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Fuchs T, Zlamy M, Zöggeler T, Appelt D, Niedermayr K, Siedl A, Gasser V, Eder J, Ellemunter H. Detection of cytokines in nasal lavage samples of patients with cystic fibrosis: comparison of two different cytokine detection assays. BMC Pulm Med 2024; 24:286. [PMID: 38890643 PMCID: PMC11186286 DOI: 10.1186/s12890-024-03103-9] [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: 11/20/2023] [Accepted: 06/14/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is a genetic multisystem disorder. Inflammatory processes, which presumably begin early in infancy, play a crucial role in the progression of the disease. The detection of inflammatory biomarkers, especially in the airways, has therefore gained increasing attention. Due to improved treatment options, patients with CF produce less sputum. Nasal lavage samples therefore represent a promising alternative to induced sputum or bronchoalveolar lavage specimens. However, methodology of cytokine measurements is not standardised and comparisons of results are therefore often difficult. The aim of this study was to identify suitable detection methods of cytokines in nasal lavage samples by comparison of two different assays. METHODS Nasal lavage samples were obtained from the same patient at the same time by trained respiratory physiotherapists using a disposable syringe and 10 ml of 0.9% sodium chloride per nostril during outpatient visits. The cytokines IL-17 A, IL-2, IL-6 and IL-10 were measured using two different assays (BD™ and Milliplex®), which have already been applied in sputum and nasal lavage samples, despite different lower detection limits. RESULTS 22 participants were included in the study. In 95.5% of measurements, values were below the limit of detection with respect to the BD™ assay. Only IL-6 could be detected in approximately half of the patients. Individual cytokine levels were considerably higher when measured with Milliplex®, which is also reflected in a statistically significant manner (p = < 0.01). CONCLUSION The right choice of analysis method is crucial for measuring inflammatory markers in nasal lavage samples. Compared to the literature, Milliplex® showed higher detection rates and similar concentrations to other studies. TRIAL REGISTRATION Ethics approval was obtained from the ethics committee at Medical University of Innsbruck (EK Nr: 1055/2022).
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Affiliation(s)
- Teresa Fuchs
- Department of Pediatrics III, Cystic Fibrosis Centre Innsbruck, Medical University of Innsbruck, Innsbruck, Austria.
| | - Manuela Zlamy
- Tiroler Gesundheitsfond, Amt der Tiroler Landesregierung, Innsbruck, Austria
| | - Thomas Zöggeler
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Dorothea Appelt
- Department of Pediatrics III, Cystic Fibrosis Centre Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Niedermayr
- Department of Pediatrics I, Cystic Fibrosis Centre Innsbruck, Tirol Kliniken, Innsbruck, Austria
| | - Anja Siedl
- Department of Pediatrics I, Cystic Fibrosis Centre Innsbruck, Tirol Kliniken, Innsbruck, Austria
| | - Verena Gasser
- Department of Pediatrics I, Cystic Fibrosis Centre Innsbruck, Tirol Kliniken, Innsbruck, Austria
| | - Johannes Eder
- Department of Pediatrics I, Cystic Fibrosis Centre Innsbruck, Tirol Kliniken, Innsbruck, Austria
| | - Helmut Ellemunter
- Department of Pediatrics III, Cystic Fibrosis Centre Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
- Medical University of Innsbruck, Austria, Medical Research Affiliate, Innsbruck, Austria
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2
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Schwarz C, Bend J, Hebestreit H, Hogardt M, Hügel C, Illing S, Mainz JG, Rietschel E, Schmidt S, Schulte-Hubbert B, Sitter H, Wielpütz MO, Hammermann J, Baumann I, Brunsmann F, Dieninghoff D, Eber E, Ellemunter H, Eschenhagen P, Evers C, Gruber S, Koitschev A, Ley-Zaporozhan J, Düesberg U, Mentzel HJ, Nüßlein T, Ringshausen FC, Sedlacek L, Smaczny C, Sommerburg O, Sutharsan S, Vonberg RP, Weber AK, Zerlik J. [CF Lung Disease - a German S3 Guideline: Pseudomonas aeruginosa]. Pneumologie 2024; 78:367-399. [PMID: 38350639 DOI: 10.1055/a-2182-1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Cystic Fibrosis (CF) is the most common autosomal recessive genetic multisystemic disease. In Germany, it affects at least 8000 people. The disease is caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene leading to dysfunction of CFTR, a transmembrane chloride channel. This defect causes insufficient hydration of the airway epithelial lining fluid which leads to reduction of the mucociliary clearance.Even if highly effective, CFTR modulator therapy has been available for some years and people with CF are getting much older than before, recurrent and chronic infections of the airways as well as pulmonary exacerbations still occur. In adult CF life, Pseudomonas aeruginosa (PA) is the most relevant pathogen in colonisation and chronic infection of the lung, leading to further loss of lung function. There are many possibilities to treat PA-infection.This is a S3-clinical guideline which implements a definition for chronic PA-infection and demonstrates evidence-based diagnostic methods and medical treatment in order to give guidance for individual treatment options.
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Affiliation(s)
- Carsten Schwarz
- Klinikum Westbrandenburg GmbH, Standort Potsdam, Deutschland
| | - Jutta Bend
- Mukoviszidose Institut gGmbH, Bonn, Deutschland
| | | | - Michael Hogardt
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Frankfurt, Deutschland
| | - Christian Hügel
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
| | | | - Jochen G Mainz
- Klinikum Westbrandenburg, Standort Brandenburg an der Havel, Universitätsklinikum der Medizinischen Hochschule Brandenburg (MHB), Brandenburg an der Havel, Deutschland
| | - Ernst Rietschel
- Medizinische Fakultät der Universität zu Köln, Mukoviszidose-Zentrum, Klinik und Poliklinik für Kinder- und Jugendmedizin, Köln, Deutschland
| | - Sebastian Schmidt
- Ernst-Moritz-Arndt Universität Greifswald, Kinderpoliklinik, Allgemeine Pädiatrie, Greifswald, Deutschland
| | | | - Helmut Sitter
- Philipps-Universität Marburg, Institut für theoretische Medizin, Marburg, Deutschland
| | - Marc Oliver Wielpütz
- Universitätsklinikum Heidelberg, Klinik für Diagnostische und Interventionelle Radiologie, Heidelberg, Deutschland
| | - Jutta Hammermann
- Universitäts-Mukoviszidose-Zentrum "Christiane Herzog", Dresden, Deutschland
| | - Ingo Baumann
- Universität Heidelberg, Hals-Nasen-Ohrenklinik, Heidelberg, Deutschland
| | - Frank Brunsmann
- Allianz Chronischer Seltener Erkrankungen (ACHSE) e. V., Deutschland (Patient*innenvertreter)
| | | | - Ernst Eber
- Medizinische Universität Graz, Univ. Klinik für Kinder- und Jugendheilkunde, Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Graz, Österreich
| | - Helmut Ellemunter
- Tirolkliniken GmbH, Department für Kinderheilkunde, Pädiatrie III, Innsbruck, Österreich
| | | | | | - Saskia Gruber
- Medizinische Universität Wien, Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Österreich
| | - Assen Koitschev
- Klinikum Stuttgart - Standort Olgahospital, Klinik für Hals-Nasen-Ohrenkrankheiten, Stuttgart, Deutschland
| | - Julia Ley-Zaporozhan
- Klinik und Poliklinik für Radiologie, Kinderradiologie, LMU München, Deutschland
| | | | - Hans-Joachim Mentzel
- Universitätsklinikum Jena, Sektion Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Jena, Deutschland
| | - Thomas Nüßlein
- Gemeinschaftsklinikum Mittelrhein, Klinik für Kinder- und Jugendmedizin Koblenz und Mayen, Koblenz, Deutschland
| | - Felix C Ringshausen
- Medizinische Hochschule Hannover, Klinik für Pneumologie und Infektiologie und Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland
| | - Ludwig Sedlacek
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover, Deutschland
| | - Christina Smaczny
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
| | - Olaf Sommerburg
- Universitätsklinikum Heidelberg, Sektion Pädiatrische Pneumologie, Allergologie und Mukoviszidose-Zentrum, Heidelberg, Deutschland
| | | | - Ralf-Peter Vonberg
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover, Deutschland
| | | | - Jovita Zerlik
- Altonaer Kinderkrankenhaus gGmbH, Abteilung Physiotherapie, Hamburg, Deutschland
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3
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Burgel PR, Ballmann M, Drevinek P, Heijerman H, Jung A, Mainz JG, Peckham D, Plant BJ, Schwarz C, Taccetti G, Smyth A. Considerations for the use of inhaled antibiotics for Pseudomonas aeruginosa in people with cystic fibrosis receiving CFTR modulator therapy. BMJ Open Respir Res 2024; 11:e002049. [PMID: 38702073 PMCID: PMC11086488 DOI: 10.1136/bmjresp-2023-002049] [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: 09/01/2023] [Accepted: 04/11/2024] [Indexed: 05/06/2024] Open
Abstract
The major cause of mortality in people with cystic fibrosis (pwCF) is progressive lung disease characterised by acute and chronic infections, the accumulation of mucus, airway inflammation, structural damage and pulmonary exacerbations. The prevalence of Pseudomonas aeruginosa rises rapidly in the teenage years, and this organism is the most common cause of chronic lung infection in adults with cystic fibrosis (CF). It is associated with an accelerated decline in lung function and premature death. New P. aeruginosa infections are treated with antibiotics to eradicate the organism, while chronic infections require long-term inhaled antibiotic therapy. The prevalence of P. aeruginosa infections has decreased in CF registries since the introduction of CF transmembrane conductance regulator modulators (CFTRm), but clinical observations suggest that chronic P. aeruginosa infections usually persist in patients receiving CFTRm. This indicates that pwCF may still need inhaled antibiotics in the CFTRm era to maintain long-term control of P. aeruginosa infections. Here, we provide an overview of the changing perceptions of P. aeruginosa infection management, including considerations on detection and treatment, the therapy burden associated with inhaled antibiotics and the potential effects of CFTRm on the lung microbiome. We conclude that updated guidance is required on the diagnosis and management of P. aeruginosa infection. In particular, we highlight a need for prospective studies to evaluate the consequences of stopping inhaled antibiotic therapy in pwCF who have chronic P. aeruginosa infection and are receiving CFTRm. This will help inform new guidelines on the use of antibiotics alongside CFTRm.
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Affiliation(s)
- Pierre-Régis Burgel
- Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- ERN-lung CF Network, Frankfurt, Germany
| | - Manfred Ballmann
- Kinder- und Jugendklinik der Universitätsmedizin Rostock, Rostock, Germany
| | - Pavel Drevinek
- Department of Medical Microbiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Harry Heijerman
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andreas Jung
- Division of Respiratory Medicine, University Children's Hospital, Zurich, Switzerland
| | - Jochen G Mainz
- Medizinische Hochschule Brandenburg (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Daniel Peckham
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Barry J Plant
- Cork Adult Cystic Fibrosis Centre, Cork University Hospital, University College, Cork, Republic of Ireland
| | - Carsten Schwarz
- HMU-Health and Medical University Potsdam, Internal Medicine and Pneumology, Clinic Westbrandenburg, Division of Cystic Fibrosis, CF Center Westbrandenburg, Campus Potsdam, Potsdam, Germany
| | - Giovanni Taccetti
- Meyer Children's Hospital IRCCS, Cystic Fibrosis Regional Reference Centre, Department of Paediatric Medicine, Florence, Italy
| | - Alan Smyth
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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4
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Simmonds NJ, Southern KW, De Wachter E, De Boeck K, Bodewes F, Mainz JG, Middleton PG, Schwarz C, Vloeberghs V, Wilschanski M, Bourrat E, Chalmers JD, Ooi CY, Debray D, Downey DG, Eschenhagen P, Girodon E, Hickman G, Koitschev A, Nazareth D, Nick JA, Peckham D, VanDevanter D, Raynal C, Scheers I, Waller MD, Sermet-Gaudelus I, Castellani C. ECFS standards of care on CFTR-related disorders: Identification and care of the disorders. J Cyst Fibros 2024:S1569-1993(24)00037-7. [PMID: 38508949 DOI: 10.1016/j.jcf.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/06/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
This is the third paper in the series providing updated information and recommendations for people with cystic fibrosis transmembrane conductance regulator (CFTR)-related disorder (CFTR-RD). This paper covers the individual disorders, including the established conditions - congenital absence of the vas deferens (CAVD), diffuse bronchiectasis and chronic or acute recurrent pancreatitis - and also other conditions which might be considered a CFTR-RD, including allergic bronchopulmonary aspergillosis, chronic rhinosinusitis, primary sclerosing cholangitis and aquagenic wrinkling. The CFTR functional and genetic evidence in support of the condition being a CFTR-RD are discussed and guidance for reaching the diagnosis, including alternative conditions to consider and management recommendations, is provided. Gaps in our knowledge, particularly of the emerging conditions, and future areas of research, including the role of CFTR modulators, are highlighted.
