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Rahi MS, Mudgal M, Asokar BK, Yella PR, Gunasekaran K. Management of Refractory Chronic Obstructive Pulmonary Disease: A Review. Life (Basel) 2024; 14:542. [PMID: 38792564 PMCID: PMC11122447 DOI: 10.3390/life14050542] [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: 03/11/2024] [Revised: 04/07/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common condition with an estimated prevalence of 12% in adults over the age of 30 years worldwide. COPD is a leading cause of morbidity and mortality globally, with a substantial economic and social burden. There are an estimated 3 million deaths annually due to COPD. However, most of the patients with COPD respond to routine interventions like bronchodilator therapy, assessing supplemental oxygen needs, smoking cessation, vaccinations, and pulmonary rehabilitation. There is a significant number of patients who unfortunately progress to have persistent symptoms despite these interventions. Refractory COPD is not yet formally defined. Patients with severe persistent symptoms or exacerbations despite appropriate care can be considered to have refractory COPD. Managing refractory COPD needs a multidimensional approach. In this review article, we will discuss essential interventions like ensuring adequate inhaler techniques, exploring the need for non-invasive ventilatory support, use of chronic antibiotics and phosphodiesterase inhibitors to advanced therapies like bronchoscopic lung volume reduction surgery, and the upcoming role of anti-IL5 agents in managing patients with refractory COPD. We will also discuss non-pharmacologic interventions like psycho-social support and nutritional support. We will conclude by discussing the palliative care aspect of managing patients with refractory COPD. Through this review article, we aim to better the approach to managing patients with refractory COPD and discuss new upcoming therapies.
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Affiliation(s)
- Mandeep Singh Rahi
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Lawrence and Memorial Hospital, New London, CT 06320, USA
| | - Mayuri Mudgal
- Department of Internal Medicine, Camden Clark Medical Center, Parkersburg, WV 26101, USA;
| | - Bharat Kumar Asokar
- Division of Medical Sciences, The Tamilnadu Dr. MGR University, Chennai 600032, Tamilnadu, India;
| | | | - Kulothungan Gunasekaran
- Division of Pulmonary Diseases and Critical Care Medicine, Yuma Regional Medical Center, Yuma, AZ 85364, USA;
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2
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Li S, Lin L, Zhao J, Yang Z, Zhong Y, Huang L, Chen J, Zhang L, Ding Y, Xie T. The Study of the Influence of IL5RA Variants on Chronic Obstructive Pulmonary Disease. COPD 2023; 20:338-347. [PMID: 37905709 DOI: 10.1080/15412555.2023.2270729] [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: 07/09/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex disease, and its pathogenesis is influenced by genetic factors. This study aimed to evaluate the role of IL5RA genetic variation in the risk of COPD. In this study, 498 patients with COPD and 498 normal controls were recruited. Subsequently, five SNPs (rs3804795, rs2290610, rs13097407, rs334782, and rs3856850) in the IL5RA gene were genotyped. Logistic analysis examined the association of five single nucleotide polymorphisms (SNPs) in IL5RA with the risk of COPD under various genetic models. Furthermore, the association between IL5RA and susceptibility to COPD was comprehensively analyzed with stratification based on age, sex, smoking, and alcohol consumption. Our study showed that IL5RA rs13097407 reduced susceptibility to COPD (OR = 0.43, p < 0.001, p (FDR)< 0.001). On the other hand, rs3856850 was associated with an increased risk of COPD (OR = 1.71, p = 0.002, p (FDR) = 0.002). Interestingly, the effect of IL5RA SNPs on susceptibility to COPD was found to be influenced by factors such as sex and smoking. IL5RA gene variants were significantly associated with susceptibility to COPD.
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Affiliation(s)
- Siguang Li
- Department of General Practice, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
| | - Lingsang Lin
- Department of General Practice, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
| | - Jie Zhao
- Department of Pulmonary and Critical Care Medicine, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
| | - Zehua Yang
- Department of Pulmonary and Critical Care Medicine, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
| | - Yi Zhong
- Department of General Practice, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
| | - Linhui Huang
- Department of Pulmonary and Critical Care Medicine, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
| | - Jie Chen
- Department of General Practice, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
| | - Lei Zhang
- Department of Pulmonary and Critical Care Medicine, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
| | - Yipeng Ding
- Department of General Practice, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
- Department of Pulmonary and Critical Care Medicine, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
| | - Tian Xie
- Department of Pulmonary and Critical Care Medicine, Hainan affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, Hainan, China
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3
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Jiang Y, Deng S, Hu X, Luo L, Zhang Y, Zhang D, Li X, Feng J. Identification of potential biomarkers and immune infiltration characteristics in severe asthma. Int J Immunopathol Pharmacol 2022; 36:3946320221114194. [PMID: 35817495 PMCID: PMC9280849 DOI: 10.1177/03946320221114194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We hope to identify key molecules that can be used as markers of asthma severity and investigate their correlation with immune cell infiltration in severe asthma. METHODS An asthma dataset was downloaded from the Gene Expression Omnibus database and then processed by R software to obtain differentially expressed genes (DEGs). First, multiple enrichment platforms were applied to analyze crucial biological processes and pathways and protein-protein interaction networks related to the DEGs. We next combined least absolute shrinkage and selection operator logistic regression and the support vector machine-recursive feature elimination algorithms to screen diagnostic markers of severe asthma. Then, a local cohort consisting of 40 asthmatic subjects (24 with moderate asthma and 16 with severe asthma) was used for biomarker validation. Finally, infiltration of immune cells in asthma bronchoalveolar lavage fluid and their correlation with the screened markers was evaluated by CIBERSORT. RESULTS A total of 97 DEGs were identified in this study. Most of these genes are enriched in T cell activation and immune response in the asthma biological process. CC-chemokine receptor 7 (CCR7) and natural killer cell protein 7(NKG7) were identified as markers of severe asthma. The highest area under the ROC curve (AUC) was from a new indicator combining CCR7 and NKG7 (AUC = 0.851, adj. p < 0.05). Resting and activated memory CD4 T cells, activated NK cells, and CD8 T cells were found to be significantly higher in the severe asthma group (adj. p < 0.01). CCR7 and NKG7 were significantly correlated with these infiltrated cells that showed differences between the two groups. In addition, CCR7 was found to be significantly positively correlated with eosinophils (r = 0.38, adj. p < 0.05) infiltrated in bronchoalveolar lavage fluid. CONCLUSION CCR7 and NKG7 might be used as potential markers for asthma severity, and their expression may be associated with differences in immune cell infiltration in the moderate and severe asthma groups.
