1
|
Stone RC, Chen V, Burgess J, Pannu S, Tomic-Canic M. Genomics of Human Fibrotic Diseases: Disordered Wound Healing Response. Int J Mol Sci 2020; 21:ijms21228590. [PMID: 33202590 PMCID: PMC7698326 DOI: 10.3390/ijms21228590] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
Fibrotic disease, which is implicated in almost half of all deaths worldwide, is the result of an uncontrolled wound healing response to injury in which tissue is replaced by deposition of excess extracellular matrix, leading to fibrosis and loss of organ function. A plethora of genome-wide association studies, microarrays, exome sequencing studies, DNA methylation arrays, next-generation sequencing, and profiling of noncoding RNAs have been performed in patient-derived fibrotic tissue, with the shared goal of utilizing genomics to identify the transcriptional networks and biological pathways underlying the development of fibrotic diseases. In this review, we discuss fibrosing disorders of the skin, liver, kidney, lung, and heart, systematically (1) characterizing the initial acute injury that drives unresolved inflammation, (2) identifying genomic studies that have defined the pathologic gene changes leading to excess matrix deposition and fibrogenesis, and (3) summarizing therapies targeting pro-fibrotic genes and networks identified in the genomic studies. Ultimately, successful bench-to-bedside translation of observations from genomic studies will result in the development of novel anti-fibrotic therapeutics that improve functional quality of life for patients and decrease mortality from fibrotic diseases.
Collapse
Affiliation(s)
- Rivka C. Stone
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, FL 33136, USA; (V.C.); (J.B.)
- Correspondence: (R.C.S.); (M.T.-C.)
| | - Vivien Chen
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, FL 33136, USA; (V.C.); (J.B.)
| | - Jamie Burgess
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, FL 33136, USA; (V.C.); (J.B.)
- Medical Scientist Training Program in Biomedical Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sukhmani Pannu
- Department of Dermatology, Tufts Medical Center, Boston, MA 02116, USA;
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami-Miller School of Medicine, Miami, FL 33136, USA; (V.C.); (J.B.)
- John P. Hussman Institute for Human Genomics, University of Miami-Miller School of Medicine, Miami, FL 33136, USA
- Correspondence: (R.C.S.); (M.T.-C.)
| |
Collapse
|
2
|
Avdeev SN, Chikina SY, Nagatkina OV. Idiopathic pulmonary fibrosis: a new international clinical guideline. ACTA ACUST UNITED AC 2019. [DOI: 10.18093/0869-0189-2019-29-5-525-552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S. N. Avdeev
- I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia (Sechenov University); Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
| | - S. Yu. Chikina
- I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia (Sechenov University)
| | | |
Collapse
|
3
|
Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, Behr J, Cottin V, Danoff SK, Morell F, Flaherty KR, Wells A, Martinez FJ, Azuma A, Bice TJ, Bouros D, Brown KK, Collard HR, Duggal A, Galvin L, Inoue Y, Jenkins RG, Johkoh T, Kazerooni EA, Kitaichi M, Knight SL, Mansour G, Nicholson AG, Pipavath SNJ, Buendía-Roldán I, Selman M, Travis WD, Walsh S, Wilson KC. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2019; 198:e44-e68. [PMID: 30168753 DOI: 10.1164/rccm.201807-1255st] [Citation(s) in RCA: 2352] [Impact Index Per Article: 470.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This document provides clinical recommendations for the diagnosis of idiopathic pulmonary fibrosis (IPF). It represents a collaborative effort between the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society. METHODS The evidence syntheses were discussed and recommendations formulated by a multidisciplinary committee of IPF experts. The evidence was appraised and recommendations were formulated, written, and graded using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS The guideline panel updated the diagnostic criteria for IPF. Previously defined patterns of usual interstitial pneumonia (UIP) were refined to patterns of UIP, probable UIP, indeterminate, and alternate diagnosis. For patients with newly detected interstitial lung disease (ILD) who have a high-resolution computed tomography scan pattern of probable UIP, indeterminate, or an alternative diagnosis, conditional recommendations were made for performing BAL and surgical lung biopsy; because of lack of evidence, no recommendation was made for or against performing transbronchial lung biopsy or lung cryobiopsy. In contrast, for patients with newly detected ILD who have a high-resolution computed tomography scan pattern of UIP, strong recommendations were made against performing surgical lung biopsy, transbronchial lung biopsy, and lung cryobiopsy, and a conditional recommendation was made against performing BAL. Additional recommendations included a conditional recommendation for multidisciplinary discussion and a strong recommendation against measurement of serum biomarkers for the sole purpose of distinguishing IPF from other ILDs. CONCLUSIONS The guideline panel provided recommendations related to the diagnosis of IPF.
Collapse
|
4
|
Mekov EV, Petkov RE, Kostadinov DT, Antonov KA, Jelev DT. Chronic Obstructive Pulmonary Disease and Hepatitis C. Folia Med (Plovdiv) 2019; 59:132-138. [PMID: 28704182 DOI: 10.1515/folmed-2017-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/10/2016] [Indexed: 11/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a preventable, treatable disease with significant extrapulmonary manifestations that could affect negatively its course in some patients. Hepatitis C virus infection (HCV), on the other hand, is associated with a number of extrahepatic manifestations. COPD patients have increased prevalence of HCV and patients with HCV, especially older ones, have increased prevalence and faster progression of COPD. HCV infection exerts long-term effects on lung tissue and is an additional risk factor for the development of COPD. The presence of HCV is associated with an accelerated loss of lung function in COPD patients, especially in current smokers. COPD could represent extrahepatic manifestation associated with HCV infection. The aim of this article was to review the literature on prevalence of HCV in COPD and vice versa, pathogenetic link and the consequences of their mutual existence.
