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Işık YE, Aydın Z. Comparative analysis of machine learning approaches for predicting respiratory virus infection and symptom severity. PeerJ 2023; 11:e15552. [PMID: 37404475 PMCID: PMC10317018 DOI: 10.7717/peerj.15552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/23/2023] [Indexed: 07/06/2023] Open
Abstract
Respiratory diseases are among the major health problems causing a burden on hospitals. Diagnosis of infection and rapid prediction of severity without time-consuming clinical tests could be beneficial in preventing the spread and progression of the disease, especially in countries where health systems remain incapable. Personalized medicine studies involving statistics and computer technologies could help to address this need. In addition to individual studies, competitions are also held such as Dialogue for Reverse Engineering Assessment and Methods (DREAM) challenge which is a community-driven organization with a mission to research biology, bioinformatics, and biomedicine. One of these competitions was the Respiratory Viral DREAM Challenge, which aimed to develop early predictive biomarkers for respiratory virus infections. These efforts are promising, however, the prediction performance of the computational methods developed for detecting respiratory diseases still has room for improvement. In this study, we focused on improving the performance of predicting the infection and symptom severity of individuals infected with various respiratory viruses using gene expression data collected before and after exposure. The publicly available gene expression dataset in the Gene Expression Omnibus, named GSE73072, containing samples exposed to four respiratory viruses (H1N1, H3N2, human rhinovirus (HRV), and respiratory syncytial virus (RSV)) was used as input data. Various preprocessing methods and machine learning algorithms were implemented and compared to achieve the best prediction performance. The experimental results showed that the proposed approaches obtained a prediction performance of 0.9746 area under the precision-recall curve (AUPRC) for infection (i.e., shedding) prediction (SC-1), 0.9182 AUPRC for symptom class prediction (SC-2), and 0.6733 Pearson correlation for symptom score prediction (SC-3) by outperforming the best leaderboard scores of Respiratory Viral DREAM Challenge (a 4.48% improvement for SC-1, a 13.68% improvement for SC-2, and a 13.98% improvement for SC-3). Additionally, over-representation analysis (ORA), which is a statistical method for objectively determining whether certain genes are more prevalent in pre-defined sets such as pathways, was applied using the most significant genes selected by feature selection methods. The results show that pathways associated with the 'adaptive immune system' and 'immune disease' are strongly linked to pre-infection and symptom development. These findings contribute to our knowledge about predicting respiratory infections and are expected to facilitate the development of future studies that concentrate on predicting not only infections but also the associated symptoms.
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Affiliation(s)
- Yunus Emre Işık
- Department of Management Information Systems, Sivas Cumhuriyet University, Sivas, Turkey
| | - Zafer Aydın
- Department of Computer Engineering, Abdullah Gül University, Kayseri, Turkey
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Mechanism of action of DSP-7888 (adegramotide/nelatimotide) Emulsion, a peptide-based therapeutic cancer vaccine with the potential to turn up the heat on non-immunoreactive tumors. Clin Transl Oncol 2023; 25:396-407. [PMID: 36138335 PMCID: PMC9510518 DOI: 10.1007/s12094-022-02946-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Wilms' tumor 1 (WT1) is highly expressed in various solid tumors and hematologic malignancies. DSP-7888 (adegramotide/nelatimotide) Emulsion is an investigational therapeutic cancer vaccine comprising three synthetic epitopes derived from WT1. We evaluated the mechanism of action of DSP-7888 Emulsion, which is hypothesized to induce WT1-specific cytotoxic T lymphocytes (CTLs) and helper T lymphocytes (HTLs). METHODS The ability of nelatimotide and adegramotide to induce WT1-specific CD8+ T cells and CD4+ T cells was assessed in human peripheral blood mononuclear cells (PBMCs). The ability of DSP-7888 Emulsion to induce WT1-specific CTLs in vivo was assessed using human leukocyte antigen-I (HLA-I) transgenic mice. To assess how adegramotide, the helper peptide in DSP-7888 Emulsion, enhances WT1-specific CTLs, HLA-I transgenic mice were administered DSP-7888 or nelatimotide-only Emulsion. Interferon-gamma secretion under antigen stimulation by splenocytes co-cultured with or without tumor cells was then quantified. The effects of combination treatment with DSP-7888 Emulsion and an anti-programmed cell death protein 1 (PD-1) antibody on tumor volume and the frequency of tumor-infiltrating WT1-specific T cells were assessed in HLA-I transgenic mice implanted with WT1 antigen-positive tumors. RESULTS The peptides in DSP-7888 Emulsion were shown to induce WT1-specific CTLs and HTLs in both human PBMCs and HLA-I transgenic mice. Unlike splenocytes from nelatimotide-only Emulsion-treated mice, splenocytes from DSP-7888 Emulsion-treated mice exhibited high levels of interferon-gamma secretion, including when co-cultured with tumor cells; interferon-gamma secretion was further enhanced by concomitant treatment with anti-PD-1. HLA-I transgenic mice administered DSP-7888 Emulsion plus anti-PD-1 experienced significantly greater reductions in tumor size than mice treated with either agent alone. This reduction in tumor volume was accompanied by increased numbers of tumor-infiltrating WT1-specific CTLs. CONCLUSIONS DSP-7888 Emulsion can promote both cytotoxic and helper T-cell-mediated immune responses against WT1-positive tumors. Adegramotide enhances CTL numbers, and the CTLs induced by treatment with both nelatimotide and adegramotide are capable of functioning within the immunosuppressive tumor microenvironment. The ability of anti-PD-1 to enhance the antitumor activity of DSP-7888 Emulsion in mice implanted with WT1-positive tumors suggests the potential for synergy.