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Affiliation(s)
- Yuanyuan Jiang
- Center of Respiratory Medicine, Xiangya Hospital, 12570Central South University, Changsha, Hunan, China
| | - Shuanglinzi Deng
- Center of Respiratory Medicine, Xiangya Hospital, 12570Central South University, Changsha, Hunan, China
| | - Xinyue Hu
- Center of Respiratory Medicine, Xiangya Hospital, 12570Central South University, Changsha, Hunan, China
| | - Lisha Luo
- Center of Respiratory Medicine, Xiangya Hospital, 12570Central South University, Changsha, Hunan, China
| | - Yingyu Zhang
- Center of Respiratory Medicine, Xiangya Hospital, 12570Central South University, Changsha, Hunan, China
| | - Daimo Zhang
- Center of Respiratory Medicine, Xiangya Hospital, 12570Central South University, Changsha, Hunan, China
| | - Xiaozhao Li
- Department of Nephrology, Xiangya Hospital, 12570Central South University, Changsha, Hunan, China
| | - Juntao Feng
- Center of Respiratory Medicine, Xiangya Hospital, 12570Central South University, Changsha, Hunan, China
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4
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Zhang C, Wang Y, Zhang M, Su X, Lei T, Yu H, Liu J. Monoclonal Antibodies Targeting IL-5 or IL-5Rα in Eosinophilic Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:754268. [PMID: 34795588 PMCID: PMC8594629 DOI: 10.3389/fphar.2021.754268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Although the predominant airway inflammation in chronic obstructive pulmonary disease (COPD) is neutrophilic, approximately 20-40% of COPD patients present with eosinophilic airway inflammation. Compared with non-eosinophilic COPD patients, eosinophilic COPD patients are characterized by a greater number of total exacerbations and higher hospitalization rates. Furthermore, anti-interleukin-5 (IL-5) therapy, consisting of monoclonal antibodies (mAbs) targeting IL-5 or IL-5 receptor α (IL-5Rα), has been proven to be effective in severe eosinophilic asthma. This meta-analysis aimed to determine the efficacy and safety of anti-IL-5 therapy in eosinophilic COPD. Methods: We searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to August 2020 (updated in June 2021) to identify studies comparing anti-IL-5 therapy (including mepolizumab, benralizumab, and reslizumab) with placebo in eosinophilic COPD patients. Results: Anti-IL-5 therapy was associated with a decrease in acute exacerbation rate (RR 0.89; 95% CI 0.84 to 0.95, I 2 = 0%) and the severe adverse events (RR 0.90; 95% CI 0.84 to 0.97, I 2 = 0%). However, no significant improvement was observed in pre-bronchodilator forced expiratory volume in 1 s (FEV1) (WMD 0.01; 95% CI -0.01 to 0.03, I 2 = 25.9%), SGRQ score (WMD -1.17; 95% CI -2.05 to -0.29, I 2 = 0%), and hospital admission rate (RR 0.91; 95% CI 0.78 to 1.07, I 2 = 20.8%). Conclusion: Anti-IL-5 therapy significantly reduced the annual acute exacerbation rate and severe adverse events in eosinophilic COPD patients. However, it did not improve lung function, quality of life, and hospitalization rate.
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Affiliation(s)
- Chuchu Zhang
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Yalei Wang
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Meng Zhang
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Xiaojie Su
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Ting Lei
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Haichuan Yu
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Jian Liu
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China
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5
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Metabolomic analysis of lung cancer patients with chronic obstructive pulmonary disease using gas chromatography-mass spectrometry. J Pharm Biomed Anal 2020; 190:113524. [PMID: 32795777 DOI: 10.1016/j.jpba.2020.113524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 02/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD), characterized by intermittent exacerbations and clinical subphenotypes like emphysema and chronic bronchitis, poses a significant risk of lung cancer (LC) development. Metabolomic studies of COPD are scarce, and those of LC patients with COPD subphenotypes have not been investigated. To study metabolite profile alteration in LC patients with different COPD subphenotypes, lung paracancer tissue from 10 LC (CON) patients, 10 LC patients with emphysema (E), and 9 LC patients with chronic bronchitis (CB) were analyzed using gas chromatography-mass spectrometry. Multivariate analysis indicated a distinct separation between LC patients with COPD subphenotypes and LC patients. Overall, 60, 55, 33 and 63 differential metabolites (DM) were identified in comparisons between CB vs CON, E vs CON, CB vs E, and CB + E vs CON, respectively, and of these, 8 DM were shared in all comparisons. Among the high altered metabolites, E samples showed higher 'acetol' than CON samples, and lower 'azelaic acid', '3-methylglutaric acid' and 'allose'. CB samples showed higher 'turanose' and 'o-phosphoserine' and lower 'anandamide' than CON and E samples. In CB and E samples, 'galactonic acid', '2-mercaptoethanesulfonic acid', 'D-alanyl-D-alanine' '3-methylglutaric acid', 'glycine', 'L-4-Hydroxyphenylglycine' and 'O-phosphonothreonine' had common alteration trends compared with those of CON samples. 'Glycine', 'L-4-Hydroxyphenylglycine' and 'O-phosphonothreonine' were significantly enriched in glycine, serine and threonine metabolism pathways. The total differential metabolites detected were remarkably altered in pyrimidine, beta-alanine and purine metabolism. Our study provided altered DM patterns of lung paracancer tissue, the key metabolites and their enriched metabolic pathways in LC patients with different COPD subphenotypes.