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Affiliation(s)
- N J Simmonds
- Adult Cystic Fibrosis Centre, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, UK.
| | - K W Southern
- Department of Women's and Children's Health, University of Liverpool, University of Liverpool, Alder Hey Children's Hospital, Liverpool, UK
| | - E De Wachter
- Cystic Fibrosis Center, Pediatric Pulmonology department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - K De Boeck
- Department of Pediatrics, University of Leuven, Leuven, Belgium
| | - F Bodewes
- Pediatric Gastroenterology and Hepatology, Department of Pediatrics, University of Groningen Medical Center, Groningen, the Netherlands
| | - J G Mainz
- Cystic Fibrosis Center, Brandenburg Medical School (MHB), University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - P G Middleton
- Cystic Fibrosis and Bronchiectasis Service, Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, News South Wales, Australia
| | - C Schwarz
- HMU-Health and Medical University Potsdam, CF Center Westbrandenburg, Campus Potsdam, Germany
| | - V Vloeberghs
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Wilschanski
- CF Center, Department of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - E Bourrat
- APHP, Service de Dermatologie, CRMR MAGEC Nord St Louis, Hôpital-Saint Louis, Paris, France
| | - J D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - C Y Ooi
- a) School of Clinical Medicine, Discipline of Paediatrics and Child Health, Medicine & Health, University of New South Wales, Level 8, Centre for Child Health Research & Innovation Bright Alliance Building Cnr Avoca & High Streets, Randwick, Sydney, NSW, Australia, 2031; b) Sydney Children's Hospital, Gastroenterology Department, High Street, Randwick, Sydney, NSW, Australia, 2031
| | - D Debray
- Pediatric Hepatology unit, Centre de Référence Maladies Rares (CRMR) de l'atrésie des voies biliaires et cholestases génétiques (AVB-CG), National network for rare liver diseases (Filfoie), ERN rare liver, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - D G Downey
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | - E Girodon
- Service de Médecine Génomique des Maladies de Système et d'Organe, APHP.Centre - Université de Paris Cité, Hôpital Cochin, Paris, France
| | - G Hickman
- APHP, Service de Dermatologie, CRMR MAGEC Nord St Louis, Hôpital-Saint Louis, Paris, France
| | - A Koitschev
- Klinikum Stuttgart, Pediatric Otorhinolaryngology, Stuttgart, Germany
| | - D Nazareth
- a) Adult CF Unit, Liverpool Heart and Chest Hospital NHS Foundation Trust, U.K; b) Clinical Infection, Microbiology and Immunology, University of Liverpool, UK
| | - J A Nick
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - D Peckham
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - D VanDevanter
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - C Raynal
- Laboratory of molecular genetics, University Hospital of Montpellier and INSERM U1046 PHYMEDEXP, Montpellier, France
| | - I Scheers
- Department of Pediatrics, Pediatric Gastroenterology and Hepatology Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - M D Waller
- Adult Cystic Fibrosis and Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; Honorary Senior Lecturer, King's College London, London, United Kingdom
| | - I Sermet-Gaudelus
- INSERM U1151, Institut Necker Enfants Malades, Paris, France; Université de Paris, Paris, France; Centre de référence Maladies Rares, Mucoviscidose et maladies apparentées, Hôpital Necker Enfants malades, Paris, France
| | - C Castellani
- IRCCS Istituto Giannina Gaslini, Cystic Fibrosis Center, Genoa, Italy
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Mainz JG, Duckstein F, Zagoya C, Koitschev A. Chronic rhinosinusitis in people with CF, a rapidly changing field. J Cyst Fibros 2024; 23:183-184. [PMID: 38604889 DOI: 10.1016/j.jcf.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Jochen G Mainz
- Cystic Fibrosis Center, Brandenburg Medical School (MHB) University. Klinikum Westbrandenburg, Klinik für Kinder- und Jugendmedizin, Hochstraβe 29, 14770, Brandenburg an der Havel, Germany.
| | - Franziska Duckstein
- Cystic Fibrosis Center, Brandenburg Medical School (MHB) University. Klinikum Westbrandenburg, Klinik für Kinder- und Jugendmedizin, Hochstraβe 29, 14770, Brandenburg an der Havel, Germany
| | - Carlos Zagoya
- Cystic Fibrosis Center, Brandenburg Medical School (MHB) University. Klinikum Westbrandenburg, Klinik für Kinder- und Jugendmedizin, Hochstraβe 29, 14770, Brandenburg an der Havel, Germany
| | - Assen Koitschev
- Klinikum Stuttgart - Standort Olgahospital, Klinik für Hals-Nasen-Ohrenkrankheiten, Stuttgart, Germany
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Chung J, Boutin S, Frey DL, Joachim C, Mall MA, Sommerburg O. Nasal lavage microbiome, but not nasal swab microbiome, correlates with sinonasal inflammation in children with cystic fibrosis. J Cyst Fibros 2024; 23:226-233. [PMID: 38199892 DOI: 10.1016/j.jcf.2023.12.011] [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: 08/23/2023] [Revised: 12/08/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Cystic fibrosis (CF) is characterized by highly viscous mucus obstructing the lower and upper airways, chronic neutrophil inflammation and infection resulting not only in lung destruction but also in paranasal sinus involvement. The pathogenesis of CF-associated chronic rhinosinusitis (CRS) is still not well understood, and it remains unclear how the microbiome in the upper airways (UAW) influences paranasal sinus inflammation. METHODS In a cross-sectional study in pediatric patients with CF under stable disease conditions, we examined the microbiome in relation to inflammation by comparing nasal swabs (NS) and nasal lavage (NL) as two UAW sampling methods. The microbiota structure of both NS and NL was determined by 16S rRNA gene amplicon sequencing. In addition, pro-inflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α) and proteases (SLPI, TIMP-1, NE/A1-AT complex) as well as neutrophil elastase activity were measured in NL. RESULTS Simultaneous NS and NL samples were collected from 36 patients with CF (age range: 7 - 19 years). The microbiome of NS samples was shown to be significantly lower in α-diversity and evenness compared to NL samples. NS samples were particularly found to be colonized with Staphylococcus species. NL microbiome was shown to correlate much better with the sinonasal inflammation status than NS microbiome. Especially the detection of Moraxella in NL was associated with increased inflammatory response. CONCLUSION Our results show that the NL microbiome reflects sinonasal inflammation better than NS and support NL as a promising tool for simultaneous assessment of the UAW microbiome and inflammation in children with CF.
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Affiliation(s)
- Jaehi Chung
- Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University of Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany.
| | - Sébastien Boutin
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany; Department of Infectiology and Microbiology, University Hospital Schleswig Holstein, Lübeck 23538, Germany
| | - Dario L Frey
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany; Division Systems Biology of Signal Transduction, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Cornelia Joachim
- Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University of Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany
| | - Marcus A Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité-Universitätsmedizin Berlin, Berlin 13353, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin 10178, Germany; German Center for Lung Research (DZL), Associated Partner Site, Berlin 13353, Germany
| | - Olaf Sommerburg
- Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University of Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany
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7
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Zetlen HL, Stanley Lee A, Nurhussien L, Sun W, Kang CM, Zanobetti A, Rice MB. Personal air pollution exposure and metals in the nasal epithelial lining fluid of COPD patients. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:021002. [PMID: 36873424 PMCID: PMC9972880 DOI: 10.1088/2752-5309/acbbe5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 02/16/2023]
Abstract
Sampling of the nasal epithelial lining fluid is a potential method to assess exposure to air pollution within the respiratory tract among high risk populations. We investigated associations of short- and long-term particulate matter exposure (PM) and pollution-related metals in the nasal fluid of people with chronic obstructive pulmonary disease (COPD). This study included 20 participants with moderate-to-severe COPD from a larger study who measured long-term personal exposure to PM2.5 using portable air monitors and short-term PM2.5 and black carbon (BC) using in-home samplers for the seven days preceding nasal fluid collection. Nasal fluid was sampled from both nares by nasosorption, and inductively coupled plasma mass spectrometry was used to determine the concentration of metals with major airborne sources. Correlations of selected elements (Fe, Ba, Ni, Pb, V, Zn, Cu) were determined within the nasal fluid. Associations between personal long-term PM2.5 and seven day home PM2.5 and BC exposure and nasal fluid metal concentrations were determined by linear regression. Within nasal fluid samples, concentrations of vanadium and nickel (r = 0.8) and lead and zinc (r = 0.7) were correlated. Seven day and long-term PM2.5 exposure were both associated with higher levels of copper, lead, and vanadium in the nasal fluid. BC exposure was associated with higher levels of nickel in the nasal fluid. Levels of certain metals in the nasal fluid may serve as biomarkers of air pollution exposure in the upper respiratory tract.
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Affiliation(s)
- Hilary L Zetlen
- Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Anna Stanley Lee
- Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Lina Nurhussien
- Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Wendy Sun
- Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Choong-Min Kang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Mary B Rice
- Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
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8
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Zetlen HL, Cao KT, Schichlein KD, Knight N, Maecker HT, Nadeau KC, Rebuli ME, Rice MB. Comparison of multiplexed protein analysis platforms for the detection of biomarkers in the nasal epithelial lining fluid of healthy subjects. J Immunol Methods 2023; 517:113473. [PMID: 37059295 PMCID: PMC10715563 DOI: 10.1016/j.jim.2023.113473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Multiplexed protein analysis platforms are a novel and efficient way to characterize biomarkers in a variety of biological samples. Few studies have compared protein quantitation and reproducibility of results across platforms. We utilize a novel nasosorption technique to collect nasal epithelial lining fluid (NELF) from healthy subjects, and compare the detection of proteins in NELF across three commonly used platforms. METHODS NELF was collected from both nares of twenty healthy subjects using an absorbent fibrous matrix and analyzed using three different protein analysis platforms: Luminex, Meso Scale Discovery (MSD), and Olink. Twenty-three protein analytes were shared across two or more platforms, and correlations across platforms were assessed using Spearman correlations. RESULTS Among the twelve proteins represented on all three platforms, IL1⍺ and IL6 were very highly correlated (Spearman correlation coefficient [r] ≥ 0.9); CCL3, CCL4, and MCP1 were highly correlated (r ≥ 0.7); and IFNɣ, IL8, and TNF⍺ were moderately correlated (r ≥ 0.5). Four proteins (IL2, IL4, IL10, IL13) were poorly correlated across at least two platform comparisons (r < 0.5); for two of these proteins (IL10 and IL13), the majority of observations were below the limits of detection for Olink and Luminex. DISCUSSION Multiplexed protein analysis platforms are a promising method for analyzing nasal samples for biomarkers of interest in respiratory health research. For most proteins evaluated, there was good correlation across platforms, although results were less consistent for low abundance proteins. Of the three platforms tested, MSD had the highest sensitivity for analyte detection.