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Poole JA, Mikuls TR, Thiele GM, Gaurav R, Nelson AJ, Duryee MJ, Mitra A, Hunter C, Wyatt TA, England BR, Ascherman DP. Increased susceptibility to organic dust exposure-induced inflammatory lung disease with enhanced rheumatoid arthritis-associated autoantigen expression in HLA-DR4 transgenic mice. Respir Res 2022; 23:160. [PMID: 35717175 PMCID: PMC9206339 DOI: 10.1186/s12931-022-02085-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Immunogenetic as well as environmental and occupational exposures have been linked to the development of rheumatoid arthritis (RA), RA-associated lung disease, and other primary lung disorders. Importantly, various inhalants can trigger post-translational protein modifications, resulting in lung autoantigen expression capable of stimulating pro-inflammatory and/or pro-fibrotic immune responses. To further elucidate gene-environment interactions contributing to pathologic lung inflammation, we exploited an established model of organic dust extract (ODE) exposure with and without collagen-induced arthritis (CIA) in C57BL/6 wild type (WT) versus HLA-DR4 transgenic mice. ODE-induced airway infiltration driven by neutrophils was significantly increased in DR4 versus WT mice, with corresponding increases in bronchoalveolar lavage fluid (BALF) levels of TNF-⍺, IL-6, and IL-33. Lung histopathology demonstrated increased number of ectopic lymphoid aggregates comprised of T and B cells following ODE exposure in DR4 mice. ODE also induced citrullination, malondialdehyde acetaldehyde (MAA) modification, and vimentin expression that co-localized with MAA and was enhanced in DR4 mice. Serum and BALF anti-MAA antibodies were strikingly increased in ODE-treated DR4 mice. Coupling ODE exposure with Type II collagen immunization (CIA) resulted in similarly augmented pro-inflammatory lung profiles in DR4 mice (relative to WT mice) that was accompanied by a profound increase in infiltrating lung CD4+ and CD8+ T cells as well as CD19+CD11b+ autoimmune B cells. Neither modeling strategy induced significant arthritis. These findings support a model in which environmental insults trigger enhanced post-translational protein modification and lung inflammation sharing immunopathological features with RA-associated lung disease in the selected immunogenetic background of HLA-DR4 mice.
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Affiliation(s)
- Jill A. Poole
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Ted R. Mikuls
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Geoffrey M. Thiele
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Rohit Gaurav
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Amy J. Nelson
- grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Michael J. Duryee
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Ananya Mitra
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Carlos Hunter
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Todd A. Wyatt
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA ,grid.266813.80000 0001 0666 4105Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Bryant R. England
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Dana P. Ascherman
- grid.21925.3d0000 0004 1936 9000Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
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Lan G, Huang C, Liu Y, Feng Y, Ni Y, Shi G. How does comorbid bronchiectasis affect asthmatic patients? A meta-analysis. J Asthma 2020; 58:1314-1328. [PMID: 32552078 DOI: 10.1080/02770903.2020.1784194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Asthma and bronchiectasis are known to be two distinct diseases with different etiology, pathophysiology, management, and prognosis. However, a high prevalence of bronchiectasis has been reported in patients with severe asthma. Thus, it is of great importance to identify the impact of bronchiectasis on asthmatic patients.Data sources: Databases including PubMed, Embase, Cochrane, Web of Science were searched comprehensively to identify relevant human clinical studies published until February 2020.Study selections: Two investigators (Gelei Lan and Guochao Shi) independently obtained the potentially eligible articles based on their titles and abstracts. When opinions differed between the investigators, discussions were made to reach an agreement. The authors of the included studies were contacted for inquiry when necessary. RESULTS Six observational studies with 1004 patients were included in the meta-analysis. The mean prevalence of bronchiectasis in patients with asthma was 35.2% (ranging from 2.2% to 47%). Asthmatic patients with bronchiectasis were older, had a longer disease duration, exhibited greater severity, and showed more frequent exacerbations and hospitalization, and poorer lung function, compared with the patients without bronchiectasis. CONCLUSION Despite of the heterogeneity between included studies and detectable publication bias, this meta-analysis demonstrated the impact of comorbid bronchiectasis on asthmatic patients. Thus, coexistence of bronchiectasis should be considered a clinical phenotype of asthma, which may have associations with exacerbation and hospitalization.
