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Ackermann M, Werlein C, Plucinski E, Leypold S, Kühnel MP, Verleden SE, Khalil HA, Länger F, Welte T, Mentzer SJ, Jonigk DD. The role of vasculature and angiogenesis in respiratory diseases. Angiogenesis 2024; 27:293-310. [PMID: 38580869 DOI: 10.1007/s10456-024-09910-2] [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: 12/20/2023] [Accepted: 02/11/2024] [Indexed: 04/07/2024]
Abstract
In European countries, nearly 10% of all hospital admissions are related to respiratory diseases, mainly chronic life-threatening diseases such as COPD, pulmonary hypertension, IPF or lung cancer. The contribution of blood vessels and angiogenesis to lung regeneration, remodeling and disease progression has been increasingly appreciated. The vascular supply of the lung shows the peculiarity of dual perfusion of the pulmonary circulation (vasa publica), which maintains a functional blood-gas barrier, and the bronchial circulation (vasa privata), which reveals a profiled capacity for angiogenesis (namely intussusceptive and sprouting angiogenesis) and alveolar-vascular remodeling by the recruitment of endothelial precursor cells. The aim of this review is to outline the importance of vascular remodeling and angiogenesis in a variety of non-neoplastic and neoplastic acute and chronic respiratory diseases such as lung infection, COPD, lung fibrosis, pulmonary hypertension and lung cancer.
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Affiliation(s)
- Maximilian Ackermann
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany.
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Witten, Germany.
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | | | - Edith Plucinski
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Sophie Leypold
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany
| | - Mark P Kühnel
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Stijn E Verleden
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Hassan A Khalil
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, USA
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Florian Länger
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany
| | - Tobias Welte
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Steven J Mentzer
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, USA
- Laboratory of Adaptive and Regenerative Biology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Danny D Jonigk
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
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2
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Schupp JC, Manning EP, Chioccioli M, Kamp JC, Christian L, Ryu C, Herzog E, Kühnel MP, Prasse A, Kaminski N, Jonigk DD, Homer RJ. Alveolar Vascular Remodeling in Nonspecific Interstitial Pneumonia: Replacement of Normal Lung Capillaries with COL15A1-Positive Endothelial Cells. Am J Respir Crit Care Med 2023; 208:819-822. [PMID: 37552025 PMCID: PMC10563189 DOI: 10.1164/rccm.202303-0544le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Jonas C Schupp
- Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, Connecticut
- Department of Respiratory Medicine
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), and
- German Center for Lung Research (DZL), Hannover, Germany
| | - Edward P Manning
- Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Maurizio Chioccioli
- Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, Connecticut
| | - Jan C Kamp
- Department of Respiratory Medicine
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), and
- German Center for Lung Research (DZL), Hannover, Germany
| | - Leonard Christian
- Department of Respiratory Medicine
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), and
- German Center for Lung Research (DZL), Hannover, Germany
| | - Changwan Ryu
- Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, Connecticut
| | - Erica Herzog
- Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, Connecticut
| | - Mark P Kühnel
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), and
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
- German Center for Lung Research (DZL), Hannover, Germany
- University Clinic of the RWTH Aachen University, Aachen, Germany; and
| | - Antje Prasse
- Department of Respiratory Medicine
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), and
- German Center for Lung Research (DZL), Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Naftali Kaminski
- Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, Connecticut
| | - Danny D Jonigk
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), and
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
- German Center for Lung Research (DZL), Hannover, Germany
- University Clinic of the RWTH Aachen University, Aachen, Germany; and
| | - Robert J Homer
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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Olsson KM, Corte TJ, Kamp JC, Montani D, Nathan SD, Neubert L, Price LC, Kiely DG. Pulmonary hypertension associated with lung disease: new insights into pathomechanisms, diagnosis, and management. THE LANCET. RESPIRATORY MEDICINE 2023; 11:820-835. [PMID: 37591300 DOI: 10.1016/s2213-2600(23)00259-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 08/19/2023]
Abstract
Patients with chronic lung diseases, particularly interstitial lung disease and chronic obstructive pulmonary disease, frequently develop pulmonary hypertension, which results in clinical deterioration, worsening of oxygen uptake, and an increased mortality risk. Pulmonary hypertension can develop and progress independently from the underlying lung disease. The pulmonary vasculopathy is distinct from that of other forms of pulmonary hypertension, with vascular ablation due to loss of small pulmonary vessels being a key feature. Long-term tobacco exposure might contribute to this type of pulmonary vascular remodelling. The distinct pathomechanisms together with the underlying lung disease might explain why treatment options for this condition remain scarce. Most drugs approved for pulmonary arterial hypertension have shown no or sometimes harmful effects in pulmonary hypertension associated with lung disease. An exception is inhaled treprostinil, which improves exercise capacity in patients with interstitial lung disease and pulmonary hypertension. There is a pressing need for safe, effective treatment options and for reliable, non-invasive diagnostic tools to detect and characterise pulmonary hypertension in patients with chronic lung disease.
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Affiliation(s)
- Karen M Olsson
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH), German Center for Lung Research, Hannover, Germany.
