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Renaud-Picard B, Berra G, Hwang D, Huszti E, Miyamoto E, Berry GJ, Pal P, Juvet S, Keshavjee S, Martinu T. Spectrum of chronic lung allograft dysfunction pathology in human lung transplantation. J Heart Lung Transplant 2024:S1053-2498(24)01563-8. [PMID: 38663465 DOI: 10.1016/j.healun.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/11/2024] [Accepted: 04/09/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Long-term survival after lung transplantation (LTx) remains limited by chronic lung allograft dysfunction (CLAD), which includes 2 main phenotypes: bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), with possible overlap. We aimed to detail and quantify pathological features of these CLAD sub-types. METHODS Peripheral and central paraffin-embedded explanted lung samples were obtained from 20 consecutive patients undergoing a second LTx for CLAD, from 3 lobes. Thirteen lung samples, collected from non-transplant lobectomies or donor lungs, were used as controls. Blinded semi-quantitative grading was performed to assess airway fibrotic changes, parenchymal and pleural fibrosis, and epithelial and vascular abnormalities. RESULTS CLAD lung samples had higher scores for all airway- and lung-related parameters compared to controls. There was a notable overlap in histologic scores between BOS and RAS, with a wide range of scores in both conditions. Parenchymal and vascular fibrosis scores were significantly higher in RAS compared to BOS (p = 0.003 for both). We observed a significant positive correlation between the degree of inflammation around each airway, the severity of epithelial changes, and airway fibrosis. Immunofluorescence staining demonstrated a trend toward a lower frequency of club cells in CLAD and a higher frequency of apoptotic club cells in BOS samples (p = 0.01). CONCLUSIONS CLAD is a spectrum of airway, parenchymal, and pleural fibrosis, as well as epithelial, vascular, and inflammatory pathologic changes, where BOS and RAS overlap significantly. Our semi-quantitative grading score showed a generally high inter-reader reliability and may be useful for future CLAD histologic assessments.
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Affiliation(s)
- Benjamin Renaud-Picard
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada; INSERM Unité Mixte de Recherche 1260, Regenerative Nanomedicine, University of Strasbourg, Strasbourg, France
| | - Gregory Berra
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada; Service de Pneumologie, Département de Médecine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - David Hwang
- Department of Pathology, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Ei Miyamoto
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Gerald J Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Prodipto Pal
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Stephen Juvet
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tereza Martinu
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Basil MC, Alysandratos KD, Kotton DN, Morrisey EE. Lung repair and regeneration: Advanced models and insights into human disease. Cell Stem Cell 2024; 31:439-454. [PMID: 38492572 PMCID: PMC11070171 DOI: 10.1016/j.stem.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
The respiratory system acts as both the primary site of gas exchange and an important sensor and barrier to the external environment. The increase in incidences of respiratory disease over the past decades has highlighted the importance of developing improved therapeutic approaches. This review will summarize recent research on the cellular complexity of the mammalian respiratory system with a focus on gas exchange and immunological defense functions of the lung. Different models of repair and regeneration will be discussed to help interpret human and animal data and spur the investigation of models and assays for future drug development.
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Affiliation(s)
- Maria C Basil
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn, Children's Hospital of Philadelphia (CHOP) Lung Biology Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Konstantinos-Dionysios Alysandratos
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University and Boston Medical Center, Boston, MA 02118, USA.
| | - Darrell N Kotton
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University and Boston Medical Center, Boston, MA 02118, USA.
| | - Edward E Morrisey
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn, Children's Hospital of Philadelphia (CHOP) Lung Biology Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Verleden SE, Hendriks JMH, Snoeckx A, Mai C, Mentens Y, Callebaut W, De Belie B, Van Schil PE, Verplancke V, Janssens A, Jacob J, Pakzad A, Conlon TM, Guvenc G, Yildirim AÖ, Pauwels P, Koljenovic S, Kwakkel-Van Erp JM, Lapperre TS. Small Airway Disease in Pre-Chronic Obstructive Pulmonary Disease with Emphysema: A Cross-Sectional Study. Am J Respir Crit Care Med 2024; 209:683-692. [PMID: 38055196 DOI: 10.1164/rccm.202301-0132oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 12/06/2023] [Indexed: 12/07/2023] Open
Abstract
Rationale: Small airway disease is an important pathophysiological feature of chronic obstructive pulmonary disease (COPD). Recently, "pre-COPD" has been put forward as a potential precursor stage of COPD that is defined by abnormal spirometry findings or significant emphysema on computed tomography (CT) in the absence of airflow obstruction. Objective: To determine the degree and nature of (small) airway disease in pre-COPD using microCT in a cohort of explant lobes/lungs. Methods: We collected whole lungs/lung lobes from patients with emphysematous pre-COPD (n = 10); Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I (n = 6), II (n = 6), and III/IV (n = 7) COPD; and controls (n = 10), which were analyzed using CT and microCT. The degree of emphysema and the number and morphology of small airways were compared between groups, and further correlations were investigated with physiologic measures. Airway and parenchymal pathology was also validated with histopathology. Measurements and Main Results: The numbers of transitional bronchioles and terminal bronchioles per milliliter of lung were significantly lower in pre-COPD and GOLD stages I, II, and III/IV COPD compared with controls. In addition, the number of alveolar attachments of the transitional bronchioles and terminal bronchioles was also lower in pre-COPD and all COPD groups compared with controls. We did not find any differences between the pre-COPD and COPD groups in CT or microCT measures. The percentage of emphysema on CT showed the strongest correlation with the number of small airways in the COPD groups. Histopathology showed an increase in the mean chord length and a decrease in alveolar surface density in pre-COPD and all GOLD COPD stages compared with controls. Conclusions: Lungs of patients with emphysematous pre-COPD already show fewer small airways and airway remodeling even in the absence of physiologic airway obstruction.
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Affiliation(s)
- Stijn E Verleden
- Division of Thoracic Surgery, Antwerp Surgical Training, Anatomy and Research Centre
- Department of Thoracic and Vascular Surgery
- Department of Pulmonology
| | - Jeroen M H Hendriks
- Division of Thoracic Surgery, Antwerp Surgical Training, Anatomy and Research Centre
- Department of Thoracic and Vascular Surgery
| | - Annemiek Snoeckx
- Department of Molecular Morphology Microscopy, Faculty of Medicine and Health Sciences
- Department of Radiology
| | | | - Yves Mentens
- Department of Pulmonology, General Hospital Herentals, Herentals, Belgium
| | - Wim Callebaut
- Department of Pulmonology, General Hospital Voorkempen, Malle, Belgium
| | - Bruno De Belie
- Department of Pulmonology, General Hospital, Rumst, Belgium
| | - Paul E Van Schil
- Division of Thoracic Surgery, Antwerp Surgical Training, Anatomy and Research Centre
- Department of Thoracic and Vascular Surgery
| | | | | | - Joseph Jacob
- Department of Radiology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Ashkan Pakzad
- Department of Radiology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Thomas M Conlon
- Comprehensive Pneumology Center, Institute of Lung Health and Immunity, Helmholtz Munich, Munich, Germany; and
| | - Guney Guvenc
- Comprehensive Pneumology Center, Institute of Lung Health and Immunity, Helmholtz Munich, Munich, Germany; and
| | - Ali Önder Yildirim
- Comprehensive Pneumology Center, Institute of Lung Health and Immunity, Helmholtz Munich, Munich, Germany; and
- Institute of Experimental Pneumology, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Patrick Pauwels
- Center for Oncologic Research, and
- Department of Pathology, University Hospital Antwerp, Edegem, Belgium
| | - Senada Koljenovic
- Center for Oncologic Research, and
- Department of Pathology, University Hospital Antwerp, Edegem, Belgium
| | - Johanna M Kwakkel-Van Erp
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
- Department of Pulmonology
| | - Thérèse S Lapperre
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
- Department of Pulmonology
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Kerckhof P, Ambrocio GPL, Beeckmans H, Kaes J, Geudens V, Bos S, Willems L, Vermaut A, Vermant M, Goos T, De Fays C, Aversa L, Mohamady Y, Vanstapel A, Orlitová M, Van Slambrouck J, Jin X, Varghese V, Josipovic I, Boone MN, Dupont LJ, Weynand B, Dubbeldam A, Van Raemdonck DE, Ceulemans LJ, Gayan-Ramirez G, De Sadeleer LJ, McDonough JE, Vanaudenaerde BM, Vos R. Ventilatory capacity in CLAD is driven by dysfunctional airway structure. EBioMedicine 2024; 101:105030. [PMID: 38394744 PMCID: PMC10897920 DOI: 10.1016/j.ebiom.2024.105030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Chronic lung allograft dysfunction (CLAD) encompasses three main phenotypes: bronchiolitis obliterans syndrome (BOS), restrictive allograft syndrome (RAS) and a Mixed phenotype combining both pathologies. How the airway structure in its entirety is affected in these phenotypes is still poorly understood. METHODS A detailed analysis of airway morphometry was applied to gain insights on the effects of airway remodelling on the distribution of alveolar ventilation in end-stage CLAD. Ex vivo whole lung μCT and tissue-core μCT scanning of six control, six BOS, three RAS and three Mixed explant lung grafts (9 male, 9 female, 2014-2021, Leuven, Belgium) were used for digital airway reconstruction and calculation of airway dimensions in relation to luminal obstructions. FINDINGS BOS and Mixed explants demonstrated airway obstructions of proximal bronchioles (starting at generation five), while RAS explants particularly had airway obstructions in the most distal bronchioles (generation >12). In BOS and Mixed explants 76% and 84% of bronchioles were obstructed, respectively, while this was 22% in RAS. Bronchiolar obstructions were mainly caused by lymphocytic inflammation of the airway wall or fibrotic remodelling, i.e. constrictive bronchiolitis. Proximal bronchiolectasis and imbalance in distal lung ventilation were present in all CLAD phenotypes and explain poor lung function and deterioration of specific lung function parameters. INTERPRETATION Alterations in the structure of conducting bronchioles revealed CLAD to affect alveolar ventilatory distribution in a regional fashion. The significance of various obstructions, particularly those associated with mucus, is highlighted. FUNDING This research was funded with the National research fund Flanders (G060322N), received by R.V.
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Affiliation(s)
- Pieterjan Kerckhof
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Gene P L Ambrocio
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium; Division of Pulmonary Medicine, Department of Internal Medicine, University of the Philippines - Philippine General Hospital, Manilla, The Philippines
| | - Hanne Beeckmans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Janne Kaes
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Vincent Geudens
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Saskia Bos
- Newcastle University, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Lynn Willems
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Astrid Vermaut
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Marie Vermant
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Tinne Goos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Charlotte De Fays
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium; Pole of Pneumology, ENT, and Dermatology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Lucia Aversa
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Yousry Mohamady
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium; Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | | | - Jan Van Slambrouck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Xin Jin
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Vimi Varghese
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium; Department of Heart and Lung Transplant, Yashoda Hospitals, Hyderabad, India
| | - Iván Josipovic
- Department of Physics and Astronomy, UGCT, Radiation Physics, Ghent University, Gent, Belgium
| | - Matthieu N Boone
- Department of Physics and Astronomy, UGCT, Radiation Physics, Ghent University, Gent, Belgium
| | - Lieven J Dupont
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Adriana Dubbeldam
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Laurens J De Sadeleer
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium; Cell Circuits in Systems Medicine of Lung Disease (Schiller Lab), Institute of Lung Health and Immunity (LHI) / Comprehensive Pneumology Centre (CPC), German Centre for Lung Research, Helmholtz Zentrum München, München, Germany
| | - John E McDonough
- Department of Medicine, McMaster University, Firestone Institute of Respiratory Health, Hamilton, Canada
| | - Bart M Vanaudenaerde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
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Rousselière A, Delbos L, Foureau A, Reynaud-Gaubert M, Roux A, Demant X, Le Pavec J, Kessler R, Mornex JF, Messika J, Falque L, Le Borgne A, Boussaud V, Tissot A, Hombourger S, Bressollette-Bodin C, Charreau B. Changes in HCMV immune cell frequency and phenotype are associated with chronic lung allograft dysfunction. Front Immunol 2023; 14:1143875. [PMID: 37187736 PMCID: PMC10175754 DOI: 10.3389/fimmu.2023.1143875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Background Human cytomegalovirus (HCMV) infection is common and often severe in lung transplant recipients (LTRs), and it is a risk factor associated with chronic lung allograft dysfunction (CLAD). The complex interplay between HCMV and allograft rejection is still unclear. Currently, no treatment is available to reverse CLAD after diagnosis, and the identification of reliable biomarkers that can predict the early development of CLAD is needed. This study investigated the HCMV immunity in LTRs who will develop CLAD. Methods This study quantified and phenotyped conventional (HLA-A2pp65) and HLA-E-restricted (HLA-EUL40) anti-HCMV CD8+ T (CD8 T) cell responses induced by infection in LTRs developing CLAD or maintaining a stable allograft. The homeostasis of immune subsets (B, CD4T, CD8 T, NK, and γδT cells) post-primary infection associated with CLAD was also investigated. Results At M18 post-transplantation, HLA-EUL40 CD8 T responses were less frequently found in HCMV+ LTRs (21.7%) developing CLAD (CLAD) than in LTRs (55%) keeping a functional graft (STABLE). In contrast, HLA-A2pp65 CD8 T was equally detected in 45% of STABLE and 47.8% of CLAD LTRs. The frequency of HLA-EUL40 and HLA-A2pp65 CD8 T among blood CD8 T cells shows lower median values in CLAD LTRs. Immunophenotype reveals an altered expression profile for HLA-EUL40 CD8 T in CLAD patients with a decreased expression for CD56 and the acquisition of PD-1. In STABLE LTRs, HCMV primary infection causes a decrease in B cells and inflation of CD8 T, CD57+/NKG2C+ NK, and δ2-γδT cells. In CLAD LTRs, the regulation of B, total CD8 T, and δ2+γδT cells is maintained, but total NK, CD57+/NKG2C+ NK, and δ2-γδT subsets are markedly reduced, while CD57 is overexpressed across T lymphocytes. Conclusions CLAD is associated with significant changes in anti-HCMV immune cell responses. Our findings propose that the presence of dysfunctional HCMV-specific HLA-E-restricted CD8 T cells together with post-infection changes in the immune cell distribution affecting NK and γδT cells defines an early immune signature for CLAD in HCMV+ LTRs. Such a signature may be of interest for the monitoring of LTRs and may allow an early stratification of LTRs at risk of CLAD.