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Affiliation(s)
- Hilary L Zetlen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America.
| | - Kevin T Cao
- Center for Environmental Medicine, Asthma, and Lung Biology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Kevin D Schichlein
- Center for Environmental Medicine, Asthma, and Lung Biology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Noelle Knight
- Center for Environmental Medicine, Asthma, and Lung Biology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Holden T Maecker
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy & Asthma Research, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Meghan E Rebuli
- Center for Environmental Medicine, Asthma, and Lung Biology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Mary B Rice
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
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9
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Pienkowska K, Pust MM, Gessner M, Gaedcke S, Thavarasa A, Rosenboom I, Morán Losada P, Minso R, Arnold C, Hedtfeld S, Dorda M, Wiehlmann L, Mainz JG, Klockgether J, Tümmler B. The Cystic Fibrosis Upper and Lower Airway Metagenome. Microbiol Spectr 2023; 11:e0363322. [PMID: 36892308 PMCID: PMC10101124 DOI: 10.1128/spectrum.03633-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/17/2023] [Indexed: 03/10/2023] Open
Abstract
The microbial metagenome in cystic fibrosis (CF) airways was investigated by whole-genome shotgun sequencing of total DNA isolated from nasal lavage samples, oropharyngeal swabs, and induced sputum samples collected from 65 individuals with CF aged 7 to 50 years. Each patient harbored a personalized microbial metagenome unique in microbial load and composition, the exception being monocultures of the most common CF pathogens Staphylococcus aureus and Pseudomonas aeruginosa from patients with advanced lung disease. The sampling of the upper airways by nasal lavage uncovered the fungus Malassezia restricta and the bacterium Staphylococcus epidermidis as prominent species. Healthy and CF donors harbored qualitatively and quantitatively different spectra of commensal bacteria in their sputa, even in the absence of any typical CF pathogen. If P. aeruginosa, S. aureus, or Stenotrophomonas maltophilia belonged to the trio of the most abundant species in the CF sputum metagenome, common inhabitants of the respiratory tract of healthy subjects, i.e., Eubacterium sulci, Fusobacterium periodonticum, and Neisseria subflava, were present only in low numbers or not detectable. Random forest analysis identified the numerical ecological parameters of the bacterial community, such as Shannon and Simpson diversity, as the key parameters that globally distinguish sputum samples from CF and healthy donors. IMPORTANCE Cystic fibrosis (CF) is the most common life-limiting monogenetic disease in European populations and is caused by mutations in the CFTR gene. Chronic airway infections with opportunistic pathogens are the major morbidity that determines prognosis and quality of life in most people with CF. We examined the composition of the microbial communities of the oral cavity and upper and lower airways in CF patients across all age groups. From early on, the spectrum of commensals is different in health and CF. Later on, when the common CF pathogens take up residence in the lungs, we observed differential modes of depletion of the commensal microbiota in the presence of S. aureus, P. aeruginosa, S. maltophilia, or combinations thereof. It remains to be seen whether the implementation of lifelong CFTR (cystic fibrosis transmembrane conductance regulator) modulation will change the temporal evolution of the CF airway metagenome.
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Affiliation(s)
- Katarzyna Pienkowska
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Marie-Madlen Pust
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Margaux Gessner
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Svenja Gaedcke
- Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Ajith Thavarasa
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Ilona Rosenboom
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Patricia Morán Losada
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Rebecca Minso
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Christin Arnold
- Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Jena, Germany
| | - Silke Hedtfeld
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Marie Dorda
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Research Core Unit Genomics, Hannover Medical School, Hannover, Germany
| | - Lutz Wiehlmann
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
- Research Core Unit Genomics, Hannover Medical School, Hannover, Germany
| | - Jochen G. Mainz
- Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Jena, Germany
- Klinik für Kinder- und Jugendmedizin, Medizinische Hochschule Brandenburg, Brandenburg, Germany
| | - Jens Klockgether
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Burkhard Tümmler
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
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10
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Lopez EM, Stepp WH, Ebert CS, Thorp BD, Senior BA, Jaspers I, Kimple A, Rebuli ME. Site-specific detection and differential levels of immune mediators in the sinonasal mucosa. Int Forum Allergy Rhinol 2023; 13:80-84. [PMID: 35780482 DOI: 10.1002/alr.23056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Erin M Lopez
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Wesley H Stepp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ilona Jaspers
- Center for Environmental Medicine, Asthma and Lung Biology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Meghan E Rebuli
- Center for Environmental Medicine, Asthma and Lung Biology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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11
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Erdmann N, Schilling T, Hentschel J, Lehmann T, von Bismarck P, Ankermann T, Duckstein F, Baier M, Zagoya C, Mainz JG. Divergent dynamics of inflammatory mediators and multiplex PCRs during airway infection in cystic fibrosis patients and healthy controls: Serial upper airway sampling by nasal lavage. Front Immunol 2022; 13:947359. [PMID: 36466839 PMCID: PMC9716083 DOI: 10.3389/fimmu.2022.947359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In cystic fibrosis (CF), acute respiratory exacerbations critically enhance pulmonary destruction. Since these mainly occur outside regular appointments, they remain unexplored. We previously elaborated a protocol for home-based upper airway (UAW) sampling obtaining nasal-lavage fluid (NLF), which, in contrast to sputum, does not require immediate processing. The aim of this study was to compare UAW inflammation and pathogen colonization during stable phases and exacerbations in CF patients and healthy controls. METHODS Initially, we obtained NLF by rinsing 10 ml of isotonic saline/nostril during stable phases. During exacerbations, subjects regularly collected NLF at home. CF patients directly submitted one aliquot for microbiological cultures. The remaining samples were immediately frozen until transfer on ice to our clinic, where PCR analyses were performed and interleukin (IL)-1β/IL-6/IL-8, neutrophil elastase (NE), matrix metalloproteinase (MMP)-9, and tissue inhibitor of metalloproteinase (TIMP)-1 were assessed. RESULTS Altogether, 49 CF patients and 38 healthy controls (HCs) completed the study, and 214 NLF samples were analyzed. Of the 49 CF patients, 20 were at least intermittently colonized with P. aeruginosa and received azithromycin and/or inhaled antibiotics as standard therapy. At baseline, IL-6 and IL-8 tended to be elevated in CF compared to controls. During infection, inflammatory mediators increased in both cohorts, reaching significance only for IL-6 in controls (p=0.047). Inflammatory responses tended to be higher in controls [1.6-fold (NE) to 4.4-fold (MMP-9)], while in CF, mediators increased only moderately [1.2-1.5-fold (IL-6/IL-8/NE/TIMP-1/MMP-9)]. Patients receiving inhalative antibiotics or azithromycin (n=20 and n=15, respectively) revealed lower levels of IL-1β/IL-6/IL-8 and NE during exacerbation compared to CF patients not receiving those antibiotics. In addition, CF patients receiving azithromycin showed MMP-9 levels significantly lower than CF patients not receiving azithromycin at stable phase and exacerbation. Altogether, rhinoviruses were the most frequently detected virus, detected at least once in n=24 (49.0%) of the 49 included pwCF and in n=26 (68.4%) of the 38 healthy controls over the 13-month duration of the study. Remarkably, during exacerbation, rhinovirus detection rates were significantly higher in the HC group compared to those in CF patients (65.8% vs. 22.4%; p<0.0001). CONCLUSION Non-invasive and partially home-based UAW sampling opens new windows for the assessment of inflammation and pathogen colonization in the unified airway system.
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Affiliation(s)
- Nina Erdmann
- Cystic Fibrosis Centre, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | | | - Julia Hentschel
- Institute of Human Genetics, Leipzig University Hospital, Leipzig, Germany
| | - Thomas Lehmann
- Jena University Hospital, Center for Clinical Studies (Biometrics), Jena, Germany
| | - Philipp von Bismarck
- Klinik für Kinder- und Jugendmedizin I, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
| | - Tobias Ankermann
- Klinik für Kinder- und Jugendmedizin I, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
| | - Franziska Duckstein
- Cystic Fibrosis Centre, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Michael Baier
- Jena University Hospital, Department of Medical Microbiology, Jena, Germany
| | - Carlos Zagoya
- Cystic Fibrosis Centre, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Jochen G. Mainz
- Cystic Fibrosis Centre, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
- Jena University Hospital, CF-Center, Jena, Germany
- Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Cottbus, Brandenburg an der Havel and Potsdam, Germany
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12
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Jiang Y, Han J, Na J, Fang J, Qi C, Lu J, Liu X, Zhou C, Feng J, Zhu W, Liu L, Jiang H, Hua Z, Pan G, Yan L, Sun W, Yang Z. Exposure to microplastics in the upper respiratory tract of indoor and outdoor workers. CHEMOSPHERE 2022; 307:136067. [PMID: 35987269 DOI: 10.1016/j.chemosphere.2022.136067] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/23/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to determine the presence of microplastics (MPs) in the upper respiratory tract of indoor and outdoor workers, to assess the type and the extent of contamination. Sputum and nasal lavage fluid were collected, and plastic particles were quantitatively analyzed by polarizing microscopy and a laser direct infrared chemical imaging system. The polarized light microscopy results showed that suspicious MPs were found in the nasal lavage and sputum of both couriers and office staff, and the abundance of MPs in the nasal lavage of office staff was significantly higher than in couriers (P < 0.0001). The chemical imaging results showed that polycarbonate (24.2%) and polyvinylchloride (PVC) (23.0%) were the predominant plastic materials in the sputum of couriers, while polyamide (PA) (25.3%) and polyethylene (22.9%) were dominant in the nasal lavage fluid. The sputum and nasal lavage fluid of office staff were both dominated by PVC (39.1% and 41.1%, respectively) and PA (24.8% and 31.6%, respectively). Therefore, this study revealed that microplastic pollution was found in the respiratory tract of both indoor and outdoor workers, but the distribution of MP particles differed between the two populations.
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Affiliation(s)
- Ying Jiang
- Institute of Preventive Medicine, China Medical University, Shenyang, People's Republic of China; Institute of Inspection and Testing, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China.
| | - Jinchi Han
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, People's Republic of China
| | - Jun Na
- Institute of Preventive Medicine, China Medical University, Shenyang, People's Republic of China; Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Jing Fang
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, People's Republic of China
| | - Chanchan Qi
- Institute of Preventive Medicine, China Medical University, Shenyang, People's Republic of China; Institute of Inspection and Testing, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Junge Lu
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, People's Republic of China
| | - Xiaojing Liu
- Institute of Preventive Medicine, China Medical University, Shenyang, People's Republic of China; Institute of Inspection and Testing, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Changhe Zhou
- Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Jing Feng
- Institute of Preventive Medicine, China Medical University, Shenyang, People's Republic of China; Institute of Inspection and Testing, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Weiwei Zhu
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, People's Republic of China
| | - Li Liu
- Institute of Preventive Medicine, China Medical University, Shenyang, People's Republic of China; Institute of Chronic Diseases, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - He Jiang
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, People's Republic of China
| | - Zhenggang Hua
- Institute of Preventive Medicine, China Medical University, Shenyang, People's Republic of China; Institute of Inspection and Testing, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China
| | - Guowei Pan
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, People's Republic of China
| | - Lingjun Yan
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, People's Republic of China
| | - Wei Sun
- Research Center for Universal Health, School of Public Health, China Medical University, Shenyang, People's Republic of China.
| | - Zuosen Yang
- Institute of Preventive Medicine, China Medical University, Shenyang, People's Republic of China; Institute of Inspection and Testing, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People's Republic of China.
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13
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Payton AD, Perryman AN, Hoffman JR, Avula V, Wells H, Robinette C, Alexis NE, Jaspers I, Rager JE, Rebuli ME. Cytokine signature clusters as a tool to compare changes associated with tobacco product use in upper and lower airway samples. Am J Physiol Lung Cell Mol Physiol 2022; 322:L722-L736. [PMID: 35318855 PMCID: PMC9054348 DOI: 10.1152/ajplung.00299.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study compared baseline cytokine signatures in upper and lower airway samples and evaluated how groups of co-expressed cytokines change with tobacco product use. Matched nasal lavage fluid (NLF), nasal epithelial lining fluid (NELF), sputum, and circulating serum samples were collected from 14 non-smokers, 13 cigarette smokers, and 17 e-cigarette users. Samples were analyzed for 22 cytokines and cytokine signatures were compared across each sample, followed by identification of cytokine clusters with co-modulation patterns within each type of sample, which were subsequently evaluated for potential alterations associated with tobacco product use using eigenvector analyses. Findings included individual cytokine analyses that were carried out using crude, adjusted, and stratified models. Results were confirmed using a separate validation cohort of similar size and characteristics. Cytokine signatures in the respiratory tract were significantly correlated (NLF, NELF, and sputum) compared to randomly permutated signatures, while serum was not. Cytokines clusters identified in upper and lower airways samples were modified in association with tobacco product use, particularly e-cigarettes, showing significant changes in cytokines involved in host defense and chemotactic immune cell recruitment. Overall, analyses at the individual cytokine-level demonstrated less sensitivity and did not identify biologically meaningful differences between tobacco product use groups, highlighting the utility of cluster-based evaluations. NELF cytokine clusters and associated tobacco product disruptions were confirmed in an independent validation cohort. Hence, novel systems-level patterns uncovered changes induced by tobacco products, in particular, elevations in e-cigarette user nasal eigencytokines and identified that upper airway samples simulate cytokine patterns in lower airways.