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Affiliation(s)
- Gelei Lan
- Department of Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai 200025, China
| | - Chunrong Huang
- Department of Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai 200025, China
| | - Yahui Liu
- Department of Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai 200025, China
| | - Yun Feng
- Department of Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai 200025, China
| | - Yingmeng Ni
- Department of Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai 200025, China
| | - Guochao Shi
- Department of Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai 200025, China
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Bush A, Floto RA. Pathophysiology, causes and genetics of paediatric and adult bronchiectasis. Respirology 2019; 24:1053-1062. [PMID: 30801930 DOI: 10.1111/resp.13509] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
Bronchiectasis has historically been considered to be irreversible dilatation of the airways, but with modern imaging techniques it has been proposed that 'irreversible' be dropped from the definition. The upper limit of normal for the ratio of airway to arterial development increases with age, and a developmental perspective is essential. Bronchiectasis (and persistent bacterial bronchitis, PBB) is a descriptive term and not a diagnosis, and should be the start not the end of the patient's diagnostic journey. PBB, characterized by airway infection and neutrophilic inflammation but without significant airway dilatation may be a precursor of bronchiectasis, and there are many commonalities in the microbiology and the pathology, which are reviewed in this article. A high index of suspicion is essential, and a history of chronic wet or productive cough for more than 4-8 weeks should prompt investigation. There are numerous underlying causes of bronchiectasis, although in many cases no cause is found. Causes include post-infectious, especially after tuberculosis, adenoviral or pertussis infection; aspiration syndromes; defects in host defence, which may solely affect the airways (cystic fibrosis, not considered in this review, and primary ciliary dyskinesia); and primary ciliary dyskinesia or be systemic, such as common variable immunodeficiency; genetic syndromes; and anatomical defects such as intraluminal airway obstruction (e.g. foreign body), intramural obstruction (e.g. complete cartilage rings) and external airway compression (e.g. by tuberculous lymph nodes). Identification of the underlying cause is important, because some of these conditions have specific treatments and others genetic implications for the family.
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Affiliation(s)
- Andrew Bush
- Department of Paediatrics, Imperial College, London, UK.,Department of Paediatric Respirology, National Heart and Lung Institute, London, UK.,Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - R Andres Floto
- Department of Respiratory Biology, University of Cambridge, Cambridge, UK.,Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK
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Orb Q, Pulsipher A, Smith KA, Ashby S, Alt JA. Correlation between systemic inflammatory response and quality of life in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:458-465. [PMID: 30657646 PMCID: PMC6491244 DOI: 10.1002/alr.22289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/19/2018] [Accepted: 12/20/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Local sinonasal inflammation resulting from altered T-cell immune signaling is a contributor to the pathogenesis of chronic rhinosinusitis (CRS). CRS patients experience negative impacts on quality of life (QOL) and suffer from comorbidities linked to systemic inflammation. However, systemic inflammatory profiling to evaluate the association between systemic inflammation and QOL in CRS has not been performed. Our objectives were to compare local and systemic inflammatory gene expression in patients with CRS to determine if systemic markers of inflammation associate with disease severity and disease-specific QOL. METHODS A prospective observational study was conducted comparing 16 patients with CRS to 10 controls. Inflammatory gene expression in the anterior ethmoid tissues and peripheral blood of patients was measured using multiplex gene expression analysis and correlated to disease severity (computed tomography and nasal endoscopy) and disease-specific QOL (22-item Sino-Nasal Outcome Test [SNOT-22] and Rhinosinusitis Disability Index) using linear regression analyses. RESULTS Patients with CRS showed significant increases in the expression of ctla4 and jak1 in sinonasal tissue and blood (p < 0.05), whereas the gene expression of hla-dqa1, hla-dqb1, and dusp4 was significantly decreased in patients with CRS compared to controls (p < 0.05). Soluble and local ctla4 and jak1 showed a significant positive correlation with clinical markers of disease severity and disease-specific QOL (p < 0.05). CONCLUSION Local and systemic gene expression involved in T-cell immune signaling was found to be significantly altered in the blood and sinonasal tissues of patients with CRS compared to controls and significantly correlated to disease severity and QOL in patients with CRS.
