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Yombo DJK, Madala SK, Vemulapalli CP, Ediga HH, Hardie WD. Pulmonary fibroelastosis - A review. Matrix Biol 2023; 124:1-7. [PMID: 37922998 PMCID: PMC10841596 DOI: 10.1016/j.matbio.2023.10.003] [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: 07/10/2023] [Revised: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Elastin is a long-lived fibrous protein that is abundant in the extracellular matrix of the lung. Elastic fibers provide the lung the characteristic elasticity during inhalation with recoil during exhalation thereby ensuring efficient gas exchange. Excessive deposition of elastin and other extracellular matrix proteins reduces lung compliance by impairing ventilation and compromising gas exchange. Notably, the degree of elastosis is associated with the progressive decline in lung function and survival in patients with interstitial lung diseases. Currently there are no proven therapies which effectively reduce the elastin burden in the lung nor prevent dysregulated elastosis. This review describes elastin's role in the healthy lung, summarizes elastosis in pulmonary diseases, and evaluates the current understanding of elastin regulation and dysregulation with the goal of guiding future research efforts to develop novel and effective therapies.
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Affiliation(s)
- Dan J K Yombo
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, OH, USA
| | - Satish K Madala
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio USA
| | - Chanukya P Vemulapalli
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio USA
| | - Harshavardhana H Ediga
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio USA
| | - William D Hardie
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, OH, USA.
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Soumagne T, Quétant S, Guillien A, Falque L, Hess D, Aguilaniu B, Degano B. Insight into the relationship between forced vital capacity and transfer of the lungs for carbon monoxide in patients with idiopathic pulmonary fibrosis. Respir Med Res 2023; 84:101042. [PMID: 37734234 DOI: 10.1016/j.resmer.2023.101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/17/2023] [Accepted: 07/11/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Forced vital capacity (FVC) is routinely used to quantify the severity and identify the progression of idiopathic pulmonary fibrosis (IPF). Although less commonly used, lung transfer of carbon monoxide (TLCO) correlates better with the severity of IPF than does FVC. METHODS Aiming at studying how FVC behaves in relation to TLCO, we analysed cross-sectional data from 430 IPF patients, of which 221 had at least 2 assessments (performed 2.4 ± 1.9 years apart) available for longitudinal analyses. Thresholds for identifying "abnormal" FVC and TLCO values were the statistically-defined lower limits of normal (LLN). For patients with longitudinal data, mean annual absolute declines of FVC and TLCO were calculated. RESULTS The correlation between FVC and TLCO (%predicted) was weak (R2=0.21). FVC was "abnormal" (i.e., CONCLUSION In IPF, a "normal" FVC should be viewed with caution as it is most often associated with an "abnormal" TLCO, a parameter that is strongly correlated with the morphological extent of the disease. Only 1/3 of the patients with a FVC-based progression criterion also had a TLCO progression criterion. In contrast, 2/3 of patients with a TLCO progression criterion also had a FVC progression criterion.
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Affiliation(s)
- Thibaud Soumagne
- Service de Pneumologie et Soins intensifs respiratoires, Hôpital Européen Georges-Pompidou, Assistance Publique des hôpitaux de Paris, Paris, France
| | - Sébastien Quétant
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Alicia Guillien
- Épidemiologie environnementale appliquée à la reproduction et à la santé respiratoire, INSERM, CNRS, Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), U1209, Grenoble, France
| | - Loïc Falque
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - David Hess
- Programme Colibri, Association pour la complémentarité des connaissances et des pratiques de la pneumologie (aCCPP), 19 avenue Marcelin Berthelot, 38100, Grenoble, France
| | - Bernard Aguilaniu
- Programme Colibri, Association pour la complémentarité des connaissances et des pratiques de la pneumologie (aCCPP), 19 avenue Marcelin Berthelot, 38100, Grenoble, France; Université Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Laboratoire HP2, INSERM U1300, Université Grenoble Alpes, Grenoble, France.
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Ishida Y, Kuninaka Y, Mukaida N, Kondo T. Immune Mechanisms of Pulmonary Fibrosis with Bleomycin. Int J Mol Sci 2023; 24:ijms24043149. [PMID: 36834561 PMCID: PMC9958859 DOI: 10.3390/ijms24043149] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Fibrosis and structural remodeling of the lung tissue can significantly impair lung function, often with fatal consequences. The etiology of pulmonary fibrosis (PF) is diverse and includes different triggers such as allergens, chemicals, radiation, and environmental particles. However, the cause of idiopathic PF (IPF), one of the most common forms of PF, remains unknown. Experimental models have been developed to study the mechanisms of PF, and the murine bleomycin (BLM) model has received the most attention. Epithelial injury, inflammation, epithelial-mesenchymal transition (EMT), myofibroblast activation, and repeated tissue injury are important initiators of fibrosis. In this review, we examined the common mechanisms of lung wound-healing responses after BLM-induced lung injury as well as the pathogenesis of the most common PF. A three-stage model of wound repair involving injury, inflammation, and repair is outlined. Dysregulation of one or more of these three phases has been reported in many cases of PF. We reviewed the literature investigating PF pathogenesis, and the role of cytokines, chemokines, growth factors, and matrix feeding in an animal model of BLM-induced PF.
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Cell-Specific Response of NSIP- and IPF-Derived Fibroblasts to the Modification of the Elasticity, Biological Properties, and 3D Architecture of the Substrate. Int J Mol Sci 2022; 23:ijms232314714. [PMID: 36499041 PMCID: PMC9738992 DOI: 10.3390/ijms232314714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
Abstract
The fibrotic fibroblasts derived from idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP) are surrounded by specific environments, characterized by increased stiffness, aberrant extracellular matrix (ECM) composition, and altered lung architecture. The presented research was aimed at investigating the effect of biological, physical, and topographical modification of the substrate on the properties of IPF- and NSIP-derived fibroblasts, and searching for the parameters enabling their identification. Soft and stiff polydimethylsiloxane (PDMS) was chosen for the basic substrates, the properties of which were subsequently tuned. To obtain the biological modification of the substrates, they were covered with ECM proteins, laminin, fibronectin, and collagen. The substrates that mimicked the 3D structure of the lungs were prepared using two approaches, resulting in porous structures that resemble natural lung architecture and honeycomb patterns, typical of IPF tissue. The growth of cells on soft and stiff PDMS covered with proteins, traced using fluorescence microscopy, confirmed an altered behavior of healthy and IPF- and NSIP-derived fibroblasts in response to the modified substrate properties, enabling their identification. In turn, differences in the mechanical properties of healthy and fibrotic fibroblasts, determined using atomic force microscopy working in force spectroscopy mode, as well as their growth on 3D-patterned substrates were not sufficient to discriminate between cell lines.
