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Berigei SR, Nandy S, Yamamoto S, Raphaely RA, DeCoursey A, Lee J, Sharma A, Auchincloss HG, Gaissert H, Lanuti M, Ott HC, Sachdeva UM, Wright CD, Zhao SH, Hallowell RW, Shea BS, Muniappan A, Keyes CM, Hariri LP. Microscopic Small Airway Abnormalities Identified in Early Idiopathic Pulmonary Fibrosis In Vivo Using Endobronchial Optical Coherence Tomography. Am J Respir Crit Care Med 2024; 210:473-483. [PMID: 38747674 PMCID: PMC11351792 DOI: 10.1164/rccm.202401-0249oc] [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: 01/30/2024] [Accepted: 05/15/2024] [Indexed: 08/16/2024] Open
Abstract
Rationale: Idiopathic pulmonary fibrosis (IPF) affects the subpleural lung but is considered to spare small airways. Micro-computed tomography (micro-CT) studies demonstrated small airway reduction in end-stage IPF explanted lungs, raising questions about small airway involvement in early-stage disease. Endobronchial optical coherence tomography (EB-OCT) is a volumetric imaging modality that detects microscopic features from subpleural to proximal airways. Objectives: In this study, EB-OCT was used to evaluate small airways in early IPF and control subjects in vivo. Methods: EB-OCT was performed in 12 subjects with IPF and 5 control subjects (matched by age, sex, smoking history, height, and body mass index). Subjects with IPF had early disease with mild restriction (FVC: 83.5% predicted), which was diagnosed per current guidelines and confirmed by surgical biopsy. EB-OCT volumetric imaging was acquired bronchoscopically in multiple, distinct, bilateral lung locations (total: 97 sites). IPF imaging sites were classified by severity into affected (all criteria for usual interstitial pneumonia present) and less affected (some but not all criteria for usual interstitial pneumonia present). Bronchiole count and small airway stereology metrics were measured for each EB-OCT imaging site. Measurements and Main Results: Compared with the number of bronchioles in control subjects (mean = 11.2/cm3; SD = 6.2), there was significant bronchiole reduction in subjects with IPF (42% loss; mean = 6.5/cm3; SD = 3.4; P = 0.0039), including in IPF affected (48% loss; mean: 5.8/cm3; SD: 2.8; P < 0.00001) and IPF less affected (33% loss; mean: 7.5/cm3; SD: 4.1; P = 0.024) sites. Stereology metrics showed that IPF-affected small airways were significantly larger, more distorted, and more irregular than in IPF-less affected sites and control subjects. IPF less affected and control airways were statistically indistinguishable for all stereology parameters (P = 0.36-1.0). Conclusions: EB-OCT demonstrated marked bronchiolar loss in early IPF (between 30% and 50%), even in areas minimally affected by disease, compared with matched control subjects. These findings support small airway disease as a feature of early IPF, providing novel insight into pathogenesis and potential therapeutic targets.
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Affiliation(s)
| | - Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Satomi Yamamoto
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Rebecca A. Raphaely
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | | | - Jaeyul Lee
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Amita Sharma
- Department of Radiology
- Harvard Medical School, Boston, Massachusetts
| | | | - Henning Gaissert
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Michael Lanuti
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Harald C. Ott
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Uma M. Sachdeva
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Cameron D. Wright
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | | | - Robert W. Hallowell
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Barry S. Shea
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Ashok Muniappan
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Colleen M. Keyes
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts; and
- Harvard Medical School, Boston, Massachusetts
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2
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Barkas GI, Daniil Z, Kotsiou OS. The Role of Small Airway Disease in Pulmonary Fibrotic Diseases. J Pers Med 2023; 13:1600. [PMID: 38003915 PMCID: PMC10672167 DOI: 10.3390/jpm13111600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Small airway disease (SAD) is a pathological condition that affects the bronchioles and non-cartilaginous airways 2 mm or less in diameter. These airways play a crucial role in respiratory function and are often implicated in various pulmonary disorders. Pulmonary fibrotic diseases are characterized by the thickening and scarring of lung tissue, leading to progressive respiratory failure. We aimed to present the link between SAD and fibrotic lung conditions. The evidence suggests that SAD may act as a precursor or exacerbating factor in the progression of fibrotic diseases. Patients with fibrotic conditions often exhibit signs of small airway dysfunction, which can contribute to worsening respiratory symptoms and decreased lung function. Moreover, individuals with advanced SAD are at a heightened risk of developing fibrotic changes in the lung. The interplay between inflammation, environmental factors, and genetic predisposition further complicates this association. The early detection and management of SAD can potentially mitigate the progression of fibrotic diseases, highlighting the need for comprehensive clinical evaluation and research. This review emphasizes the need to understand the evolving connection between SAD and pulmonary fibrosis, urging further detailed research to clarify the causes and potential treatment between the two entities.
