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Sánchez-Díez S, Muñoz X, Montalvo T, Ojanguren I, Romero-Mesones C, Senar JC, Peracho-Tobeña V, Cruz MJ. Sensitization to avian and fungal proteins in different work environments. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:96. [PMID: 37957771 PMCID: PMC10644561 DOI: 10.1186/s13223-023-00852-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Hypersensitivity pneumonitis (HP) is usually caused by the inhalation of avian and fungal proteins. The present study assesses a cohort of Urban Pest Surveillance and Control Service (UPSCS) workers with high exposure to avian and fungal antigens, in order to identify their degree of sensitization and the potential risk of developing HP. METHODS Workers were divided according to their work activity into Nest pruners (Group 1) and Others (Group 2). All individuals underwent a medical interview, pulmonary function tests and the determination of specific IgG antibodies. Antigenic proteins of pigeon sera were analysed using two-dimensional immunoblotting. Proteins of interest were sequenced by liquid-chromatography-mass spectrometry (LC-MS). RESULTS 101 workers were recruited (76 men, average age: 42 yrs); (Group 1 = 41, Group 2 = 60). Up to 30% of the study population exhibited increased levels of IgGs to pigeon, small parrot and parrot, and up to 60% showed high levels of Aspergillus and Penicillium IgGs. In Group 1, specific parakeet and Mucor IgGs were higher (p = 0.044 and 0.003 respectively) while DLCO/VA% were lower (p = 0.008) than in Group 2. Two-dimensional immunoblotting showed protein bands of 20-30 KDa recognized by HP patients but not by workers. LC-MS analysis identified Ig Lambda chain and Apolipoprotein A-I as candidate proteins for distinguishing HP patients from exposed workers. CONCLUSIONS Two pigeon proteins were identified that may play a role in the development of pathological differences between HP patients and exposed workers. DLCO/VA may have a predictive value in the development of HP disease.
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Affiliation(s)
- Silvia Sánchez-Díez
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Passeig Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Xavier Muñoz
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Passeig Vall d'Hebron, 119, 08035, Barcelona, Spain.
- CIBER Enfermedades Respiratorias (Ciberes), Madrid, Spain.
| | - Tomás Montalvo
- Servicio de Vigilancia y Control de Plagas Urbanas Agencia de Salud Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (Ciberesp), Madrid, Spain
| | - Iñigo Ojanguren
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Passeig Vall d'Hebron, 119, 08035, Barcelona, Spain
- CIBER Enfermedades Respiratorias (Ciberes), Madrid, Spain
| | - Christian Romero-Mesones
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Passeig Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Juan Carlos Senar
- Departamento de Ecología Evolutiva y de la Conducta, Museo de Ciencias Naturales de Barcelona, Barcelona, Spain
| | - Victor Peracho-Tobeña
- Servicio de Vigilancia y Control de Plagas Urbanas Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - María-Jesús Cruz
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Passeig Vall d'Hebron, 119, 08035, Barcelona, Spain
- CIBER Enfermedades Respiratorias (Ciberes), Madrid, Spain
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Trușculescu AA, Manolescu DL, Broască L, Ancușa VM, Ciocârlie H, Pescaru CC, Vaștag E, Oancea CI. Enhancing Imagistic Interstitial Lung Disease Diagnosis by Using Complex Networks. Medicina (B Aires) 2022; 58:medicina58091288. [PMID: 36143965 PMCID: PMC9504499 DOI: 10.3390/medicina58091288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/28/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: Diffuse interstitial lung diseases (DILD) are a heterogeneous group of over 200 entities, some with dramatical evolution and poor prognostic. Because of their overlapping clinical, physiopathological and imagistic nature, successful management requires early detection and proper progression evaluation. This paper tests a complex networks (CN) algorithm for imagistic aided diagnosis fitness for the possibility of achieving relevant and novel DILD management data. Materials and Methods: 65 DILD and 31 normal high resolution computer tomography (HRCT) scans were selected and analyzed with the CN model. Results: The algorithm is showcased in two case reports and then statistical analysis on the entire lot shows that a CN algorithm quantifies progression evaluation with a very fine accuracy, surpassing functional parameters’ variations. The CN algorithm can also be successfully used for early detection, mainly on the ground glass opacity Hounsfield Units band of the scan. Conclusions: A CN based computer aided diagnosis could provide the much-required data needed to successfully manage DILDs.
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Affiliation(s)
- Ana Adriana Trușculescu
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timișoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Diana Luminița Manolescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania
- Correspondence:
| | - Laura Broască
- Department of Computer and Information Technology, Automation and Computers Faculty, “Politehnica” University of Timișoara, Vasile Pârvan Blvd. No. 2, 300223 Timișoara, Romania
| | - Versavia Maria Ancușa
- Department of Computer and Information Technology, Automation and Computers Faculty, “Politehnica” University of Timișoara, Vasile Pârvan Blvd. No. 2, 300223 Timișoara, Romania
| | - Horia Ciocârlie
- Department of Computer and Information Technology, Automation and Computers Faculty, “Politehnica” University of Timișoara, Vasile Pârvan Blvd. No. 2, 300223 Timișoara, Romania
| | - Camelia Corina Pescaru
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timișoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Emanuela Vaștag
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timișoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Cristian Iulian Oancea
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timișoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timișoara, Romania
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Sánchez-Díez S, Munoz X, Ojanguren I, Romero-Mesones C, Espejo D, Villar A, Gómez-Olles S, Cruz MJ. YKL-40 and KL-6 Levels in Serum and Sputum of Patients Diagnosed With Hypersensitivity Pneumonitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2414-2423. [PMID: 35788062 DOI: 10.1016/j.jaip.2022.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND YKL-40 (chitinase 3-like-1) and Krebs von den Lungen-6 (KL-6) are 2 promising biomarkers that may have an important role in the management of interstitial lung diseases (ILD). OBJECTIVE The aim of this study was to investigate the values of KL-6 and YKL-40 as biomarkers in the diagnosis and prognosis of patients with hypersensitivity pneumonitis (HP). METHODS A cross-sectional study conducted in 49 patients diagnosed with HP due to exposure to birds (n = 32) or fungi (n = 17), 48 patients with other ILD, and 67 healthy volunteers. Patients with HP were divided into fibrotic and nonfibrotic. Serum and sputum YKL-40 and KL-6 levels were determined using commercial enzyme-linked immunosorbent assay kits. Receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of both biomarkers for the diagnosis of HP. Pulmonary function tests were performed in patients during follow-up. RESULTS KL-6 and YKL-40 levels were significantly higher in serum of patients with HP exposed to birds with a fibrotic pattern than in controls (P < .0001 and .0055, respectively). Serum KL-6 levels were also significantly higher in patients with fibrotic HP exposed to fungi compared with the control group (P = .0001). In patients with HP exposed to fungi, sputum KL-6 and YKL-40 levels were higher in those with a fibrotic pattern (P = .0289 and .016, respectively). ROC analysis showed that the range between 55-121 ng/mL for serum YKL-40 levels and 346-1441 U/mL for serum KL-6 levels had the best sensitivity and specificity for discriminating between patients with HP, healthy controls, and patients with idiopathic pulmonary fibrosis (IPF). In patients with HP, serum KL-6 levels correlated negatively with total lung capacity (r = -0.485; P = .0103) and diffusing capacity of the lungs for carbon monoxide (r = -0.534; P = .0002) at 12 months. CONCLUSIONS Both KL-6 and YKL-40 proteins seem to be capable of distinguishing patients with HP from healthy individuals and from patients with IPF. Their sensitivity and specificity confirm their potential role as biomarkers. KL-6 may also be a predictor of disease progression.
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Affiliation(s)
- Silvia Sánchez-Díez
- Pulmonology Service, Department of Medicine, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Xavier Munoz
- Pulmonology Service, Department of Medicine, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, Spain.
| | - Iñigo Ojanguren
- Pulmonology Service, Department of Medicine, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Christian Romero-Mesones
- Pulmonology Service, Department of Medicine, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - David Espejo
- Pulmonology Service, Department of Medicine, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Ana Villar
- Pulmonology Service, Department of Medicine, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Susana Gómez-Olles
- Pulmonology Service, Department of Medicine, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - María-Jesús Cruz
- Pulmonology Service, Department of Medicine, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
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Pediatric hypersensitivity pneumonitis: literature update and proposal of a diagnostic algorithm. Ital J Pediatr 2022; 48:51. [PMID: 35346317 PMCID: PMC8962565 DOI: 10.1186/s13052-022-01239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is a rare disease in childhood with the prevalence of 4 cases per 1 million children and an incidence of 2 cases per year. The average age of diagnosis at pediatric age is approximately 10 years. The pathogenesis of HP is characterized by an immunological reaction caused by recurrent exposure to triggering environmental agents (mostly bird antigens in children). The clinical picture of HP is complex and variable in children, often presenting in subacute forms with cough and exertion dyspnea. A diagnosis of HP should be considered in patients with an identified exposure to a triggering antigen, respiratory symptoms, and radiologic signs of interstitial lung disease. Blood tests and pulmonary function tests (PFT) support the diagnosis. Bronchoscopy (with bronchoalveolar lavage and tissue biopsy) may be needed in unclear cases. Antigen provocation test is rarely required. Of note, the persistence of symptoms despite various treatment regimens may support HP diagnosis. The avoidance of single/multiple triggers is crucial for effective treatment. No evidence- based guidelines for treatment are available; in particular, the role of systemic glucocorticoids in children is unclear. With adequate antigen avoidance, the prognosis in children with HP is generally favorable.