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Gong H, Chen L, He Y, Hua K, Ma B, Gao Y, Xu X, Hu X, Jin H. Pleural thickening induced by Glaesserella parasuis infection was linked to increased collagen and elastin. Front Cell Infect Microbiol 2022; 12:952377. [PMID: 36034702 PMCID: PMC9409878 DOI: 10.3389/fcimb.2022.952377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Glaesserella parasuis is well-known for causing Glässer’s disease, which costs the worldwide swine industry millions of dollars each year. It has been reported the symptom of pleural thickening during Glässer’s disease but this symptom has received little attention. And there is no research on the elements which promote pleural thickening. In this study, pleural thickening was discovered to be associated with increased collagen fibers and elastic fibers. Furthermore, collagen-I and elastin were found to be up-regulated and concentrated in the pleura at the mRNA and protein levels following infection. To summarize, our findings add to the theoretical understanding of Glässer’s disease and provide strong support for further research into the pathogenic mechanism of Glaesserella parasuis and the program’s target treatment.
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Affiliation(s)
- Huimin Gong
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China
- College of Animal Medicine, Huazhong Agricultural University, Wuhan, China
- Hubei Provincial Key Laboratory of Preventive Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Liying Chen
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China
- College of Animal Medicine, Huazhong Agricultural University, Wuhan, China
- Hubei Provincial Key Laboratory of Preventive Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Yanling He
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China
- College of Animal Medicine, Huazhong Agricultural University, Wuhan, China
- Hubei Provincial Key Laboratory of Preventive Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Kexin Hua
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China
- College of Animal Medicine, Huazhong Agricultural University, Wuhan, China
- Hubei Provincial Key Laboratory of Preventive Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Bin Ma
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China
- College of Animal Medicine, Huazhong Agricultural University, Wuhan, China
- Hubei Provincial Key Laboratory of Preventive Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Yuan Gao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China
- College of Animal Medicine, Huazhong Agricultural University, Wuhan, China
- Hubei Provincial Key Laboratory of Preventive Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Xiaojuan Xu
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China
- Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Xueying Hu
- College of Animal Medicine, Huazhong Agricultural University, Wuhan, China
| | - Hui Jin
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China
- College of Animal Medicine, Huazhong Agricultural University, Wuhan, China
- Hubei Provincial Key Laboratory of Preventive Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
- *Correspondence: Hui Jin,
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Duhig EE. Usual interstitial pneumonia: a review of the pathogenesis and discussion of elastin fibres, type II pneumocytes and proposed roles in the pathogenesis. Pathology 2022; 54:517-525. [PMID: 35778287 DOI: 10.1016/j.pathol.2022.05.002] [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: 05/11/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
The pathogenesis of idiopathic pulmonary fibrosis (IPF) and its histological counterpart, usual interstitial pneumonia (UIP) remains debated. IPF/UIP is a disease characterised by respiratory restriction, and while there have been recent advances in treatment, mortality remains high. Genetic and environmental factors predispose to its development and aberrant alveolar repair is thought to be central. Following alveolar injury, the type II pneumocyte (AEC2) replaces the damaged thin type I pneumocytes. Despite the interstitial fibroblast being considered instrumental in formation of the fibrosis, there has been little consideration for a role for AEC2 in the repair of the septal interstitium. Elastin is a complex protein that conveys flexibility and recoil to the lung. The fibroblast is presumed to produce elastin but there is evidence that the AEC2 may have a role in production or deposition. While the lung is an elastic organ, the role of elastin in repair of lung injury and its possible role in UIP has not been explored in depth. In this paper, pathogenetic mechanisms of UIP involving AEC2 and elastin are reviewed and the possible role of AEC2 in elastin generation is proposed.
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Affiliation(s)
- Edwina E Duhig
- Sullivan Nicolaides Pathology, The John Flynn Hospital, Tugun, Qld, Australia; UQ Thoracic Research Centre, The Prince Charles Hospital, Chermside, Qld, Australia; Faculty of Medicine, The University of Queensland, Herston, Qld, Australia.
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7
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Orzechowska B, Awsiuk K, Wnuk D, Pabijan J, Stachura T, Soja J, Sładek K, Raczkowska J. Discrimination between NSIP- and IPF-Derived Fibroblasts Based on Multi-Parameter Characterization of Their Growth, Morphology and Physic-Chemical Properties. Int J Mol Sci 2022; 23:ijms23042162. [PMID: 35216278 PMCID: PMC8880018 DOI: 10.3390/ijms23042162] [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: 01/20/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The aim of the research presented here was to find a set of parameters enabling discrimination between three types of fibroblasts, i.e., healthy ones and those derived from two disorders mimicking each other: idiopathic pulmonary fibrosis (IPF), and nonspecific interstitial pneumonia (NSIP). Methods: The morphology and growth of cells were traced using fluorescence microscopy and analyzed quantitatively using cell proliferation and substrate cytotoxicity indices. The viability of cells was recorded using MTS assays, and their stiffness was examined using atomic force microscopy (AFM) working in force spectroscopy (FS) mode. To enhance any possible difference in the examined parameters, experiments were performed with cells cultured on substrates of different elasticities. Moreover, the chemical composition of cells was determined using time-of-flight secondary ion mass spectrometry (ToF-SIMS), combined with sophisticated analytical tools, i.e., Multivariate Curve Resolution (MCR) and Principal Component Analysis (PCA). Results: The obtained results demonstrate that discrimination between cell lines derived from healthy and diseased patients is possible based on the analysis of the growth of cells, as well as their physical and chemical properties. In turn, the comparative analysis of the cellular response to altered stiffness of the substrates enables the identification of each cell line, including distinguishing between IPF- and NSIP-derived fibroblasts.
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Affiliation(s)
- Barbara Orzechowska
- Institute of Nuclear Physics Polish Academy of Sciences, Radzikowskiego 152, 31-342 Krakow, Poland; (B.O.); (J.P.)
| | - Kamil Awsiuk
- The Marian Smoluchowski Institute of Physics, Jagiellonian University, Łojasiewicza 11, 30-428 Krakow, Poland;
- Jagiellonian Center of Biomedical Imaging, Jagiellonian University, Łojasiewicza 11, 30-348 Krakow, Poland
| | - Dawid Wnuk
- Department of Cell Biology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387 Krakow, Poland;
| | - Joanna Pabijan
- Institute of Nuclear Physics Polish Academy of Sciences, Radzikowskiego 152, 31-342 Krakow, Poland; (B.O.); (J.P.)
| | - Tomasz Stachura
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Krakow, Poland; (T.S.); (J.S.); (K.S.)
| | - Jerzy Soja
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Krakow, Poland; (T.S.); (J.S.); (K.S.)
| | - Krzysztof Sładek
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Krakow, Poland; (T.S.); (J.S.); (K.S.)
