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Jones TL, Roberts C, Elliott S, Glaysher S, Green B, Shute JK, Chauhan AJ. Respiratory Pathogens at Exacerbation in Chronic Bronchitis With Airway Bacterial Colonisation: A Cohort Study. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13811. [PMID: 39162176 PMCID: PMC11333943 DOI: 10.1111/crj.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2024] [Accepted: 06/29/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND AND OBJECTIVE COPD and bronchiectasis are common causes of morbidity, particularly around exacerbation. Colonisation with respiratory pathogens can increase the frequency and severity of exacerbations. However, bacterial and viral presence at exacerbation in people with airway colonisation has not been well studied. METHODS A 6-month cohort study of participants (n = 30) with chronic bronchitis due to bronchiectasis (n = 26) and/or COPD (n = 13) and colonisation with Pseudomonas aeruginosa or Haemophilus influenzae was proven on two sputum cultures at exacerbation in the previous 12 months. Participants were provided self-management education and collected sputum samples daily. Sputum samples at baseline (at least 14 days before or after an exacerbation) and at each exacerbation were examined for a panel of 34 respiratory pathogens using commercially available RT-PCR kits and compared to results obtained using culture methods for the detection of bacteria. RESULTS Participants provided 29 baseline samples and 71 samples at exacerbation. In 17/29 baseline samples, RT-PCR analysis confirmed the organism demonstrated by culture, while 12 samples showed a discrepancy from culture results. Most exacerbations (57.7%) were not associated with acquiring new bacteria or viruses, while 19.8% showed new bacteria, 15.7% new viruses and 7% both new viruses and bacteria. CONCLUSION Over half of exacerbations were not associated with new organisms in this cohort of participants with chronic bronchitis and colonisation. However, 26.8% demonstrated a new bacterial species in sputum, which is relevant for antibiotic therapy. Baseline RT-PCR and culture results were discordant in one-third of participants.
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Affiliation(s)
- Thomas L Jones
- Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Claire Roberts
- Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Scott Elliott
- Translational Research Laboratory, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Sharon Glaysher
- Translational Research Laboratory, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Ben Green
- Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Janis K Shute
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Anoop J Chauhan
- Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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2
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Santus P, Signorello JC, Danzo F, Lazzaroni G, Saad M, Radovanovic D. Anti-Inflammatory and Anti-Oxidant Properties of N-Acetylcysteine: A Fresh Perspective. J Clin Med 2024; 13:4127. [PMID: 39064168 PMCID: PMC11278452 DOI: 10.3390/jcm13144127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
N-acetyl-L-cysteine (NAC) was initially introduced as a treatment for mucus reduction and widely used for chronic respiratory conditions associated with mucus overproduction. However, the mechanism of action for NAC extends beyond its mucolytic activity and is complex and multifaceted. Contrary to other mucoactive drugs, NAC has been found to exhibit antioxidant, anti-infective, and anti-inflammatory activity in pre-clinical and clinical reports. These properties have sparked interest in its potential for treating chronic lung diseases, including chronic obstructive pulmonary disease (COPD), bronchiectasis (BE), cystic fibrosis (CF), and idiopathic pulmonary fibrosis (IPF), which are associated with oxidative stress, increased levels of glutathione and inflammation. NAC's anti-inflammatory activity is noteworthy, and it is not solely secondary to its antioxidant capabilities. In ex vivo models of COPD exacerbation, the anti-inflammatory effects have been observed even at very low doses, especially with prolonged treatment. The mechanism involves the inhibition of the activation of NF-kB and neurokinin A production, resulting in a reduction in interleukin-6 production, a cytokine abundantly present in the sputum and breath condensate of patients with COPD and correlates with the number of exacerbations. The unique combination of mucolytic, antioxidant, anti-infective, and anti-inflammatory properties positions NAC as a safe, cost-effective, and efficacious therapy for a plethora of respiratory conditions.
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Affiliation(s)
- Pierachille Santus
- Division of Respiratory Diseases, “L. Sacco” University Hospital, Università degli Studi di Milano, 20122 Milano, Italy; (J.C.S.); (F.D.); (G.L.); (D.R.)
| | - Juan Camilo Signorello
- Division of Respiratory Diseases, “L. Sacco” University Hospital, Università degli Studi di Milano, 20122 Milano, Italy; (J.C.S.); (F.D.); (G.L.); (D.R.)
| | - Fiammetta Danzo
- Division of Respiratory Diseases, “L. Sacco” University Hospital, Università degli Studi di Milano, 20122 Milano, Italy; (J.C.S.); (F.D.); (G.L.); (D.R.)
| | - Giada Lazzaroni
- Division of Respiratory Diseases, “L. Sacco” University Hospital, Università degli Studi di Milano, 20122 Milano, Italy; (J.C.S.); (F.D.); (G.L.); (D.R.)
| | - Marina Saad
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
| | - Dejan Radovanovic
- Division of Respiratory Diseases, “L. Sacco” University Hospital, Università degli Studi di Milano, 20122 Milano, Italy; (J.C.S.); (F.D.); (G.L.); (D.R.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
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3
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Kim GD, Lim EY, Shin HS. Macrophage Polarization and Functions in Pathogenesis of Chronic Obstructive Pulmonary Disease. Int J Mol Sci 2024; 25:5631. [PMID: 38891820 PMCID: PMC11172060 DOI: 10.3390/ijms25115631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD), the major leading cause of mortality worldwide, is a progressive and irreversible respiratory condition characterized by peripheral airway and lung parenchymal inflammation, accompanied by fibrosis, emphysema, and airflow limitation, and has multiple etiologies, including genetic variance, air pollution, and repetitive exposure to harmful substances. However, the precise mechanisms underlying the pathogenesis of COPD have not been identified. Recent multiomics-based evidence suggests that the plasticity of alveolar macrophages contributes to the onset and progression of COPD through the coordinated modulation of numerous transcription factors. Therefore, this review focuses on understanding the mechanisms and functions of macrophage polarization that regulate lung homeostasis in COPD. These findings may provide a better insight into the distinct role of macrophages in COPD pathogenesis and perspective for developing novel therapeutic strategies targeting macrophage polarization.
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Affiliation(s)
- Gun-Dong Kim
- Division of Food Functionality Research, Korea Food Research Institute (KFRI), Wanju 55365, Republic of Korea; (G.-D.K.); (E.Y.L.)
| | - Eun Yeong Lim
- Division of Food Functionality Research, Korea Food Research Institute (KFRI), Wanju 55365, Republic of Korea; (G.-D.K.); (E.Y.L.)
| | - Hee Soon Shin
- Division of Food Functionality Research, Korea Food Research Institute (KFRI), Wanju 55365, Republic of Korea; (G.-D.K.); (E.Y.L.)
- Department of Food Biotechnology, Korea University of Science and Technology (UST), Daejeon 34113, Republic of Korea
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4
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Kou Z, Liu K, Qiao Z, Wang Y, Li Y, Li Y, Yu X, Han W. The alterations of oral, airway and intestine microbiota in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Front Immunol 2024; 15:1407439. [PMID: 38779669 PMCID: PMC11109405 DOI: 10.3389/fimmu.2024.1407439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Background Increasing evidence indicates the microbial ecology of chronic obstructive pulmonary disease (COPD) is intricately associated with the disease's status and severity, and distinct microbial ecological variations exist between COPD and healthy control (HC). This systematic review and meta-analysis aimed to summarize microbial diversity indices and taxa relative abundance of oral, airway, and intestine microbiota of different stages of COPD and HC to make comparisons. Methods A comprehensive systematic literature search was conducted in PubMed, Embase, the Web of Science, and the Cochrane Library databases to identify relevant English articles on the oral, airway, and intestine microbiota in COPD published between 2003 and 8 May 2023. Information on microbial diversity indices and taxa relative abundance of oral, airway, and intestine microbiota was collected for comparison between different stages of COPD and HC. Results A total of 20 studies were included in this review, involving a total of 337 HC participants, 511 COPD patients, and 154 AECOPD patients. We observed that no significant differences in alpha diversity between the participant groups, but beta diversity was significantly different in half of the included studies. Compared to HC, Prevotella, Streptococcus, Actinomyces, and Veillonella of oral microbiota in SCOPD were reduced at the genus level. Most studies supported that Haemophilus, Lactobacillus, and Pseudomonas were increased, but Veillonella, Prevotella, Actinomyces, Porphyromonas, and Atopobium were decreased at the genus level in the airway microbiota of SCOPD. However, the abundance of Haemophilus, Lactobacillus and Pseudomonas genera exhibited an increase, whereas Actinomyces and Porphyromonas showed a decrease in the airway microbiota of AECOPD compared to HC. And Lachnospira of intestine microbiota in SCOPD was reduced at the genus level. Conclusion The majority of published research findings supported that COPD exhibited decreased alpha diversity compared to HC. However, our meta-analysis does not confirm it. In order to further investigate the characteristics and mechanisms of microbiome in the oral-airway- intestine axis of COPD patients, larger-scale and more rigorous studies are needed. Systematic review registration PROSPERO (https://www.crd.york.ac.uk/prospero/), identifier CRD42023418726.
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Affiliation(s)
- Ziwei Kou
- Department of Medicine, Qingdao University, Qingdao, China
| | - Kai Liu
- Department of Rehabilitation Medicine, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Zhengtong Qiao
- School of Rehabilitation Medical, Binzhou Medical University, Yantai, China
| | - Yaoyao Wang
- Department of Medicine, Qingdao University, Qingdao, China
| | - Yanmiao Li
- Department of Medicine, Qingdao University, Qingdao, China
| | - Yinan Li
- Department of Medicine, Qingdao University, Qingdao, China
| | - Xinjuan Yu
- Clinical Research Center, Qingdao Key Laboratory of Common Diseases, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Wei Han
- Department of Respiratory and Critical Medicine, Qingdao Key Laboratory of Common Diseases, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China
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Duan JX, Guan XX, Cheng W, Deng DD, Chen P, Liu C, Zhou Y, Hammock BD, Yang HH. COX-2/sEH-Mediated Macrophage Activation Is a Target for Pulmonary Protection in Mouse Models of Chronic Obstructive Pulmonary Disease. J Transl Med 2024; 104:100319. [PMID: 38158123 DOI: 10.1016/j.labinv.2023.100319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
Effective inhibition of macrophage activation is critical for resolving inflammation and restoring pulmonary function in patients with chronic obstructive pulmonary disease (COPD). In this study, we identified the dual-enhanced cyclooxygenase-2 (COX-2)/soluble epoxide hydrolase (sEH) as a novel regulator of macrophage activation in COPD. Both COX-2 and sEH were found to be increased in patients and mice with COPD and in macrophages exposed to cigarette smoke extract. Pharmacological reduction of the COX-2 and sEH by 4-(5-phenyl-3-{3-[3-(4-trifluoromethylphenyl)-ureido]-propyl}-pyrazol-1-yl)-benzenesulfonamide (PTUPB) effectively prevented macrophage activation, downregulated inflammation-related genes, and reduced lung injury, thereby improving respiratory function in a mouse model of COPD induced by cigarette smoke and lipopolysaccharide. Mechanistically, enhanced COX-2/sEH triggered the activation of the NACHT, LRR, and PYD domains-containing protein 3 inflammasome, leading to the cleavage of pro-IL-1β into its active form in macrophages and amplifying inflammatory responses. These findings demonstrate that targeting COX-2/sEH-mediated macrophage activation may be a promising therapeutic strategy for COPD. Importantly, our data support the potential use of the dual COX-2 and sEH inhibitor PTUPB as a therapeutic drug for the treatment of COPD.
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Affiliation(s)
- Jia-Xi Duan
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China; Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xin-Xin Guan
- Department of Physiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Wei Cheng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Ding-Ding Deng
- Department of Respiratory Medicine, First Affiliated People's Hospital of Shaoyang College, Shaoyang, China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Cong Liu
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yong Zhou
- Department of Physiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Bruce D Hammock
- Department of Entomology and Nematology and UC Davis Comprehensive Cancer Center, University of California, Davis, One Shields Avenue, Davis, California
| | - Hui-Hui Yang
- Department of Physiology, School of Basic Medical Science, Central South University, Changsha, China.
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He S, Taher NM, Hvorecny KL, Ragusa MJ, Bahl CD, Hickman AB, Dyda F, Madden DR. Molecular basis for the transcriptional regulation of an epoxide-based virulence circuit in Pseudomonas aeruginosa. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.16.572601. [PMID: 38293063 PMCID: PMC10827105 DOI: 10.1101/2024.01.16.572601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
The opportunistic pathogen Pseudomonas aeruginosa infects cystic fibrosis (CF) patient airways and produces a virulence factor Cif that is associated with worse outcomes. Cif is an epoxide hydrolase that reduces cell-surface abundance of the cystic fibrosis transmembrane conductance regulator (CFTR) and sabotages pro-resolving signals. Its expression is regulated by a divergently transcribed TetR family transcriptional repressor. CifR represents the first reported epoxide-sensing bacterial transcriptional regulator, but neither its interaction with cognate operator sequences nor the mechanism of activation has been investigated. Using biochemical and structural approaches, we uncovered the molecular mechanisms controlling this complex virulence operon. We present here the first molecular structures of CifR alone and in complex with operator DNA, resolved in a single crystal lattice. Significant conformational changes between these two structures suggest how CifR regulates the expression of the virulence gene cif. Interactions between the N-terminal extension of CifR with the DNA minor groove of the operator play a significant role in the operator recognition of CifR. We also determined that cysteine residue Cys107 is critical for epoxide sensing and DNA release. These results offer new insights into the stereochemical regulation of an epoxide-based virulence circuit in a critically important clinical pathogen.