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Affiliation(s)
- Alexis D Payton
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,The Institute for Environmental Health Solutions, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alexia N Perryman
- Curriculum in Toxicology and Environmental Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica R Hoffman
- Curriculum for the Environment and Ecology, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Vennela Avula
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,The Institute for Environmental Health Solutions, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Heather Wells
- Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carole Robinette
- Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of 12 Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ilona Jaspers
- Curriculum in Toxicology and Environmental Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of 12 Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,The Institute for Environmental Health Solutions, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Julia E Rager
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Curriculum in Toxicology and Environmental Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,The Institute for Environmental Health Solutions, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Meghan E Rebuli
- Curriculum in Toxicology and Environmental Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of 12 Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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14
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Malizia V, Ferrante G, Cilluffo G, Gagliardo R, Landi M, Montalbano L, Fasola S, Profita M, Licari A, Marseglia GL, La Grutta S. Endotyping Seasonal Allergic Rhinitis in Children: A Cluster Analysis. Front Med (Lausanne) 2022; 8:806911. [PMID: 35155483 PMCID: PMC8825866 DOI: 10.3389/fmed.2021.806911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Seasonal Allergic Rhinitis (SAR) is a heterogeneous inflammatory disease. We hypothesized that a cluster analysis based on the evaluation of cytokines in nasal lavage (NL) could characterize distinctive SAR endotypes in children. Methods This cross-sectional study enrolled 88 children with SAR. Detailed medical history was obtained by well-trained physicians. Quality of life and sleep quality were assessed through standardized questionnaires [Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Pittsburgh Sleep Quality Index (PSQI) respectively]. Children were grouped through K-means clustering using Interleukin (IL)-5, IL-17, IL-23, and Interferon (INF)-γ in NL. Results Out of the 88 patients enrolled, 80 were included in the cluster analysis, which revealed three SAR endotypes. Cluster 1 showed lower levels of IL-5 and IL-17 and intermediate levels of IL-23 and IFN-γ; Cluster 2 had higher levels of IL-5 and intermediate levels of IL-17, IL-23, and IFN-γ; Cluster 3 showed higher levels of IL-17, IL-23, and IFN-γ and intermediate levels of IL-5. Cluster 1 showed intermediate values of nasal pH and nasal nitric oxide (nNO), and a lower percentage of neutrophils at nasal cytology than Clusters 2 and 3. Cluster 2 had a lower level of nasal pH, a higher nNO, higher scores in the ocular domain of PRQLQ, and worse sleep quality than Clusters 1 and 3. Cluster 3 showed a higher percentage of neutrophils at nasal cytology than Clusters 1 and 2. Conclusions Our study identified three endotypes based on the evaluation of cytokines in NL, highlighting that childhood SAR is characterized by heterogeneous inflammatory cytokines.
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Affiliation(s)
- Velia Malizia
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Giuliana Ferrante
- Paediatric Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Giovanna Cilluffo
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Rosalia Gagliardo
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Massimo Landi
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy.,Pediatric National Healthcare System, Turin, Italy
| | - Laura Montalbano
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Salvatore Fasola
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Mirella Profita
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania La Grutta
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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15
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Increased Inflammatory Markers Detected in Nasal Lavage Correlate with Paranasal Sinus Abnormalities at MRI in Adolescent Patients with Cystic Fibrosis. Antioxidants (Basel) 2021; 10:antiox10091412. [PMID: 34573044 PMCID: PMC8465538 DOI: 10.3390/antiox10091412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 01/08/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a characteristic feature of cystic fibrosis (CF) multiorgan disease and develops early in the life of patients with CF. The study aimed to correlate the inflammatory markers and the presence of structural abnormalities detected by MRI in the paranasal sinuses of patients with CF. Methods: Nasal lavage and MRI of the paranasal sinuses was performed in a cohort of 30 CF patients (median age 14 y; range 7–20 y). Morphological abnormalities characteristic of CF were evaluated with a dedicated CRS MRI scoring system and correlated with different inflammation parameters measured in nasal lavage. Inflammation of the paranasal sinuses was positively associated with structural abnormalities in MRI. The concentration of the pro-inflammatory markers neutrophil elastase (NE) and the neutrophil elastase/alpha1-antitrypsin (NE/A1AT) complex correlated significantly with CRS-MRI sum score (p < 0.05, r = 0.416 and p < 0.05, r = 0.366, respectively). S. aureus infection was associated with the increased pro-inflammatory cytokine activity of IL-6 and IL-8, and increased levels of NE/A1AT complex in our patients (p < 0.05, respectively). CRS-MRI sum score and individual sinus MRI scores were positively associated with inflammatory activity as a sign of CRS pathology present in CF.
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Mainz JG, Arnold C, Wittstock K, Hipler UC, Lehmann T, Zagoya C, Duckstein F, Ellemunter H, Hentschel J. Ivacaftor Reduces Inflammatory Mediators in Upper Airway Lining Fluid From Cystic Fibrosis Patients With a G551D Mutation: Serial Non-Invasive Home-Based Collection of Upper Airway Lining Fluid. Front Immunol 2021; 12:642180. [PMID: 34025651 PMCID: PMC8131546 DOI: 10.3389/fimmu.2021.642180] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
In cystic fibrosis (CF) therapy, the recent approval of CF-transmembrane conductance regulator (CFTR) channel modulators is considered to be the major breakthrough. However, the current first-line approach based mainly on pulmonary function to measure effects of the novel therapy, tested by forced expiratory volumes in one second (FEV1), provides restricted sensitivity to detect early structural damages. Accordingly, there is a need for new sensitive surrogate parameters. Most interestingly, these should quantify inflammation that precedes a decline of pulmonary function. We present a novel method assessing inflammatory markers in the upper airways’ epithelial lining fluid (ELF) obtained by nasal lavage (NL). In contrast to broncho-alveolar lavage, ELF sampling by NL is an attractive method due to its limited invasiveness which allows repeated analyses, even performed in a home-based setting. In a longitudinal cohort study (ClinicalTrials.gov, Identifier: NCT02311140), we assessed changes of inflammatory mediators in 259 serially obtained nasal lavages taken up to every second day before and during therapy with ivacaftor from ten CF patients carrying a G551D mutation. Patients were trained to sample NL-fluid at home, to immediately freeze and transfer chilled secretions to centers. Neutrophil Elastase, Interleukins IL-1β, IL-6 and IL-8 in NL were quantified. During 8-12 weeks of ivacaftor-treatment, median values of IL-1β and IL-6 significantly declined 2.29-fold (2.97→1.30 pg/mL), and 1.13-fold (6.48→5.72 pg/mL), respectively. In parallel, sweat tests and pulmonary function improved considerably. This is the first study assessing changes of airway inflammation on a day-to-day basis in CF patients receiving a newly administered CFTR-modulator therapy. It proves a decline of airway inflammation during ivacaftor-therapy.
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Affiliation(s)
- Jochen G Mainz
- Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany.,CF-Center, Jena University Hospital, Jena, Germany.,Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus -Senftenberg, The Brandenburg Medical School Theodor Fontane and the University of Potsdam, Cottbus, Brandenburg an der Havel and Potsdam, Germany
| | | | | | | | - Thomas Lehmann
- Jena University Hospital, Centre for Clinical Studies (Biometrics), Jena, Germany
| | - Carlos Zagoya
- Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Franziska Duckstein
- Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | | | - Julia Hentschel
- Institute of Human Genetics, Leipzig University Hospital, Leipzig, Germany
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Evaluation of the upper airway microbiome and immune response with nasal epithelial lining fluid absorption and nasal washes. Sci Rep 2020; 10:20618. [PMID: 33244064 PMCID: PMC7692476 DOI: 10.1038/s41598-020-77289-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 11/03/2020] [Indexed: 01/04/2023] Open
Abstract
Despite being commonly used to collect upper airway epithelial lining fluid, nasal washes are poorly reproducible, not suitable for serial sampling, and limited by a dilution effect. In contrast, nasal filters lack these limitations and are an attractive alternative. To examine whether nasal filters are superior to nasal washes as a sampling method for the characterization of the upper airway microbiome and immune response, we collected paired nasal filters and washes from a group of 40 healthy children and adults. To characterize the upper airway microbiome, we used 16S ribosomal RNA and shotgun metagenomic sequencing. To characterize the immune response, we measured total protein using a BCA assay and 53 immune mediators using multiplex magnetic bead-based assays. We conducted statistical analyses to compare common microbial ecology indices and immune-mediator median fluorescence intensities (MFIs) between sample types. In general, nasal filters were more likely to pass quality control in both children and adults. There were no significant differences in microbiome community richness, α-diversity, or structure between pediatric samples types; however, these were all highly dissimilar between adult sample types. In addition, there were significant differences in the abundance of amplicon sequence variants between sample types in children and adults. In adults, total proteins were significantly higher in nasal filters than nasal washes; consequently, the immune-mediator MFIs were not well detected in nasal washes. Based on better quality control sequencing metrics and higher immunoassay sensitivity, our results suggest that nasal filters are a superior sampling method to characterize the upper airway microbiome and immune response in both children and adults.
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Raidt J, Brillault J, Brinkmann F, Jung A, Koerner-Rettberg C, Koitschev A, Linz-Keul H, Nüßlein T, Ringshausen FC, Röhmel J, Rosewich M, Werner C, Omran H. [Management of Primary Ciliary Dyskinesia]. Pneumologie 2020; 74:750-765. [PMID: 32977348 PMCID: PMC7671756 DOI: 10.1055/a-1235-1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Die Primäre Ciliäre Dyskinesie (PCD, MIM 242650) ist eine seltene hereditäre Multisystemerkrankung mit klinisch heterogenem Phänotyp. Leitsymptom ist eine chronische Sekretretention der oberen und unteren Atemwege, welche durch die Dysfunktion motiler respiratorischer Zilien entsteht. In der Folge kommt es zur Ausbildung von Bronchiektasen, häufig zu einer Infektion durch Pseudomonas aeruginosa sowie einer abnehmenden Lungenfunktion bis hin zum Lungenversagen. Bislang gibt es kaum evidenzbasierte Therapieempfehlungen, da randomisierte Langzeitstudien zur Behandlung der PCD fehlten. In diesem Jahr wurden die Daten einer ersten placebokontrollierten Medikamentenstudie bei PCD veröffentlicht. Anlässlich dieses Meilensteins im Management der PCD wurde der vorliegende Übersichtsartikel als Konsens von Patientenvertretern sowie Klinikern, die langjährige Erfahrung in der Behandlung der PCD haben, verfasst. Diese Arbeit bietet eine Zusammenfassung aktuell eingesetzter Behandlungsverfahren, die überwiegend auf persönlichen Erfahrungen und Expertenmeinungen beruhen oder von anderen Atemwegserkrankungen wie der Cystischen Fibrose (CF), COPD oder Bronchiektasen-Erkrankung abgeleitet werden. Da es derzeit keine kurative Therapie für PCD gibt, stehen symptomatische Maßnahmen wie die regelmäßige Reinigung der Atemwege und die Behandlung von rezidivierenden Atemwegsinfektionen im Fokus. Nicht respiratorische Manifestationen werden organspezifisch behandelt. Um neben der ersten Medikamentenstudie mehr evidenzbasiertes Wissen zu generieren, werden weitere Projekte etabliert, u. a. ein internationales PCD-Register. Hierüber wird Patienten der Zugang zu klinischen und wissenschaftlichen Studien erleichtert und die Vernetzung behandelnder Zentren gefördert. Des Weiteren können Erkenntnisse über eine Genotyp-spezifische Erkrankungsschwere erlangt werden, um folglich die therapeutische Versorgung der Patienten zu verbessern und somit zu individualisieren.
