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Sampley S, Bhasin D, Sekhri K, Singh H, Gupta O. Effect of Aviptadil, a Novel Therapy, on Clinical Outcomes of Patients with Viral-related Severe ARDS: A Retrospective Observational Study. Indian J Crit Care Med 2024; 28:70-74. [PMID: 38510776 PMCID: PMC10949283 DOI: 10.5005/jp-journals-10071-24594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/28/2023] [Indexed: 03/22/2024] Open
Abstract
Background Dealing with life-threatening viral acute respiratory distress syndrome (ARDS) has always been challenging and with the recent COVID pandemic experience, there is still the need of newer therapies to alleviate mortality. Aviptadil, has shown significant beneficial results in covid. We share our experience with this molecule by doing a retrospective study to evaluate the effect of this drug on clinical outcomes in viral-related Ards patients. Materials and methods In this study, all patients with severe viral-related Ards received Aviptadil along with the conventional treatment. The oxygen saturation, SpO2/FiO2 (ratio of pulse oximetric saturation to fractional inspired oxygen) (S/F) ratio and PaO2/FiO2 (ratio of arterial oxygen partial pressure to fractional inspired oxygen) (p/f) ratio, before and after completion of the drug were studied. Radiological clearance and time for complete recovery from respiratory failure was noted. All variables pre- and postadministration of the drug were compared. Results A total of 68 patients with viral pneumonias were admitted to intensive care unit (Icu) and only 6 patients had severe Ards, who received Aviptadil. The mean oxygen saturation significantly improved from 87.86% before the first Aviptadil dose to 93.43% post 3 days of infusion. Similarly, improvement was seen in PaO2 values from 54.32 to 68.4 posttherapy (p-value < 0.004). SpO2/FiO2 (ratio of pulse oximetric saturation to fractional inspired oxygen) ratio hiked from 149 to 336 at the end of the 3 days infusion (p-value < 0.003). RALE scoring system was used for radiological clearance and the mean change in the score was from 6.42 to 2.5 (p-value 0.00). The average length of stay in the Icu was 12.14 days. No adverse effects were noted. Conclusion Aviptadil has shown to improve the clinical outcomes in patients with severe viral-related ards without any adverse effects. How to cite this article Sampley S, Bhasin D, Sekhri K, Singh H, Gupta O. Effect of Aviptadil, a Novel Therapy, on Clinical Outcomes of Patients with Viral-related Severe ARDS: A Retrospective Observational Study. Indian J Crit Care Med 2024;28(1):70-74.
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Affiliation(s)
- Supriya Sampley
- Medical Intensive Care Unit, Max Super Speciality Hospital, Mohali, Punjab, India
| | - Deepak Bhasin
- Department of Pulmonology and Critical Care, Max Super Speciality Hospital, Mohali, Punjab, India
| | - Kavita Sekhri
- Department of Pharmacology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Punjab University, Chandigarh, India
| | - Harpal Singh
- Department of Pulmonology and Critical Care, Max Super Speciality Hospital, Mohali, Punjab, India
| | - Onkar Gupta
- Department of Pulmonology and Critical Care, Max Super Speciality Hospital, Mohali, Punjab, India
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Ikonomou L, Magnusson M, Dries R, Herzog EL, Hynds RE, Borok Z, Park JA, Skolasinski S, Burgess JK, Turner L, Mojarad SM, Mahoney JE, Lynch T, Lehmann M, Thannickal VJ, Hook JL, Vaughan AE, Hoffman ET, Weiss DJ, Ryan AL. Stem cells, cell therapies, and bioengineering in lung biology and disease 2021. Am J Physiol Lung Cell Mol Physiol 2022; 323:L341-L354. [PMID: 35762622 PMCID: PMC9484991 DOI: 10.1152/ajplung.00113.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022] Open
Abstract
The 9th biennial conference titled "Stem Cells, Cell Therapies, and Bioengineering in Lung Biology and Diseases" was hosted virtually, due to the ongoing COVID-19 pandemic, in collaboration with the University of Vermont Larner College of Medicine, the National Heart, Lung, and Blood Institute, the Alpha-1 Foundation, the Cystic Fibrosis Foundation, and the International Society for Cell & Gene Therapy. The event was held from July 12th through 15th, 2021 with a pre-conference workshop held on July 9th. As in previous years, the objectives remained to review and discuss the status of active research areas involving stem cells (SCs), cellular therapeutics, and bioengineering as they relate to the human lung. Topics included 1) technological advancements in the in situ analysis of lung tissues, 2) new insights into stem cell signaling and plasticity in lung remodeling and regeneration, 3) the impact of extracellular matrix in stem cell regulation and airway engineering in lung regeneration, 4) differentiating and delivering stem cell therapeutics to the lung, 5) regeneration in response to viral infection, and 6) ethical development of cell-based treatments for lung diseases. This selection of topics represents some of the most dynamic and current research areas in lung biology. The virtual workshop included active discussion on state-of-the-art methods relating to the core features of the 2021 conference, including in situ proteomics, lung-on-chip, induced pluripotent stem cell (iPSC)-airway differentiation, and light sheet microscopy. The conference concluded with an open discussion to suggest funding priorities and recommendations for future research directions in basic and translational lung biology.
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Affiliation(s)
- Laertis Ikonomou
- Department of Oral Biology, University at Buffalo, State University of New York, Buffalo, New York
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York
| | - Mattias Magnusson
- Division of Molecular Medicine and Gene Therapy, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Ruben Dries
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Erica L Herzog
- Yale Interstitial Lung Disease Center of Excellence, Pulmonary and Critical Care Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Robert E Hynds
- Epithelial Cell Biology in ENT Research Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Zea Borok
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, California
| | - Jin-Ah Park
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Janette K Burgess
- Department of Pathology and Medical Biology, Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Leigh Turner
- Department of Health, Society, and Behavior, University of California, Irvine Program In Public Health, Irvine, California
| | - Sarah M Mojarad
- Engineering in Society Program, Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | | | - Thomas Lynch
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Mareike Lehmann
- Institute of Lung Health and Immunity, Comprehensive Pneumology Center Munich, Helmholtz Zentrum München, Munich, Germany
| | - Victor J Thannickal
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jamie L Hook
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
- Global Health and Emerging Pathogens Institute, Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Andrew E Vaughan
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Evan T Hoffman
- Department of Medicine, University of Vermont, Burlington, Vermont
| | - Daniel J Weiss
- Department of Medicine, University of Vermont, Burlington, Vermont
| | - Amy L Ryan
- Hastings Center for Pulmonary Research, Department of Medicine, University of Southern California, Los Angeles, California
- Department of Stem Cell and Regenerative Medicine, University of Southern California, Los Angeles, California
- Department of Anatomy and Cell Biology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Davido B, Lemarie B, Gault E, Pepin M, Jaffal K, Beaune S, Dahmane L, Dumoulin J, Greffe S, Annane D, De Truchis P. Superinfection is associated with short-term outcome and mortality in viral respiratory tract infections during the fall-winter seasons 2016-2018 in the Greater Paris area: the SUPERFLUOUS study. Int J Infect Dis 2022; 119:217-224. [DOI: 10.1016/j.ijid.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022] Open
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Lemarie B, Boussaid G, Gault E, Prigent H, Beaune S, Moreau F, Dumoulin J, Pepin M, Greffe S, De Truchis P, Davido B. Predictors of hospitalization and superinfection in viral respiratory tract infections between influenza and paramyxoviruses: the SUPERFLUOUS study. J Infect Dis 2021; 226:1027-1035. [PMID: 34636898 DOI: 10.1093/infdis/jiab525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Viral respiratory tract infections (VRTIs) are one of the most common diseases, but the risk of superinfection has never been compared depending on virus species. METHODS Multicenter retrospective study conducted amongst adults tested positive to VRTIs by RT-PCR. We compared characteristics between influenza (A-B) and paramyxoviruses (RSV,PIV1,PIV3 and hMPV) and identified predictors of superinfection and hospitalization. RESULTS 590 patients had a VRTI, including 347 (59%) influenza and 243 paramyxoviruses with comparable superinfections between groups (53% vs 60%). In multivariate analyses, predictors of superinfections were: age>75 years-old (aOR=2.37, 95%CI [1.65-3.40]), chronic respiratory disease (aOR=1.79, 95%CI [1.20-2.67]) and biological abnormalities (neutrophils>7000/mm 3, aOR=1.98, 95%CI [1.34-2.91]; eosinophils<50/mm 3, aOR=2.53, 95%CI [1.61-3.98]; PCT>0.25ng/mL, aOR=2.8, 95%CI [1.65-4.73]). Predictors of hospitalisation were: age>75 years-old (aOR=3.49, 95%CI [2.17-5.63]), paramyxovirus infection (aOR=2.28, 95%CI [1.39-3.75]), long-term use of inhaled corticosteroids (aOR=2.49, 95%CI [1.13-5.49]) and biological abnormalities (neutrophils>7000/mm 3, aOR=2.38, 95%CI [1.37-4.12]; PCT>0.25ng/mL, aOR=2.49, 95%CI [1.23-5.02]). Kaplan-Meier survival curves showed that influenza-infected patients experienced a higher mortality than paramyxoviruses (8.9% versus 4.5% respectively, p=0.017). CONCLUSION Our study revealed a high rate of superinfection (56%), not related to viral species. However influenza was associated with a poorer prognosis than paramyxoviruses, pleading for a broader and large-scale vaccination of individual at risk of VRTIs.