| | - Joanna Raczkowska
- The Marian Smoluchowski Institute of Physics, Jagiellonian University, Łojasiewicza 11, 30-428 Krakow, Poland;
- Jagiellonian Center of Biomedical Imaging, Jagiellonian University, Łojasiewicza 11, 30-348 Krakow, Poland
- Correspondence:
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8
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Gad El-Hak HN, Mohamed OE, Nabil ZI. Evaluating the protective role of Deglycyrrhizinated licorice root supplement on bleomycin induced pulmonary oxidative damage. Toxicol Mech Methods 2021; 32:180-193. [PMID: 34488542 DOI: 10.1080/15376516.2021.1977881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The goal of this study was to investigate the protective effect of licorice supplements in a rat model of Bleomycin-induced lung oxidative damage over a duration of one month. The rats were randomly divided into six groups (n = 10 per group). Control group; Bleomycin group (B): rats were IP injected with bleomycin 5 mg/kg twice weekly. Licorice group (L): rats received orally 300 mg/kg licorice extract. Bleomycin and a low dose of Licorice group (BLLG): rats received orally 75 mg/kg licorice daily and injected as the B group. Bleomycin and a middle dose of Licorice group (BMLG): rats received orally 150 mg/kg licorice daily and injected as the Bleomycin group. Bleomycin and a high dose of Licorice group (BHLG): rats received orally 300 mg/kg licorice daily and injected as the Bleomycin group. Treatment with Bleomycin induced inflammation and oxidative damage to the lungs expressed in the disturbance of the measured parameters in the blood serum, the lung tissue, and the broncholavage fluid. In addition to the decreased expression of superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), and catalase (CAT) in the lung tissues. Bleomycin caused deformative changes in the histopathological and cellular examination of the lungs especially in the alveolar cells and the interstitial space. On the other hand, treated the bleomycin group with different doses of licorice supplement activates the antioxidant defense mechanism and attenuates the oxidative damage and damage induced to the lung. In conclusion, Deglycyrrhizinated licorice root supplement provided strong antioxidant and protective effects on Bleomycin-induced lung damage.
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Affiliation(s)
- Heba N Gad El-Hak
- Zoology Department, Faculty of Science, Suez Canal University, Ismailia, Egypt
| | - Osman E Mohamed
- Zoology Department, Faculty of Science, Suez Canal University, Ismailia, Egypt
| | - Zohour I Nabil
- Zoology Department, Faculty of Science, Suez Canal University, Ismailia, Egypt
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9
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Thunnissen E, Motoi N, Minami Y, Matsubara D, Timens W, Nakatani Y, Ishikawa Y, Baez-Navarro X, Radonic T, Blaauwgeers H, Borczuk AC, Noguchi M. Elastin in pulmonary pathology: relevance in tumors with lepidic or papillary appearance. A comprehensive understanding from a morphological viewpoint. Histopathology 2021; 80:457-467. [PMID: 34355407 PMCID: PMC9293161 DOI: 10.1111/his.14537] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/22/2021] [Accepted: 08/03/2021] [Indexed: 11/08/2022]
Abstract
Elastin and collagen are the main components of the lung connective tissue network, and together provide the lung with elasticity and tensile strength. In pulmonary pathology, elastin staining is used to variable extents in different countries. These uses include evaluation of the pleura in staging, and the distinction of invasion from collapse of alveoli after surgery (iatrogenic collapse). In the latter, elastin staining is used to highlight distorted but pre‐existing alveolar architecture from true invasion. In addition to variable levels of use and experience, the interpretation of elastin staining in some adenocarcinomas leads to interpretative differences between collapsed lepidic patterns and true papillary patterns. This review aims to summarise the existing data on the use of elastin staining in pulmonary pathology, on the basis of literature data and morphological characteristics. The effect of iatrogenic collapse and the interpretation of elastin staining in pulmonary adenocarcinomas is discussed in detail, especially for the distinction between lepidic patterns and papillary carcinoma.
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Affiliation(s)
- Erik Thunnissen
- Department of Pathology, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Noriko Motoi
- Dept. of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Minami
- National Organization Hospital Ibarakihigashi National Hospital, The Center of Chest Diseases and Severe Motor & Intellectual Disabilities, Pathology Department, Tokai-mura, Naka-gun, Ibaraki, Japan
| | - Daisuke Matsubara
- Division of Integrative Pathology, Jichi Medical University, Tochigi, Japan
| | - Wim Timens
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands
| | - Yukio Nakatani
- Department of Pathology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Yuichi Ishikawa
- Department of Pathology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | | | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Hans Blaauwgeers
- Department of Pathology, OLVG LAB BV, Amsterdam, the Netherlands
| | - Alain C Borczuk
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Masayuki Noguchi
- Department of Pathology, Institute of Basic Medical Sciences, University of Tsukuba, Tsukuba, Japan
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Pulmonary Fibroelastotic Remodelling Revisited. Cells 2021; 10:cells10061362. [PMID: 34205982 PMCID: PMC8227669 DOI: 10.3390/cells10061362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/27/2022] Open
Abstract
Pulmonary fibroelastotic remodelling occurs within a broad spectrum of diseases with vastly divergent outcomes. So far, no comprehensive terminology has been established to adequately address and distinguish histomorphological and clinical entities. We aimed to describe the range of fibroelastotic changes and define stringent histological criteria. Furthermore, we wanted to clarify the corresponding terminology in order to distinguish clinically relevant variants of pulmonary fibroelastotic remodelling. We revisited pulmonary specimens with fibroelastotic remodelling sampled during the last ten years at a large European lung transplant centre. Consensus-based definitions of specific variants of fibroelastotic changes were developed on the basis of well-defined cases and applied. Systematic evaluation was performed in a steps-wise algorithm, first identifying the fulcrum of the respective lesions, and then assessing the morphological changes, their distribution and the features of the adjacent parenchyma. We defined typical alveolar fibro-elastosis as collagenous effacement of the alveolar spaces with accompanying hyper-elastosis of the remodelled and paucicellular alveolar walls, independent of the underlying disease in 45 cases. Clinically, this pattern could be seen in (idiopathic) pleuroparenchymal fibro-elastosis, interstitial lung disease with concomitant alveolar fibro-elastosis, following hematopoietic stem cell and lung transplantation, autoimmune disease, radio-/chemotherapy, and pulmonary apical caps. Novel in-transit and activity stages of fibroelastotic remodelling were identified. For the first time, we present a comprehensive definition of fibroelastotic remodelling, its anatomic distribution, and clinical associations, thereby providing a basis for stringent patient stratification and prediction of outcome.
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Mlika M, Bacha S, Braham E, El Mezni F. The inter-connection between fibrosis and microvascular remodeling in idiopathic pulmonary fibrosis: Reality or just a phenomenon. Respir Med Case Rep 2015; 17:30-3. [PMID: 27222781 PMCID: PMC4821327 DOI: 10.1016/j.rmcr.2015.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 11/29/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis is the most frequent interstitial disease with the worst prognosis. It is characterized by an uncontrolled fibrosis which is difficult to manage. The pathogenesis of this disease remains unclear with many theories resulting in multiple target therapies. The relation between fibrosis and vascular remodeling has been debated in the literature with different results that may seem contradictory. AIM We target to evaluate the connection between fibrosis and vascular remodeling in usual interstitial pneumonia. MATERIAL AND METHODS 26 cases of idiopathic pulmonary fibrosis were reviewed by 2 pathologists and the diagnosis of UIP was retained according to the American Thoracic Society's criteria. Fibrotic changes and vascular remodeling were evaluated blindly. The fibrotic changes were classified as severe, intermediate and mild. Vascular occlusion was graded in 4 grades extending from medial hypertrophy (grade 1) to plexiform lesions of the vascular wall (grade 4). RESULTS We noticed that severe degrees of fibrosis were correlated with severe grades of vascular obstruction. In fact, our 26 cases were classified as severe fibrosis in 11 cases with grade IV vascular lesions in 6 cases, intermediate fibrosis in 12 cases with grade II vascular lesions in 8 cases and mild fibrosis in 3 cases with grade I vascular lesions in all cases. CONCLUSION Many theories have been reported concerning the UIP's pathogenesis. Recently, many authors reported that the primum movens of these lesions was an epithelial/endothelial injury which induces uncontrolled fibrosis and microvascular remodeling using different pathways. This puts emphasis on the necessity of multi-target therapies in order to improve the management of this fatal disease.