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Affiliation(s)
- Quinn Orb
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Abigail Pulsipher
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Kristine A Smith
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Shaelene Ashby
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
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Gao YH, Guan WJ, Chen RC, Zhang GJ. Asthma and risk of bronchiectasis exacerbation: we still need more evidence. Eur Respir J 2018; 48:1246-1247. [PMID: 27694413 DOI: 10.1183/13993003.00780-2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Yong-Hua Gao
- Dept of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rong-Chang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guo-Jun Zhang
- Dept of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Jaat FG, Hasan SF, Perry A, Cookson S, Murali S, Perry JD, Lanyon CV, De Soyza A, Todryk SM. Anti-bacterial antibody and T cell responses in bronchiectasis are differentially associated with lung colonization and disease. Respir Res 2018; 19:106. [PMID: 29848315 PMCID: PMC5977760 DOI: 10.1186/s12931-018-0811-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/14/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND As a way to determine markers of infection or disease informing disease management, and to reveal disease-associated immune mechanisms, this study sought to measure antibody and T cell responses against key lung pathogens and to relate these to patients' microbial colonization status, exacerbation history and lung function, in Bronchiectasis (BR) and Chronic Obstructive Pulmonary Disease (COPD). METHODS One hundred nineteen patients with stable BR, 58 with COPD and 28 healthy volunteers were recruited and spirometry was performed. Bacterial lysates were used to measure specific antibody responses by ELISA and T cells by ELIspot. Cytokine secretion by lysate-stimulated T cells was measured by multiplex cytokine assay whilst activation phenotype was measured by flow cytometry. RESULTS Typical colonization profiles were observed in BR and COPD, dominated by P.aeruginosa, H.influenzae, S.pneumoniae and M.catarrhalis. Colonization frequency was greater in BR, showing association with increased antibody responses against P.aeruginosa compared to COPD and HV, and with sensitivity of 73% and specificity of 95%. Interferon-gamma T cell responses against P.aeruginosa and S.pneumoniae were reduced in BR and COPD, whilst reactive T cells in BR had similar markers of homing and senescence compared to healthy volunteers. Exacerbation frequency in BR was associated with increased antibodies against P. aeruginosa, M.catarrhalis and S.maltophilia. T cell responses against H.influenzae showed positive correlation with FEV1% (r = 0.201, p = 0.033) and negative correlation with Bronchiectasis Severity Index (r = - 0.287, p = 0.0035). CONCLUSION Our findings suggest a difference in antibody and T cell immunity in BR, with antibody being a marker of exposure and disease in BR for P.aeruginosa, M.catarrhalis and H.influenzae, and T cells a marker of reduced disease for H.influenzae.
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Affiliation(s)
- Fathia G Jaat
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.,Zawia University, Zawia, Libya
| | - Sajidah F Hasan
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.,College of Pharmacy, University of Kerbala, Kerbala, Iraq
| | - Audrey Perry
- Department of Microbiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Sharon Cookson
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Santosh Murali
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - John D Perry
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.,Department of Microbiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Clare V Lanyon
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Anthony De Soyza
- Adult Bronchiectasis Service, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Stephen M Todryk
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK. .,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
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Chuchalin AG. [Bronchiectasis]. TERAPEVT ARKH 2017; 89:4-17. [PMID: 28378723 DOI: 10.17116/terarkh20178934-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper presents information on possible approaches to the classification, pathogenesis, and determination of the etiological causes of bronchiectasis. It discusses a group of bronchiectasis-associated diseases. It gives a detailed diagnostic algorithm aimed to establish the etiology of bronchiectasis and the markers of the efficiency of different treatment options. Much attention is paid to genetically predetermined bronchiectasis. Universal approaches to treating patients with bronchiectasis as a whole, as well as treatments for certain entities of bronchiectasis are discussed.
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Affiliation(s)
- A G Chuchalin
- Pulmonology Research Institute, Federal Biomedical Agency of Health of Russia, Moscow, Russia
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Oka S, Furukawa H, Shimada K, Sugii S, Hashimoto A, Komiya A, Fukui N, Suda A, Tsunoda S, Ito S, Katayama M, Nakamura T, Saisho K, Sano H, Migita K, Nagaoka S, Tsuchiya N, Tohma S. Association of human leukocyte antigen alleles with chronic lung diseases in rheumatoid arthritis. Rheumatology (Oxford) 2016; 55:1301-7. [DOI: 10.1093/rheumatology/kew025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Indexed: 11/13/2022] Open
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Boyton RJ, Altmann DM. Bronchiectasis: Current Concepts in Pathogenesis, Immunology, and Microbiology. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2016; 11:523-54. [PMID: 26980162 DOI: 10.1146/annurev-pathol-012615-044344] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bronchiectasis is a disorder of persistent lung inflammation and recurrent infection, defined by a common pathological end point: irreversible bronchial dilatation arrived at through diverse etiologies. This suggests an interplay between immunogenetic susceptibility, immune dysregulation, bacterial infection, and lung damage. The damaged epithelium impairs mucus removal and facilitates bacterial infection with increased cough, sputum production, and airflow obstruction. Lung infection is caused by respiratory bacterial and fungal pathogens, including Pseudomonas aeruginosa, Haemophilus, Aspergillus fumigatus, and nontuberculous mycobacteria. Recent studies have highlighted the relationship between the lung microbiota and microbial-pathogen niches. Disease may result from environments favoring interleukin-17-driven neutrophilia. Bronchiectasis may present in autoimmune disease, as well as conditions of immune dysregulation, such as combined variable immune deficiency, transporter associated with antigen processing-deficiency syndrome, and hyperimmunoglobulin E syndrome. Differences in prevalence across geography and ethnicity implicate an etiological mix of genetics and environment underpinning susceptibility.