Collapse
Affiliation(s)
- Evgeni V Mekov
- Clinical Center for Pulmonary Diseases, St. Sofi a Hospital for Pulmonary Diseases, Medical University of Sofi a, Sofi a, Bulgaria
| | - Rosen E Petkov
- Clinical Center for Pulmonary Diseases, St. Sofi a Hospital for Pulmonary Diseases, Medical University of Sofi a, Sofi a, Bulgaria
| | - Dimitar T Kostadinov
- Clinical Center for Pulmonary Diseases, St. Sofi a Hospital for Pulmonary Diseases, Medical University of Sofi a, Sofi a, Bulgaria
| | - Krasimir A Antonov
- Clinic of Gastroenterology, St. Ivan Rilski University Hospital, Medical University of Sofi a, Sofi a, Bulgaria
| | - Deian T Jelev
- Clinic of Gastroenterology, St. Ivan Rilski University Hospital, Medical University of Sofi a, Sofi a, Bulgaria
| |
Collapse
|
5
|
Abdul-Hafez A, Mohamed T, Omar H, Shemis M, Uhal BD. The renin angiotensin system in liver and lung: impact and therapeutic potential in organ fibrosis. JOURNAL OF LUNG, PULMONARY & RESPIRATORY RESEARCH 2018; 5:00160. [PMID: 30175235 PMCID: PMC6114139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Liver and lung fibrosis are two main organ diseases that are of particular importance in both Egypt and the US. Hepatitis C Virus "HCV" infection and idiopathic pulmonary fibrosis (IPF) are fibrotic diseases of the liver and lung respectively. The liver and lung are reported in literature to share many immune/inflammatory responses to damage through the lung-liver axis. Most importantly, HCV was shown to enhance the development of IPF and is considered one of the risk factors for IPF. The renin angiotensin system (RAS) plays a critical role in the fibrogenesis and inflammation damage of many organs including liver and lung. The relatively recently identified component of RAS, angiotensin converting enzyme-2 (ACE-2), has shown a promising therapeutic potential in models of liver and pulmonary fibrosis. This article reviews the role of RAS in organ fibrosis with focus on role of ACE-2 in fibrotic diseases of the liver and the lung.
Collapse
Affiliation(s)
- Amal Abdul-Hafez
- Department of Pediatrics and Human Development, Michigan State University, USA
| | - Tarek Mohamed
- Department of Pediatrics and Human Development, Michigan State University, USA
| | - Hanan Omar
- Department of Biochemistry and Molecular Biology, Theodor Bilharz Research Institute, Egypt
| | - Mohamed Shemis
- Department of Biochemistry and Molecular Biology, Theodor Bilharz Research Institute, Egypt
| | - Bruce D Uhal
- Department of Physiology, Michigan State University, USA
| |
Collapse
|
6
|
Kamal AM, Mitruț P, Kamal CK, Alexandru DO, Tica A. Pegylated Interferon-Induced Sarcoidosis Presenting With Anterior Uveitis in a Patient with Chronic Hepatitis C - Case Report. CURRENT HEALTH SCIENCES JOURNAL 2015; 41:379-384. [PMID: 30538846 PMCID: PMC6243515 DOI: 10.12865/chsj.41.04.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 12/01/2015] [Indexed: 11/23/2022]
Abstract
Sarcoidosis is a chronic inflammatory systemic disorder of unknown etiology. It is known to be triggered by an autoimmune process, and is currently recognized as a rare adverse event to interferon therapy for Hepatitis C Virus Infection. Clinical presentation of interferon-triggered sarcoidosis is varied, but ocular manifestation as a first symptom was only once, previously reported. We report the case of a 32 year old woman, infected with hepatitis C, for whom antiviral therapy was initiated. Prior to treatment, the patient had outstanding medical history. Three months from the initiation, patient accused pain and redness of the left eye and mild visual loss. The diagnosis of Interferon induced sarcoidosis was established. We are presenting this case because it illustrates the possibility of sudden and severe complications and we want to emphasize the importance of performing ophthalmological examination in patients treated with pegylated interferon α.
Collapse
Affiliation(s)
- A M Kamal
- Internal Medicine Department, University of Medicine and Pharmacy of Craiova, Romania
| | - P Mitruț
- Internal Medicine Department, University of Medicine and Pharmacy of Craiova, Romania
| | - C K Kamal
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - D O Alexandru
- Department of Medical Informatics, University of Medicine and Pharmacy of Craiova, Romania
| | - A Tica
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Romania
| |
Collapse
|
7
|
Goh LY, Card T, Fogarty AW, McKeever TM. The association of exposure to hepatitis B and C viruses with lung function and respiratory disease: a population based study from the NHANES III database. Respir Med 2014; 108:1733-40. [PMID: 25456709 DOI: 10.1016/j.rmed.2014.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/13/2014] [Accepted: 10/17/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Globally, 500 million people are chronically infected with Hepatitis B virus (HBV) and Hepatitis C virus (HCV). While these viruses are notorious for their detrimental effect on the liver they are also known to affect multiple organs in the body including the lungs. AIM To investigate if exposure to HBV and HCV is associated with lung function and respiratory diseases. METHODS Data from the Third National Health and Nutrition Examination Survey (NHANES III) was analysed using multiple linear regressions to investigate the association between exposure to HBV and HCV with the various measures of lung function, while multiple logistic regressions were used to evaluate the association with the respiratory diseases asthma and chronic obstructive pulmonary disease (COPD). RESULTS Exposure to HCV was significantly associated with an increase in Forced Expiratory Volume in 1 s, FEV1 (Coef: 97.94 ml, 95% CI: 38.87 to 157.01) and Full Vital Capacity, FVC (Coef: 90 ml, 95% CI: 14.50 to 166.24). Individuals who had been exposed to both HBV and HCV also had a significantly higher FEV1 (Coef: 145.82, CI: 60.68 to 230.94) and FVC (Coef: 195.09, CI: 78.91 to 311.26). There was also a significant association between exposure to HBV and asthma (OR: 1.28, 95% CI: 1.05 to 1.58). These associations were no longer significant after additionally adjusting for cocaine and marijuana use as well as poverty income ratio. CONCLUSION Our research implies that hepatotropic viruses may affect the respiratory system, but more work at a population level is needed to further explore these associations.