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6
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Baines KJ, Negewo NA, Gibson PG, Fu JJ, Simpson JL, Wark PAB, Fricker M, McDonald VM. A Sputum 6 Gene Expression Signature Predicts Inflammatory Phenotypes and Future Exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:1577-1590. [PMID: 32669843 PMCID: PMC7337431 DOI: 10.2147/copd.s245519] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/24/2020] [Indexed: 02/05/2023] Open
Abstract
Background The 6 gene expression signature (6GS) predicts inflammatory phenotype, exacerbation risk, and corticosteroid responsiveness in asthma. In COPD, patterns of airway inflammation are similar, suggesting the 6GS may be useful. This study determines the diagnostic and prognostic ability of 6GS in predicting inflammatory phenotypes and exacerbation risk in COPD. Methods We performed 2 studies: a cross-sectional phenotype prediction study in stable COPD (total N=132; n=34 eosinophilic (E)-COPD, n=42 neutrophilic (N)-COPD, n=39 paucigranulocytic (PG)-COPD, n=17 mixed-granulocytic (MG)-COPD) that assessed 6GS ability to discriminate phenotypes (eosinophilia≥3%; neutrophilia≥61%); and a prospective cohort study (total n=54, n=8 E-COPD; n=18 N-COPD; n=20 PG-COPD; n=8 MG-COPD, n=21 exacerbation prone (≥2/year)) that investigated phenotype and exacerbation prediction utility. 6GS was measured by qPCR and evaluated using multiple logistic regression and area under the curve (AUC). Short-term reproducibility (intra-class correlation) and phenotyping method agreement (κ statistic) were assessed. Results In the phenotype prediction study, 6GS could accurately identify and discriminate patients with E-COPD from N-COPD (AUC=96.4%; p<0.0001), PG-COPD (AUC=88.2%; p<0.0001) or MG-COPD (AUC=86.2%; p=0.0001), as well as N-COPD from PG-COPD (AUC=83.6%; p<0.0001) or MG-COPD (AUC=87.4%; p<0.0001) and was reproducible. In the prospective cohort study, 6GS had substantial agreement for neutrophilic inflammation (82%, κ=0.63, p<0.001) and moderate agreement for eosinophilic inflammation (78%, κ=0.42, p<0.001). 6GS could significantly discriminate exacerbation prone patients (AUC=77.2%; p=0.034). Higher IL1B levels were associated with poorer lung function and increased COPD severity. Conclusion 6GS can significantly and reproducibly discriminate COPD inflammatory phenotypes and predict exacerbation prone patients and may become a useful molecular diagnostic tool assisting COPD management.
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Affiliation(s)
- Katherine J Baines
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia
| | - Netsanet A Negewo
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Juan-Juan Fu
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia
| | - Peter A B Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Michael Fricker
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa M McDonald
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia.,School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
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7
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Narendra DK, Hanania NA. Targeting IL-5 in COPD. Int J Chron Obstruct Pulmon Dis 2019; 14:1045-1051. [PMID: 31190789 PMCID: PMC6529620 DOI: 10.2147/copd.s155306] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/12/2019] [Indexed: 11/23/2022] Open
Abstract
Many patients with chronic obstructive pulmonary disease (COPD) continue to experience exacerbations despite receiving standard-of-care treatments. Novel approaches to COPD treatment focus on understanding and targeting molecular mechanisms of airway inflammation, airway obstruction, remodeling and lung destruction. Several identified phenotypes and endotypes of COPD will pave the future path for a more personalized approach to therapy. Although well known to be associated with neutrophilic inflammation, COPD may also be driven by eosinophilic inflammation both at stable states and during exacerbation. Targeting eosinophilic inflammation has been successful in managing severe eosinophilic asthma and may hold promise in certain phenotypes of COPD. The most promising biologic treatments at an advanced stage of development are agents blocking interleukin (IL)-5 or its receptor. This review examines our current understanding of the eosinophilic inflammation in COPD and the rationale for IL-5 targeting agents.
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Affiliation(s)
- Dharani K Narendra
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
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8
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Michalak B, Piwowarski JP, Granica S, Waltenberger B, Atanasov AG, Khan SY, Breuss JM, Uhrin P, Żyżyńska-Granica B, Stojakowska A, Stuppner H, Kiss AK. Eupatoriopicrin Inhibits Pro-inflammatory Functions of Neutrophils via Suppression of IL-8 and TNF-alpha Production and p38 and ERK 1/2 MAP Kinases. JOURNAL OF NATURAL PRODUCTS 2019; 82:375-385. [PMID: 30653318 DOI: 10.1021/acs.jnatprod.8b00939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
During chronic inflammation, neutrophils acting locally as effector cells not only activate antibacterial defense but also promote the inflammatory response. Interleukin 8 (IL-8), the main cytokine produced by activated neutrophils, positively correlates with the severity of respiratory tract diseases. By screening European plants traditionally used for treating respiratory tract diseases, we found that extracts of aerial parts of Eupatorium cannabinum inhibit IL-8 release from neutrophils. Using bioassay-guided fractionation, we identified five sesquiterpene lactones, eupatoriopicrin (1), 5'-deoxyeupatoriopicrin (2), hiyodorilactone A (3), 3-hydroxy-5'- O-acetyleupatoriopicrin = hiyodorilactone D (4), and hiyodorilactone B (5), that efficiently (IC50 < 1 μM) inhibited IL-8 and TNF-α release in lipopolysaccharide (LPS)-stimulated human neutrophils. Moreover, all these sesquiterpene lactones suppressed the adhesion of human neutrophils to an endothelial monolayer by downregulating the expression of the β2 integrin CD11b/CD18 on the neutrophil surface. Furthermore, eupatoriopicrin efficiently suppressed LPS-induced phosphorylation of p38 MAPK and ERK and attenuated neutrophil infiltration in the thioglycolate-induced peritonitis model in mice. Altogether, these results demonstrate the potential of the sesquiterpene lactone eupatoriopicrin as a lead substance for targeting inflammation.