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Affiliation(s)
- J Raidt
- Klinik für Kinder- und Jugendmedizin, Allgemeine Pädiatrie, Universitätsklinikum Münster, Münster
| | - J Brillault
- Kartagener Syndrom & Primäre Ciliäre Dyskinesie e. V., Herbolzheim
| | - F Brinkmann
- Pädiatrische Pneumologie und CF-Centrum, Universitätsklinik für Kinder- und Jugendmedizin Bochum, Bochum
| | - A Jung
- Abteilung für Pneumologie, Universitäts-Kinderspital Zürich, Zürich, Schweiz
| | | | - A Koitschev
- Abteilung Pädiatrische HNO-Heilkunde und Otologie, Olgahospital, Klinikum Stuttgart, Stuttgart
| | | | - T Nüßlein
- Klinik für Kinder- und Jugendmedizin Koblenz, Gemeinschaftsklinikum Mittelrhein, Koblenz
| | - F C Ringshausen
- Klinik für Pneumologie, Medizinische Hochschule Hannover (MHH), Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Deutsches Zentrum für Lungenforschung (DZL), Hannover
| | - J Röhmel
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin
| | | | - C Werner
- Kinder- und Jugendmedizin, Helios Kliniken Schwerin, Schwerin
| | - H Omran
- Klinik für Kinder- und Jugendmedizin, Allgemeine Pädiatrie, Universitätsklinikum Münster, Münster
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Monoacylglycerol Form of Omega-3s Improves Its Bioavailability in Humans Compared to Other Forms. Nutrients 2020; 12:nu12041014. [PMID: 32272659 PMCID: PMC7230359 DOI: 10.3390/nu12041014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022] Open
Abstract
Numerous benefits are attributed to omega-3 fatty acids (OM3) especially in cardiovascular health. However, bioavailability and clinical efficacy depend on numerous factors, including OM3 form, food matrix effects (especially the lipid content of the diet), and metabolic capacity. Here, we show in humans that a "pre-digested" OM3-sn-1(3)-monoacylglycerol lipid structure (OM3-MAG) has a significantly greater absorption at high therapeutic doses (2.9 g/day) than the most commonly OM3-ethyl ester (3.1 g/day) form (used for the treatment of hypertriglyceridemia), and a comparable profile to other pre-digested OM3 free fatty acids (OM3-FFA) structure (3.2 g/day). Nutritional supplement doses of MAG resulted in similar increases in OM3 blood level, compared to OM3 triacylglycerols (OM3-TAG) supplements in obese subjects (1.2 g/day) under low fat diet, and in children with cystic fibrosis (1.0 g/day). These results suggest that both forms of pre-digested OM3-MAG and OM3-FFA are effectively absorbed and re-incorporated effectively into triacylglycerols inside the enterocytes, before being exported into the chylomicrons lipid transport system. The pre-digested OM3-MAG might provide a more effective therapy in severe cardiovascular conditions where high doses of OM3 are required and a low-fat diet is indicated, which limited digestive lipase activity.
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20
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Mauch RM, Hentschel J, Aanaes K, Barucha A, Nolasco da Silva MT, Levy CE, Høiby N, Mainz JG. Antibody response against Pseudomonas aeruginosa and its relationship with immune mediators in the upper and lower airways of cystic fibrosis patients. Pediatr Pulmonol 2020; 55:959-967. [PMID: 32022432 DOI: 10.1002/ppul.24671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The upper airways (UAW) are a niche and a reservoir of Pseudomonas aeruginosa strains that cause chronic infection of the lower airways (LAW) in cystic fibrosis (CF). Here, we assessed the role of anti-P. aeruginosa immunoglobulin A (IgA) and IgG antibodies in upper and lower airway infections in cystic fibrosis patients. METHODS Nasal lavage fluid and induced sputum samples of 40 CF patients were microbiologically cultured. We searched for correlations between anti-P. aeruginosa IgA and IgG levels, measured by enzyme-linked immunosorbent assay (optical density), and unspecific immune mediators in both specimens. RESULTS Anti-P. aeruginosa IgA (median optical density: 0.953 vs 0.298) and IgG (0.120 vs 0.059) were significantly higher in nasal lavage than in sputum, but not significantly different between patients with and without chronic P. aeruginosa infection in UAW. Matrix metallopeptidase-9 (MMP-9) in nasal lavage and neutrophil elastase (NE) in sputum were predictors of IgA in nasal lavage and IgA in sputum, respectively. IgA was a predictor of myeloperoxidase (MPO) in nasal lavage. Tissue inhibitor of metalloproteinases-1 (TIMP-1) was a predictor of IgG in sputum. IgG, TIMP-1, and NE in sputum were predictors of IgG in nasal lavage. CONCLUSION The anti-P. aeruginosa IgA response was more prominent in CF patients' UAW, indicating a lower degree of inflammatory responses. Proteases may play a role in the anti-P. aeruginosa humoral response in the upper and LAW, and anti-P. aeruginosa IgG may be involved in the crosstalk between upper and lower airways in cystic fibrosis patients.
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Affiliation(s)
- Renan M Mauch
- Center for Investigation in Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Julia Hentschel
- Institute of Human Genetics, University of Leipzig, Leipzig, Germany
| | - Kasper Aanaes
- Department of Oto-Rhino-Laryngology, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark
| | - Anton Barucha
- Department of Pediatric Pulmonology/Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Marcos T Nolasco da Silva
- Center for Investigation in Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.,Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Carlos E Levy
- Department of Clinical Pathology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Niels Høiby
- Department of International Health, Immunology, and Microbiology, Costerton Biofilm Center, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jochen G Mainz
- Department of Pediatric Pulmonology/Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany.,Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Jena, Germany
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21
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Son MJ, Jung J, Kim Y, Yeum C, Lee SM, Jung SY, Kwon O, Kim S, Kang J, Kim H, Lee J, Lee D. Treating nasal symptoms associated with rhinitis using the intranasal herbal ointment Biyeom-go: A prospective observational study. Clin Otolaryngol 2019; 44:997-1003. [PMID: 31468673 PMCID: PMC6916331 DOI: 10.1111/coa.13425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of the current study was to investigate the effectiveness and clinical feasibility of Biyeom-go for the treatment of nasal symptoms associated with rhinitis. DESIGN Prospective observational study. SETTING This study was conducted at the Woosuk Korean Medicine Medical Center in South Korea. PARTICIPANTS Fifty-eight patients with rhinitis participated in this study. All patients received Biyeom-go treatment >3 times daily for a total of 4 weeks. MAIN OUTCOME MEASURES The primary outcome was the total nasal symptom score. Mini-rhinoconjunctivitis quality of life questionnaire, nasal endoscopy index, total serum immunoglobulin E levels and immunologic factors in nasal lavage fluid were also measured. RESULTS Biyeom-go administration was associated with significant improvements in total nasal symptoms scores (P < .0001) and mini-rhinoconjunctivitis quality of life questionnaire scores (P < .0001) in a time-dependent manner. The nasal endoscopy index also significantly improved at weeks 2 (P = .0049), 3 (P < .0001) and 4 (P = .0001) after Biyeom-go treatment. Significantly, increased interleukin-2 levels (P = .005) and decreased interleukin-8, chemokine (C-C motif) ligand (CCL) 5, chemokine (C-X-C motif) ligand (CXCL) 9, CCL2 and CXCL10 levels were observed in the nasal lavage fluid. CONCLUSIONS The present findings suggest that Biyeom-go may be beneficial for the management of rhinitis symptoms and rhinitis-associated quality of life. Further well-designed randomised controlled trials are needed to evaluate the effectiveness of Biyeom-go for rhinitis.
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Affiliation(s)
- Mi Ju Son
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonKorea
| | - Jeeyoun Jung
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonKorea
| | - Young‐Eun Kim
- Future Medicine DivisionKorea Institute of Oriental MedicineDaejeonKorea
| | | | - So Min Lee
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonKorea
| | - So Young Jung
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonKorea
| | - Ojin Kwon
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonKorea
| | - Sungha Kim
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonKorea
| | - Jeong‐In Kang
- Deptartment of Ophthalmology, Otolaryngology, and DermatologyCollege of Korean MedicineWoo‐Suk UniversityJeonju‐siKorea
| | - Hye‐Lin Kim
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonKorea
| | - Jung‐Eun Lee
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonKorea
| | - Dong‐Hyo Lee
- Deptartment of Ophthalmology, Otolaryngology, and DermatologyCollege of Korean MedicineWoo‐Suk UniversityJeonju‐siKorea
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Pienkowska K, Wiehlmann L, Tümmler B. Metagenome – Inferred bacterial replication rates in cystic fibrosis airways. J Cyst Fibros 2019; 18:653-656. [DOI: 10.1016/j.jcf.2019.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/15/2018] [Accepted: 01/11/2019] [Indexed: 01/23/2023]
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Baumann R, Brand P, Chaker A, Markert A, Rack I, Davatgarbenam S, Joraslafsky S, Gerhards B, Kraus T, Gube M. Human nasal mucosal C-reactive protein responses after inhalation of ultrafine welding fume particles: positive correlation to systemic C-reactive protein responses. Nanotoxicology 2018; 12:1130-1147. [DOI: 10.1080/17435390.2018.1498930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- R. Baumann
- Institute for Occupational and Social Medicine, Aachen University of Technology, Aachen, Germany
| | - P. Brand
- Institute for Occupational and Social Medicine, Aachen University of Technology, Aachen, Germany
| | - A. Chaker
- Department of Otorhinolaryngology and Center of Allergy and Environment (ZAUM), Technical University Munich, Munich, Germany
| | - A. Markert
- Institute for Occupational and Social Medicine, Aachen University of Technology, Aachen, Germany
| | - I. Rack
- Institute for Occupational and Social Medicine, Aachen University of Technology, Aachen, Germany
| | - S. Davatgarbenam
- Institute for Occupational and Social Medicine, Aachen University of Technology, Aachen, Germany
| | - S. Joraslafsky
- Institute for Occupational and Social Medicine, Aachen University of Technology, Aachen, Germany
| | - B. Gerhards
- Welding and Joining Institute (ISF), Aachen University of Technology, Aachen, Germany
| | - T. Kraus
- Institute for Occupational and Social Medicine, Aachen University of Technology, Aachen, Germany
| | - M. Gube
- Institute for Occupational and Social Medicine, Aachen University of Technology, Aachen, Germany
- Health Office of the City and Area of Aachen, Aachen, Germany
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Jaudszus A, Arnold C, Hentschel J, Hünniger K, Baier M, Mainz JG. Increased cytokines in cystic fibrosis patients' upper airways during a new P. aeruginosa colonization. Pediatr Pulmonol 2018; 53:881-887. [PMID: 29624919 DOI: 10.1002/ppul.24004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/14/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Previously, we found linkages of inflammatory mediator levels in CF upper airways (UAW) sampled by nasal lavage (NL) to disease severity and to chronic pathogen colonization such as Pseudomonas aeruginosa (PsA). Here, we assess UAW cytokine dynamics in CF patients with a new PsA colonization. METHODS We measured cytokines in 149 longitudinally obtained NL samples from 34 CF patients. Cytokine concentrations determined prior to, at the time of de novo PsA detection in either UAW or lower airways (LAW), and in a subsequent PsA free period in newly colonized patients (PsA-new/n = 7) were compared to levels of not- (PsA-free/n = 13) and chronically colonized patients (PsA-chron/n = 14). Moreover, serological and clinical data were compiled. RESULTS Concentrations of IL-1ß, IL-6, and IL-8 in samples taken prior to new PsA detection were comparable with PsA-free patients. At the time of PsA detection and, most interestingly, irrespective of whether PsA occurred in the UAW or LAW, IL-8 increased (P = 0.009) and IL-6 tended to increase (P = 0.081). In these patients, detection of PsA was not related to elevated PsA antibody-titers. In comparison, NL of PsA-chron patients revealed generally lower IL-8 and IL-1β concentrations as in PsA-free patients, most likely due to a consequent antibiotic and anti-inflammatory therapy (eg, with azithromycin). CONCLUSIONS Monitoring cytokine dynamics in the UAW by serial NL sampling may be valuable in the early phase of PsA acquisition and, thus, increase the chance to adjust treatment options early and more specifically.