Collapse
Affiliation(s)
- Li Yen Goh
- School of Community Health Sciences, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG51PB, United Kingdom.
| | - Tim Card
- School of Community Health Sciences, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG51PB, United Kingdom
| | - Andrew W Fogarty
- School of Community Health Sciences, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG51PB, United Kingdom.
| | - Tricia M McKeever
- School of Community Health Sciences, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG51PB, United Kingdom.
| |
Collapse
|
8
|
Fischer WA, Drummond MB, Merlo CA, Thomas DL, Brown R, Mehta SH, Wise RA, Kirk GD. Hepatitis C virus infection is not an independent risk factor for obstructive lung disease. COPD 2014; 11:10-6. [PMID: 23862666 PMCID: PMC4302731 DOI: 10.3109/15412555.2013.800854] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Several epidemiological studies have suggested that hepatitis C virus (HCV) infection is associated with the presence of obstructive lung disease (OLD). However, there is a strong link between HCV infection and tobacco abuse, a major risk factor for the development of OLD. In this study we analyzed clinical, laboratory and spirometric data from 1068 study participants to assess whether HCV infection, viremia, or HCV-associated end organ damage were associated with OLD. Demographics, risk behavior, serologic status for HCV and HIV, and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome (AIDS) Linked to the IntraVenous Experience (ALIVE) study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Of 1,068 participants, 890 (83%) were HCV positive and 174 (16%) met spirometric criteria for OLD. Factors independently associated with OLD were age and BMI. HCV infection, viral load and HCV-associated end organ damage were similar in participants with and without OLD. In summary, there was no independent association between markers of HCV exposure, chronicity, viremia, or HCV-associated end-organ damage with OLD. Our findings support the strong correlation between HCV status, injection drug use, and smoking. These data suggest that HCV may not be a sole contributor to the increased prevalence of OLD described in previous studies of HCV-infected individuals.
Collapse
Affiliation(s)
- William A. Fischer
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael B. Drummond
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christian A. Merlo
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David L. Thomas
- Division of Infectious Diseases, School of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Brown
- Departments of Anesthesiology/Critical Care Medicine; Environmental Health Sciences, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Shruti H. Mehta
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert A. Wise
- Division of Pulmonary and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Greg D. Kirk
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
9
|
Abstract
Respiratory dysfunction is common with HIV infection, but few studies have directly assessed whether HIV remains an independent risk factor for pulmonary function abnormalities in the antiretroviral therapy era. Additionally, few studies have focused on pulmonary outcomes in HIV+ women. We tested associations between risk factors for respiratory dysfunction and pulmonary outcomes in 63 HIV+ and 36 HIV-uninfected women enrolled in the Women's Interagency HIV Study. Diffusing capacity (DL(CO)) was significantly lower in HIV+ women (65.5% predicted vs. 72.7% predicted, P = 0.01), and self-reported dyspnea in HIV+ participants was associated with both DL(CO) impairment and airflow obstruction. Providers should be aware that DL(CO) impairment is common in HIV infection, and that either DL(CO) impairment or airflow obstruction may cause respiratory symptoms in this population.
Collapse
|
10
|
El-Etreby S, Gad YZ, Zeidan A, Elmalky N, Attiya M, El-Badrawy A, Ibrahem L. Chronic hepatitis C genotype 4 infection and interstitial pulmonary fibrosis. EGYPTIAN LIVER JOURNAL 2012. [DOI: 10.1097/01.elx.0000415485.73087.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
11
|
Garib JR, Garcia GF, Teixeira R, Lima e Silva FDC. Dyspnoea in patients with chronic hepatitis C treated with pegylated interferon and ribavirin. ACTA ACUST UNITED AC 2011; 43:625-31. [DOI: 10.3109/00365548.2011.574150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
12
|
Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, Colby TV, Cordier JF, Flaherty KR, Lasky JA, Lynch DA, Ryu JH, Swigris JJ, Wells AU, Ancochea J, Bouros D, Carvalho C, Costabel U, Ebina M, Hansell DM, Johkoh T, Kim DS, King TE, Kondoh Y, Myers J, Müller NL, Nicholson AG, Richeldi L, Selman M, Dudden RF, Griss BS, Protzko SL, Schünemann HJ. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011; 183:788-824. [PMID: 21471066 PMCID: PMC5450933 DOI: 10.1164/rccm.2009-040gl] [Citation(s) in RCA: 5042] [Impact Index Per Article: 387.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This document is an international evidence-based guideline on the diagnosis and management of idiopathic pulmonary fibrosis, and is a collaborative effort of the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association. It represents the current state of knowledge regarding idiopathic pulmonary fibrosis (IPF), and contains sections on definition and epidemiology, risk factors, diagnosis, natural history, staging and prognosis, treatment, and monitoring disease course. For the diagnosis and treatment sections, pragmatic GRADE evidence-based methodology was applied in a question-based format. For each diagnosis and treatment question, the committee graded the quality of the evidence available (high, moderate, low, or very low), and made a recommendation (yes or no, strong or weak). Recommendations were based on majority vote. It is emphasized that clinicians must spend adequate time with patients to discuss patients' values and preferences and decide on the appropriate course of action.