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Affiliation(s)
- Benoit Lemarie
- Maladies Infectieuses, Hôpital Raymond Poincaré - Garches, France
| | | | - Elyanne Gault
- Virologie, Hôpital Ambroise-Paré, AP-HP - Boulogne-Billancourt, France
| | - Helene Prigent
- Exploration Fonctionnelles Respiratoires, Hôpital Raymond-Poincaré, APHP, - Garches , France
| | - Sebastien Beaune
- Service d'Accueil des Urgences, Hôpital Ambroise Paré, AP-HP - Boulogne-Billancourt , France
| | - Frederique Moreau
- Virologie, Hôpital Ambroise-Paré, AP-HP - Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Pneumologie, Hôpital Ambroise Paré, AP-HP - Boulogne-Billancourt , France
| | - Marion Pepin
- Gériatrie, Hôpital Ambroise Paré, AP-HP - Boulogne-Billancourt, France
| | - Segolene Greffe
- Médecine Interne, Hôpital Ambroise Paré, AP-HP - Boulogne-Billancourt, France
| | | | - Benjamin Davido
- Maladies Infectieuses, Hôpital Raymond Poincaré - Garches, France
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Smiechowicz J, Barteczko-Grajek B, Adamik B, Bojko J, Gozdzik W, Lipinska-Gediga M. Influenza in patients with respiratory failure admitted to intensive care units in Poland and the use of extracorporeal respiratory support: a survey-based multicenter study. BMC Infect Dis 2021; 21:954. [PMID: 34525950 PMCID: PMC8441232 DOI: 10.1186/s12879-021-06672-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background In Poland, little is known about the most serious cases of influenza that need admittance to the intensive care unit (ICU), as well as the use of extracorporeal respiratory support. Methods This was an electronic survey comprising ICUs in two administrative regions of Poland. The aim of the study was to determine the number of influenza patients with respiratory failure admitted to the ICU in the autumn–winter season of 2018/2019. Furthermore, respiratory support, outcome and other pathogens detected in the airways were investigated. Results Influenza infection was confirmed in 76 patients. The A(H1N1)pdm09 strain was the most common. 34 patients died (44.7%). The median age was 62 years, the median sequential organ failure assessment (SOFA) score was 11 and was higher in patients who died (12 vs. 10, p = 0.017). Mechanical ventilation was used in 75 patients and high flow nasal oxygen therapy in 1 patient. Extracorporeal membrane oxygenation (ECMO) was used in 7 patients (6 survived), and extracorporeal carbon dioxide removal (ECCO2R) in 2 (1 survived). The prone position was used in 16 patients. In addition, other pathogens were detected in the airways on admittance to the ICU. Conclusion A substantial number of influenza infections occurred in the autumn–winter season of 2018/2019 that required costly treatment in the intensive care units. Upon admission to the ICU, influenza patients had a high degree of organ failure as assessed by the SOFA score, and the mortality rate was 44.7%. Advanced extracorporeal respiratory techniques offer real survival opportunities to patients with severe influenza-related ARDS. The presence of coinfection should be considered in patients with influenza and respiratory failure. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06672-w.
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Affiliation(s)
- Jakub Smiechowicz
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland.
| | - Barbara Barteczko-Grajek
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Barbara Adamik
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Jozef Bojko
- Department of Anaesthesiology and Intensive Therapy, Provincial Hospital in Opole, Kosnego 53, 46-020, Opole, Poland
| | - Waldemar Gozdzik
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Malgorzata Lipinska-Gediga
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland.,Department of Anaesthesiology and Intensive Therapy, 4th Military Hospital of Wroclaw, Weigla 5, 50-981, Wrocław, Poland
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Logette E, Lorin C, Favreau C, Oshurko E, Coggan JS, Casalegno F, Sy MF, Monney C, Bertschy M, Delattre E, Fonta PA, Krepl J, Schmidt S, Keller D, Kerrien S, Scantamburlo E, Kaufmann AK, Markram H. A Machine-Generated View of the Role of Blood Glucose Levels in the Severity of COVID-19. Front Public Health 2021; 9:695139. [PMID: 34395368 PMCID: PMC8356061 DOI: 10.3389/fpubh.2021.695139] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 started spreading toward the end of 2019 causing COVID-19, a disease that reached pandemic proportions among the human population within months. The reasons for the spectrum of differences in the severity of the disease across the population, and in particular why the disease affects more severely the aging population and those with specific preconditions are unclear. We developed machine learning models to mine 240,000 scientific articles openly accessible in the CORD-19 database, and constructed knowledge graphs to synthesize the extracted information and navigate the collective knowledge in an attempt to search for a potential common underlying reason for disease severity. The machine-driven framework we developed repeatedly pointed to elevated blood glucose as a key facilitator in the progression of COVID-19. Indeed, when we systematically retraced the steps of the SARS-CoV-2 infection, we found evidence linking elevated glucose to each major step of the life-cycle of the virus, progression of the disease, and presentation of symptoms. Specifically, elevations of glucose provide ideal conditions for the virus to evade and weaken the first level of the immune defense system in the lungs, gain access to deep alveolar cells, bind to the ACE2 receptor and enter the pulmonary cells, accelerate replication of the virus within cells increasing cell death and inducing an pulmonary inflammatory response, which overwhelms an already weakened innate immune system to trigger an avalanche of systemic infections, inflammation and cell damage, a cytokine storm and thrombotic events. We tested the feasibility of the hypothesis by manually reviewing the literature referenced by the machine-generated synthesis, reconstructing atomistically the virus at the surface of the pulmonary airways, and performing quantitative computational modeling of the effects of glucose levels on the infection process. We conclude that elevation in glucose levels can facilitate the progression of the disease through multiple mechanisms and can explain much of the differences in disease severity seen across the population. The study provides diagnostic considerations, new areas of research and potential treatments, and cautions on treatment strategies and critical care conditions that induce elevations in blood glucose levels.
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Affiliation(s)
- Emmanuelle Logette
- Blue Brain Project, École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Henry Markram
- Blue Brain Project, École polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland
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Somayaji R, Neradilek MB, Szpiro AA, Lofy KH, Jackson ML, Goss CH, Duchin JS, Neuzil KM, Ortiz JR. Effects of Air Pollution and Other Environmental Exposures on Estimates of Severe Influenza Illness, Washington, USA. Emerg Infect Dis 2021; 26. [PMID: 32310747 PMCID: PMC7181929 DOI: 10.3201/eid2605.190599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Ecologic models of influenza burden may be confounded by other exposures that share winter seasonality. We evaluated the effects of air pollution and other environmental exposures in ecologic models estimating influenza-associated hospitalizations. We linked hospitalization data, viral surveillance, and environmental data, including temperature, relative humidity, dew point, and fine particulate matter for 3 counties in Washington, USA, for 2001-2012. We used negative binomial regression models to estimate the incidence of influenza-associated respiratory and circulatory (RC) hospitalizations and to assess the effect of adjusting for environmental exposures on RC hospitalization estimates. The modeled overall incidence rate of influenza-associated RC hospitalizations was 31/100,000 person-years. The environmental parameters were statistically associated with RC hospitalizations but did not appreciably affect the event rate estimates. Modeled influenza-associated RC hospitalization rates were similar to published estimates, and inclusion of environmental covariates in the model did not have a clinically important effect on severe influenza estimates.