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Sánchez-Díez S, Cruz MJ, Álvarez-Simón D, Montalvo T, Muñoz X, Hoet PM, Vanoirbeek JA, Gómez-Ollés S. A rapid test for the environmental detection of pigeon antigen. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 788:147789. [PMID: 34134383 PMCID: PMC8404041 DOI: 10.1016/j.scitotenv.2021.147789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Avoidance of inhaled bird antigens is essential to prevent hypersensitivity pneumonitis disease progression. The aim of the present study was to develop a sandwich enzyme link immunoassay (ELISA) and an immunochromatographic test (ICT) and compare their ability to detect pigeon antigens in environmental samples. METHODS An amplified sandwich ELISA using pigeon serum as a calibration standard and a ICT using gold-labeled anti-pigeon serum antibodies for the rapid detection of pigeon antigens in environmental samples were developed. Twenty-two different airborne samples were collected and analysed using both methods. Strip density values obtained with ICT were calculated and compared with the concentrations determined by the ELISA method for pigeon antigens. Strips results were also visually analysed by five independent evaluators. RESULTS The ELISA method to quantify pigeon antigen had a broader range (58.4 and 10,112.2 ng/ml), compared to the ICT assay (420 to 3360 ng/ml). A kappa index of 0.736 (p < 0.0001) was obtained between the observers evaluating the ICT strips. The results of the ELISA and the relative density of the ICT showed a highly significant correlation (rs:0.935; p < 0.0001). Bland-Altman plot also confirmed excellent agreement between the two methods (mean difference: -1.626; p < 0.0001). CONCLUSIONS Since there was a good correlation between both assays, we can conclude that the rapid and simple ICT assay is a good and valid alternative, which does not require expensive equipment, for the validated ELISA technique.
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Affiliation(s)
- Silvia Sánchez-Díez
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain; CIBER Enfermedades Respiratorias (Ciberes), Madrid, Spain
| | - María-Jesús Cruz
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain; CIBER Enfermedades Respiratorias (Ciberes), Madrid, Spain.
| | - Daniel Álvarez-Simón
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain
| | - Tomás Montalvo
- Servicio de Vigilancia y Control de Plagas Urbanas, Agencia de Salud Pública de Barcelona, Spain; CIBER de Epidemiología y Salud Pública (Ciberesp), Madrid, Spain
| | - Xavier Muñoz
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain; CIBER Enfermedades Respiratorias (Ciberes), Madrid, Spain; Departamento de Biología Celular, Fisiología e Inmunología, Universidad Autónoma de Barcelona, Cataluña, Spain
| | - Peter M Hoet
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Jeroen A Vanoirbeek
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Susana Gómez-Ollés
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain; CIBER Enfermedades Respiratorias (Ciberes), Madrid, Spain
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Tony FA, Soliman YMA, Salem HA. Effect of Oral Methyl Prednisolone on Different Radiological Patterns of Hypersensitivity Pneumonitis. J Asthma Allergy 2021; 14:501-511. [PMID: 34007188 PMCID: PMC8121673 DOI: 10.2147/jaa.s299939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/09/2021] [Indexed: 12/29/2022] Open
Abstract
Background Hypersensitivity pneumonitis (HP) is an immune-mediated disorder that causes inflammation of interstitial lung, bronchioles, and alveoli. Although corticosteroids have been used as first line treatment for HP for many years, it does not provide satisfactory results in all patients. The aim of this study is to compare the effect of oral methylprednisolone on different radiological patterns of HP to identify the most adequate candidates for corticosteroids. Patients and Methods Fifty-three patients with confirmed diagnosis of HP were divided into two groups according to their radiological patterns based on high resolution computed tomography (HRCT) findings. The first group included 21 patients with fibrotic HP (fHP), the second group included 32 patients without fibrosis; non-fibrotic HP patients (nfHP). The second group is divided into 3 subgroups: mosaic, attenuation, centrilobular nodules and finally, ground-glass opacities. All patients were administered methylprednisolone by dose 0.5mg/kg/day for eight consecutive weeks. HRCT was performed at the beginning of the study. Spirometry, six-minute walk and oximetry were performed periodically to assess the patients' progress. Results Upon finalizing the treatment process, a significant improvement was noticed in FEV1 (p < 0.001), FVC (p <0.001), six-minute walk test (p =0.001) and oximetry (p <0.05) in nfHP compared to the fHP patients. However, there was a significant improvement in (p <0.01), FVC (p <0.01), oximetry (p <0.01) and six-minute walk test (p <0.01) in fibrotic patients after receiving the treatment. There was no significant difference in the response of FEV1 (p =0.82), FVC (p =0.15), six-minute walk test (p =0.36) and oximetry (p =0.27) among the subgroups of nfHP patients. Conclusion It was accordingly concluded that corticosteroid treatment is more effective in treatment of nfHP than fHP patients but still has effect on fibrotic patients. There is no significant difference in the response to corticosteroids among nfHP patients' subgroups.
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Affiliation(s)
- Fatma Ahmed Tony
- Clinical Pharmacy Department, Faculty of Pharmacy, British University in Egypt (BUE), Cairo, Egypt
| | | | - Hoda A Salem
- Pharmacy Practice Department, Faculty of Pharmacy, Tabuk University and Al-Azhar University, Nasr City, Egypt
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Ceci Bonello E, Gauci J, Bonello S, Fsadni P, Montefort S. Rituximab therapy in a patient with steroid-refractory bird fancier's lung. BMJ Case Rep 2020; 13:13/12/e237232. [PMID: 33370981 PMCID: PMC7757452 DOI: 10.1136/bcr-2020-237232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 62-year-old woman presented with a 3-month history of shortness of breath on exertion and dry cough. On examination, she was noted to have fine end-inspiratory crepitations over the upper zone of the lungs. Pulmonary function tests (PFTs) showed a restrictive defect. Initial chest radiography revealed diffuse reticular interstitial shadowing while high-resolution CT scan of the thorax showed fibrotic changes. Avian precipitins were also highly positive for pigeons, parrots and budgerigars. Taking into account these results, the patient was diagnosed with hypersensitivity pneumonitis. Antigen avoidance, oral glucocorticoids and azathioprine achieved an initial improvement in PFTs and symptoms; however, the patient still deteriorated, requiring long-term oxygen therapy. While working the patient up for lung transplantation, rituximab was given to good effect (acting as a bridging therapy) as it achieved symptomatic relief and stabilisation of her PFTs.
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Affiliation(s)
| | - Jonathan Gauci
- Department of Respiratory Medicine, Mater Dei Hospital, L-Imsida, Malta
| | - Sarah Bonello
- Department of Respiratory Medicine, Mater Dei Hospital, L-Imsida, Malta
| | - Peter Fsadni
- Department of Respiratory Medicine, Mater Dei Hospital, L-Imsida, Malta
| | - Stephen Montefort
- Department of Respiratory Medicine, Mater Dei Hospital, L-Imsida, Malta
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Ramírez-Aragón M, Hernández-Sánchez F, Rodríguez-Reyna TS, Buendía-Roldán I, Güitrón-Castillo G, Núñez-Alvarez CA, Hernández-Ramírez DF, Benavides-Suárez SA, Esquinca-González A, Torres-Machorro AL, Mendoza-Milla C. The Transcription Factor SCX is a Potential Serum Biomarker of Fibrotic Diseases. Int J Mol Sci 2020; 21:ijms21145012. [PMID: 32708589 PMCID: PMC7404299 DOI: 10.3390/ijms21145012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/19/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022] Open
Abstract
Fibrosing diseases are causes of morbidity and mortality around the world, and they are characterized by excessive extracellular matrix (ECM) accumulation. The bHLH transcription factor scleraxis (SCX) regulates the synthesis of ECM proteins in heart fibrosis. SCX expression was evaluated in lung fibroblasts and tissue derived from fibrotic disease patients and healthy controls. We also measured SCX in sera from 57 healthy controls, and 56 Idiopathic Pulmonary Fibrosis (IPF), 40 Hypersensitivity Pneumonitis (HP), and 100 Systemic Sclerosis (SSc) patients. We report high SCX expression in fibroblasts and tissue from IPF patients versus controls. High SCX-serum levels were observed in IPF (0.663 ± 0.559 ng/mL, p < 0.01) and SSc (0.611 ± 0.296 ng/mL, p < 0.001), versus controls (0.351 ± 0.207 ng/mL) and HP (0.323 ± 0.323 ng/mL). Serum levels of the SCX heterodimerization partner, TCF3, did not associate with fibrotic illness. IPF patients with severely affected respiratory capacities and late-stage SSc patients presenting anti-topoisomerase I antibodies and interstitial lung disease showed the highest SCX-serum levels. SCX gain-of-function induced the expression of alpha-smooth muscle actin (α-SMA/ACTA2) in fibroblasts when co-overexpressed with TCF3. As late and severe stages of the fibrotic processes correlated with high circulating SCX, we postulate it as a candidate biomarker of fibrosis and a potential therapeutic target.
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Affiliation(s)
- Miguel Ramírez-Aragón
- Departamento de Investigación en Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Belisario Domínguez Sección XVI, Alcaldía Tlalpan, Mexico City 14080, Mexico; (M.R.-A.); (I.B.-R.); (G.G.-C.)
- Departamento de Neuropatología Molecular, División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de Mexico, Mexico City 04510, Mexico
| | - Fernando Hernández-Sánchez
- Departamento de Investigación en Virología y Micología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Belisario Domínguez Sección XVI, Alcaldía Tlalpan, Mexico City 14080, Mexico;
| | - Tatiana S. Rodríguez-Reyna
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI. Alcaldía Tlalpan, Mexico City 14080, Mexico; (T.S.R.-R.); (C.A.N.-A.); (D.F.H.-R.); (S.A.B.-S.); (A.E.-G.)
| | - Ivette Buendía-Roldán
- Departamento de Investigación en Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Belisario Domínguez Sección XVI, Alcaldía Tlalpan, Mexico City 14080, Mexico; (M.R.-A.); (I.B.-R.); (G.G.-C.)
| | - Gael Güitrón-Castillo
- Departamento de Investigación en Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Belisario Domínguez Sección XVI, Alcaldía Tlalpan, Mexico City 14080, Mexico; (M.R.-A.); (I.B.-R.); (G.G.-C.)
| | - Carlos A. Núñez-Alvarez
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI. Alcaldía Tlalpan, Mexico City 14080, Mexico; (T.S.R.-R.); (C.A.N.-A.); (D.F.H.-R.); (S.A.B.-S.); (A.E.-G.)
| | - Diego F. Hernández-Ramírez
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI. Alcaldía Tlalpan, Mexico City 14080, Mexico; (T.S.R.-R.); (C.A.N.-A.); (D.F.H.-R.); (S.A.B.-S.); (A.E.-G.)
| | - Sergio A. Benavides-Suárez
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI. Alcaldía Tlalpan, Mexico City 14080, Mexico; (T.S.R.-R.); (C.A.N.-A.); (D.F.H.-R.); (S.A.B.-S.); (A.E.-G.)
| | - Alexia Esquinca-González
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI. Alcaldía Tlalpan, Mexico City 14080, Mexico; (T.S.R.-R.); (C.A.N.-A.); (D.F.H.-R.); (S.A.B.-S.); (A.E.-G.)
| | - Ana Lilia Torres-Machorro
- Departamento de Investigación en Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Belisario Domínguez Sección XVI, Alcaldía Tlalpan, Mexico City 14080, Mexico; (M.R.-A.); (I.B.-R.); (G.G.-C.)