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Affiliation(s)
- Amélie Rousselière
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, Nantes, France
| | - Laurence Delbos
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, Nantes, France
| | - Aurore Foureau
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, Nantes, France
- Nantes Université, CHU Nantes, Service de Pneumologie, Institut du thorax, Nantes, France
| | - Martine Reynaud-Gaubert
- CHU de Marseille, APHM, Hôpital Nord, Service de Pneumologie et Equipe de Transplantation pulmonaire; Marseille, France; Aix-Marseille Université, Marseille, France
| | - Antoine Roux
- Hôpital Foch, Service de pneumologie, Suresnes, France
| | - Xavier Demant
- Hôpital Haut-Lévêque, Service de pneumologie, CHU de Bordeaux, Bordeaux, France
| | - Jérôme Le Pavec
- Service de Pneumologie et de Transplantation Pulmonaire, Groupe Hospitalier Marie-Lannelongue -Paris Saint Joseph, Le Plessis-Robinson, France
- Université Paris-Saclay, Le Kremlin Bicêtre, France
- UMR_S 999, Université Paris–Sud, Inserm, Groupe hospitalier Marie-Lannelongue-Saint Joseph, Le Plessis-Robinson, France
| | - Romain Kessler
- Groupe de transplantation pulmonaire des hôpitaux universitaires de Strasbourg, Inserm-Université de Strasbourg, Strasbourg, France
| | - Jean-François Mornex
- Université de Lyon, Université Lyon1, INRAE, IVPC, Lyon, France
- Hospices Civils de Lyon, GHE, Service de Pneumologie, Inserm, Lyon, France
| | - Jonathan Messika
- APHP, Nord-Université Paris Cité, Hôpital Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
- Physiopathology and Epidemiology of Respiratory Diseases, UMR1152 INSERM and Université de Paris, Paris, France
| | - Loïc Falque
- Service Hospitalier Universitaire Pneumologie et Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France
| | | | - Véronique Boussaud
- Service de Pneumologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Adrien Tissot
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, Nantes, France
- Nantes Université, CHU Nantes, Service de Pneumologie, Institut du thorax, Nantes, France
| | - Sophie Hombourger
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, Nantes, France
| | - Céline Bressollette-Bodin
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, Nantes, France
- CHU Nantes, Nantes Université, Laboratoire de Virologie, Nantes, France
| | - Béatrice Charreau
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche Translationnelle en Transplantation et Immunologie, Nantes, France
- CHU Nantes, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France
- *Correspondence: Béatrice Charreau,
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Markers of Bronchiolitis Obliterans Syndrome after Lung Transplant: Between Old Knowledge and Future Perspective. Biomedicines 2022; 10:biomedicines10123277. [PMID: 36552035 PMCID: PMC9775233 DOI: 10.3390/biomedicines10123277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Bronchiolitis obliterans syndrome (BOS) is the most common form of CLAD and is characterized by airflow limitation and an obstructive spirometric pattern without high-resolution computed tomography (HRCT) evidence of parenchymal opacities. Computed tomography and microCT analysis show abundant small airway obstruction, starting from the fifth generation of airway branching and affecting up to 40-70% of airways. The pathogenesis of BOS remains unclear. It is a multifactorial syndrome that leads to pathological tissue changes and clinical manifestations. Because BOS is associated with the worst long-term survival in LTx patients, many studies are focused on the early identification of BOS. Markers may be useful for diagnosis and for understanding the molecular and immunological mechanisms involved in the onset of BOS. Diagnostic and predictive markers of BOS have also been investigated in various biological materials, such as blood, BAL, lung tissue and extracellular vesicles. The aim of this review was to evaluate the scientific literature on markers of BOS after lung transplant. We performed a systematic review to find all available data on potential prognostic and diagnostic markers of BOS.
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7
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Ackermann M, Kamp JC, Werlein C, Walsh CL, Stark H, Prade V, Surabattula R, Wagner WL, Disney C, Bodey AJ, Illig T, Leeming DJ, Karsdal MA, Tzankov A, Boor P, Kühnel MP, Länger FP, Verleden SE, Kvasnicka HM, Kreipe HH, Haverich A, Black SM, Walch A, Tafforeau P, Lee PD, Hoeper MM, Welte T, Seeliger B, David S, Schuppan D, Mentzer SJ, Jonigk DD. The fatal trajectory of pulmonary COVID-19 is driven by lobular ischemia and fibrotic remodelling. EBioMedicine 2022; 85:104296. [PMID: 36206625 PMCID: PMC9535314 DOI: 10.1016/j.ebiom.2022.104296] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND COVID-19 is characterized by a heterogeneous clinical presentation, ranging from mild symptoms to severe courses of disease. 9-20% of hospitalized patients with severe lung disease die from COVID-19 and a substantial number of survivors develop long-COVID. Our objective was to provide comprehensive insights into the pathophysiology of severe COVID-19 and to identify liquid biomarkers for disease severity and therapy response. METHODS We studied a total of 85 lungs (n = 31 COVID autopsy samples; n = 7 influenza A autopsy samples; n = 18 interstitial lung disease explants; n = 24 healthy controls) using the highest resolution Synchrotron radiation-based hierarchical phase-contrast tomography, scanning electron microscopy of microvascular corrosion casts, immunohistochemistry, matrix-assisted laser desorption ionization mass spectrometry imaging, and analysis of mRNA expression and biological pathways. Plasma samples from all disease groups were used for liquid biomarker determination using ELISA. The anatomic/molecular data were analyzed as a function of patients' hospitalization time. FINDINGS The observed patchy/mosaic appearance of COVID-19 in conventional lung imaging resulted from microvascular occlusion and secondary lobular ischemia. The length of hospitalization was associated with increased intussusceptive angiogenesis. This was associated with enhanced angiogenic, and fibrotic gene expression demonstrated by molecular profiling and metabolomic analysis. Increased plasma fibrosis markers correlated with their pulmonary tissue transcript levels and predicted disease severity. Plasma analysis confirmed distinct fibrosis biomarkers (TSP2, GDF15, IGFBP7, Pro-C3) that predicted the fatal trajectory in COVID-19. INTERPRETATION Pulmonary severe COVID-19 is a consequence of secondary lobular microischemia and fibrotic remodelling, resulting in a distinctive form of fibrotic interstitial lung disease that contributes to long-COVID. FUNDING This project was made possible by a number of funders. The full list can be found within the Declaration of interests / Acknowledgements section at the end of the manuscript.
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Affiliation(s)
- Maximilian Ackermann
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Jan C. Kamp
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Christopher Werlein
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Claire L. Walsh
- Centre for Advanced Biomedical Imaging, University College London, UK
| | - Helge Stark
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Verena Prade
- Research Unit Analytical Pathology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Rambabu Surabattula
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Willi L. Wagner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Member of the German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Catherine Disney
- Department of Mechanical Engineering, University College London, UK
| | | | - Thomas Illig
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Hannover Unified Biobank, Hannover Medical School, Hannover Medical School, Germany
| | - Diana J. Leeming
- Hannover Unified Biobank, Hannover Medical School, Hannover Medical School, Germany
| | | | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Mark P. Kühnel
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Florian P. Länger
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Stijn E. Verleden
- Department of Thoracic Surgery, University Hospital Antwerp Edegem, Belgium
| | - Hans M. Kvasnicka
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Germany
| | - Hans H. Kreipe
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Germany
| | - Stephen M. Black
- Department of Cellular Biology and Pharmacology, Center for Translational Research, Florida International University, USA
| | - Axel Walch
- Nordic Bioscience Biomarkers and Research, Herlev, Denmark
| | - Paul Tafforeau
- European Synchrotron Radiation Facility, Grenoble, France
| | - Peter D. Lee
- Hannover Unified Biobank, Hannover Medical School, Hannover Medical School, Germany
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Benjamin Seeliger
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Detlef Schuppan
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Steven J. Mentzer
- Laboratory of Adaptive and Regenerative Biology, Harvard Medical School, Brigham & Women's Hospital, Boston, United States
| | - Danny D. Jonigk
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
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8
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Glanville AR, Benden C, Bergeron A, Cheng GS, Gottlieb J, Lease ED, Perch M, Todd JL, Williams KM, Verleden GM. Bronchiolitis obliterans syndrome after lung or haematopoietic stem cell transplantation: current management and future directions. ERJ Open Res 2022; 8:00185-2022. [PMID: 35898810 PMCID: PMC9309343 DOI: 10.1183/23120541.00185-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/18/2022] [Indexed: 11/05/2022] Open
Abstract
Bronchiolitis obliterans syndrome (BOS) may develop after either lung or haematopoietic stem cell transplantation (HSCT), with similarities in histopathological features and clinical manifestations. However, there are differences in the contributory factors and clinical trajectories between the two conditions. BOS after HSCT occurs due to systemic graft-versus-host-disease (GVHD), whereas BOS after lung transplantation is limited to the lung allograft. BOS diagnosis after HSCT is more challenging, as the lung function decline may occur due to extrapulmonary GVHD, causing sclerosis or inflammation in the fascia or muscles of the respiratory girdle. Treatment is generally empirical with no established effective therapies. This review provides rare insights and commonalities of both conditions, that are not well elaborated elsewhere in contemporary literature, and highlights the importance of cross disciplinary learning from experts in other transplant modalities. Treatment algorithms for each condition are presented, based on the published literature and consensus clinical opinion. Immunosuppression should be optimised, and other conditions or contributory factors treated where possible. When initial treatment fails, the ultimate therapeutic option is lung transplantation (or re-transplantation in the case of BOS after lung transplantation) in carefully selected candidates. Novel therapies under investigation include aerosolised liposomal cyclosporine, Janus kinase inhibitors, antifibrotic therapies, and (in patients with BOS after lung transplantation) B-cell–directed therapies. Effective novel treatments that have a tangible impact on survival and thereby avoid the need for lung transplantation or re-transplantation are urgently required.
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9
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Niroomand A, Ghaidan H, Hallgren O, Hansson L, Larsson H, Wagner D, Mackova M, Halloran K, Hyllén S, Lindstedt S. Corticotropin releasing hormone as an identifier of bronchiolitis obliterans syndrome. Sci Rep 2022; 12:8413. [PMID: 35589861 PMCID: PMC9120482 DOI: 10.1038/s41598-022-12546-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Lung transplantion (LTx) recipients have low long-term survival and a high incidence of bronchiolitis obliterans syndrome (BOS), an inflammation of the small airways in chronic rejection of a lung allograft. There is great clinical need for a minimally invasive biomarker of BOS. Here, 644 different proteins were analyzed to detect biomarkers that distinguish BOS grade 0 from grades 1–3. The plasma of 46 double lung transplant patients was analyzed for proteins using a high-component, multiplex immunoassay that enables analysis of protein biomarkers. Proximity Extension Assay (PEA) consists of antibody probe pairs which bind to targets. The resulting polymerase chain reaction (PCR) reporter sequence can be quantified by real-time PCR. Samples were collected at baseline and 1-year post transplantation. Enzyme-linked immunosorbent assay (ELISA) was used to validate the findings of the PEA analysis across both time points and microarray datasets from other lung transplantation centers demonstrated the same findings. Significant decreases in the plasma protein levels of CRH, FERC2, IL-20RA, TNFB, and IGSF3 and an increase in MMP-9 and CTSL1 were seen in patients who developed BOS compared to those who did not. In this study, CRH is presented as a novel potential biomarker in the progression of disease because of its decreased levels in patients across all BOS grades. Additionally, biomarkers involving the remodeling of the extracellular matrix (ECM), such as MMP-9 and CTSL1, were increased in BOS patients.
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Affiliation(s)
- Anna Niroomand
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Haider Ghaidan
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund Stem Cell Center, Lund University, Lund, Sweden.,Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, 221 85, Lund, Sweden
| | - Oskar Hallgren
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lennart Hansson
- Department of Pulmonology and Transplantation, Skåne University Hospital, Lund, Sweden
| | - Hillevi Larsson
- Department of Pulmonology and Transplantation, Skåne University Hospital, Lund, Sweden
| | - Darcy Wagner
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Lund Stem Cell Center, Lund University, Lund, Sweden.,Department of Experimental Medical Sciences, Lung Bioengineering and Regeneration, Lund University, Lund, Sweden
| | - Martina Mackova
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kieran Halloran
- Alberta Transplant Applied Genomics Center, University of Alberta, Edmonton, Canada
| | - Snejana Hyllén
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Cardiothoracic Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Sandra Lindstedt
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden. .,Department of Clinical Sciences, Lund University, Lund, Sweden. .,Lund Stem Cell Center, Lund University, Lund, Sweden. .,Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, 221 85, Lund, Sweden.
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10
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Ancel J, Guecamburu M, Marques Da Silva V, Schilfarth P, Boyer L, Pilette C, Martin C, Devillier P, Berger P, Zysman M, Le Rouzic O, Gonzalez-Bermejo J, Degano B, Burgel PR, Ahmed E, Roche N, Deslee G. [Take-home messages from the COPD 2021 biennial of the French Society of Respiratory Diseases. Understanding to so as to better innovate]. Rev Mal Respir 2022; 39:427-441. [PMID: 35568574 DOI: 10.1016/j.rmr.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The first COPD biennial organized by the French Society of Respiratory Diseases (SPLF) took place on 17 December 2021. STATE OF THE ART The objective of the biennial was to discuss current knowledge regarding COPD pathophysiology, current treatments, research development, and future therapeutic approaches. PERSPECTIVES The different lecturers laid emphasis on the complexity of pathophysiologic mechanisms including bronchial, bronchiolar and parenchymal alterations, and also dwelt on the role of microbiota composition in COPD pathenogenesis. They pointed out that addition to inhaled treatments, ventilatory support and endoscopic approaches have been increasingly optimized. The development of new therapeutic pathways such as biotherapy and cell therapy (stem cells…) call for further exploration. CONCLUSIONS The dynamism of COPD research was repeatedly underlined, and needs to be further reinforced, the objective being to "understand so as to better innovate" so as to develop effective new strategies for treatment and management of COPD.
