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Deng AF, Wang FX, Wang SC, Zhang YZ, Bai L, Su JC. Bone-organ axes: bidirectional crosstalk. Mil Med Res 2024; 11:37. [PMID: 38867330 PMCID: PMC11167910 DOI: 10.1186/s40779-024-00540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/31/2024] [Indexed: 06/14/2024] Open
Abstract
In addition to its recognized role in providing structural support, bone plays a crucial role in maintaining the functionality and balance of various organs by secreting specific cytokines (also known as osteokines). This reciprocal influence extends to these organs modulating bone homeostasis and development, although this aspect has yet to be systematically reviewed. This review aims to elucidate this bidirectional crosstalk, with a particular focus on the role of osteokines. Additionally, it presents a unique compilation of evidence highlighting the critical function of extracellular vesicles (EVs) within bone-organ axes for the first time. Moreover, it explores the implications of this crosstalk for designing and implementing bone-on-chips and assembloids, underscoring the importance of comprehending these interactions for advancing physiologically relevant in vitro models. Consequently, this review establishes a robust theoretical foundation for preventing, diagnosing, and treating diseases related to the bone-organ axis from the perspective of cytokines, EVs, hormones, and metabolites.
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Affiliation(s)
- An-Fu Deng
- Institute of Translational Medicine, Organoid Research Center, Shanghai University, Shanghai, 200444, China
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, 200444, China
| | - Fu-Xiao Wang
- Institute of Translational Medicine, Organoid Research Center, Shanghai University, Shanghai, 200444, China
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, 200444, China
| | - Si-Cheng Wang
- Institute of Translational Medicine, Organoid Research Center, Shanghai University, Shanghai, 200444, China
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, 200444, China
- Department of Orthopedics, Shanghai Zhongye Hospital, Shanghai, 200444, China
| | - Ying-Ze Zhang
- Department of Orthopaedics, the Third Hospital of Hebei Medical University, Orthopaedic Research Institution of Hebei Province, NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, 050051, China.
| | - Long Bai
- Institute of Translational Medicine, Organoid Research Center, Shanghai University, Shanghai, 200444, China.
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, 200444, China.
- School of Medicine, Shanghai University, Shanghai, 200444, China.
- Wenzhou Institute of Shanghai University, Wenzhou, 325000, Zhejiang, China.
| | - Jia-Can Su
- Institute of Translational Medicine, Organoid Research Center, Shanghai University, Shanghai, 200444, China.
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, 200444, China.
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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2
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Mou K, Chan SMH, Vlahos R. Musculoskeletal crosstalk in chronic obstructive pulmonary disease and comorbidities: Emerging roles and therapeutic potentials. Pharmacol Ther 2024; 257:108635. [PMID: 38508342 DOI: 10.1016/j.pharmthera.2024.108635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a multifaceted respiratory disorder characterized by progressive airflow limitation and systemic implications. It has become increasingly apparent that COPD exerts its influence far beyond the respiratory system, extending its impact to various organ systems. Among these, the musculoskeletal system emerges as a central player in both the pathogenesis and management of COPD and its associated comorbidities. Muscle dysfunction and osteoporosis are prevalent musculoskeletal disorders in COPD patients, leading to a substantial decline in exercise capacity and overall health. These manifestations are influenced by systemic inflammation, oxidative stress, and hormonal imbalances, all hallmarks of COPD. Recent research has uncovered an intricate interplay between COPD and musculoskeletal comorbidities, suggesting that muscle and bone tissues may cross-communicate through the release of signalling molecules, known as "myokines" and "osteokines". We explored this dynamic relationship, with a particular focus on the role of the immune system in mediating the cross-communication between muscle and bone in COPD. Moreover, we delved into existing and emerging therapeutic strategies for managing musculoskeletal disorders in COPD. It underscores the development of personalized treatment approaches that target both the respiratory and musculoskeletal aspects of COPD, offering the promise of improved well-being and quality of life for individuals grappling with this complex condition. This comprehensive review underscores the significance of recognizing the profound impact of COPD on the musculoskeletal system and its comorbidities. By unravelling the intricate connections between these systems and exploring innovative treatment avenues, we can aspire to enhance the overall care and outcomes for COPD patients, ultimately offering hope for improved health and well-being.
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Affiliation(s)
- Kevin Mou
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Stanley M H Chan
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Ross Vlahos
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
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3
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Xiang Y, Luo X. Extrapulmonary Comorbidities Associated with Chronic Obstructive Pulmonary Disease: A Review. Int J Chron Obstruct Pulmon Dis 2024; 19:567-578. [PMID: 38476124 PMCID: PMC10927883 DOI: 10.2147/copd.s447739] [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: 11/01/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Most patients with chronic obstructive pulmonary disease (COPD) suffer from at least one additional, clinically relevant chronic disease. To a degree, the high global prevalence and mortality rate of COPD is closely related to its extrapulmonary effects. Moreover, the various of comorbidities of COPD and itself interact with each other, resulting in diverse clinical manifestations and individual differences, and thus further influencing the prognosis as well as healthcare burden of COPD patients. This is closely related to the common risk factors of chronic diseases (aging, smoking, inactivity, etc.). Additionally, some pathophysiological mechanisms caused by COPD, including the systemic inflammatory response, hypoxia, oxidative stress, and others, also have an impact on other systems. But comprehensive management and medical interventions have not yet been established. The clinicians should improve their knowledge and skills in diagnosing as well as treating the comorbidities of COPD, and then aim to develop more individualized, efficient diagnostic and therapeutic strategies for different patients to achieve greater clinical benefits. In this article, we will review the risk factors, mechanisms, and treatment strategies for extrapulmonary comorbidities in chronic obstructive pulmonary disease, including cardiovascular diseases, diabetes, anemia, osteoporosis, emotional disorders, and gastroesophageal reflux disease.
