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Raghav PK, Mann Z, Ahluwalia SK, Rajalingam R. Potential treatments of COVID-19: Drug repurposing and therapeutic interventions. J Pharmacol Sci 2023; 152:1-21. [PMID: 37059487 PMCID: PMC9930377 DOI: 10.1016/j.jphs.2023.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/31/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infection is caused when Spike-protein (S-protein) present on the surface of SARS-CoV-2 interacts with human cell surface receptor, Angiotensin-converting enzyme 2 (ACE2). This binding facilitates SARS-CoV-2 genome entry into the human cells, which in turn causes infection. Since the beginning of the pandemic, many different therapies have been developed to combat COVID-19, including treatment and prevention. This review is focused on the currently adapted and certain other potential therapies for COVID-19 treatment, which include drug repurposing, vaccines and drug-free therapies. The efficacy of various treatment options is constantly being tested through clinical trials and in vivo studies before they are made medically available to the public.
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Affiliation(s)
- Pawan Kumar Raghav
- Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
| | | | - Simran Kaur Ahluwalia
- Amity Institute of Biotechnology, Amity University, Sector-125, Noida, Uttar Pradesh, India
| | - Raja Rajalingam
- Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Radzikowska E, Fijolek J. Update on cryptogenic organizing pneumonia. Front Med (Lausanne) 2023; 10:1146782. [PMID: 37153105 PMCID: PMC10157489 DOI: 10.3389/fmed.2023.1146782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Cryptogenic organizing pneumonia (COP) is a form of idiopathic interstitial pneumonia that results from the pulmonary reaction to various unidentified injuries. Secondary organizing pneumonia is diagnosed when the triggering factor has been identified; it is mainly caused by infections, toxic substance exposure, drugs, connective tissue diseases, malignancies, autoimmune diseases, bone marrow, or organ transplantation, and radiotherapy. There has been an increase in the number of reports of drug-induced organizing pneumonia (OP). New biological therapies, interferon, monoclonal antibodies, anti-interleukin antibodies, and PD1/PDL-1 inhibitors may induce this specific pulmonary reaction. The classical form of COP is usually subacute and does not manifest as severe disease. Patients maintain sufficient respiratory function, and treatment with steroids is usually effective. Several specific forms of OP (e.g., the cicatricial variant or acute fibrinous type) have distinct clinical and histological features, require higher doses of immunosuppressive drugs, and have a worse prognosis. In the era of administering steroid-sparing therapies for the treatment of interstitial lung diseases, connective tissue dases, and other conditions, it is important to emphasize this type of therapy for patients with COP.
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Organizing Pneumonia Due to Nivolumab. Am J Ther 2022; 29:e738-e740. [PMID: 32897903 DOI: 10.1097/mjt.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Cendon L, Rafecas Codern A, de la Rosa D, Castellví I, Spagnolo P, Castillo D. Systematic Review of Systemic Corticosteroids for Treatment of Organizing Pneumonia. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37496960 PMCID: PMC10369534 DOI: 10.1016/j.opresp.2022.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Regardless corticosteroids are recommended for the treatment of organizing pneumonia there is limited evidence supporting this practice. Thus, we performed a systematic review of the literature on systemic corticosteroid treatment for organizing pneumonia. Methods A search was implemented in the PubMed database (Medline) for articles published in the last 20 years. Those studies with incomplete or insufficient data and case reports were excluded. We collected data including: demographics, clinical data, diagnostic procedures, aetiology, treatment regimen (drug, posology, duration, response) and evolution. Results A total of 135 publications were selected and finally 13 studies with 849 patients were included in the review: 12 retrospective observational studies and a single prospective observational study. Most of the patients were started on treatment with systemic corticosteroids - a total of 627 (30-100% depending on the series), but there was a great heterogeneity regarding drug, doses and duration. On those that started treatment, 226 (36%) presented a relapse of the disease during follow-up. Only one study provided information regarding treatment side-effects. Conclusion The findings of this systematic review show the low quality data supporting the use of corticosteroids for the treatment of organizing pneumonia. This highlights a need to undertake appropriately designed studies to investigate which is the most appropriate treatment regimen that trades off benefits and risks of prolonged corticosteroid administration.
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Kajimura Y, Nakamura Y, Hirano T, Tanaka Y, Yamamoto K, Tokunaga Y, Sasaki T, Oishi K, Yujiri T, Matsunaga K, Tanizawa Y. Significance of alveolar nitric oxide concentration in the airway of patients with organizing pneumonia after allogeneic hematopoietic stem cell transplantation. Ann Hematol 2022; 101:1803-1813. [PMID: 35604470 DOI: 10.1007/s00277-022-04868-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
Organizing pneumonia (OP) is a complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and a manifestation of peripheral airway/alveolar inflammation. Recently, alveolar nitric oxide concentration (Calv) has been revealed as a noninvasive marker of peripheral airway inflammation; however, whether Calv levels are associated with OP and peripheral airway in patients after allo-HSCT remains unclear. Herein, we evaluated whether Calv levels could reflect the presence of OP and structural airway changes in patients after allo-HSCT. We measured the eNO levels of 38 patients (6 with OP and 32 without OP) who underwent allo-HSCT. Three-dimensional computed tomography (CT) analysis of the airway was performed in 19 patients. We found that in patients with OP, Calv levels were significantly higher than in those without OP (10.6 vs. 5.5 ppb, p < 0.01). Receiver-operating characteristic analyses revealed a Calv cut-off value for OP detection of 10.2 ppb. No significant differences in the patient characteristics, except for the presence of OP (p < 0.01), were noted between the two groups stratified by the Calv cut-off value. Three-dimensional CT images of the airway revealed gradually increasing positive correlations between Calv levels and airway wall area of the third-, fourth-, and fifth-generation bronchi (r = 0.20, 0.31, 0.38; p = 0.42, 0.19, 0.038, respectively), indicating that Calv levels are strongly correlated with the wall thickness of the distal bronchi. Our results suggest that the Calv level may be a useful noninvasive detectable marker for OP after an allo-HSCT.
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Affiliation(s)
- Yasuko Kajimura
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Yukinori Nakamura
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
| | - Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Yoshinori Tanaka
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Kaoru Yamamoto
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Yoshihiro Tokunaga
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Takahiro Sasaki
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Keiji Oishi
- Department of Medicine and Clinical Science, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Toshiaki Yujiri
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Yukio Tanizawa
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
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Abstract
Acute exacerbation is a major cause of morbidity and mortality in patients with idiopathic pulmonary fibrosis. Although the real nature of it is still not clear and there is no proven effective therapy, progress has been made since the consensus definition and diagnostic criteria were proposed. The trial results of several new innovative therapies in idiopathic pulmonary fibrosis have suggested a potential for benefit in acute exacerbation of idiopathic pulmonary fibrosis, leading to double blind randomized clinical trials in this area. This article reviews the present knowledge on acute exacerbation of idiopathic pulmonary fibrosis, focusing on the triggering factors and treatment.
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Ma S, Kan B, Jian X, Li C, Zheng Y, Sun C, Tao Y, Cui S, Jian T. Secondary organizing pneumonia following occupational acute nitrogen oxide poisoning: a case report. J Int Med Res 2021; 49:3000605211010734. [PMID: 33947260 PMCID: PMC8113927 DOI: 10.1177/03000605211010734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Secondary organizing pneumonia (SOP) is a nonspecific inflammatory response
towards acute lung injuries caused by various diseases. However, organizing
pneumonia (OP) secondary to occupational acute nitrogen oxide poisoning has been
reported rarely. We report a 49-year-old man who suffered from nitrogen oxide
poisoning after inhaling mixed gas at work. After pathological examination, he
was diagnosed with OP. In the absence of other underlying factors causing OP, he
was diagnosed with SOP owing to acute nitrogen oxide poisoning. After systematic
treatment, the patient recovered and was discharged in better health. In
patients with lung injury caused by acute nitrogen oxide poisoning, physicians
should be alert to the risk of patients subsequently developing SOP, and timely
diagnosis and treatment are essential for complete recovery.