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Affiliation(s)
- J Ancel
- Inserm UMRS-1250, service de pneumologie, université Reims Champagne Ardenne, hôpital Maison Blanche, Reims, France
| | - M Guecamburu
- Service des maladies respiratoires, hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | - V Marques Da Silva
- Inserm U955, FHU SENEC, université Paris-Est Créteil, institut Mondor de recherche biomédicale, équipe GEIC2O, Créteil, France
| | - P Schilfarth
- Service des maladies respiratoires, hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France; Inserm U1045, centre de recherche cardio-thoracique de Bordeaux, Pessac, France
| | - L Boyer
- Département de physiologie-explorations fonctionnelles, université Paris-Est, hôpital Henri-Mondor, AP-HP, UMR S955, FHU SENEC, UPEC, Créteil, France
| | - C Pilette
- Département de pneumologie, université catholique de Louvain, cliniques universitaires Saint-Luc et institut de recherche expérimentale et clinique, Bruxelles, Belgique
| | - C Martin
- Inserm U1016, service de pneumologie, AP-HP Paris, hôpital Cochin et institut Cochin, université de Paris, Paris, France
| | - P Devillier
- Département des maladies respiratoires, unité de recherche en pharmacologie respiratoire, VIM Suresnes (UMR 0892, université Paris-Saclay), hôpital Foch, Suresnes, France
| | - P Berger
- Service d'exploration fonctionnelle respiratoire, département de pharmacologie, centre de recherche cardiothoracique, U1045, CIC 1401, Pessac, France
| | - M Zysman
- Service des maladies respiratoires, hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France; Inserm U1045, centre de recherche cardio-thoracique de Bordeaux, Pessac, France
| | - O Le Rouzic
- Inserm, CIIL Center for infection and immunity of Lille, université de Lille, CHU de Lille, pneumologie et immuno-allergologie, Institut Pasteur de Lille, U1019 - UMR9017, Lille, France
| | - J Gonzalez-Bermejo
- Inserm, UMRS115 neurophysiologie respiratoire expérimentale et clinique, service de pneumologie, médecine intensive et réanimation (département R3S), Sorbonne université, groupe hospitalier universitaire AP-HP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - B Degano
- Inserm 1042, service de pneumologie physiologie, CHU de Grenoble, Grenoble, France
| | - P-R Burgel
- Inserm U1016, service de pneumologie, AP-HP Paris, hôpital Cochin et institut Cochin, université de Paris, Paris, France
| | - E Ahmed
- Département des maladies respiratoires, IRMB, université de Montpellier, CHU de Montpellier, Montpellier, France
| | - N Roche
- Inserm U1016, service de pneumologie, AP-HP Paris, hôpital Cochin et institut Cochin, université de Paris, Paris, France
| | - G Deslee
- Inserm UMRS-1250, service de pneumologie, université Reims Champagne Ardenne, hôpital Maison Blanche, Reims, France.
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11
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Xu F, Vasilescu DM, Kinose D, Tanabe N, Ng KW, Coxson HO, Cooper JD, Hackett TL, Verleden SE, Vanaudenaerde BM, Stevenson CS, Lenburg ME, Spira A, Tan WC, Sin DD, Ng RT, Hogg JC. The molecular and cellular mechanisms associated with the destruction of terminal bronchioles in COPD. Eur Respir J 2022; 59:2101411. [PMID: 34675046 DOI: 10.1183/13993003.01411-2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/27/2021] [Indexed: 11/05/2022]
Abstract
RATIONALE Peripheral airway obstruction is a key feature of chronic obstructive pulmonary disease (COPD), but the mechanisms of airway loss are unknown. This study aims to identify the molecular and cellular mechanisms associated with peripheral airway obstruction in COPD. METHODS Ten explanted lung specimens donated by patients with very severe COPD treated by lung transplantation and five unused donor control lungs were sampled using systematic uniform random sampling (SURS), resulting in 240 samples. These samples were further examined by micro-computed tomography (CT), quantitative histology and gene expression profiling. RESULTS Micro-CT analysis showed that the loss of terminal bronchioles in COPD occurs in regions of microscopic emphysematous destruction with an average airspace size of ≥500 and <1000 µm, which we have termed a "hot spot". Based on microarray gene expression profiling, the hot spot was associated with an 11-gene signature, with upregulation of pro-inflammatory genes and downregulation of inhibitory immune checkpoint genes, indicating immune response activation. Results from both quantitative histology and the bioinformatics computational tool CIBERSORT, which predicts the percentage of immune cells in tissues from transcriptomic data, showed that the hot spot regions were associated with increased infiltration of CD4 and CD8 T-cell and B-cell lymphocytes. INTERPRETATION The reduction in terminal bronchioles observed in lungs from patients with COPD occurs in a hot spot of microscopic emphysema, where there is upregulation of IFNG signalling, co-stimulatory immune checkpoint genes and genes related to the inflammasome pathway, and increased infiltration of immune cells. These could be potential targets for therapeutic interventions in COPD.
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Affiliation(s)
- Feng Xu
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Dragoş M Vasilescu
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Daisuke Kinose
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Naoya Tanabe
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Harvey O Coxson
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Joel D Cooper
- Division of Thoracic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Tillie-Louise Hackett
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Stijn E Verleden
- Laboratory of Respiratory Diseases, BREATHE, Dept of CHROMETA, KU Leuven, Leuven, Belgium
| | | | | | - Marc E Lenburg
- Division of Computational Biomedicine, Dept of Medicine, Boston University, Boston, MA, USA
| | - Avrum Spira
- Division of Computational Biomedicine, Dept of Medicine, Boston University, Boston, MA, USA
| | - Wan C Tan
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Don D Sin
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Raymond T Ng
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
- Dept of Computer Science, The University of British Columbia, Vancouver, BC, Canada
| | - James C Hogg
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
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12
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Basil MC, Cardenas-Diaz FL, Kathiriya JJ, Morley MP, Carl J, Brumwell AN, Katzen J, Slovik KJ, Babu A, Zhou S, Kremp MM, McCauley KB, Li S, Planer JD, Hussain SS, Liu X, Windmueller R, Ying Y, Stewart KM, Oyster M, Christie JD, Diamond JM, Engelhardt JF, Cantu E, Rowe SM, Kotton DN, Chapman HA, Morrisey EE. Human distal airways contain a multipotent secretory cell that can regenerate alveoli. Nature 2022; 604:120-126. [PMID: 35355013 PMCID: PMC9297319 DOI: 10.1038/s41586-022-04552-0] [Citation(s) in RCA: 113] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/14/2022] [Indexed: 02/07/2023]
Abstract
The human lung differs substantially from its mouse counterpart, resulting in a distinct distal airway architecture affected by disease pathology in chronic obstructive pulmonary disease. In humans, the distal branches of the airway interweave with the alveolar gas-exchange niche, forming an anatomical structure known as the respiratory bronchioles. Owing to the lack of a counterpart in mouse, the cellular and molecular mechanisms that govern respiratory bronchioles in the human lung remain uncharacterized. Here we show that human respiratory bronchioles contain a unique secretory cell population that is distinct from cells in larger proximal airways. Organoid modelling reveals that these respiratory airway secretory (RAS) cells act as unidirectional progenitors for alveolar type 2 cells, which are essential for maintaining and regenerating the alveolar niche. RAS cell lineage differentiation into alveolar type 2 cells is regulated by Notch and Wnt signalling. In chronic obstructive pulmonary disease, RAS cells are altered transcriptionally, corresponding to abnormal alveolar type 2 cell states, which are associated with smoking exposure in both humans and ferrets. These data identify a distinct progenitor in a region of the human lung that is not found in mouse that has a critical role in maintaining the gas-exchange compartment and is altered in chronic lung disease.
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Affiliation(s)
- Maria C Basil
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fabian L Cardenas-Diaz
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaymin J Kathiriya
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael P Morley
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Justine Carl
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexis N Brumwell
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jeremy Katzen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine J Slovik
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Apoorva Babu
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Su Zhou
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Madison M Kremp
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine B McCauley
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA, USA
| | - Shanru Li
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph D Planer
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shah S Hussain
- Department of Medicine and the Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xiaoming Liu
- Department of Anatomy and Cell Biology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Rebecca Windmueller
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yun Ying
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathleen M Stewart
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Oyster
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason D Christie
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua M Diamond
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John F Engelhardt
- Department of Anatomy and Cell Biology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Edward Cantu
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven M Rowe
- Department of Medicine and the Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Darrell N Kotton
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA, USA
- The Pulmonary Center and Department of Medicine, Boston University and Boston Medical Center, Boston, MA, USA
| | - Harold A Chapman
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Edward E Morrisey
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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13
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Verleden SE, Braubach P, Werlein C, Plucinski E, Kuhnel MP, Snoeckx A, El Addouli H, Welte T, Haverich A, Laenger FP, Dettmer S, Pauwels P, Verplancke V, Van Schil PE, Lapperre T, Kwakkel-Van-Erp JM, Ackermann M, Hendriks JMH, Jonigk D. From Macroscopy to Ultrastructure: An Integrative Approach to Pulmonary Pathology. Front Med (Lausanne) 2022; 9:859337. [PMID: 35372395 PMCID: PMC8965844 DOI: 10.3389/fmed.2022.859337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Pathology and radiology are complimentary tools, and their joint application is often crucial in obtaining an accurate diagnosis in non-neoplastic pulmonary diseases. However, both come with significant limitations of their own: Computed Tomography (CT) can only visualize larger structures due to its inherent–relatively–poor resolution, while (histo) pathology is often limited due to small sample size and sampling error and only allows for a 2D investigation. An innovative approach of inflating whole lung specimens and subjecting these subsequently to CT and whole lung microCT allows for an accurate matching of CT-imaging and histopathology data of exactly the same areas. Systematic application of this approach allows for a more targeted assessment of localized disease extent and more specifically can be used to investigate early mechanisms of lung diseases on a morphological and molecular level. Therefore, this technique is suitable to selectively investigate changes in the large and small airways, as well as the pulmonary arteries, veins and capillaries in relation to the disease extent in the same lung specimen. In this perspective we provide an overview of the different strategies that are currently being used, as well as how this growing field could further evolve.
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Affiliation(s)
- Stijn E. Verleden
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Antwerp University, Antwerp, Belgium
- Division of Pneumology, University Hospital Antwerp, Edegem, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Peter Braubach
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | | | - Edith Plucinski
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Mark P. Kuhnel
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Annemiek Snoeckx
- Division of Radiology, University Hospital Antwerp and University of Antwerp, Edegem, Belgium
| | - Haroun El Addouli
- Division of Radiology, University Hospital Antwerp and University of Antwerp, Edegem, Belgium
| | - Tobias Welte
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Division of Pneumology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Division of Thoracic Surgery, Hannover Medical School, Hannover, Germany
| | - Florian P. Laenger
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Sabine Dettmer
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Patrick Pauwels
- Division of Pathology, University Hospital Antwerp, Edegem, Belgium
| | | | - Paul E. Van Schil
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Antwerp University, Antwerp, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Therese Lapperre
- Division of Pneumology, University Hospital Antwerp, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp University, Antwerp, Belgium
| | - Johanna M. Kwakkel-Van-Erp
- Division of Pneumology, University Hospital Antwerp, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp University, Antwerp, Belgium
| | - Maximilian Ackermann
- Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Witten, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jeroen M. H. Hendriks
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Antwerp University, Antwerp, Belgium
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Danny Jonigk
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute for Pathology, Hannover Medical School, Hannover, Germany
- *Correspondence: Danny Jonigk
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14
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Einarsson GG, Vanaudenaerde BM, Spence CD, Lee AJ, Boon M, Verleden GM, Elborn JS, Dupont LJ, Van Raemdonck D, Gilpin DF, Vos R, Verleden SE, Tunney MM. Microbial Community Composition in Explanted Cystic Fibrosis and Control Donor Lungs. Front Cell Infect Microbiol 2022; 11:764585. [PMID: 35368453 PMCID: PMC8966769 DOI: 10.3389/fcimb.2021.764585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
To date, investigations of the microbiota in the lungs of people with Cystic Fibrosis (PWCF) have primarily focused on microbial community composition in luminal mucus, with fewer studies observing the microbiota in tissue samples from explanted lung tissue. Here, we analysed both tissue and airway luminal mucus samples extracted from whole explanted lungs of PWCF and unused donor lungs. We determined if the lung microbiota in end-stage CF varied within and between patients, was spatially heterogeneous and related to localized structural damage. Microbial community composition was determined by Illumina MiSeq sequencing and related to the CF-Computed Tomography (CT) score and features of end-stage lung disease on micro-CT. Ninety-eight CF tissue (n=11 patients), 20 CF luminal mucus (n=8 patients) and 33 donor tissue (n=4 patients) samples were analysed. Additionally, we compared 20 paired CF tissue and luminal mucus samples that enabled a direct “geographical” comparison of the microbiota in these two niches. Significant differences in microbial communities were apparent between the 3 groups. However, overlap between the three groups, particularly between CF and donor tissue and CF tissue and CF luminal mucus was also observed. Microbial diversity was lower in CF luminal mucus compared to CF tissue, with dominance higher in luminal mucus. For both CF and donor tissue, intra- and inter-patient variability in ecological parameters was observed. No relationships were observed between ecological parameters and CF-CT score, or features of end-stage lung disease. The end-stage CF lung is characterised by a low diversity microbiota, differing within and between individuals. No clear relationship was observed between regional microbiota variation and structural lung damage.
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Affiliation(s)
- Gisli G. Einarsson
- Halo Research Group, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- *Correspondence: Gisli G. Einarsson,
| | - Bart M. Vanaudenaerde
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Christopher D. Spence
- Halo Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
| | - Andrew J. Lee
- Halo Research Group, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Mieke Boon
- Department of Pediatics, Cystic Fibrosis Center, UZ Leuven, Leuven, Belgium
| | - Geert M. Verleden
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - J. Stuart Elborn
- Halo Research Group, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Lieven J. Dupont
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Deirdre F. Gilpin
- Halo Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
| | - Robin Vos
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Stijn E. Verleden
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp (UA), Wilrijk, Belgium
- Department of Thoracic & Vascular Surgery, University Hospital Antwerp (UZA), Edegem, Belgium
- Department of Pneumology, University Hospital Antwerp (UZA), Edegem, Belgium
| | - Michael M. Tunney
- Halo Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
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15
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Quantitative CT Correlates with Local Inflammation in Lung of Patients with Subtypes of Chronic Lung Allograft Dysfunction. Cells 2022; 11:cells11040699. [PMID: 35203345 PMCID: PMC8870691 DOI: 10.3390/cells11040699] [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: 12/01/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 02/03/2023] Open
Abstract
Chronic rejection of lung allografts has two major subtypes, bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), which present radiologically either as air trapping with small airways disease or with persistent pleuroparenchymal opacities. Parametric response mapping (PRM), a computed tomography (CT) methodology, has been demonstrated as an objective readout of BOS and RAS and bears prognostic importance, but has yet to be correlated to biological measures. Using a topological technique, we evaluate the distribution and arrangement of PRM-derived classifications of pulmonary abnormalities from lung transplant recipients undergoing redo-transplantation for end-stage BOS (N = 6) or RAS (N = 6). Topological metrics were determined from each PRM classification and compared to structural and biological markers determined from microCT and histopathology of lung core samples. Whole-lung measurements of PRM-defined functional small airways disease (fSAD), which serves as a readout of BOS, were significantly elevated in BOS versus RAS patients (p = 0.01). At the core-level, PRM-defined parenchymal disease, a potential readout of RAS, was found to correlate to neutrophil and collagen I levels (p < 0.05). We demonstrate the relationship of structural and biological markers to the CT-based distribution and arrangement of PRM-derived readouts of BOS and RAS.