Collapse
|
13
|
Aliannejad R, Ghanei M. Hepatitis C and pulmonary fibrosis: Hepatitis C and pulmonary fibrosis. HEPATITIS MONTHLY 2011; 11:71-3. [PMID: 22087122 PMCID: PMC3206667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 01/09/2011] [Accepted: 01/12/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a hepatotropic and lymphotropic virus that causes hepatic and extrahepatic disease. Emerging clinical data suggest that chronic HCV infection can lead to many direct and indirect effects on the lung. OBJECTIVES This article discusses evidence on the relationship between HCV infection and pulmonary fibrosis to increase knowledge on this topic among clinicians and scientists and highlights the need for further study. METHODS We searched the MEDLINE, ISI WEB OF KNOWLEDGE, OVID, ELSEVIER, and MDCONSULT databases and top respiratory journals, such as the American Journal of Respiratory and Critical Care, Chest, and Thorax for articles in English using the following keywords: hepatitis C, HCV infection, IPF, pulmonary fibrosis, and interstitial pneumonitis. We reviewed the reference lists of all identified studies. RESULTS The evidence for a pathogenetic link between pulmonary fibrosis and HCV is: the higher frequency of HCV markers in IPF patients, an increase in lymphocyte and neutrophil numbers in bronchoalveolar lavage of chronic HCV infection patients, and the development of IPF in HCV-related chronic hepatitis that is treated with interferon. There is a discrepancy between studies on the frequency of HCV in IPF patients, which might be attributed to geographical differences of in the prevalence of HCV infection, selection bias in choosing the control group, and the HCV genome. CONCLUSIONS BAL studies in HCV infection are associated with increased counts of lymphocytes and neutrophils in BAL fluid. These studies show that HCV infection is associated with nonspecific pulmonary inflammatory reactions that are not compatible with IPF but that it can lead to pulmonary fibrosis. The other factor is interferon therapy. Interstitial pneumonia and sarcoidosis are well-documented complications of IFN therapy. More extensive cohort studies should be conducted to confirm an actual causal relationship between HCV infection and pulmonary fibrosis.
Collapse
Affiliation(s)
- Rasoul Aliannejad
- Respiratory Diseases and TB Research Center of Guilan University of Medical Science, Razi Hospital, Rasht, IR Iran
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran,* Corresponding author at: Mostafa Ghanei, Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Mollasadra Ave., Tehran, IR Iran. Tel.: +98-2188600067, Fax: +98-2188600067, E-mail:
| |
Collapse
|
14
|
Immune modulation of ovalbumin-induced lung injury in mice using β-glucosylceramide and a potential role of the liver. Immunobiology 2010; 216:548-57. [PMID: 21074892 DOI: 10.1016/j.imbio.2010.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 10/10/2010] [Accepted: 10/10/2010] [Indexed: 11/21/2022]
Abstract
CD1d-restricted natural killer T (NKT) cells are implicated in the pathogenesis of asthma. β-Glucosylceramide (GC), a naturally occurring lipid, was previously shown to alter NKT cell distribution in the liver. We hypothesized that GC can affect lung and liver NKT cell distribution and ameliorate asthma. Mice were sensitized by intra-peritoneal injection of ovalbumin (OVA) for 2 weeks followed by repeated intranasal OVA challenges to induce lung injury mimicking asthma. OVA induced asthma groups were either treated by intranasal instillation of normal saline, intranasal instillation of GC or inhaled budesonide. To investigate the role of the liver, hepatic fibrosis was induced using carbon tetrachloride prior to asthma induction. Allergen induced bronchoconstriction was measured prior to sacrifice. Isolated lymphocytes from lungs, livers and spleens were analyzed for OVA induced proliferation and flow cytometry. Liver and lung histology, serum aminotransferase and anti-OVA antibodies level were assessed. Treatment with GC significantly reduced OVA induced airway responsiveness (p<0.001) similar to inhaled budesonide. GC significantly reduced the peri-bronchial and peri-vascular inflammatory infiltration mainly through an effect on T cells, as suggested by decreased T cell proliferation (p=0.009). Liver CD4 and NKT cells significantly increased after GC treatment suggesting liver involvement. Inducing hepatic fibrosis blunted the propagation of asthma in spite of sufficient increase of serum anti-OVA titers. GC has an immunomodulatory effect on a murine model of experimental asthma. We also suggest that the liver acts as an immunomodulatory organ and might have a regulatory effect on pulmonary diseases.