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Affiliation(s)
- Susu He
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755 USA
| | - Noor M. Taher
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755 USA
| | - Kelli L. Hvorecny
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755 USA
| | - Michael J. Ragusa
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755 USA
- Department of Chemistry, Dartmouth, Hanover, NH 03755 USA
| | - Christopher D. Bahl
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755 USA
| | - Alison B. Hickman
- Laboratory of Molecular Biology, NIDDK, National Institutes of Health, Bethesda, MD 20892 USA
| | - Fred Dyda
- Laboratory of Molecular Biology, NIDDK, National Institutes of Health, Bethesda, MD 20892 USA
| | - Dean R. Madden
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755 USA
- Department of Chemistry, Dartmouth, Hanover, NH 03755 USA
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7
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Pragman AA, Hodgson SW, Wu T, Zank A, Reilly CS, Wendt CH. Sputum microbiome α-diversity is a key feature of the COPD frequent exacerbator phenotype. ERJ Open Res 2024; 10:00595-2023. [PMID: 38333651 PMCID: PMC10851948 DOI: 10.1183/23120541.00595-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/07/2023] [Indexed: 02/10/2024] Open
Abstract
Background The lung microbiome is an inflammatory stimulus whose role in COPD pathogenesis is incompletely understood. We hypothesised that the frequent exacerbator phenotype is associated with decreased α-diversity and increased lung inflammation. Our objective was to assess correlations between the frequent exacerbator phenotype, the microbiome and inflammation longitudinally during exacerbation-free periods. Methods We conducted a case-control longitudinal observational study of the frequent exacerbator phenotype and characteristics of the airway microbiome. 81 subjects (41 frequent and 40 infrequent exacerbators) provided nasal, oral and sputum microbiome samples at two visits over 2-4 months. Exacerbation phenotype, relevant clinical factors and sputum cytokine values were associated with microbiome findings. Results The frequent exacerbator phenotype was associated with lower sputum microbiome α-diversity (p=0.0031). This decrease in α-diversity among frequent exacerbators was enhanced when the sputum bacterial culture was positive (p<0.001). Older age was associated with decreased sputum microbiome α-diversity (p=0.0030). Between-visit β-diversity was increased among frequent exacerbators and those who experienced a COPD exacerbation between visits (p=0.025 and p=0.014, respectively). Sputum cytokine values did not differ based on exacerbation phenotype or other clinical characteristics. Interleukin (IL)-17A was negatively associated with α-diversity, while IL-6 and IL-8 were positively associated with α-diversity (p=0.012, p=0.012 and p=0.0496, respectively). IL-22, IL-17A and IL-5 levels were positively associated with Moraxella abundance (p=0.027, p=0.0014 and p=0.0020, respectively). Conclusions Even during exacerbation-free intervals, the COPD frequent exacerbator phenotype is associated with decreased sputum microbiome α-diversity and increased β-diversity. Decreased sputum microbiome α-diversity and Moraxella abundance are associated with lung inflammation.
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Affiliation(s)
- Alexa A. Pragman
- Department of Medicine, Minneapolis VA Health Care System and Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Shane W. Hodgson
- Research Service, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Tianhua Wu
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Allison Zank
- Research Service, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Cavan S. Reilly
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Chris H. Wendt
- Department of Medicine, Minneapolis VA Health Care System and Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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8
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Earle K, Valero C, Conn DP, Vere G, Cook PC, Bromley MJ, Bowyer P, Gago S. Pathogenicity and virulence of Aspergillus fumigatus. Virulence 2023; 14:2172264. [PMID: 36752587 PMCID: PMC10732619 DOI: 10.1080/21505594.2023.2172264] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/16/2022] [Indexed: 02/09/2023] Open
Abstract
Pulmonary infections caused by the mould pathogen Aspergillus fumigatus are a major cause of morbidity and mortality globally. Compromised lung defences arising from immunosuppression, chronic respiratory conditions or more recently, concomitant viral or bacterial pulmonary infections are recognised risks factors for the development of pulmonary aspergillosis. In this review, we will summarise our current knowledge of the mechanistic basis of pulmonary aspergillosis with a focus on emerging at-risk populations.
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Affiliation(s)
- Kayleigh Earle
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Clara Valero
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Daniel P. Conn
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - George Vere
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Peter C. Cook
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Michael J. Bromley
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Paul Bowyer
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sara Gago
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Bhatt SP, Agusti A, Bafadhel M, Christenson SA, Bon J, Donaldson GC, Sin DD, Wedzicha JA, Martinez FJ. Phenotypes, Etiotypes, and Endotypes of Exacerbations of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:1026-1041. [PMID: 37560988 PMCID: PMC10867924 DOI: 10.1164/rccm.202209-1748so] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 08/04/2023] [Indexed: 08/11/2023] Open
Abstract
Chronic obstructive pulmonary disease is a major health problem with a high prevalence, a rising incidence, and substantial morbidity and mortality. Its course is punctuated by acute episodes of increased respiratory symptoms, termed exacerbations of chronic obstructive pulmonary disease (ECOPD). ECOPD are important events in the natural history of the disease, as they are associated with lung function decline and prolonged negative effects on quality of life. The present-day therapy for ECOPD with short courses of antibiotics and steroids and escalation of bronchodilators has resulted in only modest improvements in outcomes. Recent data indicate that ECOPD are heterogeneous, raising the need to identify distinct etioendophenotypes, incorporating traits of the acute event and of patients who experience recurrent events, to develop novel and targeted therapies. These characterizations can provide a complete clinical picture, the severity of which will dictate acute pharmacological treatment, and may also indicate whether a change in maintenance therapy is needed to reduce the risk of future exacerbations. In this review we discuss the latest knowledge of ECOPD types on the basis of clinical presentation, etiology, natural history, frequency, severity, and biomarkers in an attempt to characterize these events.
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Affiliation(s)
- Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alvar Agusti
- Institut Respiratori (Clinic Barcelona), Càtedra Salut Respiratoria (Universitat de Barcelona), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-Barcelona), Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), España
| | - Mona Bafadhel
- Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Stephanie A. Christenson
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Gavin C. Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Don D. Sin
- Centre for Heart Lung Innovation and
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- St. Paul’s Hospital, Vancouver, British Columbia, Canada; and
| | - Jadwiga A. Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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10
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Toumpanakis D, Glynos C, Schoini P, Vassilakopoulou V, Chatzianastasiou A, Dettoraki M, Mizi E, Tsoukalas D, Perlikos F, Magkou C, Papapetropoulos A, Vassilakopoulos T. Synergistic Effects of Resistive Breathing on Endotoxin-Induced Lung Injury in Mice. Int J Chron Obstruct Pulmon Dis 2023; 18:2321-2333. [PMID: 37876659 PMCID: PMC10591622 DOI: 10.2147/copd.s424560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Resistive breathing (RB) is characterized by forceful contractions of the inspiratory muscles, mainly the diaphragm, resulting in large negative intrathoracic pressure and mechanical stress imposed on the lung. We have shown that RB induces lung injury in healthy animals. Whether RB exerts additional injurious effects when added to pulmonary or extrapulmonary lung injury is unknown. Our aim was to study the synergistic effect of RB on lipopolysaccharide (LPS)-induced lung injury. Methods C57BL/6 mice inhaled an LPS aerosol (10mg/3mL) or received an intraperitoneal injection of LPS (10 mg/kg). Mice were then anaesthetized, the trachea was surgically exposed, and a nylon band of a specified length was sutured around the trachea, to provoke a reduction of the surface area at 50%. RB through tracheal banding was applied for 24 hours. Respiratory system mechanics were measured, BAL was performed, and lung sections were evaluated for histological features of lung injury. Results LPS inhalation increased BAL cellularity, mainly neutrophils (p < 0.001 to ctr), total protein and IL-6 in BAL (p < 0.001 and p < 0.001, respectively) and increased the lung injury score (p = 0.001). Lung mechanics were not altered. Adding RB to inhaled LPS further increased BAL cellularity (p < 0.001 to LPS inh.), total protein (p = 0.016), lung injury score (p = 0.001) and increased TNFa levels in BAL (p = 0.011). Intraperitoneal LPS increased BAL cellularity, mainly macrophages (p < 0.001 to ctr.), total protein levels (p = 0.017), decreased static compliance (p = 0.004) and increased lung injury score (p < 0.001). Adding RB further increased histological features of lung injury (p = 0.022 to LPS ip). Conclusion Resistive breathing exerts synergistic injurious effects when combined with inhalational LPS-induced lung injury, while the additive effect on extrapulmonary lung injury is less prominent.
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Affiliation(s)
- Dimitrios Toumpanakis
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Constantinos Glynos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Pinelopi Schoini
- 4th Respiratory Clinic, “Sotiria” General Hospital for Thoracic Diseases of Athens, Athens, Greece
| | - Vyronia Vassilakopoulou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Athanasia Chatzianastasiou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Maria Dettoraki
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Eleftheria Mizi
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Dionysios Tsoukalas
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Fotis Perlikos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | | | - Andreas Papapetropoulos
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Division of Pharmaceutical Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Vassilakopoulos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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11
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Oscullo G, Gómez-Olivas JD, Ingles M, Mompean S, Martinez-Perez R, Suarez-Cuartin G, la Rosa-Carrillo D, Martinez-Garcia MA. Bronchiectasis-COPD Overlap Syndrome: Role of Peripheral Eosinophil Count and Inhaled Corticosteroid Treatment. J Clin Med 2023; 12:6417. [PMID: 37835060 PMCID: PMC10573192 DOI: 10.3390/jcm12196417] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Both chronic obstructive pulmonary disease and bronchiectasis are highly prevalent diseases. In both cases, inhaled corticosteroids (ICs) are associated with a decrease in exacerbations in patients with a high peripheral blood eosinophil count (BEC), but it is still not known what occurs in bronchiectasis-COPD overlap syndrome (BCOS). The present study aimed to assess the effect of ICs on various outcomes in patients with BCOS, according to BEC values. We undertook a post-hoc analysis of a cohort of 201 GOLD II-IV COPD patients with a long-term follow-up (median 74 [IQR: 40-106] months). All participants underwent computerized tomography and 115 (57.2%) had confirmed BCOS. A standardized clinical protocol was followed and two sputum samples were collected at each medical visit (every 3-6 months), whenever possible. During follow-up, there were 68 deaths (59.1%), and the mean rate of exacerbations and hospitalizations per year was 1.42 (1.2) and 0.57 (0.83), respectively. A total of 44.3% of the patients presented at least one pneumonic episode per year. The mean value of eosinophils was 402 (112) eosinophils/µL, with 27 (23.5%), 63 (54.8%), and 25 patients (21.7%) presenting, respectively, less than 100, 101-300, and more than 300 eosinophils/µL. A total of 84 patients (73.1%) took ICs. The higher the BEC, the higher the annual rate of exacerbations and hospitalizations. Patients with less than 100 eosinophils/µL presented more infectious events (incident exacerbations, pneumonic episodes, and chronic bronchial infection via pathogenic bacteria). Only those patients with eosinophilia (>300 eosinophils/µL) treated with ICs decreased the number (1.77 (1.2) vs. 1.08 (0.6), p < 0.001) and the severity (0.67 (0.8) vs. 0.35 (0.5), p = 0.011) of exacerbations, without any changes in the other infectious outcomes or mortality. In conclusion, ICs treatment in patients with BCOS with increased BEC decreased the number and severity of incident exacerbations without any negative influence on other infectious outcomes (incidence of pneumonia or chronic bronchial infection).
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Affiliation(s)
- Grace Oscullo
- Respiratory Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (G.O.); (J.D.G.-O.); (M.I.); (S.M.); (R.M.-P.)
- Instituto de Investigacion Sanitaria la Fe, 46026 Valencia, Spain
| | - Jose Daniel Gómez-Olivas
- Respiratory Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (G.O.); (J.D.G.-O.); (M.I.); (S.M.); (R.M.-P.)
- Instituto de Investigacion Sanitaria la Fe, 46026 Valencia, Spain
| | - Marina Ingles
- Respiratory Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (G.O.); (J.D.G.-O.); (M.I.); (S.M.); (R.M.-P.)
- Instituto de Investigacion Sanitaria la Fe, 46026 Valencia, Spain
| | - Sergio Mompean
- Respiratory Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (G.O.); (J.D.G.-O.); (M.I.); (S.M.); (R.M.-P.)
- Instituto de Investigacion Sanitaria la Fe, 46026 Valencia, Spain
| | - Rosalia Martinez-Perez
- Respiratory Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (G.O.); (J.D.G.-O.); (M.I.); (S.M.); (R.M.-P.)
- Instituto de Investigacion Sanitaria la Fe, 46026 Valencia, Spain
| | - Guillermo Suarez-Cuartin
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Pneumology Department, Hospital de Bellvitge, 08907 Barcelona, Spain
| | | | - Miguel Angel Martinez-Garcia
- Respiratory Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (G.O.); (J.D.G.-O.); (M.I.); (S.M.); (R.M.-P.)
- Instituto de Investigacion Sanitaria la Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
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12
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Shrestha J, Paudel KR, Nazari H, Dharwal V, Bazaz SR, Johansen MD, Dua K, Hansbro PM, Warkiani ME. Advanced models for respiratory disease and drug studies. Med Res Rev 2023; 43:1470-1503. [PMID: 37119028 PMCID: PMC10946967 DOI: 10.1002/med.21956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/02/2023] [Accepted: 03/17/2023] [Indexed: 04/30/2023]
Abstract
The global burden of respiratory diseases is enormous, with many millions of people suffering and dying prematurely every year. The global COVID-19 pandemic witnessed recently, along with increased air pollution and wildfire events, increases the urgency of identifying the most effective therapeutic measures to combat these diseases even further. Despite increasing expenditure and extensive collaborative efforts to identify and develop the most effective and safe treatments, the failure rates of drugs evaluated in human clinical trials are high. To reverse these trends and minimize the cost of drug development, ineffective drug candidates must be eliminated as early as possible by employing new, efficient, and accurate preclinical screening approaches. Animal models have been the mainstay of pulmonary research as they recapitulate the complex physiological processes, Multiorgan interplay, disease phenotypes of disease, and the pharmacokinetic behavior of drugs. Recently, the use of advanced culture technologies such as organoids and lung-on-a-chip models has gained increasing attention because of their potential to reproduce human diseased states and physiology, with clinically relevant responses to drugs and toxins. This review provides an overview of different animal models for studying respiratory diseases and evaluating drugs. We also highlight recent progress in cell culture technologies to advance integrated models and discuss current challenges and present future perspectives.