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Affiliation(s)
| | | | - Julia Hentschel
- Jena University Hospital, CF-Center, Jena, Germany.,Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
| | - Kerstin Hünniger
- Septomics Research Center, Leibniz Institute for Natural Product Research and Infection Biology- Hans-Knoell-Institute and Friedrich Schiller University, Jena, Germany
| | - Michael Baier
- Jena University Hospital, Department of Medical Microbiology, Jena, Germany
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Morlacchi LC, Greer M, Tudorache I, Blasi F, Welte T, Haverich A, Mainz JG, Gottlieb J. The burden of sinus disease in cystic fibrosis lung transplant recipients. Transpl Infect Dis 2018; 20:e12924. [DOI: 10.1111/tid.12924] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/29/2018] [Accepted: 04/01/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Letizia Corinna Morlacchi
- Internal Medicine Department; Respiratory Unit and Cystic Fibrosis Adult Centre; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano; Milan Italy
- Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Milan Italy
| | - Mark Greer
- Department of Respiratory Medicine; Lungentransplantation; Hannover Medical School; Hanover Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery; Hannover Medical School; Hanover Germany
| | - Francesco Blasi
- Internal Medicine Department; Respiratory Unit and Cystic Fibrosis Adult Centre; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano; Milan Italy
- Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Milan Italy
| | - Tobias Welte
- Department of Respiratory Medicine; Lungentransplantation; Hannover Medical School; Hanover Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH); German Centre for Lung Research (DZL); Hanover Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery; Hannover Medical School; Hanover Germany
| | - Jochen G. Mainz
- CF-Centre for Children and Adults; Department of Paediatrics; Jena University Hospital; Jena Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine; Lungentransplantation; Hannover Medical School; Hanover Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH); German Centre for Lung Research (DZL); Hanover Germany
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Soliman M, Steacy L, Thiele J, Adams D, Neighbour H, Ellis AK. Administering multiple cumulative allergen challenges: An alternative nasal allergen challenge protocol for the Allergic Rhinitis-Clinical Investigator Collaborative. Ann Allergy Asthma Immunol 2017; 117:326-8. [PMID: 27613467 DOI: 10.1016/j.anai.2016.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/11/2016] [Accepted: 06/23/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Mena Soliman
- Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Lisa Steacy
- Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
| | - Jenny Thiele
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Dan Adams
- Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Helen Neighbour
- Divisions of Clinical Immunology & Allergy and Respirology, Department of Medicine, Firestone Institute of Respiratory Health, The Research Institute at St. Joe's Hamilton and McMaster University, Hamilton, Ontario, Canada
| | - Anne K Ellis
- Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada; Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Hansel TT, Tunstall T, Trujillo-Torralbo MB, Shamji B, Del-Rosario A, Dhariwal J, Kirk PDW, Stumpf MPH, Koopmann J, Telcian A, Aniscenko J, Gogsadze L, Bakhsoliani E, Stanciu L, Bartlett N, Edwards M, Walton R, Mallia P, Hunt TM, Hunt TL, Hunt DG, Westwick J, Edwards M, Kon OM, Jackson DJ, Johnston SL. A Comprehensive Evaluation of Nasal and Bronchial Cytokines and Chemokines Following Experimental Rhinovirus Infection in Allergic Asthma: Increased Interferons (IFN-γ and IFN-λ) and Type 2 Inflammation (IL-5 and IL-13). EBioMedicine 2017; 19:128-138. [PMID: 28373098 PMCID: PMC5440599 DOI: 10.1016/j.ebiom.2017.03.033] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/09/2017] [Accepted: 03/24/2017] [Indexed: 01/04/2023] Open
Abstract
Background Rhinovirus infection is a major cause of asthma exacerbations. Objectives We studied nasal and bronchial mucosal inflammatory responses during experimental rhinovirus-induced asthma exacerbations. Methods We used nasosorption on days 0, 2–5 and 7 and bronchosorption at baseline and day 4 to sample mucosal lining fluid to investigate airway mucosal responses to rhinovirus infection in patients with allergic asthma (n = 28) and healthy non-atopic controls (n = 11), by using a synthetic absorptive matrix and measuring levels of 34 cytokines and chemokines using a sensitive multiplex assay. Results Following rhinovirus infection asthmatics developed more upper and lower respiratory symptoms and lower peak expiratory flows compared to controls (all P < 0.05). Asthmatics also developed higher nasal lining fluid levels of an anti-viral pathway (including IFN-γ, IFN-λ/IL-29, CXCL11/ITAC, CXCL10/IP10 and IL-15) and a type 2 inflammatory pathway (IL-4, IL-5, IL-13, CCL17/TARC, CCL11/eotaxin, CCL26/eotaxin-3) (area under curve day 0–7, all P < 0.05). Nasal IL-5 and IL-13 were higher in asthmatics at day 0 (P < 0.01) and levels increased by days 3 and 4 (P < 0.01). A hierarchical correlation matrix of 24 nasal lining fluid cytokine and chemokine levels over 7 days demonstrated expression of distinct interferon-related and type 2 pathways in asthmatics. In asthmatics IFN-γ, CXCL10/IP10, CXCL11/ITAC, IL-15 and IL-5 increased in bronchial lining fluid following viral infection (all P < 0.05). Conclusions Precision sampling of mucosal lining fluid identifies robust interferon and type 2 responses in the upper and lower airways of asthmatics during an asthma exacerbation. Nasosorption and bronchosorption have potential to define asthma endotypes in stable disease and at exacerbation. Following rhinovirus infection asthmatics have increased interferons and type 2 inflammation in airway mucosal lining fluid. Nasosorption cytokines and chemokines showed distinct pathways of interferon and type 2 inflammation in asthma. Precision mucosal sampling has potential for stratifying molecular endotypes of asthma. Validation of nasosorption and bronchosorption will be required for selection of asthmatics for therapy with biologics.
Experimental human rhinovirus (HRV) infection causes more severe upper and lower respiratory tract symptoms in allergic asthmatics than in healthy controls. There is greater induction of cytokines and chemokines in nasal and bronchial mucosal lining fluid (MLF) of asthmatics: with distinct pathways of type 2 and anti-viral/regulatory inflammation. Subject to further validation, analysis of MLF may prove useful in stratification of patients with asthma, and the definition of molecular endotypes. Interpretation Nasosorption and bronchosorption are precision sampling methods with potential for widespread application in respiratory and other mucosal diseases (e.g. gastrointestinal diseases). Biomarkers identified in nasosorption and bronchosorption samples will need to be validated compared to established airway sampling methods, in a range of asthma phenotypes, and with current and novel therapies.
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Affiliation(s)
- Trevor T Hansel
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK; Imperial Clinical Respiratory Research Unit (ICRRU), UK.
| | - Tanushree Tunstall
- Imperial College Healthcare NHS Trust, UK; Imperial Clinical Respiratory Research Unit (ICRRU), UK
| | - Maria-Belen Trujillo-Torralbo
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK
| | - Betty Shamji
- Novartis Institute for Biomedical Research, Horsham, UK
| | - Ajerico Del-Rosario
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK
| | - Jaideep Dhariwal
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK
| | - Paul D W Kirk
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | | | - Jens Koopmann
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; Medimmune, Cambridge, UK
| | - Aurica Telcian
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Julia Aniscenko
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Leila Gogsadze
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Eteri Bakhsoliani
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Luminita Stanciu
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Nathan Bartlett
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Michael Edwards
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Ross Walton
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK
| | - Patrick Mallia
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK
| | - Toby M Hunt
- Hunt Developments (UK) Ltd, Midhurst, West Sussex, UK
| | - Trevor L Hunt
- Hunt Developments (UK) Ltd, Midhurst, West Sussex, UK
| | - Duncan G Hunt
- Hunt Developments (UK) Ltd, Midhurst, West Sussex, UK
| | - John Westwick
- Novartis Institute for Biomedical Research, Horsham, UK
| | | | - Onn Min Kon
- Imperial College Healthcare NHS Trust, UK; Imperial Clinical Respiratory Research Unit (ICRRU), UK
| | - David J Jackson
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Guy's and St Thomas' NHS Trust
| | - Sebastian L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute (NHLI), Imperial College (IC), London, UK; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Imperial College Healthcare NHS Trust, UK
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Bock JM, Schien M, Fischer C, Naehrlich L, Kaeding M, Guntinas-Lichius O, Gerber A, Arnold C, Mainz JG. Importance to question sinonasal symptoms and to perform rhinoscopy and rhinomanometry in cystic fibrosis patients. Pediatr Pulmonol 2017; 52:167-174. [PMID: 27893197 DOI: 10.1002/ppul.23613] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/02/2016] [Accepted: 09/19/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Cystic fibrosis (CF) patients almost regularly reveal sinonasal pathology. The purpose of this study was to assess association between objective and subjective measurements of sinonasal involvement comparing nasal airflow obtained by active anterior rhinomanometry (AAR), nasal endoscopic findings, and symptoms assessed with the Sino-Nasal Outcome Test-20 (SNOT-20). METHODS Nasal cavities were explored by anterior rigid rhinoscopy and findings were compared to inspiratory nasal airflow measured by AAR to quantify nasal patency and subjective health-related quality of life in sinonasal disease obtained with the SNOT-20 questionnaire. Relations to upper and lower airway colonization with Pseudomonas aeruginosa, medical treatment, and sinonasal surgery were analysed. RESULTS A total of 124 CF patients were enrolled (mean age 19.9 ± 10.4 years, range 4-65 years). A significant association of detection of nasal polyposis (NP) in rhinoscopy was found with increased primary nasal symptoms (PNS) which include "nasal obstruction," "sneezing," "runny nose," "thick nasal discharge," and "reduced sense of smell." At the same time patients with pathologically decreased airflow neither showed elevated SNOT-20 scores nor abnormal rhinoscopic findings. Altogether, rhinomanometric and rhinoscopic findings are not significantly related. CONCLUSIONS Among SNOT-20 scores the PNS subscore is related to rhinoscopically detected polyposis and sinonasal secretion. Therefore, we recommend including short questions regarding PNS into CF-routine care. At the same time our results show that a high inspiratory airflow is not associated with a good sensation of nasal patency. Altogether, rhinomanometry is not required within routine CF-care, but it can be interesting as an outcome parameter within clinical trials. Pediatr Pulmonol. 2017;52:167-174. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- J M Bock
- Department of Paediatrics, Cystic Fibrosis Centre, Jena University Hospital, Jena, Germany
| | - M Schien
- Surgical and Perioperative Sciences, Umeå University Hospital, Umeå, Sweden
| | - C Fischer
- Department of Paediatrics, Cystic Fibrosis Centre, Jena University Hospital, Jena, Germany
| | - L Naehrlich
- Department of Paediatrics, Giessen University Hospital, Giessen, Germany
| | - M Kaeding
- CF Center, Chemnitz Hospital, Chemnitz, Germany
| | | | - A Gerber
- Department of Paediatrics, Cystic Fibrosis Centre, Jena University Hospital, Jena, Germany
| | - C Arnold
- Department of Paediatrics, Cystic Fibrosis Centre, Jena University Hospital, Jena, Germany
| | - J G Mainz
- Department of Paediatrics, Cystic Fibrosis Centre, Jena University Hospital, Jena, Germany
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Rebuli ME, Speen AM, Clapp PW, Jaspers I. Novel applications for a noninvasive sampling method of the nasal mucosa. Am J Physiol Lung Cell Mol Physiol 2016; 312:L288-L296. [PMID: 28011618 DOI: 10.1152/ajplung.00476.2016] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 12/22/2022] Open
Abstract
Reliable methods for sampling the nasal mucosa provide clinical researchers with key information regarding respiratory biomarkers of exposure and disease. For quick and noninvasive sampling of the nasal mucosa, nasal lavage (NL) collection has been widely used as a clinical tool; however, limitations including volume variability, sample dilution, and storage prevent NL collection from being used in nonlaboratory settings and analysis of low abundance biomarkers. In this study, we optimize and validate a novel methodology using absorbent Leukosorb paper cut to fit the nasal passage to extract epithelial lining fluid (ELF) from the nasal mucosa. The ELF sampling method limits the dilution of soluble mediators, allowing quantification of both high- and low-abundance soluble biomarkers such as IL-1β, IL-8, IL-6, interferon gamma-induced protein 10 (IP-10), and neutrophil elastase. Additionally, we demonstrate that this method can successfully detect the presence of respiratory pathogens such as influenza virus and markers of antibiotic-resistant bacteria in the nasal mucosa. Efficacy of ELF collection by this method is not diminished in consecutive-day sampling, and percent recovery of both recombinant IL-8 and soluble mediators are not changed despite freezing or room temperature storage for 24 h. Our results indicate that ELF collection using Leukosorb paper sampling of ELF provides a sensitive, easy-to-use, and reproducible methodology to collect concentrated amounts of soluble biomarkers from the nasal mucosa. Moreover, the methodology described herein improves upon the standard NL collection method and provides researchers with a novel tool to assess changes in nasal mucosal host defense status.