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16
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Beyond Bronchiolitis Obliterans: In-Depth Histopathologic Characterization of Bronchiolitis Obliterans Syndrome after Lung Transplantation. J Clin Med 2021; 11:jcm11010111. [PMID: 35011851 PMCID: PMC8745215 DOI: 10.3390/jcm11010111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/31/2022] Open
Abstract
Bronchiolitis obliterans syndrome (BOS) is considered an airway-centered disease, with bronchiolitis obliterans (BO) as pathologic hallmark. However, the histologic spectrum of pure clinical BOS remains poorly characterized. We provide the first in-depth histopathologic description of well-characterized BOS patients and patients without chronic lung allograft dysfunction (CLAD), defined according to the recent consensus guidelines. Explant lung tissue from 52 clinically-defined BOS and 26 non-CLAD patients (collected 1993-2018) was analyzed for histologic parameters, including but not limited to airway lesions, vasculopathy and fibrosis. In BOS, BO lesions were evident in 38 (73%) patients and varied from concentric sub-epithelial fibrotic BO to inflammatory BO, while 10/14 patients without BO displayed 'vanishing airways', defined by a discordance between arteries and airways. Chronic vascular abnormalities were detected in 22 (42%) patients. Ashcroft fibrosis scores revealed a median of 43% (IQR: 23-69) of normal lung parenchyma per patient; 26% (IQR: 18-37) of minimal alveolar fibrous thickening; and 11% (IQR: 4-18) of moderate alveolar thickening without architectural damage. Patchy areas of definite fibrotic damage to the lung structure (i.e., Ashcroft score ≥5) were present in 28 (54%) patients. Fibrosis was classified as bronchocentric (n = 21/28, 75%), paraseptal (n = 17/28, 61%) and subpleural (n = 15/28, 54%). In non-CLAD patients, BO lesions were absent, chronic vascular abnormalities present in 1 (4%) patient and mean Ashcroft scores were significantly lower compared to BOS (p = 0.0038) with 78% (IQR: 64-88) normally preserved lung parenchyma. BOS explant lungs revealed evidence of various histopathologic findings, including vasculopathy and fibrotic changes, which may contribute to the pathophysiology of BOS.
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17
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Tanabe N, Hirai T. Recent advances in airway imaging using micro-computed tomography and computed tomography for chronic obstructive pulmonary disease. Korean J Intern Med 2021; 36:1294-1304. [PMID: 34607419 PMCID: PMC8588974 DOI: 10.3904/kjim.2021.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex lung disease characterized by a combination of airway disease and emphysema. Emphysema is classified as centrilobular emphysema (CLE), paraseptal emphysema (PSE), or panlobular emphysema (PLE), and airway disease extends from the respiratory, terminal, and preterminal bronchioles to the central segmental airways. Although clinical computed tomography (CT) cannot be used to visualize the small airways, micro-CT has shown that terminal bronchiole disease is more severe in CLE than in PSE and PLE, and micro-CT findings suggest that the loss and luminal narrowing of terminal bronchioles is an early pathological change in CLE. Furthermore, the introduction of ultra-high-resolution CT has enabled direct evaluation of the proximal small (1 to 2-mm diameter) airways, and new CT analytical methods have enabled estimation of small airway disease and prediction of future COPD onset and lung function decline in smokers with and without COPD. This review discusses the literature on micro-CT and the technical advancements in clinical CT analysis for COPD. Hopefully, novel micro-CT findings will improve our understanding of the distinct pathogeneses of the emphysema subtypes to enable exploration of new therapeutic targets, and sophisticated CT imaging methods will be integrated into clinical practice to achieve more personalized management.
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Affiliation(s)
- Naoya Tanabe
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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18
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Ikezoe K, Hackett TL, Peterson S, Prins D, Hague CJ, Murphy D, LeDoux S, Chu F, Xu F, Cooper JD, Tanabe N, Ryerson CJ, Paré PD, Coxson HO, Colby TV, Hogg JC, Vasilescu DM. Small Airway Reduction and Fibrosis is an Early Pathologic Feature of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2021; 204:1048-1059. [PMID: 34343057 DOI: 10.1164/rccm.202103-0585oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE To improve disease outcomes in idiopathic pulmonary fibrosis (IPF) it is essential to understand its early pathophysiology so that it can be targeted therapeutically. OBJECTIVES Perform three-dimensional (3D) assessment of the IPF lung micro-structure using stereology and multi-resolution computed tomography (CT) imaging. METHODS Explanted lungs from IPF patients (n=8) and donor controls (n=8) were inflated with air and frozen. CT scans were used to assess large airways. Unbiased, systematic uniform random (SUR) samples (n=8/lung) were scanned with microCT for stereological assessment of small airways (number, airway wall and lumen area) and parenchymal fibrosis (volume fraction of tissue, alveolar surface area, and septal wall thickness). RESULTS The total number of airways on clinical CT was greater in IPF lungs than control lungs (p<0.01), due to an increase in the wall (p<0.05) and lumen area (p<0.05) resulting in more visible airways with a lumen larger than 2 mm. In IPF tissue samples without microscopic fibrosis, assessed by the volume fraction of tissue using microCT, there was a reduction in the number of the terminal (p<0.01) and transitional (p<0.001) bronchioles, and an increase in terminal bronchiole wall area (p<0.001) compared to control lungs. In IPF tissue samples with microscopic parenchymal fibrosis, terminal bronchioles had increased airway wall thickness (p<0.05), and dilated airway lumens (p<0.001) leading to honeycomb cyst formations. CONCLUSION This study has important implications for the current thinking on how the lung tissue is remodeled in IPF, and highlights small airways as a potential target to modify IPF outcomes.
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Affiliation(s)
- Kohei Ikezoe
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Tillie-Louise Hackett
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | | | - Dante Prins
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Cameron J Hague
- The University of British Columbia Department of Radiology, 478400, Vancouver, British Columbia, Canada
| | - Darra Murphy
- The University of British Columbia Department of Radiology, 478400, Vancouver, British Columbia, Canada
| | - Stacey LeDoux
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Fanny Chu
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Feng Xu
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Pathology and Lab Medicine, Vancouver, British Columbia, Canada
| | - Joel D Cooper
- University of Pennsylvania, 6572, Thoracic surgery, Philadelphia, Pennsylvania, United States
| | - Naoya Tanabe
- Kyoto University Graduate School of Medicine Department of Respiratory Medicine, 215651, Kyoto, Japan
| | - Christopher J Ryerson
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Medicine, Vancouver, British Columbia, Canada
| | - Peter D Paré
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Harvey O Coxson
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Thomas V Colby
- Mayo Clinic Department of Laboratory Medicine and Pathology, 195112, Rochester, Minnesota, United States
| | - James C Hogg
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Dragoş M Vasilescu
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada;
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19
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Vanstapel A, Weynand B, Kaes J, Neyrinck AP, Ceulemans LJ, Vanaudenaerde BM, Vos R, Verleden GM, Ackermann M, Verleden SE. Interalveolar Pores Increase in Aging and Severe Airway Obstruction. Am J Respir Crit Care Med 2021; 204:862-865. [PMID: 34241578 DOI: 10.1164/rccm.202102-0530le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Arno Vanstapel
- KU Leuven, 26657, Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium
| | - Birgit Weynand
- Universitaire Ziekenhuizen Leuven, 60182, Pathology, Leuven, Belgium
| | - Janne Kaes
- KU Leuven, 26657, Lung Transplant Unit, Leuven, Belgium
| | - Arne P Neyrinck
- KU Leuven, 26657, anesthesiology and lung transplant unit, Leuven, Belgium
| | | | - Bart M Vanaudenaerde
- KU Leuven, 26657, Clinical and Experimental Medicine - Laboratory of Respiratory Diseases, Leuven, Belgium
| | - Robin Vos
- KU Leuven, 26657, lung transplant unit, Leuven, Belgium
| | | | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stijn E Verleden
- Katholieke Universiteit Leuven and Universitair Ziekenhuis Gasthuisberg, Lung Transplant Unit, Leuven, Belgium;
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20
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Lupariello F, Genova T, Mussano F, Di Vella G, Botta G. Micro-CT processing's effects on microscopic appearance of human fetal cardiac samples. Leg Med (Tokyo) 2021; 53:101934. [PMID: 34225094 DOI: 10.1016/j.legalmed.2021.101934] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023]
Abstract
Higher resolution than common computed tomography has been reached through Micro-Computed Tomography (micro-CT) on small samples. Emerging forensic applications of micro-CT are the study of fetal/infant organs and whole fetuses, and their two/three-dimension reconstruction; it allows: to facilitate pathologists' role in the identification of causes of fetal stillbirth and of infant death; to create digital two and/or three-dimension representations of fetal/infant organs and whole fetuses which can be easily discussed in civil and/or penal courts. Micro-CT reconstructs cardiac anatomy of animal and human sample. There are no studies that are specifically aimed to evaluate possible effects of micro-CT processing on cardiac microscopic evaluation. This study analyzed microscopic effects of micro-CT processing on human-fetal-hearts. After processing with Lugol-solution or Microfil-MV-122-injection in coronary branches, fetal hearts underwent micro-CT scan. Then, hearts were microscopically analyzed using hematoxylin/eosin, trichrome, immunohistochemistry (IHC) for actin-protein, and IHC for desmin-intermediate-filament stains. In all cases staining was present in all fields. In all slides, disarranged myocardial proteins with increase of inter filaments and inter cellular spaces was reported. This manuscript allowed to observe post micro-CT appropriate staining and antigenic reactivity, and to identify cytoarchitecture modifications that could compromise slides' microscopic evaluation. It also highlighted a possible role of micro-CT determining this cytoarchitecture phenomenon.
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Affiliation(s)
- Francesco Lupariello
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino", corso Galileo Galilei 22, 10126 Torino, Italy.
| | - Tullio Genova
- Department of Life Sciences and Systems Biology, UNITO, via Accademia Albertina 13, 10123 Turin, Italy; CIR Dental School, Department of Surgical Sciences UNITO, via Nizza 230, 10126 Turin, Italy
| | - Federico Mussano
- CIR Dental School, Department of Surgical Sciences UNITO, via Nizza 230, 10126 Turin, Italy
| | - Giancarlo Di Vella
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino", corso Galileo Galilei 22, 10126 Torino, Italy
| | - Giovanni Botta
- A.O.U. Città della Salute e della Scienza - Anatomia Patologica U, Sezione Materno-Fetale-Pediatrica, corso Bramante 88, 10126 Torino, Italy
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21
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Müller C, Rosmark O, Åhrman E, Brunnström H, Wassilew K, Nybom A, Michaliková B, Larsson H, Eriksson LT, Schultz HH, Perch M, Malmström J, Wigén J, Iversen M, Westergren-Thorsson G. Protein Signatures of Remodeled Airways in Transplanted Lungs with Bronchiolitis Obliterans Syndrome Obtained Using Laser-Capture Microdissection. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:1398-1411. [PMID: 34111430 DOI: 10.1016/j.ajpath.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 10/25/2022]
Abstract
Bronchiolitis obliterans syndrome, a common form of chronic lung allograft dysfunction, is the major limitation to long-term survival after lung transplantation. The histologic correlate is progressive, fibrotic occlusion of small airways, obliterative bronchiolitis lesions, which ultimately lead to organ failure. The molecular composition of these lesions is unknown. In this sutdy, the protein composition of the lesions in explanted lungs from four end-stage bronchiolitis obliterans syndrome patients was analyzed using laser-capture microdissection and optimized sample preparation protocols for mass spectrometry. Immunohistochemistry and immunofluorescence were used to determine the spatial distribution of commonly identified proteins on the tissue level, and protein signatures for 14 obliterative bronchiolitis lesions were established. A set of 39 proteins, identified in >75% of lesions, included distinct structural proteins (collagen types IV and VI) and cellular components (actins, vimentin, and tryptase). Each respective lesion exhibited a unique composition of proteins (on average, n = 66 proteins), thereby mirroring the morphologic variation of the lesions. Antibody-based staining confirmed these mass spectrometry-based findings. The 14 analyzed obliterative bronchiolitis lesions showed variations in their protein content, but also common features. This study provides molecular and morphologic insights into the development of chronic rejection after lung transplantation. The protein patterns in the lesions were correlated to pathways of extracellular matrix organization, tissue development, and wound healing processes.
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Affiliation(s)
- Catharina Müller
- Lung Biology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Oskar Rosmark
- Lung Biology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Emma Åhrman
- Lung Biology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden; Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Hans Brunnström
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Division of Laboratory Medicine, Department of Genetics and Pathology, Region Skåne, Lund, Sweden
| | - Katharina Wassilew
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Annika Nybom
- Lung Biology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Barbora Michaliková
- Lung Biology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Hillevi Larsson
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Leif T Eriksson
- Lung Biology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden; Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Hans H Schultz
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Johan Malmström
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jenny Wigén
- Lung Biology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Martin Iversen
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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22
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Nakamura S, Mori K, Iwano S, Kawaguchi K, Fukui T, Hakiri S, Ozeki N, Oda M, Yokoi K. Micro-computed tomography images of lung adenocarcinoma: detection of lepidic growth patterns. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:25-31. [PMID: 32273629 PMCID: PMC7103860 DOI: 10.18999/nagjms.82.1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Micro-computed tomography (µCT) provides extremely high-resolution images of samples and can be employed as a non-destructive inspection tool. Using µCT, we can obtain images comparable with microscopic images. In this work, we have attempted to take high-resolution images of the human lung using µCT. Compared to clinical high-resolution computed tomography (HRCT) images of living body (in-vivo imaging), we can obtain extremely high-resolution images by µCT of ex-vivo tissues (resected lungs) as three-dimensional data. The purpose of this study was to distinguish between areas of normal lung and lung cancer by µCT images in order to study the feasibility of cancer diagnosis using this novel radiological image modality. Ten resected human lungs containing primary cancer were fixed by Heitzman's methods to obtain high-resolution µCT images. After fixation of the lung, images of the specimens were taken by µCT between January 2016 and November 2017. The imaging conditions were tube voltage: 90 kV and tube current: 110 µA. To compare details of images gained by conventional HRCT and µCT, we measured the thickness of the alveolar walls of the normal lung area and the cancer area of which alveoli might be replaced by tumor cells, and compared their appearance by means of histopathological images. All the nodules were diagnosed as adenocarcinoma. The median whole tumor size was 18 mm (9 mm-24 mm). Each specimen was clearly divided into areas of normal alveolar wall and of thickened alveolar wall on µCT 'visually'. Median thickness of alveolar walls of the normal lung was 0.037 mm (0.034 mm-0.048 mm), and that of the cancer area was 0.084 mm (0.074 mm-0.094 mm); there was a statistically significant difference between both thicknesses by Student's t-test (P < 0.01). The area of thickened alveolar walls on µCT corresponded well with the area of microscopically lepidic growth patterns of adenocarcinoma. We found that µCT images could be correctly divided by alveolar walls into normal lung area and lung cancer area. Further detailed investigations with regard to µCT are needed to make comparable histological diagnoses using µCT images with conventional microscopic methods of pathological diagnoses.