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Wang J, Zhang Y, Zhu F, Chen L, Wei Y, Zhu Q, Jiang J, Huang JA, Guo Q, Yang X. CircRNA expression profiling and bioinformatics analysis indicate the potential biological role and clinical significance of circRNA in influenza A virus-induced lung injury. J Biosci 2021. [PMID: 33969826 PMCID: PMC8060339 DOI: 10.1007/s12038-021-00152-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Circular RNA (circRNA) plays an important role in the regulation of multiple biological processes. However, circRNA profiling and the potential biological role of circRNA in influenza A virus (IAV)-induced lung injury have not been investigated. In the present study, circRNA expression profiles in lung tissues from mice with and without IAV-induced lung injury were analyzed using high-throughput sequencing, and differentially expressed circRNAs were verified by quantitative PCR. The gene homology of candidate circRNAs was investigated and the expression of plasma circRNAs from patients with IAV-induced acute respiratory distress syndrome (ARDS) was detected. The target microRNAs (miRNAs) of circRNAs were predicted. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed. In total, 781 circRNAs were differentially expressed between ARDS mice and control (467 were up-regulated and 314 were down-regulated). Moreover, the candidate circRNAs (Slco3a1, Nfatc2, Wdr33, and Dmd) expression showed the same trend with the sequencing results. The isoforms of circRNA Slco3a1 and Wdr33 were highly conserved between humans and mice. Plasma circRNA Slco3a1 and Wdr33 presented differential expression in patients with IAV-induced ARDS compared to control. The circRNA-miRNA interaction network and GO and KEGG analyses indicated the potential biological role of circRNAs in the development of IAV-induced lung injury. Taken together, a large number of differentially expressed circRNAs were identified in our study. CircRNA Slco3a1 and Wdr33 had significantly different expression in specimens from mice and humans, and showed a potential biological role in IAV-induced lung injury by bioinformatics analysis.
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Affiliation(s)
- Jiajia Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215000 China
| | - Yanbing Zhang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215000 China
| | - Fengfeng Zhu
- Department of Emergency and Critical Care Medicine, The Fifth People’s Hospital of Suzhou, Suzhou, 215000 China
| | - Liling Chen
- Suzhou Center for Disease Control and Prevention, Suzhou, 215004 China
| | - Yao Wei
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215000 China
| | - Qingqing Zhu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215000 China
| | - Junhong Jiang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215000 China
| | - Jian-an Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215000 China
| | - Qiang Guo
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215000 China
| | - Xinjing Yang
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215000 China
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Schneider JL, Rowe JH, Garcia-de-Alba C, Kim CF, Sharpe AH, Haigis MC. The aging lung: Physiology, disease, and immunity. Cell 2021; 184:1990-2019. [PMID: 33811810 PMCID: PMC8052295 DOI: 10.1016/j.cell.2021.03.005] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/01/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
The population is aging at a rate never seen before in human history. As the number of elderly adults grows, it is imperative we expand our understanding of the underpinnings of aging biology. Human lungs are composed of a unique panoply of cell types that face ongoing chemical, mechanical, biological, immunological, and xenobiotic stress over a lifetime. Yet, we do not fully appreciate the mechanistic drivers of lung aging and why age increases the risk of parenchymal lung disease, fatal respiratory infection, and primary lung cancer. Here, we review the molecular and cellular aspects of lung aging, local stress response pathways, and how the aging process predisposes to the pathogenesis of pulmonary disease. We place these insights into context of the COVID-19 pandemic and discuss how innate and adaptive immunity within the lung is altered with age.
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Affiliation(s)
- Jaime L Schneider
- Department of Cell Biology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA; Dana Farber Cancer Institute, Boston, MA 02115, USA; Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Jared H Rowe
- Division of Hematology Boston Children's Hospital and Division of Pediatric Oncology Dana-Farber Cancer Institute, Boston, MA 02115, USA
| | - Carolina Garcia-de-Alba
- Stem Cell Program and Divisions of Hematology/Oncology and Pulmonary Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Carla F Kim
- Stem Cell Program and Divisions of Hematology/Oncology and Pulmonary Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA; Harvard Stem Cell Institute, Cambridge, MA 02138, USA.
| | - Arlene H Sharpe
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA; Evergrande Center for Immunologic Disease, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Marcia C Haigis
- Department of Cell Biology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA.
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McQuattie-Pimentel AC, Ren Z, Joshi N, Watanabe S, Stoeger T, Chi M, Lu Z, Sichizya L, Aillon RP, Chen CI, Soberanes S, Chen Z, Reyfman PA, Walter JM, Anekalla KR, Davis JM, Helmin KA, Runyan CE, Abdala-Valencia H, Nam K, Meliton AY, Winter DR, Morimoto RI, Mutlu GM, Bharat A, Perlman H, Gottardi CJ, Ridge KM, Chandel NS, Sznajder JI, Balch WE, Singer BD, Misharin AV, Budinger GS. The lung microenvironment shapes a dysfunctional response of alveolar macrophages in aging. J Clin Invest 2021; 131:140299. [PMID: 33586677 PMCID: PMC7919859 DOI: 10.1172/jci140299] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022] Open
Abstract
Alveolar macrophages orchestrate the response to viral infections. Age-related changes in these cells may underlie the differential severity of pneumonia in older patients. We performed an integrated analysis of single-cell RNA-Seq data that revealed homogenous age-related changes in the alveolar macrophage transcriptome in humans and mice. Using genetic lineage tracing with sequential injury, heterochronic adoptive transfer, and parabiosis, we found that the lung microenvironment drove an age-related resistance of alveolar macrophages to proliferation that persisted during influenza A viral infection. Ligand-receptor pair analysis localized these changes to the extracellular matrix, where hyaluronan was increased in aged animals and altered the proliferative response of bone marrow-derived macrophages to granulocyte macrophage colony-stimulating factor (GM-CSF). Our findings suggest that strategies targeting the aging lung microenvironment will be necessary to restore alveolar macrophage function in aging.
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Affiliation(s)
| | - Ziyou Ren
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nikita Joshi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Satoshi Watanabe
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Thomas Stoeger
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, Illinois, USA
| | - Monica Chi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ziyan Lu
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lango Sichizya
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raul Piseaux Aillon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ching-I Chen
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Saul Soberanes
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Zhangying Chen
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Paul A. Reyfman
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - James M. Walter
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kishore R. Anekalla
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jennifer M. Davis
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kathryn A. Helmin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Constance E. Runyan
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Hiam Abdala-Valencia
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kiwon Nam
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Angelo Y. Meliton
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Chicago Hospitals, Chicago, Illinois, USA
| | - Deborah R. Winter
- Department of Medicine, Division of Rheumatology, Northwestern University, Chicago, Illinois, USA
| | - Richard I. Morimoto
- Department of Biochemistry and Molecular Genetics, Northwestern University, Evanston, Illinois, USA
| | - Gökhan M. Mutlu
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Chicago Hospitals, Chicago, Illinois, USA
| | - Ankit Bharat
- Department of Surgery, Division of Thoracic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Harris Perlman
- Department of Medicine, Division of Rheumatology, Northwestern University, Chicago, Illinois, USA
| | - Cara J. Gottardi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Karen M. Ridge
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Navdeep S. Chandel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jacob I. Sznajder
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - William E. Balch
- The Scripps Research Institute Department of Chemical Physiology, La Jolla, California, USA
| | - Benjamin D. Singer
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Biochemistry and Molecular Genetics, Northwestern University, Evanston, Illinois, USA
| | - Alexander V. Misharin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - G.R. Scott Budinger
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
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11
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Runyan CE, Welch LC, Lecuona E, Shigemura M, Amarelle L, Abdala‐Valencia H, Joshi N, Lu Z, Nam K, Markov NS, McQuattie‐Pimentel AC, Piseaux‐Aillon R, Politanska Y, Sichizya L, Watanabe S, Williams KJ, Budinger GRS, Sznajder JI, Misharin AV. Impaired phagocytic function in CX3CR1 + tissue-resident skeletal muscle macrophages prevents muscle recovery after influenza A virus-induced pneumonia in old mice. Aging Cell 2020; 19:e13180. [PMID: 32720752 PMCID: PMC7587460 DOI: 10.1111/acel.13180] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/14/2020] [Accepted: 05/30/2020] [Indexed: 12/23/2022] Open
Abstract
Skeletal muscle dysfunction in survivors of pneumonia disproportionately affects older individuals in whom it causes substantial morbidity. We found that skeletal muscle recovery was impaired in old compared with young mice after influenza A virus-induced pneumonia. In young mice, recovery of muscle loss was associated with expansion of tissue-resident skeletal muscle macrophages and downregulation of MHC II expression, followed by a proliferation of muscle satellite cells. These findings were absent in old mice and in mice deficient in Cx3cr1. Transcriptomic profiling of tissue-resident skeletal muscle macrophages from old compared with young mice showed downregulation of pathways associated with phagocytosis and proteostasis, and persistent upregulation of inflammatory pathways. Consistently, skeletal muscle macrophages from old mice failed to downregulate MHCII expression during recovery from influenza A virus-induced pneumonia and showed impaired phagocytic function in vitro. Like old animals, mice deficient in the phagocytic receptor Mertk showed no macrophage expansion, MHCII downregulation, or satellite cell proliferation and failed to recover skeletal muscle function after influenza A pneumonia. Our data suggest that a loss of phagocytic function in a CX3CR1+ tissue-resident skeletal muscle macrophage population in old mice precludes satellite cell proliferation and recovery of skeletal muscle function after influenza A pneumonia.