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Jan C Kamp
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH), German Center for Lung Research, Hannover, Germany
| | - David Montani
- Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, INSERM Unité Mixte de Recherche 999, Université Paris-Saclay, Paris, France
| | - Steven D Nathan
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Lavinia Neubert
- Institute of Pathology, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Laura C Price
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; NIHR Biomedical Research Centre, Sheffield, UK
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4
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Lurje I, Gaisa NT, Weiskirchen R, Tacke F. Mechanisms of organ fibrosis: Emerging concepts and implications for novel treatment strategies. Mol Aspects Med 2023; 92:101191. [PMID: 37236017 DOI: 10.1016/j.mam.2023.101191] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Fibrosis, or tissue scarring, develops as a pathological deviation from the physiological wound healing response and can occur in various organs such as the heart, lung, liver, kidney, skin, and bone marrow. Organ fibrosis significantly contributes to global morbidity and mortality. A broad spectrum of etiologies can cause fibrosis, including acute and chronic ischemia, hypertension, chronic viral infection (e.g., viral hepatitis), environmental exposure (e.g., pneumoconiosis, alcohol, nutrition, smoking) and genetic diseases (e.g., cystic fibrosis, alpha-1-antitrypsin deficiency). Common mechanisms across organs and disease etiologies involve a sustained injury to parenchymal cells that triggers a wound healing response, which becomes deregulated in the disease process. A transformation of resting fibroblasts into myofibroblasts with excessive extracellular matrix production constitutes the hallmark of disease, however, multiple other cell types such as immune cells, predominantly monocytes/macrophages, endothelial cells, and parenchymal cells form a complex network of profibrotic cellular crosstalk. Across organs, leading mediators include growth factors like transforming growth factor-β and platelet-derived growth factor, cytokines like interleukin-10, interleukin-13, interleukin-17, and danger-associated molecular patterns. More recently, insights into fibrosis regression and resolution of chronic conditions have deepened our understanding of beneficial, protective effects of immune cells, soluble mediators and intracellular signaling. Further in-depth insights into the mechanisms of fibrogenesis can provide the rationale for therapeutic interventions and the development of targeted antifibrotic agents. This review gives insight into shared responses and cellular mechanisms across organs and etiologies, aiming to paint a comprehensive picture of fibrotic diseases in both experimental settings and in human pathology.
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Affiliation(s)
- Isabella Lurje
- Department of Hepatology and Gastroenterology, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nadine T Gaisa
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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5
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Yanagihara T, Guignabert C, Kolb MRJ. Endothelial cells in pulmonary fibrosis: more than a bystander. Eur Respir J 2023; 61:2300407. [PMID: 37290810 DOI: 10.1183/13993003.00407-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Toyoshi Yanagihara
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Christophe Guignabert
- Université Paris-Saclay, Inserm, UMR_S 999, Hypertension pulmonaire: physiopathologie et innovation thérapeutique, Le Kremli-Bicêtre, France
| | - Martin R J Kolb
- Firestone Institute for Respiratory Health, Research Institute at St Joseph's Healthcare, Department of Medicine, McMaster University, Hamilton, ON, Canada
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6
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Werlein C, Ackermann M, Stark H, Shah HR, Tzankov A, Haslbauer JD, von Stillfried S, Bülow RD, El-Armouche A, Kuenzel S, Robertus JL, Reichardt M, Haverich A, Höfer A, Neubert L, Plucinski E, Braubach P, Verleden S, Salditt T, Marx N, Welte T, Bauersachs J, Kreipe HH, Mentzer SJ, Boor P, Black SM, Länger F, Kuehnel M, Jonigk D. Inflammation and vascular remodeling in COVID-19 hearts. Angiogenesis 2023; 26:233-248. [PMID: 36371548 PMCID: PMC9660162 DOI: 10.1007/s10456-022-09860-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022]
Abstract
A wide range of cardiac symptoms have been observed in COVID-19 patients, often significantly influencing the clinical outcome. While the pathophysiology of pulmonary COVID-19 manifestation has been substantially unraveled, the underlying pathomechanisms of cardiac involvement in COVID-19 are largely unknown. In this multicentre study, we performed a comprehensive analysis of heart samples from 24 autopsies with confirmed SARS-CoV-2 infection and compared them to samples of age-matched Influenza H1N1 A (n = 16), lymphocytic non-influenza myocarditis cases (n = 8), and non-inflamed heart tissue (n = 9). We employed conventional histopathology, multiplexed immunohistochemistry (MPX), microvascular corrosion casting, scanning electron microscopy, X-ray phase-contrast tomography using synchrotron radiation, and direct multiplexed measurements of gene expression, to assess morphological and molecular changes holistically. Based on histopathology, none of the COVID-19 samples fulfilled the established diagnostic criteria of viral myocarditis. However, quantification via MPX showed a significant increase in perivascular CD11b/TIE2 + -macrophages in COVID-19 over time, which was not observed in influenza or non-SARS-CoV-2 viral myocarditis patients. Ultrastructurally, a significant increase in intussusceptive angiogenesis as well as multifocal thrombi, inapparent in conventional morphological analysis, could be demonstrated. In line with this, on a molecular level, COVID-19 hearts displayed a distinct expression pattern of genes primarily coding for factors involved in angiogenesis and epithelial-mesenchymal transition (EMT), changes not seen in any of the other patient groups. We conclude that cardiac involvement in COVID-19 is an angiocentric macrophage-driven inflammatory process, distinct from classical anti-viral inflammatory responses, and substantially underappreciated by conventional histopathologic analysis. For the first time, we have observed intussusceptive angiogenesis in cardiac tissue, which we previously identified as the linchpin of vascular remodeling in COVID-19 pneumonia, as a pathognomic sign in affected hearts. Moreover, we identified CD11b + /TIE2 + macrophages as the drivers of intussusceptive angiogenesis and set forward a putative model for the molecular regulation of vascular alterations.
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Affiliation(s)
- Christopher Werlein
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Maximilian Ackermann
- Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Helge Stark
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Harshit R Shah
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Ali El-Armouche
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan Kuenzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Dermatology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jan Lukas Robertus
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Marius Reichardt
- Institute for X-Ray Physics, University of Göttingen, Göttingen, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Anne Höfer
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Lavinia Neubert
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Edith Plucinski
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Peter Braubach
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Stijn Verleden
- Department of Thoracic Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Tim Salditt
- Institute for X-Ray Physics, University of Göttingen, Göttingen, Germany
- Cluster of Excellence 'Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells' (MBExC), University of Göttingen, Göttingen, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, Aachen, Germany
| | - Tobias Welte
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Clinic of Pneumology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hans-Heinrich Kreipe
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Steven J Mentzer
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Peter Boor
- Institute of Pathology, RWTH University of Aachen, Aachen, Germany
- Institute of Pathology and Department of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Stephen M Black
- Department of Cellular Biology and Pharmacology Translational Medicine, Florida International University, Florida, USA
| | - Florian Länger
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Mark Kuehnel
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.
