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Vinokurova M, Lopes-Pires ME, Cypaite N, Shala F, Armstrong PC, Ahmetaj-Shala B, Elghazouli Y, Nüsing R, Liu B, Zhou Y, Hao CM, Herschman HR, Mitchell JA, Kirkby NS. Widening the Prostacyclin Paradigm: Tissue Fibroblasts Are a Critical Site of Production and Antithrombotic Protection. Arterioscler Thromb Vasc Biol 2024; 44:271-286. [PMID: 37823267 PMCID: PMC10749679 DOI: 10.1161/atvbaha.123.318923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Prostacyclin is a fundamental signaling pathway traditionally associated with the cardiovascular system and protection against thrombosis but which also has regulatory functions in fibrosis, proliferation, and immunity. Prevailing dogma states that prostacyclin is principally derived from vascular endothelium, although it is known that other cells can also synthesize it. However, the role of nonendothelial sources in prostacyclin production has not been systematically evaluated resulting in an underappreciation of their importance relative to better characterized endothelial sources. METHODS To address this, we have used novel endothelial cell-specific and fibroblast-specific COX (cyclo-oxygenase) and prostacyclin synthase knockout mice and cells freshly isolated from mouse and human lung tissue. We have assessed prostacyclin release by immunoassay and thrombosis in vivo using an FeCl3-induced carotid artery injury model. RESULTS We found that in arteries, endothelial cells are the main source of prostacyclin but that in the lung, and other tissues, prostacyclin production occurs largely independently of endothelial and vascular smooth muscle cells. Instead, in mouse and human lung, prostacyclin production was strongly associated with fibroblasts. By comparison, microvascular endothelial cells from the lung showed weak prostacyclin synthetic capacity compared with those isolated from large arteries. Prostacyclin derived from fibroblasts and other nonendothelial sources was seen to contribute to antithrombotic protection. CONCLUSIONS These observations define a new paradigm in prostacyclin biology in which fibroblast/nonendothelial-derived prostacyclin works in parallel with endothelium-derived prostanoids to control thrombotic risk and potentially a broad range of other biology. Although generation of prostacyclin by fibroblasts has been shown previously, the scale and systemic activity was unappreciated. As such, this represents a basic change in our understanding and may provide new insight into how diseases of the lung result in cardiovascular risk.
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Affiliation(s)
- Maria Vinokurova
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.V., M.E.L.-P., N.C., F.S., B.A.-S., Y.E., J.A.M., N.S.K.)
| | - Maria Elisa Lopes-Pires
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.V., M.E.L.-P., N.C., F.S., B.A.-S., Y.E., J.A.M., N.S.K.)
| | - Neringa Cypaite
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.V., M.E.L.-P., N.C., F.S., B.A.-S., Y.E., J.A.M., N.S.K.)
| | - Fisnik Shala
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.V., M.E.L.-P., N.C., F.S., B.A.-S., Y.E., J.A.M., N.S.K.)
| | - Paul C. Armstrong
- Blizard Institute, Queen Mary University of London, United Kingdom (P.C.A.)
| | - Blerina Ahmetaj-Shala
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.V., M.E.L.-P., N.C., F.S., B.A.-S., Y.E., J.A.M., N.S.K.)
| | - Youssef Elghazouli
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.V., M.E.L.-P., N.C., F.S., B.A.-S., Y.E., J.A.M., N.S.K.)
| | - Rolf Nüsing
- Clinical Pharmacology and Pharmacotherapy Department, Goethe University, Frankfurt, Germany (R.N.)
| | - Bin Liu
- Cardiovascular Research Centre, Shantou University Medical College, China (B.L., Y.Z.)
| | - Yingbi Zhou
- Cardiovascular Research Centre, Shantou University Medical College, China (B.L., Y.Z.)
| | - Chuan-ming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China (C.-m.H.)
| | - Harvey R. Herschman
- Department of Molecular and Medical Pharmacology, University of California Los Angeles (H.R.H.)
| | - Jane A. Mitchell
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.V., M.E.L.-P., N.C., F.S., B.A.-S., Y.E., J.A.M., N.S.K.)
| | - Nicholas S. Kirkby
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.V., M.E.L.-P., N.C., F.S., B.A.-S., Y.E., J.A.M., N.S.K.)