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Affiliation(s)
- Constance E. Runyan
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Lynn C. Welch
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Emilia Lecuona
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Masahiko Shigemura
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Luciano Amarelle
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Hiam Abdala‐Valencia
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Nikita Joshi
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Ziyan Lu
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Kiwon Nam
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Nikolay S. Markov
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | | | - Raul Piseaux‐Aillon
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Yuliya Politanska
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Lango Sichizya
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Satoshi Watanabe
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Kinola J.N. Williams
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - G. R. Scott Budinger
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Jacob I. Sznajder
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Alexander V. Misharin
- Division of Pulmonary and Critical Care MedicineFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
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12
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Hsu JC, Lee IK, Huang WC, Chen YC, Tsai CY. Clinical Characteristics and Predictors of Mortality in Critically Ill Influenza Adult Patients. J Clin Med 2020; 9:jcm9041073. [PMID: 32283858 PMCID: PMC7230963 DOI: 10.3390/jcm9041073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 02/01/2023] Open
Abstract
Severe influenza is associated with high morbidity and mortality. The aim of this study was to investigate the factors affecting the clinical outcomes of critically ill influenza patients. In this retrospective study, we enrolled critically ill adult patients with influenza at the Kaohsiung Chang Gung Memorial Hospital in Taiwan. We evaluated the demographic, clinical, and laboratory findings and examined whether any of these measurements correlated with mortality. We then created an event-based algorithm as a simple predictive tool using two variables with statistically significant associations with mortality. Between 2015 and 2018, 102 critically ill influenza patients (median age, 62 years) were assessed; among them, 41 (40.1%) patients died. Of the 94 patients who received oseltamivir therapy, 68 (72.3%) began taking oseltamivir 48 h after the onset of illness. Of the 102 patients, the major influenza-associated complications were respiratory failure (97%), pneumonia (94.1%), acute kidney injury (65.7%), adult respiratory distress syndrome (ARDS) (51%), gastrointestinal bleeding (35.3%), and bacteremia (16.7%). In the multivariate regression model, high lactate levels, ARDS, acute kidney injury, and gastrointestinal bleeding were independent predictors of mortality in critically ill influenza patients. The optimal lactate level cutoff for predicting mortality was 3.7 mmol/L with an area under curve of 0.728. We constructed an event-associated algorithm that included lactate and ARDS. Fifteen (75%) of 20 patients with lactate levels 3.7 mmol/L and ARDS died, compared with only 1 (7.7%) of 13 patients with normal lactate levels and without ARDS. We identified clinical and laboratory predictors of mortality that could aid in the care of critically ill influenza patients. Identification of these prognostic markers could be improved to prioritize key examinations that might be useful in determining patient outcomes.
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Affiliation(s)
- Jui-Chi Hsu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (J.-C.H.); (W.-C.H.); (Y.-C.C.); (C.-Y.T.)
| | - Ing-Kit Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (J.-C.H.); (W.-C.H.); (Y.-C.C.); (C.-Y.T.)
- Department of Internal Medicine, Chang Gung University Medical College, Tao-Yuan 330, Taiwan
- Correspondence:
| | - Wen-Chi Huang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (J.-C.H.); (W.-C.H.); (Y.-C.C.); (C.-Y.T.)
| | - Yi-Chun Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (J.-C.H.); (W.-C.H.); (Y.-C.C.); (C.-Y.T.)
| | - Ching-Yen Tsai
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (J.-C.H.); (W.-C.H.); (Y.-C.C.); (C.-Y.T.)
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13
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Chavez D, Gonzales‐Armayo V, Mendoza E, Palekar R, Rivera R, Rodriguez A, Salazar C, Veizaga A, Añez A. Estimation of influenza and respiratory syncytial virus hospitalizations using sentinel surveillance data-La Paz, Bolivia. 2012-2017. Influenza Other Respir Viruses 2019; 13:477-483. [PMID: 31206257 PMCID: PMC6692540 DOI: 10.1111/irv.12663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The objective was to estimate the number of hospitalizations associated with influenza and RSV using data from severe acute respiratory infection (SARI) sentinel surveillance from El Alto-La Paz. Bolivia. METHODS All persons who met the case definition for SARI at one sentinel hospital had a clinical sample collected and analyzed by rRT-PCR for influenza and by indirect immunofluorescence for RSV. The SARI-influenza and SARI-RSV case counts were stratified by six age groups. The proportion of cases captured in the sentinel hospital in relation to the non-sentinel hospitals of area was multiplied by the age-specific census population, to build the denominators. The annual incidence and a 95% confidence interval (CI) were estimated. RESULTS During 2012-2017, n = 2606 SARI cases were reported (average incidence 120/100 000 inhabitants [95% CI: 116-124]); the average incidence of influenza-associated SARI hospitalization was 15.3/100 000 (95% CI: 14.1-16.7), and the average incidence of RSV-associated SARI hospitalization was 9/100 000 inhabitants (95% CI: 8.1-10.1). The highest incidence of influenza was among those less than one year of age (average 174.7/100 000 [range: 89.1-299.5]), followed by those one to four years of age (average 51.8/100 000 [range: 19.8-115.4]) and then those 65 years of age and older (average 47.7/100 000 [range: 18.8-117]). For RSV, the highest incidence was highest among those less than one year of age (231/100 000 [range: 119.9-322.9]). CONCLUSION Influenza and RSV represent major causes of hospitalization in La Paz, Bolivia-with the highest burden among children under one year of age. Our estimates support current prevention strategies in this age group.
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14
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Ortiz JR, Neuzil KM. Influenza vaccine programs for children in low- and middle-income countries: current status and way forward. Expert Rev Vaccines 2019; 18:711-724. [DOI: 10.1080/14760584.2019.1635462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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15
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Czaja CA, Miller L, Alden N, Wald HL, Cummings CN, Rolfes MA, Anderson EJ, Bennett NM, Billing LM, Chai SJ, Eckel S, Mansmann R, McMahon M, Monroe ML, Muse A, Risk I, Schaffner W, Thomas AR, Yousey-Hindes K, Garg S, Herlihy RK. Age-Related Differences in Hospitalization Rates, Clinical Presentation, and Outcomes Among Older Adults Hospitalized With Influenza-U.S. Influenza Hospitalization Surveillance Network (FluSurv-NET). Open Forum Infect Dis 2019; 6:5510081. [PMID: 31363771 DOI: 10.1093/ofid/ofz225] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 05/30/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Rates of influenza hospitalizations differ by age, but few data are available regarding differences in laboratory-confirmed rates among adults aged ≥65 years. METHODS We evaluated age-related differences in influenza-associated hospitalization rates, clinical presentation, and outcomes among 19 760 older adults with laboratory-confirmed influenza at 14 FluSurv-NET sites during the 2011-2012 through 2014-2015 influenza seasons using 10-year age groups. RESULTS There were large stepwise increases in the population rates of influenza hospitalization with each 10-year increase in age. Rates ranged from 101-417, 209-1264, and 562-2651 per 100 000 persons over 4 influenza seasons in patients aged 65-74 years, 75-84 years, and ≥85 years, respectively. Hospitalization rates among adults aged 75-84 years and ≥85 years were 1.4-3.0 and 2.2-6.4 times greater, respectively, than rates for adults aged 65-74 years. Among patients hospitalized with laboratory-confirmed influenza, there were age-related differences in demographics, medical histories, and symptoms and signs at presentation. Compared to hospitalized patients aged 65-74 years, patients aged ≥85 years had higher odds of pneumonia (aOR, 1.2; 95% CI, 1.0-1.3; P = .01) and in-hospital death or transfer to hospice (aOR, 2.1; 95% CI, 1.7-2.6; P < .01). CONCLUSIONS Age-related differences in the incidence and severity of influenza hospitalizations among adults aged ≥65 years can inform prevention and treatment efforts, and data should be analyzed and reported using additional age strata.