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7
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Shchepikhin EI, Shmelev EI, Ergeshov AE, Zaytseva AS, Shergina EA, Adamovskaya E. Possibilities of non-invasive diagnosis of fibrotic phenotype of interstitial lung diseases. TERAPEVT ARKH 2023; 95:230-235. [PMID: 37167144 DOI: 10.26442/00403660.2023.03.202073] [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: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
Progressive pulmonary fibrosis is a major problem in respiratory medicine. Currently, there are no reliable biomarkers for early diagnosis of progressive pulmonary fibrosis, which leads to delayed diagnosis. AIM To determine the role of serum biomarkers CA-19-9 and CA-125 and the possibilities of capillaroscopy of the nail fold in the diagnosis of progressive pulmonary fibrosis. MATERIALS AND METHODS The study included 43 patients with interstitial changes in the lungs. Based on the presence/absence of signs of progression over the previous 12 months, patients were divided into 2 groups. All patients underwent forced spirometry, body plethysmography, diffusion test, CT, lung ultrasound, capillaroscopy of the nail fold, study of serum concentrations of CA-19-9 and CA-125. RESULTS In the group of patients with a progressive fibrotic phenotype of Interstitial lung diseases, a greater severity of capillaroscopic changes and a higher level of CA-19-9 were revealed. Correlation of these parameters with changes according to CT scan data (Warrick test) and lung ultrasound was shown. CONCLUSION The data obtained demonstrate the possibilities of non-invasive diagnosis of progressive fibrosing interstitial lung diseases and require further research and prospective follow-up to assess the diagnostic and prognostic role of the studied biomarkers, as well as to determine their place in clinical practice.
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8
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Verleden SE, Vanstapel A, Jacob J, Goos T, Hendriks J, Ceulemans LJ, Van Raemdonck DE, De Sadeleer L, Vos R, Kwakkel-van Erp JM, Neyrinck AP, Verleden GM, Boone MN, Janssens W, Wauters E, Weynand B, Jonigk DD, Verschakelen J, Wuyts WA. Radiologic and Histologic Correlates of Early Interstitial Lung Changes in Explanted Lungs. Radiology 2023; 307:e221145. [PMID: 36537894 PMCID: PMC7614383 DOI: 10.1148/radiol.221145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/13/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
Background Interstitial lung abnormalities (ILAs) reflect imaging features on lung CT scans that are compatible with (early) interstitial lung disease. Despite accumulating evidence regarding the incidence, risk factors, and prognosis of ILAs, the histopathologic correlates of ILAs remain elusive. Purpose To determine the correlation between radiologic and histopathologic findings in CT-defined ILAs in human lung explants. Materials and Methods Explanted lungs or lobes from participants with radiologically documented ILAs were prospectively collected from 2010 to 2021. These specimens were air-inflated, frozen, and scanned with CT and micro-CT (spatial resolution of 0.7 mm and 90 μm, respectively). Subsequently, the lungs were cut and sampled with core biopsies. At least five samples per lung underwent micro-CT and subsequent histopathologic assessment with semiquantitative remodeling scorings. Based on area-specific radiologic scoring, the association between radiologic and histopathologic findings was assessed. Results Eight lung explants from six donors (median age at explantation, 71 years [range, 60-83 years]; four men) were included (unused donor lungs, n = 4; pre-emptive lobectomy for oncologic indications, n = 2). Ex vivo CT demonstrated ground-glass opacification, reticulation, and bronchiectasis. Micro-CT and histopathologic examination demonstrated that lung abnormalities were frequently paraseptal and associated with fibrosis and lymphocytic inflammation. The histopathologic results showed varying degrees of fibrosis in areas that appeared normal on CT scans. Regions of reticulation on CT scans generally had greater fibrosis at histopathologic analysis. Vasculopathy and bronchiectasis were also often present at histopathologic examination of lungs with ILAs. Fully developed fibroblastic foci were rarely observed. Conclusion This study demonstrated direct histologic correlates of CT-defined interstitial lung abnormalities. © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Jeudy in this issue.
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Affiliation(s)
- Stijn E. Verleden
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Arno Vanstapel
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Joseph Jacob
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Tinne Goos
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Jeroen Hendriks
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Laurens J. Ceulemans
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Dirk E. Van Raemdonck
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Laurens De Sadeleer
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Robin Vos
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Johanna M. Kwakkel-van Erp
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Arne P. Neyrinck
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Geert M. Verleden
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Matthieu N. Boone
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Wim Janssens
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Els Wauters
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Birgit Weynand
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Danny D. Jonigk
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Johny Verschakelen
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
| | - Wim A. Wuyts
- From the Department of Chronic Diseases and Metabolism, BREATHE
(S.E.V., A.V., T.G., L.J.C., D.E.V.R., L.D.S., R.V., G.M.V., W.J., E.W.,
W.A.W.), Department of Cardiovascular Sciences (A.P.N.), and Department of
Imaging and Pathology (B.W., J.V.), KU Leuven, Herestraat 49, 3000 Leuven,
Belgium; Department of ASTARC, University of Antwerp, Antwerp, Belgium (S.E.V.,
J.H.); Department of Respiratory Medicine (S.E.V., J.M.K.v.E.) and Department of
Thoracic and Vascular Surgery (S.E.V., J.H.), University Hospital Antwerp,
Antwerp, Belgium; Department of Respiratory Medicine (J.J.) and Centre for
Medical Image Computing (J.J.), University College London, London, UK;
Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
(L.J.C., D.E.V.R.); Department of Physics and Astronomy, Ghent University,
Ghent, Belgium (M.N.B.); Institute of Pathology, Hannover Medical School,
Hannover, Germany (D.D.J.); and Biomedical Research in Endstage and Obstructive
Lung Disease Hannover (BREATH), Member of the German Center for Lung Research
(DZL), Hannover, Germany (D.D.J.)