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Affiliation(s)
- Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kensaku Mori
- Information and Communications Headquarters, Nagoya University Graduate School of Information Science, Nagoya, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuhei Hakiri
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Oda
- Information and Communications Headquarters, Nagoya University Graduate School of Information Science, Nagoya, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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23
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Tanabe N, Vasilescu DM, Hague CJ, Ikezoe K, Murphy DT, Kirby M, Stevenson CS, Verleden SE, Vanaudenaerde BM, Gayan-Ramirez G, Janssens W, Coxson HO, Paré PD, Hogg JC. Pathological Comparisons of Paraseptal and Centrilobular Emphysema in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2020; 202:803-811. [PMID: 32485111 DOI: 10.1164/rccm.201912-2327oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Although centrilobular emphysema (CLE) and paraseptal emphysema (PSE) are commonly identified on multidetector computed tomography (MDCT), little is known about the pathology associated with PSE compared with that of CLE.Objectives: To assess the pathological differences between PSE and CLE in chronic obstructive pulmonary disease (COPD).Methods: Air-inflated frozen lung specimens (n = 6) obtained from patients with severe COPD treated by lung transplantation were scanned with MDCT. Frozen tissue cores were taken from central (n = 8) and peripheral (n = 8) regions of each lung, scanned with micro-computed tomography (microCT), and processed for histology. The core locations were registered to the MDCT, and a percentage of PSE or CLE was assigned by radiologists to each of the regions. MicroCT scans were used to measure number and structural change of terminal bronchioles. Furthermore, microCT-based volume fractions of CLE and PSE allowed classifying cores into mild emphysema, CLE-dominant, and PSE-dominant.Measurements and Main Results: The percentages of PSE measured on MDCT and microCT were positively associated (P = 0.015). The number of terminal bronchioles per milliliter of lung and cross-sectional lumen area were significantly lower and wall area percentage was significantly higher in CLE-dominant regions compared with mild emphysema and PSE-dominant regions (all P < 0.05), whereas no difference was found between PSE-dominant and mild emphysema samples (all P > 0.5). Immunohistochemistry showed significantly higher infiltration of neutrophils (P = 0.002), but not of macrophages, CD4, CD8, or B cells, in PSE compared with CLE regions.Conclusions: The terminal bronchioles are relatively preserved, whereas neutrophilic inflammation is increased in PSE-dominant regions compared with CLE-dominant regions in patients with COPD.
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Affiliation(s)
- Naoya Tanabe
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and.,Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Cameron J Hague
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kohei Ikezoe
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
| | - Darra T Murphy
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Miranda Kirby
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and.,Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Christopher S Stevenson
- Janssen Disease Interception Accelerator, Janssen Pharmaceutical Companies of Johnson and Johnson, Beerse, Belgium; and
| | - Stijn E Verleden
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Harvey O Coxson
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
| | - Peter D Paré
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
| | - James C Hogg
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
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24
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Hayes D, Rayner RE, Hill CL, Alsudayri A, Tadesse M, Lallier SW, Parekh H, Brock GN, Cormet-Boyaka E, Reynolds SD. Airway epithelial stem cell chimerism in cystic fibrosis lung transplant recipients. J Cyst Fibros 2020; 20:165-172. [PMID: 33187933 PMCID: PMC9078212 DOI: 10.1016/j.jcf.2020.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/24/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The conducting airway epithelium is repaired by tissue specific stem cells (TSC). In response to mild/moderate injury, each TSC repairs a discrete area of the epithelium. In contrast, severe epithelial injury stimulates TSC migration and expands the stem cell's reparative domain. Lung transplantation (LTx) can cause a moderate/severe airway injury and the remodeled airway contains a chimeric mixture of donor and recipient cells. These studies supported the hypothesis, LTx stimulates TSC migration resulting in epithelial chimerism. We tested this hypothesis in cystic fibrosis (CF) LTx patients. METHODS Airway mucosal injury was quantified using bronchoscopic imaging and a novel grading system. Bronchial brushing was used to recover TSC from 10 sites in the recipient and allograft airways. TSC chimerism was quantified by short tandem repeat analysis. TSC self-renewal and differentiation potential were assayed using the clone forming cell frequency and air-liquid-interface methods. Electrophysiology was used to determine if TSC chimerism altered epithelial ion channel activity. RESULTS LTx caused a mild to moderate airway mucosal injury. Donor and recipient TSC were identified in 91% of anastomotic sites and 93% of bronchial airways. TSC chimerism did not alter stem cell self-renewal or differentiation potential. The frequency of recipient TSC was proportional to CF Transmembrane Conductance Regulator (CFTR)-dependent ion channel activity and 33% of allograft regions were at risk for abnormal CFTR activity. CONCLUSIONS LTx in CF patients stimulates bidirectional TSC migration across the anastomoses. TSC chimerism may alter ion homeostasis and compromise the host defense capability of the allograft airway epithelium.
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Affiliation(s)
- Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; Surgery, The Ohio State University College of Medicine, Columbus, OH, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rachael E Rayner
- Department of Veterinary Biosciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Cynthia L Hill
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alfahdah Alsudayri
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mahelet Tadesse
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Scott W Lallier
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Hemant Parekh
- Clinical Histocompatibility/Tissue Typing Laboratory, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Guy N Brock
- Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA; Center for Biostatistics and Bioinformatics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Estelle Cormet-Boyaka
- Department of Veterinary Biosciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Susan D Reynolds
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA; Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
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25
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Verleden SE, Kirby M, Everaerts S, Vanstapel A, McDonough JE, Verbeken EK, Braubach P, Boone MN, Aslam D, Verschakelen J, Ceulemans LJ, Neyrinck AP, Van Raemdonck DE, Vos R, Decramer M, Hackett TL, Hogg JC, Janssens W, Verleden GM, Vanaudenaerde BM. Small airway loss in the physiologically ageing lung: a cross-sectional study in unused donor lungs. THE LANCET RESPIRATORY MEDICINE 2020; 9:167-174. [PMID: 33031747 DOI: 10.1016/s2213-2600(20)30324-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Physiological lung ageing is associated with a gradual decline in dynamic lung volumes and a progressive increase in residual volume due to diminished elastic recoil of the lung, loss of alveolar tissue, and lower chest wall compliance. However, the effects of ageing on the small airways (ie, airways <2·0 mm in diameter) remain largely unknown. By using a combination of ex-vivo conventional CT (resolution 1 mm), whole lung micro-CT (resolution 150 μm), and micro-CT of extracted cores (resolution 10 μm), we aimed to provide a multiresolution assessment of the small airways in lung ageing in a large cohort of never smokers. METHODS For this cross-sectional study, we included donor lungs collected from 32 deceased never-smoking donors (age range 16-83 years). Ex-vivo CT and whole lung high-resolution CT (micro-CT) were used to determine total airway numbers, stratified by airway diameter. Micro-CT was used to assess the number, length, and diameter of terminal bronchioles (ie, the last generation of conducting airways); mean linear intercept; and surface density in four lung tissue cores from each lung, extracted using a uniform sampling approach. Regression β coefficients are calculated using linear regression and polynomial models. FINDINGS Ex-vivo CT analysis showed an age-dependent decrease in the number of airways of diameter 2·0 mm to less than 2·5 mm (β coefficient per decade -0·119, 95% CI -0·193 to -0·045; R2=0·29) and especially in airways smaller than 2·0 mm in diameter (-0·158, -0·233 to -0·084; R2=0·47), between 30 and 80 years of age, but not of the larger (≥2·5 mm) diameter airways (-0·00781, -0·04409 to 0·02848; R2=0·0007). In micro-CT analysis of small airways, the total number of terminal bronchioles per lung increased until the age of 30 years, after which an almost linear decline in the number of terminal bronchioles was observed (β coefficient per decade -2035, 95% CI -2818 to -1252; R2=0·55), accompanied by a non-significant increase in alveolar airspace size (6·44, -0·57 to 13·45, R2=0·10). Moreover, this decrease in terminal bronchioles was associated with the age-related decline of pulmonary function predicted by healthy reference values. INTERPRETATION Loss of terminal bronchioles is an important structural component of age-related decline in pulmonary function of healthy, non-smoking individuals. FUNDING Research Foundation-Flanders, KU Leuven, Parker B Francis Foundation, UGent, Canadian Institutes for Health.
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Affiliation(s)
- Stijn E Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium.
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, ON, Canada
| | - Stephanie Everaerts
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - John E McDonough
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Erik K Verbeken
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Peter Braubach
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Matthieu N Boone
- Department of Physics and Astronomy, Radiation Physics-Centre for X-ray Tomography, Ghent University, Ghent, Belgium
| | - Danesh Aslam
- Department of Physics, Ryerson University, Toronto, ON, Canada
| | | | - Laurens J Ceulemans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Robin Vos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Marc Decramer
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Tillie L Hackett
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Wim Janssens
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
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26
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Verleden SE, Von der Thüsen J, Roux A, Brouwers ES, Braubach P, Kuehnel M, Laenger F, Jonigk D. When tissue is the issue: A histological review of chronic lung allograft dysfunction. Am J Transplant 2020; 20:2644-2651. [PMID: 32185874 DOI: 10.1111/ajt.15864] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 01/25/2023]
Abstract
Although chronic lung allograft dysfunction (CLAD) remains the major life-limiting factor following lung transplantation, much of its pathophysiology remains unknown. The discovery that CLAD can manifest both clinically and morphologically in vastly different ways led to the definition of distinct subtypes of CLAD. In this review, recent advances in our understanding of the pathophysiological mechanisms of the different phenotypes of CLAD will be discussed with a particular focus on tissue-based and molecular studies. An overview of the current knowledge on the mechanisms of the airway-centered bronchiolitis obliterans syndrome, as well as the airway and alveolar injuries in the restrictive allograft syndrome and also the vascular compartment in chronic antibody-mediated rejection is provided. Specific attention is also given to morphological and molecular markers for early CLAD diagnosis or histological changes associated with subsequent CLAD development. Evidence for a possible overlap between different forms of CLAD is presented and discussed. In the end, "tissue remains the (main) issue," as we are still limited in our knowledge about the actual triggers and specific mechanisms of all late forms of posttransplant graft failure, a shortcoming that needs to be addressed in order to further improve the outcome of lung transplant recipients.
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Affiliation(s)
- Stijn E Verleden
- Lab of Respiratory Diseases, BREATH, Department of CHROMETA, KU Leuven, Leuven, Belgium.,Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany
| | - Jan Von der Thüsen
- Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Antoine Roux
- Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Emily S Brouwers
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Peter Braubach
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Mark Kuehnel
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Florian Laenger
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
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27
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Kwak SH, Lee SH, Park MS, Jeong SJ, Lee JG, Paik HC, Kim YS, Chang J, Kim SY. Risk Factors for Cytomegalovirus Reactivation in Lung Transplant Recipients. Lung 2020; 198:829-838. [PMID: 32696252 DOI: 10.1007/s00408-020-00380-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined risk factors that may have contributed to Cytomegalovirus (CMV) reactivation among patients who underwent lung transplantation (LTx). METHODS We reviewed medical records of patients who underwent LTx at a tertiary healthcare hospital in South Korea between January 2013 and May 2017. We excluded patients who died within the first year after LTx and those lost to follow-up. CMV reactivation was defined as the detection of CMV titers above 3000 copies/ml regardless of specific symptoms after prophylaxis cessation. RESULTS Of 89 patients included, 39 (43.8%) developed CMV reactivation. Of those 39 patients, 16 (41.0%) experienced additional CMV reactivation. Multivariate analysis identified lymphocyte counts below 1.0 × 103/μl (hazard ratio [HR] 49.33, p < 0.001) and use of steroids at more than twice the standard dose (HR 8.07, p < 0.001) as risk factors for CMV reactivation. The multivariate model also identified chronic kidney disease (CKD; HR 5.19, p = 0.016) and pneumonia (HR 17.22, p = 0.013) as risk factors for repetitive CMV reactivation. CONCLUSION This study suggests that lymphopenia and high doses of steroids may be important risk factors for CMV reactivation in LTx patients. Our results also suggest that repetitive CMV reactivation may be associated with CKD and pneumonia.
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Affiliation(s)
- Se Hyun Kwak
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Joon Chang
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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28
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Verleden SE, Vanstapel A, De Sadeleer L, Weynand B, Boone M, Verbeken E, Piloni D, Van Raemdonck D, Ackermann M, Jonigk DD, Verschakelen J, Wuyts WA. Quantitative analysis of airway obstruction in lymphangioleiomyomatosis. Eur Respir J 2020; 56:13993003.01965-2019. [PMID: 32108050 PMCID: PMC7330132 DOI: 10.1183/13993003.01965-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/03/2020] [Indexed: 02/02/2023]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare, cystic lung disease with progressive pulmonary function loss caused by progressively proliferating LAM cells. The degree of airway obstruction has not been well investigated within the pathogenesis of LAM.Using a combination of ex vivo computed tomography (CT), microCT and histology, the site and nature of airway obstruction in LAM explant lungs was compared with matched control lungs (n=5 each). The total number of airways per generation, total airway counts, terminal bronchioles number and surface density were compared in LAM versus control.Ex vivo CT analysis demonstrated a reduced number of airways from generation 7 on (p<0.0001) in LAM compared with control, whereas whole-lung microCT analysis confirmed the three- to four-fold reduction in the number of airways. Specimen microCT analysis further demonstrated a four-fold decrease in the number of terminal bronchioles (p=0.0079) and a decreased surface density (p=0.0079). Serial microCT and histology images directly showed the loss of functional airways by collapse of airways on the cysts and filling of the airway by exudate.LAM lungs show a three- to four-fold decrease in the number of (small) airways, caused by cystic destruction which is the likely culprit for the progressive loss of pulmonary function.