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Affiliation(s)
- Christopher A Czaja
- Colorado Department of Public Health and Environment, Denver.,Colorado School of Public Health, Aurora
| | | | - Nisha Alden
- Colorado Department of Public Health and Environment, Denver
| | | | | | | | - Evan J Anderson
- Emory University School of Medicine, Georgia Emerging Infections Program, and Atlanta Veteran's Affairs Medical Center
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, New York
| | | | - Shua J Chai
- Centers for Disease Control and Prevention, Atlanta, Georgia.,California Emerging Infections Program, Oakland
| | - Seth Eckel
- Michigan Department of Health and Human Services, Lansing
| | | | | | | | | | - Ilene Risk
- Salt Lake County Health Department, Utah
| | | | | | | | - Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Baselga-Moreno V, Trushakova S, McNeil S, Sominina A, Nunes MC, Draganescu A, Unal S, Koul P, Kyncl J, Zhang T, Kuatbayeva A, Ben-Salah A, Burtseva E, Puig-Barberà J, Díez-Domingo J. Influenza epidemiology and influenza vaccine effectiveness during the 2016-2017 season in the Global Influenza Hospital Surveillance Network (GIHSN). BMC Public Health 2019; 19:487. [PMID: 31046725 PMCID: PMC6498567 DOI: 10.1186/s12889-019-6713-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/27/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Global Influenza Hospital Surveillance Network (GIHSN) aims to determine the burden of severe influenza disease and Influenza Vaccine Effectiveness (IVE). This is a prospective, active surveillance and hospital-based epidemiological study to collect epidemiological data in the GIHSN. In the 2016-2017 influenza season, 15 sites in 14 countries participated in the GIHSN, although the analyses could not be performed in 2 sites. A common core protocol was used in order to make results comparable. Here we present the results of the GIHSN 2016-2017 influenza season. METHODS A RT-PCR test was performed to all patients that accomplished the requirements detailed on a common core protocol. Patients admitted were included in the study after signing the informed consent, if they were residents, not institutionalised, not discharged in the previous 30 days from other hospitalisation with symptoms onset within the 7 days prior to admission. Patients 5 years old or more must also complied the Influenza-Like Illness definition. A test negative-design was implemented to perform IVE analysis. IVE was estimated using a logistic regression model, with the formula IVE = (1-aOR) × 100, where aOR is the adjusted Odds Ratio comparing cases and controls. RESULTS Among 21,967 screened patients, 10,140 (46.16%) were included, as they accomplished the inclusion criteria, and tested, and therefore 11,827 (53.84%) patients were excluded. Around 60% of all patients included with laboratory results were recruited at 3 sites. The predominant strain was A(H3N2), detected in 63.6% of the cases (1840 patients), followed by B/Victoria, in 21.3% of the cases (618 patients). There were 2895 influenza positive patients (28.6% of the included patients). A(H1N1)pdm09 strain was mainly found in Mexico. IVE could only be performed in 6 sites separately. Overall IVE was 27.24 (95% CI 15.62-37.27. Vaccination seemed to confer better protection against influenza B and in people 2-4 years, or 85 years old or older. The aOR for hospitalized and testing positive for influenza was 3.02 (95% CI 1.59-5.76) comparing pregnant with non-pregnant women. CONCLUSIONS Vaccination prevented around 1 in 4 hospitalisations with influenza. Sparse numbers didn't allow estimating IVE in all sites separately. Pregnancy was found a risk factor for influenza, having 3 times more risk of being admitted with influenza for pregnant women.
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Affiliation(s)
- Víctor Baselga-Moreno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), 21 Cataluña Av, 46020 Valencia, Spain
| | - Svetlana Trushakova
- Ivanovsky Institute of Virology FSBI “N.F. Gamaleya FRCEM” Ministry of Health, Moscow, Russian Federation
| | - Shelly McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Halifax, Canada
| | - Anna Sominina
- Research Institute of Influenza, WHO National Influenza Centre of Russia, St. Petersburg, Russian Federation
| | - Marta C. Nunes
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Anca Draganescu
- National Institute of Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest (INBI “Prof. Dr. Matei Bals”), București, Romania
| | - Serhat Unal
- Turkish Society of Internal Medicine, Ankara, Turkey
| | - Parvaiz Koul
- Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, India
| | - Jan Kyncl
- National Institute of Public Health, Prague, Czech Republic
| | | | - Ainagul Kuatbayeva
- Center for Sanitary-Epidemiological Expertise and Monitoring, Almaty, Kazakhstan
| | - Afif Ben-Salah
- Pasteur Institute of Tunis, Tunis, Tunisia
- College of Medicine and Medical Sciences, Manama, Bahrain
| | - Elena Burtseva
- Ivanovsky Institute of Virology FSBI “N.F. Gamaleya FRCEM” Ministry of Health, Moscow, Russian Federation
| | - Joan Puig-Barberà
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), 21 Cataluña Av, 46020 Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), 21 Cataluña Av, 46020 Valencia, Spain
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17
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Florence JM, Krupa A, Booshehri LM, Davis SA, Matthay MA, Kurdowska AK. Inhibiting Bruton's tyrosine kinase rescues mice from lethal influenza-induced acute lung injury. Am J Physiol Lung Cell Mol Physiol 2018. [PMID: 29516781 DOI: 10.1152/ajplung.00047.2018] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Infection with seasonal influenza A virus (IAV) leads to lung inflammation and respiratory failure, a main cause of death in influenza-infected patients. Previous experiments in our laboratory indicate that Bruton's tyrosine kinase (Btk) plays a substantial role in regulating inflammation in the respiratory region during acute lung injury in mice; therefore, we sought to determine if blocking Btk activity has a protective effect in the lung during influenza-induced inflammation. The Btk inhibitor ibrutinib (also known as PCI-32765) was administered intranasally to mice starting 72 h after lethal infection with IAV. Our data indicate that treatment with the Btk inhibitor not only reduced weight loss and led to survival, but also had a dramatic effect on morphological changes to the lungs, in IAV-infected mice. Attenuation of lung inflammation indicative of acute lung injury, such as alveolar hemorrhage, interstitial thickening, and the presence of alveolar exudate, together with reduced levels of the inflammatory mediators TNFα, IL-1β, IL-6, KC, and MCP-1, strongly suggests amelioration of the pathological immune response in the lungs to promote resolution of the infection. Finally, we observed that blocking Btk specifically in the alveolar compartment led to significant attenuation of neutrophil extracellular traps released into the lung in vivo and neutrophil extracellular trap formation in vitro. Our innovative findings suggest that Btk may be a new drug target for influenza-induced lung injury, and, in general, that immunomodulatory treatment may be key in treating lung dysfunction driven by excessive inflammation.
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Affiliation(s)
- Jon M Florence
- Center for Biomedical Research, University of Texas Health Science Center at Tyler , Tyler, Texas
| | - Agnieszka Krupa
- Center for Biomedical Research, University of Texas Health Science Center at Tyler , Tyler, Texas.,Laboratory of Gastroimmunology, Department of Immunology and Infectious Biology, Faculty of Biology and Environmental Protection, University of Lodz , Lodz , Poland
| | - Laela M Booshehri
- Center for Biomedical Research, University of Texas Health Science Center at Tyler , Tyler, Texas
| | - Sandra A Davis
- Center for Biomedical Research, University of Texas Health Science Center at Tyler , Tyler, Texas
| | - Michael A Matthay
- Department of Medicine and Anesthesia, Cardiovascular Research Institute, School of Medicine, University of California , San Francisco, California
| | - Anna K Kurdowska
- Center for Biomedical Research, University of Texas Health Science Center at Tyler , Tyler, Texas
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18
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Hecker L. Mechanisms and consequences of oxidative stress in lung disease: therapeutic implications for an aging populace. Am J Physiol Lung Cell Mol Physiol 2017; 314:L642-L653. [PMID: 29351446 DOI: 10.1152/ajplung.00275.2017] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The rapid expansion of the elderly population has led to the recent epidemic of age-related diseases, including increased incidence and mortality of chronic and acute lung diseases. Numerous studies have implicated aging and oxidative stress in the pathogenesis of various pulmonary diseases; however, despite recent advances in these fields, the specific contributions of aging and oxidative stress remain elusive. This review will discuss the consequences of aging on lung morphology and physiology, and how redox imbalance with aging contributes to lung disease susceptibility. Here, we focus on three lung diseases for which aging is a significant risk factor: acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), and idiopathic pulmonary fibrosis (IPF). Preclinical and clinical development for redox- and senescence-altering therapeutic strategies are discussed, as well as scientific advancements that may direct current and future therapeutic development. A deeper understanding of how aging impacts normal lung function, redox balance, and injury-repair processes will inspire the development of new therapies to prevent and/or reverse age-associated pulmonary diseases, and ultimately increase health span and longevity. This review is intended to encourage basic, clinical, and translational research that will bridge knowledge gaps at the intersection of aging, oxidative stress, and lung disease to fuel the development of more effective therapeutic strategies for lung diseases that disproportionately afflict the elderly.