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Affiliation(s)
- Shuang Ma
- School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Baotian Kan
- School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Chenglin Li
- School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Yingying Zheng
- School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Cece Sun
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Yiming Tao
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Siqi Cui
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China.,School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Tianzi Jian
- Department of Poisoning and Occupational Diseases, Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
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Organizing Pneumonia as a Manifestation of AIDS in a Patient With Partially Treated Pneumocystis Jiroveci Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koukourakis MI. Low-Dose Radiotherapy for Late-Stage COVID-19 Pneumonia? Dose Response 2020; 18:1559325820951357. [PMID: 32944012 PMCID: PMC7475870 DOI: 10.1177/1559325820951357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 12/22/2022] Open
Abstract
Low dose radiotherapy has been used in the pre-antibiotic era for the treatment of all
kind of pneumonia, with relative success. The unimaginable daily death toll of thousands
of victims dying from COVID-19 pneumonia and the marginal therapeutic value of agents
tested, brings forward the re-evaluation of the position of radiotherapy in the treatment
of late stage lethal COVID-induced respiratory failure. A sound biological rationale
supports this idea. Immunopathology studies show that excessive inflammation and
infiltration of the lung parenchyma by immune cells is the cause of death. Mice lacking
IFNαβ receptors remain unaffected by the virus. Radiotherapy at doses of 50-200cG may
exert an intense anti-inflammatory effect and reduce the burden of inflammatory cells
infiltrating the lungs. Whether radiotherapy, in conjunction with remdesivir and/or
macrolides can reduce the dramatic death rates related to COVID-19 is an open challenge,
under the absence of an alternative solution.
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Affiliation(s)
- Michael I Koukourakis
- Department of Radiotherapy/Oncology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Kozlova N, Rozenshtein A, Mikkilineni S, Linnik Y, Epelbaum O. What lies beneath: poking a hole in the diagnosis. Thorax 2020; 75:1017-1019. [PMID: 32820082 DOI: 10.1136/thoraxjnl-2020-214745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/28/2020] [Accepted: 07/11/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Natalya Kozlova
- Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Anna Rozenshtein
- Department of Radiology, Section of Cardiac and Thoracic Imaging, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Soumya Mikkilineni
- Department of Pathology, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Yevgeniy Linnik
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Oleg Epelbaum
- Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, New York, USA
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Takemori N, Ooi HK, Imai G, Hoshino K, Saio M. Possible mechanisms of action of clarithromycin and its clinical application as a repurposing drug for treating multiple myeloma. Ecancermedicalscience 2020; 14:1088. [PMID: 33014130 PMCID: PMC7498274 DOI: 10.3332/ecancer.2020.1088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
Clarithromycin (CAM), a semisynthetic macrolide antibiotic, is a widely used antibacterial drug. Recently, the efficacy of CAM as an add-on drug for treating multiple myeloma (MM) has been noted. Its effect on treating MM has been confirmed in combination chemotherapies that include CAM. However, a single treatment of CAM has no efficacy for treating MM. Many myeloma growth factors (MGFs) including interleukin (IL)-6 are known to be closely involved in the development of MM. CAM has been shown to suppress many MGFs, particularly IL-6. The possible mechanisms of action of CAM in treating MM have been suggested to include its immunomodulatory effect, autophagy inhibition, reversibility of drug resistance, steroid-sparing/enhancing effect and suppression of MGFs. In addition, MM is characterised by uncontrolled cell growth of monoclonal immunoglobulin (Ig)-producing neoplastic plasma cells. Large quantities of unfolded or misfolded Ig production may trigger considerable endoplasmic reticulum stress. Thus, MM is originally a fragile neoplasm particularly susceptible to autophagy-, proteasome- and histone deacetylase 6-inhibitors. Taken together, CAM plays an important role in MM treatments through its synergistic mechanisms. In addition, CAM with its pleiotropic effects on cytokines including IL-6 and indirect antiviral effects might be worth a try for treating COVID-19.
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Affiliation(s)
- Nobuo Takemori
- Department of Internal Medicine, Division of Hematology, Imai Hospital, Tanaka-cho 100, Ashikaga, Tochigi 326-0822, Japan
- https://orcid.org/0000-0001-9742-8385
| | - Hong-Kean Ooi
- Department of Veterinary Medicine, Azabu University, Fuchinobe 1-17-71, Sagamihara, Kanagawa 252-5201, Japan
| | - Goro Imai
- Department of Internal Medicine, Imai Hospital, Tanaka-cho 100, Ashikaga, Tochigi 326-0822, Japan
| | - Kazuo Hoshino
- Department of Surgery, Imai Hospital, Tanaka-cho 100, Ashikaga, Tochigi 326-0822, Japan
| | - Masanao Saio
- Laboratory of Histopathology & Cytopathology, Department of Laboratory Sciences, Gunma University, Graduate School of Health Sciences, 39-22, 3-chome, Showa-machi, Maebashi, Gunma 371-8514, Japan
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12
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Zhou Y, Wang L, Huang M, Ding J, Jiang H, Zhou K, Meng F, Xiao Y, Cai H, Dai J. A long-term retrospective study of patients with biopsy-proven cryptogenic organizing pneumonia. Chron Respir Dis 2020; 16:1479973119853829. [PMID: 31159568 PMCID: PMC6547176 DOI: 10.1177/1479973119853829] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cryptogenic organizing pneumonia (COP) is characterized by good response to
corticosteroids, but frequent relapses after reduction or cessation of treatment
are noted. The incidence, risk factors of relapse, and long-term outcomes of
patients with COP remain undetermined. Patients with COP from September 2010 to
December 2017 were enrolled. Hospital and office records were used as data
sources. Clinical information, lab examinations, chest radiographs, treatment
courses, and follow-up data were collected. Relapse group was defined as
worsening of clinical manifestations in combination with progression of
radiographic abnormalities in the absence of identified causes. Eighty-seven
patients with COP were enrolled. Of them, 73 patients were treated with
corticosteroids with relapse rate yielding 31.5% (23 of 73). Eleven patients
were treated with macrolides and none of them relapsed. Fever was more common
(65.2% vs. 32.0%, p = 0.004), C-reactive protein (CRP) was
higher (31.5 ± 39.4 mg/L vs. 17.5 ± 32.2 mg/L, p = 0.038), and
diffusion capacity for carbon monoxide (DLCO) % predicted was lower (45.9 ±
14.2% vs. 57.6 ± 18.5%, p = 0.050) in relapse group compared to
nonrelapse group. Four patients who presented with organizing pneumonia (OP) as
the first manifestation were ultimately diagnosed with OP secondary to
autoimmune disease in follow-up. We showed relapse was common in COP patients
treated with corticosteroids, but the prognosis was favorable. Fever, elevated
CRP, and a reduced DLCO were related to relapse. As OP may not always be
cryptogenic, a careful follow-up should be programmed to diagnose the underlying
systemic disease.
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Affiliation(s)
- Ying Zhou
- 1 Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical School, Nanjing, Jiangsu, China
| | - Lei Wang
- 1 Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical School, Nanjing, Jiangsu, China
| | - Mei Huang
- 1 Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical School, Nanjing, Jiangsu, China
| | - Jingjing Ding
- 1 Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical School, Nanjing, Jiangsu, China
| | - Hanyi Jiang
- 1 Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical School, Nanjing, Jiangsu, China
| | - Kefeng Zhou
- 2 Department of Radiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical School, Nanjing, Jiangsu, China
| | - Fanqing Meng
- 3 Department of Pathology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical School, Nanjing, Jiangsu, China
| | - Yonglong Xiao
- 1 Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical School, Nanjing, Jiangsu, China
| | - Hourong Cai
- 1 Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical School, Nanjing, Jiangsu, China
| | - Jinghong Dai
- 1 Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical School, Nanjing, Jiangsu, China
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Bleyzac N, Goutelle S, Bourguignon L, Tod M. Azithromycin for COVID-19: More Than Just an Antimicrobial? Clin Drug Investig 2020; 40:683-686. [PMID: 32533455 PMCID: PMC7290142 DOI: 10.1007/s40261-020-00933-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nathalie Bleyzac
- Service de Pharmacie, Hospices Civils de Lyon, Groupement Hospitalier Nord, Hôpital Pierre Garraud, 136 rue du Commandant Charcot, 69005, Lyon, France
| | - Sylvain Goutelle
- Service de Pharmacie, Hospices Civils de Lyon, Groupement Hospitalier Nord, Hôpital Pierre Garraud, 136 rue du Commandant Charcot, 69005, Lyon, France.