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Affiliation(s)
- Yurong Xiang
- School of Medical and Life Science, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610000, People’s Republic of China
| | - Xiaobin Luo
- Department of Respiratory and Critical Care Medicine, Suining Central Hospital, Suining, Sichuan, 629000, People’s Republic of China
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4
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Shi Y, Shi Y, Xu Z, Wang Y. Association of Red Cell Index and Hospital Mortality in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study. Int J Chron Obstruct Pulmon Dis 2023; 18:2267-2276. [PMID: 37868623 PMCID: PMC10588751 DOI: 10.2147/copd.s427433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose This study aims to explore the association between red cell index (RCI) and hospital mortality in Chronic Obstructive Pulmonary Disease (COPD) patients in the intensive care unit. Patients and Methods This was a retrospective cohort research. The study included 821 COPD patients. Clinical data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database was conducted. Multivariate logistic regression analysis was used to assess the correlation between RCI and in-hospital mortality. Age, SOFA score, diabetes mellitus, cerebrovascular disease, congestive heart failure and mechanical ventilation were considered for subgroup analysis. Results This study comprised 821 patients, of which 16.5% (124/821) suffered hospital mortality. In the multivariate logistic regression model, RCI was positively associated with hospital mortality, each unit increase in RCI was associated with a 3% increase in hospital mortality (odds ratio [OR] =1.03; 95% confidence interval [95CI%] =1.01-1.06). Meanwhile, compare with the lowest RCI group, the highest RCI groups tended to have higher risks of hospital mortality (OR [95% CI] 2.33 [1.27-4.27]). Additionally, subgroup analysis result was persistent among all the groups. Conclusion Higher RCI was positively associated with a higher risk of mortality in critically ill patients with COPD. Further investigation is necessary to confirm these findings.
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Affiliation(s)
- Yushan Shi
- Department of Laboratory, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250000, People’s Republic of China
| | - Yanfei Shi
- Department of Pulmonary Disease, Dezhou Hospital of Traditional Chinese Medicine, Dezhou, Shanfdong, 253000, People’s Republic of China
| | - Zhangmeng Xu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610075, People’s Republic of China
| | - Yan Wang
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250000, People’s Republic of China
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5
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Tariq S, Ismail D, Thapa M, Goriparthi L, Pradeep R, Khalid K, Cooper AC, Jean-Charles G. Chronic Obstructive Pulmonary Disease and Its Effect on Red Blood Cell Indices. Cureus 2023; 15:e36100. [PMID: 37065412 PMCID: PMC10097512 DOI: 10.7759/cureus.36100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) constitutes a set of heterogeneous symptoms affecting millions of people worldwide. The associated comorbidities developing in COPD involve dysregulation in physiological pathways resulting from systemic inflammation in respiratory airways. In addition to mentioning the pathophysiology, stages, and consequences of COPD, this paper also defines red blood cell (RBC) indices such as hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, red blood cell distribution width, and RBC count. It explains the role of RBC indices and RBC structural abnormalities with disease severity and exacerbations in COPD patients. Although many factors have been studied as a marker of morbidity and mortality for COPD patients, RBC indices have emerged as revolutionary evidence. Therefore, the effectiveness of evaluating RBC indices in COPD patients and their importance as a negative predictor of survival, mortality, and clinical outcomes have been debated through rigorous literature reviews. Furthermore, the prevalence, mechanisms of development, and prognosis of underlying anemia and polycythemia in COPD have also been evaluated, with anemia most significantly associated with COPD. Therefore, more studies should be conducted to address underlying anemia in COPD patients to lessen the severity and disease burden. Correcting the RBC indices in COPD patients remarkably impacts the quality of life and reduces in-patient admissions, healthcare resource utilization, and costs. Hence, it is noteworthy to understand the significance of considering RBC indices while dealing with COPD patients.
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Li Y, Gao H, Zhao L, Wang J. Osteoporosis in COPD patients: Risk factors and pulmonary rehabilitation. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:487-496. [PMID: 35688435 PMCID: PMC9329018 DOI: 10.1111/crj.13514] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 12/15/2022]
Abstract
Objectives To present a review on the pathogenesis, risk factor and treatment of chronic obstructive pulmonary disease complicated with osteoporosis and provide new ideas for the diagnosis and treatment. Data source A systematic search is carried out using keywords as chronic obstructive pulmonary disease, osteoporosis, risk factors, and pulmonary rehabilitation. Results Patients with chronic obstructive pulmonary disease have a high prevalence of osteoporosis and a high risk of fracture. The mechanisms of osteoporosis in COPD patients are associated with general risk factors, such as smoking, reduced physical activity, low weight, and disease‐specific risk factors, such as systemic inflammatory, Vitamin D deficiency, use of glucocorticoid, anemia, hypoxemia, and hypercapnia. The treatment of osteoporosis in COPD emphasizes comprehensive intervention, which mainly include basic treatment and anti‐osteoporosis drugs. Noticeably, pulmonary rehabilitation program is an important part of treatment. Conclusions This work summarizes the pathogenesis, risk factor, prevention, and treatment of chronic obstructive pulmonary disease complicated with osteoporosis, and the latest progress of studies on chronic obstructive pulmonary disease and osteoporosis is discussed.