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Affiliation(s)
- Mona Mlika
- Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Saoussen Bacha
- Department of Pulmonology, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Emna Braham
- Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Faouzi El Mezni
- Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia
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12
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Second harmonic generation microscopy reveals altered collagen microstructure in usual interstitial pneumonia versus healthy lung. Respir Res 2015; 16:61. [PMID: 26013144 PMCID: PMC4455323 DOI: 10.1186/s12931-015-0220-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 05/13/2015] [Indexed: 01/30/2023] Open
Abstract
Background It is not understood why some pulmonary fibroses such as cryptogenic organizing pneumonia (COP) respond well to treatment, while others like usual interstitial pneumonia (UIP) do not. Increased understanding of the structure and function of the matrix in this area is critical to improving our understanding of the biology of these diseases and developing novel therapies. The objectives herein are to provide new insights into the underlying collagen- and matrix-related biological mechanisms driving COP versus UIP. Methods Two-photon second harmonic generation (SHG) and excitation fluorescence microscopies were used to interrogate and quantify differences between intrinsic fibrillar collagen and elastin matrix signals in healthy, COP, and UIP lung. Results Collagen microstructure was different in UIP versus healthy lung, but not in COP versus healthy, as indicated by the ratio of forward-to-backward propagating SHG signal (FSHG/BSHG). This collagen microstructure as assessed by FSHG/BSHG was also different in areas with preserved alveolar architecture adjacent to UIP fibroblastic foci or honeycomb areas versus healthy lung. Fibrosis was evidenced by increased col1 and col3 content in COP and UIP versus healthy, with highest col1:col3 ratio in UIP. Evidence of elastin breakdown (i.e. reduced mature elastin fiber content), and increased collagen:mature elastin ratios, were seen in COP and UIP versus healthy. Conclusions Fibrillar collagen’s subresolution structure (i.e. “microstructure”) is altered in UIP versus COP and healthy lung, which may provide novel insights into the biological reasons why unlike COP, UIP is resistant to therapies, and demonstrates the ability of SHG microscopy to potentially distinguish treatable versus intractable pulmonary fibroses.
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13
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Wibmer T, Rüdiger S, Scharnbeck D, Radermacher M, Markovic S, Stoiber KM, Rottbauer W, Schumann C. Pulmonary pulse transit time: a novel echocardiographic indicator of hemodynamic and vascular alterations in pulmonary hypertension and pulmonary fibrosis. Echocardiography 2014; 32:904-11. [PMID: 25264113 DOI: 10.1111/echo.12772] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Pulse transit time (PTT) is generally assumed to be a surrogate marker for blood pressure changes and arterial stiffness. The aim was to evaluate whether pulmonary PTT (pPTT) may be noninvasively measured by Doppler echocardiography and whether it might be valuable for detecting pulmonary hemodynamic and vascular alterations. METHODS We defined pPTT as the interval between R-wave in the ECG and the corresponding peak late systolic pulmonary vein flow velocity measured by pw-Doppler in the pulmonary vein. Twelve consecutive patients with pulmonary hypertension (PH) and 12 subjects without any cardiovascular or respiratory disease were included in the study. All patients underwent a standard echocardiography including pPTT measurement. RESULTS In the PH group, 5 patients had idiopathic pulmonary arterial hypertension (WHO 1), 1 patient PH associated with connective tissue disease (CTD, WHO 1) without pulmonary fibrosis (PF), and 6 patients PH associated with PF either due to CTD (WHO 1) or other etiology (WHO 3). Mean pPTT was significantly shorter in the PH group (138.0 ± 16.78 msec; P < 0.0001) than in the control group (383.5 ± 23.84 msec). Within the PH group, the subgroup of patients with PF showed significantly shorter mean pPTT (93.50 ± 15.47 msec; P = 0.004) than the subgroup of patients with PH without PF (182.6 ± 14.35 msec). CONCLUSIONS The results of this study suggest that pPTT might be an interesting surrogate marker of pulmonary hemodynamic and vascular alterations in PH and PF. Further studies are warranted to evaluate the possible influence of other variables on pPTT.
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Affiliation(s)
- Thomas Wibmer
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Stefan Rüdiger
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Dominik Scharnbeck
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Michael Radermacher
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Kathrin M Stoiber
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Christian Schumann
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
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Parra ER, Pincelli MS, Teodoro WR, Velosa APP, Martins V, Rangel MP, Barbas-Filho JV, Capelozzi VL. Modeling pulmonary fibrosis by abnormal expression of telomerase/apoptosis/collagen V in experimental usual interstitial pneumonia. ACTA ACUST UNITED AC 2014; 47:567-75. [PMID: 24919172 PMCID: PMC4123836 DOI: 10.1590/1414-431x20143522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 03/06/2014] [Indexed: 11/22/2022]
Abstract
Limitations on tissue proliferation capacity determined by telomerase/apoptosis
balance have been implicated in pathogenesis of idiopathic pulmonary fibrosis. In
addition, collagen V shows promise as an inductor of apoptosis. We evaluated the
quantitative relationship between the telomerase/apoptosis index, collagen V
synthesis, and epithelial/fibroblast replication in mice exposed to butylated
hydroxytoluene (BHT) at high oxygen concentration. Two groups of mice were analyzed:
20 mice received BHT, and 10 control mice received corn oil. Telomerase expression,
apoptosis, collagen I, III, and V fibers, and hydroxyproline were evaluated by
immunohistochemistry, in situ detection of apoptosis, electron
microscopy, immunofluorescence, and histomorphometry. Electron microscopy confirmed
the presence of increased alveolar epithelial cells type 1 (AEC1) in apoptosis.
Immunostaining showed increased nuclear expression of telomerase in AEC type 2 (AEC2)
between normal and chronic scarring areas of usual interstitial pneumonia (UIP).
Control lungs and normal areas from UIP lungs showed weak green birefringence of type
I and III collagens in the alveolar wall and type V collagen in the basement membrane
of alveolar capillaries. The increase in collagen V was greater than collagens I and
III in scarring areas of UIP. A significant direct association was found between
collagen V and AEC2 apoptosis. We concluded that telomerase, collagen V fiber
density, and apoptosis evaluation in experimental UIP offers the potential to control
reepithelization of alveolar septa and fibroblast proliferation. Strategies aimed at
preventing high rates of collagen V synthesis, or local responses to high rates of
cell apoptosis, may have a significant impact in pulmonary fibrosis.