Collapse
|
15
|
|
16
|
Kanazawa H. Relationship between hepatitis C virus infection and pulmonary disorders: potential mechanisms of interaction. Expert Rev Clin Immunol 2010; 2:801-10. [PMID: 20477634 DOI: 10.1586/1744666x.2.5.801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recently, an increasing number of reports have suggested that chronic hepatitis C virus (HCV) infection is associated with pulmonary disorders. The effects of HCV on the lung may present as worsening of lung function and impaired responses to therapy in patients with chronic obstructive pulmonary disease and asthma. Moreover, chronic HCV infection may be associated with the pathogenesis of interstitial lung disease. It is believed that chronic HCV infection may contribute to the immune responses modulating the pathogenic processes underlying pulmonary disorders and, therefore, may lead to a wide spectrum of clinical presentations. Potential candidates for a role in these immune responses are the CD8(+) T lymphocytes and inflammatory cytokines. In this review, the effects of HCV on the lung and the potential mechanisms of interaction between chronic HCV infection and pulmonary disorders will be discussed.
Collapse
Affiliation(s)
- Hiroshi Kanazawa
- Osaka City University, Department of Respiratory Medicine, Graduate School of Medicine, 1-4-3, Asahi-machi, Abenoku, Osaka 545-8585, Japan.
| |
Collapse
|
17
|
Khattab MA, Eslam M, Alavian SM. Hepatitis C virus as a multifaceted disease: a simple and updated approach for extrahepatic manifestations of hepatitis C virus infection. HEPATITIS MONTHLY 2010; 10:258-69. [PMID: 22312391 PMCID: PMC3271318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 08/17/2010] [Accepted: 08/30/2010] [Indexed: 12/11/2022]
Abstract
Hepatitis C virus infection is an emerging disease and a public health problem in the world. There are accumulating data regarding extra hepatic manifestation of HCV, such as rheumatologic manifestations, endocrine, hematologic, dermatologic, renal, neurologic, and systemic manifestations. The therapy of them needs more attention to some exacerbations of extra hepatic manifestation and in some situation it needs different approaches. In this review we tried to provide latest evidence for extra hepatic manifestation and management of them.
Collapse
Affiliation(s)
- Mahmoud Aboelneen Khattab
- Department of Internal Medicine, Minia University, Minia, Egypt,Corresponding author at: Dr. Mahmoud Aboelneen Khattab, Professor of Internal Medicine, Medical School, Minia University, Minia, Egypt, P.O. Box: 61111. Tel.: +20-225197818, +20-862378181, Fax: +20-86242813, E-mail:
| | - Mohammed Eslam
- Department of Internal Medicine, Minia University, Minia, Egypt
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, IR.Iran
| |
Collapse
|
18
|
Arora A, Vargas L, Kuzniar TJ. Pleural effusion associated with pegylated interferon alpha and ribavirin treatment for chronic hepatitis C. J Hosp Med 2009; 4:E45-6. [PMID: 19753589 DOI: 10.1002/jhm.452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lung toxicity related to interferon (IFN) alpha typically takes a form of interstitial pneumonitis, granulomatous inflammation, or organizing pneumonia. We report a case of a 52-year-old woman, who developed pneumonitis with exudative, lymphocytic-predominant pleural effusion following treatment with pegylated IFN alpha and ribavirin for hepatitis C. Her symptoms and lung findings resolved over 3 months of observation without corticosteroid therapy.
Collapse
Affiliation(s)
- Amit Arora
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois 60201, USA
| | | | | |
Collapse
|
19
|
Abstract
SUMMARYSome studies have suggested that chronic hepatitis C virus (HCV) infection may induce an accelerated decline of forced expiratory volume in 1 second (FEV1). We performed a cross-sectional study to determine the prevalence of HCV infection in a sample of chronic obstructive pulmonary disease (COPD) patients and in a control group of blood donors. The clinical characteristics of HCV-positive and HCV-negative patients were compared. Anti-HCV antibody was determined and confirmed by HCV-RNA. The prevalence of HCV infection in COPD patients was 7·5% (95% CI 6·52–8·48) and in blood donors was 0·41% (95% CI 0·40–0·42). The HCV-positive patients had a lower FEV1 (34·7±8·6%) and a higher BODE index (median=6) than HCV-negative patients (42·7±16·5%, median=4, respectively) (P=0·011 and 0·027, respectively). Our results suggest a high prevalence of chronic HCV infection in patients with COPD in comparison with the blood donors. HCV-positive patients have a more severe disease.
Collapse
|
20
|
Zignego AL, Ferri C, Pileri SA, Caini P, Bianchi FB. Extrahepatic manifestations of Hepatitis C Virus infection: a general overview and guidelines for a clinical approach. Dig Liver Dis 2007; 39:2-17. [PMID: 16884964 DOI: 10.1016/j.dld.2006.06.008] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Revised: 06/03/2006] [Accepted: 06/06/2006] [Indexed: 02/08/2023]
Abstract
Hepatitis C Virus is associated with a wide series of extrahepatic manifestations. Based on available data the link between the virus and some of these extrahepatic diseases is only suggested and needs further confirmation. Hepatitis C Virus-related lymphoproliferative disorders, whose prototype is mixed cryoglobulinaemia, represent the most closely related extrahepatic manifestations of Hepatitis C Virus. Other Hepatitis C Virus-associated disorders include nephropathies, thyreopathies, sicca syndrome, idiopathic pulmonary fibrosis, porphyria cutanea tarda, lichen planus, diabetes, chronic polyarthritis, cardiopathy and atherosclerosis. A pathogenetic link between Hepatitis C Virus and some extrahepatic manifestations was confirmed by their responsiveness to antiviral therapy, which is now deemed the first therapeutic option to consider. By contrast, there are diseases where treatment with interferon was ineffective or dangerous. The aim of the present paper is to outline the most recent evidence concerning extrahepatic disorders that are possibly associated with Hepatitis C Virus infection. Special emphasis will be given to discussion of the most appropriate clinical approaches to be adopted in order to diagnose, treat (possibly prevent) and follow-up extrahepathic diseases in patients with Hepatitis C Virus infection.