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Affiliation(s)
- Jesus Shrestha
- School of Biomedical EngineeringUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Keshav Raj Paudel
- Centre for InflammationCentenary Institute and University of Technology SydneySydneyNew South WalesAustralia
| | - Hojjatollah Nazari
- School of Biomedical EngineeringUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Vivek Dharwal
- Centre for InflammationCentenary Institute and University of Technology SydneySydneyNew South WalesAustralia
| | - Sajad Razavi Bazaz
- School of Biomedical EngineeringUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Matt D. Johansen
- Centre for InflammationCentenary Institute and University of Technology SydneySydneyNew South WalesAustralia
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of HealthUniversity of TechnologySydneyNew South WalesAustralia
- Faculty of Health, Australian Research Centre in Complementary & Integrative MedicineUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Philip M. Hansbro
- Centre for InflammationCentenary Institute and University of Technology SydneySydneyNew South WalesAustralia
| | - Majid Ebrahimi Warkiani
- School of Biomedical EngineeringUniversity of Technology SydneySydneyNew South WalesAustralia
- Institute for Biomedical Materials and Devices, Faculty of ScienceUniversity of Technology SydneyUltimoNew South WalesAustralia
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13
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Pitiot A, Ferreira M, Parent C, Boisseau C, Cortes M, Bouvart L, Paget C, Heuzé-Vourc'h N, Sécher T. Mucosal administration of anti-bacterial antibodies provide long-term cross-protection against Pseudomonas aeruginosa respiratory infection. Mucosal Immunol 2023; 16:312-325. [PMID: 36990281 DOI: 10.1016/j.mucimm.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/22/2023] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
Bacterial respiratory infections, either acute or chronic, are major threats to human health. Direct mucosal administration, through the airways, of therapeutic antibodies (Abs) offers a tremendous opportunity to benefit patients with respiratory infections. The mode of action of anti-infective Abs relies on pathogen neutralization and crystallizable fragment (Fc)-mediated recruitment of immune effectors to facilitate their elimination. Using a mouse model of acute pneumonia induced by Pseudomonas aeruginosa, we depicted the immunomodulatory mode of action of a neutralizing anti-bacterial Abs. Beyond the rapid and efficient containment of the primary infection, the Abs delivered through the airways harnessed genuine innate and adaptive immune responses to provide long-term protection, preventing secondary bacterial infection. In vitro antigen-presenting cells stimulation assay, as well as in vivo bacterial challenges and serum transfer experiments indicate an essential contribution of immune complexes with the Abs and pathogen in the induction of the sustained and protective anti-bacterial humoral response. Interestingly, the long-lasting response protected partially against secondary infections with heterologous P. aeruginosa strains. Overall, our findings suggest that Abs delivered mucosally promotes bacteria neutralization and provides protection against secondary infection. This opens novel perspectives for the development of anti-infective Abs delivered to the lung mucosa, to treat respiratory infections.
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Affiliation(s)
- Aubin Pitiot
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université de Tours, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France
| | - Marion Ferreira
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université de Tours, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France
| | - Christelle Parent
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université de Tours, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France
| | - Chloé Boisseau
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université de Tours, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France
| | - Mélanie Cortes
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université de Tours, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France
| | - Laura Bouvart
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université de Tours, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France
| | - Christophe Paget
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université de Tours, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France
| | - Nathalie Heuzé-Vourc'h
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université de Tours, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France
| | - Thomas Sécher
- INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France; Université de Tours, Centre d'Etude des Pathologies Respiratoires, U1100, F-37032 Tours, France.
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14
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Chatziparasidis G, Kantar A, Grimwood K. Pathogenesis of nontypeable Haemophilus influenzae infections in chronic suppurative lung disease. Pediatr Pulmonol 2023. [PMID: 37133207 DOI: 10.1002/ppul.26446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/09/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
The respiratory tract antimicrobial defense system is a multilayered defense mechanism that relies upon mucociliary clearance and components of both the innate and adaptive immune systems to protect the lungs from inhaled or aspirated microorganisms. One of these potential pathogens, nontypeable Haemophilus influenzae (NTHi), adopts several, multifaceted redundant strategies to successfully colonize the lower airways and establish a persistent infection. NTHi can impair mucociliary clearance, express multiple multifunctional adhesins for various cell types within the respiratory tract and evade host defenses by surviving within and between cells, forming biofilms, increasing antigenic drift, secreting proteases and antioxidants, and by host-pathogen cross-talk, impair macrophage and neutrophil function. NTHi is recognized as an important pathogen in several chronic lower respiratory disorders, such as protracted bacterial bronchitis, bronchiectasis, cystic fibrosis, and primary ciliary dyskinesia. The persistence of NTHi in human airways, including its capacity to form biofilms, results in chronic infection and inflammation, which can ultimately injure airway wall structures. The complex nature of the molecular pathogenetic mechanisms employed by NTHi is incompletely understood but improved understanding of its pathobiology will be important for developing effective therapies and vaccines, especially given the marked genetic heterogeneity of NTHi and its possession of phase-variable genes. Currently, no vaccine candidates are ready for large phase III clinical trials.
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Affiliation(s)
- Grigorios Chatziparasidis
- Paediatric Respiratory Unit, IASO Hospital, Larissa, Thessaly, Greece
- Faculty of Nursing, Thessaly University, Larissa, Greece
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Instituti Ospedalieri Bergamaschi, Bergamo, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Keith Grimwood
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia
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15
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Saha P, Jain S, Mukherjee I, Panda SR, Zeki AA, Naidu V, Sharma P. The effects of dual IQOS and cigarette smoke exposure on airway epithelial cells: implications for lung health and respiratory disease pathogenesis. ERJ Open Res 2023; 9:00558-2022. [PMID: 37260462 PMCID: PMC10227640 DOI: 10.1183/23120541.00558-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Background Cigarette smoking remains a primary cause of chronic lung diseases. After a steady decline, smoking rates have recently increased especially with the introduction of newer electronic nicotine delivery devices, and it is also emerging that dual- or poly-product usage is on the rise. Additionally, with the introduction of IQOS (a heated tobacco product) globally, its impact on human health needs to be investigated. In this study we tested if dual exposure (cigarette smoke (CS)+IQOS) is detrimental to lung epithelial cells when compared with CS or IQOS exposure alone. Methods Human airway epithelial cells (BEAS-2B) were exposed to either CS, IQOS or their dual combination (CS+IQOS) at concentrations of 0.1%, 1.0%, 2.5% and 5.0%. Cytotoxicity, oxidative stress, mitochondrial homeostasis, mitophagy and effects on epithelial-mesenchymal transition (EMT) signalling were assessed. Results Both CS and IQOS alone significantly induced loss of cell viability in a concentration-dependent manner which was further enhanced by dual exposure compared with IQOS alone (p<0.01). Dual exposure significantly increased oxidative stress and perturbed mitochondrial homeostasis when compared with CS or IQOS alone (p<0.05). Additionally, dual exposure induced EMT signalling as shown by increased mesenchymal (α-smooth muscle actin and N-cadherin) and decreased epithelial (E-cadherin) markers when compared with CS or IQOS alone (p<0.05). Conclusion Collectively, our study demonstrates that dual CS+IQOS exposure enhances pathogenic signalling mediated by oxidative stress and mitochondrial dysfunction leading to EMT activation, which is an important regulator of small airway fibrosis in obstructive lung diseases.
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Affiliation(s)
- Pritam Saha
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati, India
- These authors contributed equally
| | - Siddhi Jain
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati, India
- These authors contributed equally
| | - Ipsita Mukherjee
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati, India
- These authors contributed equally
| | - Samir R. Panda
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati, India
| | - Amir A. Zeki
- UC Davis School of Medicine, UC Davis Lung Center and Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California – Davis, Sacramento, CA, USA
| | - V.G.M. Naidu
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati, India
| | - Pawan Sharma
- Center for Translational Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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16
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Brown MA, Morgan SB, Donachie GE, Horton KL, Pavord ID, Arancibia-Cárcamo CV, Hinks TSC. Epithelial immune activation and intracellular invasion by non-typeable Haemophilus influenzae. Front Cell Infect Microbiol 2023; 13:1141798. [PMID: 37180449 PMCID: PMC10167379 DOI: 10.3389/fcimb.2023.1141798] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Type-2 low asthma affects 30-50% of people with severe asthma and includes a phenotype characterized by sputum neutrophilia and resistance to corticosteroids. Airways inflammation in type-2 low asthma or COPD is potentially driven by persistent bacterial colonization of the lower airways by bacteria such as non-encapsulated Haemophilus influenzae (NTHi). Although pathogenic in the lower airways, NTHi is a commensal of the upper airways. It is not known to what extent these strains can invade airway epithelial cells, persist intracellularly and activate epithelial cell production of proinflammatory cytokines, and how this differs between the upper and lower airways. We studied NTHi infection of primary human bronchial epithelial cells (PBECs), primary nasal epithelial cells (NECs) and epithelial cell lines from upper and lower airways. NTHi strains differed in propensity for intracellular and paracellular invasion. We found NTHi was internalized within PBECs at 6 h, but live intracellular infection did not persist at 24 h. Confocal microscopy and flow cytometry showed NTHi infected secretory, ciliated and basal PBECs. Infection of PBECs led to induction of CXCL8, interleukin (IL)-1β, IL-6 and TNF. The magnitude of cytokine induction was independent of the degree of intracellular invasion, either by differing strains or by cytochalasin D inhibition of endocytosis, with the exception of the inflammasome-induced mediator IL-1β. NTHi-induced activation of TLR2/4, NOD1/2 and NLR inflammasome pathways was significantly stronger in NECs than in PBECs. These data suggest that NTHi is internalized transiently by airway epithelial cells and has capacity to drive inflammation in airway epithelial cells.
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Affiliation(s)
- Mary A. Brown
- Respiratory Medicine Unit and National Institute for Health Research Oxford Biomedical Research Centre, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Sophie B. Morgan
- Respiratory Medicine Unit and National Institute for Health Research Oxford Biomedical Research Centre, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Gillian E. Donachie
- Respiratory Medicine Unit and National Institute for Health Research Oxford Biomedical Research Centre, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Katie L. Horton
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, United Kingdom
| | - Ian D. Pavord
- Respiratory Medicine Unit and National Institute for Health Research Oxford Biomedical Research Centre, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Carolina V. Arancibia-Cárcamo
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine, University of Oxford, Oxford, United Kingdom
| | - Timothy S. C. Hinks
- Respiratory Medicine Unit and National Institute for Health Research Oxford Biomedical Research Centre, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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17
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Ryan EM, Sadiku P, Coelho P, Watts ER, Zhang A, Howden AJM, Sanchez-Garcia MA, Bewley M, Cole J, McHugh BJ, Vermaelen W, Ghesquiere B, Carmeliet P, Rodriguez Blanco G, Von Kriegsheim A, Sanchez Y, Rumsey W, Callahan JF, Cooper G, Parkinson N, Baillie K, Cantrell DA, McCafferty J, Choudhury G, Singh D, Dockrell DH, Whyte MKB, Walmsley SR. NRF2 Activation Reprograms Defects in Oxidative Metabolism to Restore Macrophage Function in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 207:998-1011. [PMID: 36724365 PMCID: PMC7614437 DOI: 10.1164/rccm.202203-0482oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) is a disease characterized by persistent airway inflammation and disordered macrophage function. The extent to which alterations in macrophage bioenergetics contribute to impaired antioxidant responses and disease pathogenesis has yet to be fully delineated. Objectives: Through the study of COPD alveolar macrophages (AMs) and peripheral monocyte-derived macrophages (MDMs), we sought to establish if intrinsic defects in core metabolic processes drive macrophage dysfunction and redox imbalance. Methods: AMs and MDMs from donors with COPD and healthy donors underwent functional, metabolic, and transcriptional profiling. Measurements and Main Results: We observed that AMs and MDMs from donors with COPD display a critical depletion in glycolytic- and mitochondrial respiration-derived energy reserves and an overreliance on glycolysis as a source for ATP, resulting in reduced energy status. Defects in oxidative metabolism extend to an impaired redox balance associated with defective expression of the NADPH-generating enzyme, ME1 (malic enzyme 1), a known target of the antioxidant transcription factor NRF2 (nuclear factor erythroid 2-related factor 2). Consequently, selective activation of NRF2 resets the COPD transcriptome, resulting in increased generation of TCA cycle intermediaries, improved energetic status, favorable redox balance, and recovery of macrophage function. Conclusions: In COPD, an inherent loss of metabolic plasticity leads to metabolic exhaustion and reduced redox capacity, which can be rescued by activation of the NRF2 pathway. Targeting these defects, via NRF2 augmentation, may therefore present an attractive therapeutic strategy for the treatment of the aberrant airway inflammation described in COPD.
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Affiliation(s)
- Eilise M. Ryan
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
| | - Pranvera Sadiku
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
| | - Patricia Coelho
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
| | - Emily R. Watts
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
| | - Ailiang Zhang
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
| | - Andrew J. M. Howden
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, United Kingdom
| | - Manuel A. Sanchez-Garcia
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
| | - Martin Bewley
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Joby Cole
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Brian J. McHugh
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
| | - Wesley Vermaelen
- Metabolomics Expertise Centre, VIB-KU Leuven Centre for Cancer Biology, Leuven, Belgium
| | - Bart Ghesquiere
- Metabolomics Expertise Centre, VIB-KU Leuven Centre for Cancer Biology, Leuven, Belgium
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, Centre for Cancer Biology, VIB, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | | | | | - Yolanda Sanchez
- GlaxoSmithKline Research & Development, Collegeville, Pennsylvania
| | - William Rumsey
- GlaxoSmithKline Research & Development, Collegeville, Pennsylvania
| | | | - George Cooper
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
| | - Nicholas Parkinson
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Kenneth Baillie
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Doreen A. Cantrell
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, United Kingdom
| | - John McCafferty
- NHS Lothian, Respiratory Medicine, Edinburgh, United Kingdom; and
| | - Gourab Choudhury
- NHS Lothian, Respiratory Medicine, Edinburgh, United Kingdom; and
| | - Dave Singh
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - David H. Dockrell
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
| | - Moira K. B. Whyte
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
| | - Sarah R. Walmsley
- University of Edinburgh Centre for Inflammation Research, The Queen’s Medical Research Institute
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18
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Feng S, Yang Y, Wang F, Shi W, Xu J, Tang G, Xie J, Zhong N, Liang Z, Chen R. Low human beta-defensin-2 levels in the sputum of COPD patients are associated with the risk of exacerbations. BMC Pulm Med 2023; 23:106. [PMID: 37003996 PMCID: PMC10064533 DOI: 10.1186/s12890-023-02364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/21/2023] [Indexed: 04/03/2023] Open
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) is a complicated chronic inflammatory disease. It is important to investigate the characteristics of acute exacerbation of COPD to develop new therapeutic strategies. OBJECTIVE This study aimed to determine the relationship between the human beta-defensin-2 (hBD-2) levels and aggravation of COPD. METHODS We detected the sputum hBD-2 level of 254 patients from Guangzhou, China, for 2 years. The study participants were categorized into the COPD group (n = 203, GOLD 0-4) and the control group (n = 51, 40-79 years old). At baseline, 12th month, and 24th month, we detected the sputum hBD-2 level and levels of cytokines, such as CXCL10, CXCL11, and IFN. RESULTS At baseline, there were no significant differences in the sputum and serum hBD-2 levels between the patients and the controls. However, the sputum hBD-2 levels of patients who had at least one symptom aggravation over the next 2 years were significantly lower than those of patients without any exacerbations (1130.9 ± 858.4 pg/mL vs. 2103.7 ± 1294.2 pg/mL, respectively; p = 0.001). Nevertheless, there were no statistically significant differences in the sputum hBD-2 levels between patients (no aggravation history) and controls (2084.9 ± 1317.6 pg/mL vs. 2152.5 ± 1251.6 pg/mL, respectively; p = 0.626). We used a logistic regression model to assess the relationship between aggravation and sputum hBD-2 levels. Interestingly, we found that low hBD-2 level (< 1000 pg/mL) was significantly associated with exacerbations. Specifically, patients with low hBD-2 levels were more likely to experience exacerbations in the next 12 months (0.333 vs. 0.117; p = 0.001). Moreover, we compared the hBD-2 levels between controls and patients with GOLD 3-4 and found that participants with bacteria (+) and/or viruses (+) had an association between hBD-2 level and disease severity (p = 0.02). CONCLUSION Patients at risk of exacerbations are more likely to have lower sputum hBD-2 levels. These results have important implications for future therapies for COPD.