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Affiliation(s)
- Barbara Michalak
- Department of Pharmacognosy and Molecular Basis of Phytotherapy , Medical University of Warsaw , Warsaw 02-097 , Poland
| | - Jakub P Piwowarski
- Department of Pharmacognosy and Molecular Basis of Phytotherapy , Medical University of Warsaw , Warsaw 02-097 , Poland
| | - Sebastian Granica
- Department of Pharmacognosy and Molecular Basis of Phytotherapy , Medical University of Warsaw , Warsaw 02-097 , Poland
| | - Birgit Waltenberger
- Institute of Pharmacy/Pharmacognosy and Center for Molecular Biosciences Innsbruck (CMBI) , University of Innsbruck , Innsbruck 6020 , Austria
| | - Atanas G Atanasov
- Institute of Genetics and Animal Breeding of the Polish Academy of Science , Jastrzębiec 05-552 , Poland
- Department of Pharmacognosy , University of Vienna , Vienna 1010 , Austria
| | - Shafaat Y Khan
- Institute of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology , Medical University of Vienna , Vienna 1090 , Austria
- Department of Zoology , University of Sargodha , Sargodha 40010 , Pakistan
| | - Johannes M Breuss
- Institute of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology , Medical University of Vienna , Vienna 1090 , Austria
| | - Pavel Uhrin
- Institute of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology , Medical University of Vienna , Vienna 1090 , Austria
| | - Barbara Żyżyńska-Granica
- Department of Pharmacodynamics, Faculty of Pharmacy , Medical University of Warsaw , Warsaw 02-097 , Poland
| | - Anna Stojakowska
- Institute of Pharmacology, Department of Phytochemistry , Polish Academy of Sciences , Kraków 30-024 , Poland
| | - Hermann Stuppner
- Institute of Pharmacy/Pharmacognosy and Center for Molecular Biosciences Innsbruck (CMBI) , University of Innsbruck , Innsbruck 6020 , Austria
| | - Anna K Kiss
- Department of Pharmacognosy and Molecular Basis of Phytotherapy , Medical University of Warsaw , Warsaw 02-097 , Poland
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9
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Svenningsen S, Nair P. Asthma Endotypes and an Overview of Targeted Therapy for Asthma. Front Med (Lausanne) 2017; 4:158. [PMID: 29018800 PMCID: PMC5622943 DOI: 10.3389/fmed.2017.00158] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/12/2017] [Indexed: 12/04/2022] Open
Abstract
Guidelines for the management of severe asthma do not emphasize the measurement of the inflammatory component of airway disease to indicate appropriate treatments or to monitor response to treatment. Inflammation is a central component of asthma and contributes to symptoms, physiological, and structural abnormalities. It can be assessed by a number of endotyping strategies based on “omics” technology such as proteomics, transcriptomics, and metabolomics. It can also be assessed using simple cellular responses by quantitative cytometry in sputum. Bronchitis may be eosinophilic, neutrophilic, mixed-granulocytic, or paucigranulocytic (eosinophils and neutrophils not elevated). Eosinophilic bronchitis is usually a Type 2 (T2)-driven process and therefore a sputum eosinophilia of greater than 3% usually indicates a response to treatment with corticosteroids or novel therapies directed against T2 cytokines such as IL-4, IL-5, and IL-13. Neutrophilic bronchitis represents a non-T2-driven disease, which is generally a predictor of response to antibiotics and may be a predictor to therapies targeted at pathways that lead to neutrophil recruitment such as TNF, IL-1, IL-6, IL-8, IL-23, and IL-17. Paucigranulocytic disease may not warrant anti-inflammatory therapy. These patients, whose symptoms may be driven largely by airway hyper-responsiveness may benefit from smooth muscle-directed therapies such as bronchial thermoplasty or mast-cell directed therapies. This review will briefly summarize the current knowledge regarding “omics-based signatures” and cellular endotyping of severe asthma and give an overview of segmentation of asthma therapeutics guided by the endotype.
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Affiliation(s)
| | - Parameswaran Nair
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,St Joseph's Healthcare, Hamilton, ON, Canada
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10
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Gangwar RS, Minai-Fleminger Y, Seaf M, Gutgold A, Shikotra A, Barber C, Chauhan A, Holgate S, Bradding P, Howarth P, Eliashar R, Berkman N, Levi-Schaffer F. CD48 on blood leukocytes and in serum of asthma patients varies with severity. Allergy 2017; 72:888-895. [PMID: 27859399 DOI: 10.1111/all.13082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND CD48 is a membrane receptor (mCD48) on eosinophils and mast cells and exists in a soluble form (sCD48). CD48 has a pivotal role in murine asthma and in the proinflammatory interactions of mast cells with eosinophils via its ligand CD244. Thus, CD48 might be important in human asthma. METHODS Therefore, two separate cohorts (IL and UK) comprising mild, moderate, and severe asthma and healthy volunteers were evaluated for blood leukocyte mCD48 expression and sCD48 in serum. Asthmatic bronchial biopsies were immunostained for CD48. sCD48 effect on CD244-dependent eosinophil activation was evaluated. RESULTS Eosinophil mCD48 expression was significantly elevated in moderate while downregulated in severe asthma. mCD48 expression on B, T, and NK cells and monocytes in severe asthma was significantly increased. sCD48 levels were significantly higher in mild while reduced in severe asthma. sCD48 optimal cutoff values for differentiating asthma from health were identified as >1482 pg/ml (IL) and >1619 pg/ml (UK). In asthmatic bronchial biopsies, mCD48 was expressed predominantly by eosinophils. sCD48 inhibited anti-CD244-induced eosinophil activation. CONCLUSIONS mCD48 and sCD48 are differentially expressed in the peripheral blood of asthma patients of varying severity. sCD48 inhibits CD244-mediated eosinophil activation. These findings suggest that CD48 may play an important role in human asthma.