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Affiliation(s)
- E R Parra
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S Pincelli
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - W R Teodoro
- Disciplina de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A P P Velosa
- Disciplina de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - V Martins
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M P Rangel
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J V Barbas-Filho
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - V L Capelozzi
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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15
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Miele A, Dhaliwal K, Du Toit N, Murchison JT, Dhaliwal C, Brooks H, Smith SH, Hirani N, Schwarz T, Haslett C, Wallace WA, McGorum BC. Chronic Pleuropulmonary Fibrosis and Elastosis of Aged Donkeys. Chest 2014; 145:1325-1332. [DOI: 10.1378/chest.13-1306] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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16
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Parra ER, Aguiar Junior AC, Silva LO, Souza HSP, Espinoza JD, Capelozzi VL. Morphometric evaluation of nitric oxide synthase isoforms and their cytokine regulators predict pulmonary dysfunction and survival in systemic sclerosis. Braz J Med Biol Res 2013; 46:881-91. [PMID: 24141615 PMCID: PMC3854315 DOI: 10.1590/1414-431x20133061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 08/06/2013] [Indexed: 01/08/2023] Open
Abstract
Because histopathological changes in the lungs of patients with systemic
sclerosis (SSc) are consistent with alveolar and vessel cell damage, we presume
that this interaction can be characterized by analyzing the expression of
proteins regulating nitric oxide (NO) and plasminogen activator inhibitor-1
(PAI-1) synthesis. To validate the importance of alveolar-vascular interactions
and to explore the quantitative relationship between these factors and other
clinical data, we studied these markers in 23 cases of SSc nonspecific
interstitial pneumonia (SSc-NSIP). We used immunohistochemistry and morphometry
to evaluate the amount of cells in alveolar septa and vessels staining for NO
synthase (NOS) and PAI-1, and the outcomes of our study were cellular and
fibrotic NSIP, pulmonary function tests, and survival time until death. General
linear model analysis demonstrated that staining for septal inducible NOS (iNOS)
related significantly to staining of septal cells for interleukin (IL)-4 and to
septal IL-13. In univariate analysis, higher levels of septal and vascular cells
staining for iNOS were associated with a smaller percentage of septal and
vascular cells expressing fibroblast growth factor and myofibroblast
proliferation, respectively. Multivariate Cox model analysis demonstrated that,
after controlling for SSc-NSIP histological patterns, just three variables were
significantly associated with survival time: septal iNOS (P=0.04), septal IL-13
(P=0.03), and septal basic fibroblast growth factor (bFGF; P=0.02). Augmented
NOS, IL-13, and bFGF in SSc-NSIP histological patterns suggest a possible
functional role for iNOS in SSc. In addition, the extent of iNOS, PAI-1, and
IL-4 staining in alveolar septa and vessels provides a possible independent
diagnostic measure for the degree of pulmonary dysfunction and fibrosis with an
impact on the survival of patients with SSc.
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Affiliation(s)
- E R Parra
- Universidade de São Paulo, Departamento de Patologia, Faculdade de Medicina, São Paulo,SP, Brasil
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17
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Silva PHRQD, Parra ER, Zocolaro WS, Narde I, Rodrigues F, Kairalla RA, Carvalho CRRD, Capelozzi VL. Imunofenotipagem e remodelamento da matriz extracelular na sarcoidose pulmonar e extrapulmonar. J Bras Pneumol 2012; 38:321-30. [DOI: 10.1590/s1806-37132012000300007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 02/28/2012] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Investigar o significado de marcadores de imunidade celular e de componentes elásticos/colágeno da matriz extracelular em estruturas granulomatosas em biópsias de pacientes com sarcoidose pulmonar ou extrapulmonar. MÉTODOS: Determinações qualitativas e quantitativas de células inflamatórias, de fibras de colágeno e de fibras elásticas em estruturas granulomatosas em biópsias cirúrgicas de 40 pacientes com sarcoidose pulmonar e extrapulmonar foram realizadas por histomorfometria, imuno-histoquímica, e técnicas de coloração com picrosirius e resorcina-fucsina de Weigert. RESULTADOS: A densidade de linfócitos, macrófagos e neutrófilos nas biópsias extrapulmonares foi significativamente maior do que nas biópsias pulmonares. Os granulomas pulmonares apresentaram uma quantidade significativamente maior de fibras de colágeno e menor densidade de fibras elásticas que os granulomas extrapulmonares. A quantidade de macrófagos nos granulomas pulmonares correlacionou-se com CVF (p < 0,05), ao passo que as quantidades de linfócitos CD3+, CD4+ e CD8+ correlacionaram-se com a relação VEF1/CVF e com CV. Houve correlações negativas entre CPT e contagem de células CD1a+ (p < 0,05) e entre DLCO e densidade de fibras colágenas/elásticas (r = -0,90; p = 0,04). CONCLUSÕES: A imunofenotipagem e o remodelamento apresentaram características diferentes nas biópsias dos pacientes com sarcoidose pulmonar e extrapulmonar. Essas diferenças correlacionaram-se com os dados clínicos e espirométricos dos pacientes, sugerindo que há duas vias envolvidas no mecanismo de depuração de antígenos, que foi mais eficaz nos pulmões e linfonodos.
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Affiliation(s)
| | | | | | - Ivy Narde
- Universidade de São Paulo, São Paulo, Brasil
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18
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Parra ER, Falzoni R, Capelozzi VL. Vascular dysfunction by myofibroblast activation in patients with idiopathic pulmonary fibrosis and prognostic significance. Braz J Med Biol Res 2012; 45:665-75. [PMID: 22527129 PMCID: PMC3854274 DOI: 10.1590/s0100-879x2012007500066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 04/09/2012] [Indexed: 11/23/2022] Open
Abstract
In this study, we demonstrated the importance of telomerase protein expression and determined the relationships among telomerase, endothelin-1 (ET-1) and myofibroblasts during early and late remodeling of parenchymal and vascular areas in usual interstitial pneumonia (UIP) using 27 surgical lung biopsies from patients with idiopathic pulmonary fibrosis (IPF). Telomerase+, myofibroblasts α-SMA+, smooth muscle cells caldesmon+, endothelium ET-1+ cellularity, and fibrosis severity were evaluated in 30 fields covering normal lung parenchyma, minimal fibrosis (fibroblastic foci), severe (mural) fibrosis, and vascular areas of UIP by the point-counting technique and a semiquantitative score. The impact of these markers was determined in pulmonary functional tests and follow-up until death from IPF. Telomerase and ET-1 expression was significantly increased in normal and vascular areas compared to areas of fibroblast foci. Telomerase and ET-1 expression was inversely correlated with minimal fibrosis in areas of fibroblast foci and directly associated with severe fibrosis in vascular areas. Telomerase activity in minimal fibrosis areas was directly associated with diffusing capacity of the lung for oxygen/alveolar volume and ET-1 expression and indirectly associated with diffusing capacity of the lungs for carbon monoxide and severe fibrosis in vascular areas. Cox proportional hazards regression revealed a low risk of death for females with minimal fibrosis displaying high telomerase and ET-1 expression in normal areas. Vascular dysfunction by telomerase/ET-1 expression was found earlier than vascular remodeling by myofibroblast activation in UIP with impact on IPF evolution, suggesting that strategies aimed at preventing the effect of these mediators may have a greater impact on patient outcome.