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Grants
- 202201020451 Science and Technology Program of Guangzhou
- 202201020451 Science and Technology Program of Guangzhou
- 202201020451 Science and Technology Program of Guangzhou
- 202201020451 Science and Technology Program of Guangzhou
- 202201020451 Science and Technology Program of Guangzhou
- 202201020451 Science and Technology Program of Guangzhou
- 202201020451 Science and Technology Program of Guangzhou
- 202201020451 Science and Technology Program of Guangzhou
- 202201020451 Science and Technology Program of Guangzhou
- 202201020451 Science and Technology Program of Guangzhou
- C2019001, C2019031, C2021073 Medical Scientific Research Foundation of Guangdong Province
- C2019001, C2019031, C2021073 Medical Scientific Research Foundation of Guangdong Province
- C2019001, C2019031, C2021073 Medical Scientific Research Foundation of Guangdong Province
- C2019001, C2019031, C2021073 Medical Scientific Research Foundation of Guangdong Province
- C2019001, C2019031, C2021073 Medical Scientific Research Foundation of Guangdong Province
- C2019001, C2019031, C2021073 Medical Scientific Research Foundation of Guangdong Province
- C2019001, C2019031, C2021073 Medical Scientific Research Foundation of Guangdong Province
- C2019001, C2019031, C2021073 Medical Scientific Research Foundation of Guangdong Province
- C2019001, C2019031, C2021073 Medical Scientific Research Foundation of Guangdong Province
- C2019001, C2019031, C2021073 Medical Scientific Research Foundation of Guangdong Province
- 2022YFF0710802 the National Key Research and Development Program of China
- 2022YFF0710802 the National Key Research and Development Program of China
- 2022YFF0710802 the National Key Research and Development Program of China
- 2022YFF0710802 the National Key Research and Development Program of China
- 2022YFF0710802 the National Key Research and Development Program of China
- 2022YFF0710802 the National Key Research and Development Program of China
- 2022YFF0710802 the National Key Research and Development Program of China
- 2022YFF0710802 the National Key Research and Development Program of China
- 2022YFF0710802 the National Key Research and Development Program of China
- 2022YFF0710802 the National Key Research and Development Program of China
- NoKCXFZ202002011008256 the Sustainable Development Project of Shenzhen Science and Technology Innovation Commission (China)
- NoKCXFZ202002011008256 the Sustainable Development Project of Shenzhen Science and Technology Innovation Commission (China)
- NoKCXFZ202002011008256 the Sustainable Development Project of Shenzhen Science and Technology Innovation Commission (China)
- NoKCXFZ202002011008256 the Sustainable Development Project of Shenzhen Science and Technology Innovation Commission (China)
- NoKCXFZ202002011008256 the Sustainable Development Project of Shenzhen Science and Technology Innovation Commission (China)
- NoKCXFZ202002011008256 the Sustainable Development Project of Shenzhen Science and Technology Innovation Commission (China)
- NoKCXFZ202002011008256 the Sustainable Development Project of Shenzhen Science and Technology Innovation Commission (China)
- NoKCXFZ202002011008256 the Sustainable Development Project of Shenzhen Science and Technology Innovation Commission (China)
- NoKCXFZ202002011008256 the Sustainable Development Project of Shenzhen Science and Technology Innovation Commission (China)
- NoKCXFZ202002011008256 the Sustainable Development Project of Shenzhen Science and Technology Innovation Commission (China)
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Affiliation(s)
- Shengchuan Feng
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Yuqiong Yang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Fengyan Wang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Weijuan Shi
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Jiaxuan Xu
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Guoyan Tang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Jiaxing Xie
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Nanshan Zhong
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Zhenyu Liang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China.
| | - Rongchang Chen
- Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), 518020, Shenzhen, China.
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19
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Alsayed AR, Abed A, Jarrar YB, Alshammari F, Alshammari B, Basheti IA, Zihlif M. Alteration of the Respiratory Microbiome in Hospitalized Patients with Asthma-COPD Overlap during and after an Exacerbation. J Clin Med 2023; 12:2118. [PMID: 36983122 PMCID: PMC10051973 DOI: 10.3390/jcm12062118] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/30/2023] Open
Abstract
The immediate aim of this study was to comparatively examine the bacterial respiratory microbiome of patients in a stable state and during an exacerbation of asthma-COPD (chronic obstructive pulmonary disease) overlap (ACO). This prospective observational study took place in Jordan between 1 September 2021 and 30 April 2022. Sputum samples from patients with recognized ACO were acquired within 48 h of the exacerbation onset and again at 3 weeks following the exacerbation. The next-generation sequencing Illumina MiSeq was employed and uncovered significantly high bacterial diversity in the sputa. The results showed a significant decrease in the taxonomic richness in the sputum samples collected during the exacerbation episodes compared with those collected from patients in a stable state (p = 0.008), with an increase in the taxonomic evenness (p < 0.005). This change in the composition of the airway bacterial community suggests that the replacement of a significant portion of the airway microbiome with certain microorganisms may play a role in the decrease in microbial diversity observed during an ACO exacerbation. Greater knowledge of this link could allow for a more focused administration of antibiotics, especially during exacerbations, improving clinical efficacy and patient outcomes.
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Affiliation(s)
- Ahmad R. Alsayed
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931-166, Jordan
| | - Anas Abed
- Pharmacological and Diagnostic Research Centre, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 11931-166, Jordan
| | - Yazun Bashir Jarrar
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt 19117, Jordan
| | - Farhan Alshammari
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 2440, Saudi Arabia
| | - Bushra Alshammari
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
| | - Iman A. Basheti
- Faculty of Pharmacy, Sydney University, Sydney, NSW 2006, Australia
| | - Malek Zihlif
- Department of Pharmacology, School of Medicine, The University of Jordan, Amman 11942, Jordan
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20
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Alsayed AR, Abed A, Khader HA, Al-Shdifat LMH, Hasoun L, Al-Rshaidat MMD, Alkhatib M, Zihlif M. Molecular Accounting and Profiling of Human Respiratory Microbial Communities: Toward Precision Medicine by Targeting the Respiratory Microbiome for Disease Diagnosis and Treatment. Int J Mol Sci 2023; 24:4086. [PMID: 36835503 PMCID: PMC9966333 DOI: 10.3390/ijms24044086] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
The wide diversity of microbiota at the genera and species levels across sites and individuals is related to various causes and the observed differences between individuals. Efforts are underway to further understand and characterize the human-associated microbiota and its microbiome. Using 16S rDNA as a genetic marker for bacterial identification improved the detection and profiling of qualitative and quantitative changes within a bacterial population. In this light, this review provides a comprehensive overview of the basic concepts and clinical applications of the respiratory microbiome, alongside an in-depth explanation of the molecular targets and the potential relationship between the respiratory microbiome and respiratory disease pathogenesis. The paucity of robust evidence supporting the correlation between the respiratory microbiome and disease pathogenesis is currently the main challenge for not considering the microbiome as a novel druggable target for therapeutic intervention. Therefore, further studies are needed, especially prospective studies, to identify other drivers of microbiome diversity and to better understand the changes in the lung microbiome along with the potential association with disease and medications. Thus, finding a therapeutic target and unfolding its clinical significance would be crucial.
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Affiliation(s)
- Ahmad R. Alsayed
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
| | - Anas Abed
- Pharmacological and Diagnostic Research Centre, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 11931, Jordan
| | - Heba A. Khader
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Laith M. H. Al-Shdifat
- Department of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
| | - Luai Hasoun
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
| | - Mamoon M. D. Al-Rshaidat
- Laboratory for Molecular and Microbial Ecology (LaMME), Department of Biological Sciences, School of Sciences, The University of Jordan, Amman 11942, Jordan
| | - Mohammad Alkhatib
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Malek Zihlif
- Department of Pharmacology, School of Medicine, The University of Jordan, Amman 11942, Jordan
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21
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Carrera-Salinas A, González-Díaz A, Ehrlich RL, Berbel D, Tubau F, Pomares X, Garmendia J, Domínguez MÁ, Ardanuy C, Huertas D, Marín A, Montón C, Mell JC, Santos S, Marti S. Genetic Adaptation and Acquisition of Macrolide Resistance in Haemophilus spp. during Persistent Respiratory Tract Colonization in Chronic Obstructive Pulmonary Disease (COPD) Patients Receiving Long-Term Azithromycin Treatment. Microbiol Spectr 2023; 11:e0386022. [PMID: 36475849 PMCID: PMC9927455 DOI: 10.1128/spectrum.03860-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) benefit from the immunomodulatory effect of azithromycin, but long-term administration may alter colonizing bacteria. Our goal was to identify changes in Haemophilus influenzae and Haemophilus parainfluenzae during azithromycin treatment. Fifteen patients were followed while receiving prolonged azithromycin treatment (Hospital Universitari de Bellvitge, Spain). Four patients (P02, P08, P11, and P13) were persistently colonized by H. influenzae for at least 3 months and two (P04 and P11) by H. parainfluenzae. Isolates from these patients (53 H. influenzae and 18 H. parainfluenzae) were included to identify, by whole-genome sequencing, antimicrobial resistance changes and genetic variation accumulated during persistent colonization. All persistent lineages isolated before treatment were azithromycin-susceptible but developed resistance within the first months, apart from those belonging to P02, who discontinued the treatment. H. influenzae isolates from P08-ST107 acquired mutations in 23S rRNA, and those from P11-ST2480 and P13-ST165 had changes in L4 and L22. In H. parainfluenzae, P04 persistent isolates acquired changes in rlmC, and P11 carried genes encoding MefE/MsrD efflux pumps in an integrative conjugative element, which was also identified in H. influenzae P11-ST147. Other genetic variation occurred in genes associated with cell wall and inorganic ion metabolism. Persistent H. influenzae strains all showed changes in licA and hgpB genes. Other genes (lex1, lic3A, hgpC, and fadL) had variation in multiple lineages. Furthermore, persistent strains showed loss, acquisition, or genetic changes in prophage-associated regions. Long-term azithromycin therapy results in macrolide resistance, as well as genetic changes that likely favor bacterial adaptation during persistent respiratory colonization. IMPORTANCE The immunomodulatory properties of azithromycin reduce the frequency of exacerbations and improve the quality of life of COPD patients. However, long-term administration may alter the respiratory microbiota, such as Haemophilus influenzae, an opportunistic respiratory colonizing bacteria that play an important role in exacerbations. This study contributes to a better understanding of COPD progression by characterizing the clinical evolution of H. influenzae in a cohort of patients with prolonged azithromycin treatment. The emergence of macrolide resistance during the first months, combined with the role of Haemophilus parainfluenzae as a reservoir and source of resistance dissemination, is a cause for concern that may lead to therapeutic failure. Furthermore, genetic variations in cell wall and inorganic ion metabolism coding genes likely favor bacterial adaptation to host selective pressures. Therefore, the bacterial pathoadaptive evolution in these severe COPD patients raise our awareness of the possible spread of macrolide resistance and selection of host-adapted clones.
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Affiliation(s)
- Anna Carrera-Salinas
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
| | - Aida González-Díaz
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Rachel L. Ehrlich
- Department of Microbiology and Immunology, Center for Genomic Sciences, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Dàmaris Berbel
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Fe Tubau
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Xavier Pomares
- Department of Respiratory Medicine, Hospital de Sabadell, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Junkal Garmendia
- Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
- Instituto de Agrobiotecnología, CSIC-Gobierno de Navarra, Mutilva, Spain
| | - M. Ángeles Domínguez
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
- Research Network for Infectious Diseases (CIBERINFEC), ISCIII, Madrid, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Carmen Ardanuy
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Daniel Huertas
- Department of Respiratory Medicine, Hospital Residència Sant Camil, Consorci Sanitari Alt Penedès-Garraf, Barcelona, Spain
| | - Alicia Marín
- Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
- Department of Respiratory Medicine, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Conchita Montón
- Department of Respiratory Medicine, Hospital de Sabadell, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Joshua Chang Mell
- Department of Microbiology and Immunology, Center for Genomic Sciences, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Salud Santos
- Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
- Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Sara Marti
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
- Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Spain
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22
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Bacterial Patterns and Empiric Antibiotic Use in COPD Patients With Community-Acquired Pneumonia. Arch Bronconeumol 2023; 59:90-100. [PMID: 36376121 DOI: 10.1016/j.arbres.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is strongly associated with the development of community-acquired pneumonia (CAP). Limited data are available on risk factors for difficult to manage bacteria such as Pseudomonas aeruginosa in COPD patients with CAP. Our objective was to assess the microbiological patterns associated with risk factors that determine empiric antibiotic therapy in hospitalized COPD patients with CAP. METHODS We performed a secondary data analysis of an international, multicenter, observational, point-prevalence study involving hospitalized COPD patients with CAP from March to June 2015. After identifying the risk factors associated with different microorganisms, we developed a scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy in this population. RESULTS We enrolled 689 hospitalized COPD patients with CAP with documented microbiological testing. The most frequent microorganisms isolated were Streptococcus pneumoniae (8%) and Gram-negative bacteria (8%), P. aeruginosa (7%) and Haemophilus influenzae (3%). We developed a scoring system incorporating the variables independently associated with P. aeruginosa that include a previous P. aeruginosa isolation or infection (OR 14.2 [95%CI 5.7-35.2]), hospitalization in the past 12 months (OR 3.7 [1.5-9.2]), and bronchiectasis (OR 3.2 [1.4-7.2]). Empiric anti-pseudomonal antibiotics were overutilized in COPD patients with CAP. The new scoring system has the potential to reduce empiric anti-pseudomonal antibiotic use from 54.1% to 6.2%. CONCLUSIONS COPD patients with CAP present different microbiological profiles associated with unique risk factors. Anti-pseudomonal treatment is a critical decision when selecting empiric antibiotic therapy. We developed a COPD scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy.