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Affiliation(s)
- R. S. Gangwar
- Pharmacology & Experimental Therapeutics Unit; Institute for Drug Research; School of Pharmacy; Faculty of Medicine; The Hebrew University of Jerusalem; Jerusalem Israel
| | - Y. Minai-Fleminger
- Pharmacology & Experimental Therapeutics Unit; Institute for Drug Research; School of Pharmacy; Faculty of Medicine; The Hebrew University of Jerusalem; Jerusalem Israel
| | - M. Seaf
- Pharmacology & Experimental Therapeutics Unit; Institute for Drug Research; School of Pharmacy; Faculty of Medicine; The Hebrew University of Jerusalem; Jerusalem Israel
| | - A. Gutgold
- Pharmacology & Experimental Therapeutics Unit; Institute for Drug Research; School of Pharmacy; Faculty of Medicine; The Hebrew University of Jerusalem; Jerusalem Israel
| | - A. Shikotra
- Department of Infection, Immunity and Inflammation; Institute for Lung Health; University of Leicester; Leicester UK
| | - C. Barber
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
- NIHR Respiratory Biomedical Research Unit; Southampton General Hospital; Southampton UK
| | - A. Chauhan
- Portsmouth Hospitals NHS Trust; Portsmouth UK
| | - S. Holgate
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
- NIHR Respiratory Biomedical Research Unit; Southampton General Hospital; Southampton UK
| | - P. Bradding
- Department of Infection, Immunity and Inflammation; Institute for Lung Health; University of Leicester; Leicester UK
| | - P. Howarth
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
- NIHR Respiratory Biomedical Research Unit; Southampton General Hospital; Southampton UK
| | - R. Eliashar
- Department of Otolaryngology/Head and Neck Surgery; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - N. Berkman
- Institute of Pulmonary Medicine; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - F. Levi-Schaffer
- Pharmacology & Experimental Therapeutics Unit; Institute for Drug Research; School of Pharmacy; Faculty of Medicine; The Hebrew University of Jerusalem; Jerusalem Israel
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11
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Zykov KA, Ovcharenko SI. Approaches to drug therapy for COPD in Russia: a proposed therapeutic algorithm. Int J Chron Obstruct Pulmon Dis 2017; 12:1125-1133. [PMID: 28442899 PMCID: PMC5396832 DOI: 10.2147/copd.s125594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Until recently, there have been few clinical algorithms for the management of patients with COPD. Current evidence-based clinical management guidelines can appear to be complex, and they lack clear step-by-step instructions. For these reasons, we chose to create a simple and practical clinical algorithm for the management of patients with COPD, which would be applicable to real-world clinical practice, and which was based on clinical symptoms and spirometric parameters that would take into account the pathophysiological heterogeneity of COPD. This optimized algorithm has two main fields, one for nonspecialist treatment by primary care and general physicians and the other for treatment by specialized pulmonologists. Patients with COPD are treated with long-acting bronchodilators and short-acting drugs on a demand basis. If the forced expiratory volume in one second (FEV1) is ≥50% of predicted and symptoms are mild, treatment with a single long-acting muscarinic antagonist or long-acting beta-agonist is proposed. When FEV1 is <50% of predicted and/or the COPD assessment test score is ≥10, the use of combined bronchodilators is advised. If there is no response to treatment after three months, referral to a pulmonary specialist is recommended for pathophysiological endotyping: 1) eosinophilic endotype with peripheral blood or sputum eosinophilia >3%; 2) neutrophilic endotype with peripheral blood neutrophilia >60% or green sputum; or 3) pauci-granulocytic endotype. It is hoped that this simple, optimized, step-by-step algorithm will help to individualize the treatment of COPD in real-world clinical practice. This algorithm has yet to be evaluated prospectively or by comparison with other COPD management algorithms, including its effects on patient treatment outcomes. However, it is hoped that this algorithm may be useful in daily clinical practice for physicians treating patients with COPD in Russia.
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Affiliation(s)
- Kirill A Zykov
- Laboratory of Pulmonology, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
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12
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Aziz-Ur-Rehman A, Dasgupta A, Kjarsgaard M, Hargreave FE, Nair P. Sputum cell counts to manage prednisone-dependent asthma: effects on FEV 1 and eosinophilic exacerbations. Allergy Asthma Clin Immunol 2017; 13:17. [PMID: 28396690 PMCID: PMC5379704 DOI: 10.1186/s13223-017-0190-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/02/2017] [Indexed: 12/13/2022] Open
Abstract
Background Prednisone dependence in asthma is usually described based on clinical and spirometric characteristics. It is generally believed that these patients have frequent exacerbations and lose lung function rapidly because of uncontrolled airway eosinophilia. Objectives The objectives of this study are to report the effect on asthma exacerbations and the change in lung function over time in prednisone-dependent asthma when severe asthma is managed using a protocol that aims to maintain normal sputum cell counts. Methods A retrospective survey of patients prospectively assessed in a university tertiary care asthma clinic. Results 52 patients (30 males, mean age 51 years, 64% non-atopic) were followed for a median period of 5.4 years (min–max: 0.2–35.2). Monitoring with the aim of keeping sputum eosinophils below 3% resulted in higher doses of corticosteroids (median daily dose of prednisone was 10 mg and for inhaled corticosteroids was 1500 μg of fluticasone equivalent) than at baseline and this was associated with predictable adverse effects. Despite the disease severity, 10 patients (19%) did not require LABA for symptom control. Most importantly, over the period of follow-up, there were only 0.3 eosinophilic exacerbations/patient/year. Overall, there was an increase in FEV1 over the period of follow-up (mean +84.6 ml/year) rather than an expected decline. Conclusions Monitoring of eosinophils in sputum enables to maintain symptom control and preserve FEV1 in patients with severe prednisone-dependent asthma.