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Affiliation(s)
- E R Parra
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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19
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Parra ER, Araujo CAL, Lombardi JG, Ab'Saber AM, Carvalho CRR, Kairalla RA, Capelozzi VL. Lymphatic fluctuation in the parenchymal remodeling stage of acute interstitial pneumonia, organizing pneumonia, nonspecific interstitial pneumonia and idiopathic pulmonary fibrosis. ACTA ACUST UNITED AC 2012; 45:466-72. [PMID: 22488224 PMCID: PMC3854286 DOI: 10.1590/s0100-879x2012007500055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 03/21/2012] [Indexed: 11/24/2022]
Abstract
Because the superficial lymphatics in the lungs are distributed in the subpleural, interlobular and peribroncovascular interstitium, lymphatic impairment may occur in the lungs of patients with idiopathic interstitial pneumonias (IIPs) and increase their severity. We investigated the distribution of lymphatics in different remodeling stages of IIPs by immunohistochemistry using the D2-40 antibody. Pulmonary tissue was obtained from 69 patients with acute interstitial pneumonia/diffuse alveolar damage (AIP/DAD, N = 24), cryptogenic organizing pneumonia/organizing pneumonia (COP/OP, N = 6), nonspecific interstitial pneumonia (NSIP/NSIP, N = 20), and idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP, N = 19). D2-40+ lymphatic in the lesions was quantitatively determined and associated with remodeling stage score. We observed an increase in the D2-40+ percent from DAD (6.66 ± 1.11) to UIP (23.45 ± 5.24, P = 0.008) with the advanced process of remodeling stage of the lesions. Kaplan-Meier survival curves showed a better survival for patients with higher lymphatic D2-40+ expression than 9.3%. Lymphatic impairment occurs in the lungs of IIPs and its severity increases according to remodeling stage. The results suggest that disruption of the superficial lymphatics may impair alveolar clearance, delay organ repair and cause severe disease progress mainly in patients with AIP/DAD. Therefore, lymphatic distribution may serve as a surrogate marker for the identification of patients at greatest risk for death due to IIPs.
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Affiliation(s)
- E R Parra
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, Brasil.
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20
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Martins RS, Teodoro WR, Simplício H, Capellozi VL, Siqueira MG, Yoshinari NH, Pereira Plese JP, Teixeira MJ. Influence of Suture on Peripheral Nerve Regeneration and Collagen Production at the Site of Neurorrhaphy: An Experimental Study. Neurosurgery 2011; 68:765-72; discussion 772. [DOI: 10.1227/neu.0b013e3182077332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Roberto Sergio Martins
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, São Paulo University School of Medicine and Hospital do Servidor Público do Estado
| | - Walcy Rosolio Teodoro
- Division of Rheumatology, São Paulo University School of Medicine, São Paulo, Brazil
| | - Hougelle Simplício
- Department of Neurosurgery, São Paulo University School of Medicine, São Paulo, Brazil
| | - Vera Luiza Capellozi
- Departament of Pathology, São Paulo University School of Medicine, São Paulo, Brazil
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Parra ER, Aguiar AC, Teodoro WR, de Souza R, Yoshinari NH, Capelozzi VL. Collagen V and vascular injury promote lung architectural changes in systemic sclerosis. CLINICAL RESPIRATORY JOURNAL 2010; 3:135-42. [PMID: 20298396 DOI: 10.1111/j.1752-699x.2008.00118.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a multisystem disorder characterized by inflammation, fibrosis and vascular damage. The aim of this study was to evaluate the interactions between basement membrane disruption, endothelial injury and collagen V deposition on the vascular wall, as well as their association with pulmonary function tests in patients with SSc. METHOD The endothelial apoptosis was assessed by TUNEL and electron microscopy, and quantified through the point-counting technique. To evaluate basement membrane integrity, laminin immunostaining and electron microscopy were used. Immunofluorescence and morphometric analysis were used to determine the amount of collagen V in the vascular walls in 23 open lung biopsies of patients with SSc without pulmonary hypertension. Normal lung tissue was obtained from five individuals who had died of traumatic injuries. RESULTS The apoptosis index in SSc was higher in the endothelial cells (13.83 +/- 6.83) when compared with the control (2.51 +/- 2.06) group (P < 0.001) and confirmed by electron microscopy. We observed an important disruption of the basement membrane on the vascular wall shown by discontinuous laminin immunostaining and electron microscopy. An increase in collagen V on the vascular wall of the SSc group was observed (45.28 +/- 13.21), when compared with control group (22.90 +/- 4.13, P < 0.001), and this difference was statistically significant. An inverse correlation was found between vital capacity, forced vital capacity, forced expiratory volume in 1 s, vascular collagen V and endothelial apoptosis (P < 0.05). CONCLUSIONS We conclude that the endothelial apoptosis and vascular collagen V interaction reinforce the vascular pathway in the SSc pathogenesis. Further studies are needed to determine whether this relationship is causal or consequential.
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Affiliation(s)
- Edwin Roger Parra
- Departament of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
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Interobserver diagnostic variability at "moderate" agreement levels could significantly change the prognostic estimates of clinicopathologic studies: evaluation of the problem using evidence from patients with diffuse lung disease. Ann Diagn Pathol 2010; 14:88-93. [PMID: 20227013 DOI: 10.1016/j.anndiagpath.2009.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/01/2009] [Indexed: 11/24/2022]
Abstract
Does interobserver diagnostic variability (IODV) influence the accuracy of prognostic estimates of clinicopathologic studies? "Best evidence" from usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) patients was used to investigate the effects of IODV. Systematic literature review identified studies of UIP and NSIP providing "best evidence." Survival proportions from studies were compared using chi(2) and meta-analysis. Interobserver diagnostic variability was simulated in the data arbitrarily at 5% to 30% intervals. The various "diagnoses" were evaluated with kappa, and chi(2) statistics were used to evaluate the interobserver agreement and compare survival proportions. The survival proportions for UIP and NSIP patients in 7 retrospective level III studies ranged from 11% to 58% and 39% to 100%, respectively. Analysis of simulation results with kappa and chi(2) statistics showed that IODV greater than 10% resulted in significantly different survival proportion estimations. Interobserver diagnostic variability at moderate agreement levels significantly influences prognostic estimates. Evaluation and minimization of IODV in future clinicopathologic studies are indicated.