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9
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Evaluation of Retinal Vascularity Index in Patients with COVID-19: A Case-Control Study. Ophthalmol Ther 2023; 12:879-894. [PMID: 36547863 PMCID: PMC9774073 DOI: 10.1007/s40123-022-00630-8] [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: 08/14/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate the impact of COVID-19 infection on retinal microvasculature by topographically mapping the retinal arteriole-to-venule ratio (AVR). METHODS In a comparative cross-sectional case-control study, fundus photos were obtained in COVID-19-infected patients and healthy controls. AVT was measured over 16 points across the retina using retinal vascularity index (RVI)-a novel semi-automated computerized parameter based on retinal vasculature. RESULTS A total of 51 COVID-19-positive patients and 65 healthy controls were enrolled in the study. Overall, the mean RVI of all 16 points across the retina was 0.34 ± 0.02 in patients with COVID-19 and 0.33 ± 0.02 in control subjects (p = 0.64). Out of the 16 points being measured, three points had a statistically significant greater value in patients with COVID compared to normal controls. CONCLUSION Localised greater RVI values were found in some of the points in COVID-19-positive patients, which likely indicates a more focal change of the vasculature.
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10
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Biomarkers for Chronic Lung Allograft Dysfunction: Ready for Prime Time? Transplantation 2023; 107:341-350. [PMID: 35980878 PMCID: PMC9875844 DOI: 10.1097/tp.0000000000004270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) remains a major hurdle impairing lung transplant outcome. Parallel to the better clinical identification and characterization of CLAD and CLAD phenotypes, there is an increasing urge to find adequate biomarkers that could assist in the earlier detection and differential diagnosis of CLAD phenotypes, as well as disease prognostication. The current status and state-of-the-art of biomarker research in CLAD will be discussed with a particular focus on radiological biomarkers or biomarkers found in peripheral tissue, bronchoalveolar lavage' and circulating blood' in which significant progress has been made over the last years. Ultimately, although a growing number of biomarkers are currently being embedded in the follow-up of lung transplant patients, it is clear that one size does not fit all. The future of biomarker research probably lies in the rigorous combination of clinical information with findings in tissue, bronchoalveolar lavage' or blood. Only by doing so, the ultimate goal of biomarker research can be achieved, which is the earlier identification of CLAD before its clinical manifestation. This is desperately needed to improve the prognosis of patients with CLAD after lung transplantation.
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11
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Ackermann M, Tafforeau P, Brunet J, Kamp JC, Werlein C, Kühnel MP, Jacob J, Walsh CL, Lee PD, Welte T, Jonigk DD. Comment on: Intrapulmonary shunt and alveolar dead space in a cohort of patients with acute COVID-19 pneumonitis and early recovery. Eur Respir J 2023; 61:2202121. [PMID: 36634926 PMCID: PMC9909205 DOI: 10.1183/13993003.02121-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 01/14/2023]
Abstract
With the greatest interest we read the paper by Harbut et al. [1] describing the role of intrapulmonary shunting and alveolar dead space in patients with acute COVID-19 pneumonitis. We are grateful for them sharing their valuable functional blood and alveolar gas exchange data, pointing out a significant alveolar dead space of nearly 30% in recovered COVID-19 patients, suggesting a persistent pulmonary vascular pathology. Although COVID-19 related hypoxaemia is characterised by preserved oxygen saturation, a ventilation–perfusion mismatch and increased alveolar ventilation/perfusion ratio heterogeneity, the underlying morphological evidence of this physiological enigma has not been fully understood. A compelling explanation for mosaic-like micro-ischaemia in the severe pathology of COVID-19 pneumonitis, which reflects the vasculopathy affecting the secondary lobule and the interlobular septae http://bit.ly/3GwMkII
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Affiliation(s)
- Maximilian Ackermann
- Institute of Pathology and 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
| | - Paul Tafforeau
- European Synchrotron Radiation Facility, Grenoble, France
| | - Joseph Brunet
- European Synchrotron Radiation Facility, Grenoble, France
| | - Jan C Kamp
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | | | - Mark P Kühnel
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire L Walsh
- Department of Mechanical Engineering, University College London, London, UK
| | - Peter D Lee
- Department of Mechanical Engineering, University College London, London, UK
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Danny D Jonigk
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- Institute of Pathology, University Clinics of RWTH University, Aachen, Germany
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12
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Yang C, Han Z, Zhan W, Wang Y, Feng J. Predictive investigation of idiopathic pulmonary fibrosis subtypes based on cellular senescence-related genes for disease treatment and management. Front Genet 2023; 14:1157258. [PMID: 37035748 PMCID: PMC10079953 DOI: 10.3389/fgene.2023.1157258] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF), a chronic, progressive lung disease characterized by interstitial remodeling and tissue destruction, affects people worldwide and places a great burden on society. Cellular senescence is thought to be involved in the mechanisms and development of IPF. The aim of this study was to predictively investigate subtypes of IPF according to cellular senescence-related genes and their correlation with the outcome of patients with IPF, providing possible treatment and management options for disease control. Methods: Gene expression profiles and follow-up data were obtained from the GEO database. Senescence-related genes were obtained from the CSGene database and analyzed their correlation with the outcome of IPF. A consensus cluster was constructed to classify the samples based on correlated genes. The GSVA and WGCNA packages in R were used to calculate the immune-related enriched fractions and construct gene expression modules, respectively. Metascape and the clusterProfiler package in R were used to enrich gene functions. The ConnectivityMap was used to probe suitable drugs for potential treatment. Results: A total of 99 cellular senescence-related genes were associated with IPF prognosis. Patients with IPF were divided into two subtypes with significant prognostic differences. Subtype S2 was characterized by enhanced fibrotic progression and infection, leading to acute exacerbation of IPF and poor prognosis. Finally, five cellular senescence-related genes, TYMS, HJURP, UBE2C, BIRC5, and KIF2C, were identified as potential biomarkers in poor prognostic patients with IPF. Conclusion: The study findings indicate that cellular senescence-related genes can be used to distinguish the prognosis of patients with IPF. Among them, five genes can be used as candidate biomarkers to predict patients with a poor prognostic subtype for which anti-fibrosis and anti-infection treatments could be suitable.