Collapse
Affiliation(s)
- A L Zignego
- Department of Internal Medicine, Medical School, Center for Research, Transfer and High Education DENOthe, Center for the Study of Systemic Manifestations of Hepatitis Viruses MaSVE, University of Florence, Florence, Italy.
| | | | | | | | | |
Collapse
|
21
|
Erturk A, Tokgonul AN, Capan N, Erturk H, Dursun AB, Bozkaya H. Pulmonary alterations in patients with chronic HCV infection. Dig Liver Dis 2006; 38:673-6. [PMID: 16793354 DOI: 10.1016/j.dld.2006.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Revised: 05/10/2006] [Accepted: 05/12/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic hepatitis C virus infection has been reported in association with several extrahepatic manifestations. Included in this list is interstitial lung involvement. AIMS The aim of the present study was to evaluate pulmonary alterations in patients with chronic hepatitis C virus infection. PATIENTS Twenty-one patients with chronic hepatitis C virus infection were enrolled into a prospective study. One patient has been excluded because of underlying tuberculosis. METHODS All patients underwent pulmonary function tests, diffusion capacity for carbon monoxide and high-resolution computed tomography of the chest. RESULTS Forced vital capacity, forced expiratory volume in first second/forced vital capacity and forced expiratory volume in first second values were reduced to less than 80% of predicted values in 3, 11 and 5 patients, respectively. Diffusion capacity for carbon monoxide was low in 12 patients (60%), 8 of whom had simultaneous decrease in diffusion capacity for carbon monoxide/VA values. Thorax high-resolution computed tomography revealed abnormal findings in eight patients (40%). Fifteen patients with chronic hepatitis C virus infection (75%) had at least one pulmonary alteration as evidenced by abnormal pulmonary function tests, diffusion capacity for carbon monoxide and/or high-resolution computed tomography results. CONCLUSION In spite of a limited study population, these findings may implicate that pulmonary manifestations of chronic hepatitis C virus infection are frequently underdiagnosed.
Collapse
Affiliation(s)
- A Erturk
- Department of Respiratory Medicine, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
22
|
Kanazawa H. Anticholinergic agents in asthma: chronic bronchodilator therapy, relief of acute severe asthma, reduction of chronic viral inflammation and prevention of airway remodeling. Curr Opin Pulm Med 2006; 12:60-7. [PMID: 16357581 DOI: 10.1097/01.mcp.0000198066.73328.3a] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW It is difficult to identify specific groups of asthmatic patients who may benefit from acute or chronic use of anticholinergic agents. Therefore, an important consideration is how anticholinergic agents can be used to achieve clinically effective treatment of asthma. RECENT FINDINGS A genotype-stratified study revealed that greater bronchoprotective effect of anticholinergic agents was observed in asthmatic patients with the Arg/Arg genotype of the beta2-adrenergic receptor. Anticholinergic agents could add to the bronchodilation obtained with beta2-agonists on acute severe asthma. CD8+ T lymphocytes induced by chronic hepatitis C viral infection causes chronic obstructive pulmonary disease-like inflammation in asthma. Virus-specific CD8+ T lymphocytes may induce cholinergic activation in asthma through M2 receptor dysfunction. Therefore, anticholinergic agents are highly effective for asthma associated with chronic viral infection. In contrast, asthma with chronic obstructive pulmonary disease-like inflammation appears to be poorly responsive to beta2-agonists and can lead to partially irreversible airflow limitation. Moreover, a recent report suggested that treatment with inhaled tiotropium bromide markedly inhibited the increase in airway smooth muscle mass, myosin expression, and contractility in asthma. SUMMARY Anticholinergic agents may benefit stable asthmatics, particularly those who have the Arg/Arg genotype. These agents have a demonstrated role in combination with beta2-agonists in the treatment of acute severe asthma, and may benefit asthmatics with chronic obstructive pulmonary disease-like inflammation. Moreover, these agents could be also beneficial in preventing airway remodeling in asthmatic airways.
Collapse
Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Asahi-machi, Abenoku, Osaka, Japan.
| |
Collapse
|
23
|
Goldberg HJ, Fiedler D, Webb A, Jagirdar J, Hoyumpa AM, Peters J. Sarcoidosis after treatment with interferon-alpha: a case series and review of the literature. Respir Med 2006; 100:2063-8. [PMID: 16675213 DOI: 10.1016/j.rmed.2006.03.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 03/02/2006] [Accepted: 03/04/2006] [Indexed: 01/30/2023]
Abstract
Recombinant interferon-alpha (rINF-alpha) is an immunomodulator used in the treatment of various conditions, including viral infections and malignancies. The use of rINF-alpha has been associated with the development of sarcoidosis in recent case reports. In this series, we report the incidence of sarcoidosis in recipients of rINF-alpha for hepatitis C viral (HCV) infection at our institution. We also review the 57 additional cases of sarcoidosis associated with rINF-alpha described in the literature, including clinical presentation, radiographic findings, management, and outcomes, and discuss the potential mechanisms by which rINF-alpha may lead to the development of sarcoidosis.