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Affiliation(s)
- Afia Aziz-Ur-Rehman
- Department of Medicine, McMaster University and St Joseph's Healthcare Hamilton, Hamilton, ON Canada
| | - Angira Dasgupta
- Department of Medicine, McMaster University and St Joseph's Healthcare Hamilton, Hamilton, ON Canada
| | - Melanie Kjarsgaard
- Department of Medicine, McMaster University and St Joseph's Healthcare Hamilton, Hamilton, ON Canada
| | - Frederick E Hargreave
- Department of Medicine, McMaster University and St Joseph's Healthcare Hamilton, Hamilton, ON Canada
| | - Parameswaran Nair
- Department of Medicine, McMaster University and St Joseph's Healthcare Hamilton, Hamilton, ON Canada.,Firestone Institute for Respiratory Health, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
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13
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Ho T, Dasgupta A, Hargreave FE, Nair P. The use of cellular and molecular biomarkers to manage COPD exacerbations. Expert Rev Respir Med 2017; 11:403-411. [PMID: 28347199 DOI: 10.1080/17476348.2017.1307738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) exacerbations are a common cause of respiratory morbidity and mortality, and have various etiologies. Multiple cellular and molecular biomarkers have been associated with exacerbations. Quantitative sputum cell counts are able to identify the presence and type of bronchitis, which is an important contributor to exacerbations. Their utility to monitor bronchitis and to help treat exacerbations has been evaluated, yet they are not used in routine clinical practice. Areas covered: This review will provide a brief summary of biomarkers utilized in COPD, with a focus on the application of cellular markers for the management of exacerbations. A case study will demonstrate the application of these methods. With quantitative sputum cell counts, the presence of eosinophilic bronchitis predicts corticosteroid-responsiveness, while neutrophilic bronchitis identifies infection and suggests the need for antibiotics. Gastroesophageal reflux-related aspiration and heart failure can also be identified by examining sputum. Expert commentary: Quantitative sputum cytometry is an essential tool in the management of exacerbations of COPD, particularly those prone to frequent exacerbations. Treatment based on sputum cell counts is superior to current guideline-based recommendations to prevent future exacerbations and hospitalizations in observational and single-centre controlled trials. Large multicentre clinical trials are necessary to confirm this.
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Affiliation(s)
- Terence Ho
- a Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, and Department of Medicine , McMaster University , Hamilton , ON , Canada
| | - Angira Dasgupta
- a Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, and Department of Medicine , McMaster University , Hamilton , ON , Canada
| | - Frederick E Hargreave
- a Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, and Department of Medicine , McMaster University , Hamilton , ON , Canada
| | - Parameswaran Nair
- a Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, and Department of Medicine , McMaster University , Hamilton , ON , Canada
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14
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Nair P, Martin JG, Cockcroft DC, Dolovich M, Lemiere C, Boulet LP, O'Byrne PM. Airway Hyperresponsiveness in Asthma: Measurement and Clinical Relevance. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:649-659.e2. [PMID: 28163029 DOI: 10.1016/j.jaip.2016.11.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
Airway hyperresponsiveness is a characteristic feature of asthma, and its measurement is an important tool in its diagnosis. With a few caveats, methacholine bronchial provocation by a 2-minute tidal breathing method is highly sensitive; a negative test result (PC20 > 16 mg/mL, PD20 > 400 μg) rules out current asthma with reasonable certainty. A PC20 value of less than 1 mg/mL/PD20 value of less than 25 μg is highly specific (ie, diagnostic) but quite insensitive for asthma. For accurate interpretation of the test results, it is important to control and standardize technical factors that have an impact on nebulizer performance. In addition to its utility to relate symptoms such as cough, wheeze, and shortness of breath to variable airflow obstruction (ie, to diagnose current asthma), the test is useful to make a number of other clinical assessments. These include (1) evaluation of patients with occupational asthma, (2) evaluation of patients with exercise-induced respiratory symptoms, (3) evaluation of novel asthma medications, (4) evaluation of relative potency of inhaled bronchodilators, (5) as a biomarker to adjust anti-inflammatory therapy to improve clinical outcomes, and (6) in the evaluation of patients with severe asthma to rule out masqueraders such as laryngeal dysfunction. The actual mechanism of altered smooth muscle behavior in asthma that is assessed by direct (eg, methacholine) or indirect (eg, allergen) bronchial provocation remains one of the most fundamental questions related to asthma that needs to be determined. The test is underutilized in clinical practice.
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Affiliation(s)
- Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada.
| | - James G Martin
- Meakins Christie Laboratories and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Donald C Cockcroft
- Division of Respirology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Myrna Dolovich
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Catherine Lemiere
- Department of Medicine, Sacre Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Louis-Philippe Boulet
- Division of Respirology, Department of Medicine, University of Laval, Laval, Quebec, Canada
| | - Paul M O'Byrne
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
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15
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Saltürk C, Karakurt Z, Adiguzel N, Kargin F, Sari R, Celik ME, Takir HB, Tuncay E, Sogukpinar O, Ciftaslan N, Mocin O, Gungor G, Oztas S. Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit? Int J Chron Obstruct Pulmon Dis 2015; 10:1837-46. [PMID: 26392758 PMCID: PMC4572725 DOI: 10.2147/copd.s88058] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND COPD exacerbations requiring intensive care unit (ICU) admission have a major impact on morbidity and mortality. Only 10%-25% of COPD exacerbations are eosinophilic. AIM To assess whether eosinophilic COPD exacerbations have better outcomes than non-eosinophilic COPD exacerbations in the ICU. METHODS This retrospective observational cohort study was conducted in a thoracic, surgery-level III respiratory ICU of a tertiary teaching hospital for chest diseases from 2013 to 2014. Subjects previously diagnosed with COPD and who were admitted to the ICU with acute respiratory failure were included. Data were collected electronically from the hospital database. Subjects' characteristics, complete blood count parameters, neutrophil to lymphocyte ratio (NLR), delta NLR (admission minus discharge), C-reactive protein (CRP) on admission to and discharge from ICU, length of ICU stay, and mortality were recorded. COPD subjects were grouped according to eosinophil levels (>2% or ≤2%) (group 1, eosinophilic; group 2, non-eosinophilic). These groups were compared with the recorded data. RESULTS Over the study period, 647 eligible COPD subjects were enrolled (62 [40.3% female] in group 1 and 585 [33.5% female] in group 2). Group 2 had significantly higher C-reactive protein, neutrophils, NLR, delta NLR, and hemoglobin, but a lower lymphocyte, monocyte, and platelet count than group 1, on admission to and discharge from the ICU. Median (interquartile range) length of ICU stay and mortality in the ICU in groups 1 and 2 were 4 days (2-7 days) vs 6 days (3-9 days) (P<0.002), and 12.9% vs 24.9% (P<0.034), respectively. CONCLUSION COPD exacerbations with acute respiratory failure requiring ICU admission had a better outcome with a peripheral eosinophil level >2%. NLR and peripheral eosinophilia may be helpful indicators for steroid and antibiotic management.