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23
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Kayongo A, Robertson NM, Siddharthan T, Ntayi ML, Ndawula JC, Sande OJ, Bagaya BS, Kirenga B, Mayanja-Kizza H, Joloba ML, Forslund SK. Airway microbiome-immune crosstalk in chronic obstructive pulmonary disease. Front Immunol 2023; 13:1085551. [PMID: 36741369 PMCID: PMC9890194 DOI: 10.3389/fimmu.2022.1085551] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) has significantly contributed to global mortality, with three million deaths reported annually. This impact is expected to increase over the next 40 years, with approximately 5 million people predicted to succumb to COPD-related deaths annually. Immune mechanisms driving disease progression have not been fully elucidated. Airway microbiota have been implicated. However, it is still unclear how changes in the airway microbiome drive persistent immune activation and consequent lung damage. Mechanisms mediating microbiome-immune crosstalk in the airways remain unclear. In this review, we examine how dysbiosis mediates airway inflammation in COPD. We give a detailed account of how airway commensal bacteria interact with the mucosal innate and adaptive immune system to regulate immune responses in healthy or diseased airways. Immune-phenotyping airway microbiota could advance COPD immunotherapeutics and identify key open questions that future research must address to further such translation.
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Affiliation(s)
- Alex Kayongo
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda,Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda,Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda,Department of Medicine, Center for Emerging Pathogens, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, United States
| | | | - Trishul Siddharthan
- Division of Pulmonary Medicine, School of Medicine, University of Miami, Miami, FL, United States
| | - Moses Levi Ntayi
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda,Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda,Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Josephine Caren Ndawula
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Obondo J. Sande
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bernard S. Bagaya
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Harriet Mayanja-Kizza
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses L. Joloba
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sofia K. Forslund
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany,Experimental and Clinical Research Center, a cooperation of Charité - Universitatsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany,Charité-Universitatsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany,Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany,*Correspondence: Sofia K. Forslund,
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24
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Martínez-García MÁ, Alvar Agusti. POINT: Is Chronic Bacterial Infection Clinically Relevant in COPD? Yes. Chest 2022; 162:970-972. [PMID: 36344127 DOI: 10.1016/j.chest.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 06/10/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Miguel Ángel Martínez-García
- Respiratory Department. Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid Spain, Valencia, Spain.
| | - Alvar Agusti
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid Spain, Valencia, Spain; Cátedra de Salud Respiratoria, Universidad de Barcelona, Barcelona, Spain; Pulmonary Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain; Institut d'investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
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25
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Verres Y, da Silva CO, Aljebawi B, Bodin A, Barreto E, Lagente V, Victoni T. Impact of JAK/STAT inhibitors on human monocyte-derived-macrophages stimulated by cigarette smoke extract and lipopolysaccharide. Clin Exp Pharmacol Physiol 2022; 49:1187-1196. [PMID: 35876719 DOI: 10.1111/1440-1681.13705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/07/2023]
Abstract
The main risk factor for chronic obstructive pulmonary disease (COPD) is cigarette smoke (CS). It can alter many immune cells functions such as phagocytosis, efferocytosis and cytokine production. Cytokines play a role in the orchestration of inflammation in COPD. The JAK/STAT pathways are among the most important signalling components of cytokines. The objective of this work was to investigate the role of the JAK/STAT pathway with regard to cytokine release and microsphere uptake capacity (to minimize the non-specific scavenging) in human monocyte-derived-macrophages (MDMs). The MDMs were stimulated by cigarette smoke extract (CSE) alone or in combination with lipopolysaccharide (LPS). CSE alone was not associated with significant changes in the cytokine, with the exception of IL-8/CXCL8 production. However, CSE disturbed cytokine production in LPS-stimulated MDMs. CSE increase CXCL-8 and CCL2 release in LPS-stimulated monocyte-derived macrophages and suppressed the production of IL-6 and CXCL1 in these cells. CSE also decreased microsphere uptake capacity by MDMs. Then, CSE + LPS-stimulated MDMs were treated with two different JAK inhibitors. AG490 (specific inhibitor of JAK2) and ruxolitinib (inhibitor of JAK1 and JAK2). JAK/STAT inhibitors, particularly ruxolitinib, attenuated in cytokine production without completely inhibiting when compared with dexamethasone. On the other hand, the cells exposed to dexamethasone are nearly unable to capture the microspheres, while both JAK inhibitors do not affect the uptake capacity. In summary, our results showed the versatility of ruxolitinib which might bring a better balance disturbance of cytokine release and uptake capacity. The information regarding the distinctive effect of JAK/STAT inhibitors may be useful in the development of novel treatments for COPD.
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Affiliation(s)
- Yann Verres
- INSERM, INRAE, CHU Rennes, Université Rennes, NuMeCan Institute (Nutrition, Metabolism and Cancer), Rennes, France
| | - Camila Oliveira da Silva
- Laboratory of Histocompatibility and Cryopreservation, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Bachar Aljebawi
- INSERM, INRAE, CHU Rennes, Université Rennes, NuMeCan Institute (Nutrition, Metabolism and Cancer), Rennes, France
| | - Aude Bodin
- INSERM, INRAE, CHU Rennes, Université Rennes, NuMeCan Institute (Nutrition, Metabolism and Cancer), Rennes, France
| | - Emiliano Barreto
- Laboratory of Cell Biology, Federal University of Alagoas, Maceió, Brazil
| | - Vincent Lagente
- INSERM, INRAE, CHU Rennes, Université Rennes, NuMeCan Institute (Nutrition, Metabolism and Cancer), Rennes, France
| | - Tatiana Victoni
- University of Lyon, VetAgro Sup, APCSe, - UP 2021.A101, Marcy l'Étoile, France
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Chronic Bronchial Infection Is Associated with More Rapid Lung Function Decline in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2022; 19:1842-1847. [PMID: 35666811 DOI: 10.1513/annalsats.202108-974oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: Some patients with chronic obstructive pulmonary disease (COPD) suffer accelerated lung function (forced expiratory volume in 1 second [FEV1]) decline over time. Objectives: To investigate the relationship between chronic bronchial infection (CBI) and, in particular, the isolation of Pseudomonas aeruginosa (PA), and FEV1 decline in COPD. Methods: Post-hoc analysis of a prospective cohort of 201 patients with COPD followed up every 3-6 months for 84 months. CBI was defined as ⩾3 sputum positive cultures of the same pathogenic micro-organism (PPM) over 1 year. Patients were stratified according to the presence of CBI by any PPM, as well by a single or multiple isolation of PA during follow-up. An adjusted mixed-effects linear regression model was used to investigate the independent effects of CBI and PA isolation on FEV1 decline over time. Results: During follow-up, PPMs were never isolated in 43.3% of patients, in 23.9% of them PPMs were isolated once, and CBI by any PPM was confirmed in 32.8% of participants. FEV1 decline in the entire cohort was 33.7 (95% confidence interval [CI], 21.4-46.1) ml/year. This was significantly increased in patients with CBI by any PPM (57.1 [95% CI, 28.5-79.3] ml/year) and in those in whom PA was isolated at least once (48.5 [95% CI, 27.3-88.2] ml/year). Multivariable analysis showed that the presence of both CBI by any PPM, and at least one PA isolation, were independent factors associated with faster FEV1 decline adjusted by baseline FEV1, presence of bronchiectasis, body mass index, age, exacerbations, smoking status, symptoms, baseline treatment, and comorbidities. Conclusions: The presence of CBI by any PPM, and one or more PA isolation, were independently associated with FEV1 decline in patients with COPD.
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Closing the Loop on the Vicious Circle in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2022; 19:1803-1805. [PMID: 36318080 PMCID: PMC9667802 DOI: 10.1513/annalsats.202208-697ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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28
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Eklöf J, Alispahic IA, Sivapalan P, Wilcke T, Seersholm N, Armbruster K, Kjærgaard JL, Saeed MI, Nielsen TL, Browatzki A, Overgaard RH, Fenlev CS, Harboe ZB, Andreassen HF, Lapperre TS, Pedersen L, Johnsen S, Ulrik CS, Janner J, Moberg M, Heidemann M, Weinreich UM, Vijdea R, Linde H, Titlestad I, Johansson SL, Rosenvinge FS, Østergaard C, Ghathian KSA, Gundersen L, Christensen CW, Bangsborg J, Jensen TT, Sørensen VM, Ellingsgaard T, Datcu R, Coia JE, Bodtger U, Jensen JUS. Targeted AntiBiotics for Chronic pulmonary diseases (TARGET ABC): can targeted antibiotic therapy improve the prognosis of Pseudomonas aeruginosa-infected patients with chronic pulmonary obstructive disease, non-cystic fibrosis bronchiectasis, and asthma? A multicenter, randomized, controlled, open-label trial. Trials 2022; 23:817. [PMID: 36167555 PMCID: PMC9513970 DOI: 10.1186/s13063-022-06720-z] [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: 09/05/2021] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa infection is seen in chronic pulmonary disease and is associated with exacerbations and poor long-term prognosis. However, evidence-based guidelines for the management and treatment of P. aeruginosa infection in chronic, non-cystic fibrosis (CF) pulmonary disease are lacking. The aim of this study is to investigate whether targeted antibiotic treatment against P. aeruginosa can reduce exacerbations and mortality in patients with chronic obstructive pulmonary disease (COPD), non-CF bronchiectasis, and asthma. METHODS This study is an ongoing multicenter, randomized, controlled, open-label trial. A total of 150 patients with COPD, non-CF bronchiectasis or asthma, and P. aeruginosa-positive lower respiratory tract samples will be randomly assigned with a 1:1 ratio to either no antibiotic treatment or anti-pseudomonal antibiotic treatment with intravenous beta-lactam and oral ciprofloxacin for 14 days. The primary outcome, analyzed with two co-primary endpoints, is (i) time to prednisolone and/or antibiotic requiring exacerbation or death, in the primary or secondary health sector, within days 20-365 from study allocation and (ii) days alive and without exacerbation within days 20-365 from the study allocation. DISCUSSION This trial will determine whether targeted antibiotics can benefit future patients with chronic, non-CF pulmonary disease and P. aeruginosa infection in terms of reduced morbidity and mortality, thus optimizing therapeutic approaches in this large group of chronic patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03262142 . Registered on August 25, 2017.
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Affiliation(s)
- Josefin Eklöf
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Imane Achir Alispahic
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Pradeesh Sivapalan
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Internal Medicine, Zealand Hospital, University of Copenhagen, Roskilde, Denmark
| | - Torgny Wilcke
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels Seersholm
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Karin Armbruster
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Lyngby Kjærgaard
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mohamad Isam Saeed
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thyge Lynghøj Nielsen
- Department of Respiratory and Infectious Diseases, Frederikssund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Browatzki
- Department of Respiratory and Infectious Diseases, Frederikssund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Holmen Overgaard
- Department of Respiratory and Infectious Diseases, Frederikssund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Camilla Sund Fenlev
- Department of Respiratory and Infectious Diseases, Frederikssund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zitta Barella Harboe
- Department of Respiratory and Infectious Diseases, Frederikssund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Helle Frost Andreassen
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Therese Sophie Lapperre
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Stine Johnsen
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Julie Janner
- Department of Respiratory Medicine, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mia Moberg
- Department of Respiratory Medicine, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maria Heidemann
- Department of Respiratory Medicine, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Medicine, Aalborg University Hospital, University of Aalborg, Aalborg, Denmark
| | - Roxana Vijdea
- Department of Respiratory Medicine, Aalborg University Hospital, University of Aalborg, Aalborg, Denmark
| | - Hans Linde
- Department of Clinical Microbiology, Aalborg University Hospital, University of Aalborg, Aalborg, Denmark
| | - Ingrid Titlestad
- Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Sofie Lock Johansson
- Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Khaled Saoud Ali Ghathian
- Department of Clinical Microbiology, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lise Gundersen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Jette Bangsborg
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Torben Tranborg Jensen
- Department of Internal Medicine, Section of Respiratory Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - Vibeke Muff Sørensen
- Department of Internal Medicine, Section of Respiratory Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - Thilde Ellingsgaard
- Department of Internal Medicine, Section of Respiratory Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - Raluca Datcu
- Department of Clinical Microbiology, Hospital of South West Jutland, Esbjerg, Denmark
| | - John Eugenio Coia
- Department of Clinical Microbiology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand Hospital, University of Copenhagen, Roskilde, Denmark.,Department of Respiratory Medicine, Naestved Hospital, University of Southern Denmark, Naestved, Denmark
| | - Jens Ulrik Stæhr Jensen
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,PERSIMUNE: Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Hulina-Tomašković A, Somborac-Bačura A, Grdić Rajković M, Hlapčić I, Jonker MR, Heijink IH, Rumora L. Extracellular Hsp70 modulates 16HBE cells' inflammatory responses to cigarette smoke and bacterial components lipopolysaccharide and lipoteichoic acid. Cell Stress Chaperones 2022; 27:587-597. [PMID: 36029374 PMCID: PMC9485373 DOI: 10.1007/s12192-022-01294-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/03/2022] Open
Abstract
Cigarette smoke is a major risk factor for chronic obstructive pulmonary disease (COPD), leading to chronic inflammation, while bacterial components lipopolysaccharide (LPS) and lipoteichoic acid (LTA) are often present in airways of COPD patients, especially during exacerbations.We hypothesised that extracellular heat shock protein 70 (eHsp70), a damage-associated molecular pattern elevated in serum of COPD patients, induces inflammation and alters cigarette smoke and LPS/LTA-induced inflammatory effects in the airway epithelium.We used 16HBE cells exposed to recombinant human (rh)Hsp70 and its combinations with cigarette smoke extract (CSE), LPS or LTA to investigate those assumptions, and we determined pro-inflammatory cytokines' secretion as well as TLR2 and TLR4 gene expression.rhHsp70 and CSE alone stimulated IL-6, IL-8 and TNF-α secretion. CSE and rhHsp70 had antagonistic effect on IL-6 secretion, while combinations of LPS or LTA with rhHsp70 showed antagonistic effect on TNF-α release. By using specific inhibitors, we demonstrated that effects of rhHsp70 on cytokines' secretion were mediated via NF-κB and/or MAPK signalling pathways. rhHsp70 increased, and CSE decreased TLR2 gene expression compared to untreated cells, but their combinations increased it compared to CSE alone. LPS and rhHsp70 combinations decreased TLR2 gene expression compared to untreated cells. TLR4 expression was not induced by any of the treatments.In conclusion, we demonstrated that extracellular Hsp70 modulates pro-inflammatory responses of human airway epithelial cells to cigarette smoke and bacterial components LPS and LTA. Simultaneous presence of those compounds and their interactions might lead to inappropriate immune responses and adverse consequences in COPD.