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Affiliation(s)
- Stijn E Verleden
- Respiratory Diseases, Dept of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium .,Both authors contributed equally
| | - Arno Vanstapel
- Respiratory Diseases, Dept of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium.,Both authors contributed equally
| | - Laurens De Sadeleer
- Respiratory Diseases, Dept of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | | | - Matthieu Boone
- Dept of Physics and Astronomy, Radiation Physics-Centre for X-ray Tomography, Ghent University, Ghent, Belgium
| | | | - Davide Piloni
- The Respiratory Disease Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Dirk Van Raemdonck
- Thoracic Surgery, Dept of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Institute of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, Witten-Herdecke University, Wuppertal, Germany
| | - Danny D Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | | | - Wim A Wuyts
- Respiratory Diseases, Dept of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
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29
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Vanstapel A, Dubbeldam A, Weynand B, Verbeken EK, Vos R, Neyrinck AP, Vasilescu DM, Ceulemans LJ, Frick AE, Van Raemdonck DE, Verschakelen J, Vanaudenaerde BM, Verleden GM, Verleden SE. Histopathologic and radiologic assessment of nontransplanted donor lungs. Am J Transplant 2020; 20:1712-1719. [PMID: 31985888 DOI: 10.1111/ajt.15790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 01/25/2023]
Abstract
Donor organ shortage results in significant waiting list mortality. Donor lung assessment is currently based on donors' history, gas exchange, chest X-ray, bronchoscopy findings, and ultimately in situ inspection but remains subjective. We correlated histopathology and radiology in nontransplanted donor lungs with the clinical indications to decline the offered organ. Sixty-two donor lungs, not used for transplantation (2010-2019), were procured, air-inflated, frozen, scanned with computed tomography, systematically sampled, and histologically and radiologically assessed. Thirty-nine (63%) lungs were declined for allograft-related reasons. In 13/39 (33%) lungs, histology could not confirm the reason for decline, in an additional 8/39 (21%) lungs, histologic abnormalities were only considered mild. In 16/39 (41%) lungs, radiology could not confirm the reason for decline. Twenty-three (37%) donor lungs were not transplanted due to extrapulmonary causes, of which three (13%) lungs displayed severe histologic abnormalities (pneumonia, n = 2; emphysema, n = 1), in addition to mild emphysema in 9 (39%) lungs and minor bronchopneumonia in 1 (4%). Radiology revealed ground-glass opacities in 8/23 (35%) and emphysema in 4/23 (17%) lungs. Histopathologic and radiologic assessment of nontransplanted donor lungs revealed substantial discrepancy with the clinical reason for decline. Optimization of donor lung assessment is necessary to improve current organ acceptance rates.
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Affiliation(s)
- Arno Vanstapel
- Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.,Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | | | - Birgit Weynand
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Eric K Verbeken
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Dragoş M Vasilescu
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurens J Ceulemans
- Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Anna E Frick
- Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | | | - Bart M Vanaudenaerde
- Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Lung Transplant Unit, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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Vasilescu DM, Phillion AB, Kinose D, Verleden SE, Vanaudenaerde BM, Verleden GM, Van Raemdonck D, Stevenson CS, Hague CJ, Han MK, Cooper JD, Hackett TL, Hogg JC. Comprehensive stereological assessment of the human lung using multiresolution computed tomography. J Appl Physiol (1985) 2020; 128:1604-1616. [PMID: 32298211 DOI: 10.1152/japplphysiol.00803.2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The application of stereology to lung casts and two-dimensional microscopy images is the gold standard for quantification of the human lung anatomy. However, these techniques are labor intensive, involving fixation, embedding, and histological sectioning of samples and thus have prevented comprehensive studies. Our objective was to demonstrate the application of stereology to volumetric multiresolution computed tomography (CT) to efficiently and extensively quantify the human lung anatomy. Nontransplantable donor lungs from individuals with no evidence of respiratory disease (n = 13) were air inflated, frozen at 10 cmH2O, and scanned using CT. Systematic uniform random samples were taken, scanned using micro-CT, and assessed using stereology. The application of stereology to volumetric CT imaging enabled comprehensive quantification of total lung volume, volume fractions of alveolar, alveolar duct, and tissue, mean linear intercept, alveolar surface area, alveolar surface area density, septal wall thickness, alveolar number, number-weighted mean alveolar volume, and the number and morphometry of terminal and transitional bronchioles. With the use of this data set, we found that women and men have the same number of terminal bronchioles (last generation of conducting airways), but men have longer terminal bronchioles, a smaller wall area percentage, and larger lungs due to a greater number of alveoli per acinus. The application of stereology to multiresolution CT imaging enables comprehensive analysis of the human lung parenchyma that identifies differences between men and women. The reported data set of normal donor lungs aged 25-77 yr provides reference data for future studies of chronic lung disease to determine exact changes in tissue pathology.NEW & NOTEWORTHY Stereology has been the gold standard to quantify the three-dimensional lung anatomy using two-dimensional microscopy images. However, such techniques are labor intensive. This study provides a method that applies stereology to volumetric computed tomography images of frozen whole human lungs and systematic uniform random samples. The method yielded a comprehensive data set on the small airways and parenchymal lung structures, highlighting morphometric sex differences and providing a reference data set for future pathological studies.
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Affiliation(s)
- Dragoş M Vasilescu
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - André B Phillion
- Department of Materials Science and Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Daisuke Kinose
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stijn E Verleden
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven-Gasthuisberg, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven-Gasthuisberg, Leuven, Belgium
| | - Geert M Verleden
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven-Gasthuisberg, Leuven, Belgium
| | - Dirk Van Raemdonck
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven-Gasthuisberg, Leuven, Belgium
| | | | - Cameron J Hague
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Joel D Cooper
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tillie-Louise Hackett
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Recent developments within micro-computed tomography (μCT) imaging have combined to extend our capacity to image tissue in three (3D) and four (4D) dimensions at micron and sub-micron spatial resolutions, opening the way for virtual histology, live cell imaging, subcellular imaging and correlative microscopy. Pivotal to this has been the development of methods to extend the contrast achievable for soft tissue. Herein, we review the new capabilities within the field of life sciences imaging, and consider how future developments in this field could further benefit the life sciences community.
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Affiliation(s)
- Shelley D Rawson
- The Henry Royce Institute and School of Materials, The University of Manchester, Manchester, M13 9PL, UK
| | - Jekaterina Maksimcuka
- The Henry Royce Institute and School of Materials, The University of Manchester, Manchester, M13 9PL, UK
| | - Philip J Withers
- The Henry Royce Institute and School of Materials, The University of Manchester, Manchester, M13 9PL, UK
| | - Sarah H Cartmell
- The Henry Royce Institute and School of Materials, The University of Manchester, Manchester, M13 9PL, UK.
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32
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Verleden SE, Tanabe N, McDonough JE, Vasilescu DM, Xu F, Wuyts WA, Piloni D, De Sadeleer L, Willems S, Mai C, Hostens J, Cooper JD, Verbeken EK, Verschakelen J, Galban CJ, Van Raemdonck DE, Colby TV, Decramer M, Verleden GM, Kaminski N, Hackett TL, Vanaudenaerde BM, Hogg JC. Small airways pathology in idiopathic pulmonary fibrosis: a retrospective cohort study. THE LANCET RESPIRATORY MEDICINE 2020; 8:573-584. [PMID: 32061334 DOI: 10.1016/s2213-2600(19)30356-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The observation that patients with idiopathic pulmonary fibrosis (IPF) can have higher than normal expiratory flow rates at low lung volumes led to the conclusion that the airways are spared in IPF. This study aimed to re-examine the hypothesis that airways are spared in IPF using a multiresolution imaging protocol that combines multidetector CT (MDCT), with micro-CT and histology. METHODS This was a retrospective cohort study comparing explanted lungs from patients with severe IPF treated by lung transplantation with a cohort of unused donor (control) lungs. The donor control lungs had no known lung disease, comorbidities, or structural lung injury, and were deemed appropriate for transplantation on review of the clinical files. The diagnosis of IPF in the lungs from patients was established by a multidisciplinary consensus committee according to existing guidelines, and was confirmed by video-assisted thoracic surgical biopsy or by pathological examination of the contralateral lung. The control and IPF groups were matched for age, sex, height, and bodyweight. Samples of lung tissue were compared using the multiresolution imaging approach: a cascade of clinical MDCT, micro-CT, and histological imaging. We did two experiments: in experiment 1, all the lungs were randomly sampled; in experiment 2, samples were selected from regions of minimal and established fibrosis. The patients and donors were recruited from the Katholieke Universiteit Leuven (Leuven, Belgium) and the University of Pennsylvania Hospital (Philadelphia, PA, USA). The study took place at the Katholieke Universiteit Leuven, and the University of British Columbia (Vancouver, BC, Canada). FINDINGS Between Oct 5, 2009, and July 22, 2016, explanted lungs from patients with severe IPF (n=11), were compared with a cohort of unused donor (control) lungs (n=10), providing 240 samples of lung tissue for comparison using the multiresolution imaging approach. The MDCT specimen scans show that the number of visible airways located between the ninth generation (control 69 [SD 22] versus patients with IPF 105 [33], p=0·0023) and 14th generation (control 9 [6] versus patients with IPF 49 [28], p<0·0001) of airway branching are increased in patients with IPF, which we show by micro-CT is due to thickening of their walls and distortion of their lumens. The micro-CT analysis showed that compared with healthy (control) lung anatomy (mean 5·6 terminal bronchioles per mL [SD 1·6]), minimal fibrosis in IPF tissue was associated with a 57% loss of the terminal bronchioles (mean 2·4 terminal bronchioles per mL [SD 1·0]; p<0·0001), the appearance of fibroblastic foci, and infiltration of the tissue by inflammatory immune cells capable of forming lymphoid follicles. Established fibrosis in IPF tissue had a similar reduction (66%) in the number of terminal bronchioles (mean 1·9 terminal bronchioles per mL [SD 1·4]; p<0·0001) and was dominated by increased airspace size, Ashcroft fibrosis score, and volume fractions of tissue and collagen. INTERPRETATION Small airways disease is a feature of IPF, with significant loss of terminal bronchioles occuring within regions of minimal fibrosis. On the basis of these findings, we postulate that the small airways could become a potential therapeutic target in IPF. FUNDING Katholieke Universiteit Leuven, US National Institutes of Health, BC Lung Association, and Genentech.
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Affiliation(s)
- Stijn E Verleden
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Naoya Tanabe
- University of British Columbia, Department of Pathology and Center for Heart and Lung Innovation at St Paul's Hospital, Vancouver, BC, Canada; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - John E McDonough
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Dragoş M Vasilescu
- University of British Columbia, Department of Pathology and Center for Heart and Lung Innovation at St Paul's Hospital, Vancouver, BC, Canada
| | - Feng Xu
- University of British Columbia, Department of Pathology and Center for Heart and Lung Innovation at St Paul's Hospital, Vancouver, BC, Canada
| | - Wim A Wuyts
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Davide Piloni
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium; The Respiratory Disease Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Laurens De Sadeleer
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Stijn Willems
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Cindy Mai
- Department of Radiology, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | | | - Joel D Cooper
- Department of Thoracic Surgery University of Pennsylvania, Philadelphia, PA, USA
| | - Erik K Verbeken
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Johny Verschakelen
- Department of Radiology, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Craig J Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Dirk E Van Raemdonck
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Thomas V Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Marc Decramer
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Geert M Verleden
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Naftali Kaminski
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT, USA
| | - Tillie-Louise Hackett
- University of British Columbia, Department of Pathology and Center for Heart and Lung Innovation at St Paul's Hospital, Vancouver, BC, Canada
| | - Bart M Vanaudenaerde
- Department of Clinical and Experimental Medicine, Division of Respiratory Diseases, Katholieke Universiteit Leuven, University Hospitals Leuven, Leuven, Belgium
| | - James C Hogg
- University of British Columbia, Department of Pathology and Center for Heart and Lung Innovation at St Paul's Hospital, Vancouver, BC, Canada.
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Sacreas A, Taupin JL, Emonds MP, Daniëls L, Van Raemdonck DE, Vos R, Verleden GM, Vanaudenaerde BM, Roux A, Verleden SE. Intragraft donor-specific anti-HLA antibodies in phenotypes of chronic lung allograft dysfunction. Eur Respir J 2019; 54:13993003.00847-2019. [PMID: 31439680 DOI: 10.1183/13993003.00847-2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Circulating anti-human leukocyte antigen (HLA) serum donor-specific antibodies (sDSAs) increase the risk of chronic lung allograft dysfunction (CLAD) and mortality. Discrepancies between serological and pathological/clinical findings are common. Therefore, we aimed to assess the presence of tissue-bound graft DSAs (gDSAs) in CLAD explant tissue compared with sDSAs. METHODS Tissue cores, obtained from explant lungs of unused donors (n=10) and patients with bronchiolitis obliterans syndrome (BOS; n=18) and restrictive allograft syndrome (RAS; n=18), were scanned with micro-computed tomography before elution of antibodies. Total IgG levels were measured via ELISA. Anti-HLA class I and II IgG gDSAs were identified using Luminex single antigen beads and compared with DSAs found in serum samples. RESULTS Overall, mean fluorescence intensity was higher in RAS eluates compared with BOS and controls (p<0.0001). In BOS, two patients were sDSA+/gDSA+ and two patients were sDSA-/gDSA+. In RAS, four patients were sDSA+/gDSA+, one patient was sDSA+/gDSA- and five patients were sDSA-/gDSA+. Serum and graft results combined, DSAs were more prevalent in RAS compared with BOS (56% versus 22%; p=0.04). There was spatial variability in gDSA detection in one BOS patient and three RAS patients, who were all sDSA-. Total graft IgG levels were higher in RAS than BOS (p<0.0001) and in gDSA+ versus gDSA- (p=0.0008), but not in sDSA+ versus sDSA- (p=0.33). In RAS, total IgG levels correlated with fibrosis (r= -0.39; p=0.02). CONCLUSIONS This study underlines the potential of gDSA assessment as complementary information to sDSA findings. The relevance and applications of gDSAs need further investigation.
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Affiliation(s)
- Annelore Sacreas
- Leuven Lung Transplant Group, Dept of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Jean-Luc Taupin
- Laboratoire d'Immunologie et Histocompatibilité, Saint-Louis Hospital, Paris, France
| | - Marie-Paule Emonds
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium.,Dept of Immunology and Microbiology, KU Leuven, Leuven, Belgium
| | - Liesbeth Daniëls
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Dirk E Van Raemdonck
- Leuven Lung Transplant Group, Dept of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium.,Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Leuven Lung Transplant Group, Dept of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Leuven Lung Transplant Group, Dept of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Leuven Lung Transplant Group, Dept of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Antoine Roux
- Service de Transplantation Pulmonaire, Foch Hospital, Suresnes, France
| | - Stijn E Verleden
- Leuven Lung Transplant Group, Dept of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
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Abstract
Lung transplantation is an accepted therapeutic option for end-stage lung diseases. Its history starts in the 1940s, initially hampered by early deaths due to perioperative problems and acute rejection. Improvement of surgical techniques and the introduction of immunosuppressive drugs resulted in longer survival. Chronic lung allograft dysfunction (CLAD), a new complication appeared and remains the most serious complication today. CLAD, the main reason why survival after lung transplantation is impaired compared to other solid-organ transplantations is characterized by a gradually increasing shortness of breath, reflected in a deterioration of pulmonary function status, respiratory insufficiency and possibly death.