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Parra ER, Bielecki LC, Ribeiro JMDFP, Andrade Balsalobre FD, Teodoro WR, Capelozzi VL. Association between decreases in type V collagen and apoptosis in mouse lung chemical carcinogenesis: a preliminary model to study cancer cell behavior. Clinics (Sao Paulo) 2010; 65:425-32. [PMID: 20454501 PMCID: PMC2862677 DOI: 10.1590/s1807-59322010000400012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 12/17/2009] [Accepted: 12/23/2009] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE The importance of type V collagen and its relationships with other types of collagen and with vascular and epithelial apoptosis were studied in a model of chemical carcinogenesis in the mouse lung. METHODS TWO GROUPS OF MALE BALB/C MICE WERE STUDIED: a) animals that received two intraperitoneal doses of 3 g/kg urethane carcinogen (urethane group = 24); and b) animals submitted to a sham procedure, comparable to the test group (control group = 7). Both groups were sacrificed after 120 days. In situ detection of apoptosis, immunohistochemistry, immunofluorescence and histomorphometry were used to evaluate the fraction occupied by the tumor, vascular and epithelial apoptosis, and type V, III and I collagen fibers in the lung parenchyma from both groups. RESULTS The lung parenchyma from the urethane group showed low fractions of vascular and epithelial apoptosis as well as reduced type V collagen fibers when compared to the control group. A significant direct association was found between type V and III collagen fibers and epithelial apoptosis, type V collagen fibers and vascular apoptosis, and type V and type I collagen fibers. CONCLUSION The results show that a direct link between low amounts of type V collagen and decreased cell apoptosis may favor cancer cell growth in the mouse lung after chemical carcinogenesis, suggesting that strategies aimed at preventing decreased type V collagen synthesis or local responses to reduced apoptosis may have a greater impact in lung cancer control.
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Affiliation(s)
- Edwin Roger Parra
- Departament of Pathology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
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24
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Parra ER, Otani LH, de Carvalho EF, Ab'Saber A, Capelozzi VL. Systemic sclerosis and idiopathic interstitial pneumonia: histomorphometric differences in lung biopsies. J Bras Pneumol 2010; 35:529-40. [PMID: 19618033 DOI: 10.1590/s1806-37132009000600006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 12/05/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the parenchymal and extracellular matrix remodeling process in two histologic patterns-nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP)-in cases of idiopathic and sclerosis/systemic sclerosis (SSc)-associated interstitial pneumonia. METHODS We examined 15 cases of idiopathic NSIP, 10 cases of idiopathic UIP, 5 cases of SSc-UIP and 9 cases of SSc-NSIP. In the lung parenchyma, epithelial cells, endothelial cells and myofibroblasts were evaluated by immunohistochemical staining, whereas histochemical staining was used in order to evaluate collagen/elastic fibers in the extracellular matrix. RESULTS The percentage of surfactant protein A-positive epithelial cells was significantly greater in idiopathic NSIP than in SSc-NSIP, as well as being greater in idiopathic UIP than in SSc-UIP. Idiopathic NSIP and idiopathic UIP presented significantly higher immunoexpression of alpha smooth muscle actin in myofibroblasts than did SSc-NSIP and SSc-UIP. The percentage of CD34 endothelial cells in the pulmonary microvasculature was significant lower in idiopathic UIP than in SSc-UIP. The density of collagen fibers was significantly greater in idiopathic NSIP and idiopathic UIP than in SSc-NSIP and UIP. In contrast, the elastic fiber density was significantly lower in idiopathic UIP than in SSc-UIP. CONCLUSIONS Increased collagen synthesis, destruction of elastic fibers, high myofibroblast proliferation and poor microvascularization might represent a remodeling process found in idiopathic interstitial pneumonia, whereas the reverse might represent a repair process in SSc-associated interstitial pneumonia.
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Affiliation(s)
- Edwin Roger Parra
- University of São Paulo School of Medicine, CEP 01246-903, São Paulo, Brazil.
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25
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Souza P, Rizzardi F, Noleto G, Atanazio M, Bianchi O, Parra ER, Teodoro WR, Carrasco S, Velosa APP, Fernezlian S, Ab'saber AM, Antonângelo L, Takagaki T, Schainberg CG, Yoshinari NH, Capelozzi VL. Refractory remodeling of the microenvironment by abnormal type V collagen, apoptosis, and immune response in non-small cell lung cancer. Hum Pathol 2009; 41:239-48. [PMID: 19828174 DOI: 10.1016/j.humpath.2009.07.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
Abstract
Collagen V shows promise as an inducer of the death response via caspases. Remodeling of the microenvironment by collagen V, tumoral/vascular apoptosis, and the immune response were evaluated, based on the prognosis of 65 patients with surgically excised non-small cell lung cancer. Immunofluorescence, immunohistochemistry, morphometry, tridimensional reconstruction, and a real-time polymerase chain reaction were used to evaluate the amount, structure, and molecular chains of collagen V, tumoral and vascular apoptosis, immune cells, and microvessel density. The impact of these markers was tested on follow-up until death from recurrent lung cancer occurred. A decreased and abnormal synthesis of collagen V was found to lead to increased angiogenesis due to a low endothelial death rate and a low immune response. A Cox model analysis, controlled for the lymph node stage, demonstrated that only collagen V and vascular apoptosis variables were significantly associated with survival time. A point at the median for collagen V and vascular apoptosis divided patients into 2 groups, each with a distinctive prognosis. Those with a collagen V higher than 9.40% and vascular apoptosis higher than 1.09% had a low risk of death (0.27 and 0.41, respectively) compared to those with a collagen V lower than 9.40% and vascular apoptosis lower than 1.09%. Collagen V and vascular apoptosis in resected non-small cell lung cancer was strongly related to the prognosis, suggesting that strategies aimed at preventing low collagen V synthesis, or local responses to low vascular apoptosis may have a greater impact in lung cancer treatment.
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Affiliation(s)
- Paola Souza
- Departament of Pathology, Faculdade de Medicina da Universidade de São Paulo 01246-903, Brazil
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Wick MR, Kendall TJ, Ritter JH. Asbestosis: demonstration of distinctive interstitial fibroelastosis: a pilot study. Ann Diagn Pathol 2009; 13:297-302. [PMID: 19751905 DOI: 10.1016/j.anndiagpath.2009.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 05/21/2009] [Indexed: 11/30/2022]
Abstract
Asbestosis has long been defined as a diffuse interstitial "fibrotic" process, in similarity to other chronic interstitial pulmonary diseases. To address the hypothesis (which was based on morphological nuances) that the interstitial connective tissue response in asbestosis may be fibroelastotic rather than fibrotic, a comparative characterization of the connective response in cases of asbestosis and other forms of interstitial lung disease was performed. Archival open lung biopsies or autopsy specimens of pulmonary diseases featuring interstitial connective tissue abnormalities (15 of asbestosis, 21 of organizing pneumonia, 15 usual interstitial pneumonitis/idiopathic pulmonary fibrosis [IPF], 9 organizing diffuse alveolar damage, 9 "nonspecific" interstitial pneumonitis, 4 sarcoidosis, 3 each of desquamative interstitial pneumonia and chronic amiodarone toxicity, 2 cryptogenic organizing pneumonias, and 1 each of chronic hypersensitivity pneumonitis and chronic eosinophilic pneumonitis [85 total]) were stained histochemically with hematoxylin and eosin, Perl's method, Gomori's trichrome procedure, and the Verhoeff-van Gieson technique. Representative subsets of the cases (n = 20) were also studied immunohistologically using an antibody to elastin. Fibroelastosis in each of the samples was assessed for the degree of response and its location using a 3-tiered scale. The degree of fibroelastosis in the 15 cases of asbestosis was variable, with the pattern being peribronchial and perivascular in all instances; at least 2 asbestos bodies were identified in fibroelastotic foci in each of the 15 cases as highlighted with Perl's stain. Forty-seven cases of nonasbestotic lung disease (71%) showed interstitial fibrosis with a variable (usually modest) amount of admixed elastic tissue; when present, elastic fibers were distributed in a diffuse interstitial pattern, with or without perivascular accentuation. All cases of IPF also showed areas of fibroelastosis, but those foci were confined to regions of overt "honeycomb" change. No asbestos bodies were seen in any disease except asbestosis, and a predominantly peribronchial pattern of fibroelastosis was not identified in any nonasbestotic interstitial lung disease in this study. The authors conclude that the types and patterns of pulmonary connective tissue response in interstitial lung diseases may provide additional diagnostic clues to the presence of asbestosis.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology, University of Virginia Medical Center, Charlottesville, VA 22908-0214, USA.