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Affiliation(s)
- Meghan E Rebuli
- Curriculum in Toxicology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Adam M Speen
- Curriculum in Toxicology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Phillip W Clapp
- Curriculum in Toxicology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Ilona Jaspers
- Curriculum in Toxicology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; .,Center for Environmental Medicine, Asthma, and Lung Biology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina; and.,Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Colonization of CF patients’ upper airways with S. aureus contributes more decisively to upper airway inflammation than P. aeruginosa. Med Microbiol Immunol 2016; 205:485-500. [DOI: 10.1007/s00430-016-0463-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/20/2016] [Indexed: 01/29/2023]
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Sino nasal inhalation of isotonic versus hypertonic saline (6.0%) in CF patients with chronic rhinosinusitis - Results of a multicenter, prospective, randomized, double-blind, controlled trial. J Cyst Fibros 2016; 15:e57-e66. [PMID: 27267518 DOI: 10.1016/j.jcf.2016.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic rhinosinusitis is a hallmark of Cystic fibrosis (CF) impairing the patients' quality of life and overall health. However, therapeutic options have not been sufficiently evaluated. Bronchial inhalation of mucolytic substances is a gold standard in CF therapy. Previously, we found that sinonasal inhalation of dornase alfa as vibrating aerosol reduces symptoms of chronic rhinosinusitis more effectively than NaCl 0.9% (net treatment benefit: -5.87±2.3 points, p=0.017; SNOT-20 total score). This multicenter study compares the effect of NaCl 6.0% vs. NaCl 0.9% following the protocol from our preceding study with dornase alfa. METHODS Sixty nine CF patients with chronic rhinosinusitis in eleven German CF centers were randomized to receive sinonasal vibrating inhalation of either NaCl 6.0% or NaCl 0.9% for 28days. After 28days of wash-out, patients crossed over to the alternative treatment. The primary outcome parameter was symptom score in the disease-specific quality of life Sino-Nasal Outcome Test-20 (SNOT-20). Additionally, pulmonary function was assessed, as well as rhinomanometry and inflammatory markers in nasal lavage (neutrophil elastase, interleukin (IL)-1β, IL-6, and IL-8) in a subgroup. RESULTS Both therapeutic arms were well tolerated and showed slight improvements in SNOT-20 total scores (NaCl 6.0%: -3.1±6.5 points, NaCl 0.9%: -5.1±8.3 points, ns). In both treatment groups, changes of inflammatory parameters in nasal lavage from day 1 to day 29 were not significant. We suppose that the irritating properties of NaCl 6.0% reduced the suitability of the SNOT-20 scores as an outcome parameter. Alternative primary outcome parameters such as MR-imaging or the quantity of sinonasal secretions mobilized with both saline concentrations were, however, not feasible. CONCLUSION Sinonasal inhalation with NaCl 6.0% did not lead to superior results vs. NaCl 0.9%, whereas dornase alfa had been significantly more effective than NaCl 0.9%.
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Mårtensson A, Greiff L, Lamei SS, Lindstedt M, Olofsson TC, Vasquez A, Cervin A. Effects of a honeybee lactic acid bacterial microbiome on human nasal symptoms, commensals, and biomarkers. Int Forum Allergy Rhinol 2016; 6:956-63. [PMID: 27080343 DOI: 10.1002/alr.21762] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/05/2016] [Accepted: 02/04/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lactic acid bacteria (LAB) can restore commensal microbiomes and prevent infections. Arguably, nasal administrations of LAB may therefore be beneficial in chronic rhinosinusitis (CRS). Previous studies have examined effects of topical/nasal LAB in children with secretory otitis media, but little is as yet known about their effects on the human nasal airway. The aim of this pilot study was to examine effects on nasal symptoms and commensal bacteria in healthy subjects of nasal administration of a honeybee LAB microbiome; ie, a mixture of 9 Lactobacillus spp. and 4 Bifidobacterium spp. obtained from the honeybee Apis mellifera. Furthermore, we aimed to assess whether or not the honeybee LAB produced a local inflammatory response. METHODS Twenty-two healthy subjects received a single administration of honeybee LAB in a sham-controlled, double-blinded, and crossover design. Using questionnaires, microbiological methods, and nasal lavages, they were assessed regarding symptoms, changes to commensal bacteria, and inflammatory products in nasal lavage fluids. RESULTS The honeybee LAB did not produce any symptoms or other untoward effects. No changes were observed of commensal bacteria by the honeybee LAB, and no inflammatory response was detected (compared to sham); ie, unaffected nasal lavage fluid levels of monocyte chemoattractant protein-1 (MCP-1), interleukin-8 (IL-8), monokine induced by interferon-γ (MIG), interleukin-15 (IL-15), epidermal growth factor (EGF), eotaxin, interferon gamma-induced protein-10 (IP-10), and interleukin-1 receptor antagonist (IL-1RA). CONCLUSION A single human nasal administration of a honeybee LAB microbiome is well tolerated. Specifically, it does not affect commensal bacteria and does not produce an inflammatory response.
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Affiliation(s)
- Anders Mårtensson
- Department of Otorhinolaryngology (ORL), Helsingborg Hospital, Helsingborg, Sweden
| | - Lennart Greiff
- Department of ORL-Head and Neck Surgery, Skåne University Hospital, Lund, Sweden.
| | - Sepideh S Lamei
- Department of Laboratory Medicine, Lund, Section of Medical Microbiology, Lund University, Lund, Sweden
| | - Malin Lindstedt
- Department of Immunotechnology, Lund University, Lund, Sweden
| | - Tobias C Olofsson
- Department of Laboratory Medicine, Lund, Section of Medical Microbiology, Lund University, Lund, Sweden
| | - Alejandra Vasquez
- Department of Laboratory Medicine, Lund, Section of Medical Microbiology, Lund University, Lund, Sweden
| | - Anders Cervin
- Department of ORL-Head and Neck Surgery, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, Australia
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Chronic Rhinosinusitis as a Crucial Symptom of Cystic Fibrosis—Case Report and Discussion on the Sinonasal Compartment as Site of Pseudomonas aeruginosa Acquisition into CF Airways. SINUSITIS 2016. [DOI: 10.3390/sinusitis1010049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Dantoft TM, Skovbjerg S, Andersson L, Claeson AS, Lind N, Nordin S, Brix S. Inflammatory Mediator Profiling of n-butanol Exposed Upper Airways in Individuals with Multiple Chemical Sensitivity. PLoS One 2015; 10:e0143534. [PMID: 26599866 PMCID: PMC4657963 DOI: 10.1371/journal.pone.0143534] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/05/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Multiple Chemical Sensitivity (MCS) is a chronic condition characterized by reports of recurrent symptoms in response to low level exposure to various chemical substances. Recent findings suggests that dysregulation of the immune system may play a role in MCS pathophysiology. OBJECTIVES The aim of this study was to examine baseline and low dose n-butanol-induced upper airway inflammatory response profiles in MCS subjects versus healthy controls. METHOD Eighteen participants with MCS and 18 age- and sex-matched healthy controls were enrolled in the study. Epithelial lining fluid was collected from the nasal cavity at three time points: baseline, within 15 minutes after being exposed to 3.7 ppm n-butanol in an exposure chamber and four hours after exposure termination. A total of 19 cytokines and chemokines were quantified. Furthermore, at baseline and during the exposure session, participants rated the perceived intensity, valence and levels of symptoms and autonomic recordings were obtained. RESULTS The physiological and psychophysical measurements during the n-butanol exposure session verified a specific response in MCS individuals only. However, MCS subjects and healthy controls displayed similar upper airway inflammatory mediator profiles (P>0.05) at baseline. Likewise, direct comparison of mediator levels in the MCS group and controls after n-butanol exposure revealed no significant group differences. CONCLUSION We demonstrate no abnormal upper airway inflammatory mediator levels in MCS subjects before or after a symptom-eliciting exposure to low dose n-butanol, implying that upper airways of MCS subjects are functionally intact at the level of cytokine and chemokine production and secretory capacity. This suggests that previous findings of increased cytokine plasma levels in MCS are unlikely to be caused by systemic priming via excessive upper airway inflammatory processes.