- Consejo Nacional de Ciencia y Tecnología and Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Belisario Domínguez Sección XVI, Alcaldía Tlalpan, Mexico City 14080, Mexico
- Correspondence: (A.L.T.-M.); (C.M.-M.); Tel.: +52-555-487-1700 (ext.5257) (A.L.T.-M. & C.M.-M.)
| | - Criselda Mendoza-Milla
- Departamento de Investigación en Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Belisario Domínguez Sección XVI, Alcaldía Tlalpan, Mexico City 14080, Mexico; (M.R.-A.); (I.B.-R.); (G.G.-C.)
- Correspondence: (A.L.T.-M.); (C.M.-M.); Tel.: +52-555-487-1700 (ext.5257) (A.L.T.-M. & C.M.-M.)
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Sánchez-Ortiz M, Cruz MJ, Sánchez-Díez S, Villar A, Ojanguren I, Muñoz X. Immunomodulatory effect of pigeon serum in an acute and chronic murine model of bird fanciers lung. ENVIRONMENTAL RESEARCH 2020; 182:108981. [PMID: 31830693 DOI: 10.1016/j.envres.2019.108981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Since the immunopathological mechanisms of bird fancier's lung (BFL) are not well known, we created two models of the disease (acute and chronic BFL) to study and compare the pathways involved in its immunopathogenesis. MATERIALS AND METHODS C57BL/6 mice were used. Two intraperitoneal injections of 100 μL of commercial pigeon serum (PS) or saline (SAL) were administered with an interval of 48 h in between. Subsequently, intranasal instillations of 40 μL of PS or SAL were performed three days a week, for three weeks in the acute model (AC/PS) and for twelve weeks in the chronic model (CR/PS). Total lung capacity (TLC) was assessed. Pulmonary inflammation was evaluated in bronchoalveolar lavage (BAL), and total serum immunoglobulin (Ig) G was measured in serum samples 24 h, 7 days and 14 days after the last exposure. Histological studies of lungs were assessed. RESULTS A drop in TLC was observed in treated mice. This decrease was more marked in the CR/PS group (p < 0.001). Neutrophil and lymphocyte counts increased in both AC/PS and CR/PS groups (p < 0.01). The extent of airway inflammation was also examined in the histological analysis of the lungs, which showed predominant perivascular and peribronchiolar inflammation, with centrilobular oedema and subpleural inflammation in the AC/PS group. In the CR/PS group, the changes were greater, with increased levels of IL-5, IL-17F, IL-13 and IL-10 and decreased levels of IL-2. CONCLUSIONS Bronchial inflammation is present in acute and chronic models of HP following exposure to PS. Our results support the role of neutrophils and IL-17 in the development of the disease and an evolution towards a Th-2 immune response in chronic HP. These models may serve as a tool for future studies of the pathogenesis of HP.
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Affiliation(s)
- M Sánchez-Ortiz
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Spain
| | - M J Cruz
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER Respiratory Diseases (Ciberes), Spain.
| | - S Sánchez-Díez
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Villar
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER Respiratory Diseases (Ciberes), Spain
| | - I Ojanguren
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER Respiratory Diseases (Ciberes), Spain
| | - X Muñoz
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER Respiratory Diseases (Ciberes), Spain; Department of Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Spain
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10
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Shiroshita A, Tanaka Y, Nakashima K, Furukawa Y, Kataoka Y. Diagnostic accuracy of specific IgG antibodies for bird fancier's lung: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:655. [PMID: 31930056 DOI: 10.21037/atm.2019.10.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Serologic assays for specific immunoglobulin G (IgG) antibodies are available for diagnosing the condition of bird fancier's lung, however, their usefulness is controversial. This systematic review was aimed at investigating the diagnostic accuracy of specific IgG antibodies used for avian antigens. Methods Medline, Embase, the Cochrane Library, the International Clinical Trials Registry Platform, and the Web of Science were searched for studies performed to evaluate the diagnostic accuracy of the Ouchterlony method, enzyme-linked immunosorbent assays (ELISAs), electrosyneresis, and ImmunoCAP assays for diagnosing bird fancier's lung. Nine articles were included in the meta-analysis. The pooled sensitivity and specificity were summarized using a bivariate mixed-effects model, and a hierarchical summary receiver operating characteristic curve was rendered to determine the diagnostic accuracy of the antibodies. Results The pooled sensitivities and specificities of each specific IgG antibody were 82.9% (95% confidence interval, 71.1-90.5%) and 93.0% (95% confidence interval, 74.4-98.4%) for the Ouchterlony method, 92.5% (95% confidence interval, 71.3-98.4%) and 90.8% (95% confidence interval, 72.1-97.4%) for ELISAs, 90.0% (95% confidence interval, 55.5-99.7%) and 84.6% (95% confidence interval, 73.5-92.4%) for the electrosyneresis method, and 43.5% (95% confidence interval, 35.3-52.1%) and 100% (95% confidence interval, 0-100%) for ImmunoCAP assays. The overall quality of the collective evidence was low, primarily due to the high risk of bias, indirectness, and imprecision of the included studies. Conclusions The Ouchterlony method demonstrated high specificity, the ELISA method showed high sensitivity, and the diagnostic utilities of electrosyneresis and ImmunoCAP assay testing remain unclear.
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Affiliation(s)
| | - Yu Tanaka
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Kei Nakashima
- Department of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | | | - Yuki Kataoka
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.,Department of Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
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11
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Morell F, Ojanguren I, Villar A, Ramon MA, Muñoz X, Cruz MJ. Addition of Rituximab to Oral Corticosteroids in the Treatment of Chronic Hypersensitivity Pneumonitis. Arch Bronconeumol 2019; 56:254-256. [PMID: 31506211 DOI: 10.1016/j.arbres.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/04/2019] [Accepted: 07/05/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Ferran Morell
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Iñigo Ojanguren
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Servei de Pneumología, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Ana Villar
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Servei de Pneumología, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - María Antonia Ramon
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Xavier Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Servei de Pneumología, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - María Jesús Cruz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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12
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Ojanguren I, Morell F, Ramón M, Villar A, Romero C, Cruz MJ, Muñoz X. Long-term outcomes in chronic hypersensitivity pneumonitis. Allergy 2019; 74:944-952. [PMID: 30515826 DOI: 10.1111/all.13692] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 08/13/2018] [Accepted: 08/26/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The objective of this study was to analyze mortality, possible predictors of long-term survival, and health-related quality of life of a large chronic hypersensitivity pneumonitis (CHP) patient sample. METHODS Longitudinal study in patients diagnosed with CHP during 2004-2013, followed for at least 1 year. Patients remaining alive and consenting to participate had a follow-up visit during 2015, including a complete pulmonary function study and the EuroQol-5D and Beck Depression and Anxiety Inventories. RESULTS Out of the 160 patients finally included, 87 remained alive. Seventy-three had died or underwent lung transplantation at the time of the study with a median survival of 7.0 (4.4-14.5) years. A Cox proportional risk model showed that factors associated with lower survival were as follows: increased age, a low percentage of lymphocytes in bronchoalveolar lavage (BAL), a decreased transfer factor of the lung for carbonmonoxide (DLCO), presence of honeycomb in the high-resolution chest scan (HRCT), and the usual interstitial pneumonia (UIP) histologic pattern. At follow-up, all patients presented an EuroQol-5D score <0.8 and 21(50%) and 9(28.6%) subjects presented a probable anxiety and depressive syndrome, respectively. CONCLUSION CHP is a severe disease with a bad mid-term prognosis. Lymphocyte values in BAL and DLCO values at baseline, presence of honeycomb in HRCT, and UIP histologic pattern were found to be predictors of survival. Early accurate diagnosis of the disease is fundamental for prompt initiation of antigen avoidance.
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Affiliation(s)
- Iñigo Ojanguren
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
- CIBER Enfermedades Respiratorias (Ciberes) Madrid Spain
| | - Ferran Morell
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
- CIBER Enfermedades Respiratorias (Ciberes) Madrid Spain
| | - María‐Antonia Ramón
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
| | - Ana Villar
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
- CIBER Enfermedades Respiratorias (Ciberes) Madrid Spain
| | - Christian Romero
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
| | - María Jesús Cruz
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
- CIBER Enfermedades Respiratorias (Ciberes) Madrid Spain
| | - Xavier Muñoz
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
- CIBER Enfermedades Respiratorias (Ciberes) Madrid Spain
- Departamento de Biología Celular Fisiología e inmunología Universidad Autónoma de Barcelona Barcelona Cataluña España
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Adams TN, Newton CA, Batra K, Abu-Hijleh M, Barbera T, Torrealba J, Glazer CS. Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis. Lung 2018; 196:617-622. [PMID: 29959521 DOI: 10.1007/s00408-018-0139-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Making the diagnosis of HP is challenging due to a lack of consensus criteria and variability of both pathologic and radiographic findings. The purpose of this retrospective study was to determine the diagnostic utility of the combination of BAL lymphocyte count and TBBX in patients with HP. METHODS We conducted a retrospective cohort study of all patients with a MDD diagnosis of HP at a single center. RESULTS 155 patients were included in the study. 49% of patients who underwent BAL had a lymphocyte count > 20, 42% had a lymphocyte count > 30, and 34% had lymphocyte count > 40%. The median BAL lymphocyte count was higher in inflammatory HP compared to fibrotic HP. The addition of TBBX to BAL significantly increased the diagnostic yield regardless of the BAL lymphocyte cutoff used. The yield of bronchoscopy with TBBX and BAL when a lymphocyte count > 40% was used as a cutoff was 52%. CONCLUSIONS Our study suggests that the combination of TBBX with BAL significantly increases the likelihood that the procedure will provide adequate additional information to allow a confident MDD diagnosis of HP and may reduce the need for SLB in the diagnostic workup of HP.