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35
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Everaerts S, McDonough JE, Verleden SE, Josipovic I, Boone M, Dubbeldam A, Mathyssen C, Serré J, Dupont LJ, Gayan-Ramirez G, Verschakelen J, Hogg JC, Verleden GM, Vanaudenaerde BM, Janssens W. Airway morphometry in COPD with bronchiectasis: a view on all airway generations. Eur Respir J 2019; 54:13993003.02166-2018. [DOI: 10.1183/13993003.02166-2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 08/03/2019] [Indexed: 11/05/2022]
Abstract
The pathophysiological processes underlying bronchiectasis in chronic obstructive pulmonary disease (COPD) are not understood. In COPD, both small and large airways are progressively lost. It is currently not known to what extent the different airway generations of patients with COPD and bronchiectasis are involved.COPD explant lungs with bronchiectasis were compared to COPD explant lungs without bronchiectasis and unused donor lungs as controls. In order to investigate all airway generations, a multimodal imaging approach using different resolutions was conducted. Per group, five lungs were frozen (n=15) and underwent computed tomography (CT) imaging for large airway evaluation, with four tissue cores per lung imaged for measurements of the terminal bronchioles. Two additional lungs per group (n=6) were air-dried for lobar microCT images that allow airway segmentation and three-dimensional quantification of the complete airway tree.COPD lungs with bronchiectasis had significantly more airways compared to COPD lungs without bronchiectasis (p<0.001), with large airway numbers similar to control lungs. This difference was present in both upper and lower lobes. Lack of tapering was present (p=0.010) and larger diameters were demonstrated in lower lobes with bronchiectasis (p=0.010). MicroCT analysis of tissue cores showed similar reductions of tissue percentage, surface density and number of terminal bronchioles in both COPD groups compared to control lungs.Although terminal bronchioles were equally reduced in COPD lungs with and without bronchiectasis, significantly more large and small airways were found in COPD lungs with bronchiectasis.
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Phenotypical diversity of airway morphology in chronic lung graft vs. host disease after stem cell transplantation. Mod Pathol 2019; 32:817-829. [PMID: 30723292 DOI: 10.1038/s41379-019-0203-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023]
Abstract
Pulmonary graft vs. host disease is a diverse and underestimated complication following allogenic hematopoietic stem cell transplantation. We aimed to compare the airway architecture with chronic lung allograft dysfunction post lung transplantation. Inflated explant lungs from graft vs. host disease patients were compared with lungs with chronic lung allograft dysfunction following lung transplantation, and control lungs using a combination of CT, microCT, and histology (n = 6 per group) and pathology in the (small) airways was further quantified and analyzed. Following allogenic hematopoietic stem cell transplantation, three patients presented as bronchiolitis obliterans syndrome and three patients showed interstitial changes and restriction. The CT analysis demonstrated a strong similarity between bronchiolitis obliterans syndrome after lung transplantation and post allogenic hematopoietic stem cell transplantation, evidenced by severe ( > 50%) airway obstruction from generation 9, with 70.8% of the airways ending in obstruction. Further analysis indicated that the airways either collapsed or accumulated matrix along a segment of the airway. In patients with restriction and interstitial changes following allogenic hematopoietic stem cell transplantation, the degree of airway obstruction was lower compared with bronchiolitis obliterans syndrome post allogenic hematopoietic stem cell transplantation, but similar to restrictive allograft syndrome post lung transplantation, showing a lower proportion of airway obstruction (20-35%), decreased number of terminal bronchioles per lung (p < 0.01), and parenchymal fibrosis. We observed similarities in the airway and parenchymal morphometric changes in lung graft vs. host disease and with chronic lung allograft dysfunction following lung transplantation, suggesting similar pathophysiological mechanisms.
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The pleural mesothelium and transforming growth factor-β1 pathways in restrictive allograft syndrome: A pre-clinical investigation. J Heart Lung Transplant 2019; 38:570-579. [DOI: 10.1016/j.healun.2019.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 12/21/2022] Open
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Glanville AR, Verleden GM, Todd JL, Benden C, Calabrese F, Gottlieb J, Hachem RR, Levine D, Meloni F, Palmer SM, Roman A, Sato M, Singer LG, Tokman S, Verleden SE, von der Thüsen J, Vos R, Snell G. Chronic lung allograft dysfunction: Definition and update of restrictive allograft syndrome-A consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant 2019; 38:483-492. [PMID: 31027539 DOI: 10.1016/j.healun.2019.03.008] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Allan R Glanville
- Lung Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Jamie L Todd
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | | | - Fiorella Calabrese
- Department of Cardiothoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center for Lung Research, Hannover, Germany
| | - Ramsey R Hachem
- Division of Pulmonary & Critical Care, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Deborah Levine
- Pulmonary Disease and Critical Care Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Federica Meloni
- Department of Respiratory Diseases Policlinico San Matteo Foundation & University of Pavia, Pavia, Italy
| | - Scott M Palmer
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - Antonio Roman
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Masaaki Sato
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Lianne G Singer
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sofya Tokman
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | - Jan von der Thüsen
- Department of Pathology, University Medical Center, Rotterdam, The Netherlands
| | - Robin Vos
- University Hospital Gasthuisberg, Leuven, Belgium
| | - Gregory Snell
- Lung Transplant Service, The Alfred Hospital, Melbourne, Victoria, Australia
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39
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Role of 18F-FDG PET/CT in Restrictive Allograft Syndrome After Lung Transplantation. Transplantation 2019; 103:823-831. [DOI: 10.1097/tp.0000000000002393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Hochhegger B, Langer FW, Irion K, Souza A, Moreira J, Baldisserotto M, Pallaoro Y, Muller E, Medeiros TM, Altmayer S, Marchiori E. Pulmonary Acinus: Understanding the Computed Tomography Findings from an Acinar Perspective. Lung 2019; 197:259-265. [PMID: 30900014 DOI: 10.1007/s00408-019-00214-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/05/2019] [Indexed: 12/17/2022]
Abstract
The lung acinus is the most distal portion of the airway responsible for the gas exchange. The normal acini are not visible on conventional computed tomography (CT), but the advent of micro-CT improved the understanding of the microarchitecture of healthy acini. The comprehension of the acinar architecture is pivotal for the understanding of CT findings of diseases that involve the acini. Centriacinar emphysema, for example, presents as round areas of low attenuation due to the destruction of the most central acini with compensatory enlargement of proximal acini due to alveolar wall destruction. In pulmonary fibrosis, intralobular septal fibrosis manifests as acinar wall thickening with an overlap of acinar collapse and compensatory dilation of surrounding acini constituting the cystic disease typical of the usual interstitial pneumonia pattern. This is a state-of-the-art review to describe the acinar structure from the micro-CT perspective and display how the comprehension of the acinar structure can aid in the interpretation of its microarchitecture disruption on conventional CT.
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Affiliation(s)
- Bruno Hochhegger
- Medical Imaging Research Laboratory, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil. .,Postgraduate program, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil. .,LABIMED - Medical Imaging Research Lab, Department of Radiology, Pavilhão, Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 75, Porto Alegre, 90020-160, Brazil.
| | - Felipe W Langer
- Department of Radiology and Imaging Diagnosis, Federal University of Santa Maria, Santa Maria, Brazil
| | - Klaus Irion
- Department of Radiology, Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool, L14 3PE, UK
| | - Arthur Souza
- Department of Radiology, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil
| | - José Moreira
- Medical Imaging Research Laboratory, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Matteo Baldisserotto
- Postgraduate program, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Yana Pallaoro
- Medical Imaging Research Laboratory, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Enrico Muller
- Postgraduate program, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Tassia Machado Medeiros
- Postgraduate program, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Stephan Altmayer
- Medical Imaging Research Laboratory, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Bailey KE, Floren ML, D'Ovidio TJ, Lammers SR, Stenmark KR, Magin CM. Tissue-informed engineering strategies for modeling human pulmonary diseases. Am J Physiol Lung Cell Mol Physiol 2019; 316:L303-L320. [PMID: 30461289 PMCID: PMC6397349 DOI: 10.1152/ajplung.00353.2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 12/14/2022] Open
Abstract
Chronic pulmonary diseases, including idiopathic pulmonary fibrosis (IPF), pulmonary hypertension (PH), and chronic obstructive pulmonary disease (COPD), account for staggering morbidity and mortality worldwide but have limited clinical management options available. Although great progress has been made to elucidate the cellular and molecular pathways underlying these diseases, there remains a significant disparity between basic research endeavors and clinical outcomes. This discrepancy is due in part to the failure of many current disease models to recapitulate the dynamic changes that occur during pathogenesis in vivo. As a result, pulmonary medicine has recently experienced a rapid expansion in the application of engineering principles to characterize changes in human tissues in vivo and model the resulting pathogenic alterations in vitro. We envision that engineering strategies using precision biomaterials and advanced biomanufacturing will revolutionize current approaches to disease modeling and accelerate the development and validation of personalized therapies. This review highlights how advances in lung tissue characterization reveal dynamic changes in the structure, mechanics, and composition of the extracellular matrix in chronic pulmonary diseases and how this information paves the way for tissue-informed engineering of more organotypic models of human pathology. Current translational challenges are discussed as well as opportunities to overcome these barriers with precision biomaterial design and advanced biomanufacturing techniques that embody the principles of personalized medicine to facilitate the rapid development of novel therapeutics for this devastating group of chronic diseases.
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Affiliation(s)
- Kolene E Bailey
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Michael L Floren
- Cardiovascular Pulmonary Research Laboratories, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Tyler J D'Ovidio
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Steven R Lammers
- Department of Bioengineering, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Kurt R Stenmark
- Cardiovascular Pulmonary Research Laboratories, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Chelsea M Magin
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
- Department of Bioengineering, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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42
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Sacreas A, Yang JYC, Vanaudenaerde BM, Sigdel TK, Liberto JM, Damm I, Verleden GM, Vos R, Verleden SE, Sarwal MM. The common rejection module in chronic rejection post lung transplantation. PLoS One 2018; 13:e0205107. [PMID: 30289917 PMCID: PMC6173434 DOI: 10.1371/journal.pone.0205107] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
Rationale Recent studies suggest that similar injury mechanisms are in place across different solid organ transplants, resulting in the identification of a common rejection module (CRM), consisting of 11 genes that are overexpressed during acute and, to a lesser extent, chronic allograft rejection. Objectives We wanted to evaluate the usefulness of the CRM module in identifying acute rejection (AR) and different phenotypes of chronic lung transplant rejection (CLAD), i.e., bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), using transbronchial brushings, broncho-alveolar lavage (BAL) samples, and explant tissue. Methods Gene expression measurements for the 11 CRM genes (CD6, TAP1, CXCL10, CXCL9, INPP5D, ISG20, LCK, NKG7, PSMB9, RUNX3, and BASP1) were performed via qRT-PCR in 14 transbronchial brushings (AR, n = 4; no AR, n = 10), 32 BAL samples (stable, n = 13; AR, n = 8; BOS, n = 9; RAS, n = 10), and 44 tissue specimens (unused donor lungs, n = 15; BOS, n = 13; RAS, n = 16). A geometric mean score was calculated to quantitate overall burden of immune injury and a new computational model was built for the most significant genes in lung transplant injury. Results Acute rejection showed a significant difference in almost every gene analysed, validating previous observations from microarray analysis. RAS tissue demonstrated a higher geometric mean score (6.35) compared to donor tissue (4.09, p = 0.018). Analysis of individual CRM genes showed an increased expression of ISG20, CXCL10 and CXCL9 in RAS. In BAL samples, no differences were detected in gene expression or geometric mean scores between the various groups (stable, 5.15; AR, 5.81; BOS, 5.62; RAS, 7.31). A newly modelled 2-gene tissue CRM score did not demonstrate any difference between BOS and RAS (p>0.05). However, the model was able to discriminate RAS from BOS tissue (AUC = 0.75, 95% CI = 0.55–0.94, p = 0.025). Conclusion Transcriptional tissue analysis for CRM genes in CLAD can identify acute rejection and distinguish RAS from BOS. The immune activation in RAS seems similar to acute rejection after kidney/liver/heart transplantation.
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Affiliation(s)
- Annelore Sacreas
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism, and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Joshua Y. C. Yang
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Bart M. Vanaudenaerde
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism, and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Tara K. Sigdel
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Juliane M. Liberto
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Izabella Damm
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Geert M. Verleden
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism, and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Robin Vos
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism, and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Stijn E. Verleden
- Leuven Lung Transplant Unit, Department of Chronic Diseases, Metabolism, and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
- * E-mail: (SEV); (MMS)
| | - Minnie M. Sarwal
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail: (SEV); (MMS)
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43
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Sun N, Fernandez IE, Wei M, Witting M, Aichler M, Feuchtinger A, Burgstaller G, Verleden SE, Schmitt-Kopplin P, Eickelberg O, Walch A. Pharmacometabolic response to pirfenidone in pulmonary fibrosis detected by MALDI-FTICR-MSI. Eur Respir J 2018; 52:13993003.02314-2017. [PMID: 30072508 DOI: 10.1183/13993003.02314-2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 07/15/2018] [Indexed: 11/05/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a fatal condition that reduces life expectancy and shows a limited response to available therapies. Pirfenidone has been approved for treatment of IPF, but little is known about the distinct metabolic changes that occur in the lung upon pirfenidone administration.Here, we performed a proof-of-concept study using high-resolution quantitative matrix-assisted laser desorption/ionisation Fourier-transform ion cyclotron resonance mass spectrometry imaging (MALDI-FTICR-MSI) to simultaneously detect, visualise and quantify in situ endogenous and exogenous metabolites in lungs of mice subjected to experimental fibrosis and human patients with IPF, and to assess the effect of pirfenidone treatment on metabolite levels.Metabolic pathway analysis and endogenous metabolite quantification revealed that pirfenidone treatment restores redox imbalance and glycolysis in IPF tissues, and downregulates ascorbate and aldarate metabolism, thereby likely contributing to in situ modulation of collagen processing. As such, we detected specific alterations in metabolite pathways in fibrosis and, importantly, metabolic recalibration following pirfenidone treatment.Together, these results highlight the suitability of high-resolution MALDI-FTICR-MSI for deciphering the therapeutic effects of pirfenidone and provide a preliminary analysis of the metabolic changes that occur during pirfenidone treatment in vivo These data may therefore contribute to improvement of currently available therapies for IPF.