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Affiliation(s)
- Yujuan Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Hongchang Gao
- Department of Pulmonary and Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Lei Zhao
- Department of Pulmonary and Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Jinrui Wang
- Department of Pulmonary and Critical Care Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
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7
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Safonova JI, Kozhevnikova MV, Danilogorskaya YA, Zheleznykh EA, Ilgisonis IS, Privalova EV, Khabarova NV, Belenkov YN. Possible pathway for heart failure with preserved ejection fraction prevention and treatment: the angiotensin-converting enzyme inhibitor effect on endothelial function in comorbid patients. KARDIOLOGIIA 2022; 62:65-71. [PMID: 35168535 DOI: 10.18087/cardio.2022.1.n1952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
Aim To evaluate the effect of perindopril on the endothelial function and levels of endothelial dysfunction markers in groups of patients with heart failure with preserved (HFpEF) and mid-range (intermediate) left ventricular ejection fraction (HFmrEF).Material and methods 40 patients with HFpEF (n=20) and HFmrEF (n=20) were evaluated. At baseline, parameters of the morpho-functional state of large blood vessels and of microvessels were evaluated with photoplethysmography, and levels of E-selectin and endothelin-1 (ET-1) were measured. The patients were prescribed perindopril, and after 12 months of treatment, photoplethysmographic parameters and endothelial dysfunction markers were determined again.Results After 12 months of the perindopril treatment, improvements in the endothelial function of both large blood vessels and microvessels were noted. The phase shift increased from 10.1 to 10.9 ms in the HFpEF group (р=0.001) and from 8.35 to 9.65 ms in the HFmrEF group (р=0.002). Furthermore, the occlusion index increased from 1.45 to 1.75 in patients with HFpEF (р=0.004) and from 1.5 to 1.75 in patients with HFmrEF (р=0.010). The Е-selectin concentration decreased in both groups, from 57.25 to 42.4 ng/ml (р=0.00008) and from 40.5 to 35.7 ng/ml (р=0.010) in patients with HFpEF and HFmrEF, respectively. The ET-1 concentration decreased from pg/ml (р=0.010) in patients with HFpEF whereas in patients with HFmrEF, there was no significant change in the ET-1 concentration after 12 months of the perindopril treatment.Conclusion At 12 months, the endothelial function improved and E-selectin and ET-1 levels decreased in patients with HFpEF and HFmrEF.
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Affiliation(s)
- Ju I Safonova
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - M V Kozhevnikova
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | | | - E A Zheleznykh
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - I S Ilgisonis
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - E V Privalova
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - N V Khabarova
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - Yu N Belenkov
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
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Clinical Markers of Chronic Hypoxemia in Respiratory Patients Residing at Moderate Altitude. Life (Basel) 2021; 11:life11050428. [PMID: 34068590 PMCID: PMC8150591 DOI: 10.3390/life11050428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022] Open
Abstract
Supplemental oxygen (SO) increases survival in hypoxemic patients. In hypoxia, mammals respond by modulating O2-sensitive transducers that stabilize the transcription factor hypoxia-inducible factor-1-alpha (HIF-1α), which transactivates the genes that govern angiogenesis and metabolic pathways. Residing at high altitudes exposes millions of people to hypoxemia with potential adverse consequences on their health. We aimed to identify markers of hypoxemia that can be used in the evaluation of patients in addition to pulse oximetry and arterial blood gases, especially those that could respond after 1 month of oxygen use. We performed a prospective pilot study at 2240 m above sea level, with repeated measurements before and after (b/a) 1-month home oxygen therapy in 70 patients with lung diseases, of which 24/20 have COPD, 41/39 obstructive sleep apnea (OSA), and 5/2 with interstitial lung diseases (ILD), all of them having chronic hypoxemia, as well as 70 healthy subjects as controls. Proteins evaluated included HIF-1α, vascular endothelial growth factor (VEGF), and erythropoietin (EPO). Among the main results, we found that hypoxemic patients had normal levels of HIF-1α but increased EPO compared with healthy controls. VEGF levels were heterogeneous in the sample studied, similar to the control group in COPD, slightly increased in OSA, and decreased in fibrosis. With oxygen treatment, the HIF-1α and EPO decreased in COPD and OSA but not in fibrosis, and VEGF remained constant over time. In conclusion, erythropoietin and HIF-1α identified hypoxemia initially and responded to oxygen. In pulmonary fibrosis, HIF-1α, EPO, and VEGF increased with oxygen therapy, which is likely linked to the disease's pathogenesis and clinical course rather than hypoxemia.
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Yammine K, Hayek F, Assi C. Is there an association between anemia and diabetic foot ulcers? A systematic review and meta-analysis. Wound Repair Regen 2021; 29:432-442. [PMID: 33591644 DOI: 10.1111/wrr.12902] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/29/2020] [Accepted: 01/21/2021] [Indexed: 12/11/2022]
Abstract
Anemia was found to be prevalent in patients with diabetes mellitus. Higher rates of anemia were reported in patients having diabetic foot ulcers (DFU). With the presence of an altered microcirculation, the potential negative effects of anemia might impede ulcer healing leading to higher rates of amputation and mortality. Medline, Embase, Scopus, CINAHL, Cochrane Library, and Google Scholar, were searched for from inception to locate relevant papers reporting any association between anemia and diabetic foot ulcers. The meta-analysis included 15 studies with 2895 patients. The weighted prevalence anemia rates of the total, mild-to-moderate DFU, and severe DFU groups were as follows: 69.7%, 49.5%, and 73%, respectively. For the hemoglobin level outcome, the same samples yielded the following pooled means: 11.00 ± 1.13, 12.08 ± 0.8, and 10.57 ± 0.68 g/dl. Individual studies showed association between low levels of hemoglobin and higher rates of non-healing ulcer, amputation, and mortality. This review demonstrated (a) a clear association between the presence of anemia and diabetic foot ulcers, (b) a clear association between the severity of anemia and the severity of DFUs, and (c) that anemia could be a predictor of amputation and mortality. Whether anemia is a predictor of adverse outcomes or an independent risk factor is to be further investigated.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon.,Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.,Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
| | - Fady Hayek
- Division of Vascular Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon.,Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
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Trends and factors of botanical dietary supplement use among US adults with COPD from 1999 to 2016. PLoS One 2020; 15:e0239674. [PMID: 32991612 PMCID: PMC7523968 DOI: 10.1371/journal.pone.0239674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The potential effects of botanical dietary supplements (BDS) in the treatment of asthma have been proposed. However, the evidence of the effects of BDS use among patients with COPD is limited. The objective of our study was to exam the trends and effects of BDS use among US adults with COPD. METHODS A serial, cross-sectional study was conducted by using data of the NHANSE from 1999 to 2016 (n = 53,348). COPD (n = 2,580) was identified by using self-reported diagnosis history, and any BDS use was identified in the past 30 days. The prevalence of BDS use was calculated for respondents with and without COPD. Simple linear regression models were applied to test for trends in BDS use. Multiple logistic regression models were used to identify the factors of BDS use and patients' clinical outcomes, including all-cause hospitalization and abnormal hemoglobin levels, associated with BDS use. The results were weighted to represent national estimates. RESULTS The prevalence of BDS use was greater among participants who had COPD compared to the referent group (mean 16.77% vs. 15.11%, p = 0.044). The trend of BDS use decreased from 1999 through 2016 in COPD group (p = 0.0023), but the trend remained stable in the non-COPD group (P>0.05). Results of multivariate logistic regression models showed that patients with higher family income (≥100% FPL) and graduated from college were more likely to use BDS compared with non-users. BDS use was associated with a lower likelihood of having all-cause hospitalization (adjusted odds ratio = 0.64; 95% CI 0.45-0.92) and abnormal levels of hemoglobin (adjusted odds ratio = 0.67; 95% CI 0.49-0.92) among adult COPD patients, after adjusting for covariates. CONCLUSIONS The overall use of BDS decreased during 1999 through 2016 for US adults with COPD. The potential benefit of these supplemental medications use for clinical outcomes might exist for adult COPD patients.