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Affiliation(s)
- Rosemary J Boyton
- Lung Immunology Group, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom; .,Department of Respiratory Medicine, Royal Brompton & Harefield NHS Foundation Trust, London SW3 6NP, United Kingdom
| | - Daniel M Altmann
- Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom
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Quigley KJ, Reynolds CJ, Goudet A, Raynsford EJ, Sergeant R, Quigley A, Worgall S, Bilton D, Wilson R, Loebinger MR, Maillere B, Altmann DM, Boyton RJ. Chronic Infection by Mucoid Pseudomonas aeruginosa Associated with Dysregulation in T-Cell Immunity to Outer Membrane Porin F. Am J Respir Crit Care Med 2015; 191:1250-64. [PMID: 25789411 PMCID: PMC4476516 DOI: 10.1164/rccm.201411-1995oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 03/19/2015] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Pseudomonas aeruginosa (PA) is an environmental pathogen that commonly infects individuals with cystic fibrosis (CF) and non-CF bronchiectasis, impacting morbidity and mortality. To understand the pathobiology of interactions between the bacterium and host adaptive immunity and to inform rational vaccine design, it is important to understand the adaptive immune correlates of disease. OBJECTIVES To characterize T-cell immunity to the PA antigen outer membrane porin F (OprF) by analyzing immunodominant epitopes in relation to infection status. METHODS Patients with non-CF bronchiectasis were stratified by frequency of PA isolation. T-cell IFN-γ immunity to OprF and its immunodominant epitopes was characterized. Patterns of human leukocyte antigen (HLA) restriction of immunodominant epitopes were defined using HLA class II transgenic mice. Immunity was characterized with respect to cytokine and chemokine secretion, antibody response, and T-cell activation transcripts. MEASUREMENTS AND MAIN RESULTS Patients were stratified according to whether PA was never, sometimes (<50%), or frequently (≥50%) isolated from sputum. Patients with frequent PA sputum-positive isolates were more likely to be infected by mucoid PA, and they showed a narrow T-cell epitope response and a relative reduction in Th1 polarizing transcription factors but enhanced immunity with respect to antibody production, innate cytokines, and chemokines. CONCLUSIONS We have defined the immunodominant, HLA-restricted T-cell epitopes of OprF. Our observation that chronic infection is associated with a response of narrowed specificity, despite strong innate and antibody immunity, may help to explain susceptibility in these individuals and pave the way for better vaccine design to achieve protective immunity.
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Affiliation(s)
- Kathryn J. Quigley
- Lung Immunology Group, Infectious Diseases and Immunity, Department of Medicine, Medical Research Council and Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, Centre for Respiratory Infection, Hammersmith Hospital, Imperial College, London, United Kingdom
| | - Catherine J. Reynolds
- Lung Immunology Group, Infectious Diseases and Immunity, Department of Medicine, Medical Research Council and Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, Centre for Respiratory Infection, Hammersmith Hospital, Imperial College, London, United Kingdom
| | - Amelie Goudet
- CEA-Saclay, Institute of Biology and Technologies, SIMOPRO, Labex LERMIT, Labex VRI, Gif Sur Yvette, France
| | - Eleanor J. Raynsford
- Lung Immunology Group, Infectious Diseases and Immunity, Department of Medicine, Medical Research Council and Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, Centre for Respiratory Infection, Hammersmith Hospital, Imperial College, London, United Kingdom
| | - Ruhena Sergeant
- H & I Laboratory, Hammersmith Hospital, Imperial College, National Health Service Trust, London, United Kingdom
| | - Andrew Quigley
- Structural Genomics Consortium, Oxford University, Oxford, United Kingdom
| | - Stefan Worgall
- Department of Genetic Medicine and
- Department of Pediatrics, Weill Cornell Medical College, New York, New York; and
| | - Diana Bilton
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Robert Wilson
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Michael R. Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Bernard Maillere
- CEA-Saclay, Institute of Biology and Technologies, SIMOPRO, Labex LERMIT, Labex VRI, Gif Sur Yvette, France
| | - Daniel M. Altmann
- Lung Immunology Group, Infectious Diseases and Immunity, Department of Medicine, Medical Research Council and Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, Centre for Respiratory Infection, Hammersmith Hospital, Imperial College, London, United Kingdom
| | - Rosemary J. Boyton
- Lung Immunology Group, Infectious Diseases and Immunity, Department of Medicine, Medical Research Council and Asthma United Kingdom Centre in Allergic Mechanisms of Asthma, Centre for Respiratory Infection, Hammersmith Hospital, Imperial College, London, United Kingdom
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
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13