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Affiliation(s)
- Traci N Adams
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA.
| | - Chad A Newton
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Muhanned Abu-Hijleh
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Tyonn Barbera
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Jose Torrealba
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig S Glazer
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
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Bhattacharyya P, Dasgupta S, Paul M, Saha D, Sengupta S, Bhattacharyya PP. High-resolution computerized tomography changes in diffuse parenchymal lung disease from chronic hypersensitivity pneumonitis related to bird antigen. Lung India 2018; 35:215-219. [PMID: 29697078 PMCID: PMC5946554 DOI: 10.4103/lungindia.lungindia_293_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Chronic hypersensitivity pneumonitis (HP) is the most common cause of diffuse parenchymal lung disease (DPLD) in India. There is no data regarding the avian antigen exposure-associated DPLD from the country. Methods: Chronic HP from exposure to avian antigen was diagnosed when the high resolution computerized tomography (HRCT) showed features for HP and was supported by the history of exposure to pigeons, the presence of precipitin antibodies (IgG) to avian antigen in high titre with negative rheumatoid factor, antinuclear antibody, and no clinical clue for a collagen vascular disease. The HRCT changes were noted on Likert scale (0–5) in terms of affection of peripheral and/or axial involvement, reticulation, honeycombing, haze, mosaic, traction bronchiectasis, pleural reactions, features of pulmonary hypertension, and air cysts. Cardiomegaly and independent cardiac chamber enlargement were also recorded. Results: The lower lobes were predominantly (65.6%) affected with similar frequency (78.1) of peripheral and axial parenchymal affection. The parenchymal changes in HRCT were haze or ground-glass opacity (100%), mosaic appearance (93.75%), reticulations (68.75%), traction bronchiectasis (34.3%), air cysts (21.8%), and honeycombing (9.37%). Pleural reactions, though not described so far, were found in 50% of cases. Features of pulmonary hypertension (87.5%), cardiomegaly (50%), left and right atrial enlargement (81.2% and 78.1%), and right ventricular enlargement (31.2%) were the common echocardiography findings. Conclusion: Chronic HP from avian exposure shows predominantly lower lobe involvement with haze, reticulation, features of pulmonary hypertension, and pleural reactions as common HRCT findings. The likelihood of pulmonary hypertension appears high and although honeycombing is often present, the classical UIP pattern has not been found.
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Affiliation(s)
| | - Sanjukta Dasgupta
- Research Scholar, School of Medical Science and Technology, IIT Kharagpur, West Bengal, India
| | - Mintu Paul
- Department of Parenchymal Lung Disease, Institute of Pulmocare and Research, Kolkata, West Bengal, India
| | - Dipanjan Saha
- Department of Parenchymal Lung Disease, Institute of Pulmocare and Research, Kolkata, West Bengal, India
| | - Sayoni Sengupta
- Department of Parenchymal Lung Disease, Institute of Pulmocare and Research, Kolkata, West Bengal, India
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CT findings associated with survival in chronic hypersensitivity pneumonitis. Eur Radiol 2017; 27:5127-5135. [DOI: 10.1007/s00330-017-4936-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/01/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
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Abd El-Kareem D, Akl YM, Nakhla GA, Elhindawi AA, Eltorky MA. Clinico- pathologic presentation of hypersensitivity pneumonitis in Egyptian patients: a multidisciplinary study. Multidiscip Respir Med 2017; 12:10. [PMID: 28503304 PMCID: PMC5421323 DOI: 10.1186/s40248-017-0091-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/12/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) is a common diffuse parenchymal lung disease in Egypt which can be difficult to recognize due to the dynamic symptoms & associated environmental factors. METHODS Forty-three Egyptian patients were enrolled in this study, presenting with dyspnea and cough, predominant ground-glass opacity (GGO) in high-resolution computed tomography (HRCT) where lung biopsy was needed to establish the diagnosis. RESULTS The age range was 15 to 60 years. Females represented 90.7% (39 patients) while 9.3% (4 patients) of our patients were males. History of contact with birds was detected in 9 (20.9%) patients. Most of our patients (60.5%) didn't have exposure history, and only 8 patients (18.6%) were living in geographic areas in Egypt that are known for the exposure to environmental etiologic factors (cane sugar exhaust fumes). The most common HRCT pattern was GGO with mosaic parenchyma in 18 patients (41.86%), followed by GGO with centrilobular nodules in 9 patients (20.93%), then isolated diffuse GGO in 5 patients (11.62%), GGO with traction bronchiectasis in 4 patients (9.3%), GGO with consolidation in 3 patients (6.97%), GGO with reticulations in 2 patients (4.65%), and GGO with cysts in 2 patients (4.65%). The most common histologic finding was isolated multinucleated giant cells in 38 patients (88.3%) commonly found in airspaces (24 patients) and less commonly in the interstitium (14 patients), followed by interstitial pneumonia and cellular bronchiolitis in 36 patients (83.7% each), interstitial ill-formed non-necrotizing granulomas in 12 patients (27.9%), fibrosis in 10 patients (23.2%), and organizing pneumonia pattern in 4 patients (9.3%). CONCLUSION The diagnosis of HP presenting with predominant GGO pattern in HRCT requires a close interaction among clinicians, radiologists, and pathologists. Some environmental and household factors may be underestimated as etiologic factors. Further environmental and genetic studies are needed especially in patients with negative exposure history.
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Affiliation(s)
- Dalia Abd El-Kareem
- Department of Pathology, Faculty of Medicine – Kasr Al-Ainy, Cairo University, Cairo, 11562 Egypt
| | - Yosri M. Akl
- Department of Pulmonary Medicine, Faculty of Medicine – Kasr Al-Ainy, Cairo University, Cairo, 11562 Egypt
| | - Gina A. Nakhla
- Department of Pathology, Faculty of Medicine – Kasr Al-Ainy, Cairo University, Cairo, 11562 Egypt
| | - Ali A. Elhindawi
- Department of Pathology, Faculty of Medicine – Kasr Al-Ainy, Cairo University, Cairo, 11562 Egypt
| | - Mahmoud A. Eltorky
- Department of Pathology, University of Texas Medical Branch (UTMB), 301 University Blvd #1, Galveston, TX 77555 USA
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Eng SS, DeFelice ML. The Role and Immunobiology of Eosinophils in the Respiratory System: a Comprehensive Review. Clin Rev Allergy Immunol 2016; 50:140-58. [PMID: 26797962 DOI: 10.1007/s12016-015-8526-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The eosinophil is a fully delineated granulocyte that disseminates throughout the bloodstream to end-organs after complete maturation in the bone marrow. While the presence of eosinophils is not uncommon even in healthy individuals, these granulocytes play a central role in inflammation and allergic processes. Normally appearing in smaller numbers, higher levels of eosinophils in the peripheral blood or certain tissues typically signal a pathologic process. Eosinophils confer a beneficial effect on the host by enhancing immunity against molds and viruses. However, tissue-specific elevation of eosinophils, particularly in the respiratory system, can cause a variety of short-term symptoms and may lead to long-term sequelae. Eosinophils often play a role in more commonly encountered disease processes, such as asthma and allergic responses in the upper respiratory tract. They are also integral in the pathology of less common diseases including eosinophilic pneumonia, allergic bronchopulmonary aspergillosis, hypersensitivity pneumonitis, and drug reaction with eosinophilia and systemic symptoms. They can be seen in neoplastic disorders or occupational exposures as well. The involvement of eosinophils in pulmonary disease processes can affect the method of diagnosis and the selection of treatment modalities. By analyzing the complex interaction between the eosinophil and its environment, which includes signaling molecules and tissues, different therapies have been discovered and created in order to target disease processes at a cellular level. Innovative treatments such as mepolizumab and benralizumab will be discussed. The purpose of this article is to further explore the topic of eosinophilic presence, activity, and pathology in the respiratory tract, as well as discuss current and future treatment options through a detailed literature review.
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Affiliation(s)
- Stephanie S Eng
- Thomas Jefferson University, Philadelphia, PA, USA
- Division of Allergy and Immunology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA
| | - Magee L DeFelice
- Thomas Jefferson University, Philadelphia, PA, USA.
- Division of Allergy and Immunology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA.
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Long X, He X, Ohshimo S, Griese M, Sarria R, Guzman J, Costabel U, Bonella F. Serum YKL-40 as predictor of outcome in hypersensitivity pneumonitis. Eur Respir J 2016; 49:13993003.01924-2015. [DOI: 10.1183/13993003.01924-2015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 09/29/2016] [Indexed: 01/13/2023]
Abstract
YKL-40, a chitinase-like protein mainly secreted by macrophages, neutrophils and epithelial cells, is increased in patients with idiopathic interstitial pneumonia and sarcoidosis. We aimed to investigate the role of YKL-40 as a biomarker in hypersensitivity pneumonitis (HP).72 HP patients, 100 interstitial lung disease (ILD) controls and 60 healthy controls were studied. YKL-40 was measured by ELISA in serum and bronchoalveolar lavage fluid (BALF) at baseline and follow-up. The relationship between YKL-40 levels, clinical variables and disease outcome was evaluated.Baseline serum YKL-40 levels were significantly higher in HP patients than in healthy controls (p<0.001), but lower than in patients with other ILDs. Baseline BALF YKL-40 levels in HP patients were the highest among ILD patients. In HP patients, serum YKL-40 correlated with the diffusing capacity of the lung for carbon monoxide at baseline (p<0.01) and over time (p<0.001). HP patients whose disease progressed or who died had higher baseline YKL-40 levels than those who remained stable and survived (p<0.001). At a cut-off of 119 ng·mL−1, the baseline serum YKL-40 level predicted disease progression (hazard ratio 6.567; p<0.001), and at a cut-off of 150 ng·mL−1 was associated with mortality (hazard ratio 9.989; p<0.001).Serum YKL-40 may be a useful prognostic biomarker in HP patients.
