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Methods of Sputum and Mucus Assessment for Muco-Obstructive Lung Diseases in 2022: Time to “Unplug” from Our Daily Routine! Cells 2022; 11:cells11050812. [PMID: 35269434 PMCID: PMC8909676 DOI: 10.3390/cells11050812] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 01/27/2023] Open
Abstract
Obstructive lung diseases, such as chronic obstructive pulmonary disease, asthma, or non-cystic fibrosis bronchiectasis, share some major pathophysiological features: small airway involvement, dysregulation of adaptive and innate pulmonary immune homeostasis, mucus hyperproduction, and/or hyperconcentration. Mucus regulation is particularly valuable from a therapeutic perspective given it contributes to airflow obstruction, symptom intensity, disease severity, and to some extent, disease prognosis in these diseases. It is therefore crucial to understand the mucus constitution of our patients, its behavior in a stable state and during exacerbation, and its regulatory mechanisms. These are all elements representing potential therapeutic targets, especially in the era of biologics. Here, we first briefly discuss the composition and characteristics of sputum. We focus on mucus and mucins, and then elaborate on the different sample collection procedures and how their quality is ensured. We then give an overview of the different direct analytical techniques available in both clinical routine and more experimental settings, giving their advantages and limitations. We also report on indirect mucus assessment procedures (questionnaires, high-resolution computed tomography scanning of the chest, lung function tests). Finally, we consider ways of integrating these techniques with current and future therapeutic options. Cystic fibrosis will not be discussed given its monogenic nature.
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Abrami M, Maschio M, Conese M, Confalonieri M, Gerin F, Dapas B, Farra R, Adrover A, Torelli L, Ruaro B, Grassi G, Grassi M. Combined use of rheology and portable low-field NMR in cystic fibrosis patients. Respir Med 2021; 189:106623. [PMID: 34624628 DOI: 10.1016/j.rmed.2021.106623] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/01/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND As most cystic fibrosis (CF) patients progress to respiratory failure, lung functionality assessment is pivotal. We previously developed a test that indirectly monitors airways (inflammation/functional test) by measuring the spin-spin relaxation time (T2m) of the water hydrogens present in CF sputum. Here the T2m significance in the monitoring of CF lung disease was further investigated by studying the correlation of T2m with: 1) sputum viscoelasticity, 2) mucociliary clearability index (MCI)/cough clearability index (CCI) and 3) sputum average mesh-size. METHODS Sputum samples from 25 consenting CF subjects were analyzed by rheology tests (elastic modulus G and zero shear viscosity η0) and Low Field Nuclear Magnetic (LF-NMR) resonance (T2m). MCI/CCI were calculated from the rheological parameters. The average mesh-size (ξ) of the sputum structure was then evaluated by rheology/LF-NMR, together with FEV1 for each patient. RESULTS There was an inverse correlation between G and η0 versus T2m, indicating that a worsening of the lung condition (T2m-FEV1 drop) is paralleled by an increase in sputum viscoelasticity (G and η0) favoring mucus stasis/inflammation. A direct correlation was also observed between T2m and MCI/CCI, showing that T2m provides information as to airway mucus clearing. Moreover, there was a direct correlation between T2m and the average sputum mesh size (ξ). CONCLUSIONS We demonstrated a correlation between T2m (measured in CF patient's sputum) and the sputum viscoelasticity/average mesh-size and with MCI/CCI, parameters related to airway mucus clearing. Thus, the present data strengthen the potential of our test to provide indirect monitoring of airway disease course in CF patients as T2m depends on mucus solid concentration and nanostructure.
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Affiliation(s)
- Michela Abrami
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127, Trieste, Italy
| | - Massimo Maschio
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via Dell'Istria, 65, I-34137, Trieste, Italy
| | - Massimo Conese
- Department of Medical and Surgical Sciences, Foggia University, Ospedali Riuniti, Via L. Pinto, 1, I-71122, Foggia, Italy
| | - Marco Confalonieri
- Cattinara University Hospital, Pulmonology Department, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Fabio Gerin
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127, Trieste, Italy
| | - Barbara Dapas
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Rossella Farra
- Clinical Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Alessandra Adrover
- Department of Chemical Engineering, Materials and Environment, Sapienza University of Roma, Via Eudossiana 18, I-00184, Rome, Italy
| | - Lucio Torelli
- Clinical Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Barbara Ruaro
- Cattinara University Hospital, Pulmonology Department, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Gabriele Grassi
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149, Trieste, Italy.
| | - Mario Grassi
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127, Trieste, Italy
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O'Neil LM, Jefferson ND. Direct Visualization of Laryngeal Mucociliary Clearance in Adults. Ann Otol Rhinol Laryngol 2019; 128:1048-1053. [PMID: 31271035 DOI: 10.1177/0003489419859376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Mucociliary clearance is a protective mechanism of the respiratory tract that facilitates the removal of foreign particles and microorganisms. There is a paucity of data on the mucociliary clearance in the adult larynx. Our study aims to visualize and describe the mucociliary clearance of the adult larynx in healthy subjects. METHODOLOGY Subjects were identified from a volunteer database. Exclusion criteria included laryngeal disease, previous laryngeal surgery, recent upper respiratory infection, and current smoking. A high-definition videolaryngoscope was used to visualize the larynx. The larynx was topicalised with local anesthetic. Methylene blue was placed on both false vocal cords and at the petiole of the epiglottis. Dye clearance was recorded and analyzed. RESULTS In total, 10 participants participated, 7 men and 3 women, with a mean age of 42 ± 15.7 years (range: 25-71). The average reflux symptom index score was 1.4. Clearance of the dye from the false vocal cords followed a uniform lateral flow, up onto the aryepiglottic folds. The dye from the petiole had minimal vertical movement. Swallowing cleared dye from the aryepiglottic folds. The average time for dye clearance to the aryepiglottic fold was 2.21 ± 1.14 minutes. CONCLUSIONS This is the first study visualizing the mucociliary clearance of the larynx. Ciliary directionality was consistent in the participants studied, with dye moving superolateral from the false cords to the aryepiglottic fold. Swallowing was an effective mechanism for clearance from the endolarynx, when the dye had reached the aryepiglottic fold. Future research can study potential alterations in laryngeal mucociliary clearance in chronic disease states.
