early may allow intervention which could limit progression. The 'indeterminate for usual interstitial pneumonia' (iUIP) CT pattern, defined in the 2018 IPF guidelines, could be a precursor to IPF but there is limited data on how patients with iUIP progress over time. OBJECTIVE To evaluate the radiological progression of iUIP and explore factors linked to progression to IPF. METHODS We performed a retrospective analysis of a lung fibrosis clinic cohort (n=230) seen between 2013 and 2017. Cases with iUIP were identified; first ever CTs for each patient found and categorised as 'non-progressor' or 'progressors' (the latter defined as increase in extent of disease or to 'definite' or 'probable' UIP CT pattern) during their follow-up. Lung function trends, haematological data and patient demographics were examined to explore disease evolution and potential contribution to progression. RESULTS 48 cases with iUIP CT pattern were identified. Of these, 32 had follow-up CT scans, of which 23 demonstrated progression. 17 patients in this cohort were diagnosed with IPF over a mean (SD) period of 3.9 (±1.9) years. Monocyte (HR: 23, 95% CI: 1.6 to 340, p=0.03) and neutrophil levels (HR: 1.8, 95% CI: 1.3 to 2.3, p<0.001), obtained around the time of initial CT, were associated with progression to IPF using Cox proportional hazard modelling. CONCLUSION 53% of our evaluable patients with iUIP progressed to IPF over a mean of 4 years. Monocyte and neutrophil levels at initial CT were significantly associated with progression in disease. These data provide a single-centre analysis of the evolution of patients with iUIP CT pattern, and first signal for potential factors associated with progression to IPF.
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Affiliation(s)
- Andrew Achaiah
- MRC Human Immunology Unit, University of Oxford, Headington, Oxford, UK.,Interstitial Lung Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Amila Rathnapala
- Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrea Pereira
- Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Harriet Bothwell
- Interstitial Lung Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kritica Dwivedi
- Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rosie Barker
- Interstitial Lung Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel Benamore
- Thoracic Radiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel K Hoyles
- Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Valentina Iotchkova
- Computational Biology and Statistics Unit, Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Headington, Oxford, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Headington, Oxford, UK .,Interstitial Lung Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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249
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Tsitoura E, Trachalaki A, Vasarmidi E, Mastrodemou S, Margaritopoulos GA, Kokosi M, Fanidis D, Galaris A, Aidinis V, Renzoni E, Tzanakis N, Wells AU, Antoniou KM. Collagen 1a1 Expression by Airway Macrophages Increases In Fibrotic ILDs and Is Associated With FVC Decline and Increased Mortality. Front Immunol 2021; 12:645548. [PMID: 34867934 PMCID: PMC8635798 DOI: 10.3389/fimmu.2021.645548] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Within the Interstitial Lung Diseases (ILD), patients with idiopathic pulmonary fibrosis (IPF) and a subset of those with non-IPF fibrotic ILD have a distinct clinical phenotype of progression despite management. This group of patients has been collectively termed the progressive fibrotic phenotype (PFP). Their early recognition may facilitate access to antifibrotic therapies to prevent or slow progression. Macrophages/monocytes within the lung orchestrate the progression and maintenance of fibrosis. A novel role for monocyte-derived macrophages during tissue damage and wound healing is the expression of collagens. We examined Collagen 1a1 expression in airway macrophages from ILD patients at diagnosis. COL1A1 mRNA levels from BAL cells were elevated in IPF and Non-IPF patients. The presence of a UIP pattern and a subsequent progressive phenotype were significantly associated with the higher BAL COL1A1 levels. In Non-IPF patients, higher COL1A1 levels were associated with a more than twofold increase in mortality. The intracellular localisation of COL1A1 in airway macrophages was demonstrated by confocal microscopy in CD45 and CD163 co-staining assays. Additionally, airway macrophages co-expressed COL1A1 with the profibrotic SPP1 gene product osteopontin. The levels of SPP1 mRNA and OPN in the BAL were significantly higher in IPF and Non-IPF patients relative to healthy. Our results suggest that profibrotic airway macrophages are increased in the BAL of patients with IPF and other ILDs and co-express COL1A1 and OPN. Importantly, COL1A1 expression by pro-fibrotic airway macrophages could be a marker of disease progression and poor survival in ILDs.
