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Suzuki T, Tsujino I, Harabayashi W, Shima H, Nakamura J, Sato T, Suzuki M, Takeda Y, Konno S. Pulmonary arterial hypertension in an 80-year-old man with long-term use of cyclophosphamide. Respir Med Case Rep 2023; 44:101867. [PMID: 37229484 PMCID: PMC10203762 DOI: 10.1016/j.rmcr.2023.101867] [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: 12/05/2022] [Revised: 04/28/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
An 80-year-old man diagnosed with primary macroglobulinemia 7 years earlier had been treated with cyclophosphamide, following which he developed dyspnea on exertion. Cyclophosphamide was discontinued. The patient's dyspnea, however, failed to improve. Right heart catheterization (RHC) revealed precapillary pulmonary hypertension (PH). He was transferred to our institution for further examination. Prior use of cyclophosphamide was the patient's only risk factor for PH, and cyclophosphamide use was considered as a possible cause of PH in this case. He was treated with tadalafil and dyspnea gradually improved. A follow-up RHC exhibited improvement in mean pulmonary arterial pressure and pulmonary vascular resistance.
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Affiliation(s)
- Takatoshi Suzuki
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Ichizo Tsujino
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Wataru Harabayashi
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hideki Shima
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Junichi Nakamura
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Takahiro Sato
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yukari Takeda
- Department of Hematology, Tonan Hospital, N4, W7, Kita-ku, Sapporo, 060-0004, Japan
| | - Satohi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
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Miwa H, Sakao S, Sanada TJ, Suzuki H, Hata A, Shiina Y, Kobayashi T, Kato F, Nishimura R, Tanabe N, Voelkel N, Yoshino I, Tatsumi K. Cell Tracking Suggests Pathophysiological and Therapeutic Role of Bone Marrow Cells in Sugen5416/Hypoxia Rat Model of Pulmonary Arterial Hypertension. Can J Cardiol 2021; 37:913-923. [PMID: 33609715 DOI: 10.1016/j.cjca.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The mechanism of vascular remodelling in pulmonary arterial hypertension (PAH) remains unclear. Hence, defining the origin of cells constituting intractable vascular lesions in PAH is expected to facilitate therapeutic progress. Herein, we aimed to evaluate the origin of intractable vascular lesions in PAH rodent models via bone marrow (BM) and orthotopic lung transplantation (LT). METHODS To trace BM-derived cells, we prepared chimeric rats transplanted with BM cells from green fluorescent protein (GFP) transgenic rats. Male rats were transplanted with lungs obtained from female rats and vice versa. Pulmonary hypertension was induced in the transplanted rats via Sugen5416 treatment and subsequent chronic hypoxia (Su/Hx). RESULTS In the chimeric Su/Hx models, GFP-positive cells were observed in the pulmonary vascular area. Moreover, the right ventricular systolic pressure was significantly lower compared with wild-type Su/Hx rats without BM transplantation (P = 0.009). PAH suppression was also observed in rats that received allograft transplanted BM transplantation. In male rats that received LT and Su/Hx, BM-derived cells carrying the Y chromosome were also detected in neointimal occlusive lesions of the transplanted lungs received from female rats. CONCLUSIONS BM-derived cells participate in pulmonary vascular remodelling in the Su/Hx rat model, whereas BM transplantation may contribute to suppression of development of PAH.