- Univ Lyon, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon & UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, Lyon, France.
| | - Laurent Bourguignon
- Service de Pharmacie, Hospices Civils de Lyon, Groupement Hospitalier Nord, Hôpital Pierre Garraud, 136 rue du Commandant Charcot, 69005, Lyon, France
- Univ Lyon, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon & UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, Lyon, France
| | - Michel Tod
- Service de Pharmacie, Hospices Civils de Lyon, Groupement Hospitalier Nord, Hôpital Pierre Garraud, 136 rue du Commandant Charcot, 69005, Lyon, France
- Univ Lyon, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon & UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, Lyon, France
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Maruyama K, Sakaguchi H, Koh S, Nishida K. Remarkable reduction of precipitates on intraocular lenses by oral macrolide antibiotics. J Cataract Refract Surg 2019; 45:1835-1837. [DOI: 10.1016/j.jcrs.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Indexed: 11/26/2022]
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15
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Grassin-Delyle S, Salvator H, Mantov N, Abrial C, Brollo M, Faisy C, Naline E, Couderc LJ, Devillier P. Bitter Taste Receptors (TAS2Rs) in Human Lung Macrophages: Receptor Expression and Inhibitory Effects of TAS2R Agonists. Front Physiol 2019; 10:1267. [PMID: 31632299 PMCID: PMC6783802 DOI: 10.3389/fphys.2019.01267] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/19/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bitter-taste receptors (TAS2Rs) are involved in airway relaxation but are also expressed in human blood leukocytes. We studied TAS2R expression and the effects of TAS2R agonists on the lipopolysaccharide (LPS)-induced cytokine release in human lung macrophages (LMs). METHODS Lung macrophages were isolated from patients undergoing surgery for carcinoma. We used RT-qPCR to measure transcripts of 16 TAS2Rs (TAS2Rs 3/4/5/7/8/9/10/14/19/20/31/38/39/43/45 and 46) in unstimulated and LPS-stimulated (10 ng.mL-1) LMs. The macrophages were also incubated with TAS2R agonists for 24 h. Supernatant levels of the cytokines TNF-α, CCL3, CXCL8 and IL-10 were measured using ELISAs. RESULTS The transcripts of all 16 TAS2Rs were detected in macrophages. The addition of LPS led to an increase in the expression of most TAS2Rs, which was significant for TAS2R7 and 38. Although the promiscuous TAS2R agonists, quinine and denatonium, inhibited the LPS-induced release of TNF-α, CCL3 and CXCL8, diphenidol was inactive. Partially selective agonists (dapsone, colchicine, strychnine, and chloroquine) and selective agonists [erythromycin (TAS2R10), phenanthroline (TAS2R5), ofloxacin (TAS2R9), and carisoprodol (TAS2R14)] also suppressed the LPS-induced cytokine release. In contrast, two other agonists [sodium cromoglycate (TAS2R20) and saccharin (TAS2R31 and 43)] were inactive. TAS2R agonists suppressed IL-10 production - suggesting that this anti-inflammatory cytokine is not involved in the inhibition of cytokine production. CONCLUSION Human LMs expressed TAS2Rs. Experiments with TAS2R agonists' suggested the involvement of TAS2Rs 3, 4, 5, 9, 10, 14, 30, 39 and 40 in the inhibition of cytokine production. TAS2Rs may constitute new drug targets in inflammatory obstructive lung disease.
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Affiliation(s)
- Stanislas Grassin-Delyle
- Department of Airway Diseases, Foch Hospital, Suresnes, France
- INSERM UMR 1173, UFR Simone Veil - Santé, University Versailles Saint-Quentin, University of Paris-Saclay, Montigny-le-Bretonneux, France
| | - Hélène Salvator
- Department of Airway Diseases, Foch Hospital, Suresnes, France
- Laboratory of Research in Respiratory Pharmacology–UPRES EA 220, Foch Hospital, University Versailles Saint-Quentin, University of Paris-Saclay, Suresnes, France
| | - Nikola Mantov
- Laboratory of Research in Respiratory Pharmacology–UPRES EA 220, Foch Hospital, University Versailles Saint-Quentin, University of Paris-Saclay, Suresnes, France
| | - Charlotte Abrial
- Laboratory of Research in Respiratory Pharmacology–UPRES EA 220, Foch Hospital, University Versailles Saint-Quentin, University of Paris-Saclay, Suresnes, France
| | - Marion Brollo
- Laboratory of Research in Respiratory Pharmacology–UPRES EA 220, Foch Hospital, University Versailles Saint-Quentin, University of Paris-Saclay, Suresnes, France
| | - Christophe Faisy
- Laboratory of Research in Respiratory Pharmacology–UPRES EA 220, Foch Hospital, University Versailles Saint-Quentin, University of Paris-Saclay, Suresnes, France
| | - Emmanuel Naline
- Department of Airway Diseases, Foch Hospital, Suresnes, France
- Laboratory of Research in Respiratory Pharmacology–UPRES EA 220, Foch Hospital, University Versailles Saint-Quentin, University of Paris-Saclay, Suresnes, France
| | - Louis-Jean Couderc
- Department of Airway Diseases, Foch Hospital, Suresnes, France
- Laboratory of Research in Respiratory Pharmacology–UPRES EA 220, Foch Hospital, University Versailles Saint-Quentin, University of Paris-Saclay, Suresnes, France
| | - Philippe Devillier
- Department of Airway Diseases, Foch Hospital, Suresnes, France
- Laboratory of Research in Respiratory Pharmacology–UPRES EA 220, Foch Hospital, University Versailles Saint-Quentin, University of Paris-Saclay, Suresnes, France
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16
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Aslam W, Perez-Guerra F, Jebakumar D, Culver DA, Ghamande S. Acute fibrinous organising pneumonia presenting as a cavitary lung lesion and treatment response to azithromycin. BMJ Case Rep 2019; 12:12/8/e230868. [PMID: 31439559 DOI: 10.1136/bcr-2019-230868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute fibrinous organising pneumonia is distinct from the classic diffuse alveolar damage, organising pneumonia and eosinophilic pneumonia. A 52-year-old woman presented with fever, productive cough, night sweats and left-sided pleuritic chest pain for a week. Physical examination was significant only for decreased breath sounds in the left infraclavicular area laterally. Imaging studies revealed a peripheral thick-walled left upper lobe cavitary lesion, left lower lobe consolidation and an enlarged subcarinal lymph node. She was treated with doxycycline for 10 days without improvement. Pertinent laboratory tests, microbiologic workup and fibre-optic bronchoscopy were non-diagnostic and a CT-guided left upper lobe lung biopsy revealed acute fibrinous organising pneumonia. She was treated with azithromycin with complete resolution of symptoms. To our knowledge, this is the first reported case of acute fibrinous organising pneumonia presenting as a cavitary lung lesion and the first with treatment response to azithromycin.
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Affiliation(s)
- Waqas Aslam
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott & White Medical Center, Texas A & M University, College of Medicine, Temple, Texas, USA
| | - Francisco Perez-Guerra
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott & White Medical Center, Texas A & M University, College of Medicine, Temple, Texas, USA
| | - Deborah Jebakumar
- Department of Pathology and Laboratory Medicine, Baylor Scott & White Medical Center, Texas A & M University, College of Medicine, Temple, Texas, USA
| | - Daniel A Culver
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shekhar Ghamande
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott & White Medical Center, Texas A & M University, College of Medicine, Temple, Texas, USA
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Wu C, Xu K, Wang Z, Chen Z, Sun Z, Yu W, Ji N, Huang M, Zhang M. Increased neutrophils and IL-17A in a rare organizing pneumonia secondary to extrapulmonary operation. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:344. [PMID: 31475214 DOI: 10.21037/atm.2019.06.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Organizing pneumonia (OP) is a clinical syndrome caused by various diseases. The most common causes are infection, connective tissue disease, radiation therapy, drug reaction and thoracic operation. Herein, we describe the case of a patient that developed OP after fracture internal fixation. The case was confirmed to be OP by computer tomographic (CT)-guided percutaneous needle lung biopsy, and other causes of OP were excluded. After the initiation of corticosteroid therapy, marked clinical and radiographic improvements occurred. In addition, we discovered increased neutrophils and IL-17A in the lung tissue of the patient. To the best of our knowledge, this is the first case report about OP secondary to extrapulmonary operation.