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Effects of anemia on the survival of patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Expert Rev Respir Med 2020; 14:1267-1277. [PMID: 32869670 DOI: 10.1080/17476348.2020.1816468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Anemia is often seen in chronic obstructive pulmonary disease (COPD) patients. However, the implications of anemia on the outcomes of patients with COPD is not clearly known. Therefore, we conducted a systematic review and meta-analysis to evaluate the effects of anemia on the morbidity and mortality of patients with COPD. METHODS We followed PRISMA guidelines to perform a systematic identification of relevant publications in the literature on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. RESULTS Out of 1845 records, we included data from 15 articles including 420 970 participants in this review. Our systematic review presents a 2b level of evidence suggesting a higher duration of hospital stay, Charlson comorbidity index score, and mortality rate for patients with COPD and anemia than for patients with COPD without anemia. The meta-analysis revealed a moderate effect increase in the mean duration of hospital stay (Hedge's g, 0.55), Charlson comorbidity index (0.68), and mortality rate (0.49) in patients with COPD and anemia as compared to those in patients with COPD without anemia. CONCLUSION The current systematic review and meta-analysis provide evidence regarding the detrimental consequences of anemia on the morbidity and mortality of patients with COPD.
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12
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Pizzini A, Aichner M, Sonnweber T, Tancevski I, Weiss G, Löffler-Ragg J. The Significance of iron deficiency and anemia in a real-life COPD cohort. Int J Med Sci 2020; 17:2232-2239. [PMID: 32922186 PMCID: PMC7484656 DOI: 10.7150/ijms.46163] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Current evidence suggests an increased prevalence of iron deficiency (ID) and anemia in chronic obstructive pulmonary disease (COPD). ID and subsequent anemia can be due to iron losses via bleeding resulting in absolute ID or inflammation-driven retention of iron within macrophages resulting in functional ID and anemia of inflammation. Methods: This is a retrospective analysis of 204 non-exacerbated COPD patients in outpatient care. Current definitions of absolute and functional ID were applied to determine the prevalence of ID and to analyze associations to disease severity in terms of lung function parameters and clinical symptoms. Results: The studied cohort of COPD patients demonstrated a high prevalence of ID, ranging from 30 to 40% during the observation time. At the initial presentation, absolute or functional ID was found in 9.3% to 12.3% of COPD individuals, whereas combined forms of absolute and functional ID were most prevalent (25.9% of all individuals). The prevalence of ID increased during longitudinal follow-up (37 ± 15 months), and especially combined forms of ID were significantly related to anemia. Anemia prevalence ranged between 14.2% and 20.8% during the observation period and anemia was associated with lower FEV1, DLCOc, and CRP elevation. Accordingly, ID was associated with decreased FEV1, DLCOc, and an elevation in CRP. Conclusion: ID is common in COPD patients, but a uniform definition for accurate diagnosis does not exist. Prevalence of functional ID and anemia increased during follow-up. The associations of ID and anemia with reduced functional lung capacity and elevated inflammation may reflect a more severe COPD phenotype.
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Affiliation(s)
- Alex Pizzini
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Aichner
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Sonnweber
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ivan Tancevski
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria.,Christian Doppler Laboratory for Iron Metabolism and Anemia Research, Medical University of Innsbruck, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
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13
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Patel MS, McKie E, Steiner MC, Pascoe SJ, Polkey MI. Anaemia and iron dysregulation: untapped therapeutic targets in chronic lung disease? BMJ Open Respir Res 2019; 6:e000454. [PMID: 31548896 PMCID: PMC6733331 DOI: 10.1136/bmjresp-2019-000454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022] Open
Abstract
Hypoxia is common in many chronic lung diseases. Beyond pulmonary considerations, delivery of oxygen (O2) to the tissues and subsequent O2 utilisation is also determined by other factors including red blood cell mass and iron status; consequently, disruption to these mechanisms provides further physiological strains on an already stressed system. O2 availability influences ventilation, regulates pulmonary blood flow and impacts gene expression throughout the body. Deleterious effects of poor tissue oxygenation include decreased exercise tolerance, increased cardiac strain and pulmonary hypertension in addition to pathophysiological involvement of multiple other organs resulting in progressive frailty. Increasing inspired O2 is expensive, disliked by patients and does not normalise tissue oxygenation; thus, other strategies that improve O2 delivery and utilisation may provide novel therapeutic opportunities in patients with lung disease. In this review, we focus on the rationale and possibilities for doing this by increasing haemoglobin availability or improving iron regulation.