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Affiliation(s)
| | | | | | - Yubao Wang
- *Correspondence: Yubao Wang, ; Jing Feng,
| | - Jing Feng
- *Correspondence: Yubao Wang, ; Jing Feng,
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13
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Engelbrecht E, Kooistra T, Knipe RS. The Vasculature in Pulmonary Fibrosis. CURRENT TISSUE MICROENVIRONMENT REPORTS 2022; 3:83-97. [PMID: 36712832 PMCID: PMC9881604 DOI: 10.1007/s43152-022-00040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 02/02/2023]
Abstract
Purpose of Review The current paradigm of idiopathic pulmonary fibrosis (IPF) pathogenesis involves recurrent injury to a sensitive alveolar epithelium followed by impaired repair responses marked by fibroblast activation and deposition of extracellular matrix. Multiple cell types are involved in this response with potential roles suggested by advances in single-cell RNA sequencing and lung developmental biology. Notably, recent work has better characterized the cell types present in the pulmonary endothelium and identified vascular changes in patients with IPF. Recent Findings Lung tissue from patients with IPF has been examined at single-cell resolution, revealing reductions in lung capillary cells and expansion of a population of vascular cells expressing markers associated with bronchial endothelium. In addition, pre-clinical models have demonstrated a fundamental role for aging and vascular permeability in the development of pulmonary fibrosis. Summary Mounting evidence suggests that the endothelium undergoes changes in the context of fibrosis, and these changes may contribute to the development and/or progression of pulmonary fibrosis. Additional studies will be needed to further define the functional role of these vascular changes.
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Affiliation(s)
| | - Tristan Kooistra
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rachel S. Knipe
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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14
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Neb H, Talbot SR, Ruskowski K, Brkic D, Sonntagbauer M, Adam EH, von Knethen A, Zacharowski K, Heinicke U. HIGH HEPARANASE LEVEL IN SURVIVORS OF COVID-19 - INDICATOR OF VASCULAR AND PULMONARY RECOVERY? Shock 2022; 58:514-523. [PMID: 36548643 DOI: 10.1097/shk.0000000000002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Background: Severe progression of coronavirus disease 2019 (COVID-19) causes respiratory failure and critical illness. Recently, COVID-19 has been associated with heparanase (HPSE)-induced endothelial barrier dysfunction and inflammation, so called endothelitis, and therapeutic treatment with heparin or low-molecular-weight heparin (LMWH) targeting HPSE has been postulated. Because, up to this date, clinicians are unable to measure the severity of endothelitis, which can lead to multiorgan failure and concomitant death, we investigated plasma levels of HPSE and heparin-binding protein (HBP) in COVID-19 intensive care patients to render a possible link between endothelitis and these plasma parameters. Therefore, a prospective prolonged cohort study was conducted, including 47 COVID-19 patients from the intensive care unit. Plasma levels of HPSE, and HBP were measured daily by enzyme-linked immunosorbent assay in survivors (n = 35) and nonsurvivors (n = 12) of COVID-19 from admission until discharge or death. All patients were either treated with heparin or LMWH, aiming for an activated partial thromboplastin time of ≥60 seconds or an anti-Xa level of >0.8 IU/mL using enoxaparin, depending on the clinical status of the patient (patients with extracorporeal membrane oxygenation or >0.1 μg/kg/min noradrenaline received heparin, all others enoxaparin). Results: We found significantly higher plasma levels of HPSE and HBP in survivors and nonsurvivors of COVID-19, compared with healthy controls. Still, interestingly, plasma HPSE levels were significantly higher ( P < 0.001) in survivors compared with nonsurvivors of COVID-19. In contrast, plasma HBP levels were significantly reduced ( P < 0.001) in survivors compared with nonsurvivors of COVID-19. Furthermore, when patients received heparin, they had significantly lower HPSE ( P = 2.22 e - 16) and significantly higher HBP ( P = 0.00013) plasma levels as when they received LMWH. Conclusion: Our results demonstrated that patients, who recover from COVID-19-induced vascular and pulmonary damage and were discharged from the intensive care unit, have significantly higher plasma HPSE level than patients who succumb to COVID-19. Therefore, HPSE is not suitable as marker for disease severity in COVID-19 but maybe as marker for patient's recovery. In addition, patients receiving therapeutic heparin treatment displayed significantly lower heparanse plasma level than upon therapeutic treatment with LMWH.
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Affiliation(s)
- Holger Neb
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Steven R Talbot
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Katharina Ruskowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Djurdjina Brkic
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Michael Sonntagbauer
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Elisabeth H Adam
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | | | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Ulrike Heinicke
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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15
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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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16
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Kamp JC, Neubert L, Ackermann M, Stark H, Plucinski E, Shah HR, Janciauskiene S, Bergmann AK, Schmidt G, Welte T, Haverich A, Werlein C, Braubach P, Laenger F, Schwerk N, Olsson KM, Fuge J, Park DH, Schupp JC, Hoeper MM, Kuehnel MP, Jonigk DD. A Morphomolecular Approach to Alveolar Capillary Dysplasia. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:1110-1121. [PMID: 35649494 DOI: 10.1016/j.ajpath.2022.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
Alveolar capillary dysplasia (ACD) is a rare lung developmental disorder leading to persistent pulmonary arterial hypertension and fatal outcomes in newborns. The current study analyzed the microvascular morphology and the underlying molecular background of ACD. One ACD group (n = 7), one pulmonary arterial hypertension group (n = 20), and one healthy con1trol group (n = 16) were generated. Samples of histologically confirmed ACD were examined by exome sequencing and array-based comparative genomic hybridization. Vascular morphology was analyzed using scanning electron microscopy of microvascular corrosion casts. Gene expression and biological pathways were analyzed using two panels on inflammation/kinase-specific genes and a comparison analysis tool. Compartment-specific protein expression was analyzed using immunostaining. In ACD, there was an altered capillary network, a high prevalence of intussusceptive angiogenesis, and increased activity of C-X-C motif chemokine receptor 4 (CXCR4), hypoxia-inducible factor 1α (HIF1A), and angiopoietin signaling pathways compared with pulmonary arterial hypertension/healthy controls. Histologically, there was a markedly increased prevalence of endothelial tyrosine kinase receptor (TEK/TIE2)+ macrophages in ACD, compared with the other groups, whereas the CXCR4 ligand CXCL12 and HIF1A showed high expression in all groups. ACD is characterized by dysfunctional capillaries and a high prevalence of intussusceptive angiogenesis. The results indicate that endothelial CXCR4, HIF1A, and angiopoietin signaling as well as TIE2+ macrophages are crucial for the induction of intussusceptive angiogenesis and vascular remodeling. Future studies should address the use of anti-angiogenic agents in ACD, where TIE2 appears as a promising target.