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Affiliation(s)
- Louise Hecker
- Division of Pulmonary, Allergy and Critical Care and Sleep Medicine, University of Arizona , Tucson, Arizona and Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona
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19
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Budinger GRS, Kohanski RA, Gan W, Kobor MS, Amaral LA, Armanios M, Kelsey KT, Pardo A, Tuder R, Macian F, Chandel N, Vaughan D, Rojas M, Mora AL, Kovacs E, Duncan SR, Finkel T, Choi A, Eickelberg O, Chen D, Agusti A, Selman M, Balch WE, Busse P, Lin A, Morimoto R, Sznajder JI, Thannickal VJ. The Intersection of Aging Biology and the Pathobiology of Lung Diseases: A Joint NHLBI/NIA Workshop. J Gerontol A Biol Sci Med Sci 2017; 72:1492-1500. [PMID: 28498894 PMCID: PMC5861849 DOI: 10.1093/gerona/glx090] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/10/2017] [Indexed: 12/31/2022] Open
Abstract
Death from chronic lung disease is increasing and chronic obstructive pulmonary disease has become the third leading cause of death in the United States in the past decade. Both chronic and acute lung diseases disproportionately affect elderly individuals, making it likely that these diseases will become more frequent and severe as the worldwide population ages. Chronic lung diseases are associated with substantial morbidity, frequently resulting in exercise limiting dyspnea, immobilization, and isolation. Therefore, effective strategies to prevent or treat lung disease are likely to increase healthspan as well as life span. This review summarizes the findings of a joint workshop sponsored by the NIA and NHLBI that brought together investigators focused on aging and lung biology. These investigators encouraged the use of genetic systems and aged animals in the study of lung disease and the development of integrative systems-based platforms that can dynamically incorporate data sets that describe the genomics, transcriptomics, epigenomics, metabolomics, and proteomics of the aging lung in health and disease. Further research was recommended to integrate benchmark biological hallmarks of aging in the lung with the pathobiology of acute and chronic lung diseases with divergent pathologies for which advanced age is the most important risk factor.
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Affiliation(s)
- GR Scott Budinger
- Feinberg School of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Ronald A Kohanski
- Division of Aging Biology, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Weiniu Gan
- Division of Lung Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael S Kobor
- Center for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Luis A Amaral
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, Illinois
| | - Mary Armanios
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karl T Kelsey
- Departments of Epidemiology, Laboratory Medicine & Pathology, Brown University, Providence, Rhode Island
| | - Annie Pardo
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan, México
| | - Rubin Tuder
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado
| | - Fernando Macian
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York
| | - Navdeep Chandel
- Feinberg School of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Douglas Vaughan
- Feinberg School of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Mauricio Rojas
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ana L Mora
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Kovacs
- Department of Surgery, University of Colorado at Denver Health Sciences Center, Denver, Colorado
| | | | - Toren Finkel
- Center for Molecular Medicine, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Augustine Choi
- Weill Cornell Medical College, Division of Pulmonary and Critical Care Medicine, Weill Department of Medicine, New York, New York
| | - Oliver Eickelberg
- Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus
| | - Danica Chen
- Program in Metabolic Biology, Nutritional Sciences & Toxicology, University of California, Berkeley, California
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Spain
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan, México
| | - William E Balch
- Department of Chemical Physiology, Department of Cell and Molecular Biology, The Skaggs Institute of Chemical Biology, The Scripps Research Institute, La Jolla, California
| | - Paula Busse
- Division of Clinical Immunology, Department of Medicine, Mount Sinai School of Medicine, New York, New York
| | - Anning Lin
- Ben May Department for Cancer Research, University of Chicago, Chicago, Illinois
| | - Richard Morimoto
- Department of Molecular Biosciences, Rice Institute for Biomedical Research, Northwestern University, Evanston, Illinois
| | - Jacob I Sznajder
- Feinberg School of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
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Makarkov AI, Chierzi S, Pillet S, Murai KK, Landry N, Ward BJ. Plant-made virus-like particles bearing influenza hemagglutinin (HA) recapitulate early interactions of native influenza virions with human monocytes/macrophages. Vaccine 2017; 35:4629-4636. [DOI: 10.1016/j.vaccine.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/30/2017] [Accepted: 07/02/2017] [Indexed: 02/07/2023]
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21
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Somayaji R, Goss CH, Khan U, Neradilek M, Neuzil KM, Ortiz JR. Cystic Fibrosis Pulmonary Exacerbations Attributable to Respiratory Syncytial Virus and Influenza: A Population-Based Study. Clin Infect Dis 2017; 64:1760-1767. [PMID: 28329304 PMCID: PMC5848232 DOI: 10.1093/cid/cix203] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/02/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND. Characterization of the role of respiratory viral pathogens on cystic fibrosis (CF) pulmonary disease is needed. We aimed to determine the association of influenza and respiratory syncytial virus (RSV) activity with risk of pulmonary exacerbation (PEx) in persons with CF in the United States. METHODS. We conducted a cohort study from January 2003 to March 2009 using the CF Foundation Patient Registry merged with Centers for Disease Control and Prevention respiratory virus surveillance data. The primary goal was to determine the association between regional influenza or RSV detections with risk of PEx requiring intravenous antibiotics or hospitalization. We analyzed outcomes by geographic region and week of event using multivariable regression models adjusted for demographic and clinical predictors of PEx stratified for children (<18 years) and adults (≥18 years) to calculate relative risks (RRs) of PEx. RESULTS. There were 21022 individuals (52% male) in the CF patient cohort in 2003 comprised of 12702 children and 8320 adults. The overall incidence rate of PEx was 521.9 per 10000 person-months. In children, a 10% increase in the proportion of surveillance tests positive for influenza or RSV was significantly associated with increased PEx risk (RR, 1.02; 95% confidence interval [CI], 1.01-1.03) and (RR, 1.05; 95% CI, 1.02-1.07), respectively. In adults, surveillance tests positive for influenza (RR, 1.02; 95% CI, 1.01-1.02), but not RSV (RR, 0.99; 95% CI, .98-1.01), had a significant association with PEx risk. CONCLUSIONS. Our large CF population-based cohort demonstrated a significant association between PEx risk and influenza activity in children and adults and with RSV activity in children.
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Affiliation(s)
- Ranjani Somayaji
- Department of Medicine, University of Calgary, Alberta, Canada
- Department of Medicine, University of Washington
| | | | - Umer Khan
- Cystic Fibrosis Therapeutics Development Network, Seattle Children's Hospital, and
| | | | - Kathleen M Neuzil
- Center for Vaccine Development, University of Maryland, Baltimore; and
| | - Justin R Ortiz
- Department of Medicine and Global Health, University of Washington, Seattle
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Puig-Barberà J, Burtseva E, Yu H, Cowling BJ, Badur S, Kyncl J, Sominina A. Influenza epidemiology and influenza vaccine effectiveness during the 2014-2015 season: annual report from the Global Influenza Hospital Surveillance Network. BMC Public Health 2016; 16 Suppl 1:757. [PMID: 27556802 PMCID: PMC5001209 DOI: 10.1186/s12889-016-3378-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Global Influenza Hospital Surveillance Network (GIHSN) has established a prospective, active surveillance, hospital-based epidemiological study to collect epidemiological and virological data for the Northern and Southern Hemispheres over several consecutive seasons. It focuses exclusively on severe cases of influenza requiring hospitalization. A standard protocol is shared between sites allowing comparison and pooling of results. During the 2014-2015 influenza season, the GIHSN included seven coordinating sites from six countries (St. Petersburg and Moscow, Russian Federation; Prague, Czech Republic; Istanbul, Turkey; Beijing, China; Valencia, Spain; and Rio de Janeiro, Brazil). Here, we present the detailed epidemiological and influenza vaccine effectiveness findings for the Northern Hemisphere 2014-2015 influenza season.