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Trachalaki A, Sultana N, Wells AU. An update on current and emerging drug treatments for idiopathic pulmonary fibrosis. Expert Opin Pharmacother 2023:1-18. [PMID: 37183672 DOI: 10.1080/14656566.2023.2213436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Idiopathic Pulmonary Fibrosis (IPF) is a progressive and devastating lung disease, characterized by progressive lung scarring. AREAS COVERED Prior to antifibrotic therapy (pirfenidone and nintedanib), there was no validated pharmaceutical therapy for IPF. Both antifibrotics can slow disease progression, however, IPF remains a detrimental disease with poor prognosis and treated survival rates of less than 7 years from diagnosis. Despite their effect the disease remains non-reversible and progressing whilst their side effect profile is often challenging. Treatment of comorbidities is also crucial. In this review, we discuss the current pharmacological management as well as management of comorbidities and symptoms. We also reviewed clinicaltrials.gov and summarised all the mid to late stage clinical trials (phase II and III) registered in IPF over the last 7 years and discuss the most promising drugs in clinical development. EXPERT OPINION Future for IPF management will need to focus on current unresolved issues. First a primary pathogenetic pathway has not been clearly identified. Future management may involve a combination of brushstroke approach with antifibrotics with targeted treatments for specific pathways in patient subsets following an 'oncological' approach. Another unmet need is management of exacerbations, which are deathly in most cases as well as either treating or preventing lung cancer.
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Affiliation(s)
- Athina Trachalaki
- The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, Imperial College, London, UK
- Imperial College NHS Hospitals, London UK
| | | | - Athol Umfrey Wells
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, UK
- The Margaret Turner Warwick Centre for Fibrosing Lung Diseases, Imperial College London National Heart and Lung Institute, Imperial College, London, UK
- Imperial College NHS Hospitals, London UK
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Waxman AB, Elia D, Adir Y, Humbert M, Harari S. Recent advances in the management of pulmonary hypertension with interstitial lung disease. Eur Respir Rev 2022; 31:31/165/210220. [PMID: 35831007 DOI: 10.1183/16000617.0220-2021] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/23/2022] [Indexed: 11/05/2022] Open
Abstract
Pulmonary hypertension (PH) is known to complicate various forms of interstitial lung disease (ILD), including idiopathic pulmonary fibrosis, the interstitial pneumonias and chronic hypersensitivity pneumonitis. Pathogenesis of PH-ILD remains incompletely understood, and probably has overlap with other forms of pre-capillary pulmonary hypertension. PH-ILD carries a poor prognosis, and is associated with increased oxygen requirements, and a decline in functional capacity and exercise tolerance. Despite most patients having mild-moderate pulmonary hypertension, more severe pulmonary hypertension and signs of right heart failure are observed in a subset of cases. Clinical suspicion and findings on pulmonary function, computed tomography and echocardiography are often the initial steps towards diagnosis. Definitive diagnosis is obtained by right heart catheterisation demonstrating pre-capillary pulmonary hypertension. Drugs approved for pulmonary arterial hypertension have been investigated in several randomised controlled trials in PH-ILD patients, leading to discouraging results until the recent INCREASE study. This review provides an overview of the current understanding, approach to diagnosis and recent advances in treatment.
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Affiliation(s)
- Aaron B Waxman
- Center for Pulmonary Heart Disease, Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Davide Elia
- Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, MultiMedica IRCCS, Milan, Italy
| | - Yochai Adir
- Pulmonology Division, Lady Davis-Carmel Medical Center, Haifa, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, The Technion, Haifa, Israel
| | - Marc Humbert
- Université Paris-Saclay, INSERM UMR_S 999, Assistance Publique Hôpitaux de Paris, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Sergio Harari
- Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, MultiMedica IRCCS, Milan, Italy.,Dept of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Harari S, Wells AU, Wuyts WA, Nathan SD, Kirchgaessler KU, Bengus M, Behr J. The 6-min walk test as a primary end-point in interstitial lung disease. Eur Respir Rev 2022; 31:31/165/220087. [PMID: 36002171 DOI: 10.1183/16000617.0087-2022] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/14/2022] [Indexed: 12/23/2022] Open
Abstract
There is a need for clinical trial end-points to better assess how patients feel and function, so that interventions can be developed which alleviate symptoms and improve quality of life. Use of 6-min walk test (6MWT) outcomes as a primary end-point in interstitial lung disease (ILD) trials is growing, particularly for drugs targeting concurrent pulmonary hypertension. However, 6MWT outcomes may be influenced differentially by interstitial lung and pulmonary vascular components of ILD, making interpretation complicated. We propose that using 6MWT outcomes, including 6-min walk distance or oxygen desaturation, as primary end-points should depend upon the study population (how advanced the ILD is; whether vasculopathy is significant), the degree of disease progression, and, importantly, the effect of study treatment expected. We argue that the 6MWT as a single outcome measure is suitable as a primary end-point if the treatment goal is to improve functional performance or prevent disease progression within a study population of patients with advanced ILD or those with ILD and co-existent vasculopathy. In addition, we discuss the potential of composite primary end-points incorporating 6MWT outcomes, outlining important considerations to ensure that they are appropriate for the study population and treatment goals.
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Affiliation(s)
- Sergio Harari
- Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Ospedale San Guiseppe, MultiMedica IRCCS, Milan, Italy
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, University of Leuven, Leuven, Belgium
| | - Steven D Nathan
- The Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | | | | | - Jürgen Behr
- Dept of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany .,Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Munich, Germany
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