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Lemin AJ, Darke C. Prevalence of HLA-DQA1 alleles and haplotypes in blood donors resident in Wales. Int J Immunogenet 2014; 41:480-3. [DOI: 10.1111/iji.12154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/08/2014] [Accepted: 09/25/2014] [Indexed: 11/30/2022]
Affiliation(s)
- A. J. Lemin
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
| | - C. Darke
- Welsh Transplantation and Immunogenetics Laboratory; Welsh Blood Service; Pontyclun Wales UK
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McDonnell M, Anwar G, Rutherford R, De Soyza A, Worthy S, Corris P, Lordan J, Bourke S, Afolabi G, Ward C, Middleton P, Middleton D. Lack of association between KIR and HLA-C type and susceptibility to idiopathic bronchiectasis. Respir Med 2014; 108:1127-33. [DOI: 10.1016/j.rmed.2014.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/12/2014] [Accepted: 05/30/2014] [Indexed: 12/24/2022]
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15
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Poppelwell L, Chalmers JD. Defining severity in non-cystic fibrosis bronchiectasis. Expert Rev Respir Med 2014; 8:249-62. [DOI: 10.1586/17476348.2014.896204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Nannini C, Medina-Velasquez YF, Achenbach SJ, Crowson CS, Ryu JH, Vassallo R, Gabriel SE, Matteson EL, Bongartz T. Incidence and mortality of obstructive lung disease in rheumatoid arthritis: a population-based study. Arthritis Care Res (Hoboken) 2013; 65:1243-50. [PMID: 23436637 DOI: 10.1002/acr.21986] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 02/13/2013] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Pulmonary disease represents an important extraarticular manifestation of rheumatoid arthritis (RA). While the association of RA and interstitial lung disease is widely acknowledged, obstructive lung disease (OLD) in RA is less well understood. We therefore aimed to assess the incidence, risk factors, and mortality of OLD in patients with RA. METHODS We examined a population-based incident cohort of patients with RA and a comparison cohort of individuals without RA. OLD was defined using a strict composite criterion. Cox proportional hazards models were used to compare OLD incidence between the RA and comparator cohorts to investigate risk factors and to explore the impact of OLD on patient survival. RESULTS A total of 594 patients with RA and 596 subjects without RA were followed for a mean of 16.3 and 19.4 years, respectively. The lifetime risk of developing OLD was 9.6% for RA patients and 6.2% for subjects without RA (hazard ratio [HR] 1.54, 95% confidence interval [95% CI] 1.01-2.34). The risk of developing OLD was higher among male patients, among current or former smokers, and for individuals with more severe RA. Survival of RA patients diagnosed with OLD was worse compared to those without OLD (HR 2.09, 95% CI 1.47-2.97). CONCLUSION Patients with RA are at higher risk of developing OLD, which is significantly associated with premature mortality. Effective diagnostic and therapeutic strategies to detect and manage OLD in patients with RA may help to improve survival in these patients.
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McCarlie VW, Hartsfield JK, Blum JS, González-Cabezas C, Chin JR, Eckert GJ, Morford LA, Pescovitz MD, Rodriguez H, Fontana M, Gregory RL. Total IgA and IgA reactivity to antigen I/II epitopes in HLA-DRB1*04 positive subjects. OPEN JOURNAL OF IMMUNOLOGY 2013; 3:82-92. [PMID: 24386612 PMCID: PMC3875298 DOI: 10.4236/oji.2013.33012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bacterial adherence to the acquired dental pellicle, important in dental caries (caries), is mediated by receptor-adhesins such as salivary agglutinin binding to Streptococcus mutans antigen I/II (I/II). Ten selected I/II epitopes were chosen to determine their reactivity to human salivary IgA. Previous studies suggested that a specific HLA biomarker group (HLA-DRB1*04) may have differential influence of immune responses to I/II. However, it was not known whether secretory IgA (SIgA) responses to the selected epitopes from HLA-DRB1*04 positive subjects were different compared to controls, or across other caries-related factors such as total IgA (TIgA). Thirty-two total subjects were matched according to HLA type, gender, ethnicity and age. HLA genotyping, oral bacterial, immunoglobulin and antibody analyses were performed. A large observed difference emerged with regard to the natural immune reservoir of TIgA in HLA-DRB1*04 positive subjects, specifically, a 27.6% reduction compared to controls. In contrast to all other epitopes studied, HLA-DRB1*04 positive subjects also exhibited reduced reactivity to I/II epitope 834-853. HLA-DRB1*04 positive subjects exhibited lower specific SIgA activity/TIgA to 834-853 and also a lower specific reactivity to 834-853/whole cell S. mutans UA159. Furthermore, HLA-DRB1*04 positive subjects exhibited lower responses to I/II in its entirety. The large observed difference in TIgA and the 834-853 reactivity pattern across multiple measures suggest potentially important connections pertaining to the link between HLA-DRB1*04 and caries.