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Pereira CA, Gimenez A, Kuranishi L, Storrer K. Chronic hypersensitivity pneumonitis. J Asthma Allergy 2016; 9:171-181. [PMID: 27703382 PMCID: PMC5036552 DOI: 10.2147/jaa.s81540] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Hypersensitivity pneumonitis (HSP) is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary.
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Affiliation(s)
| | - Andréa Gimenez
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
| | - Lilian Kuranishi
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
| | - Karin Storrer
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
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Magee AL, Montner SM, Husain A, Adegunsoye A, Vij R, Chung JH. Imaging of Hypersensitivity Pneumonitis. Radiol Clin North Am 2016; 54:1033-1046. [PMID: 27719974 DOI: 10.1016/j.rcl.2016.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The management of hypersensitivity pneumonitis (HP) depends on early identification of the disease process, which is complicated by its nonspecific clinical presentation in addition to variable and diverse laboratory and radiologic findings. HP is the result of exposure and sensitization to myriad aerosolized antigens. HP develops in the minority of antigenic exposures, and conversely has been documented in patients with no identifiable exposure, complicating the diagnostic algorithm significantly. Prompt diagnosis and early intervention are critical in slowing the progression of irreversible parenchymal damage, and additionally in preserving the quality of life of affected patients.
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Affiliation(s)
- Andrea L Magee
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA.
| | - Steven M Montner
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA
| | - Aliya Husain
- Department of Pathology, The University of Chicago, 5841 South Maryland Avenue, #6101, Chicago, IL 60637, USA
| | - Ayodeji Adegunsoye
- Department of Pathology, The University of Chicago, 5841 South Maryland Avenue, #6101, Chicago, IL 60637, USA
| | - Rekha Vij
- Department of Pulmonology & Critical Care, The University of Chicago, 5841 South Maryland Avenue, MC6076, Chicago, IL 60637, USA
| | - Jonathan H Chung
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA
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Identification of Antigenic Proteins from Lichtheimia corymbifera for Farmer's Lung Disease Diagnosis. PLoS One 2016; 11:e0160888. [PMID: 27490813 PMCID: PMC4973876 DOI: 10.1371/journal.pone.0160888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/26/2016] [Indexed: 11/19/2022] Open
Abstract
The use of recombinant antigens has been shown to improve both the sensitivity and the standardization of the serological diagnosis of Farmer’s lung disease (FLD). The aim of this study was to complete the panel of recombinant antigens available for FLD serodiagnosis with antigens of Lichtheimia corymbifera, known to be involved in FLD. L. corymbifera proteins were thus separated by 2D electrophoresis and subjected to western blotting with sera from 7 patients with FLD and 9 healthy exposed controls (HEC). FLD-associated immunoreactive proteins were identified by mass spectrometry based on a protein database specifically created for this study and subsequently produced as recombinant antigens. The ability of recombinant antigens to discriminate patients with FLD from controls was assessed by ELISA performed with sera from FLD patients (n = 41) and controls (n = 43) recruited from five university hospital pneumology departments of France and Switzerland. Forty-one FLD-associated immunoreactive proteins from L. corymbifera were identified. Six of them were produced as recombinant antigens. With a sensitivity and specificity of 81.4 and 77.3% respectively, dihydrolipoyl dehydrogenase was the most effective antigen for discriminating FLD patients from HEC. ELISA performed with the putative proteasome subunit alpha type as an antigen was especially specific (88.6%) and could thus be used for FLD confirmation. The production of recombinant antigens from L. corymbifera represents an additional step towards the development of a standardized ELISA kit for FLD diagnosis.
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22
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Sayed SS, Agmy GM, Said AF, Kasem AH. Assessment of transthoracic sonography in patients with interstitial lung diseases. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.184375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Khalil N, Churg A, Muller N, O'Connor R. Environmental, Inhaled and Ingested Causes of Pulmonary Fibrosis. Toxicol Pathol 2016; 35:86-96. [PMID: 17325977 DOI: 10.1080/01926230601064787] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pulmonary fibrosis is a general term that refers to a collection of connective tissue around alveolar structures. There are over 200 disorders where the lungs may be involved in a fibrotic response. To determine the cause of pulmonary fibrosis requires an in depth understanding of the pathogenesis of pulmonary fibrosis and breadth of knowledge of the causative agents and associated disorders that may lead to pulmonary fibrosis. A comprehensive evaluation of the patient is absolutely essential, starting with detailed history that includes an occupational and environmental history because fibrogenic exposures can occur in many settings. Equally important is a history of ingestion of pharmaceutical or nonpharmaceutical substances. A physical examination and judicious investigations are always a part of any comprehensive clinical assessment but they are not commonly helpful in elucidating the cause of most pulmonary fibrotic disorders. Although, a chest film is invariably done, a logical and strongly recommended next step is a high-resolution computed tomography (HRCT). HRCT provides a better assessment of the radiological pattern, may suggest a diagnosis as well as direct the site, and type of lung biopsy. If the history and investigations do not lead to a diagnosis then a lung biopsy is required. Prevention or removal of the inciting agent is critical to the treatment of these disorders and in some instances corticosteroids may be of help.
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Affiliation(s)
- Nasreen Khalil
- Department of Medicine, Respiratory Division, Vancouver General Hospital, V5Z 1M9, The University of British Columbia, Canada.
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Cramer C, Schlünssen V, Bendstrup E, Stokholm ZA, Vestergaard JM, Frydenberg M, Kolstad HA. Risk of hypersensitivity pneumonitis and interstitial lung diseases among pigeon breeders. Eur Respir J 2016; 48:818-25. [PMID: 27230447 DOI: 10.1183/13993003.00376-2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/24/2016] [Indexed: 11/05/2022]
Abstract
We studied the risk of hypersensitivity pneumonitis and other interstitial lung diseases (ILDs) among pigeon breeders.This is a retrospective follow-up study from 1980 to 2013 of 6920 pigeon breeders identified in the records of the Danish Racing Pigeon Association. They were compared with 276 800 individually matched referents randomly drawn from the Danish population. Hospital based diagnoses of hypersensitivity pneumonitis and other ILDs were identified in the National Patient Registry 1977-2013. Stratified Cox regression analyses estimated the hazard ratios (HR) of hypersensitivity pneumonitis and other ILDs adjusted for occupation, residence and redeemed prescription of medication with ILDs as a possible side-effect. Subjects were censored at death, emigration or a diagnosis of connective tissue disease.The overall incidence rate of ILD was 77.4 per 100 000 person-years among the pigeon breeders and 50.0 among the referents. This difference corresponded to an adjusted HR of 1.56 (95% CI 1.26-1.94). The adjusted HRs of hypersensitivity pneumonitis and other ILDs for pigeon breeders were 14.36 (95% CI 8.10-25.44) and 1.33 (95% CI 1.05-1.69), respectively.This study shows an increased risk of ILD among pigeon breeders compared with the referent population. Protective measures are recommended even though ILD leading to hospital contact remains rare among pigeon breeders.
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Affiliation(s)
- Christine Cramer
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Vivi Schlünssen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Zara Ann Stokholm
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Frydenberg
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
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Pulmonary Function Abnormalities in Regard to Age at the Time of Diagnosis of Hypersensitivity Pneumonitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 861:75-84. [DOI: 10.1007/5584_2015_137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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26
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Rognon B, Reboux G, Roussel S, Barrera C, Dalphin JC, Fellrath JM, Monod M, Millon L. Western blotting as a tool for the serodiagnosis of farmer's lung disease: validation with Lichtheimia corymbifera protein extracts. J Med Microbiol 2015; 64:359-368. [PMID: 25666836 DOI: 10.1099/jmm.0.000037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/06/2015] [Indexed: 11/18/2022] Open
Abstract
Electrosyneresis and double diffusion are immunoprecipitation techniques commonly used in the serological diagnosis of Farmer's lung disease (FLD). These techniques are reliable but lack standardization. The aim of this study was to evaluate Western blotting for the serodiagnosis of FLD. We carried out Western blotting with an antigenic extract of Lichtheimia corymbifera, an important aetiological agent of the disease. The membranes were probed with sera from 21 patients with FLD and 21 healthy exposed controls to examine the IgG antibody responses against purified somatic antigens. Given the low prevalence of the disease, 21 patients could be considered as a relevant series. Four bands were significantly more frequently represented in membranes probed with FLD sera (bands at 27.7, 40.5, 44.0 and 50.5 kDa) than those probed with control sera. We assessed the diagnostic value of different criteria alone or in combination. The diagnostic accuracy of the test was highest with the inclusion of at least two of the following criteria: at least five bands on the strip and the presence of one band at 40.5 or 44.0 kDa. Sensitivity, specificity and positive and negative predictive values were all 81%, and the odds ratio was 18.06. Inclusion of bands of high intensity diminished rather than improved the diagnostic value of the test. We concluded that Western blotting is a valuable technique for the serodiagnosis of FLD. The industrial production of ready-to-use membranes would enable the routine use of this technique in laboratories, and provide reliable and standardized diagnostic results within a few hours.