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Affiliation(s)
- Chaojie Wu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Kun Xu
- Department of Respiratory Medicine, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Zhengxia Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhongqi Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhixiao Sun
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wenqing Yu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Department of Infectious Disease, Taizhou People's Hospital, Taizhou 225300, China
| | - Ningfei Ji
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Mao Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Mingshun Zhang
- NHC Key Laboratory of Antibody Technique, Nanjing Medical University, Nanjing 211166, China.,Department of Immunology, Nanjing Medical University, Nanjing 211166, China
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18
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Yu G, Ji H, Meng C, Huang Y, Gao G, Liu C, Wang S, Zhang L, Ju J. Surgical management of organizing pneumonia: a retrospective study of 24 cases in a single Centre. J Cardiothorac Surg 2019; 14:122. [PMID: 31253173 PMCID: PMC6599375 DOI: 10.1186/s13019-019-0939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/17/2019] [Indexed: 11/29/2022] Open
Abstract
Background Organizing pneumonia (OP) is a rare disease that is often easily misdiagnosed as a malignancy. The diagnosis of OP can prove quite challenging. Patients typically receive treatment with high-dose corticosteroids. Relapse is common if corticosteroid treatment is reduced or stopped. However, given that long-term corticosteroid treatment often results in significant side-effects, the aim of this study was to discuss the diagnosis and surgical treatment of OP. Material and methods The medical records of 24 patients with pathologically diagnosed OP between October 2007 and January 2019 were retrospectively reviewed. All patients underwent thoracic computed tomography (CT) and transbronchial biopsy or CT-guided percutaneous needle aspiration. We analysed the clinical manifestations, radiological findings, diagnostic methods, treatment, and follow-up outcomes of all patients. Results In total, 24 patients with OP were identified. The study included 17 (70.8%) men and 7 (29.2%) women, and the mean age was 61.25 ± 11.33 years (range: 31–82). The most common symptom was cough (n = 16; 66.6%), and the most common radiological finding was consolidation (n = 13; 54.2%) on thoracic CT. The diagnosis of OP was made by transbronchial biopsy in 11 patients (45.8%), and percutaneous needle aspiration biopsy in 13 (54.2%). We performed 11 wedge resections, 9 segmentectomy, and 4 lobectomies. Twenty patients underwent video-assisted thoracoscopic surgery (VATS), and 4 underwent thoracotomy. Complete lesion resection was obtained in all patients, and all patients were discharged from the hospital between 5 and 11 days after surgery. The mean follow-up period was 59.1 ± 34.5 (range: 2–134) months. Residual lesions or local or distant recurrence were not observed. Conclusions OP is a rare disease, and the exact aetiology remains unclear. Preoperative diagnosis is difficult to achieve despite the use of transbronchial biopsy or CT-guided percutaneous needle aspiration. Complete surgical resection represents an effective method for the treatment of OP.
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Affiliation(s)
- Ge Yu
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Huaijun Ji
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China.
| | - Chuizheng Meng
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Yixuan Huang
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Guogang Gao
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Chuanping Liu
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Shanlei Wang
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Lei Zhang
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China
| | - Jin Ju
- Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, China.
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20
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Ando M, Ono T, Usagawa Y, Yoshikawa H, Hirano T, Tokimatsu I, Kadota JI. The development of diffuse panbronchiolitis during the treatment with long-term, low-dose clarithromycin for chronic sinusitis. J Infect Chemother 2018; 25:147-150. [PMID: 30097373 DOI: 10.1016/j.jiac.2018.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/20/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
Diffuse panbronchiolitis (DPB) is a progressive inflammatory airway disease characterized by a chronic cough, copious sputum expectation, dyspnea, and chronic sinusitis. Owing to the long-term treatment of low-dose macrolides, the prognosis has been remarkably improved. However, in some cases, patients are refractory to macrolides, and the subsequent treatment strategies are controversial. We herein present a patient with the onset of DPB during treatment with long-term, low-dose clarithromycin (CAM) for chronic sinusitis who was successfully treated by switching to long-term treatment with normal-dose CAM. We should recognize that DPB may develop in patients with chronic sinusitis despite treatment with a long-term, low-dose macrolide. We also propose that increasing the dose of macrolide may be a useful strategy for treating refractory patients.
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Affiliation(s)
- Masaru Ando
- Department of Respiratory Medicine and Infectious Diseases, Outa University Faculty of Medicine, Japan.
| | - Tomoko Ono
- Department of Respiratory Medicine and Infectious Diseases, Outa University Faculty of Medicine, Japan
| | - Yuko Usagawa
- Department of Respiratory Medicine and Infectious Diseases, Outa University Faculty of Medicine, Japan
| | - Hiroki Yoshikawa
- Department of Respiratory Medicine and Infectious Diseases, Outa University Faculty of Medicine, Japan
| | - Takashi Hirano
- Department of Otolaryngology Head and Neck Surgery, Oita University Faculty of Medicine, Japan
| | - Issei Tokimatsu
- Department of Respiratory Medicine and Infectious Diseases, Outa University Faculty of Medicine, Japan; Department of Infection Prevention and Control, Kobe University Hospital, Japan
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Outa University Faculty of Medicine, Japan
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21
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Ciftci F, Kumbasar ÖÖ. Seven patients with cryptogenic organizing pneumonia succesfully treated with clarithromycin. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2018; 35:165-170. [PMID: 32476898 DOI: 10.36141/svdld.v35i2.6887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/02/2018] [Indexed: 11/02/2022]
Abstract
Cryptogenic organizing pneumonia is a type of idiopathic interstitial pneumonia with a subacute presentation characterized by variable degrees of cough and dyspnea. As a consequence of the upregulation of inflammatory mediators in cryptogenic organizing pneumonia, it typically responds to anti-inflammatory therapy. Although the majority of patients recover completely with long term oral corticosteroids, relapse is common and their long term use is associated with many adverse effects. Macrolides antiinflammatory agents that appear effective and safe for the treatment of cryptogenic organizing pneumonia. Herein, we analyzed the clinical properties of seven cryptogenic organizing pneumonia patients without severe functional loss who were treated with clarithromycin. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 165-170).
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Affiliation(s)
- Fatma Ciftci
- Ankara University School of Medicine, Department of Chest Disease, Ankara, Turkey
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22
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Vieira A, Vale A, Melo N, Caetano Mota P, Jesus J, Cunha R, Guimarães S, Souto Moura C, Morais A. Organizing pneumonia revisited: insights and uncertainties from a series of 67 patients. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2018; 35:129-138. [PMID: 32476892 PMCID: PMC7170093 DOI: 10.36141/svdld.v35i2.6860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/08/2018] [Indexed: 12/23/2022]
Abstract
Background: Organizing pneumonia (OP) is classified as an acute/subacute pneumonia according to the American Thoracic Society/European Respiratory Society statement (2013 update). Although its clinical presentation, radiologic and histologic features are well established, data on the relevance of potential causes, corticosteroid doses and length, or management of relapses are based on heterogeneous series of patients. Objectives: The aims of this study were to describe clinical presentation, diagnosis and treatment of OP, explore potential causes, discuss strategies for managing relapses, and analyze prognostic factors. We also discuss our findings in relation to relevant data in the literature. Methods: We performed a cross-sectional study of all patients diagnosed with OP at a tertiary referral center in northern Portugal between 2008 and 2015. Results: Sixty-seven patients were diagnosed with OP over the 7-year study period. Dyspnea and cough were the most common presenting symptoms and approximately 30% of patients were hospitalized at the time of diagnosis. Approximately half of the patients were receiving drugs described as potential causes of OP. Microorganisms were isolated in approximately one-third of patients. Other potential causes identified were hematologic disorders, neoplasms, connective tissue diseases, myelodysplastic syndromes, immunodeficiencies, radiotherapy, and bird exposure. Cryptogenic OP was diagnosed in just 16 patients (23.8%). Corticosteroids were the most common treatment and 11 patients (16.4%) experienced relapse. Conclusions: The findings for this series of patients confirm the extreme variability of the contexts in which OP can occur and suggest that rather than a distinct, homogeneous clinicopathologic entity, OP is a non-specific reaction whose outcomes are dependent on the cause. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 129-138).