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Affiliation(s)
- Cüneyt Saltürk
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Zuhal Karakurt
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Nalan Adiguzel
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Feyza Kargin
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Rabia Sari
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - M Emin Celik
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Huriye Berk Takir
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Eylem Tuncay
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Ozlem Sogukpinar
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Nezihe Ciftaslan
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Ozlem Mocin
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Gokay Gungor
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
| | - Selahattin Oztas
- Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic. Surgery Teaching Hospital, Istanbul, Turkey
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16
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Mangueira LFB, Ramalho LDSN, Lira AB, Ramalho JDA, Oliveira KM, de Almeida Torres AIP, do Nascimento VMV, Lima CMBL, Aragão CFS, Diniz MDFFM. Clinical safety evaluation of a tea containing Cissampelos sympodialis in healthy volunteers. REVISTA BRASILEIRA DE FARMACOGNOSIA-BRAZILIAN JOURNAL OF PHARMACOGNOSY 2015. [DOI: 10.1016/j.bjp.2015.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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17
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Cabanski M, Fields B, Boue S, Boukharov N, DeLeon H, Dror N, Geertz M, Guedj E, Iskandar A, Kogel U, Merg C, Peck MJ, Poussin C, Schlage WK, Talikka M, Ivanov NV, Hoeng J, Peitsch MC. Transcriptional profiling and targeted proteomics reveals common molecular changes associated with cigarette smoke-induced lung emphysema development in five susceptible mouse strains. Inflamm Res 2015; 64:471-86. [PMID: 25962837 PMCID: PMC4464601 DOI: 10.1007/s00011-015-0820-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 03/15/2015] [Accepted: 04/11/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mouse models are useful for studying cigarette smoke (CS)-induced chronic pulmonary pathologies such as lung emphysema. To enhance translation of large-scale omics data from mechanistic studies into pathophysiological changes, we have developed computational tools based on reverse causal reasoning (RCR). OBJECTIVE In the present study we applied a systems biology approach leveraging RCR to identify molecular mechanistic explanations of pathophysiological changes associated with CS-induced lung emphysema in susceptible mice. METHODS The lung transcriptomes of five mouse models (C57BL/6, ApoE (-/-) , A/J, CD1, and Nrf2 (-/-) ) were analyzed following 5-7 months of CS exposure. RESULTS We predicted 39 molecular changes mostly related to inflammatory processes including known key emphysema drivers such as NF-κB and TLR4 signaling, and increased levels of TNF-α, CSF2, and several interleukins. More importantly, RCR predicted potential molecular mechanisms that are less well-established, including increased transcriptional activity of PU.1, STAT1, C/EBP, FOXM1, YY1, and N-COR, and reduced protein abundance of ITGB6 and CFTR. We corroborated several predictions using targeted proteomic approaches, demonstrating increased abundance of CSF2, C/EBPα, C/EBPβ, PU.1, BRCA1, and STAT1. CONCLUSION These systems biology-derived candidate mechanisms common to susceptible mouse models may enhance understanding of CS-induced molecular processes underlying emphysema development in mice and their relevancy for human chronic obstructive pulmonary disease.
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Affiliation(s)
- Maciej Cabanski
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
- />Novartis Pharma AG, Novartis Institutes for Biomedical Research (NIBR), 4002 Basel, Switzerland
| | - Brett Fields
- />Selventa, One Alewife Center, Cambridge, MA 02140 USA
| | - Stephanie Boue
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | | | - Hector DeLeon
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Natalie Dror
- />Selventa, One Alewife Center, Cambridge, MA 02140 USA
| | - Marcel Geertz
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
- />Bayer Technology Services GmbH, 51368 Leverkusen, Germany
| | - Emmanuel Guedj
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Anita Iskandar
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Ulrike Kogel
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Celine Merg
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Michael J. Peck
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Carine Poussin
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Walter K. Schlage
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Marja Talikka
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Nikolai V. Ivanov
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Julia Hoeng
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Manuel C. Peitsch
- />Philip Morris International Research and Development, Philip Morris Products S.A, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
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Chu DK, Al-Garawi A, Llop-Guevara A, Pillai RA, Radford K, Shen P, Walker TD, Goncharova S, Calhoun WJ, Nair P, Jordana M. Therapeutic potential of anti-IL-6 therapies for granulocytic airway inflammation in asthma. Allergy Asthma Clin Immunol 2015; 11:14. [PMID: 25878673 PMCID: PMC4397814 DOI: 10.1186/s13223-015-0081-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 04/07/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Determining the cellular and molecular phenotypes of inflammation in asthma can identify patient populations that may best benefit from targeted therapies. Although elevated IL-6 and polymorphisms in IL-6 signalling are associated with lung dysfunction in asthma, it remains unknown if elevated IL-6 levels are associated with a specific cellular inflammatory phenotype, and how IL-6 blockade might impact such inflammatory responses. METHODS Patients undergoing exacerbations of asthma were phenotyped according to their airway inflammatory characteristics (normal cell count, eosinophilic, neutrophilic, mixed granulocytic), sputum cytokine profiles, and lung function. Mice were exposed to the common allergen, house dust-mite (HDM), in the presence or absence of endogenous IL-6. The intensity and nature of lung inflammation, and levels of pro-granulocytic cytokines and chemokines under these conditions were analyzed. RESULTS Elevated IL-6 was associated with a lower FEV1 in patients with mixed eosinophilic-neutrophilic bronchitis. In mice, allergen exposure increased lung IL-6 and IL-6 was produced by dendritic cells and alveolar macrophages. Loss-of-function of IL-6 signalling (knockout or antibody-mediated neutralization) abrogated elevations of eosinophil and neutrophil recruiting cytokines/chemokines and allergen-induced airway inflammation in mice. CONCLUSIONS We demonstrate the association of pleiotropic cellular airway inflammation with IL-6 using human and animal data. These data suggest that exacerbations of asthma, particularly those with a combined eosinophilic and neutrophilic bronchitis, may respond to therapies targeting the IL-6 pathway and therefore, provide a rational basis for initiation of clinical trials to evaluate this.