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Affiliation(s)
- Joan Puig-Barberà
- Foundation for the Promotion of Health and Biomedical Research in the Valencia Region FISABIO - Public Health, Avda Catalunya 21, 46020, Valencia, Spain.
| | - Elena Burtseva
- D.I. Ivanovsky Institute of Virology FGBC "N.F. Gamaleya FRCEM" Ministry of Health of Russian Federation, Moscow, Russian Federation, Russia
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Benjamin J Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Selim Badur
- National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jan Kyncl
- National Institute of Public Health (NIPH), Prague, Czech Republic
| | - Anna Sominina
- Research Institute of Influenza, Saint Petersburg, Russian Federation, Russia
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Abstract
Seasonal and pandemic influenza are the two faces of respiratory infections caused by influenza viruses in humans. As seasonal influenza occurs on an annual basis, the circulating virus strains are closely monitored and a yearly updated vaccination is provided, especially to identified risk populations. Nonetheless, influenza virus infection may result in pneumonia and acute respiratory failure, frequently complicated by bacterial coinfection. Pandemics are, in contrary, unexpected rare events related to the emergence of a reassorted human-pathogenic influenza A virus (IAV) strains that often causes increased morbidity and spreads extremely rapidly in the immunologically naive human population, with huge clinical and economic impact. Accordingly, particular efforts are made to advance our knowledge on the disease biology and pathology and recent studies have brought new insights into IAV adaptation mechanisms to the human host, as well as into the key players in disease pathogenesis on the host side. Current antiviral strategies are only efficient at the early stages of the disease and are challenged by the genomic instability of the virus, highlighting the need for novel antiviral therapies targeting the pulmonary host response to improve viral clearance, reduce the risk of bacterial coinfection, and prevent or attenuate acute lung injury. This review article summarizes our current knowledge on the molecular basis of influenza infection and disease progression, the key players in pathogenesis driving severe disease and progression to lung failure, as well as available and envisioned prevention and treatment strategies against influenza virus infection.
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Affiliation(s)
- Christin Peteranderl
- Department of Internal Medicine II, University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Susanne Herold
- Department of Internal Medicine II, University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Carole Schmoldt
- Department of Internal Medicine II, University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
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Murray MA, Chotirmall SH. The Impact of Immunosenescence on Pulmonary Disease. Mediators Inflamm 2015; 2015:692546. [PMID: 26199462 PMCID: PMC4495178 DOI: 10.1155/2015/692546] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/09/2015] [Indexed: 01/09/2023] Open
Abstract
The global population is aging with significant gains in life expectancy particularly in the developed world. Consequently, greater focus on understanding the processes that underlie physiological aging has occurred. Key facets of advancing age include genomic instability, telomere shortening, epigenetic changes, and declines in immune function termed immunosenescence. Immunosenescence and its associated chronic low grade systemic "inflamm-aging" contribute to the development and progression of pulmonary disease in older individuals. These physiological processes predispose to pulmonary infection and confer specific and unique clinical phenotypes observed in chronic respiratory disease including late-onset asthma, chronic obstructive pulmonary disease, and pulmonary fibrosis. Emerging concepts of the gut and airway microbiome further complicate the interrelationship between host and microorganism particularly from an immunological perspective and especially so in the setting of immunosenescence. This review focuses on our current understanding of the aging process, immunosenescence, and how it can potentially impact on various pulmonary diseases and the human microbiome.
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Affiliation(s)
- Michelle A. Murray
- Department of Respiratory Medicine, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland
| | - Sanjay H. Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232
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25
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Thannickal VJ, Murthy M, Balch WE, Chandel NS, Meiners S, Eickelberg O, Selman M, Pardo A, White ES, Levy BD, Busse PJ, Tuder RM, Antony VB, Sznajder JI, Budinger GRS. Blue journal conference. Aging and susceptibility to lung disease. Am J Respir Crit Care Med 2015; 191:261-9. [PMID: 25590812 DOI: 10.1164/rccm.201410-1876pp] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The aging of the population in the United States and throughout the developed world has increased morbidity and mortality attributable to lung disease, while the morbidity and mortality from other prevalent diseases has declined or remained stable. Recognizing the importance of aging in the development of lung disease, the American Thoracic Society (ATS) highlighted this topic as a core theme for the 2014 annual meeting. The relationship between aging and lung disease was discussed in several oral symposiums and poster sessions at the annual ATS meeting. In this article, we used the input gathered at the conference to develop a broad framework and perspective to stimulate basic, clinical, and translational research to understand how the aging process contributes to the onset and/or progression of lung diseases. A consistent theme that emerged from the conference was the need to apply novel, systems-based approaches to integrate a growing body of genomic, epigenomic, transcriptomic, and proteomic data and elucidate the relationship between biologic hallmarks of aging, altered lung function, and increased susceptibility to lung diseases in the older population. The challenge remains to causally link the molecular and cellular changes of aging with age-related changes in lung physiology and disease susceptibility. The purpose of this review is to stimulate further research to identify new strategies to prevent or treat age-related lung disease.
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26
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Herold S, Becker C, Ridge KM, Budinger GRS. Influenza virus-induced lung injury: pathogenesis and implications for treatment. Eur Respir J 2015; 45:1463-78. [PMID: 25792631 DOI: 10.1183/09031936.00186214] [Citation(s) in RCA: 303] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/07/2015] [Indexed: 01/21/2023]
Abstract
The influenza viruses are some of the most important human pathogens, causing substantial seasonal and pandemic morbidity and mortality. In humans, infection of the lower respiratory tract of can result in flooding of the alveolar compartment, development of acute respiratory distress syndrome and death from respiratory failure. Influenza-mediated damage of the airway, alveolar epithelium and alveolar endothelium results from a combination of: 1) intrinsic viral pathogenicity, attributable to its tropism for host airway and alveolar epithelial cells; and 2) a robust host innate immune response, which, while contributing to viral clearance, can worsen the severity of lung injury. In this review, we summarise the molecular events at the virus-host interface during influenza virus infection, highlighting some of the important cellular responses. We discuss immune-mediated viral clearance, the mechanisms promoting or perpetuating lung injury, lung regeneration after influenza-induced injury, and recent advances in influenza prevention and therapy.
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Affiliation(s)
- Susanne Herold
- Dept of Internal Medicine II, Universities Giessen and Marburg Lung Center (UGMLC), Justus-Liebig University, Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Christin Becker
- Dept of Internal Medicine II, Universities Giessen and Marburg Lung Center (UGMLC), Justus-Liebig University, Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Karen M Ridge
- Pulmonary and Critical Care Medicine, Northwestern University, Chicago, IL, USA
| | - G R Scott Budinger
- Pulmonary and Critical Care Medicine, Northwestern University, Chicago, IL, USA
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27
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Pilkinton MA, Talbot HK. Update on Vaccination Guidelines for Older Adults. J Am Geriatr Soc 2015; 63:584-8. [DOI: 10.1111/jgs.13375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - H. Keipp Talbot
- Department of Medicine; School of Medicine; Vanderbilt University; Nashville Tennessee
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28
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Madigan EA, Kenneley I. Barriers and Facilitators to Provision of Influenza and Pneumococcal Vaccines in Home Health Care Agencies. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2015; 27:13-17. [PMID: 28579735 DOI: 10.1177/1084822314530993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The recommendations for influenza and pneumococcal vaccines are widely known yet the rates of both immunizations for home health care patients are 70 percent or less. The purpose of this study was to identify the facilitators and barriers to immunizations ultimately to improve vaccination rates among home health care patients. Using a multi-case study approach with five agencies and one group of administrators, facilitators included providing patients with a vaccine "card" and using the agency electronic medical record (EMR) for decision support/reminders. We determined that there were patient barriers (misperceptions about vaccines in general, difficulty in recalling vaccine status) and provider barriers (misperceptions about vaccines among health care workers, home health care agencies not receiving accurate information from other providers or difficulty in determining vaccine status).