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Affiliation(s)
- V. Wallace McCarlie
- Department of Pediatric Dentistry and Orthodontics, School of Dental Medicine, East Carolina University, Greenville, USA
| | - James K. Hartsfield
- Center for Oral Health Research, Division of Orthodontics, Department of Oral Health Science, and Department of Microbiology, Immunology and Molecular Genetics, Colleges of Dentistry and Medicine, University of Kentucky, Lexington, USA
| | - Janice S. Blum
- Department of Microbiology and Immunology, School of Medicine, Indiana University, Indianapolis, USA
| | - Carlos González-Cabezas
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, USA
| | - Judith R. Chin
- Department of Pediatric Dentistry, School of Dentistry, Indiana University, Indianapolis, USA
| | - George J. Eckert
- Department of Biostatistics, Schools of Medicine and Public Health, Indiana University, Indianapolis, USA
| | - Lorri A. Morford
- Center for Oral Health Research, Division of Orthodontics, Department of Oral Health Science, College of Dentistry, University of Kentucky, Lexington, USA
| | - Mark D. Pescovitz
- Departments of Surgery and Microbiology and Immunology, School of Medicine, Indiana University, Indianapolis, USA
| | - Henry Rodriguez
- Department of Pediatrics, College of Medicine, University of South Florida, Tampa, USA
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, USA
| | - Richard L. Gregory
- Departments of Oral Biology and Preventive and Community Dentistry, and Department of Pathology and Laboratory Medicine, Schools of Dentistry and Medicine, Indiana University, Indianapolis, USA
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18
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Chalmers JD, McHugh BJ, Doherty C, Smith MP, Govan JR, Kilpatrick DC, Hill AT. Mannose-binding lectin deficiency and disease severity in non-cystic fibrosis bronchiectasis: a prospective study. THE LANCET RESPIRATORY MEDICINE 2013; 1:224-32. [DOI: 10.1016/s2213-2600(13)70001-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Boyton RJ, Reynolds CJ, Quigley KJ, Altmann DM. Immune mechanisms and the impact of the disrupted lung microbiome in chronic bacterial lung infection and bronchiectasis. Clin Exp Immunol 2013; 171:117-23. [PMID: 23286938 DOI: 10.1111/cei.12003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2012] [Indexed: 12/27/2022] Open
Abstract
Recent studies analysing immunogenetics and immune mechanisms controlling susceptibility to chronic bacterial infection in bronchiectasis implicate dysregulated immunity in conjunction with chronic bacterial infection. Bronchiectasis is a structural pathological end-point with many causes and disease associations. In about half of cases it is termed idiopathic, because it is of unknown aetiology. Bronchiectasis is proposed to result from a 'vicious cycle' of chronic bacterial infection and dysregulated inflammation. Paradoxically, both immune deficiency and excess immunity, either in the form of autoimmunity or excessive inflammatory activation, can predispose to disease. It appears to be a part of the spectrum of inflammatory, autoimmune and atopic conditions that have increased in prevalence through the 20th century, attributed variously to the hygiene hypothesis or the 'missing microbiota'. Immunogenetic studies showing a strong association with human leucocyte antigen (HLA)-Cw*03 and HLA-C group 1 homozygosity and combinational analysis of HLA-C and killer immunoglobulin-like receptors (KIR) genes suggests a shift towards activation of natural killer (NK) cells leading to lung damage. The association with HLA-DR1, DQ5 implicates a role for CD4 T cells, possibly operating through influence on susceptibility to specific pathogens. We hypothesize that disruption of the lung microbial ecosystem, by infection, inflammation and/or antibiotic therapy, creates a disturbed, simplified, microbial community ('disrupted microbiota') with downstream consequences for immune function. These events, acting with excessive NK cell activation, create a highly inflammatory lung environment that, in turn, permits the further establishment and maintenance of chronic infection dominated by microbial pathogens. This review discusses the implication of these concepts for the development of therapeutic interventions.
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Affiliation(s)
- R J Boyton
- Lung Immunology Group, Section of Infectious Diseases and Immunity, Hammersmith Campus, Department of Medicine, Centre for Respiratory Infection, Imperial College London, UK.
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Truong T. The overlap of bronchiectasis and immunodeficiency with asthma. Immunol Allergy Clin North Am 2012; 33:61-78. [PMID: 23337065 DOI: 10.1016/j.iac.2012.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Bronchiectasis should be considered as a differential diagnosis for, as well as a comorbidity in, patients with asthma, especially severe or long-standing asthma. Chronic airway inflammation is thought to be the primary cause, as with chronic or recurrent pulmonary infection and autoimmune conditions that involve the airways. Consequently, immunodeficiencies with associated increased susceptibility to respiratory tract infections or chronic inflammatory airways also increase the risk of developing bronchiectasis. Chronic bronchiectasis is associated with impaired mucociliary clearance and increased bronchial secretions, leading to airway obstruction and airflow limitation, which can lead to exacerbation of underlying asthma or increased asthma symptoms.
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Affiliation(s)
- Tho Truong
- Allergy and Clinical Immunology, National Jewish Health, Denver, CO, USA.