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Affiliation(s)
- A.L. Vieira
- Pulmonology Department, Hospital de Braga, Braga, Portugal
| | - A. Vale
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - N. Melo
- Pulmonology Department and Diffuse Lung Diseases Study Group, Centro Hospitalar de São João, Porto, Portugal
| | - P. Caetano Mota
- Pulmonology Department and Diffuse Lung Diseases Study Group, Centro Hospitalar de São João, Porto, Portugal
- Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
| | - J.M. Jesus
- Radiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - R. Cunha
- Radiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - S. Guimarães
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - C. Souto Moura
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - A. Morais
- Pulmonology Department and Diffuse Lung Diseases Study Group, Centro Hospitalar de São João, Porto, Portugal
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
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23
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Petitpierre N, Cottin V, Marchand-Adam S, Hirschi S, Rigaud D, Court-Fortune I, Jouneau S, Israël-Biet D, Molard A, Cordier JF, Lazor R. A 12-week combination of clarithromycin and prednisone compared to a 24-week prednisone alone treatment in cryptogenic and radiation-induced organizing pneumonia. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2018; 35:230-238. [PMID: 32476907 DOI: 10.36141/svdld.v35i3.6547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 02/06/2018] [Indexed: 11/02/2022]
Abstract
Background: Some data suggest that anti-inflammatory macrolides may be effective to treat organizing pneumonia (OP) and prevent relapses, but no formal comparison with prednisone alone is available. To explore this issue, we retrospectively compared the efficacy of a 12-week combined regimen of clarithromycin and prednisone with a 24-week prednisone alone regimen in OP. Methods: A standard 12-week regimen of combined clarithromycin and prednisone was designed for the treatment of cryptogenic or radiation-induced OP, aiming at reducing the cumulated prednisone dose and the relapse rate. Its use was left to the discretion of the treating physicians, members of the Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires. Data were compared to a historical control group treated with a standard 24-week prednisone alone regimen. Results: 16 patients were treated with combined therapy and 21 with prednisone alone. Complete radiological remission was achieved in 63% of the combined therapy group and 81% of the prednisone alone group (p=0.38). Symptomatic relapses occurred in 81% of the combined therapy group, and 52% of the prednisone alone group (p=0.14). No side effect of clarithromycin was reported. Conclusions: In patients with cryptogenic or radiation-induced OP, a 12-week regimen of clarithromycin and prednisone showed no benefit on remission rate and relapse rate as compared to a 24-week prednisone only regimen. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 230-238).
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Affiliation(s)
- Nicolas Petitpierre
- Interstitial and rare lung diseases Unit, Department of Respiratory Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Cottin
- Department of Respiratory Medicine and Reference Center for rare lung diseases, Lyon University Hospital, Lyon, France
| | | | - Sandrine Hirschi
- Department of Respiratory Medicine, Strasbourg University Hospital, Strasbourg, France
| | | | | | - Stéphane Jouneau
- Department of Respiratory Medicine, Competences center for rare pulmonary diseases, IRSET UMR 1085, Rennes 1 University, Rennes University Hospital, Rennes, France
| | - Dominique Israël-Biet
- Department of Respiratory Medicine, Georges-Pompidou European Hospital, Paris, France
| | - Anita Molard
- Department of Respiratory Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Jean-François Cordier
- Department of Respiratory Medicine and Reference Center for rare lung diseases, Lyon University Hospital, Lyon, France
| | - Romain Lazor
- Interstitial and rare lung diseases Unit, Department of Respiratory Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Department of Respiratory Medicine and Reference Center for rare lung diseases, Lyon University Hospital, Lyon, France
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24
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Faverio P, Bini F, Vaghi A, Pesci A. Long-term macrolides in diffuse interstitial lung diseases. Eur Respir Rev 2017; 26:26/146/170082. [DOI: 10.1183/16000617.0082-2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/07/2017] [Indexed: 12/18/2022] Open
Abstract
In the present review we provide currently available evidence for the use of macrolides in the treatment of diffuse interstitial lung diseases (ILDs). Up to now, research on macrolides has mainly focused on three areas. First, macrolides have shown some promising results in cellular models and case reports as antifibrotic agents, by promoting autophagy and clearance of intracellular protein aggregates and acting as regulators of surfactant homeostasis. Secondly, macrolides have an immunomodulatory effect, which has been applied in some organising pneumonia cases. In particular, macrolides have been tested in association with systemic corticosteroids as steroid-sparing agents and alone as either first-line agents in mild cases or second-line agents where steroids were poorly tolerated or had failed. Thirdly, a recent area of research concerns the possible role of macrolides as modulators of lung microbiota and the host–microbiota interaction. This function has been particularly studied in idiopathic pulmonary fibrosis patients, in whom changes in microbiota have been proved to be associated with disease progression. However, the lack of high-quality studies makes the application of macrolide therapy in ILDs a field in which research should be conducted on a large scale.
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25
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Vande Vusse LK, Madtes DK. Early Onset Noninfectious Pulmonary Syndromes after Hematopoietic Cell Transplantation. Clin Chest Med 2017; 38:233-248. [PMID: 28477636 PMCID: PMC7126669 DOI: 10.1016/j.ccm.2016.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Lisa K Vande Vusse
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mailstop D5-360, Seattle, WA 98109, USA; Division of Pulmonary and Critical Care Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - David K Madtes
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mailstop D5-360, Seattle, WA 98109, USA
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26
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Leoni D, Encina B, Rello J. Managing the oncologic patient with suspected pneumonia in the intensive care unit. Expert Rev Anti Infect Ther 2017; 14:943-60. [PMID: 27573637 DOI: 10.1080/14787210.2016.1228453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Solid cancer patients are frequently admitted in intensive care units for critical events. Improving survival rates in this setting is considered an achievable goal today. Respiratory failure is the main reason for admission, representing a primary target for research. AREAS COVERED This review presents a diagnostic and therapeutic algorithm for pneumonia and other severe respiratory events in the solid cancer population. It aims to increase awareness of the risk factors and the different etiologies in this changing scenario in which neutropenia no longer seems to be a decisive factor in poor outcome. Bacterial pneumonia is the leading cause, but opportunistic diseases and non-infectious etiologies, especially unexpected adverse effects of radiation, biological drugs and monoclonal antibodies, are becoming increasingly frequent. Options for respiratory support and diagnostics are discussed and indications for antibiotics in the management of pneumonia are detailed. Expert commentary: Prompt initiation of critical care to facilitate optimal decision-making in the management of respiratory failure, early etiological assessment and appropriate antibiotic therapy are cornerstones in management of severe pneumonia in oncologic patients.
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Affiliation(s)
- D Leoni
- a Infectious Disease Department , Tor Vergata University Hospital, University of 'La Sapienza' , Rome , Italy.,b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain
| | - B Encina
- b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain
| | - J Rello
- b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain.,c Centro de Investigación Biomédica En Red - Enfermedades Respiratorias (CIBERES) , Vall d'Hebron Institute of Research , Barcelona , Spain.,d Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
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27
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Radzikowska E, Wiatr E, Langfort R, Bestry I, Skoczylas A, Szczepulska-Wójcik E, Gawryluk D, Rudziński P, Chorostowska-Wynimko J, Roszkowski-Śliż K. Cryptogenic organizing pneumonia-Results of treatment with clarithromycin versus corticosteroids-Observational study. PLoS One 2017; 12:e0184739. [PMID: 28945804 PMCID: PMC5612459 DOI: 10.1371/journal.pone.0184739] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 08/30/2017] [Indexed: 01/15/2023] Open
Abstract
Background Cryptogenic organizing pneumonia (COP) is a clinicopathological syndrome of unknown origin. Corticosteroids are the standard treatment, but clarithromycin (CAM) is also effective. The aim of this observational retrospective study was to compare the results of CAM versus prednisone (PRE) treatment in patients with biopsy-proven OP without respiratory insufficiency. Material and methods In a 15-year period, 40 patients were treated with CAM (500 mg twice daily orally for 3 months) and 22 with PRE (mean initial dose of 0.67 ± 0.24 mg/kg/d for a mean of 8.59 ± 3.05 months). Results The clinical presentation, laboratory, and radiological findings did not differ markedly between patients treated with CAM and PRE, with the exception of a higher frequency of sweats (55% vs. 23%; p < 0.015), ground glass opacities (95% vs. 50%; p <0.0001) and nodular lesions (45% vs. 18%; p = 0.036) in the CAM group. A complete response was achieved in 35(88%) patients treated with CAM and in all treated with PRE. Patients treated with PRE relapsed more frequently than those treated with CAM (54.5% vs. 10%; p < 0.0001). Corticosteroid-related adverse events were noticed in 8(6.5%) patients (with one death), but CAM caused only one (2.5%) allergic reaction. A FVC >80% identified patients who might be successfully treated with CAM with a sensitivity of 60% and a specificity of 88.57% (AUC 0.869; 95% CI 0.684–1; p = 0.008); the figures for the FEV1 were >70%, a sensitivity of 60%, and a specificity of 91.43% (AUC 0.809; 95%CI 0.609–1; p = 0.027). Conclusions CAM can be used to treat COP patients in whom the pulmonary function parameters are within normal limits. Such therapy is shorter, better tolerated, and associated with fewer adverse events and relapses than is PRE. However, the therapy is ineffective in some patients.