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Affiliation(s)
- Bénédicte Rognon
- Parasitology-Mycology Department, University Hospital, Besançon, France.,UMR Chrono-Environnement 6249/CNRS, University of Besançon, France
| | - Gabriel Reboux
- Parasitology-Mycology Department, University Hospital, Besançon, France.,UMR Chrono-Environnement 6249/CNRS, University of Besançon, France
| | - Sandrine Roussel
- Parasitology-Mycology Department, University Hospital, Besançon, France.,UMR Chrono-Environnement 6249/CNRS, University of Besançon, France
| | - Coralie Barrera
- Parasitology-Mycology Department, University Hospital, Besançon, France.,UMR Chrono-Environnement 6249/CNRS, University of Besançon, France
| | - Jean-Charles Dalphin
- Department of Respiratory Disease, University Hospital, Besançon, France.,UMR Chrono-Environnement 6249/CNRS, University of Besançon, France
| | - Jean-Marc Fellrath
- Department of Pulmonary Medicine, University Hospital, Neuchatel, Switzerland
| | - Michel Monod
- Department of Dermatology, University Hospital, Lausanne, Switzerland
| | - Laurence Millon
- Parasitology-Mycology Department, University Hospital, Besançon, France.,UMR Chrono-Environnement 6249/CNRS, University of Besançon, France
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Immune responses to airborne fungi and non-invasive airway diseases. Semin Immunopathol 2014; 37:83-96. [DOI: 10.1007/s00281-014-0471-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/04/2014] [Indexed: 12/19/2022]
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Muñoz X, Sánchez-Ortiz M, Torres F, Villar A, Morell F, Cruz MJ. Diagnostic yield of specific inhalation challenge in hypersensitivity pneumonitis. Eur Respir J 2014; 44:1658-65. [PMID: 25142480 DOI: 10.1183/09031936.00060714] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Reliable methods are needed to diagnose hypersensitivity pneumonitis. The aim of the study was to establish the diagnostic yield of specific inhalation challenge (SIC) in patients with hypersensitivity pneumonitis. All patients with suspected hypersensitivity pneumonitis in whom SIC was performed (n=113) were included. SIC was considered positive when patients showed a decrease of >15% in forced vital capacity (FVC) or >20% in diffusing capacity of the lung for carbon dioxide, or a decrease of 10% to 15% in FVC accompanied by a temperature increase of 0.5°C within 24 h of inhalation of the antigen. SIC was positive to the agents tested in 68 patients: 64 received a diagnosis of hypersensitivity pneumonitis and SIC results were considered false-positive in the remaining four patients. In the SIC-negative group (n=45), 24 patients received a diagnosis of hypersensitivity pneumonitis and SIC results were considered false-negative, and 21 patients were diagnosed with other respiratory diseases. The sensitivity and specificity of the test were 72.7% and 84%, respectively. Having hypersensitivity pneumonitis caused by an antigen other than birds or fungi predicted a false-negative result (p=0.001). In hypersensitivity pneumonitis, positive SIC testing virtually confirms the diagnosis, whereas negative testing does not rule it out, especially when the antigenic sources are not birds or fungi.
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Affiliation(s)
- Xavier Muñoz
- Pulmonology Service, Medicine Dept, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER Enfermedades Respiratorias (Ciberes), Spain Dept of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mónica Sánchez-Ortiz
- Pulmonology Service, Medicine Dept, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER Enfermedades Respiratorias (Ciberes), Spain
| | - Ferran Torres
- Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Villar
- Pulmonology Service, Medicine Dept, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER Enfermedades Respiratorias (Ciberes), Spain
| | - Ferran Morell
- Pulmonology Service, Medicine Dept, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER Enfermedades Respiratorias (Ciberes), Spain
| | - María-Jesús Cruz
- Pulmonology Service, Medicine Dept, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER Enfermedades Respiratorias (Ciberes), Spain
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Villar A, Muñoz X, Sanchez-Vidaurre S, Gómez-Ollés S, Morell F, Cruz MJ. Bronchial inflammation in hypersensitivity pneumonitis after antigen-specific inhalation challenge. Respirology 2014; 19:891-9. [PMID: 24890329 DOI: 10.1111/resp.12323] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/15/2014] [Accepted: 04/09/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to compare the inflammatory profile before and after specific inhalation challenge (SIC) in induced sputum from patients with hypersensitivity pneumonitis (HP) and to investigate whether different causal antigens define the resulting profile. METHODS A prospective study was conducted in 27 patients with HP: 15 patients due to exposure to birds (BHP) and 12 due to exposure to fungi (FHP), confirmed by SIC. Induced sputum was obtained before and/or 24 h after SIC. Cell types were determined by differential cell count using optical microscopy. Interferon-γ, interleukin (IL)-12p70, IL-2, IL-10, IL-8, IL-6, IL-4, IL-5, IL-1β, tumour necrosis factor (TNF)-α and TNF-β levels were measured in the supernatants. RESULTS Following SIC, higher sputum neutrophilia levels (P = 0.048) and an increase in IL-8 levels (P = 0.017) were found in patients with FHP than in those with BHP. FHP patients also showed increased IL-1β, IL12-p70 and IL5 levels (P = 0.011, P = 0.036 and P = 0.018, respectively) after SIC. In BHP, a trend towards increases in sputum eosinophils and TH2 cytokines (IL4, IL5) was seen following SIC (P = 0.059, P = 0.068 and P = 0.075 respectively). CONCLUSIONS This study shows that bronchial inflammation is present in patients with HP evidenced by increases in sputum neutrophils and eosinophils following exposure to the offending antigen during SIC.
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Affiliation(s)
- Ana Villar
- Department of Medicine, Pulmonology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Network for Biomedical Research in Respiratory Disease (CIBER Enfermedades Respiratorias or CIBERES), Salud Carlos III Health Institute, Barcelona, Spain
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Xu JF, Shen L, Zhang Y, Zhang P, Qu JM, Li HP. Lung biopsy-proved hypersensitivity pneumonitis without known offending antigen: characteristics and follow-up. CLINICAL RESPIRATORY JOURNAL 2014; 8:297-304. [PMID: 24188571 DOI: 10.1111/crj.12071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 10/16/2013] [Accepted: 10/30/2013] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Hypersensitivity pneumonitis (HP) without known offending antigen is hard to diagnose. OBJECTIVES The purpose of this study was to identify and analyze the clinical features of lung biopsy-proved HP. METHODS A retrospective cohort study was performed using a database from a 900-bed specialty hospital. Twenty-eight patients with the diagnosis of HP through lung biopsy were enrolled. Demographic data and clinical characteristics, radiologic characteristics, serologic and pulmonary function results, histopathologic changes, treatment and follow-up were analyzed. RESULTS Of all the patients, serum interleukin-1β, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), eosinophil cationic protein and immunoglobulin E (IgE) were increased in over 50% patients, but decreased significantly after corticosteroid therapy (P < 0.05). An initially reduced diffusion lung capacity for carbon monoxide was noted in 92.9% patients, while 39.3% patients had hypoxemia. Ground-glass opacities on the basis of interlobular septa thickening were observed in 71.4% cases. Histopathological findings demonstrated peribronchiolar lymphocytic infiltrates, poorly formed non-caseating granulomas fibrosis in all acute and subacute HP patients' lungs. Ninety-two percent of patients got improvement after corticosteroid therapy when assessed by computer tomography scans and pulmonary function tests. CONCLUSIONS For suspected HP patients who without known offending antigens, earlier diagnosed by lung biopsy and followed by corticosteroid therapy showed promising. It might prevent the disease progression to lung fibrosis.
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Affiliation(s)
- Jin-Fu Xu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Rouzet A, Reboux G, Rognon B, Barrera C, De Vuyst P, Dalphin JC, Millon L, Roussel S. Immunogenic proteins specific to different bird species in bird fancier's lung. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2014; 77:724-30. [PMID: 24786679 DOI: 10.1080/15287394.2014.889616] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Bird fancier's lung (BFL) is a disease produced by exposure to avian proteins present in droppings, blooms, and serum of a variety of birds. Although serological test results are currently used to confirm clinical diagnosis of the disease, bird species specificity is poorly understood. This study aimed to contribute to a better understanding of the specificity of immunogenic proteins revealed from the droppings of three bird species. Sera from four patients with BFL and two controls without exposure were analyzed by Western blotting with antigens from droppings of two pigeon and budgerigar strains and two hen species. When the antigens from the droppings of the three bird species were compared, the profile of immunogenic proteins was different and there were similarities between strains of the same species. Only one 68-kD protein was common to pigeon and budgerigar droppings, while proteins of 200, 175, 140, 100, and 35 kD were detected as specific in one bird species. These results provide insight to further characterize these proteins, and to design new serological tests specific to different bird species. These tests may help to refine strategies of antigenic exclusion and also to allow a patient compensation in case of BFL of occupational origin.
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Affiliation(s)
- Adeline Rouzet
- a Parasitology-Mycology Department , University Hospital of Besançon , Besançon , France
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Travis WD, Costabel U, Hansell DM, King TE, Lynch DA, Nicholson AG, Ryerson CJ, Ryu JH, Selman M, Wells AU, Behr J, Bouros D, Brown KK, Colby TV, Collard HR, Cordeiro CR, Cottin V, Crestani B, Drent M, Dudden RF, Egan J, Flaherty K, Hogaboam C, Inoue Y, Johkoh T, Kim DS, Kitaichi M, Loyd J, Martinez FJ, Myers J, Protzko S, Raghu G, Richeldi L, Sverzellati N, Swigris J, Valeyre D. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2013; 188:733-48. [PMID: 24032382 DOI: 10.1164/rccm.201308-1483st] [Citation(s) in RCA: 2669] [Impact Index Per Article: 242.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In 2002 the American Thoracic Society/European Respiratory Society (ATS/ERS) classification of idiopathic interstitial pneumonias (IIPs) defined seven specific entities, and provided standardized terminology and diagnostic criteria. In addition, the historical "gold standard" of histologic diagnosis was replaced by a multidisciplinary approach. Since 2002 many publications have provided new information about IIPs. PURPOSE The objective of this statement is to update the 2002 ATS/ERS classification of IIPs. METHODS An international multidisciplinary panel was formed and developed key questions that were addressed through a review of the literature published between 2000 and 2011. RESULTS Substantial progress has been made in IIPs since the previous classification. Nonspecific interstitial pneumonia is now better defined. Respiratory bronchiolitis-interstitial lung disease is now commonly diagnosed without surgical biopsy. The clinical course of idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia is recognized to be heterogeneous. Acute exacerbation of IIPs is now well defined. A substantial percentage of patients with IIP are difficult to classify, often due to mixed patterns of lung injury. A classification based on observed disease behavior is proposed for patients who are difficult to classify or for entities with heterogeneity in clinical course. A group of rare entities, including pleuroparenchymal fibroelastosis and rare histologic patterns, is introduced. The rapidly evolving field of molecular markers is reviewed with the intent of promoting additional investigations that may help in determining diagnosis, and potentially prognosis and treatment. CONCLUSIONS This update is a supplement to the previous 2002 IIP classification document. It outlines advances in the past decade and potential areas for future investigation.