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Affiliation(s)
- Thomas Meinertz Dantoft
- Danish Research Centre for Chemical Sensitivities, Copenhagen University Hospital, Gentofte, Denmark
- Center for Biological Sequence Analysis, Department of Systems Biology, Technical University of Denmark, Kongens Lyngby, Denmark
- * E-mail: ;
| | - Sine Skovbjerg
- Research Centre for Prevention and Health, Capital Region, Copenhagen, Denmark
| | - Linus Andersson
- Department of Psychology, Umeå University, Umeå, Sweden
- Department of Occupational and Public Health Sciences, University of Gävle, Umeå, Sweden
| | | | - Nina Lind
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Susanne Brix
- Center for Biological Sequence Analysis, Department of Systems Biology, Technical University of Denmark, Kongens Lyngby, Denmark
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Nasal Lipopolysaccharide Challenge and Cytokine Measurement Reflects Innate Mucosal Immune Responsiveness. PLoS One 2015; 10:e0135363. [PMID: 26367003 PMCID: PMC4569396 DOI: 10.1371/journal.pone.0135363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 07/18/2015] [Indexed: 01/27/2023] Open
Abstract
Background Practical methods of monitoring innate immune mucosal responsiveness are lacking. Lipopolysaccharide (LPS) is a component of the cell wall of Gram negative bacteria and a potent activator of Toll-like receptor (TLR)-4. To measure LPS responsiveness of the nasal mucosa, we administered LPS as a nasal spray and quantified chemokine and cytokine levels in mucosal lining fluid (MLF). Methods We performed a 5-way cross-over, single blind, placebo-controlled study in 15 healthy non-atopic subjects (n = 14 per protocol). Doses of ultrapure LPS (1, 10, 30 or 100μg/100μl) or placebo were administered by a single nasal spray to each nostril. Using the recently developed method of nasosorption with synthetic adsorptive matrices (SAM), a series of samples were taken. A panel of seven cytokines/chemokines were measured by multiplex immunoassay in MLF. mRNA for intercellular cell adhesion molecule-1 (ICAM-1) was quantified from nasal epithelial curettage samples taken before and after challenge. Results Topical nasal LPS was well tolerated, causing no symptoms and no visible changes to the nasal mucosa. LPS induced dose-related increases in MLF levels of IL-1β, IL-6, CXCL8 (IL-8) and CCL3 (MIP-1α) (AUC at 0.5 to 10h, compared to placebo, p<0.05 at 30 and 100μg LPS). At 100μg LPS, IL-10, IFN-α and TNF-α were also increased (p<0.05). Dose-related changes in mucosal ICAM-1 mRNA were also seen after challenge, and neutrophils appeared to peak in MLF at 8h. However, 2 subjects with high baseline cytokine levels showed prominent cytokine and chemokine responses to relatively low LPS doses (10μg and 30μg LPS). Conclusions Topical nasal LPS causes dose-dependent increases in cytokines, chemokines, mRNA and cells. However, responsiveness can show unpredictable variations, possibly because baseline innate tone is affected by environmental factors. We believe that this new technique will have wide application in the study of the innate immune responses of the respiratory mucosa. Key Messages Ultrapure LPS was used as innate immune stimulus in a human nasal challenge model, with serial sampling of nasal mucosal lining fluid (MLF) by nasosorption using a synthetic absorptive matrix (SAM), and nasal curettage of mucosal cells. A dose response could be demonstrated in terms of levels of IL-1β, IL-6, CXCL8 and CCL3 in MLF, as well as ICAM-1 mRNA in nasal curettage specimens, and levels of neutrophils in nasal lavage. Depending on higher baseline levels of inflammation, there were occasional magnified innate inflammatory responses to LPS. Trial Registration Clinical Trials.gov NCT02284074
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Mirowsky J, Gordon T. Noninvasive effects measurements for air pollution human studies: methods, analysis, and implications. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2015; 25:354-80. [PMID: 25605444 PMCID: PMC6659729 DOI: 10.1038/jes.2014.93] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/26/2014] [Accepted: 11/05/2014] [Indexed: 05/09/2023]
Abstract
Human exposure studies, compared with cell and animal models, are heavily relied upon to study the associations between health effects in humans and air pollutant inhalation. Human studies vary in exposure methodology, with some work conducted in controlled settings, whereas other studies are conducted in ambient environments. Human studies can also vary in the health metrics explored, as there exists a myriad of health effect end points commonly measured. In this review, we compiled mini reviews of the most commonly used noninvasive health effect end points that are suitable for panel studies of air pollution, broken into cardiovascular end points, respiratory end points, and biomarkers of effect from biological specimens. Pertinent information regarding each health end point and the suggested methods for mobile collection in the field are assessed. In addition, the clinical implications for each health end point are summarized, along with the factors identified that can modify each measurement. Finally, the important research findings regarding each health end point and air pollutant exposures were reviewed. It appeared that most of the adverse health effects end points explored were found to positively correlate with pollutant levels, although differences in study design, pollutants measured, and study population were found to influence the magnitude of these effects. Thus, this review is intended to act as a guide for researchers interested in conducting human exposure studies of air pollutants while in the field, although there can be a wider application for using these end points in many epidemiological study designs.
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Affiliation(s)
- Jaime Mirowsky
- Department of Environmental Medicine, New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York, USA
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Müller U, Hentschel J, Janhsen WK, Hünniger K, Hipler UC, Sonnemann J, Pfister W, Böer K, Lehmann T, Mainz JG. Changes of Proteases, Antiproteases, and Pathogens in Cystic Fibrosis Patients' Upper and Lower Airways after IV-Antibiotic Therapy. Mediators Inflamm 2015; 2015:626530. [PMID: 26185365 PMCID: PMC4491395 DOI: 10.1155/2015/626530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/18/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In cystic fibrosis (CF) the upper (UAW) and lower airways (LAW) are reservoirs for pathogens like Pseudomonas aeruginosa. The consecutive hosts' release of proteolytic enzymes contributes to inflammation and progressive pulmonary destruction. Objectives were to assess dynamics of protease : antiprotease ratios and pathogens in CF-UAW and LAW sampled by nasal lavage (NL) and sputum before and after intravenous- (IV-) antibiotic therapy. METHODS From 19 IV-antibiotic courses of 17 CF patients NL (10 mL/nostril) and sputum were collected before and after treatment. Microbiological colonization and concentrations of NE/SLPI/CTSS (ELISA) and MMP-9/TIMP-1 (multiplex bead array) were determined. Additionally, changes of sinonasal symptoms were assessed (SNOT-20). RESULTS IV-antibiotic treatment had more pronounced effects on inflammatory markers in LAW, whereas trends to decrease were also found in UAW. Ratios of MMP-9/TIMP-1 were higher in sputum, and ratios of NE/SLPI were higher in NL. Remarkably, NE/SLPI ratio was 10-fold higher in NL compared to healthy controls. SNOT-20 scores decreased significantly during therapy (P = 0.001). CONCLUSION For the first time, changes in microbiological patterns in UAW and LAW after IV-antibiotic treatments were assessed, together with changes of protease/antiprotease imbalances. Delayed responses of proteases and antiproteases to IV-antibiotic therapy were found in UAW compared to LAW.
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Affiliation(s)
- Ulrike Müller
- Department of Pediatrics, Cystic Fibrosis Center, Jena University Hospital, 07740 Jena, Germany
| | - Julia Hentschel
- Department of Pediatrics, Cystic Fibrosis Center, Jena University Hospital, 07740 Jena, Germany
| | - Wibke K. Janhsen
- Department of Pediatrics, Cystic Fibrosis Center, Jena University Hospital, 07740 Jena, Germany
| | - Kerstin Hünniger
- Septomics Research Center, Friedrich Schiller University, 07745 Jena, Germany
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, Jena, Germany
| | | | - Jürgen Sonnemann
- Department of Pediatric Hematology and Oncology, Jena University Hospital, 07740 Jena, Germany
| | - Wolfgang Pfister
- Institute of Medical Microbiology, University of Jena, 07740 Jena, Germany
| | - Klas Böer
- Institute for Clinical Chemistry and Laboratory Diagnostics, Jena University Hospital, 07740 Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, 07740 Jena, Germany
| | - Jochen G. Mainz
- Department of Pediatrics, Cystic Fibrosis Center, Jena University Hospital, 07740 Jena, Germany
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Pseudomonas aeruginosa Acquisition in Cystic Fibrosis Patients in Context of Otorhinolaryngological Surgery or Dentist Attendance: Case Series and Discussion of Preventive Concepts. Case Rep Infect Dis 2015; 2015:438517. [PMID: 25866686 PMCID: PMC4381717 DOI: 10.1155/2015/438517] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/25/2015] [Accepted: 03/02/2015] [Indexed: 01/23/2023] Open
Abstract
Introduction. P. aeruginosa is the primary cause for pulmonary destruction and premature death in cystic fibrosis (CF). Therefore, prevention of airway colonization with the pathogen, ubiquitously present in water, is essential. Infection of CF patients with P. aeruginosa after dentist treatment was proven and dental unit waterlines were identified as source, suggesting prophylactic measures. For their almost regular sinonasal involvement, CF patients often require otorhinolaryngological (ORL) attendance. Despite some fields around ORL-procedures with comparable risk for acquisition of P. aeruginosa, such CF cases have not yet been reported. We present four CF patients, who primarily acquired P. aeruginosa around ORL surgery, and one around dentist treatment. Additionally, we discuss risks and preventive strategies for CF patients undergoing ORL-treatment. Perils include contact to pathogen-carriers in waiting rooms, instrumentation, suction, drilling, and flushing fluid, when droplets containing pathogens can be nebulized. Postsurgery mucosal damage and debridement impair sinonasal mucociliary clearance, facilitating pathogen proliferation and infestation. Therefore, sinonasal surgery and dentist treatment of CF patients without chronic P. aeruginosa colonization must be linked to repeated microbiological assessment. Further studies must elaborate whether all CF patients undergoing ORL-surgery require antipseudomonal prophylaxis, including nasal lavages containing antibiotics. Altogether, this underestimated risk requires structured prevention protocols.
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Protease-antiprotease imbalances differ between Cystic Fibrosis patients' upper and lower airway secretions. J Cyst Fibros 2014; 14:324-33. [PMID: 25286826 DOI: 10.1016/j.jcf.2014.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/31/2014] [Accepted: 09/02/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Balanced levels of proteases and anti-proteases are essential in host defense systems. In CF patients' lungs, elevated protease/anti-protease-ratios contribute to damage of airway tissue and premature death with the inherited disease. Little is known about upper airway protease equilibrium in CF. METHODS Neutrophil elastase (NE), Secretory leukocyte protease inhibitor (SLPI), matrix metalloproteinase (MMP)9, tissue inhibitors of metalloproteinase (TIMP)1, cathepsin S (CTSS) and the corresponding cellular distribution were assessed in the nasal lavage (NL) and sputum of 40 CF patients. RESULTS Concentrations of all proteases and anti-proteases were markedly higher in sputum than in NL (NE: 10-fold, SLPI: 5000-fold). Interestingly, the NE/SLPI ratio was 726-fold higher in NL compared to sputum, while the MMP9/TIMP1 ratio was 4.5-fold higher in sputum compared to NL. DISCUSSION This first study to compare protease/anti-protease networks of CF upper and lower airways by NL and sputum reveals substantial differences between both compartments' immunological responses. This finding may have implications for sinonasal and pulmonary treatment, possibly leading to new therapeutic approaches.
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Mainz JG, Michl R, Arnold C. Response to Karadag. J Cyst Fibros 2014; 13:602-3. [PMID: 25081561 DOI: 10.1016/j.jcf.2014.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Jochen G Mainz
- Jena University Hospital, Cystic Fibrosis Center, Kochstrasse 2, 07745 Jena, Germany.
| | - Ruth Michl
- Jena University Hospital, Cystic Fibrosis Center, Kochstrasse 2, 07745 Jena, Germany
| | - Christin Arnold
- Jena University Hospital, Cystic Fibrosis Center, Kochstrasse 2, 07745 Jena, Germany
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Hentschel J, Jäger M, Beiersdorf N, Fischer N, Doht F, Michl RK, Lehmann T, Markert UR, Böer K, Keller PM, Pletz MW, Mainz JG. Dynamics of soluble and cellular inflammatory markers in nasal lavage obtained from cystic fibrosis patients during intravenous antibiotic treatment. BMC Pulm Med 2014; 14:82. [PMID: 24885494 PMCID: PMC4024110 DOI: 10.1186/1471-2466-14-82] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 04/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In cystic fibrosis (CF) patients, the upper airways display the same ion channel defect as evident in the lungs, resulting in chronic inflammation and infection. Recognition of the sinonasal area as a site of first and persistent infection with pathogens, such as Pseudomonas aeruginosa, reinforces the "one-airway" hypothesis. Therefore, we assessed the effect of systemic antibiotics against pulmonary pathogens on sinonasal inflammation. METHODS Nasal lavage fluid (NLF) from 17 CF patients was longitudinally collected prior to and during elective intravenous (i.v.) antibiotic treatment to reduce pathogen burden and resulting inflammation (median treatment time at time of analysis: 6 days). Samples were assessed microbiologically and cytologically. Cytokine and chemokine expression was measured by Cytometric Bead Array and ELISA (interleukin (IL)-1β, IL-6, IL-8, MPO, MMP9, RANTES and NE). Findings were compared with inflammatory markers from NLF obtained from 52 healthy controls. RESULTS Initially, the total cell count of the NLF was significantly higher in CF patients than in controls. However after i.v. antibiotic treatment it decreased to a normal level. Compared with controls, detection frequencies and absolute concentrations of MPO, IL-8, IL-6 and IL-1β were also significantly higher in CF patients. The detection frequency of TNF was also higher. Furthermore, during i.v. therapy sinonasal concentrations of IL-6 decreased significantly (P = 0.0059), while RANTES and MMP9 levels decreased 10-fold and two-fold, respectively. PMN-Elastase, assessed for the first time in NFL, did not change during therapy. CONCLUSIONS Analysis of NLF inflammatory markers revealed considerable differences between controls and CF patients, with significant changes during systemic i.v. AB treatment within just 6 days. Thus, our data support further investigation into the collection of samples from the epithelial surface of the upper airways by nasal lavage as a potential diagnostic and research tool.
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Affiliation(s)
- Julia Hentschel
- CF-Centre, Pediatrics, Jena University Hospital, Jena, Germany.
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