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Affiliation(s)
- Elżbieta Radzikowska
- III Department of Lung Disease National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
- * E-mail:
| | - Elżbieta Wiatr
- III Department of Lung Disease National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Renata Langfort
- Pathology Department National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Iwona Bestry
- Radiology Department National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Agnieszka Skoczylas
- Geriatrics Department National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Ewa Szczepulska-Wójcik
- Pathology Department National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Dariusz Gawryluk
- III Department of Lung Disease National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Piotr Rudziński
- Thoracic Surgery Department National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Joanna Chorostowska-Wynimko
- Laboratory of Molecular Diagnostics and Immunology National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Kazimierz Roszkowski-Śliż
- III Department of Lung Disease National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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28
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Winstone TA, Levy RD, Shojania K, Murphy D, Churg A, Ryerson C. Organizing Pneumonia in an Adult With Chronic Recurrent Noninfectious Osteomyelitis: A Case Report and Literature Review. Chest 2017; 152:e21-e24. [PMID: 28797395 DOI: 10.1016/j.chest.2017.04.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/03/2017] [Accepted: 04/18/2017] [Indexed: 11/19/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an idiopathic inflammatory disorder primarily of children and adolescents that is characterized by multifocal nonpyogenic relapsing and remitting inflammatory bone lesions. Pulmonary abnormalities are rarely associated with CRMO, with two reported cases of consolidation on chest CT that occurred in children. We present a case of organizing pneumonia in an adult patient with CRMO. The concurrent worsening of pulmonary and bone disease suggests that CRMO may be a rare cause of organizing pneumonia.
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Affiliation(s)
- Tiffany A Winstone
- Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada.
| | - Robert D Levy
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kamran Shojania
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Darra Murphy
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Andrew Churg
- Department of Pathology, University of British Columbia, Vancouver, Canada
| | - Chris Ryerson
- Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
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Kawamura K, Ichikado K, Yasuda Y, Anan K, Suga M. Azithromycin for idiopathic acute exacerbation of idiopathic pulmonary fibrosis: a retrospective single-center study. BMC Pulm Med 2017. [PMID: 28629448 PMCID: PMC5477160 DOI: 10.1186/s12890-017-0437-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is a fatal condition without an established pharmaceutical treatment. Most patients are treated with high-dose corticosteroids and broad-spectrum antibiotics. Azithromycin is a macrolide with immunomodulatory activity and may be beneficial for treatment of acute lung injury. The objective of this study was to determine the effect of azithromycin on survival of patients with idiopathic AE of IPF. Methods We evaluated 85 consecutive patients hospitalized in our department for idiopathic AE of IPF from April 2005 to August 2016. The initial 47 patients were treated with a fluoroquinolone-based regimen (control group), and the following 38 consecutive patients were treated with azithromycin (500 mg/day) for 5 days. Idiopathic AE of IPF was defined using the criteria established by the 2016 International Working Group. Results Mortality in patients treated with azithromycin was significantly lower than in those treated with fluoroquinolones (azithromycin, 26% vs. control, 70%; p < 0.001). Multivariate analysis revealed that the two variables were independently correlated with 60-day mortality as determined by the Acute Physiology and Chronic Health Evaluation II score (p = 0.002) and azithromycin use (p < 0.001). Conclusion Azithromycin may improve survival in patients with idiopathic AE of IPF.
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Affiliation(s)
- Kodai Kawamura
- Division of Respiratory Medicine, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kumamoto Hospital, Kumamoto, Kumamoto, 861-4193, Japan.
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kumamoto Hospital, Kumamoto, Kumamoto, 861-4193, Japan
| | - Yuko Yasuda
- Division of Respiratory Medicine, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kumamoto Hospital, Kumamoto, Kumamoto, 861-4193, Japan
| | - Keisuke Anan
- Division of Respiratory Medicine, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kumamoto Hospital, Kumamoto, Kumamoto, 861-4193, Japan
| | - Moritaka Suga
- Division of Respiratory Medicine, Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc., Saiseikai Kumamoto Hospital, Kumamoto, Kumamoto, 861-4193, Japan
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Hodge S, Tran HB, Hamon R, Roscioli E, Hodge G, Jersmann H, Ween M, Reynolds PN, Yeung A, Treiberg J, Wilbert S. Nonantibiotic macrolides restore airway macrophage phagocytic function with potential anti-inflammatory effects in chronic lung diseases. Am J Physiol Lung Cell Mol Physiol 2017; 312:L678-L687. [PMID: 28258107 DOI: 10.1152/ajplung.00518.2016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 11/22/2022] Open
Abstract
We reported defective efferocytosis associated with cigarette smoking and/or airway inflammation in chronic lung diseases, including chronic obstructive pulmonary disease, severe asthma, and childhood bronchiectasis. We also showed defects in phagocytosis of nontypeable Haemophilus influenzae (NTHi), a common colonizer of the lower airway in these diseases. These defects could be substantially overcome with low-dose azithromycin; however, chronic use may induce bacterial resistance. The aim of the present study was therefore to investigate two novel macrolides-2'-desoxy-9-(S)-erythromycylamine (GS-459755) and azithromycin-based 2'-desoxy molecule (GS-560660)-with significantly diminished antibiotic activity against Staphylococcus aureus, Streptococcus pneumonia, Moraxella catarrhalis, and H. influenzae We tested their effects on efferocytosis, phagocytosis of NTHi, cell viability, receptors involved in recognition of apoptotic cells and/or NTHi (flow cytometry), secreted and cleaved intracellular IL-1β (cytometric bead array, immunofluorescence/confocal microscopy), and nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) using primary alveolar macrophages and THP-1 macrophages ± 10% cigarette smoke extract. Dose-response experiments showed optimal prophagocytic effects of GS-459755 and GS-560660 at concentrations of 0.5-1 µg/ml compared with our findings with azithromycin. Both macrolides significantly improved phagocytosis of apoptotic cells and NTHi (e.g., increases in efferocytosis and phagocytosis of NTHi: GS-459755, 23 and 22.5%, P = 0.043; GS-560660, 23.5 and 22%, P = 0.043, respectively). Macrophage viability remained >85% following 24 h exposure to either macrolide at concentrations up to 20 µg/ml. Secreted and intracellular-cleaved IL-1β was decreased with both macrolides with no significant changes in recognition molecules c-mer proto-oncogene tyrosine kinase; scavenger receptor class A, member 1; Toll-like receptor 2/4; or CD36. Particulate cytoplasmic immunofluorescence of NLRP3 inflammasome was also reduced significantly. We conclude that GS-459755 and GS-560660 may be useful for reducing airway inflammation in chronic lung diseases without inducing bacterial resistance.