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Affiliation(s)
| | | | - Michael C Steiner
- Leicester Biomedical Research Centre - Respiratory, Institute for Lung Health, University of Leicester, Leicester, UK
| | | | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, UK
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14
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Rejeb H, Ben Khelifa M, Ben Abdallah J, Mrad S, Ben Rejeb M, Hayouni A, Benzarti M, Limem K, Kortas M, Rouatbi S, Ben Saad H. The Effects of Ramadan-Fasting (RF) on Inflammatory and Hematological Indices of Stable Chronic Obstructive Pulmonary Disease (COPD) Male Patients: A Pilot Study. Am J Mens Health 2018; 12:2089-2103. [PMID: 30117367 PMCID: PMC6199458 DOI: 10.1177/1557988318794304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
No previous study has evaluated the effects of RF on inflammatory and hematological indices of COPD patients. The main objective of the present pilot study was to assess the effects of RF on some inflammatory and hematological indices measured in male patients with stable COPD. Fifteen COPD patients (mean ± SD of age: 71 ± 6 years) who fasted during Ramadan 2017 volunteered for the study. Three sessions (Before-Ramadan, End-Ramadan and After-Ramadan) were selected. Spirometry tests and blood samples were consistently performed 2.5-4.5 hr before the interruption of the fasting. Assessment sessions comprised: spirometry, inflammatory [erythrocyte sedimentation rate (ESR); C-reactive protein (CRP)] and hematological [red and white blood cells (RBC, WBC); hemoglobin; hematocrit; mean corpuscular volume; mean corpuscular hemoglobin; platelets] indices. Findings were analyzed by applying Friedman ANOVA. The median (lower-upper quartiles) of ESR (Before-Ramadan: 3 (2-9), End-Ramadan: 7 (0-13), After-Ramadan: 9 (5-15) mm/h) and CRP (Before-Ramadan: 20 (11-38), End-Ramadan: 15 (9-34), After-Ramadan: 20 (12-46) mg/L) were not significantly affected by RF. Among all the hematological indices, RF influenced only hemoglobin (Before-Ramadan: 14.4 ± 2.2, End-Ramadan: 13.4 ± 1.3, After-Ramadan: 12.2 ± 0.9 g/dL), hematocrit (Before-Ramadan: 45 ± 7, End-Ramadan: 40 ± 4, After-Ramadan: 39 ± 4%), RBC (Before-Ramadan: 5.1 ± 1.0, End-Ramadan: 4.6 ± 0.7, After-Ramadan: 4.4 ± 0.5 106/mm3) and WBC (Before-Ramadan: 8,673 ± 1,911, End-Ramadan: 7,840 ± 1,526, After-Ramadan: 9,507 ± 2,190/mm3). Compared to the Before-Ramadan session, the End-Ramadan session values for hemoglobin, hematocrit, RBC and WBC were lower. Compared to the After-Ramadan session, the End-Ramadan session values for hemoglobin and WBC were higher and lower, respectively. In conclusion, RF caused significant reduction in hemoglobin, hematocrit, RBC and WBC. However, it did not induce any significant changes in the CRP and ESR indices.
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Affiliation(s)
- Hadhemi Rejeb
- Pulmonary Department, Farhat HACHED
Hospital, Sousse, Tunisia
| | | | | | - Sawssan Mrad
- Laboratory of Biochemistry, Farhat
HACHED Hospital, Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care
Safety, Sahloul Hospital, Sousse, Tunisia
| | | | | | - Khelifa Limem
- Laboratory of Biochemistry, Farhat
HACHED Hospital, Sousse, Tunisia
| | - Mondher Kortas
- Laboratory of Hematology, Farhat HACHED
Hospital, Sousse, Tunisia
| | - Sonia Rouatbi
- Laboratory of Physiology and Functional
Explorations, Farhat HACHED Hospital, Sousse, Tunisia
| | - Helmi Ben Saad
- Laboratory of Physiology and Functional
Explorations, Farhat HACHED Hospital, Sousse, Tunisia,Heart Failure (LR12SP09) Research
Laboratory, Farhat HACHED Hospital, Sousse, Tunisia,Laboratory of Physiology. Faculty of
Medicine of Sousse, University of Sousse. Sousse, Tunisia,Helmi Ben Saad, Laboratory of Physiology,
Faculty of Medicine of Sousse, Street Mohamed KAROUI, Sousse, 4000, Tunisia.
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15
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Protective Effect of Jianpiyifei II Granule against Chronic Obstructive Pulmonary Disease via NF- κB Signaling Pathway. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:4265790. [PMID: 30174706 PMCID: PMC6098891 DOI: 10.1155/2018/4265790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/29/2018] [Accepted: 07/08/2018] [Indexed: 01/31/2023]
Abstract
Jianpiyifei II granule (JPYF II) is an oriental herbal formula used clinically in China to treat chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the anti-inflammatory and antioxidative activities of JPYF II in a mouse model of COPD induced by lipopolysaccharide (LPS) and cigarette smoke (CS) and in RAW264.7 cells stimulated with cigarette smoke extract (CSE). Mice were given LPS via intratracheal instillation on days 1 and 15 and exposed to CS generated from 4 cigarettes/day for 28 days. The mice were treated with 0.75, 1.5, or 3 g/kg/d JPYF II by intragastric administration in low, middle, and high dose groups, respectively, for two weeks. RAW264.7 cells were stimulated by CSE and treated with JPYF II at doses of 12.5, 25, or 50 μg/mL. In the mouse model of LPS and CS-induced COPD, JPYF II decreased inflammatory cell counts in broncho alveolar lavage fluid (BALF), in addition to mRNA expression of proinflammatory cytokines and metalloproteinases (MMPs) in lung tissues. In addition, JPYF II elevated catalase (CAT) and glutathione peroxidase (GSH-Px) activities and reduced the levels of malondialdehyde (MDA) and IκBα and p65 phosphorylation and inflammatory cell infiltration in the lung tissues. In RAW264.7 cells stimulated with CSE, JPYF II inhibited the mRNA levels of inflammatory mediators and the phosphorylation of IκBα and p65. Our results suggest that JPYF II enhanced anti-inflammatory and antioxidative activities in a mouse model of COPD induced by LPS and CS and in RAW264.7 cells stimulated with CSE via inhibition of the NF-κB pathway.