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Affiliation(s)
- Luke M O'Neil
- Department of Otolaryngology, Head and Neck Surgery, John Hunter Hospital, Newcastle, NSW, Australia.,School of Medicine, The University of Newcastle, Australia, NSW, Australia
| | - Niall D Jefferson
- Department of Otolaryngology, Head and Neck Surgery, John Hunter Hospital, Newcastle, NSW, Australia.,School of Medicine, The University of Newcastle, Australia, NSW, Australia
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Assessing mucociliary transport of single particles in vivo shows variable speed and preference for the ventral trachea in newborn pigs. Proc Natl Acad Sci U S A 2014; 111:2355-60. [PMID: 24474805 DOI: 10.1073/pnas.1323633111] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mucociliary transport (MCT) is an innate defense mechanism that removes particulates, noxious material, and microorganisms from the lung. Several airway diseases exhibit abnormal MCT, including asthma, chronic bronchitis, and cystic fibrosis. However, it remains uncertain whether MCT abnormalities contribute to the genesis of disease or whether they are secondary manifestations that may fuel disease progression. Limitations of current MCT assays and of current animal models of human disease have hindered progress in addressing these questions. Therefore, we developed an in vivo assay of MCT, and here we describe its use in newborn wild-type pigs. We studied pigs because they share many physiological, biochemical, and anatomical features with humans and can model several human diseases. We used X-ray multidetector-row-computed tomography to track movement of individual particles in the large airways of newborn pigs. Multidetector-row-computed tomography imaging provided high spatial and temporal resolution and registration of particle position to airway anatomy. We discovered that cilia orientation directs particles to the ventral tracheal surface. We also observed substantial heterogeneity in the rate of individual particle movement, and we speculate that variations in mucus properties may be responsible. The increased granularity of MCT data provided by this assay may provide an opportunity to better understand host defense mechanisms and the pathogenesis of airway disease.
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Wilson M, Berney C, Behan A, Robinson N. The Effect of Intravenous Lidocaine Infusion on Bronchoalveolar Lavage Cytology in Equine Recurrent Airway Obstruction. J Vet Intern Med 2012; 26:1427-32. [DOI: 10.1111/j.1939-1676.2012.01010.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/16/2012] [Accepted: 08/20/2012] [Indexed: 12/17/2022] Open
Affiliation(s)
- M.E. Wilson
- Equine Pulmonary Laboratory; Large Animal Clinical Sciences; Michigan State University; East Lansing; MI
| | - C. Berney
- Equine Pulmonary Laboratory; Large Animal Clinical Sciences; Michigan State University; East Lansing; MI
| | - A.L. Behan
- Equine Pulmonary Laboratory; Large Animal Clinical Sciences; Michigan State University; East Lansing; MI
| | - N.E. Robinson
- Equine Pulmonary Laboratory; Large Animal Clinical Sciences; Michigan State University; East Lansing; MI
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Hua X, Zeman KL, Zhou B, Hua Q, Senior BA, Tilley SL, Bennett WD. Noninvasive real-time measurement of nasal mucociliary clearance in mice by pinhole gamma scintigraphy. J Appl Physiol (1985) 2010; 108:189-96. [PMID: 19797687 PMCID: PMC2885071 DOI: 10.1152/japplphysiol.00669.2009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 09/25/2009] [Indexed: 11/22/2022] Open
Abstract
Mucociliary clearance (MCC) is the key defense mechanism in the upper airways, as the removal of debris-laden mucus in the sinuses completely depends on MCC. So far, how the nasal MCC is regulated remains unknown. Recently, mice deficient in genes encoding the components of MCC apparatus have been generated, which will allow investigators to conduct more in-depth nasal MCC studies. However, the methodology necessary to comprehensively evaluate the nasal MCC in this species is not well established. We therefore developed a novel method to measure nasal MCC in live mice using pinhole gamma camera. Insoluble radiolabeled particles were delivered into the noses of lightly anesthetized mice. The nasal clearance of these particles was measured continuously in a real-time manner. The effect of three different anesthetics-avertin, pentobarbital, and isoflurane-on nasal MCC was also determined. In mice anesthetized by 1.1% isoflurane, radiolabeled particles were immediately moved into the oropharynx, which was significantly accelerated by the treatment of hypertonic but not isotonic saline. According to the clearance rate, the mouse nasal MCC presented two distinct phases: a rapid phase and a slow phase. In addition, we found that isoflurane had a very small inhibitory effect on nasal MCC vs. both avertin and pentobarbital. This was further supported by its dose response. Collectively, we have developed a noninvasive method to monitor the real-time nasal MCC in live mice under physiological conditions. It provides more comprehensive evaluation on nasal MCC rather than assessing a single component of the MCC apparatus in isolation.
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Affiliation(s)
- Xiaoyang Hua
- Pulmonary Division, Department of Medicine, CB 7219, Burnett Womack Bldg., Univ. of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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