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Affiliation(s)
- Na Sun
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.,These authors contributed equally to this work
| | - Isis E Fernandez
- Comprehensive Pneumology Center, Helmholtz Zentrum München, Ludwig Maximilian University München, Member of the German Center for Lung Research (DZL), Munich, Germany.,These authors contributed equally to this work
| | - Mian Wei
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Michael Witting
- Research Unit Analytical BioGeoChemistry, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Michaela Aichler
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Annette Feuchtinger
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Gerald Burgstaller
- Comprehensive Pneumology Center, Helmholtz Zentrum München, Ludwig Maximilian University München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Stijn E Verleden
- Laboratory of Pneumology, Dept of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Philippe Schmitt-Kopplin
- Research Unit Analytical BioGeoChemistry, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Oliver Eickelberg
- Comprehensive Pneumology Center, Helmholtz Zentrum München, Ludwig Maximilian University München, Member of the German Center for Lung Research (DZL), Munich, Germany.,Division of Respiratory Sciences and Critical Care Medicine, Dept of Medicine, University of Colorado, Denver, CO, USA.,These authors contributed equally to this work
| | - Axel Walch
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.,These authors contributed equally to this work
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44
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Everaerts S, Lammertyn EJ, Martens DS, De Sadeleer LJ, Maes K, van Batenburg AA, Goldschmeding R, van Moorsel CHM, Dupont LJ, Wuyts WA, Vos R, Gayan-Ramirez G, Kaminski N, Hogg JC, Janssens W, Verleden GM, Nawrot TS, Verleden SE, McDonough JE, Vanaudenaerde BM. The aging lung: tissue telomere shortening in health and disease. Respir Res 2018; 19:95. [PMID: 29751799 PMCID: PMC5948770 DOI: 10.1186/s12931-018-0794-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 04/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Telomere shortening has been associated with several lung diseases. However, telomere length is generally measured in peripheral blood leucocytes rather than in lung tissue, where disease occurs. Consequently, telomere dynamics have not been established for the normal human lung nor for diseased lung tissue. We hypothesized an age- and disease-dependent shortening of lung tissue telomeres. Methods At time of (re-)transplantation or autopsy, 70 explant lungs were collected: from unused donors (normal, n = 13) and patients with cystic fibrosis (CF, n = 12), chronic obstructive pulmonary disease (COPD, n = 11), chronic hypersensitivity pneumonitis (cHP, n = 9), bronchiolitis obliterans syndrome (BOS) after prior transplantation (n = 11) and restrictive allograft syndrome (RAS) after prior transplantation (n = 14). Lungs were inflated, frozen and then scanned using CT. Four tissue cores from distinct lung regions were sampled for analysis. Disease severity was evaluated using CT and micro CT imaging. DNA was extracted from the samples and average relative telomere length (RTL) was determined using real-time qPCR. Results The normal lungs showed a decrease in RTL with age (p < 0.0001). Of the diseased lungs, only BOS and RAS showed significant RTL decrease with increasing lung age (p = 0.0220 and p = 0.0272 respectively). Furthermore, we found that RTL showed considerable variability between samples within both normal and diseased lungs. cHP, BOS and RAS lungs had significant shorter RTL in comparison with normal lungs, after adjustment for lung age, sex and BMI (p < 0.0001, p = 0.0051 and p = 0.0301 respectively). When investigating the relation between RTL and regional disease severity in CF, cHP and RAS, no association was found. Conclusion These results show a progressive decline in telomere length with age in normal, BOS and RAS lungs. cHP, BOS and RAS lungs demonstrated shorter RTL compared to normal lungs. Lung tissue RTL does not associate with regional disease severity within the lung. Therefore, tissue RTL does not seem to fully reflect peripheral blood telomere length. Electronic supplementary material The online version of this article (10.1186/s12931-018-0794-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie Everaerts
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium.
| | - Elise J Lammertyn
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
| | - Dries S Martens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Laurens J De Sadeleer
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
| | - Karen Maes
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
| | - Aernoud A van Batenburg
- Department of Pulmonology, St Antonius ILD Center of Excellence, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Roel Goldschmeding
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Coline H M van Moorsel
- Department of Pulmonology, St Antonius ILD Center of Excellence, St Antonius Hospital, Nieuwegein, the Netherlands.,Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lieven J Dupont
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Wim A Wuyts
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
| | - Naftali Kaminski
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, CT, USA
| | - James C Hogg
- University of British Columbia James Hogg Research Centre, St. Paul's Hospital, Vancouver, BC, Canada
| | - Wim Janssens
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Geert M Verleden
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
| | - John E McDonough
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Aging (CHROMETA), KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
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45
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Froidure A, Ladjemi MZ, Pilette C. Interleukin-1α: a key player for epithelial-to-mesenchymal signalling in COPD? Eur Respir J 2018; 48:301-4. [PMID: 27478185 DOI: 10.1183/13993003.01180-2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Antoine Froidure
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium Cliniques Universitaires Saint-Luc, Service de Pneumologie, Brussels, Belgium UMR Inserm U1152, Labex Inflammex, Université Paris 7, Paris, France These authors contributed equally to this manuscript
| | - Maha Zohra Ladjemi
- UMR Inserm U1152, Labex Inflammex, Université Paris 7, Paris, France These authors contributed equally to this manuscript
| | - Charles Pilette
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium Cliniques Universitaires Saint-Luc, Service de Pneumologie, Brussels, Belgium
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46
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von der Thüsen JH, Vandermeulen E, Vos R, Weynand B, Verbeken EK, Verleden SE. The histomorphological spectrum of restrictive chronic lung allograft dysfunction and implications for prognosis. Mod Pathol 2018; 31:780-790. [PMID: 29327719 DOI: 10.1038/modpathol.2017.180] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 12/31/2022]
Abstract
Chronic lung allograft dysfunction continues to be the main contributor to poor long-term allograft survival after lung transplantation. The restrictive phenotype of chronic lung allograft dysfunction carries a particularly poor prognosis. Little is known about the pathogenetic mechanisms involved in restrictive chronic lung allograft dysfunction. In this study, we performed histomorphological and immunohistochemical analysis of restrictive chronic lung allograft dysfunction lungs. Explant lung tissue from 21 restrictive chronic lung allograft dysfunction patients was collected and histopathologic patterns of rejection, fibrosis and vascular changes were scored after routine histochemical stains and additional immunohistochemistry for endothelial markers and C4d. In all, 75% of cases showed evidence of acute cellular rejection; lymphocytic bronchiolitis was absent in most lungs, whereas in 55% there was obliterative bronchiolitis. Almost half of the cases showed a pattern consistent with pleuroparenchymal fibro-elastosis (n=10), and a subset showed nonspecific interstitial pneumonia (n=5) or irregular emphysema (n=5). Fibrinous alveolar exudates were frequently seen in association with fibrosis (n=6), but no diffuse alveolar damage was found. Evidence of microvascular damage was present in most cases. An emphysematous pattern of fibrosis was associated with a better survival (P=0.0030), whereas fibrinous exudates were associated with a worse survival (P=0.0007). In addition to the previously described nonspecific interstitial pneumonia and pleuroparenchymal fibro-elastosis patterns in restrictive chronic lung allograft dysfunction, we are the first to describe a pattern of fibrosis-induced subpleural/paraseptal emphysema. This pattern confers a better survival, whereas fibrinous exudates are associated with a worse survival. We believe that our findings offer a pathogenetic theory for pleuroparenchymal fibro-elastosis in restrictive chronic lung allograft dysfunction, and show that restrictive chronic lung allograft dysfunction is an increasingly heterogeneous disease with presumably different mechanisms of subpattern formation.
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Affiliation(s)
| | - Elly Vandermeulen
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | | | | | - Stijn E Verleden
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
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47
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Taher H, Bauer C, Abston E, Kaczka DW, Bhatt SP, Zabner J, Brower RG, Beichel RR, Eberlein M. Chest wall strapping increases expiratory airflow and detectable airway segments in computer tomographic scans of normal and obstructed lungs. J Appl Physiol (1985) 2018; 124:1186-1193. [PMID: 29357485 PMCID: PMC6008079 DOI: 10.1152/japplphysiol.00184.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 11/22/2022] Open
Abstract
Chest wall strapping (CWS) induces breathing at low lung volumes but also increases parenchymal elastic recoil. In this study, we tested the hypothesis that CWS dilates airways via airway-parenchymal interdependence. In 11 subjects (6 healthy and 5 with mild to moderate COPD), pulmonary function tests and lung volumes were obtained in control (baseline) and the CWS state. Control and CWS-CT scans were obtained at 50% of control (baseline) total lung-capacity (TLC). CT lung volumes were analyzed by CT volumetry. If control and CWS-CT volumetry did not differ by more than 25%, airway dimensions were analyzed via automated airway segmentation. CWS-TLC was reduced on average to 71% of control-TLC in normal subjects and 79% of control-TLC in subjects with COPD. CWS increased expiratory airflow at 50% of control-TLC by 41% (3.50 ± 1.6 vs. 4.93 ± 1.9 l/s, P = 0.04) in normals and 316% in COPD(0.25 ± 0.05 vs 0.79 ± 0.39 l/s, P = 0.04). In 10 subjects (5 normals and 5 COPD), control and CWS-CT scans at 50% control-TLC did not differ more than 25% on CT volumetry and were included in the airway structure analysis. CWS increased the mean number of detectable airways with a diameter of ≤2 mm by 32.5% (65 ± 10 vs. 86 ± 124, P = 0.01) in normal subjects and by 79% (59 ± 19 vs. 104 ± 16, P = 0.01) in subjects with COPD. There was no difference in the number of detectable airways with diameters 2-4 mm and >4 mm in normal or in COPD subjects. In conclusion, CWS enhances the detection of small airways via automated CT airway segmentation and increases expiratory airflow in normal subjects as well as in subjects with mild to moderate COPD. NEW & NOTEWORTHY In normal and COPD subjects, chest wall strapping(CWS) increased the number of detectable small airways using automated CT airway segmentation. The concept of dysanapsis expresses the physiological variation in the geometry of the tracheobronchial tree and lung parenchyma based on development. We propose a dynamic concept to dysanapsis in which CWS leads to breathing at lower lung volumes with a corresponding increase in the size of small airways, a potentially novel, nonpharmacological treatment for COPD.
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Affiliation(s)
- Hisham Taher
- Department and Internal Medicine, University of Iowa , Iowa City, Iowa
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa , Iowa City, Iowa
| | - Christian Bauer
- Department of Electrical and Computer Engineering, University of Iowa , Iowa City, Iowa
- Iowa Institute for Biomedical Imaging, University of Iowa , Iowa City, Iowa
| | - Eric Abston
- Department and Internal Medicine, University of Iowa , Iowa City, Iowa
| | - David W Kaczka
- Department of Anesthesiology, University of Iowa , Iowa City, Iowa
- Department of Biomedical Engineering, University of Iowa , Iowa City, Iowa
- Department of Radiology, University of Iowa , Iowa City, Iowa
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama , Birmingham, Alabama
| | - Joseph Zabner
- Department and Internal Medicine, University of Iowa , Iowa City, Iowa
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa , Iowa City, Iowa
| | - Roy G Brower
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University - Baltimore, Maryland
| | - Reinhard R Beichel
- Department and Internal Medicine, University of Iowa , Iowa City, Iowa
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa , Iowa City, Iowa
- Department of Electrical and Computer Engineering, University of Iowa , Iowa City, Iowa
- Iowa Institute for Biomedical Imaging, University of Iowa , Iowa City, Iowa
| | - Michael Eberlein
- Department and Internal Medicine, University of Iowa , Iowa City, Iowa
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa , Iowa City, Iowa
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48
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Vanaudenaerde B, Verleden S, Neyrinck A, Verleden G, Vos R. A New Step in the Marathon of Understanding Chronic Rejection after Lung Transplantation. Am J Respir Cell Mol Biol 2018; 56:683-684. [PMID: 28569594 DOI: 10.1165/rcmb.2017-0060ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bart Vanaudenaerde
- 1 Department of Clinical and Experimental Disease Katholieke Universiteit Leuven Leuven, Belgium
| | - Stijn Verleden
- 1 Department of Clinical and Experimental Disease Katholieke Universiteit Leuven Leuven, Belgium
| | - Arne Neyrinck
- 1 Department of Clinical and Experimental Disease Katholieke Universiteit Leuven Leuven, Belgium
| | - Geert Verleden
- 1 Department of Clinical and Experimental Disease Katholieke Universiteit Leuven Leuven, Belgium
| | - Robin Vos
- 1 Department of Clinical and Experimental Disease Katholieke Universiteit Leuven Leuven, Belgium
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49
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Fakhro M, Broberg E, Algotsson L, Hansson L, Koul B, Gustafsson R, Wierup P, Ingemansson R, Lindstedt S. Double lung, unlike single lung transplantation might provide a protective effect on mortality and bronchiolitis obliterans syndrome. J Cardiothorac Surg 2017; 12:100. [PMID: 29178919 PMCID: PMC5702105 DOI: 10.1186/s13019-017-0666-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022] Open
Abstract
Background Survival after lung transplantation (LTx) is often limited by bronchiolitis obliterans syndrome (BOS). Method Survey of 278 recipients who underwent LTx. The endpoint used was BOS (BOS grade ≥ 2), death or Re-lung transplantation (Re-LTx) assessed by competing risk regression analyses. Results The incidence of BOS grade ≥ 2 among double LTx (DLTx) recipients was 16 ± 3% at 5 years, 30 ± 4% at 10 years, and 37 ± 5% at 20 years, compared to single LTx (SLTx) recipients whose corresponding incidence of BOS grade ≥ 2 was 11 ± 3%, 20 ± 4%, and 24 ± 5% at 5, 10, and 20 years, respectively (p > 0. 05). The incidence of BOS grade ≥ 2 by major indications ranked in descending order: other, PF, CF, COPD, PH and AAT1 (p < 0. 05). The mortality rate by major indication ranked in descending order: COPD, PH, AAT1, PF, Other and CF (p < 0. 05). Conclusion No differences were seen in the incidence of BOS grade ≥ 2 regarding type of transplant, however, DLTx recipients showed a better chance of survival despite developing BOS compared to SLTx recipients. The highest incidence of BOS was seen among CF, PF, COPD, PH, and AAT1 recipients in descending order, however, CF and PF recipients showed a better chance of survival despite developing BOS compared to COPD, PH, and AAT1 recipients.
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Affiliation(s)
- Mohammed Fakhro
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
| | - Ellen Broberg
- Department of Thoracic Intensive Care and Anesthesia, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lars Algotsson
- Department of Thoracic Intensive Care and Anesthesia, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lennart Hansson
- Department of Pulmonary Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Bansi Koul
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ronny Gustafsson
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per Wierup
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Richard Ingemansson
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sandra Lindstedt
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
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Abstract
Chronic lung allograft dysfunction (CLAD) is the major limitation to posttransplant survival. This review highlights the evolving definition of CLAD, risk factors, treatment, and expected outcomes after the development of CLAD.
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