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16
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Mosrane Y, Bougrida M, Alloui AS, Martani M, Rouabah L, Bourahli MK, Mehdioui H, Ben Saad H. [Systemic inflammatory profile of smokers with and without COPD]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:188-198. [PMID: 28838624 DOI: 10.1016/j.pneumo.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 06/14/2017] [Accepted: 07/15/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Studies comparing the systemic inflammatory profiles of smokers with and without COPD present discordant findings. AIM To compare the systemic inflammatory profile of smokers with and without COPD. METHODS This is a cross-sectional comparative study. Two groups of active smokers of more than 10 pack-years were included: 56 consecutives stable COPD (postbronchodilator FEV1/FVC<0.70) and 32 consecutives non-COPD (postbronchodilator FEV1/FVC≥0.70). Smoking and clinical, anthropometric and spirometric data were noted. The following blood biomarkers were identified: leukocytes, hemoglobin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR). According to the levels (normal/abnormal) of these markers, two groups of smokers were formed. Quantitative and qualitative data were expressed, respectively, as means±SD and percentages. RESULTS Compared to the non-COPD group, the COPD group was older (56±12 vs. 65±8 years) and had a higher smoking consumption (30±18 vs. 52±31 pack-years). Compared to the non-COPD group, the COPD group had higher values of CRP (2.06±1.24 vs. 11.32±11.03mg/L), of ESR (9.59±8.29 vs. 15.96±11.56), of IL-6 (9.28±4.69 vs. 20.27±5.31ng/L) and of TNF-α (18.38±7.98ng/L vs. 8.62±3.72ng/L). Compared to the non-COPD group, the COPD group included higher percentages of smokers with elevated CRP (0 % vs. 32 %), with leukocytosis (6 % vs. 16 %), with higher levels of IL-6 (81 % vs. 98 %) or TNF-α (91 % vs. 100 %). CONCLUSION Smokers with COPD, compared to smokers free from COPD, have a marked systemic inflammation.
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Affiliation(s)
- Y Mosrane
- Laboratoire de biologie cellulaire et moléculaire, faculté des sciences de la vie et de la nature, université Constantine 1, Constantine, Algérie.
| | - M Bougrida
- Laboratoire de recherche des maladies métaboliques, faculté de médecine de Constantine, université Constantine 3, Constantine, Algérie; Service de physiologie et des explorations fonctionnelles, CHU Benbadis, Constantine, Algérie.
| | - A S Alloui
- Laboratoire central de biochimie, CHU Benbadis, Constantine, Algérie.
| | - M Martani
- Laboratoire de recherche des maladies métaboliques, faculté de médecine de Constantine, université Constantine 3, Constantine, Algérie; Service de physiologie et des explorations fonctionnelles, CHU Benbadis, Constantine, Algérie.
| | - L Rouabah
- Laboratoire de biologie cellulaire et moléculaire, faculté des sciences de la vie et de la nature, université Constantine 1, Constantine, Algérie.
| | - M K Bourahli
- Laboratoire de recherche des maladies métaboliques, faculté de médecine de Constantine, université Constantine 3, Constantine, Algérie; Service de physiologie et des explorations fonctionnelles, CHU Benbadis, Constantine, Algérie.
| | - H Mehdioui
- Laboratoire de recherche des maladies métaboliques, faculté de médecine de Constantine, université Constantine 3, Constantine, Algérie; Service de physiologie et des explorations fonctionnelles, CHU Benbadis, Constantine, Algérie.
| | - H Ben Saad
- Laboratoire de physiologie, faculté de médecine « Ibn Eljazzar » de Sousse, université de Sousse, avenue Mohamed Karoui, 4000 Sousse, Tunisie; Service de physiologie et explorations fonctionnelles, EPS Farhat Hached, Sousse, Tunisie.
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17
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Corsonello A, Aucella F, Pedone C, Antonelli-Incalzi R. Chronic kidney disease: A likely underestimated component of multimorbidity in older patients with chronic obstructive pulmonary disease. Geriatr Gerontol Int 2017; 17:1770-1788. [DOI: 10.1111/ggi.13054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/28/2017] [Accepted: 02/20/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology; Italian National Research Center on Aging (INRCA); Cosenza Italy
| | - Filippo Aucella
- Department of Nephrology and Dialysis; Scientific Institute for Research and Health Care "Casa Sollievo della Sofferenza" IRCCS; San Giovanni Rotondo Foggia Italy
| | - Claudio Pedone
- Unit of Geriatric and Respiratory Medicine; University Campus BioMedico; Rome Italy
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18
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Robalo Nunes A, Tátá M. The impact of anaemia and iron deficiency in chronic obstructive pulmonary disease: A clinical overview. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:146-155. [PMID: 28233650 DOI: 10.1016/j.rppnen.2016.12.005] [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] [Received: 07/27/2016] [Revised: 11/28/2016] [Accepted: 12/12/2016] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Anaemia is increasingly recognised as an important comorbidity in the context of chronic obstructive pulmonary disease (COPD), but remains undervalued in clinical practice. This review aims to characterise the impact of anaemia and iron deficiency in COPD. METHODS Literature review of studies exploring the relationship between anaemia/iron deficiency and COPD, based on targeted MEDLINE and Google Scholar queries. RESULTS The reported prevalence of anaemia in COPD patients, ranging from 4.9% to 38.0%, has been highly variable, due to different characteristics of study populations and lack of a consensus on the definition of anaemia. Inflammatory processes seem to play an important role in the development of anaemia, but other causes (including nutritional deficiencies) should not be excluded from consideration. Anaemia in COPD has been associated with increased morbidity, mortality, and overall reduced quality of life. The impact of iron deficiency, irrespective of anaemia, is not as well studied, but it might have important implications, since it impacts production of red blood cells and respiratory enzymes. Treatment of anaemia/iron deficiency in COPD remains poorly studied, but it appears reasonable to assume that COPD patients should at least receive the same type of treatment as other patients. CONCLUSIONS Anaemia and iron deficiency continue to be undervalued in most COPD clinical settings, despite affecting up to one-third of patients and having negative impact on prognosis. Special efforts should be made to improve clinical management of anaemia and iron deficiency in COPD patients as a means of achieving better patient care.