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Affiliation(s)
- Sandra Hodge
- Lung Research Unit, Hanson Institute, and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia; .,Department of Medicine, University of Adelaide, Adelaide, Australia; and
| | - Hai B Tran
- Lung Research Unit, Hanson Institute, and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Rhys Hamon
- Lung Research Unit, Hanson Institute, and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Eugene Roscioli
- Lung Research Unit, Hanson Institute, and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Medicine, University of Adelaide, Adelaide, Australia; and
| | - Greg Hodge
- Lung Research Unit, Hanson Institute, and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Medicine, University of Adelaide, Adelaide, Australia; and
| | - Hubertus Jersmann
- Lung Research Unit, Hanson Institute, and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Medicine, University of Adelaide, Adelaide, Australia; and
| | - Miranda Ween
- Lung Research Unit, Hanson Institute, and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Medicine, University of Adelaide, Adelaide, Australia; and
| | - Paul N Reynolds
- Lung Research Unit, Hanson Institute, and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Medicine, University of Adelaide, Adelaide, Australia; and
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Rea G, Pignatiello M, Longobardi L, Barbieri A, Cappabianca S, Valente T. Diagnostic clues of organizing pneumonia: a case presentation. Quant Imaging Med Surg 2017; 7:144-148. [PMID: 28275568 DOI: 10.21037/qims.2016.12.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Gaetano Rea
- AO dei Colli - Monaldi Hospital, Department of Radiology, Via L Bianchi, 80131, Naples, Italy
| | - Maria Pignatiello
- Second University of Naples, Section of Radiology and Radiotherapy, Department of Clinical and Experimental Medicine "F. Magrassi, A. Lanzara" piazza Miraglia 2, 80138, Naples, Italy
| | - Luca Longobardi
- Second University of Naples, UOC Clinic Pulmonology, Department of Pneumology and Oncology, Via L. Bianchi, 80138, Naples, Italy
| | - Angela Barbieri
- Second University of Naples, Section of Radiology and Radiotherapy, Department of Clinical and Experimental Medicine "F. Magrassi, A. Lanzara" piazza Miraglia 2, 80138, Naples, Italy
| | - Salvatore Cappabianca
- Second University of Naples, Section of Radiology and Radiotherapy, Department of Clinical and Experimental Medicine "F. Magrassi, A. Lanzara" piazza Miraglia 2, 80138, Naples, Italy
| | - Tullio Valente
- AO dei Colli - Monaldi Hospital, Department of Radiology, Via L Bianchi, 80131, Naples, Italy
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32
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Mailleux M, Cornélis F, Colin GC, Baurain JF. Unusual pulmonary toxicity of ipilimumab treated by macrolides. Acta Clin Belg 2016. [DOI: 10.1179/2295333715y.0000000047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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33
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The Effectiveness of Low-dose Azithromycin in Relapsing Cryptogenic Organizing Pneumonia: A Case Report and A Review of the Literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1097/cpm.0000000000000160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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34
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Izykowski N, Kuehnel M, Hussein K, Mitschke K, Gunn M, Janciauskiene S, Haverich A, Warnecke G, Laenger F, Maus U, Jonigk D. Organizing pneumonia in mice and men. J Transl Med 2016; 14:169. [PMID: 27282780 PMCID: PMC4901413 DOI: 10.1186/s12967-016-0933-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/01/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Organizing pneumonia is a reaction pattern and an inflammatory response to acute lung injuries, and is characterized by intraluminal plugs of granulation tissue in distal airspaces. In contrast to other fibrotic pulmonary diseases, organizing pneumonia is generally responsive to corticosteroids. However, some patients do not respond to treatment, leading to respiratory failure and potentially death (up to 15 % of patients). In order to devise new therapeutic strategies, a better understanding of the disease's pathomechanisms is warranted. We previously generated a mouse model overexpressing CCL2, which generates organizing pneumonia-like changes, morphologically comparable to human patients. In this study, we investigated whether the histopathological similarities of human and murine pulmonary organizing pneumonia lesions also involve similar molecular pathways. METHODS We analyzed the similarities and differences of fibrosis-associated gene expression in individual compartments from patients with organizing pneumonia and transgenic (CCL2) mice using laser-assisted microdissection, real-time PCR and immunohistochemistry. RESULTS Gene expression profiling of human and murine organizing pneumonia lesions showed in part comparable expression levels of pivotal genes, notably of TGFB1/Tgfb1, TIMP1/Timp1, TIMP2/Timp2, COL3A1/Col3a1, CXCL12/Cxcl12, MMP2/Mmp2 and IL6/Il6. Hence, the transgenic CCL2 mouse model shows not only pathogenomic and morphological features of human organizing pneumonia but also a similar inflammatory profile. CONCLUSIONS We suggest that the CCL2-overexpressing transgenic mouse model (CCL2 Tg mice) is suitable for further investigation of fibrotic pulmonary remodeling, particularly of organizing pneumonia pathogenesis and for the search for novel therapeutic strategies.
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Affiliation(s)
- Nicole Izykowski
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany. .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany. .,German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Bad Nauheim, Germany.
| | - Mark Kuehnel
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Bad Nauheim, Germany
| | - Kais Hussein
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Kristin Mitschke
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Michael Gunn
- Department of Immunology, Duke University Medical Center, Durham, NC, USA
| | - Sabina Janciauskiene
- Department of Experimental Pneumology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Bad Nauheim, Germany
| | - Axel Haverich
- Department of Thoracic Surgery, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Bad Nauheim, Germany
| | - Gregor Warnecke
- Department of Thoracic Surgery, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Bad Nauheim, Germany
| | - Florian Laenger
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Bad Nauheim, Germany
| | - Ulrich Maus
- Department of Experimental Pneumology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Bad Nauheim, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Bad Nauheim, Germany
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Kawasumi H, Gono T, Tanaka E, Kaneko H, Kawaguchi Y, Yamanaka H. Clinical Characteristics and Cytokine Profiles of Organizing Pneumonia in Patients with Rheumatoid Arthritis Treated with or without Biologics. J Rheumatol 2016; 43:738-44. [PMID: 26834212 DOI: 10.3899/jrheum.151019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE It has been reported that organizing pneumonia (OP) develops when patients with rheumatoid arthritis (RA) are treated with biologic disease-modifying antirheumatic drugs (bDMARD). However, the clinical characteristics and pathophysiology of OP in RA remain unknown in patients treated with bDMARD. We investigated the clinical characteristics and cytokine profiles of patients with RA-OP treated with bDMARD or conventional synthetic DMARD (csDMARD). METHODS Twenty-four patients with RA who had developed OP were enrolled. These patients included 12 treated with bDMARD (bDMARD-OP subset) and 12 treated with csDMARD (csDMARD-OP subset). We compared the clinical characteristics and cytokine profiles between the patients with OP (OP subset, n = 24) and non-OP patients (non-OP subset, n = 29). RESULTS There was no significant difference in clinical characteristics between the OP subset and the non-OP subset. Four patients developed OP within 2 months of bDMARD administration. In the other 8 patients, OP developed more than 1 year after the initiation of bDMARD. OP improved with corticosteroid treatment in all bDMARD-OP patients. After OP improved, bDMARD were readministered in 6 patients, and no OP recurrence was observed in any of these patients. Our multivariate analysis revealed that serum levels of interferon-α (IFN-α), interleukin (IL)-1β, IL-6, IL-8, and interferon-γ-inducible protein 10 were significantly associated with the development of OP, although these cytokines tended to be lower in the bDMARD-OP subset than in the csDMARD-OP subset. CONCLUSION OP is unlikely to be fatal in patients treated with bDMARD or csDMARD. IFN-α and proinflammatory cytokines are associated with the pathophysiology of OP in RA.
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Affiliation(s)
- Hidenaga Kawasumi
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Takahisa Gono
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University.
| | - Eiichi Tanaka
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Hirotaka Kaneko
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Yasushi Kawaguchi
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Hisashi Yamanaka
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
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Radzikowska E, Roży A, Jaguś P, Wiatr E, Gawryluk D, Chorostowska-Wynimko J, Roszkowski-Śliż K. Cryptogenic Organizing Pneumonia: IL-1β, IL-6, IL-8, and TGF- β1 Serum Concentrations and Response to Clarithromycin Treatment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 911:77-85. [DOI: 10.1007/5584_2016_223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Qiu XH, Shao JJ, Mei JG, Li HQ, Cao HQ. Clarithromycin Synergistically Enhances Thalidomide Cytotoxicity in Myeloma Cells. Acta Haematol 2015; 135:103-9. [PMID: 26505646 DOI: 10.1159/000438855] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/20/2015] [Indexed: 01/28/2023]
Abstract
Clarithromycin (CAM) is a macrolide antibiotic that is widely used in the treatment of respiratory tract infections, sexually transmitted diseases and infections caused by the Helicobacter pylori and Mycobacterium avium complex. Recent studies showed that CAM was highly effective against multiple myeloma (MM) when used in combination with immunomodulatory drugs and dexamethasone. However, the related mechanism is still unknown. As 3 immunomodulatory agents are all effective in the respective regimen, we postulated that CAM might enhance the effect of immunomodulatory drugs. We evaluated the interaction effects of CAM and thalidomide on myeloma cells. Taking into consideration that thalidomide did not affect the proliferation of myeloma cells in vitro, we cocultured myeloma cells with peripheral blood monocytes and evaluated the effects of CAM and thalidomide on the cocultured cell model. Data showed that thalidomide and CAM synergistically inhibited the proliferation of the cells. On this same model, we also found that thalidomide and CAM synergistically decreased the secretion of tumor necrosis factor-α and interleukin-6. This might be caused by the effect of the 2 drugs on inhibiting the activation of ERK1/2 and AKT. These data suggest that the efficacy of CAM against MM was partly due to its synergistic action with the immunomodulatory agents.