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Affiliation(s)
- Jan C Kamp
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany.
| | - Lavinia Neubert
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal, Germany
| | - Helge Stark
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Edith Plucinski
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Harshit R Shah
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Sabina Janciauskiene
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Anke K Bergmann
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Gunnar Schmidt
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Axel Haverich
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christopher Werlein
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Peter Braubach
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Florian Laenger
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Karen M Olsson
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Da-Hee Park
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Jonas C Schupp
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Mark P Kuehnel
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Danny D Jonigk
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; Institute of Pathology, Hannover Medical School, Hannover, Germany
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17
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Jonigk D, Werlein C, D. Lee P, Kauczor HU, Länger F, Ackermann M. Pulmonary and Systemic Pathology in COVID-19—Holistic Pathological Analyses. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:429-435. [PMID: 35698804 PMCID: PMC9549895 DOI: 10.3238/arztebl.m2022.0231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/22/2022] [Accepted: 05/10/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic is the third worldwide coronavirus-associated disease outbreak in the past 20 years. Lung involvement, with acute respiratory distress syndrome (ARDS) in severe cases, is the main clinical feature of this disease; the cardiovascular system, the central nervous system, and the gastrointestinal tract can also be affected. The pathophysiology of both pulmonary and extrapulmonary organ damage was almost completely unknown when the pandemic began. METHODS This review is based on pertinent publications retrieved by a selective search concerning the structural changes and pathophysiology of COVID-19, with a focus on imaging techniques. RESULTS Immunohistochemical, electron-microscopic and molecular pathological analyses of tissues obtained by autopsy have improved our understanding of COVID-19 pathophysiology, including molecular regulatory mechanisms. Intussusceptive angiogenesis (IA) has been found to be a prominent pattern of damage in the affected organs of COVID-19 patients. In IA, an existing vessel changes by invagination of the endothelium and formation of an intraluminal septum, ultimately giving rise to two new lumina. This alters hemodynamics within the vessel, leading to a loss of laminar flow and its replacement by turbulent, inhomogeneous flow. IA, which arises because of ischemia due to thrombosis, is itself a risk factor for the generation of further microthrombi; these have been detected in the lungs, heart, liver, kidneys, brain, and placenta of COVID-19 patients. CONCLUSION Studies of autopsy material from various tissues of COVID-19 patients have revealed ultrastructural evidence of altered microvascularity, IA, and multifocal thrombi. These changes may contribute to the pathophysiology of post-acute interstitial fibrotic organ changes as well as to the clinical picture of long COVID.
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Affiliation(s)
- Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover site, Hannover, Germany
- *Institut für Pathologie, Medizinische Hochschule Hannover Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | | | - Peter D. Lee
- Department of Mechanical Engineering, Faculty of Engineering Science, University College London, London, UK
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Länger
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover site, Hannover, Germany
| | - Maximilian Ackermann
- Institute of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, University Hospital of Witten-Herdecke, Wuppertal, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center Mainz, Mainz, Germany
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18
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Jonigk D, Werlein C, Acker T, Aepfelbacher M, Amann KU, Baretton G, Barth P, Bohle RM, Büttner A, Büttner R, Dettmeyer R, Eichhorn P, Elezkurtaj S, Esposito I, Evert K, Evert M, Fend F, Gaßler N, Gattenlöhner S, Glatzel M, Göbel H, Gradhand E, Hansen T, Hartmann A, Heinemann A, Heppner FL, Hilsenbeck J, Horst D, Kamp JC, Mall G, Märkl B, Ondruschka B, Pablik J, Pfefferle S, Quaas A, Radbruch H, Röcken C, Rosenwald A, Roth W, Rudelius M, Schirmacher P, Slotta-Huspenina J, Smith K, Sommer L, Stock K, Ströbel P, Strobl S, Titze U, Weirich G, Weis J, Werner M, Wickenhauser C, Wiech T, Wild P, Welte T, von Stillfried S, Boor P. Organ manifestations of COVID-19: what have we learned so far (not only) from autopsies? Virchows Arch 2022; 481:139-159. [PMID: 35364700 PMCID: PMC8975445 DOI: 10.1007/s00428-022-03319-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 01/08/2023]
Abstract
The use of autopsies in medicine has been declining. The COVID-19 pandemic has documented and rejuvenated the importance of autopsies as a tool of modern medicine. In this review, we discuss the various autopsy techniques, the applicability of modern analytical methods to understand the pathophysiology of COVID-19, the major pathological organ findings, limitations or current studies, and open questions. This article summarizes published literature and the consented experience of the nationwide network of clinical, neuro-, and forensic pathologists from 27 German autopsy centers with more than 1200 COVID-19 autopsies. The autopsy tissues revealed that SARS-CoV-2 can be found in virtually all human organs and tissues, and the majority of cells. Autopsies have revealed the organ and tissue tropism of SARS-CoV-2, and the morphological features of COVID-19. This is characterized by diffuse alveolar damage, combined with angiocentric disease, which in turn is characterized by endothelial dysfunction, vascular inflammation, (micro-) thrombosis, vasoconstriction, and intussusceptive angiogenesis. These findings explained the increased pulmonary resistance in COVID-19 and supported the recommendations for antithrombotic treatment in COVID-19. In contrast, in extra-respiratory organs, pathological changes are often nonspecific and unclear to which extent these changes are due to direct infection vs. indirect/secondary mechanisms of organ injury, or a combination thereof. Ongoing research using autopsies aims at answering questions on disease mechanisms, e.g., focusing on variants of concern, and future challenges, such as post-COVID conditions. Autopsies are an invaluable tool in medicine and national and international interdisciplinary collaborative autopsy-based research initiatives are essential.