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Affiliation(s)
- Derek K Chu
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Amal Al-Garawi
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Alba Llop-Guevara
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Regina A Pillai
- Division of Pulmonary and Critical Care Medicine, and Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas USA
| | - Katherine Radford
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Pamela Shen
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Tina D Walker
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Susanna Goncharova
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - William J Calhoun
- Division of Pulmonary and Critical Care Medicine, and Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas USA
| | - Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Manel Jordana
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
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19
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Slavish DC, Graham-Engeland JE, Smyth JM, Engeland CG. Salivary markers of inflammation in response to acute stress. Brain Behav Immun 2015; 44:253-69. [PMID: 25205395 PMCID: PMC4275319 DOI: 10.1016/j.bbi.2014.08.008] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/07/2014] [Accepted: 08/17/2014] [Indexed: 12/20/2022] Open
Abstract
There is burgeoning interest in the ability to detect inflammatory markers in response to stress within naturally occurring social contexts and/or across multiple time points per day within individuals. Salivary collection is a less invasive process than current methods of blood collection and enables intensive naturalistic methodologies, such as those involving extensive repeated measures per day over time. Yet the reliability and validity of saliva-based to blood-based inflammatory biomarkers in response to stress remains unclear. We review and synthesize the published studies that have examined salivary markers of inflammation following exposure to an acute laboratory stressor. Results from each study are reviewed by analyte (IL-1β, TNF-α, IL-6, IL-2, IL-4, IL-10, IL-12, CRP) and stress type (social-cognitive and exercise-physical), after which methodological issues and limitations are addressed. Although the literature is limited, several inflammatory markers (including IL-1β, TNF-α, and IL-6) have been reliably determined from saliva and have increased significantly in response to stress across multiple studies, with effect sizes ranging from very small to very large. Although CRP from saliva has been associated with CRP in circulating blood more consistently than other biomarkers have been associated with their counterparts in blood, evidence demonstrating it reliably responds to acute stress is absent. Although the current literature is presently too limited to allow broad assertion that inflammatory biomarkers determined from saliva are valuable for examining acute stress responses, this review suggests that specific targets may be valid and highlights specific areas of need for future research.
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Affiliation(s)
- Danica C Slavish
- The Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, United States
| | - Jennifer E Graham-Engeland
- The Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, United States.
| | - Joshua M Smyth
- The Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, United States; Penn State Milton S. Hershey Medical Center, The Pennsylvania State University, University Park, PA 16802, United States
| | - Christopher G Engeland
- The Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, United States; College of Nursing, The Pennsylvania State University, University Park, PA 16802, United States
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Landolina N, Gangwar RS, Levi-Schaffer F. Mast cells' integrated actions with eosinophils and fibroblasts in allergic inflammation: implications for therapy. Adv Immunol 2015; 125:41-85. [PMID: 25591464 DOI: 10.1016/bs.ai.2014.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mast cells (MCs) and eosinophils (Eos) are the key players in the development of allergic inflammation (AI). Their cross-talk, named the Allergic Effector Unit (AEU), takes place through an array of soluble mediators and ligands/receptors interactions that enhance the functions of both the cells. One of the salient features of the AEU is the CD48/2B4 receptor/ligand binding complex. Furthermore, MCs and Eos have been demonstrated to play a role not only in AI but also in the modulation of its consequence, i.e., fibrosis/tissue remodeling, by directly influencing fibroblasts (FBs), the main target cells of these processes. In turn, FBs can regulate the survival, activity, and phenotype of both MCs and Eos. Therefore, a complex three players, MCs/Eos/FBs interaction, can take place in various stages of AI. The characterization of the soluble and physical mediated cross talk among these three cells might lead to the identification of both better and novel targets for the treatment of allergy and its tissue remodeling consequences.
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Affiliation(s)
- Nadine Landolina
- Department of Pharmacology, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roopesh Singh Gangwar
- Department of Pharmacology, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Francesca Levi-Schaffer
- Department of Pharmacology, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Mukherjee M, Sehmi R, Nair P. Anti-IL5 therapy for asthma and beyond. World Allergy Organ J 2014; 7:32. [PMID: 25709744 PMCID: PMC4326373 DOI: 10.1186/1939-4551-7-32] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/30/2014] [Indexed: 12/27/2022] Open
Abstract
Airway inflammation is considered to be the primary component contributing to the heterogeneity and severity of airway disorders. Therapeutic efficacies of diverse novel biologics targeting the inflammatory pathways are under investigation. One such target is IL-5, a type-1 cytokine that is central to the initiation and sustenance of eosinophilic airway inflammation. Over the past decade, anti-IL5 molecules have been documented to have mixed therapeutic benefits in asthmatics. Post hoc analyses of the trials reiterate the importance of identifying the IL-5-responsive patient endotypes. In fact, the currently available anti-IL5 treatments are being considered beyond asthma management; especially in clinical complications with an underlying eosinophilic pathobiology such as hypereosinophilic syndrome (HES) and eosinophilic granulomatosis and polyangitis (EGPA). In addition, closer analyses of the available data indicate alternative mechanisms of tissue eosinophilia that remain uncurbed with the current dosage and delivery platform of the anti-IL5 molecules.
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Affiliation(s)
- Manali Mukherjee
- St Joseph's Healthcare & Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
| | - Roma Sehmi
- St Joseph's Healthcare & Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
| | - Parameswaran Nair
- St Joseph's Healthcare & Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
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