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21
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Seitz AE, Olivier KN, Adjemian J, Holland SM, Prevots DR. Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest 2012; 142:432-439. [PMID: 22302301 DOI: 10.1378/chest.11-2209] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Bronchiectasis is a potentially serious condition characterized by permanent and abnormal widening of the airways, the prevalence of which is not well described. We sought to describe the trends, associated conditions, and risk factors for bronchiectasis among adults aged ≥ 65 years. METHODS A 5% sample of the Medicare outpatient claims database was analyzed for bronchiectasis trends among beneficiaries aged ≥ 65 years from 2000 to 2007. Bronchiectasis was identified using International Classification of Diseases, Ninth Revision, Clinical Modification claim diagnosis codes for acquired bronchiectasis. Period prevalence was used to describe sex- and race/ethnicity-specific rates, and annual prevalence was used to describe trends and age-specific rates. We estimated trends using Poisson regression and odds of bronchiectasis using multivariate logistic regression. RESULTS From 2000 to 2007, 22,296 people had at least one claim for bronchiectasis. The 8-year period prevalence of bronchiectasis was 1,106 cases per 100,000 people. Bronchiectasis increased by 8.7% per year. We identified an interaction between the number of thoracic CT scans and race/ethnicity; period prevalence varied by a greater degree by number of thoracic CT scans among Asians compared with whites or blacks. Among people with one CT scan, Asians had a 2.5- and 3.9-fold higher period prevalence compared with whites and blacks. CONCLUSIONS Bronchiectasis prevalence increased significantly from 2000 to 2007 in the Medicare outpatient setting and varied by age, sex, and race/ethnicity. This increase could be due to a true increase in the condition or an increased recognition of previously undiagnosed cases.
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Affiliation(s)
- Amy E Seitz
- Epidemiology Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
| | - Kenneth N Olivier
- Epidemiology Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Jennifer Adjemian
- Epidemiology Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Steven M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - D Rebecca Prevots
- Epidemiology Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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Chalmers JD, Hill AT. Mechanisms of immune dysfunction and bacterial persistence in non-cystic fibrosis bronchiectasis. Mol Immunol 2012; 55:27-34. [PMID: 23088941 DOI: 10.1016/j.molimm.2012.09.011] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/17/2012] [Accepted: 09/19/2012] [Indexed: 02/07/2023]
Abstract
Bronchiectasis is a chronic inflammatory lung disease. The underlying cause is not identified in the majority of patients, but bronchiectasis is associated with a number of severe infections, immunodeficiencies and autoimmune disorders. Regardless of the underlying cause, the disease is characterised by a vicious cycle of bacterial colonisation, airway inflammation and airway structural damage. Inflammation in bronchiectasis is predominantly neutrophil driven. Neutrophils migrate to the airway under the action of pro-inflammatory cytokines such as interleukin-8, tumour necrosis factor-α and interleukin-1β, all of which are increased in the airway of patients with bronchiectasis. Bacterial infection persists in the airway despite large numbers of neutrophils that would be expected to phagocytose and kill pathogens under normal circumstances. Evidence suggests that neutrophils are disabled by multiple mechanisms including cleavage of phagocytic receptors by neutrophil elastase and inhibition of phagocytosis by neutrophil peptides. Complement activation is impaired and neutrophil elastase may cleave activated complement from pathogens preventing effective opsonisation. Organisms also evade clearance by adapting to chronic infection. The formation of biofilms, reduced motility and the down-regulation of virulence factors are among the strategies used to subvert innate immune mechanisms. Greater understanding of the mechanisms underlying chronic colonisation in bronchiectasis will assist in the development of new treatments for this important disease.
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Affiliation(s)
- James D Chalmers
- Tayside Respiratory Research Group, University of Dundee, Ninewells Hospital, Dundee, United Kingdom.
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23
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The immune response and its therapeutic modulation in bronchiectasis. Pulm Med 2012; 2012:280528. [PMID: 23094149 PMCID: PMC3474275 DOI: 10.1155/2012/280528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/04/2012] [Indexed: 12/22/2022] Open
Abstract
Bronchiectasis (BC) is a chronic pulmonary disease with tremendous morbidity and significant mortality. As pathogen infection has been advocated as a triggering insult in the development of BC, a central role for the immune response in this process seems obvious. Inflammatory cells are present in both the airways as well as the lung parenchyma, and multiple mediators of immune cells including proteases and cytokines or their humoral products are increased locally or in the periphery. Interestingly, a defect in the immune system or suppression of immune response during conditions such as immunodeficiency may well predispose one to the devastating effects of BC. Thus, the outcome of an active immune response as detrimental or protective in the pathogenesis of BC may be dependent on the state of the patient's immunity, the severity of infection, and the magnitude of immune response. Here we reassess the function of the innate and acquired immunity in BC, the major sites of immune response, and the nature of the bioactive mediators. Furthermore, the potential link(s) between an ongoing immune response and structural alterations accompanying the disease and the success of therapies that can modulate the nature and extent of immune response in BC are elaborated upon.
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