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Affiliation(s)
- Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany.
| | | | - Till Acker
- Institute of Neuropathology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Martin Aepfelbacher
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin U Amann
- Department of Nephropathology, University Hospital Erlangen-Nürnberg, Erlangen, Germany
| | - Gustavo Baretton
- Department of Pathology, University Hospital Dresden, Dresden, Germany
| | - Peter Barth
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Rainer M Bohle
- Department of Pathology, University Hospital Saarland Homburg, Homburg, Germany
| | - Andreas Büttner
- Institute of Forensic Medicine, University Medical Center Rostock, Rostock, Germany
| | - Reinhard Büttner
- Department of Pathology, University Hospital Cologne, Cologne, Germany
| | - Reinhard Dettmeyer
- Department of Legal Medicine, University Hospital Giessen and Marburg, Giessen, Germany
| | - Philip Eichhorn
- Department of Pathology, University Hospital Erlangen-Nürnberg, Erlangen, Germany
| | - Sefer Elezkurtaj
- Department of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Irene Esposito
- Department of Pathology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Katja Evert
- Department of Pathology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Evert
- Department of Pathology, University Hospital Regensburg, Regensburg, Germany
| | - Falko Fend
- Department of Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Nikolaus Gaßler
- Department of Pathology, University Hospital Jena, Jena, Germany
| | - Stefan Gattenlöhner
- Department of Pathology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heike Göbel
- Department of Pathology, University Hospital Cologne, Cologne, Germany
| | - Elise Gradhand
- Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - Torsten Hansen
- Department of Pathology, University Hospital OWL of the Bielefeld University, Campus Lippe, Detmold, Germany
| | - Arndt Hartmann
- Department of Pathology, University Hospital Erlangen-Nürnberg, Erlangen, Germany
| | - Axel Heinemann
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank L Heppner
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany.,Cluster of Excellence, NeuroCure, Berlin, Germany
| | - Julia Hilsenbeck
- Department of Pathology, University Hospital Dresden, Dresden, Germany
| | - David Horst
- Department of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jan C Kamp
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Gita Mall
- Department of Legal Medicine, University Hospital Jena, Jena, Germany
| | - Bruno Märkl
- General Pathology and Molecular Diagnostics, University Hospital Augsburg, Augsburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jessica Pablik
- Department of Pathology, University Hospital Dresden, Dresden, Germany
| | - Susanne Pfefferle
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Quaas
- Department of Pathology, University Hospital Cologne, Cologne, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christoph Röcken
- Department of Pathology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Wilfried Roth
- Department of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Martina Rudelius
- Institute of Pathology, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Peter Schirmacher
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Slotta-Huspenina
- Department of Pathology, TUM School of Medicine of Technical University of Munich, Munich, Germany
| | - Kevin Smith
- Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - Linna Sommer
- Department of Pathology, University Hospital Dresden, Dresden, Germany
| | - Konrad Stock
- Department of Nephrology, TUM School of Medicine of Technical University of Munich, Munich, Germany
| | - Philipp Ströbel
- Department of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Stephanie Strobl
- Department of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Ulf Titze
- Department of Pathology, University Hospital OWL of the Bielefeld University, Campus Lippe, Detmold, Germany
| | - Gregor Weirich
- Department of Pathology, TUM School of Medicine of Technical University of Munich, Munich, Germany
| | - Joachim Weis
- Department of Neuropathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Werner
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Claudia Wickenhauser
- Department of Pathology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Thorsten Wiech
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Wild
- Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | | | - Peter Boor
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany. .,Department of Nephrology and Immunology, University Hospital RWTH Aachen, Aachen, Germany.
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19
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Offer S, Hartner E, Di Bucchianico S, Bisig C, Bauer S, Pantzke J, Zimmermann EJ, Cao X, Binder S, Kuhn E, Huber A, Jeong S, Käfer U, Martens P, Mesceriakovas A, Bendl J, Brejcha R, Buchholz A, Gat D, Hohaus T, Rastak N, Jakobi G, Kalberer M, Kanashova T, Hu Y, Ogris C, Marsico A, Theis F, Pardo M, Gröger T, Oeder S, Orasche J, Paul A, Ziehm T, Zhang ZH, Adam T, Sippula O, Sklorz M, Schnelle-Kreis J, Czech H, Kiendler-Scharr A, Rudich Y, Zimmermann R. Effect of Atmospheric Aging on Soot Particle Toxicity in Lung Cell Models at the Air–Liquid Interface: Differential Toxicological Impacts of Biogenic and Anthropogenic Secondary Organic Aerosols (SOAs). ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:27003. [PMID: 35112925 PMCID: PMC8812555 DOI: 10.1289/ehp9413] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background: Secondary organic aerosols (SOAs) formed from anthropogenic or biogenic gaseous precursors in the atmosphere substantially contribute to the ambient fine particulate matter [PM ≤2.5μm in aerodynamic diameter (PM2.5)] burden, which has been associated with adverse human health effects. However, there is only limited evidence on their differential toxicological impact. Objectives: We aimed to discriminate toxicological effects of aerosols generated by atmospheric aging on combustion soot particles (SPs) of gaseous biogenic (β-pinene) or anthropogenic (naphthalene) precursors in two different lung cell models exposed at the air–liquid interface (ALI). Methods: Mono- or cocultures of lung epithelial cells (A549) and endothelial cells (EA.hy926) were exposed at the ALI for 4 h to different aerosol concentrations of a photochemically aged mixture of primary combustion SP and β-pinene (SOAβPIN-SP) or naphthalene (SOANAP-SP). The internally mixed soot/SOA particles were comprehensively characterized in terms of their physical and chemical properties. We conducted toxicity tests to determine cytotoxicity, intracellular oxidative stress, primary and secondary genotoxicity, as well as inflammatory and angiogenic effects. Results: We observed considerable toxicity-related outcomes in cells treated with either SOA type. Greater adverse effects were measured for SOANAP-SP compared with SOAβPIN-SP in both cell models, whereas the nano-sized soot cores alone showed only minor effects. At the functional level, we found that SOANAP-SP augmented the secretion of malondialdehyde and interleukin-8 and may have induced the activation of endothelial cells in the coculture system. This activation was confirmed by comet assay, suggesting secondary genotoxicity and greater angiogenic potential. Chemical characterization of PM revealed distinct qualitative differences in the composition of the two secondary aerosol types. Discussion: In this study using A549 and EA.hy926 cells exposed at ALI, SOA compounds had greater toxicity than primary SPs. Photochemical aging of naphthalene was associated with the formation of more oxidized, more aromatic SOAs with a higher oxidative potential and toxicity compared with β-pinene. Thus, we conclude that the influence of atmospheric chemistry on the chemical PM composition plays a crucial role for the adverse health outcome of emissions. https://doi.org/10.1289/EHP9413
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Affiliation(s)
- Svenja Offer
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Elena Hartner