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Abstract
Pulmonary fibrosis and architectural remodeling of tissues can severely disrupt lung function, often with fatal consequences. The etiology of pulmonary fibrotic diseases is varied, with an array of triggers including allergens, chemicals, radiation and environmental particles. However, the cause of one of the most common pulmonary fibrotic conditions, idiopathic pulmonary fibrosis (IPF), is still unclear. This review examines common mechanisms of pulmonary wound-healing responses following lung injury, and highlights the pathogenesis of some of the most widespread pulmonary fibrotic diseases. A three phase model of wound repair is reviewed that includes; (1) injury; (2) inflammation; and (3) repair. In most pulmonary fibrotic conditions dysregulation at one or more of these phases has been reported. Chronic inflammation can lead to an imbalance in the production of chemokines, cytokines, growth factors, and disrupt cellular recruitment. These changes coupled with excessive pro-fibrotic IL-13 and/or TGFbeta1 production can turn a well-controlled healing response into a pathogenic fibrotic response. Endogenous regulatory mechanisms are discussed including novel areas of therapeutic intervention. Restoring homeostasis to these dysregulated healing responses, or simply neutralizing the key pro-fibrotic mediators may prevent or slow the progression of pulmonary fibrosis.
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de Carvalho EF, Parra ER, de Souza R, A'b Saber AM, Machado JDC, Capelozzi VL. Arterial and interstitial remodelling processes in non-specific interstitial pneumonia: systemic sclerosis versus idiopathic. Histopathology 2008; 53:195-204. [PMID: 18752502 DOI: 10.1111/j.1365-2559.2008.03072.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To compare septal and vascular matrix remodelling, vascular occlusion, pulmonary function tests and survival between two groups: one with idiopathic non-specific interstitial pneumonia (NSIP) and one with NSIP associated with systemic sclerosis (SSc). METHODS AND RESULTS Pulmonary biopsy specimens were examined from 40 patients, 22 with NSIP and 18 with NSIP associated with SSc. The content of septal collagen and elastic fibres, as well as the elastic fibres in the vascular interstitium, were higher in the SSc group (P = 0.01, P = 0.001 and P < 0.0001, respectively). Among pulmonary function tests, the diffusing capacity for carbon monoxide/alveolar volume was affected to a greater extent in the SSc group (59% of the predicted value in SSc and 97% in the idiopathic group). There were no differences in collagen content of the vascular interstitium, arterial occlusion, or survival between the two groups. CONCLUSIONS Although the fibrotic process is more intense in the SSc group, it does not affect the prognosis of these patients. Because the elastotic process is higher in the SSc group, this might suggest that autoimmune inflammatory mechanisms affecting the elastic fibre system play a greater role in the pathogenesis and pulmonary remodelling process of SSc NSIP than in idiopathic NSIP.
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Affiliation(s)
- E F de Carvalho
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Calabrese F, Giacometti C, Lunardi F, Valente M. Morphological and molecular markers in idiopathic pulmonary fibrosis. Expert Rev Respir Med 2008; 2:505-20. [PMID: 20477214 DOI: 10.1586/17476348.2.4.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Idiopathic pulmonary fibrosis is a progressive, lethal, interstitial lung disease with no proven effective therapy other than lung transplantation. A definitive diagnosis of the disease requires surgical lung biopsy to show a histological appearance of usual interstitial pneumonia. The main histological features include temporal and spatial heterogeneity, fibroblastic foci, extracellular matrix deposition with vessel remodeling and honeycomb changes. There are some morphological aspects that have recently been taken into account as possible prognostic markers for disease progression. Although the cellular and molecular pathways driving disease pathogenesis are complex and not fully delineated, increasing evidence suggests that a key event is ongoing alveolar epithelial injury in association with an abnormal host repair response. Inflammation seems to play a less important role and remains largely debated while increased attention has been on the role of noninflammatory structural cells, such as fibroblasts, epithelial cells and endothelial cells. The modifications and interactions among these cells are complex and regulated by various molecular factors. This article reviews the morphology of the disease, focusing on some new facets and on the principal molecular factors involved in the different aspects of parenchymal remodeling.
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Affiliation(s)
- Fiorella Calabrese
- Department of Diagnostic Medical Sciences and Special Therapies, University of Padua Medical School, Via Gabelli, 61 Padua, Italy.
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Parra ER, Noleto GS, Tinoco LJM, Capelozzi VL. Immunophenotyping and remodeling process in small airways of idiopathic interstitial pneumonias: functional and prognostic significance. CLINICAL RESPIRATORY JOURNAL 2008; 2:227-38. [DOI: 10.1111/j.1752-699x.2008.00077.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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What have anatomic and pathologic studies taught us about acute lung injury and acute respiratory distress syndrome? Curr Opin Crit Care 2008; 14:56-63. [PMID: 18195627 DOI: 10.1097/mcc.0b013e3282f449de] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW Acute lung injury and acute respiratory distress syndrome are defined as morphologic and functional manifestations of pulmonary injury of various causes. Acute lung injury and acute respiratory distress syndrome may result from direct effects on epithelial lung cells or from indirect effects on endothelial lung cells, reflecting lung involvement as part of a more distant systemic inflammatory response. This review addresses anatomic/pathologic differences between acute lung injury and acute respiratory distress syndrome lungs. RECENT FINDINGS It is well established that acute lung injury and acute respiratory distress syndrome are characterized by local and intense inflammatory responses, with accumulation of several types of cells and soluble mediators. There are parallel anti-inflammatory response and lung remodeling, with deposition of collagen. Patient outcome will depend on resolution of the initial event and on the balance between the inflammatory and remodeling responses. Several trials have attempted to modify both responses, but all have yielded negative results. SUMMARY An appreciation of the acute respiratory distress syndrome must take into account anatomic/pathologic characteristics, which depend upon the initial cause. Consideration of each pathologic mechanism will permit more precise clinical management and probably improved outcomes.
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Santana ANC, Kairalla RA, Carvalho CRR. Potential role of statin use in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2008; 177:1048. [PMID: 18434336 DOI: 10.1164/ajrccm.177.9.1048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Franco de Carvalho E, Parra ER, de Souza R, Muxfeldt A’b Saber A, Capelozzi VL. Parenchymal and Vascular Interactions in the Pathogenesis of Nonspecific Interstitial Pneumonia in Systemic Sclerosis and Idiopathic Interstitial Pneumonia. Respiration 2008; 76:146-53. [DOI: 10.1159/000112473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 09/10/2007] [Indexed: 11/19/2022] Open
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