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Affiliation(s)
- Georgios I. Barkas
- Department of Human Pathophysiology, Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece;
| | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | - Ourania S. Kotsiou
- Department of Human Pathophysiology, Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece;
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
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Uhl K, Paithankar S, Leshchiner D, Jager TE, Abdelgied M, Dixit B, Marashdeh R, Luo-Li D, Tripp K, Peraino AM, Tamae Kakazu M, Lawson C, Chesla DW, Luo-Li N, Murphy ET, Prokop J, Chen B, Girgis RE, Li X. Differential Transcriptomic Signatures of Small Airway Cell Cultures Derived from IPF and COVID-19-Induced Exacerbation of Interstitial Lung Disease. Cells 2023; 12:2501. [PMID: 37887346 PMCID: PMC10605205 DOI: 10.3390/cells12202501] [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: 08/31/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a pathological condition wherein lung injury precipitates the deposition of scar tissue, ultimately leading to a decline in pulmonary function. Existing research indicates a notable exacerbation in the clinical prognosis of IPF patients following infection with COVID-19. This investigation employed bulk RNA-sequencing methodologies to describe the transcriptomic profiles of small airway cell cultures derived from IPF and post-COVID fibrosis patients. Differential gene expression analysis unveiled heightened activation of pathways associated with microtubule assembly and interferon signaling in IPF cell cultures. Conversely, post-COVID fibrosis cell cultures exhibited distinctive characteristics, including the upregulation of pathways linked to extracellular matrix remodeling, immune system response, and TGF-β1 signaling. Notably, BMP signaling levels were elevated in cell cultures derived from IPF patients compared to non-IPF control and post-COVID fibrosis samples. These findings underscore the molecular distinctions between IPF and post-COVID fibrosis, particularly in the context of signaling pathways associated with each condition. A better understanding of the underlying molecular mechanisms holds the promise of identifying potential therapeutic targets for future interventions in these diseases.
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Affiliation(s)
- Katie Uhl
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
| | - Shreya Paithankar
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
| | - Dmitry Leshchiner
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
| | - Tara E. Jager
- Corewell Health Medical Group, Grand Rapids, MI 49503, USA (A.M.P.); (M.T.K.)
| | - Mohamed Abdelgied
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
| | - Bhavna Dixit
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
| | - Raya Marashdeh
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
| | - Dewen Luo-Li
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
| | - Kaylie Tripp
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
| | - Angela M. Peraino
- Corewell Health Medical Group, Grand Rapids, MI 49503, USA (A.M.P.); (M.T.K.)
| | | | - Cameron Lawson
- Corewell Health Medical Group, Grand Rapids, MI 49503, USA (A.M.P.); (M.T.K.)
| | - Dave W. Chesla
- Corewell Health Medical Group, Grand Rapids, MI 49503, USA (A.M.P.); (M.T.K.)
| | - Ningzhi Luo-Li
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
| | - Edward T. Murphy
- Corewell Health Medical Group, Grand Rapids, MI 49503, USA (A.M.P.); (M.T.K.)
- Richard DeVos Lung Transplant Program, Corewell Health, Grand Rapids, MI 49503, USA
| | - Jeremy Prokop
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI 48824, USA
| | - Bin Chen
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI 48824, USA
| | - Reda E. Girgis
- Corewell Health Medical Group, Grand Rapids, MI 49503, USA (A.M.P.); (M.T.K.)
| | - Xiaopeng Li
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA (D.L.); (M.A.); (B.D.); (R.M.); (J.P.)
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Cottin V. Small Airways in Pulmonary Fibrosis: Revisiting an Old Question with New Tools. Am J Respir Crit Care Med 2022; 206:516-517. [PMID: 35549841 DOI: 10.1164/rccm.202202-0350le] [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)
- Vincent Cottin
- Hospices Civils de Lyon, 26900, Reference Center for Rare Pulmonary Diseases (OrphaLung), Department of Respiratory Medicine, Louis Pradel Hospital, Lyon, France.,University Claude Bernard Lyon 1, 27098, INRAE, Lyon, France;
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