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Affiliation(s)
- Andrea Hulina-Tomašković
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Anita Somborac-Bačura
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Marija Grdić Rajković
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Iva Hlapčić
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Marnix R Jonker
- Department of Pathology and Medical Biology, Experimental Pulmonology and Inflammation Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Irene H Heijink
- Department of Pathology and Medical Biology, Experimental Pulmonology and Inflammation Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lada Rumora
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia.
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30
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Huang YS, Wang JT, Tai HM, Chang PC, Huang HC, Yang PC. Metal nanoparticles and nanoparticle composites are effective against Haemophilus influenzae, Streptococcus pneumoniae, and multidrug-resistant bacteria. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:708-715. [PMID: 35718718 DOI: 10.1016/j.jmii.2022.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Treatment for lower respiratory tract infection caused by multidrug-resistant organisms (MDRO) are often limited. This study explored the activity of different metal nanoparticles against several respiratory pathogens including MDROs. METHODS Clinical isolates of carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Klebsiella pneumoniae (CRKP), Pseudomonas aeruginosa, Haemophilus influenzae, methicillin-resistant Staphylococcus aureus (MRSA), and Streptococcus pneumoniae were tested for in vitro susceptibilities to various antibiotics and nanoparticles. Minimum inhibitory concentrations (MICs) of silver-nanoparticle (Ag-NP), selenium-nanoparticle (Se-NP), and three composites solutions ND50, NK99, and TPNT1 (contained 5 ppm Ag-NP, 60 ppm ZnO-nanoparticle, and different concentrations of gold-nanoparticle or ClO2) were determined by broth microdilution method. RESULTS Fifty isolates of each bacterial species listed above were tested. Ag-NP showed lower MICs to all species than Se-NP. The MIC50s of Ag-NP for CRAB, CRKP, P. aeruginosa, and H. influenzae were <3.125 ppm, 25 ppm, <3.125 ppm, and <3.125 ppm, respectively, while those for S. pneumoniae and MRSA were >50 ppm and 50 ppm. Among CRAB, CRKP and P. aeruginosa, the MIC50s of ND50, NK99, and TPNT1 for CRAB were the lowest (1/8 dilution, 1/8 dilution, and 1/8 dilution, respectively), and those for CRKP (>1/2 dilution, 1/2 dilution, and 1/2 dilution, respectively) were the highest. Both MRSA and S. pneumoniae showed high MIC50s to ND50, NK99, and TPNT1. CONCLUSIONS Metal nanoparticles had good in vitro activity against Gram-negative bacteria. They might be suitable to be prepared as environmental disinfectants or inhaled agents to inhibit the growth of MDR Gram-negative colonizers in the lower respiratory tracts of patients with chronic lung diseases.
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Affiliation(s)
- Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Maioli, Taiwan.
| | - Hui-Ming Tai
- Laboratory of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Pan-Chyr Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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31
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Makwana S, Patel A, Sonagara M. Correlation Between Serum Magnesium Level and Acute Exacerbation in Patients With Chronic Obstructive Pulmonary Disease (COPD). Cureus 2022; 14:e26229. [PMID: 35898387 PMCID: PMC9308137 DOI: 10.7759/cureus.26229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Although chronic obstructive pulmonary disease (COPD) is preventable and treatable, it is a major public health problem. The mortality risks are higher in patients with exacerbations. Magnesium (Mg) is crucial in numerous physiological processes, including membrane stabilization. However, incomplete information is available regarding the effect of magnesium on the frequency of acute exacerbation of COPD. Objectives To determine the serum magnesium level in COPD patients and its correlation with acute exacerbation of COPD. Materials and methods This cross-sectional study included 100 patients diagnosed with acute exacerbation of COPD. The serum magnesium level was measured in all patients with acute exacerbation of COPD at admission. Serum Mg level <1.7 mg/dl was considered hypomagnesemia. The correlation between serum magnesium level and duration of hospital stay and patient outcome was studied. Results In the present study, hypomagnesemia was reported in 57% of patients with acute exacerbation of COPD. The duration of hospital stay (more than seven days) among hypomagnesemia (80.7%) patients was significantly higher than that of the normomagnesemia patients (55.8%). Mortality in patients with hypomagnesemia was higher than in patients with normomagnesemia, although not statistically significant. Conclusion Hypomagnesaemia is a common finding in acute exacerbation of COPD. The level of magnesium found is related to the length of hospital stay, but it is not related to mortality among patients with acute exacerbation of COPD. Further studies with larger sample sizes and extended follow-up periods are required to validate the results.
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32
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Li W, Gao M, Liu J, Zhang F, Yuan R, Su Q, Wang Y, Wang Y. The prevalence of oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Expert Rev Respir Med 2022; 16:567-574. [PMID: 35670185 DOI: 10.1080/17476348.2022.2086123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) in chronic obstructive pulmonary disease (COPD) patients seriously influence the long-term prognosis of COPD patients. The aim of this study was to assess the prevalence and risk factors of OD in patients with COPD through a systematic review and meta-analysis of observational studies. METHODS We identified all observational studies on the prevalence of OD in COPD patients by searching PubMed, Embase, the Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), the China Biomedical Literature Service System (CBM), the Wanfang Database, and the WeiPu (VIP) databases from database establishment to 1 December 2020. RESULTS Results of the meta-analysis showed that the prevalence of OD in COPD patients was 32.7% (95%CI=30.1, 35.4, I2=91.5%). Dyspnea, gastroesophageal reflux disease(GERD), xerostomia, sputum bacteria, poor physical capacity, poor quality of life, and high CRP level are the risk factors for OD in COPD patients. CONCLUSION : The prevalence of OD in COPD patients is high. There were some differences in OD among COPD patients with different sex, ages, continents, evaluation methods, patient source and COPD exacerbation.
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Affiliation(s)
- Wenyan Li
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China.,West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingjing Gao
- Department of Anesthesia Surgery, the First Affiliated Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jin Liu
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Fengwa Zhang
- First Department of Gynecology, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
| | - Rongjing Yuan
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Qingling Su
- First Department of Gynecology, the First Affiliated Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yetong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
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Han L, Huang Y, Fu Q, Xue Y, Ding F, Zhang M. Tracking the response to Pseudomonas aeruginosa infection in ozone-induced chronic obstructive pulmonary disease mouse models. Biomed Pharmacother 2022; 150:112980. [PMID: 35453008 DOI: 10.1016/j.biopha.2022.112980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022] Open
Abstract
Pseudomonas aeruginosa (P. aeruginosa) is commonly isolated from the sputum of COPD patients. However, the precise role of P. aeruginosa infection in the progression of COPD, especially its role in altering inflammation remains unclear. Here, we designed mice models of COPD infected with P. aeruginosa (PA) and observed dynamic changes of lung structure, lung inflammatory microenvironment, lung function. After infection, the level of mucus secretion peaked on day 3 and remained higher throughout the study period, and the airway remodeling and emphysema was starkly apparent on day 14 and 21. On day 3, interferon-γ and interleukin (IL)- 5 levels increased rapidly, accompanied by elevated T-bet mRNA expression and CD4+T-bet+ cells; at the late stage of infection (days 14 and 21), consistent with increased GATA3 mRNA expression and CD4+GATA3+ cells, IL-4 and IL-13 levels significantly increased; IL-17A level, Foxp3 mRNA expression, CD4+ROR-γt+ cells and CD4+FOXP3+ cells remained at higher levels throughout the course of the infection. Small-airway function showed a decline from day 3 to day 21; large airway function showed a decline on day 14 and 21. Overall, P. aeruginosa infection contributed to the progression of COPD. During the infection, an early Th1-related inflammation gradually shifted to a later Th2-related inflammation, and small-airway function decline occurred earlier than that of large-airway function. On the basis of infection control, the appropriate use of glucocorticoid might slow disease progression by mitigating the enhanced Th2-related inflammation, and small airways could be also an important treatment target in P. aeruginosa -infected COPD patients.
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Affiliation(s)
- Lei Han
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Yuning Huang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Qiang Fu
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Yishu Xue
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Fengming Ding
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
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Wedzicha JA. Vaccines for COPD exacerbation prevention: do they work? THE LANCET. RESPIRATORY MEDICINE 2022; 10:422-423. [PMID: 35026178 DOI: 10.1016/s2213-2600(22)00007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK.
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35
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Love ME, Proud D. Respiratory Viral and Bacterial Exacerbations of COPD—The Role of the Airway Epithelium. Cells 2022; 11:cells11091416. [PMID: 35563722 PMCID: PMC9099594 DOI: 10.3390/cells11091416] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 12/14/2022] Open
Abstract
COPD is a leading cause of death worldwide, with acute exacerbations being a major contributor to disease morbidity and mortality. Indeed, exacerbations are associated with loss of lung function, and exacerbation frequency predicts poor prognosis. Respiratory infections are important triggers of acute exacerbations of COPD. This review examines the role of bacterial and viral infections, along with co-infections, in the pathogenesis of COPD exacerbations. Because the airway epithelium is the initial site of exposure both to cigarette smoke (or other pollutants) and to inhaled pathogens, we will focus on the role of airway epithelial cell responses in regulating the pathophysiology of exacerbations of COPD. This will include an examination of the interactions of cigarette smoke alone, and in combination with viral and bacterial exposures in modulating epithelial function and inflammatory and host defense pathways in the airways during COPD. Finally, we will briefly examine current and potential medication approaches to treat acute exacerbations of COPD triggered by respiratory infections.
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Skronska-Wasek W, Durlanik S, Le HQ, Schroeder V, Kitt K, Garnett JP, Pflanz S. The antimicrobial peptide S100A8/A9 produced by airway epithelium functions as a potent and direct regulator of macrophage phenotype and function. Eur Respir J 2022; 59:13993003.02732-2020. [PMID: 34561292 PMCID: PMC8989056 DOI: 10.1183/13993003.02732-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Elevated counts of alveolar macrophages and attenuated phagocytic capacity are associated with chronic obstructive pulmonary disease (COPD). Factors governing macrophage phagocytosis are poorly understood. In this study we aimed to compare the influence of airway epithelial cell secretions from individuals with COPD and without COPD (non-COPD) on macrophage phagocytic activity, and the role of antimicrobial peptides (AMPs). METHODS Supernatants from non-COPD and COPD small airway epithelial cell (SAEC) cultures exposed to non-typeable Haemophilus influenzae (NTHi) were applied to human monocyte-derived macrophages (MDMs) to assess their influence on phagocytosis. SAECs were analysed for changes in AMP expression by quantitative reverse transcription PCR, and the influence of select AMPs on macrophage phenotype and function was assessed by flow cytometry and metabolic activity assay. RESULTS Secretions from the apical and basolateral surface of NTHi-exposed SAECs from non-COPD donors elicited superior phagocytic capacity in MDMs. Moreover, NTHi exposure led to a rapid increase in the expression of a range of AMPs by non-COPD SAECs, but this response was delayed in COPD SAECs. We demonstrate that treatment with AMPs β-defensin 2 and S100 calcium binding protein A8/S100 calcium binding protein A9 (S100A8/A9) improved the phagocytic capacity of MDMs. In-depth analysis of the influence of S100A8/A9 on MDMs revealed a role for this AMP in macrophage phenotype and function. Furthermore, we show that the expression of S100A8 and S100A9 is directly regulated by WNT/β-catenin signalling, a known deregulated pathway in COPD. CONCLUSION In conclusion, for the first time, we demonstrate that airway epithelium from patients with COPD has a reduced capacity to support the phagocytic function of macrophages in response to acute NTHi exposure, and we identify the WNT/β-catenin signalling-modulated and epithelium-derived S100A8/A9 as a potent regulator of macrophage phenotype and function.
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Affiliation(s)
- Wioletta Skronska-Wasek
- Cancer Immunology and Immune Modulation, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany,Immunology and Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany,Corresponding author: Wioletta Skronska-Wasek ()
| | - Sibel Durlanik
- Cancer Immunology and Immune Modulation, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany
| | - Huy Quang Le
- Immunology and Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany
| | - Victoria Schroeder
- Immunology and Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany
| | - Kerstin Kitt
- Cancer Immunology and Immune Modulation, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany
| | - James Peter Garnett
- Immunology and Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany
| | - Stefan Pflanz
- Cancer Immunology and Immune Modulation, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany
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Mindt BC, DiGiandomenico A. Microbiome Modulation as a Novel Strategy to Treat and Prevent Respiratory Infections. Antibiotics (Basel) 2022; 11:antibiotics11040474. [PMID: 35453224 PMCID: PMC9029693 DOI: 10.3390/antibiotics11040474] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
Acute and chronic lower airway disease still represent a major cause of morbidity and mortality on a global scale. With the steady rise of multidrug-resistant respiratory pathogens, such as Pseudomonas aeruginosa and Klebsiella pneumoniae, we are rapidly approaching the advent of a post-antibiotic era. In addition, potentially detrimental novel variants of respiratory viruses continuously emerge with the most prominent recent example being severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To this end, alternative preventive and therapeutic intervention strategies will be critical to combat airway infections in the future. Chronic respiratory diseases are associated with alterations in the lung and gut microbiome, which is thought to contribute to disease progression and increased susceptibility to infection with respiratory pathogens. In this review we will focus on how modulating and harnessing the microbiome may pose a novel strategy to prevent and treat pulmonary infections as well as chronic respiratory disease.
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Martinez-Garcia MA, Miravitlles M. The Impact of Chronic Bronchial Infection in COPD: A Proposal for Management. Int J Chron Obstruct Pulmon Dis 2022; 17:621-630. [PMID: 35355582 PMCID: PMC8958724 DOI: 10.2147/copd.s357491] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Up to 50% of patients with chronic obstructive pulmonary disease (COPD) in stable state may carry potentially pathogenic microorganisms (PPMs) in their airways. The presence of PPMs has been associated with increased symptoms, increased risk and severity of exacerbations, a faster decline in lung function and impairment in quality of life. Although some clinical trials have demonstrated a reduction in exacerbations in patients chronically treated with systemic antibiotics, particularly macrolides, the selection of patients was based on the previous frequency of exacerbations and not on the presence of PPMs in their airways. Therefore, unlike in bronchiectasis, there is a lack of evidence-based recommendations for assessment and treatment of the presence of PPMs in either single or repeated isolations in COPD. In this article, we propose that chronic bronchial infection (CBI) in COPD be defined as the isolation of the same PPM in at least three sputum samples separated by more than one month; we review the impact of CBI on the natural course of COPD and suggest a course of action in patients with a single isolation of a PPM or suspected CBI. Antibiotic treatment in stable COPD should be recommended based on four main criteria: a) the presence of comorbid bronchiectasis, b) the demonstration of a single or multiple isolation of the same PPM, c) the clinical impact of CBI on the patients, and d) the type of PPM, either Pseudomonas aeruginosa or non-pseudomonal PPM. These recommendations are derived from evidence generated in patients with bronchiectasis and, until new evidence specifically obtained in COPD is available, they may help in the management of these challenging patients with COPD. Existing evidence suggests that inhaled therapy is insufficient to manage patients with moderate-to-severe COPD, frequent exacerbations, and CBI. New studies must be conducted in this particularly demanding population.