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Kim YH, Chung YK, Kim C, Nam ES, Kim HJ, Joo Y. A case of hypersensitivity pneumonitis with giant cells in a female dental technician. Ann Occup Environ Med 2013; 25:19. [PMID: 24472630 PMCID: PMC3923335 DOI: 10.1186/2052-4374-25-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/22/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Dental technicians are exposed to methyl methacrylate(MMA) and hard metal dusts while working, and several cases of hypersensitivity pneumonitis caused by the exposure have been reported. The authors experienced a case of hypersensitivity pneumonitis in a female dental technician who had 10 years' work experience and report the case with clinical evidence. METHOD The patient's work, personal, social, and past and present medical histories were investigated based on patient questioning and medical records. Furthermore, the workplace conditions and tools and materials the patient worked with were also evaluated. Next, the pathophysiology and risk factors of pneumonitis were studied, and studies on the relationship between hypersensitivity pneumonitis and a dental technician's exposure to dust were reviewed. Any changes in the clinical course of her disease were noted for evaluation of the work-relatedness of the disease. RESULTS The patient complained of cough and sputum for 1 year. In addition, while walking up the stairs, the patient was not able to ascend without resting due to dyspnea. She visited our emergency department due to epistaxis, and secondary hypertension was incidentally suspected. Laboratory tests including serologic, electrolyte, and endocrinologic tests and a simple chest radiograph showed no specific findings, but chest computed tomography revealed a centrilobular ground-glass pattern in both lung fields. A transbronchial biopsy was performed, and bronchoalveolar washing fluid was obtained. Among the findings of the laboratory tests, microcalcification, noncaseating granuloma containing foreign body-type giant cells, and metal particles within macrophages were identified histologically. Based on these results, hypersensitivity pneumonitis was diagnosed. The patient stopped working due to admission, and she completely quit her job within 2 months of restarting work due to reappearance of the symptoms. CONCLUSION In this study, the patient did not have typical radiologic findings, but pathological evaluation of the lung biopsy from the bronchoscope led to the suspicion of pneumonitis. Under the microscope, the sample contained fibrotic changes in the lung, multinucleated giant cells, and particles in macrophages and was diagnosed as dental technician pneumoconiosis by the pathology. Working as a dental technician had directly exposed her to light metal dust and MMA, and her clinical symptoms and radiologic findings subsided after withdrawal from exposure to the workplace. These outcomes led to the diagnosis of hypersensitity pneumonitis due to MMA exposure and strong work-relatedness.
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Affiliation(s)
- Yong-Hyun Kim
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yun Kyung Chung
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Changhwan Kim
- Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Eun suk Nam
- Department of Pathology, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Hyun-Jun Kim
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Youngsu Joo
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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CCL18 in serum, BAL fluid and alveolar macrophage culture supernatant in interstitial lung diseases. Respir Med 2013; 107:1444-52. [DOI: 10.1016/j.rmed.2013.06.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/11/2013] [Accepted: 06/03/2013] [Indexed: 11/22/2022]
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Takemura T, Akashi T, Kamiya H, Ikushima S, Ando T, Oritsu M, Sawahata M, Ogura T. Pathological differentiation of chronic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis/usual interstitial pneumonia. Histopathology 2012; 61:1026-35. [PMID: 22882269 DOI: 10.1111/j.1365-2559.2012.04322.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the histological characteristics differentiating chronic hypersensitivity pneumonitis (chronic HP) with a usual interstitial pneumonia (UIP)-like pattern from idiopathic pulmonary fibrosis (IPF)/UIP. METHODS AND RESULTS Surgical lung biopsy specimens from 22 patients with chronic HP diagnosed as having a UIP-like pattern upon histological examination and 13 patients with IPF/UIP were examined and the incidences of bronchiolitis, perilobular fibrosis, centrilobular fibrosis, bridging fibrosis, organizing pneumonia, fibroblastic foci, honeycombing, granulomas, giant cells, lymphocytic alveolitis and lymphoid follicles were compared. Bronchiolitis, centrilobular fibrosis, bridging fibrosis, organizing pneumonia, granulomas, giant cells and lymphocytic alveolitis were significantly more frequent among patients with chronic HP than among patients with IPF (all P<0.01). CONCLUSIONS Centrilobular fibrosis, bridging fibrosis and organizing pneumonia, in addition to bronchiolitis, granulomas and giant cells, are characteristic features of chronic HP with a UIP-like pattern. These features are therefore important in differentiating chronic HP from IPF/UIP, as management strategies differ for the two disorders.
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Affiliation(s)
- Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan.
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Koschel D, Holfert J, Rolle A, Holotiuk O, Höffken G. Farmer's lung in a case after bullectomy. Int Arch Allergy Immunol 2012; 158:313-6. [PMID: 22398814 DOI: 10.1159/000332960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 09/07/2011] [Indexed: 11/19/2022] Open
Abstract
We present a case of farmer's lung (FL) with the primary presenting feature of a large bulla in the lung. A 70-year-old nonsmoking woman with dyspnea on exercise was referred for surgical resection of a large bulla in the lung. The postoperative evaluation of the lung tissue revealed a follicular lymphocytic alveolitis and loosely formed granulomas suspicious for hypersensitivity pneumonitis (HP). The patient had worked in farming since her youth. Dyspnea on exercise was the only symptom, but it was related to the large bulla. No other radiologic features of HP were shown in a high-resolution CT of the lung. Specific IgG antibodies against typical antigens of FL were detected, bronchoalveolar lavage demonstrated no lymphocytic alveolitis but an inhalative challenge with own hay was positive. A diagnosis of chronic FL was made. Despite lung emphysema being a possible reaction in FL, giant bullae as primary and single manifestation of this disease have not been reported before.
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Affiliation(s)
- Dirk Koschel
- Department of Pulmonary Diseases, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.
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Pulmonary hypertension in chronic hypersensitivity pneumonitis. Lung 2012; 190:295-302. [PMID: 22258419 DOI: 10.1007/s00408-011-9361-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 12/19/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the prevalence and outcomes of pulmonary hypertension in chronic hypersensitivity pneumonitis and to examine the relationship between pulmonary function tests and pulmonary hypertension. METHODS We conducted a retrospective review of 120 patients with hypersensitivity pneumonitis seen at two centers for pulmonary diseases over a 5-year interval and identified patients with chronic hypersensitivity pneumonitis for whom both pulmonary function tests and Doppler echocardiography data were available. RESULTS Chronic hypersensitivity pneumonitis was identified in 83 patients and Doppler echocardiography data were available for 73 of them. Pulmonary hypertension (sPAP ≥ 50 mmHg) was detected in 14 patients (19%), and was associated with a greater risk of death (median survival = 23 months vs. 98 months; P=0.003). Patients with pulmonary hypertension were older and had a significantly decreased PaO(2). There was a weak correlation between pulmonary function parameters and the underlying sPAP, with significance for FVC, FEV(1), and PaO(2) and inversely with PaCO(2). CONCLUSIONS Using Doppler echocardiography for evaluation, pulmonary hypertension seems to be common in patients with chronic hypersensitivity pneumonitis, significantly impacts survival, and correlates with FVC, FEV(1), and PaO(2) and inversely with PaCO(2).
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Abstract
Cigarette smoke, a toxic collection of thousands of chemicals generated from combustion of tobacco, is recognized as the primary causative agent of certain diffuse interstitial and bronchiolar lung diseases. Most patients afflicted with these disorders are cigarette smokers, and smoking cessation has been shown to be capable of inducing disease remission and should occupy a pivotal role in the management of all smokers with these diffuse lung diseases. The role of pharmacotherapy with corticosteroids or other immunomodulating agents is not well established but may be considered in patients with progressive forms of smoking-related interstitial lung diseases.
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Affiliation(s)
- Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Gulati M. Diagnostic assessment of patients with interstitial lung disease. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2011; 20:120-7. [PMID: 21509417 DOI: 10.4104/pcrj.2010.00079] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The diagnosis of interstitial lung disease (ILD) is frequently delayed because clinical clues are neglected and respiratory symptoms are ascribed to more common pulmonary diagnoses such as chronic obstructive pulmonary disease (COPD) in the primary care setting. While ILD cases ultimately require referral to a pulmonologist, general practitioners can play a crucial role in recognising the need for, and initiating, a diagnostic evaluation. An initial assessment hinges upon a structured history and physical examination with careful attention paid to occupational, environmental and drug exposures as well as a history of symptoms suggesting connective tissue disease. Ultimately a surgical lung biopsy may be indicated, but high resolution computed tomography (HRCT) chest scans are essential to the diagnostic workup since each ILD form is characterised by a specific pattern of abnormalities.
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Affiliation(s)
- Mridu Gulati
- Department of Pulmonary & Critical Care, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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Abstract
Hypersensitivity pneumonitis (HP) is a nonimmunoglobulin E-related immune-mediated parenchymal lung disease. A 45-year-old woman who was a lifelong nonsmoker with a six-month history of frequent episodes of cough and dyspnea was admitted to hospital. She had been working as a money counter for 20 years at a central bank. Bibasilar crackles on lung auscultation, ground-glass opacities and a mosaic pattern on high-resolution computed tomography, restrictive abnormality on pulmonary function tests and mild hypoxemia were the prominent findings. Bronchoalveolar lavage fluid analysis revealed a predominance of CD4-positive T cells, and she tested positive on her natural challenge test. She was diagnosed with subacute HP based on established criteria. She was advised to discontinue counting fresh banknotes. Prednisolone was commenced, then tapered to discontinue in the ensuing six months. Clinical and radiological improvement was achieved within two months. To the authors' knowledge, the present report is the first to describe 'hard cash HP', possibly caused by chipping dust or printing dye.
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Immunoglobulin free light chains are increased in hypersensitivity pneumonitis and idiopathic pulmonary fibrosis. PLoS One 2011; 6:e25392. [PMID: 21980441 PMCID: PMC3182208 DOI: 10.1371/journal.pone.0025392] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 09/02/2011] [Indexed: 12/15/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF), a devastating lung disorder of unknown aetiology, and chronic hypersensitivity pneumonitis (HP), a disease provoked by an immunopathologic reaction to inhaled antigens, are two common interstitial lung diseases with uncertain pathogenic mechanisms. Previously, we have shown in other upper and lower airway diseases that immunoglobulin free light chains (FLCs) are increased and may be involved in initiating a local inflammation. In this study we explored if such a mechanism may also apply to HP and IPF. Methods In this study we examined the presence of FLC in serum and BAL fluid from 21 IPF and 22 HP patients and controls. IgG, IgE and tryptase concentrations were measured in BAL fluid only. The presence of FLCs, plasma cells, B cells and mast cells in lung tissue of 3 HP and 3 IPF patients and 1 control was analyzed using immunohistochemistry. Results FLC concentrations in serum and BAL fluid were increased in IPF and HP patients as compared to control subjects. IgG concentrations were only increased in HP patients, whereas IgE concentrations were comparable to controls in both patient groups. FLC-positive cells, B cells, plasma cells, and large numbers of activated mast cells were all detected in the lungs of HP and IPF patients, not in control lung. Conclusion These results show that FLC concentrations are increased in serum and BAL fluid of IPF and HP patients and that FLCs are present within affected lung tissue. This suggests that FLCs may be involved in mediating pathology in both diseases.