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Affiliation(s)
- Eliza Tsitoura
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Athina Trachalaki
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospital National Health Service (NHS) Foundation Trust, Imperial College, London, United Kingdom
| | - Eirini Vasarmidi
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Semeli Mastrodemou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - George A. Margaritopoulos
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospital National Health Service (NHS) Foundation Trust, Imperial College, London, United Kingdom
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospital National Health Service (NHS) Foundation Trust, Imperial College, London, United Kingdom
| | - Dionysios Fanidis
- Division of Immunology, Alexander Fleming Biomedical Sciences Research Centre, Athens, Greece
| | - Apostolos Galaris
- Division of Immunology, Alexander Fleming Biomedical Sciences Research Centre, Athens, Greece
| | - Vassilis Aidinis
- Division of Immunology, Alexander Fleming Biomedical Sciences Research Centre, Athens, Greece
| | - Elizabeth Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospital National Health Service (NHS) Foundation Trust, Imperial College, London, United Kingdom
| | - Nikos Tzanakis
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospital National Health Service (NHS) Foundation Trust, Imperial College, London, United Kingdom
| | - Katerina M. Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
- *Correspondence: Katerina M. Antoniou,
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250
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Ferrini E, Leo L, Corsi L, Catozzi C, Salomone F, Ragionieri L, Pennati F, Stellari FF. A new anesthesia protocol enabling longitudinal lung function measurements in neonatal rabbits by micro-CT. Am J Physiol Lung Cell Mol Physiol 2021; 321:L1206-L1214. [PMID: 34786984 DOI: 10.1152/ajplung.00328.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Micro-CT imaging is an emerging technology with many applications in small animals, e.g. the study of pulmonary diseases, although clear guidelines and critical mass of evidence are still missing in the preclinical literature. The neonatal rabbit is a valuable model for studying pulmonary development. However, the longitudinal monitoring of lung function by micro-CT can be challenging. Distinctive datasets corresponding to the end-inspiration and end-expiration phases need to be generated and analyzed to derive lung functional parameters. The quality of CT scans and the reliability of parameters obtained remains highly dependent on the anesthesia protocol used. Three different anesthetic protocols were tested. The combination of dexmedetomidine 0.25 mg/kg injected intraperitoneally followed by 1% isoflurane was found to facilitate CT imaging at 4 and 11 days after birth. Contrarily, isoflurane and ketamine plus xylazine were found unsuitable, and thus not investigated further. Total lung volumes significantly increased at day 11 compared to baseline in both respiratory phases, while lung tissue remained constant. As expected, functional residual capacity, air/tissue ratio and minute ventilation were significantly increased at day 11 in each animal. Those parameters were correlated with inspiratory capacity, compliance, elastance and resistance of both respiratory system and tissue component, as measured by flexiVent. Lung development was also evaluated by histomorphometric analyses. In conclusion, we have identified a safe and suitable anesthesia protocol for micro-CT imaging in neonatal rabbits. Moreover, the possibility to longitudinally measure lung function in the same subject dramatically reduced the intra-experimental variability.
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Affiliation(s)
- Erica Ferrini
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Ludovica Leo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luisa Corsi
- Chiesi Farmaceutici S.p.A., Corporate Pre-Clinical R&D, Parma, Italy
| | - Chiara Catozzi
- Chiesi Farmaceutici S.p.A., Corporate Pre-Clinical R&D, Parma, Italy
| | - Fabrizio Salomone
- Chiesi Farmaceutici S.p.A., Corporate Pre-Clinical R&D, Parma, Italy
| | - Luisa Ragionieri
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Francesca Pennati
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
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