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Affiliation(s)
- Miguel Angel Martinez-Garcia
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
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Ding F, Han L, Fu Q, Fan X, Tang R, Lv C, Xue Y, Tian X, Zhang M. IL-17 Aggravates Pseudomonas aeruginosa Airway Infection in Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Front Immunol 2022; 12:811803. [PMID: 35095906 PMCID: PMC8792752 DOI: 10.3389/fimmu.2021.811803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/22/2021] [Indexed: 01/02/2023] Open
Abstract
Pseudomonas aeruginosa airway infection increases risks of exacerbations and mortality in chronic obstructive pulmonary disease (COPD). We aimed to elucidate the role of IL-17 in the pathogenesis. We examined the expression and influences of IL-23/IL-17A in patients with stable COPD (n = 33) or acute COPD exacerbations with P. aeruginosa infection (n = 34). A mouse model of COPD (C57BL/6) was used to investigate the role of IL-17A in host inflammatory responses against P. aeruginosa infection through the application of IL-17A–neutralizing antibody or recombinant IL-17A. We found that P. aeruginosa infection increased IL-23/17A signaling in lungs of both COPD patients and COPD mouse models. When COPD mouse models were treated with neutralizing antibody targeting IL-17A, P. aeruginosa induced a significantly less polymorphonuclear leukocyte infiltration and less bacterial burden in their lungs compared to those of untreated counterparts. The lung function was also improved by neutralizing antibody. Furthermore, IL-17A-signaling blockade significantly reduced the expression of pro-inflammatory cytokine IL-1β, IL-18, TNF-α, CXCL1, CXCL15 and MMP-9, and increased the expression of anti-inflammatory cytokine IL-10 and IL-1Ra. The application of mouse recombinant IL-17A exacerbated P. aeruginosa-mediated inflammatory responses and pulmonary dysfunction in COPD mouse models. A cytokine protein array revealed that the expression of retinol binding protein 4 (RBP4) was down-regulated by IL-17A, and exogenous RBP4-recombinant protein resulted in a decrease in the severity of P. aeruginosa-induced airway dysfunction. Concurrent application of IL-17A-neutralizing antibody and ciprofloxacin attenuated airway inflammation and ventilation after inoculation of P. aeruginosa in COPD mouse models. Our results revealed that IL-17 plays a detrimental role in the pathogenesis of P. aeruginosa airway infection during acute exacerbations of COPD. Targeting IL-17A is a potential therapeutic strategy in controlling the outcomes of P. aeruginosa infection in COPD patients.
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Affiliation(s)
- Fengming Ding
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Han
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Fu
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinxin Fan
- Department of Tuberculosis, Fuzhou Pulmonary Hospital of Fujian Province, Fuzhou, China
| | - Rong Tang
- Department of Clinical Laboratory, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengjian Lv
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yishu Xue
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue Tian
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Martinez-García MA, Rigau D, Barrecheguren M, García-Ortega A, Nuñez A, Oscullo Yepez G, Miravitlles M. Long-Term Risk of Mortality Associated with Isolation of Pseudomonas aeruginosa in COPD: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis 2022; 17:371-382. [PMID: 35210766 PMCID: PMC8858763 DOI: 10.2147/copd.s346294] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic bronchial infection is frequent in chronic obstructive pulmonary disease (COPD), but the impact of the isolation of pathogenic bacteria, and in particular Pseudomonas aeruginosa (PA) in respiratory samples on the prognosis of COPD is unclear. Methods We conducted a systematic review of prognostic studies including patients with isolation of PA in sputum in stable state or during exacerbations of COPD. The main outcomes were all-cause mortality, respiratory mortality, and number and severity of future exacerbations. Data were expressed as hazard ratio (HR) (95% confidence interval [CI]) whenever possible. Results Of 2773 studies, eight were finally included (23,228 individuals). The mean age ranged from 65.5 to 73 years. Six studies reported data for all-cause mortality. The adjusted risk of death was almost double in patients with PA isolation (HR 1.95, 95% CI, 1.34 to 2.84; quality of evidence moderate). Patients with PA isolation showed a three times higher adjusted risk of readmission at 30 days after discharge (OR 3.60, 95% CI, 3.60 to 12.03, 1 study; quality of evidence very low), and more than double adjusted risk of death and hospitalization at two years (HR 2.80, 95% CI, 2.20 to 3.56, 1 study; quality of evidence very low). Conclusion There is moderate certainty that the isolation of PA in sputum is associated with an adjusted increased risk of death in patients with COPD.
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Affiliation(s)
- Miguel Angel Martinez-García
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - David Rigau
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Miriam Barrecheguren
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Alexa Nuñez
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Grace Oscullo Yepez
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Correspondence: Marc Miravitlles, University Hospital Vall d’Hebron, Department of Pneumology, Vall d’Hebron Barcelona Hospital Campus, Pg Vall d’Hebron 119-129, Barcelona, 08036, Spain, Email
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41
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Duszyk K, McLoughlin RF, Gibson PG, McDonald VM. The use of treatable traits to address COPD complexity and heterogeneity and to inform the care. Breathe (Sheff) 2022; 17:210118. [PMID: 35035572 PMCID: PMC8753613 DOI: 10.1183/20734735.0118-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/11/2021] [Indexed: 12/20/2022] Open
Abstract
COPD is complex and heterogeneous with respect to its aetiology, clinical presentation, phenotypes and biological mechanisms. Despite this, COPD is still diagnosed and treated according to simple clinical measures, including airflow limitation, symptoms and exacerbation frequency, leading to failure to recognise the disease's heterogeneity and/or to provide targeted interventions. COPD continues to have a very large burden of disease with suboptimal outcomes for people with the disease, including frequent hospitalisation with exacerbations, rapid lung function decline, multimorbidity and death from respiratory failure. In light of this, there have been increasing calls for a renewed taxonomy with better characterisation of COPD phenotypes and endotypes. This would allow the unravelling of COPD's complexity and heterogeneity, the implementation of targeted interventions and improved patient outcomes. The treatable traits strategy is a proposed vehicle for the implementation of precision medicine in chronic airway diseases. In this review, in addition to summarising the key knowledge on the heterogeneity of COPD, we refer to the existing evidence pertaining to the treatable traits strategy as applied in COPD and discuss implementation in different settings. COPD is a heterogeneous clinical syndrome, which requires deconstruction of its individual components to facilitate targeted treatment and improve individual patient outcomes.
https://bit.ly/2YXWgHN
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Affiliation(s)
- Katarzyna Duszyk
- National Health and Medical Research Council Centre of Excellence in Treatable Traits and Priority Research Centre for Healthy Lungs, the University of Newcastle, Newcastle, Australia
| | - Rebecca F McLoughlin
- National Health and Medical Research Council Centre of Excellence in Treatable Traits and Priority Research Centre for Healthy Lungs, the University of Newcastle, Newcastle, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre of Excellence in Treatable Traits and Priority Research Centre for Healthy Lungs, the University of Newcastle, Newcastle, Australia.,Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre of Excellence in Treatable Traits and Priority Research Centre for Healthy Lungs, the University of Newcastle, Newcastle, Australia.,Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
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42
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Muggeo A, Perotin JM, Brisebarre A, Dury S, Dormoy V, Launois C, Ancel J, Mulette P, de Champs C, Deslée G, Guillard T. Extended Bacteria Culture-Based Clustering Identifies a Phenotype Associating Increased Cough and Enterobacterales in Stable Chronic Obstructive Pulmonary Disease. Front Microbiol 2022; 12:781797. [PMID: 34970242 PMCID: PMC8712763 DOI: 10.3389/fmicb.2021.781797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by airflow limitation. This chronic respiratory disease represents the third leading cause of death worldwide. Alteration of the airway microbiota has been reported to be associated with exacerbation frequency in COPD, but its role on the symptoms in patients at stable state is still incompletely described. This study aimed to determine whether bacteria isolated in sputum can be associated with the clinical features of COPD patients within stable state. Our study highlights, for the first time, that altered microbiota with Enterobacterales is associated with pejorative clinical symptoms in stable COPD patients. The airway microbiota of 38 patients was analyzed using an extended culture approach and mass spectrometry identification. Cluster analysis by principal coordinate analysis of the bacterial communities showed that the patients could be classified into three distinct clusters in our cohort. The clusters showed no differences in proportions of the phylum, but one of them was associated with a high prevalence of Enterobacterales (71.4% in cluster 1 vs. 0% in cluster 3), loss of microbiota diversity, and higher bacterial load (107 vs. 105 CFU/ml, respectively) and characterized by predominant cough and impact on mental health. These novel findings, supported by further studies, could lead to modifying the processing of COPD sputum in the everyday practice of clinical microbiology laboratories.
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Affiliation(s)
- Anaëlle Muggeo
- Inserm UMR-S 1250 Pulmonary pathologies and cellular plasticity (P3Cell), Reims-Champagne-Ardenne University, SFR CAP Santé, Reims, France.,Laboratory of Bacteriology-Virology-Hospital Hygiene-Parasitology-Mycology, Reims University Hospital, Reims, France
| | - Jeanne-Marie Perotin
- Inserm UMR-S 1250 Pulmonary pathologies and cellular plasticity (P3Cell), Reims-Champagne-Ardenne University, SFR CAP Santé, Reims, France.,Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Audrey Brisebarre
- Inserm UMR-S 1250 Pulmonary pathologies and cellular plasticity (P3Cell), Reims-Champagne-Ardenne University, SFR CAP Santé, Reims, France
| | - Sandra Dury
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Valérian Dormoy
- Inserm UMR-S 1250 Pulmonary pathologies and cellular plasticity (P3Cell), Reims-Champagne-Ardenne University, SFR CAP Santé, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Julien Ancel
- Inserm UMR-S 1250 Pulmonary pathologies and cellular plasticity (P3Cell), Reims-Champagne-Ardenne University, SFR CAP Santé, Reims, France.,Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Pauline Mulette
- Inserm UMR-S 1250 Pulmonary pathologies and cellular plasticity (P3Cell), Reims-Champagne-Ardenne University, SFR CAP Santé, Reims, France.,Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Christophe de Champs
- Inserm UMR-S 1250 Pulmonary pathologies and cellular plasticity (P3Cell), Reims-Champagne-Ardenne University, SFR CAP Santé, Reims, France.,Laboratory of Bacteriology-Virology-Hospital Hygiene-Parasitology-Mycology, Reims University Hospital, Reims, France
| | - Gaëtan Deslée
- Inserm UMR-S 1250 Pulmonary pathologies and cellular plasticity (P3Cell), Reims-Champagne-Ardenne University, SFR CAP Santé, Reims, France.,Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Thomas Guillard
- Inserm UMR-S 1250 Pulmonary pathologies and cellular plasticity (P3Cell), Reims-Champagne-Ardenne University, SFR CAP Santé, Reims, France.,Laboratory of Bacteriology-Virology-Hospital Hygiene-Parasitology-Mycology, Reims University Hospital, Reims, France
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43
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Armitage MN, Spittle DA, Turner AM. A Systematic Review and Meta-Analysis of the Prevalence and Impact of Pulmonary Bacterial Colonisation in Stable State Chronic Obstructive Pulmonary Disease (COPD). Biomedicines 2021; 10:biomedicines10010081. [PMID: 35052762 PMCID: PMC8773377 DOI: 10.3390/biomedicines10010081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Half of acute exacerbations of COPD are due to bacterial infection, and the other half are likely influenced by microbial colonisation. The same organisms commonly cultured during acute exacerbations are often found in the sputum of patients during stability. A robust assessment of the prevalence of potentially pathogenic microorganisms (PPMs) in the sputum of stable COPD patients may help to inform the targeted prevention of exacerbation by these organisms. Methods: A systematic review and meta-analysis was carried out to determine the prevalence of PPMs in patients with COPD in the stable state. Meta-analysis of prevalence was carried out using the Freeman–Tukey double arcsine transformation random effects model, and sub-group analysis was performed for sputum modality. Prevalence of total and individual PPMs was calculated from patient-level data from individual studies. Results: Pooled prevalence of PPMs identified by sputum culture was found to be 41% (95% CI 36–47%). Significant heterogeneity was found across all studies, which can likely be attributed to inconsistent measuring and reporting of PPMs. The most commonly reported organisms were H. influenzae, M catarrhalis, S. pneumoniae, S. aureus, and P. aeruginosa. Declining lung function was weakly correlated with prevalence of PPMs. Conclusion: The airways of patients with COPD are colonised with PPMs during the stable state in almost half of patients. A complex relationship likely exists between the microbiome in the stable state and the phenotype of COPD patients. Targeted microbial therapy for preventing exacerbations of COPD should carefully consider the stable microbiome as well as the exacerbated.
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Affiliation(s)
- Michael N. Armitage
- Medical Education, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Rd., Coventry CV2 2DX, UK;
| | - Daniella A. Spittle
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK;
| | - Alice M. Turner
- University Hospitals Birmingham NHS Foundation Trust, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Correspondence:
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44
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Birru RL, Bein K, Bondarchuk N, Wells H, Lin Q, Di YP, Leikauf GD. Antimicrobial and Anti-Inflammatory Activity of Apple Polyphenol Phloretin on Respiratory Pathogens Associated With Chronic Obstructive Pulmonary Disease. Front Cell Infect Microbiol 2021; 11:652944. [PMID: 34881190 PMCID: PMC8645934 DOI: 10.3389/fcimb.2021.652944] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Bacterial infections contribute to accelerated progression and severity of chronic obstructive pulmonary disease (COPD). Apples have been associated with reduced symptoms of COPD and disease development due to their polyphenolic content. We examined if phloretin, an apple polyphenol, could inhibit bacterial growth and inflammation induced by the main pathogens associated with COPD. Phloretin displayed bacteriostatic and anti-biofilm activity against nontypeable Haemophilus influenzae (NTHi), Moraxella catarrhalis, Streptococcus pneumoniae, and to a lesser extent, Pseudomonas aeruginosa. In vitro, phloretin inhibited NTHi adherence to NCI-H292 cells, a respiratory epithelial cell line. Phloretin also exhibited anti-inflammatory activity in COPD pathogen-induced RAW 264.7 macrophages and human bronchial epithelial cells derived from normal and COPD diseased lungs. In mice, NTHi bacterial load and chemokine (C-X-C motif) ligand 1 (CXCL1), a neutrophil chemoattractant, was attenuated by a diet supplemented with phloretin. Our data suggests that phloretin is a promising antimicrobial and anti-inflammatory nutraceutical for reducing bacterial-induced injury in COPD.