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Affiliation(s)
- A Robalo Nunes
- Serviço de Imunohemoterapia/Medicina Transfusional, Hospital das Forças Armadas (Pólo de Lisboa), Lisboa, Portugal.
| | - M Tátá
- Serviço de Pneumologia, Hospital das Forças Armadas (Pólo de Lisboa), Lisboa, Portugal
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19
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Toft-Petersen AP, Torp-Pedersen C, Weinreich UM, Rasmussen BS. Association between hemoglobin and prognosis in patients admitted to hospital for COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:2813-2820. [PMID: 27877035 PMCID: PMC5108499 DOI: 10.2147/copd.s116269] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Low concentrations of hemoglobin have previously been demonstrated in many patients with COPD. There is evidence of anemia as a prognostic factor in acute exacerbations, but the detailed relationship between concentrations of hemoglobin and mortality is not known. A register-based cohort of patients admitted for the first time to Danish hospitals for acute exacerbations of COPD from 2007 through 2012 was established. Age, sex, comorbidities, medication, renal function, and concentrations of hemoglobin were retrieved. Sex-specific survival analyses were fitted for different rounded concentrations of hemoglobin. The cohort encompassed 6,969 patients. Hemoglobin below 130 g/L was present in 39% of males and below 120 g/L in 24% of females. The in-hospital mortality rates for patients with hemoglobin below or above these limits were 11.6% and 5.4%, respectively. After discharge, compared to hemoglobin 130 g/L, the hazard ratio (HR) for males with hemoglobin 120 g/L was 1.45 (95% confidence interval [CI] 1.22-1.73), adjusted HR 1.37 (95% CI 1.15-1.64). Compared to hemoglobin 120 g/L, the HR for females with hemoglobin 110 g/L was 1.4 (95% CI 1.17-1.68), adjusted HR 1.28 (95% CI 1.06-1.53). In conclusion, low concentrations of hemoglobin are frequent in COPD patients with acute exacerbations, and predict long-term mortality.
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Affiliation(s)
| | | | - Ulla Møller Weinreich
- Department of Clinical Medicine, Aalborg University
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Bodil Steen Rasmussen
- Department of Clinical Medicine, Aalborg University
- Department of Anaesthesia and Intensive Care
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20
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Okazaki R, Watanabe R, Inoue D. Osteoporosis Associated with Chronic Obstructive Pulmonary Disease. J Bone Metab 2016; 23:111-20. [PMID: 27622174 PMCID: PMC5018603 DOI: 10.11005/jbm.2016.23.3.111] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/02/2016] [Indexed: 12/23/2022] Open
Abstract
Recent epidemiological studies have revealed that osteoporosis is closely associated with common chronic diseases including diabetes, hypertension, chronic kidney disorders, and chronic obstructive pulmonary disease (COPD). COPD is a chronic inflammatory airway disease but now well known to be associated with various systemic comorbidities including osteoporosis. Osteoporosis and osteoporotic fractures are extremely common in COPD patients, which have significant impacts on their quality of life (QOL), activities of daily life (ADL), respiratory function, and possibly their prognosis. COPD-associated osteoporosis is however extremely under-recognized, hence undertreated. Recent studies have suggested that both decreased bone mineral density (BMD) and impaired bone quality compromise bone strength causing fractures in COPD. In COPD patients, various general clinical risk factors for osteoporosis are present including smoking, older age, low body weight, and physical inactivity. In addition, disease-related risk factors such as decreased pulmonary function, inflammation, glucocorticoid use and vitamin D deficiency/insufficiency have been linked to the development of osteoporosis in COPD. Increased awareness of osteoporosis in COPD, especially that of high prevalence of vertebral fractures is called upon among general physicians as well as pulmonologists. Routine screening for osteoporosis and risk assessment of fractures will enable physicians to diagnose COPD patients with comorbid osteoporosis at an early stage. Timely prevention of developing osteoporosis together with appropriate treatment of established osteoporosis may improve QOL and ADL of the COPD patients, preserve their lung function and eventually result in better prognosis in these patients.
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Affiliation(s)
- Ryo Okazaki
- Third Department of Medicine, Teikyo University Chiba Medical Center, Japan
| | - Reiko Watanabe
- Third Department of Medicine, Teikyo University Chiba Medical Center, Japan
| | - Daisuke Inoue
- Third Department of Medicine, Teikyo University Chiba Medical Center, Japan
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21
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Chuan F, Zhang M, Yao Y, Tian W, He X, Zhou B. Anemia in Patients With Diabetic Foot Ulcer. INT J LOW EXTR WOUND 2016; 15:220-6. [PMID: 27440798 DOI: 10.1177/1534734616660224] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of this study was to describe the characteristics of diabetic foot ulcer (DFU) patients with anemia and assess the relationship between anemia and DFU outcome. A retrospective cohort study was conducted on patients with DFU who attended our hospital from May 2007 to September 2014. All of the variables in the DFU patients with and without anemia were compared. In this study, 353 subjects were included, anemia was present in 236 patients (66.9%). These patients were significantly male, more likely to be a smoker, had a lower level of serum albumin and worse kidney function, more likely to use at least 2 types of antibiotics and had a worse perfusion of the lower limb, a larger and deeper ulcer and a more severe infection. A multivariate analysis showed that male sex, lower serum albumin, and worse kidney function were independent predictors of anemia in DFU patients. Additionally, in multivariate models, anemia was one of the variables that was most significantly associated with adverse outcomes and with similar findings for secondary outcomes. Receiver operating characteristic analysis determined a hemoglobin cutoff of 12.3 g/dL (females) and 12.1 g/dL (males) to identify a high-risk population of DFU patients who would have adverse outcomes. So anemia is common in patients with DFU. Although typically mild or moderate, anemia has been associated with substantial morbidity and mortality in patients with DFU.