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Affiliation(s)
- Elizabeth A Madigan
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Irena Kenneley
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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29
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Ortiz JR, Neuzil KM, Cooke CR, Neradilek MB, Goss CH, Shay DK. Influenza pneumonia surveillance among hospitalized adults may underestimate the burden of severe influenza disease. PLoS One 2014; 9:e113903. [PMID: 25423025 PMCID: PMC4244176 DOI: 10.1371/journal.pone.0113903] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/02/2014] [Indexed: 01/10/2023] Open
Abstract
Background Studies seeking to estimate the burden of influenza among hospitalized adults often use case definitions that require presence of pneumonia. The goal of this study was to assess the extent to which restricting influenza testing to adults hospitalized with pneumonia could underestimate the total burden of hospitalized influenza disease. Methods We conducted a modelling study using the complete State Inpatient Databases from Arizona, California, and Washington and regional influenza surveillance data acquired from CDC from January 2003 through March 2009. The exposures of interest were positive laboratory tests for influenza A (H1N1), influenza A (H3N2), and influenza B from two contiguous US Federal Regions encompassing the study area. We identified the two outcomes of interest by ICD-9-CM code: respiratory and circulatory hospitalizations, as well as critical illness hospitalizations (acute respiratory failure, severe sepsis, and in-hospital death). We linked the hospitalization datasets with the virus surveillance datasets by geographic region and month of hospitalization. We used negative binomial regression models to estimate the number of influenza-associated events for the outcomes of interest. We sub-categorized these events to include all outcomes with or without pneumonia diagnosis codes. Results We estimated that there were 80,834 (95% CI 29,214–174,033) influenza-associated respiratory and circulatory hospitalizations and 26,760 (95% CI 14,541–47,464) influenza-associated critical illness hospitalizations. When a pneumonia diagnosis was excluded, the estimated number of influenza-associated respiratory and circulatory hospitalizations was 24,816 (95% CI 6,342–92,624). The estimated number of influenza-associated critical illness hospitalizations was 8,213 (95% CI 3,764–20,799). Around 30% of both influenza-associated respiratory and circulatory hospitalizations, as well as influenza-associated critical illness hospitalizations did not have pneumonia diagnosis codes. Conclusions Surveillance studies which only consider hospitalizations that include a diagnosis of pneumonia may underestimate the total burden of influenza hospitalizations.
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Affiliation(s)
- Justin R. Ortiz
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Vaccine Access and Delivery Global Program, PATH, Seattle, Washington, United States of America
- * E-mail:
| | - Kathleen M. Neuzil
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Vaccine Access and Delivery Global Program, PATH, Seattle, Washington, United States of America
| | - Colin R. Cooke
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Moni B. Neradilek
- The Mountain-Whisper-Light Statistics, Seattle, Washington, United States of America
| | - Christopher H. Goss
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - David K. Shay
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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30
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Ortiz JR, Neuzil KM, Shay DK, Rue TC, Neradilek MB, Zhou H, Seymour CW, Hooper LG, Cheng PY, Goss CH, Cooke CR. The burden of influenza-associated critical illness hospitalizations. Crit Care Med 2014; 42:2325-32. [PMID: 25148596 PMCID: PMC4620028 DOI: 10.1097/ccm.0000000000000545] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Influenza is the most common vaccine-preventable disease in the United States; however, little is known about the burden of critical illness due to influenza virus infection. Our primary objective was to estimate the proportion of all critical illness hospitalizations that are attributable to seasonal influenza. DESIGN Retrospective cohort study. SETTING Arizona, California, and Washington from January 2003 to March 2009. PATIENTS All adults hospitalized with critical illness, defined by International Classification of Diseases, 9th Edition, Clinical Modification diagnosis and procedure codes for acute respiratory failure, severe sepsis, or in-hospital death. MEASUREMENTS AND MAIN RESULTS We combined the complete hospitalization discharge databases for three U.S. states, regional influenza virus surveillance, and state census data. Using negative binomial regression models, we estimated the incidence rates of adult influenza-associated critical illness hospitalizations and compared them with all-cause event rates. We also compared modeled outcomes to International Classification of Diseases, 9th Edition, Clinical Modification-coded influenza hospitalizations to assess potential underrecognition of severe influenza disease. During the study period, we estimated that 26,760 influenza-associated critical illness hospitalizations (95% CI, 14,541, 47,464) occurred. The population-based incidence estimate for influenza-associated critical illness was 12.0 per 100,000 person-years (95% CI, 6.6, 21.6) or 1.3% of all critical illness hospitalizations (95% CI, 0.7%, 2.3%). During the influenza season, 3.4% of all critical illness hospitalizations (95% CI, 1.9%, 5.8%) were attributable to influenza. There were only 2,612 critical illness hospitalizations with International Classification of Diseases, 9th Edition, Clinical Modification-coded influenza diagnoses, suggesting influenza is either undiagnosed or undercoded in a substantial proportion of critical illness. CONCLUSIONS Extrapolating our data to the 2010 U.S. population, we estimate that about 28,000 adults are hospitalized for influenza-associated critical illness annually. Influenza in many of these critically ill patients may be undiagnosed. Critical care physicians should have a high index of suspicion for influenza in the ICU, particularly when influenza is known to be circulating in their communities.
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Affiliation(s)
- Justin R. Ortiz
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Vaccine Access and Delivery Global Program, PATH, Seattle, WA, USA
| | - Kathleen M. Neuzil
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Vaccine Access and Delivery Global Program, PATH, Seattle, WA, USA
| | - David K. Shay
- Influenza Division, Centers for Disease Control and Prevention, Centers for Disease Prevention and Control, Atlanta, GA, USA
| | - Tessa C. Rue
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Hong Zhou
- Division of Health Informatics and Surveillance (proposed), Centers for Disease Prevention and Control, Atlanta, GA, USA
| | - Christopher W. Seymour
- Departments of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laura G. Hooper
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Po-Young Cheng
- Influenza Division, Centers for Disease Control and Prevention, Centers for Disease Prevention and Control, Atlanta, GA, USA
| | | | - Colin R. Cooke
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
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31
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Are influenza-associated morbidity and mortality estimates for those ≥ 65 in statistical databases accurate, and an appropriate test of influenza vaccine effectiveness? Vaccine 2014; 32:6884-6901. [PMID: 25454864 DOI: 10.1016/j.vaccine.2014.08.090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 07/14/2014] [Accepted: 08/27/2014] [Indexed: 11/22/2022]
Abstract
PURPOSES To assess the accuracy of estimates using statistical databases of influenza-associated morbidity and mortality, and precisely measure influenza vaccine effectiveness. PRINCIPAL RESULTS Laboratory testing of influenza is incomplete. Death certificates under-report influenza. Statistical database models are used as an alternative to randomised controlled trials (RCTs) to assess influenza vaccine effectiveness. Evidence of the accuracy of influenza morbidity and mortality estimates was sought from: (1) Studies comparing statistical models. For four studies Poisson and ARIMA models produced higher estimates than Serfling, and Serfling higher than GLM. Which model is more accurate is unknown. (2) Studies controlling confounders. Fourteen studies mostly controlled one confounder (one controlled comorbidities), and limited control of confounders limits accuracy. EVIDENCE FOR VACCINE EFFECTIVENESS WAS SOUGHT FROM (1) Studies of regions with increasing vaccination rates. Of five studies two controlled for confounders and one found a positive vaccination effect. Three studies did not control confounders and two found no effect of vaccination. (2) Studies controlling multiple confounders. Of thirteen studies only two found a positive vaccine effect and no mortality differences between vaccinees and non-vaccinees in non-influenza seasons, showing confounders were controlled. Key problems are insufficient testing for influenza, using influenza-like illness, heterogeneity of seasonal and pandemic influenza, population aging, and incomplete confounder control (co-morbidities, frailty, vaccination history) and failure to demonstrate control of confounders by proving no mortality differences between vaccinees and non-vaccinees in non-influenza seasons. MAJOR CONCLUSIONS Improving model accuracy requires proof of no mortality differences in pre-influenza periods between the vaccinated and non-vaccinated groups, and reduction in influenza morbidity and mortality in seasons with a good vaccine match, more virulent strains, in the younger elderly with less immune senescence, and specific outcomes (laboratory-confirmed outcomes, pneumonia deaths). Proving influenza vaccine effectiveness requires appropriately powered RCTs, testing participants with RT-PCR tests, and comprehensively monitoring morbidity and mortality.
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32
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Abstract
The Journal has been in the vanguard of publications of the respiratory microbiome, including a National Institutes of Health Workshop report, establishing the normal microbiome in patients with various risks, and in the correlation of microbiome changes with disease exacerbations and lung transplant. A new classification scheme for healthcare-associated pneumonia, risks for nosocomial Pseudomonas pneumonia, and associations between community-acquired pneumonia and risks or outcomes have been reported. The increasingly recognized role of viral respiratory tract infections was reflected in publications regarding incidence rates, risk factors, and associations with other respiratory diseases. Significant contributions to understanding and treating sepsis emerged in 2013. The role of tissue damage was highlighted in a series of publications. A much greater understanding of the importance of pathways that directly impact the pathogen at the site of infection and subsequent pathogen clearance has emerged. The Journal published important contributions across the spectrum of ineffective therapy (activated protein C), novel therapeutic ideas (statins and extracorporeal membrane oxygenation), and solidly beneficial approaches (early protocolized care). Biomarker development is maturing to include a wide array of molecular measurements increasingly aimed at aiding improved therapy.
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Affiliation(s)
- Richard G Wunderink
- 1 Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
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