Collapse
Affiliation(s)
- Hilary J Goldberg
- Brigham and Womens' Hospital, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harvard University School of Medicine, PBB Clinics-3, 75 Francis St., Boston, MA 02115, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Moorman J, Saad M, Kosseifi S, Krishnaswamy G. Hepatitis C virus and the lung: implications for therapy. Chest 2005; 128:2882-92. [PMID: 16236966 DOI: 10.1378/chest.128.4.2882] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Hepatitis C virus (HCV) infection is a chronic blood-borne disease that affects > 4,000,000 individuals in the United States. The majority of individuals with HVC infection acquire a chronic hepatitis that predisposes them to the complications of cirrhosis and hepatoma. Chronic HCV infection is, however, associated with multiple extrahepatic manifestations as well, including recently recognized effects on the lung. These include primary effects on lung function, as well as secondary effects in the settings of progressive liver disease and drug treatment for HCV. In this article, we discuss the emerging clinical data that support a role for HCV infection in lung disease, describe the multiple pulmonary manifestations of this viral infection, and outline the therapies available for specific pulmonary complications of chronic HCV infection.
Collapse
Affiliation(s)
- Jonathan Moorman
- Division of Infectious Diseases, Department of Internal Medicine, James H. Quillen VAMC and James H. Quillen College of Medicine, East Tennessee State University, Box 70622, Johnson City, TN 37614, USA.
| | | | | | | |
Collapse
|
25
|
Kanazawa H, Yoshikawa J. Alterations in T-lymphocyte subsets in the airways of asthmatic patients with active hepatitis C virus infection. Respiration 2005; 73:318-23. [PMID: 16179822 DOI: 10.1159/000088357] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 04/12/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The interaction between hepatitis C virus (HCV) infection and certain pulmonary disorders is of considerable interest. We have previously found that active HCV infection in asthmatic patients is associated with impaired responses to inhaled corticosteroid therapy. OBJECTIVES To examine differences in T-lymphocyte subsets in asthmatic airways with or without HCV infection. METHODS 12 HCV-negative and 29-HCV positive asthmatics were included in this study. All HCV-positive asthmatics received interferon (IFN) therapy (11 IFN responders and 18 IFN non-responders). T-lymphocyte subsets in induced sputum were analyzed before and 1 year after IFN therapy. RESULTS Before IFN therapy, percentages of lymphocytes and CD8+ T lymphocytes in induced sputum were higher in HCV-positive asthmatics than in HCV-negative asthmatics. After IFN therapy, there was no significant change in percentages of lymphocytes and T-lymphocyte subsets in IFN non-responders. However, percentage of lymphocytes and CD8+ T lymphocytes in IFN responders significantly decreased, while CD4+ T lymphocytes increased. Therefore, the CD4/CD8 ratio significantly increased following IFN therapy in IFN responders. In IFN responders, forced expiratory volume in 1 s (FEV(1)) after salbutamol administration significantly increased following IFN therapy, while it did not change in non-responders. In addition, in IFN responders, the change in the CD4/CD8 ratio after IFN therapy was significantly correlated with the increase in FEV(1) after salbutamol administration. CONCLUSIONS The number of CD8+ T lymphocytes increases in the airways of asthmatic patients with active HCV infection, and this may be associated with airway dysfunction in these patients.
Collapse
Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | | |
Collapse
|
26
|
Iskandar SB, McKinney LA, Shah L, Roy TM, Byrd RP. Desquamative Interstitial Pneumonia and Hepatitis C Virus Infection: A Rare Association. South Med J 2004; 97:890-3. [PMID: 15455981 DOI: 10.1097/01.smj.0000136259.92633.e8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Extrahepatic manifestations of hepatitis C virus (HCV) infection are common. The authors report the unusual occurrence of desquamative interstitial pneumonia (DIP) in a patient with HCV. An immunologic response to HCV infection may have a role in the pathogenesis of DIP in patients with chronic HCV. Since DIP is treatable, HCV patients with pulmonary infiltrates should be thoroughly investigated for this disorder. In our experience, the use of steroids in HCV-associated DIP improved the patient's respiratory status without increasing the viral load.
Collapse
Affiliation(s)
- Said B Iskandar
- The Veterans Affairs Medical Center, Mountain Home, TN 37684-4000, USA
| | | | | | | | | |
Collapse
|
27
|
Kula M, Gulmez I, Tutus A, Coskun A, Gursoy S, Oymak S. Impaired lung epithelial permeability in hepatitis C virus antibody positive patients detected by 99mTc-DTPA aerosol scintigraphy. Nucl Med Commun 2002; 23:441-6. [PMID: 11973484 DOI: 10.1097/00006231-200205000-00003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic hepatitis C virus (HCV) infection has been recently identified as an aetiological agent in idiopathic pulmonary fibrosis. The present study was designed to determine the pulmonary clearance rate of 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) in asymptomatic HCV antibody positive (HCV Ab+) patients and the role of 99mTc-DTPA aerosol scintigraphy in the early detection of lung involvement. Twenty-six non-smoker HCV Ab+ and HCV-RNA (+) patients (20 female, six male; aged 43+/-11 years), with no clinical pulmonary symptoms, and normal radiological findings, were studied. Thirty-one healthy non-smoker volunteers (24 female, seven male; aged 40+/-10 years) were taken as a control group. 99mTc-DTPA aerosol inhalation scintigraphy and pulmonary function tests were performed in all patients and in controls. On the basis of the scintigrams the percentage decline in activity per minute (Kep) was evaluated, which represented an accurate parameter of lung membrane permeability. The mean Kep values of healthy controls (0.78+/-0.13 for left lung, 0.79+/-0.14 for right lung) were significantly lower than HCV Ab+ patients (1.10+/-0.31 for left lung, 1.11+/-0.34 for right lung, P<0.001). But no significant change was observed in PFT (P>0.05). We conclude that subclinical alveolitis and/or interstitial lung disease may be present in patients with HCV Ab+, since it is known that an increase in the epithelial permeability of the lung is an early manifestation of interstitial disease.