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Affiliation(s)
- Rahel L Birru
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kiflai Bein
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Natalya Bondarchuk
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Heather Wells
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Qiao Lin
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Y Peter Di
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - George D Leikauf
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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45
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Bartziokas K, Kyriakopoulos C, Dounousi E, Kostikas K. Microalbuminuria on admission for acute exacerbation of COPD as a predictor of all-cause mortality and future exacerbations. Postgrad Med J 2021; 99:postgradmedj-2021-141206. [PMID: 34876486 DOI: 10.1136/postgradmedj-2021-141206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/13/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Microalbuminuria (MAB) is a sensitive biomarker of cardiovascular risk that is directly associated with cardiovascular events and mortality. Recent studies have evaluated the presence of MAB in patients with stable chronic obstructive pulmonary disease (COPD) or hospitalised for acute exacerbation of COPD (AECOPD). METHODS We evaluated 320 patients admitted for AECOPD in respiratory medicine departments of two tertiary hospitals. On admission, demographic, clinical and laboratory values and COPD severity were assessed. Patients were evaluated monthly for 1 year, recording new AECOPD and death from any cause. RESULTS Patients with documented MAB (urinary albumin excretion of 30-300 mg/24 hours) on admission had worse lung function (forced expiratory volume in 1 s, %) (mean (SD) 34.2 (13.6)% vs 61.5 (16.7)%), higher modified Medical Research Council (3.6 (1.2) vs 2.1 (0.8)), lower 6 min walk test (171 (63) vs 366 (104)) and more hospitalisation days (9 (2.8) vs 4.7 (1.9)) (p<0.001 for all comparisons). MAB was also correlated with Global Initiative for Chronic Obstructive Lung Disease 2020 COPD stages (p<0.001). In multivariate regression analysis, MAB was a significant predictor of longer hospitalisation duration (OR 6.847, 95% CI 3.050 to 15.370, p<0.0001). Twelve-month follow-up revealed that patients with MAB experienced more AECOPDs (4.6 (3.6) vs 2.2 (3.5), p<0.0001) and deaths, n (%) (52 (36.6) vs 14 (7.8), p<0.001). Kaplan-Meier survival curves demonstrated that patients with MAB presented with increased mortality, AECOPD and hospitalisation for AECOPD risk at 1 year (p<0.001 for all comparisons). CONCLUSIONS The presence of MAB on admission for AECOPD was associated with more severe COPD and prolonged hospitalisation, as well as with higher rates of AECOPD and mortality risk at 1-year follow-up.
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Affiliation(s)
- Konstantinos Bartziokas
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Epirus, Greece
| | - Christos Kyriakopoulos
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Epirus, Greece
| | - Evangelia Dounousi
- Nephrology Department, University of Ioannina Faculty of Medicine, Ioannina, Epirus, Greece
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Epirus, Greece
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Mincham KT, Bruno N, Singanayagam A, Snelgrove RJ. Our evolving view of neutrophils in defining the pathology of chronic lung disease. Immunology 2021; 164:701-721. [PMID: 34547115 PMCID: PMC8561104 DOI: 10.1111/imm.13419] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/13/2022] Open
Abstract
Neutrophils are critical components of the body's immune response to infection, being loaded with a potent arsenal of toxic mediators and displaying immense destructive capacity. Given the potential of neutrophils to impart extensive tissue damage, it is perhaps not surprising that when augmented these cells are also implicated in the pathology of inflammatory diseases. Prominent neutrophilic inflammation is a hallmark feature of patients with chronic lung diseases such as chronic obstructive pulmonary disease, severe asthma, bronchiectasis and cystic fibrosis, with their numbers frequently associating with worse prognosis. Accordingly, it is anticipated that neutrophils are central to the pathology of these diseases and represent an attractive therapeutic target. However, in many instances, evidence directly linking neutrophils to the pathology of disease has remained somewhat circumstantial and strategies that have looked to reduce neutrophilic inflammation in the clinic have proved largely disappointing. We have classically viewed neutrophils as somewhat crude, terminally differentiated, insular and homogeneous protagonists of pathology. However, it is now clear that this does not do the neutrophil justice, and we now recognize that these cells exhibit heterogeneity, a pronounced awareness of the localized environment and a remarkable capacity to interact with and modulate the behaviour of a multitude of cells, even exhibiting anti-inflammatory, pro-resolving and pro-repair functions. In this review, we discuss evidence for the role of neutrophils in chronic lung disease and how our evolving view of these cells may impact upon our perceived assessment of their contribution to disease pathology and efforts to target them therapeutically.
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Affiliation(s)
- Kyle T. Mincham
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Nicoletta Bruno
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Aran Singanayagam
- National Heart and Lung InstituteImperial College LondonLondonUK
- Department of Infectious DiseaseImperial College LondonLondonUK
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Shafiek H, Verdú J, Iglesias A, Ramon-Clar L, Toledo-Pons N, Lopez-Causape C, Juan C, Fraile-Ribot P, Oliver A, Cosio BG. Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD. BMJ Open Respir Res 2021; 8:e001067. [PMID: 34615691 PMCID: PMC8496398 DOI: 10.1136/bmjresp-2021-001067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease (COPD) with frequent exacerbations (ExCOPD) are commonly treated with inhaled corticosteroids (ICS) and are at risk of infections caused by potential pathogenic bacteria (PPB) including Pseudomonas aeruginosa (PsA). OBJECTIVES To investigate the association between the use of ICS and PsA infection among ExCOPD. METHODS Case-control study with longitudinal follow-up that recruited ExCOPD after a hospitalisation due to exacerbation between 2012 and 2020. Patients with isolation of PsA (COPD-PsA) in sputum either during admission or follow-up were compared with those with other or no PPB. Clinical, functional characteristics, DDD, use of ICS and survival were evaluated. Cox regression analysis was performed to evaluate the risk factors associated to PsA infection and mortality. RESULTS 358 patients (78% male, mean age 73±9 years) were enrolled and followed up for a median of 4 years (IQR=3-8). 173 patients (48.3%) had at least a positive culture for PsA. COPD-PsA had more frequent exacerbations, more severe airflow limitation and higher mortality (69.4% vs 46.5%, p<0.001). There were no differences in the use of ICS between groups but the dose of ICS was significantly higher among COPD-PsA (median of 500 µg fluticasone propionate equivalents (IQR=250-1000) vs 400 µg (IQR=200-1000), p=0.007). Blood eosinophil count (BEC) was not different between ICS users and non-users. In multivariate analysis, the dose of ICS was an independent risk factor for PsA infection and mortality but not ICS use. CONCLUSIONS ICS dose, but not its use, could be a risk factor for PsA infection in patients with severe COPD regardless of BEC.
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Affiliation(s)
- Hanaa Shafiek
- Department of Chest Diseases, Alexandria University Faculty of Medicine, Alexandria, Egypt
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Javier Verdú
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Amanda Iglesias
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Lluisa Ramon-Clar
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Nuria Toledo-Pons
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Carla Lopez-Causape
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
- Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Carlos Juan
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
- Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Pablo Fraile-Ribot
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
- Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Antonio Oliver
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
- Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Borja G Cosio
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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Thomas B, Koh MS, O'Callaghan C, Allen JC, Rutman A, Hirst RA, Connolly J, Low SY, Thun How O, Chian Min L, Lim WT, Lin Ean Oon L, He Q, Teoh OH, Lapperre TS. Dysfunctional Bronchial Cilia Are a Feature of Chronic Obstructive Pulmonary Disease (COPD). COPD 2021; 18:657-663. [PMID: 34468237 DOI: 10.1080/15412555.2021.1963695] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Impaired mucociliary clearance may increase COPD exacerbation risk. We aimed to compare bronchial ciliary function and epithelial ultrastructure of COPD patients to healthy controls and explore its relationship to exacerbator phenotypes (frequent [FE] and infrequent [IFE] exacerbator). In this cross-sectional study, 16 COPD patients and 12 controls underwent bronchial brushings. Ciliary beat frequency (CBF) and dyskinesia index (DI; % of dyskinetic cilia) were assessed using digital high-speed video microscopy, and epithelial ultrastructure using transmission electron microscopy (TEM). Bronchial epithelium in COPD showed lower CBF and higher DI, compared to controls (median [IQR] CBF: 6.8 (6.1-7.2) Hz vs 8.5 (7.7-8.9) Hz, p<0.001 and DI: 73.8 (60.7-89.8) % vs 14.5 (11.2-16.9) %, p<0.001, respectively). This was true for FE and IFE phenotypes of COPD, which were similar in terms of bronchial CBF or DI. Subgroup analyses demonstrated lower CBF and higher DI in FE and IFE COPD phenotypes compared to controls, irrespective of smoking status. TEM showed more loss of cilia, extrusion of cells, cytoplasmic blebs and dead cells in COPD patients versus controls. Profound dysfunction of bronchial cilia is a feature of COPD irrespective of exacerbation phenotype and smoking status, which is likely to contribute to poor mucus clearance in COPD.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1963695 .
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Affiliation(s)
- Biju Thomas
- Department of Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mariko Siyue Koh
- Duke-NUS Medical School, Singapore, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Christopher O'Callaghan
- Respiratory, Critical Care and Anaesthesia, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - John Carson Allen
- Department of Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Andrew Rutman
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Robert Anthony Hirst
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - John Connolly
- A*STAR, Institute of Molecular and Cell Biology, Singapore, Singapore
| | - Su Ying Low
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Ong Thun How
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Loo Chian Min
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Wan Teck Lim
- Duke-NUS Medical School, Singapore, Singapore.,A*STAR, Institute of Molecular and Cell Biology, Singapore, Singapore.,Singhealth Investigational Medicine Unit, Singapore General Hospital, Singapore, Singapore
| | - Lynette Lin Ean Oon
- Duke-NUS Medical School, Singapore, Singapore.,Department of Molecular Pathology, Singapore General Hospital, Singapore, Singapore
| | - Qixian He
- Department of Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Oon Hoe Teoh
- Department of Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Therese Sophie Lapperre
- Duke-NUS Medical School, Singapore, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.,Department of Pulmonology, University Hospital Antwerp, Antwerp, Belgium.,Laboratory of Experimental Medicine and Paediatrics, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
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Chronic Obstructive Pulmonary Disease as a Phenotype of Bronchiectasis for Long-Term Clinical Presentation and Treatment. ACTA ACUST UNITED AC 2021; 57:medicina57060579. [PMID: 34198847 PMCID: PMC8226788 DOI: 10.3390/medicina57060579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Bronchiectasis and chronic obstructive pulmonary disease (COPD) often coexist, although the causality is not currently clear. Currently, the clinical influence of COPD on patients with major bronchiectasis over time has not yet been investigated. Material and Methods: This retrospective study recruited consecutive patients with bronchiectasis from outpatient clinic between January 2006 and December 2007. Under the setting of quantification with HRCT, patients who should undergo multiple pulmonary function and exercise tests with regularclinic follow-up were included. The final analysis consisted of 66 eligible patients who were evaluated for clinical status, treatment, and sputum culture from up to 10-year electronic medical records. Results: Of these 66 patients, 45 (68%) had bronchiectasis without COPD and 21 (32%) had COPD. Patients with COPD group had a higher bronchiectasis extent score (32.21 ± 13.09 points vs. 21.89 ± 10.08 points, p = 0.001). Sputum production was reported more frequently by patients with COPD; however, no significant difference was observed after 3 years of follow-up (82.4% vs. 81.6%, p = 0.945). Bronchiectasis extent score correlated with positive sputum culture with Pseudomonas without a synergistic effect from COPD (odds ratio: 1.06, confidence interval: 1.00–1.12, p = 0.031). Regardless of COPD, after 10 years, the proportion of patients using inhaled corticosteroids and/or long-acting β2-agonist between the two groups was not significantly different. Conclusion: COPD aggravated bronchiectasis extension, which was correlated with chronic Pseudomonas aeruginosa colonisation. Moreover, COPD would affect the medium-term (in 3–5 years) bronchiectasis treatment. Therefore, the COPD phenotype of bronchiectasis could be a clinical predictor of the course of treatment.
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Martinez-Garcia MÁ, Faner R, Oscullo G, la Rosa-Carrillo D, Soler-Cataluña JJ, Ballester M, Muriel A, Agusti A. Chronic bronchial infection and incident cardiovascular events in chronic obstructive pulmonary disease patients: A long-term observational study. Respirology 2021; 26:776-785. [PMID: 34002922 DOI: 10.1111/resp.14086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/27/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Cardiovascular (CV) diseases are frequent in patients with chronic obstructive pulmonary disease (COPD). Likewise, chronic bronchial infection (CBI) is also frequent in COPD and it is associated with systemic inflammation, a well-known CV risk factor. The objective of this study was to investigate the relationship between CBI, systemic inflammation and incident CV events. METHODS A post hoc analysis of prospectively collected cohort of 201 COPD patients [Global Initiative for Chronic Obstructive Lung Disease (GOLD) II-IV] followed up every 3-6 months for 84 months was conducted. CBI was defined as ≥3 positive pathogenic microorganisms sputum cultures over 1 year, separated by ≥3 months. Systemic inflammation was assessed by circulating levels of C-reactive protein and fibrinogen. Fatal and non-fatal CV events, including coronary and cerebrovascular events as well as arrhythmia episodes, were prospectively recorded. For analysis, they were analysed separately and combined in a composite variable. RESULTS As hypothesized, CBI was associated with persistent systemic inflammation and a significantly higher incidence of CV events (HR: 3.88; 95% CI: 1.83-8.22), mainly of coronary origin independent of age, number and severity of exacerbations, comorbidities, other CV risk factors, lung function, BMI, smoking status and treatments. These associations were particularly significant in patients with CBI by Pseudomonas aeruginosa (PA). CONCLUSION CBI, particularly by PA, is associated with sustained and enhanced systemic inflammation and a higher incidence of CV events (especially coronary events). The possibility that treating CBI may decrease systemic inflammation and CV events in COPD deserves prospective, interventional studies.
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Affiliation(s)
- Miguel Ángel Martinez-Garcia
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Faner
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Institut d'investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Grace Oscullo
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Marta Ballester
- Pneumology Unit, Hospital General de Requena, Valencia, Spain
| | - Alfonso Muriel
- Biostatistic Unit, Hospital Ramón y Cajal, IRYCIS, CIBERESP and Universidad de Alcalá, Madrid, Spain
| | - Alvar Agusti
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Institut d'investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Respiratory Institute, Hospital Clinic University, Barcelona, Spain
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