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Affiliation(s)
- Fengning Chuan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Yao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenqing Tian
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoqun He
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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22
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Zimmers TA, Fishel ML, Bonetto A. STAT3 in the systemic inflammation of cancer cachexia. Semin Cell Dev Biol 2016; 54:28-41. [PMID: 26860754 PMCID: PMC4867234 DOI: 10.1016/j.semcdb.2016.02.009] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/04/2016] [Indexed: 02/07/2023]
Abstract
Weight loss is diagnostic of cachexia, a debilitating syndrome contributing mightily to morbidity and mortality in cancer. Most research has probed mechanisms leading to muscle atrophy and adipose wasting in cachexia; however cachexia is a truly systemic phenomenon. Presence of the tumor elicits an inflammatory response and profound metabolic derangements involving not only muscle and fat, but also the hypothalamus, liver, heart, blood, spleen and likely other organs. This global response is orchestrated in part through circulating cytokines that rise in conditions of cachexia. Exogenous Interleukin-6 (IL6) and related cytokines can induce most cachexia symptomatology, including muscle and fat wasting, the acute phase response and anemia, while IL-6 inhibition reduces muscle loss in cancer. Although mechanistic studies are ongoing, certain of these cachexia phenotypes have been causally linked to the cytokine-activated transcription factor, STAT3, including skeletal muscle wasting, cardiac dysfunction and hypothalamic inflammation. Correlative studies implicate STAT3 in fat wasting and the acute phase response in cancer cachexia. Parallel data in non-cancer models and disease states suggest both pathological and protective functions for STAT3 in other organs during cachexia. STAT3 also contributes to cancer cachexia through enhancing tumorigenesis, metastasis and immune suppression, particularly in tumors associated with high prevalence of cachexia. This review examines the evidence linking STAT3 to multi-organ manifestations of cachexia and the potential and perils for targeting STAT3 to reduce cachexia and prolong survival in cancer patients.
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Affiliation(s)
- Teresa A Zimmers
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States; Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, United States; IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202, United States; IUPUI Center for Cachexia Research Innovation and Therapy, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
| | - Melissa L Fishel
- IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202, United States; Department of Pediatrics, Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, United States; Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
| | - Andrea Bonetto
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States; IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN 46202, United States; IUPUI Center for Cachexia Research Innovation and Therapy, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
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23
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Inoue D, Watanabe R, Okazaki R. COPD and osteoporosis: links, risks, and treatment challenges. Int J Chron Obstruct Pulmon Dis 2016; 11:637-48. [PMID: 27099481 PMCID: PMC4820217 DOI: 10.2147/copd.s79638] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory airway disease associated with various systemic comorbidities including osteoporosis. Osteoporosis and its related fractures are common and have significant impacts on quality of life and even respiratory function in patients with COPD. COPD-associated osteoporosis is however extremely undertreated. Recent studies have suggested that both decreased bone mineral density (BMD) and impaired bone quality contribute to bone fragility, causing fractures in COPD patients. Various clinical risk factors of osteoporosis in COPD patients, including older age, emaciation, physical inactivity, and vitamin D deficiency, have also been described. It is critically important for pulmonologists to be aware of the high prevalence of osteoporosis in COPD patients and evaluate them for such fracture risks. Routine screening for osteoporosis will enable physicians to diagnose COPD patients with comorbid osteoporosis at an early stage and give them appropriate treatment to prevent fracture, which may lead to improved quality of life as well as better long-term prognosis.
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Affiliation(s)
- Daisuke Inoue
- Division of Endocrinology and Metabolism, Third Department of Medicine, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Reiko Watanabe
- Division of Endocrinology and Metabolism, Third Department of Medicine, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Ryo Okazaki
- Division of Endocrinology and Metabolism, Third Department of Medicine, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
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24
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Mean platelet volume is elevated in exacerbated and convalescent COPD patients. Clin Chim Acta 2015; 451:227-31. [DOI: 10.1016/j.cca.2015.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/20/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022]
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25
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Xu GH, Shen J, Sun P, Yang ML, Zhao PW, Niu Y, Lu JK, Wang ZQ, Gao C, Han X, Liu LL, Liu CC, Cong ZY. Anti-inflammatory effects of potato extract on a rat model of cigarette smoke-induced chronic obstructive pulmonary disease. Food Nutr Res 2015; 59:28879. [PMID: 26498426 PMCID: PMC4620637 DOI: 10.3402/fnr.v59.28879] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 11/25/2022] Open
Abstract
Highlights: (1) Potato extract (PE) exhibits non-toxic effects on mice. (2) Cigarette smoke (CS)–induced COPD rats exhibit significant thickened and disordered lung markings. (3) PE could improve the histopathological symptoms of lung tissue in COPD. (4) PE could increase the expression of IL-10 and reduce the expression of TNF-α and G-CSF in COPD rats.
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Affiliation(s)
- Gui Hua Xu
- Department of Clinical Medical Research Center, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China
| | - Jie Shen
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China
| | - Peng Sun
- Institute of Microbiology and Immunology, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Min Li Yang
- Institute of Microbiology and Immunology, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China.,Inner Mongolia Mengjian Biotechnology company, Wuchua, Inner Mongolia, China;
| | - Peng Wei Zhao
- Institute of Microbiology and Immunology, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China;
| | - Yan Niu
- Institute of Microbiology and Immunology, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Jing Kun Lu
- Institute of Microbiology and Immunology, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Zhi Qiang Wang
- Department of Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Chao Gao
- Department of Forensic Medicine, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Xue Han
- Department of Forensic Medicine, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Lei Lei Liu
- Department of Forensic Medicine, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Chen Chen Liu
- Department of Forensic Medicine, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Zhang Yue Cong
- Department of Forensic Medicine, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
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