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Affiliation(s)
- Xu-Hua Qiu
- Department of Hematology, Jinling Hospital, Nanjing, China
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38
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Jung IY, Jeon YD, Ahn MY, Goag E, Lee E, Ahn HW, Ahn JY, Ku NS, Kim JM, Choi JY. A case of bronchiolitis obliterans organizing pneumonia in an HIV-infected Korean patient successfully treated with clarithromycin. BMC Infect Dis 2015. [PMID: 26201392 PMCID: PMC4512086 DOI: 10.1186/s12879-015-1025-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Bronchiolitis obliterans organizing pneumonia (BOOP) is a type of diffuse interstitial lung disease characterized by the pathology of fibroblastic plugs in the lumens of the respiratory bronchioles, alveolar ducts, and alveoli. The occurrence of BOOP in human immunodeficiency virus (HIV)-infected patients has rarely been described, and there have been no clinical case reports in Korea. Case presentation A 24-year-old female who had been diagnosed with HIV ten years prior was admitted due to a 1-year history of cough and sputum production and a 3-day history of fever. She had poor adherence to anti-retroviral therapy (ART) due to gastrointestinal troubles. At the time of admission, her CD4 T-cell count was 5 cells/mm3. A high resolution computed tomography (CT) scan showed tiny centrilobular nodules with a tree-in-bud pattern in both lungs. Bacterial culture, Pneumocystis jirovecii polymerase chain reaction (PCR), Aspergillus galactomannan antigen (Ag) assay, and respiratory virus PCR were negative. Rapid chest x-ray improvement was seen after a 7-day treatment with anti-tuberculosis medication, ceftriaxone, and clarithromycin. Miliary tuberculosis seemed unlikely considering the rapid radiologic improvement and negative tuberculosis PCR results. Due to the unknown etiology, we performed video-assisted thoracoscopic surgery (VATS) to determine the cause of the diffuse lung infiltration. Pathologic findings were consistent with BOOP, while tissue acid-fast bacilli (AFB) stain and tuberculosis PCR results were negative. Tuberculosis medication and intravenous ceftriaxone were discontinued, while treatment with clarithromycin monotherapy was sustained. Five months after discharge, the patient was asymptomatic with a normal chest x-ray and as her adherence to ART improved, her CD4 T-cell count rose to 181 cells/mm3. Clarithromycin was discontinued at that time and the patient is currently receiving regular outpatient follow-up. Conclusion This case suggests that macrolides are a potential treatment option in HIV-infected patients with mild BOOP. In cases that are otherwise unexplained or unresponsive to treatment, BOOP should be taken into consideration and surgical biopsy performed to confirm a diagnosis of BOOP.
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Affiliation(s)
- In Young Jung
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
| | - Yong Duk Jeon
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
| | - Mi-Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
| | - Eunkyong Goag
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. .,AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - EunHye Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. .,AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Hea Won Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. .,AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. .,AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Nam Su Ku
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. .,AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. .,AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
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Ding QL, Lv D, Wang BJ, Zhang QL, Yu YM, Sun SF, Chen ZB, Ma HY, Deng ZC. Macrolide therapy in cryptogenic organizing pneumonia: A case report and literature review. Exp Ther Med 2015; 9:829-834. [PMID: 25667636 PMCID: PMC4316910 DOI: 10.3892/etm.2015.2183] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 12/15/2014] [Indexed: 01/11/2023] Open
Abstract
Cryptogenic organizing pneumonia (COP) is a pulmonary disorder associated with nonspecific clinical presentations. The macrolide class of antimicrobial agents is widely used to treat infectious and inflammatory respiratory diseases in humans. The present study reports a case of COP that was effectively treated with azithromycin in combination with glucocorticoid. A literature review of similar cases is also presented. It was found that all COP patients in the literature received macrolide treatment, including six cases with unknown clinical outcomes. For the remaining 29 patients, 20 patients initially received the macrolide as a single therapy and 4/5 of them (16 cases) were cured with a treatment time of 3–14 months, while 1/5 (4 cases) showed no improvement after treatment for 1 month and were switched to a glucocorticoid or combination treatment with a glucocorticoid, after which the disease was finally well-controlled. Side-effects of macrolide were rare. Based on this analysis, it is recommended that macrolides can be used as a first-line therapy in patients with mild COP. For patients with recurrent COP, it is suggested that macrolides should be used as an adjunctive therapy with other treatments, such as a glucocorticoid.
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Affiliation(s)
- Qun-Li Ding
- Department of Respiratory Medicine, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Dan Lv
- Department of Respiratory Medicine, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Bi-Jiong Wang
- Department of Respiratory Medicine, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Qiao-Li Zhang
- Department of Respiratory Medicine, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Yi-Ming Yu
- Department of Respiratory Medicine, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Shi-Fang Sun
- Department of Respiratory Medicine, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Zhong-Bo Chen
- Department of Respiratory Medicine, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Hong-Ying Ma
- Department of Respiratory Medicine, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Zai-Chun Deng
- Department of Respiratory Medicine, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
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Macrolide use leads to clinical and radiological improvement in patients with cryptogenic organizing pneumonia. Ann Am Thorac Soc 2014; 11:87-91. [PMID: 24460438 DOI: 10.1513/annalsats.201308-261cr] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cryptogenic organizing pneumonia is an idiopathic form of organizing pneumonia (also known as bronchiolitis obliterans organizing pneumonia). Because cryptogenic organizing pneumonia is considered an inflammatory disease, it characteristically responds to the broad-spectrum antiinflammatory corticosteroids, although relapse is common on discontinued use. Additionally, long-term use of corticosteroids has many side effects. In severe cases in which corticosteroids have failed, either cytotoxic therapy or macrolide therapy is used. Because of the toxicity and adverse effects of cytotoxic therapy (e.g., cyclophosphamide), this therapy option cannot be used long term in refractory cases. Macrolide therapy has been shown to be an effective antiinflammatory agent that is relatively safe when used on a long-term basis in patients with cryptogenic organizing pneumonia.
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Azithromycin is able to control Toxoplasma gondii infection in human villous explants. J Transl Med 2014; 12:132. [PMID: 24885122 PMCID: PMC4039046 DOI: 10.1186/1479-5876-12-132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/14/2014] [Indexed: 02/05/2023] Open
Abstract
Background Although Toxoplasma gondii infection is normally asymptomatic, severe cases of toxoplasmosis may occur in immunosuppressed patients or congenitally infected newborns. When a fetal infection is established, the recommended treatment is a combination of pyrimethamine, sulfadiazine and folinic acid (PSA). The aim of the present study was to evaluate the efficacy of azithromycin to control T. gondii infection in human villous explants. Methods Cultures of third trimester human villous explants were infected with T. gondii and simultaneously treated with either PSA or azithromycin. Proliferation of T. gondii, as well as production of cytokines and hormones by chorionic villous explants, was analyzed. Results Treatment with either azithromycin or PSA was able to control T. gondii infection in villous explants. After azithromycin or PSA treatment, TNF-α, IL-17A or TGF-β1 levels secreted by infected villous explants did not present significant differences. However, PSA-treated villous explants had decreased levels of IL-10 and increased IL-12 levels, while treatment with azithromycin increased production of IL-6. Additionally, T. gondii-infected villous explants increased secretion of estradiol, progesterone and HCG + β, while treatments with azithromycin or PSA reduced secretion of these hormones concurrently with decrease of parasite load. Conclusions In conclusion, these results suggest that azithromycin may be defined as an effective alternative drug to control T. gondii infection at the fetal-maternal interface.
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Mu X, Ubagai T, Kikuchi-Ueda T, Tansho-Nagakawa S, Nakano R, Kikuchi H, Ono Y. Effects of Erythromycin and Rifampicin on Immunomodulatory Gene Expression and Cellular Function in Human Polymorphonuclear Leukocytes. Chemotherapy 2014; 59:395-401. [DOI: 10.1159/000358818] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/17/2014] [Indexed: 01/06/2023]
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