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Jiménez-Alvarez L, Arreola JL, Ramírez-Martínez G, Ortiz-Quintero B, Gaxiola M, Reynoso-Robles R, Avila-Moreno F, Urrea F, Pardo A, Selman M, Zuñiga J. The effect of CTLA-4Ig, a CD28/B7 antagonist, on the lung inflammation and T cell subset profile during murine hypersensitivity pneumonitis. Exp Mol Pathol 2011; 91:718-22. [PMID: 21945736 DOI: 10.1016/j.yexmp.2011.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 09/06/2011] [Indexed: 12/19/2022]
Abstract
Hypersensitivity pneumonitis (HP) is an inflammatory lung disease characterized by an influx of activated T cells to the lung, in which the CD28/B7 costimulatory signals are essential for the T cell activation and the outcome of the inflammatory response. In this study, we investigated the effect of the CD28/B7 antagonist, CTLA-4Ig, on the lung inflammation and the T cell subset profile in experimental Saccharopolyspora recivirgula (SR)-induced HP. C57BL/6 mice were treated with SR or saline during two and three weeks and in addition of CTLA-4Ig was administrated after either the second or third week and mice were sacrificed seven days later. The extent of the lung inflammation was quantified by histopathology and the lung T cell subsets (Treg, Th17, γδT and NKT) were analyzed by flow cytometry. Mice treated with CTLA-4Ig showed a significant decrease in the extent of lung damage (p<0.05), and exhibited a decreased number of inflammatory cells in the bronchoalveolar lavage (BAL) with diminished CD4/CD8 T cell ratio. Also, a significant increase in the percentage of lung γδT (p<0.01) and NKT (p<0.05) cells was observed in two weeks SR-treated mice with the administration of CTLA-4Ig/SR. At 3 weeks, SR-treated mice showed an increased percentage of regulatory T cells but no significantly differences were found in the percentage of Th17 cells when compared with CTLA-4Ig/SR-treated mice. Our findings suggest that the treatment with CTLA-4Ig affects the HP progression and the lung T cell subset kinetics in mice.
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Affiliation(s)
- Luis Jiménez-Alvarez
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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Rheumatoid arthritis-associated interstitial lung disease: diagnostic dilemma. Pulm Med 2011; 2011:872120. [PMID: 21660199 PMCID: PMC3109679 DOI: 10.1155/2011/872120] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 03/01/2011] [Accepted: 03/24/2011] [Indexed: 12/20/2022] Open
Abstract
Interstitial lung disease (ILD) is an increasingly recognized complication of rheumatoid arthritis (RA) contributing to significantly increased morbidity and mortality. Diagnosis can be challenging since patients are unlikely to report dyspnea due to an overall decrease in physical activity with advanced arthritic symptoms. Additionally, infections, drug toxicity, and environmental toxins can mimic ILD, creating significant diagnostic dilemmas for the clinician. In this paper we will explore an effective clinical algorithm for the diagnosis of RA-ILD. We will also discuss features of drug-related toxicities, infections, and environmental toxins that comprise the main entities in the differential diagnosis of RA-ILD. Finally, we will explore the known and experimental treatment options that may have some benefit in the treatment of RA-ILD.
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Morphologic diversity of chronic pigeon breeder’s disease: Clinical features and survival. Respir Med 2011; 105:608-14. [DOI: 10.1016/j.rmed.2010.11.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 11/04/2010] [Accepted: 11/23/2010] [Indexed: 11/22/2022]
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Abstract
PURPOSE OF REVIEW To review the role of microorganisms in interstitial lung disease (ILD) and to emphasize their importance in initiation and course of ILD. RECENT FINDINGS ILD can be idiopathic but often causality such as drugs or connective tissue disease can be found. Multiple microorganisms have been associated with ILD. On the one hand, pulmonary infection can cause extensive pulmonary damage with patterns of an ILD. On the other hand, microorganisms can trigger the immune system and provoke an abnormal response- not directed against the causative pathogen- that may result in ILD. Moreover, patients with ILD often are susceptible to infection, and infections can importantly influence the course of ILD. Furthermore, not only an infection but also its treatment can result in a drug-induced pneumonitis, eventually resulting in long-term lung damage. SUMMARY Microorganisms can initiate and/or influence the course of ILD. Early recognition, adequate diagnostic evaluation and therapy are essential to prevent permanent damage. Prevention of infection in patients with established ILD is strongly recommended.
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Abstract
BACKGROUND Feather duvet lung (FDL) is a rare subgroup of bird fancier's lung (BFL). We were interested in determining antigen-specific IgG antibodies in patients with FDL and comparing them with those with BFL. MATERIAL AND METHODS Specific IgG antibodies against goose and duck feathers, analysed with an automated fluorimetric enzyme immunoassay, were measured in healthy subjects (group A, n = 30), in patients with FDL (group B, n = 10) and with BFL (group C, n = 35); typical specific IgG antibodies of BFL in groups B and C. RESULTS An optimal threshold value for antibodies against goose or duck feathers to differentiate patients with either BFL or FDL from healthy subjects was determined at 10.85 mg L(-1) for goose feathers and at 8.81 mg L(-1) for duck feathers, respectively. Specific IgG antibodies against goose feathers were significantly higher in group B compared with group C. A ratio of specific IgG antibodies against goose feathers and budgerigar antigens with a threshold value of 0.91 could discriminate between patients with FDL and BFL with a specificity of 97% and a sensitivity of 90%. CONCLUSIONS We were able to demonstrate the significant difference in IgG antibodies in patients with FDL and BFL and their contribution to discriminate between these similar kinds of extrinsic allergic alveolitis.
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Affiliation(s)
- Dirk Koschel
- Department of Pulmonary Diseases, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.
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Inflammatory response and dynamics of lung T cell subsets in Th1, Th2 biased and Th2 deficient mice during the development of hypersensitivity pneumonitis. Exp Mol Pathol 2010; 88:407-15. [DOI: 10.1016/j.yexmp.2010.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 03/04/2010] [Accepted: 03/04/2010] [Indexed: 12/11/2022]
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PDCD1 gene polymorphisms in different Mexican ethnic groups and their role in the susceptibility to hypersensitivity pneumonitis. Clin Biochem 2010; 43:929-31. [PMID: 20447384 DOI: 10.1016/j.clinbiochem.2010.04.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 03/31/2010] [Accepted: 04/23/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Hypersensitivity pneumonitis (HP) is an immunological disorder caused by antigen exposure in susceptible individuals. The PDCD1 polymorphisms, PD1.3 and PD1.5 have been associated with the susceptibility to inflammatory disorders. This study was conducted to test whether the PD1.3 and PD1.5 polymorphisms are associated with HP in Mexican patients and to explore the distribution of these polymorphisms in different Mexican ethnic groups. DESIGN AND METHODS We studied 98 Mexican patients with HP and 92 healthy Mexican controls. Also, 156 healthy Amerindian individuals from two ethnic groups were included (96 Mayans and 60 Mayos). Polymorphisms were determined by TaqMan 5' nuclease assays. RESULTS Significant differences in the distribution of the PD1.3 and PD1.5 genotypes between HP patients and healthy Mestizo controls were not found. We observed a significantly different distribution of these polymorphisms in Mexican Mestizos when compared to the Amerindians. CONCLUSIONS We found no association between PD1 polymorphism and HP; however the distribution of these polymorphisms was different in Mexican Mestizos and Amerindians.
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Camarena A, Aquino-Galvez A, Falfán-Valencia R, Sánchez G, Montaño M, Ramos C, Juárez A, García-de-Alba C, Granados J, Selman M. PSMB8 (LMP7) but not PSMB9 (LMP2) gene polymorphisms are associated to pigeon breeder's hypersensitivity pneumonitis. Respir Med 2010; 104:889-94. [PMID: 20153157 DOI: 10.1016/j.rmed.2010.01.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 01/15/2010] [Accepted: 01/20/2010] [Indexed: 10/19/2022]
Abstract
Hypersensitivity Pneumonitis (HP) is a lung inflammatory disorder caused by inhalation of organic particles by a susceptible host. However, only a small proportion of individuals exposed to HP-associated antigens develop the disease, suggesting that additional host/environmental factors may play a role. We have previously found that genetic susceptibility associated to the major histocompatibility complex (MHC) plays an important role in this disease. The low molecular weight proteosome (LMP, currently named PSMB) genes code for subunits of the proteosome, a multimeric enzymatic complex that degrades proteins into peptides in order to be presented in the MHC class I pathway. We hypothesized that polymorphisms in PSMB8 or PSMB9 genes could be involved in the susceptibility to HP. Thus, in this study we analyzed the polymorphic site at amino acid position 60 (Arg/His) of the fourth exon in the PSMB9 gene and the amino acid position 49 (Gln/Lys) in the second exon of PSMB8 gene in 50 Mexican patients with HP and 50 healthy ethnically matched controls. PSMB typing was performed using polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP). Our results demonstrated that HP patients had a significant increase of the PSMB8 KQ genotype frequency (OR = 7.25, CI = 2.61-21.3; p = 0.000034). No differences were found in the distribution of PSMB9 alleles/genotypes. However, PSMB9-RH/PSMB8 KQ haplotype was significantly increased in HP patients (OR = 6.77, CI = 1.34-65.31, p < 0.02). These findings suggest that PSMB8 KQ genotype could increase the risk to develop hypersensitivity pneumonitis.
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Affiliation(s)
- Angel Camarena
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Tlalpan 4502, Sección XVI, CP 14080, México City, DF, Mexico
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