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Affiliation(s)
- Hideki Miwa
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiichiro Sakao
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Takayuki Jujo Sanada
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsushi Hata
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Shiina
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Kobayashi
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Fumiaki Kato
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Rintaro Nishimura
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuhiro Tanabe
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Norbert Voelkel
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichiro Tatsumi
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, Japan
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Ranchoux B, Günther S, Quarck R, Chaumais MC, Dorfmüller P, Antigny F, Dumas SJ, Raymond N, Lau E, Savale L, Jaïs X, Sitbon O, Simonneau G, Stenmark K, Cohen-Kaminsky S, Humbert M, Montani D, Perros F. Chemotherapy-induced pulmonary hypertension: role of alkylating agents. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 185:356-71. [PMID: 25497573 DOI: 10.1016/j.ajpath.2014.10.021] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/06/2014] [Accepted: 10/14/2014] [Indexed: 01/16/2023]
Abstract
Pulmonary veno-occlusive disease (PVOD) is an uncommon form of pulmonary hypertension (PH) characterized by progressive obstruction of small pulmonary veins and a dismal prognosis. Limited case series have reported a possible association between different chemotherapeutic agents and PVOD. We evaluated the relationship between chemotherapeutic agents and PVOD. Cases of chemotherapy-induced PVOD from the French PH network and literature were reviewed. Consequences of chemotherapy exposure on the pulmonary vasculature and hemodynamics were investigated in three different animal models (mouse, rat, and rabbit). Thirty-seven cases of chemotherapy-associated PVOD were identified in the French PH network and systematic literature analysis. Exposure to alkylating agents was observed in 83.8% of cases, mostly represented by cyclophosphamide (43.2%). In three different animal models, cyclophosphamide was able to induce PH on the basis of hemodynamic, morphological, and biological parameters. In these models, histopathological assessment confirmed significant pulmonary venous involvement highly suggestive of PVOD. Together, clinical data and animal models demonstrated a plausible cause-effect relationship between alkylating agents and PVOD. Clinicians should be aware of this uncommon, but severe, pulmonary vascular complication of alkylating agents.
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Affiliation(s)
- Benoît Ranchoux
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Sven Günther
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; Assistance Publique des Hôpitaux de Paris (AP-HP), the Reference Center for Severe Pulmonary Hypertension, Pneumology and Respiratory Intensive Care Service, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | - Rozenn Quarck
- Respiratory Division, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Marie-Camille Chaumais
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; AP-HP, Pharmacy Service, Département Hospitalo-Universitaire Thorax Innovation, Hôpital Antoine Béclère, Clamart, France
| | - Peter Dorfmüller
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; Pathology Service, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Fabrice Antigny
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Sébastien J Dumas
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Nicolas Raymond
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; Pathology Service, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Edmund Lau
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; Assistance Publique des Hôpitaux de Paris (AP-HP), the Reference Center for Severe Pulmonary Hypertension, Pneumology and Respiratory Intensive Care Service, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | - Laurent Savale
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; Assistance Publique des Hôpitaux de Paris (AP-HP), the Reference Center for Severe Pulmonary Hypertension, Pneumology and Respiratory Intensive Care Service, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | - Xavier Jaïs
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; Assistance Publique des Hôpitaux de Paris (AP-HP), the Reference Center for Severe Pulmonary Hypertension, Pneumology and Respiratory Intensive Care Service, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | - Olivier Sitbon
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; Assistance Publique des Hôpitaux de Paris (AP-HP), the Reference Center for Severe Pulmonary Hypertension, Pneumology and Respiratory Intensive Care Service, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | - Gérald Simonneau
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; Assistance Publique des Hôpitaux de Paris (AP-HP), the Reference Center for Severe Pulmonary Hypertension, Pneumology and Respiratory Intensive Care Service, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | - Kurt Stenmark
- Department of Pediatrics, University of Colorado at Denver, Aurora, Colorado
| | - Sylvia Cohen-Kaminsky
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Marc Humbert
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; Assistance Publique des Hôpitaux de Paris (AP-HP), the Reference Center for Severe Pulmonary Hypertension, Pneumology and Respiratory Intensive Care Service, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | - David Montani
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France; Assistance Publique des Hôpitaux de Paris (AP-HP), the Reference Center for Severe Pulmonary Hypertension, Pneumology and Respiratory Intensive Care Service, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France
| | - Frédéric Perros
- Faculty of Medicine, Université Paris-Sud, Faculté de Médecine, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; INSERM U999, Pulmonary Arterial Hypertension: Pathophysiology and Therapeutic Innovation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France.
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