Collapse
Affiliation(s)
- M Kula
- Department of Nuclear Medicine, Erciyes University, School of Medicine, Kayseri, Turkey.
| | | | | | | | | | | |
Collapse
|
28
|
Pérez-Alvarez R, Pérez-López R, Lombraña JLS, Rodríguez M, Rodrigo L. Sarcoidosis in two patients with chronic hepatitis C treated with interferon, ribavirin and amantadine. J Viral Hepat 2002; 9:75-9. [PMID: 11851906 DOI: 10.1046/j.1365-2893.2002.00105.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We report two patients with chronic hepatitis C, both nonresponders to a previous course of interferon (IFN), who developed or suffered an exacerbation of sarcoidosis while under treatment with IFN-alpha2a, ribavirin and amantadine. Patient 1: symptoms appeared after week 4 and treatment was withdrawn at month 9 due to severe weight loss, marked dyspnea, muscular weakness, dryness of mouth and facial paralysis. Stage III pulmonary sarcoidosis and polyneuropathy were confirmed. The patient had become steroid dependent and nine months after cessation of the treatment dyspnea and muscular weakness still persisted. She achieved a complete sustained response of hepatitis C. Patient 2: presented with a previous diagnosis of granulomatous hepatitis with chronic active hepatitis C and chronic dermatitis. The treatment exacerbated a cutaneous sarcoidosis. Furthermore, hiliar adenopathies consistent with stage I sarcoidosis became evident. Sarcoidosis responded to corticosteroids, but elevated transaminases and hepatitis C viraemia resisted. Hence, the combination of amantadine with ribavirin and IFN can develop or exacerbate subclinical sarcoidosis. A synergistic effect of these three drugs is suggested.
Collapse
Affiliation(s)
- R Pérez-Alvarez
- Gastroenterology Service, Hospital Central de Asturias, Oviedo, Spain.
| | | | | | | | | |
Collapse
|
29
|
Ramos-Casals M, García-Carrasco M, Font Franco J, Ingelmo Morín M. Manifestaciones clínicas e inmunológicas asociadas a la infección crónica por el virus de la hepatitis C. Rev Clin Esp 2002. [DOI: 10.1016/s0014-2565(02)71033-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
30
|
Idilman R, Çetinkaya H, Savaş İ, Aslan N, Sak SD, Baştemir M, Sarioğlu M, Soykan İ, Bozdayı M, Colantoni A, Aydıntuğ O, Bahar K, Uzunalimoğlu Ö, Van Thiel DH, Numanoğlu N, Dökmeci A. Bronchoalveolar lavage fluid analysis in individuals with chronic hepatitis C. J Med Virol 2001. [DOI: 10.1002/jmv.2108] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
31
|
Shirai T, Honjo Y, Takashima M, Takayanagi S, Chida K, Nakamura H. Effect of interferon-α on pulmonary function and airway responsiveness in patients with chronic hepatitis C. Allergol Int 2001. [DOI: 10.1046/j.1440-1592.2001.00235.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
32
|
Ohtake N, Suzuki R, Daikuhara H, Nakai Y, Yamamoto M, Amagaya S, Ishige A, Sasaki H, Komatsu Y, Fukuda K, Hayashi S. Modulation of lung local immune responses by oral administration of a herbal medicine Sho-saiko-to. INTERNATIONAL JOURNAL OF IMMUNOPHARMACOLOGY 2000; 22:419-30. [PMID: 10727753 DOI: 10.1016/s0192-0561(00)00007-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sho-saiko-to (SST), a Chinese/Japanese herbal medicine (Kampo medicine) widely used to treat chronic hepatitis in Japan, is known to modulate immune responses, and thus its immunomodulating activity may be responsible for its bi-directional effects on the lungs as therapeutic efficacy in various lung diseases and involvement in development of interstitial pneumonia. We administered SST to BALB/c mice orally and examined the lung tissue levels of pro/anti-inflammatory cytokines, interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), and the effects of SST on acute lung injury induced by instillation of lipopolysaccharide (LPS) or IL-1. Although SST had no effect on lung TNF-alpha or IL-1beta level, it increased IL-6. Investigation of active fractions of SST suggested that multiple ingredients were supposed to be responsible for IL-6-inducing activity. Liquiritigenin, a metabolite of liquiritin which is one of the major ingredients in SST enhanced in vitro IL-6 production in anti-CD3 monoclonal antibody (anti-CD3 mAb)-stimulated lung mononuclear cells in a cell-type specific and dose-dependent manner. SST suppressed LPS-induced lung injury at the later phase when lung leak was evident while being ineffective on initial neutrophil sequestration to the lung in these models. These findings suggest that SST modulates lung inflammation by regulating local immune response.
Collapse
Affiliation(s)
- N Ohtake
- Kampo Pharmacology Department, Tsumura Central Research Laboratories, Tsumura & Co., Ibaraki, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Affiliation(s)
- A L Zignego
- Department of Internal Medicine, University of Florence, Italy.
| | | |
Collapse
|