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Sebastiano Di Bucchianico
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christoph Bisig
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Stefanie Bauer
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jana Pantzke
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Elias J. Zimmermann
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Xin Cao
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Stefanie Binder
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Evelyn Kuhn
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anja Huber
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Seongho Jeong
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Uwe Käfer
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Patrick Martens
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Arunas Mesceriakovas
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jan Bendl
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Chemistry and Environmental Engineering, University of the Bundeswehr Munich, Neubiberg, Germany
- Institute for Environmental Studies, Faculty of Science, Charles University, Prague, Czech Republic
| | - Ramona Brejcha
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Angela Buchholz
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Daniella Gat
- Department of Earth and Planetary Sciences, Faculty of Chemistry, Weizmann Institute of Science, Rehovot, Israel
| | - Thorsten Hohaus
- Institute of Energy and Climate Research, Troposphere, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Narges Rastak
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gert Jakobi
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Markus Kalberer
- Department of Environmental Sciences, University of Basel, Basel, Switzerland
| | | | - Yue Hu
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christoph Ogris
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Annalisa Marsico
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Fabian Theis
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michal Pardo
- Department of Earth and Planetary Sciences, Faculty of Chemistry, Weizmann Institute of Science, Rehovot, Israel
| | - Thomas Gröger
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Sebastian Oeder
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jürgen Orasche
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Andreas Paul
- Institute of Energy and Climate Research, Troposphere, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Till Ziehm
- Institute of Energy and Climate Research, Troposphere, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Zhi-Hui Zhang
- Department of Environmental Sciences, University of Basel, Basel, Switzerland
| | - Thomas Adam
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Chemistry and Environmental Engineering, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Olli Sippula
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Martin Sklorz
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jürgen Schnelle-Kreis
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Hendryk Czech
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Astrid Kiendler-Scharr
- Institute of Energy and Climate Research, Troposphere, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Yinon Rudich
- Department of Earth and Planetary Sciences, Faculty of Chemistry, Weizmann Institute of Science, Rehovot, Israel
| | - Ralf Zimmermann
- Joint Mass Spectrometry Center (JMSC) at Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
- JMSC at Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
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20
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Montesi SB, Zhou IY, Liang LL, Digumarthy SR, Mercaldo S, Mercaldo N, Seethamraju RT, Rosen BR, Caravan P. Dynamic contrast-enhanced magnetic resonance imaging of the lung reveals important pathobiology in idiopathic pulmonary fibrosis. ERJ Open Res 2021; 7:00907-2020. [PMID: 34760997 PMCID: PMC8573229 DOI: 10.1183/23120541.00907-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/21/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Evidence suggests that abnormalities occur in the lung microvasculature in idiopathic pulmonary fibrosis (IPF). We hypothesised that dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) could detect alterations in permeability, perfusion and extracellular extravascular volume in IPF, thus providing in vivo regional functional information not otherwise available. Methods Healthy controls and IPF subjects underwent DCE-MRI of the thorax using a dynamic volumetric radial sampling sequence and administration of gadoterate meglumine at a dose of 0.1 mmol·kg−1 at 2 mL·s−1. Model-free analysis of signal intensity versus time curves in regions of interest from a lower, middle and upper axial plane, a posterior coronal plane and the whole lung yielded parameters reflective of perfusion and permeability (peak enhancement and rate of contrast arrival (kwashin)) and the extracellular extravascular space (rate of contrast clearance (kwashout)). These imaging parameters were compared between IPF and healthy control subjects, and between fast/slow IPF progressors. Results IPF subjects (n=16, 56% male, age (range) 67.5 (60–79) years) had significantly reduced peak enhancement and slower kwashin in all measured lung regions compared to the healthy volunteers (n=17, 65% male, age (range) 58 (51–63) years) on unadjusted analyses consistent with microvascular alterations. kwashout, as a measure of the extravascular extracellular space, was significantly slower in the lower lung and posterior coronal regions in the IPF subjects consistent with an increased extravascular extracellular space. All estimates were attenuated after adjusting for age. Similar trends were observed, but only the associations with kwashin in certain lung regions remained statistically significant. Among IPF subjects, kwashout rates nearly perfectly discriminated between those with rapidly progressive disease versus those with stable/slowly progressive disease. Conclusions DCE-MRI detects changes in the microvasculature and extravascular extracellular space in IPF, thus providing in vivo regional functional information. Dynamic contrast-enhanced MRI demonstrates important in vivo lung regional microvascular and extravascular extracellular differences between IPF patients and healthy controls. These results signify IPF pathobiology and may have prognostic significance.https://bit.ly/3l14SWM
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Affiliation(s)
- Sydney B Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.,Institute for Innovation in Imaging, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,These authors contributed equally
| | - Iris Y Zhou
- Institute for Innovation in Imaging, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.,Dept of Radiology, Massachusetts General Hospital, Boston, MA, USA.,These authors contributed equally
| | - Lloyd L Liang
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Subba R Digumarthy
- Harvard Medical School, Boston, MA, USA.,Dept of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Mercaldo
- Dept of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Bruce R Rosen
- Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.,Dept of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Caravan
- Institute for Innovation in Imaging, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.,Dept of Radiology, Massachusetts General Hospital, Boston, MA, USA
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21
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Pandita A, Ekstrand M, Bjursten S, Zhao Z, Fogelstrand P, Le Gal K, Ny L, Bergo MO, Karlsson J, Nilsson JA, Akyürek LM, Levin MC, Borén J, Ewald AJ, Mostov KE, Levin M. Intussusceptive Angiogenesis in Human Metastatic Malignant Melanoma. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:2023-2038. [PMID: 34400131 PMCID: PMC8579244 DOI: 10.1016/j.ajpath.2021.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/03/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
Abstract
Angiogenesis supplies oxygen and nutrients to growing tumors. Inhibiting angiogenesis may stop tumor growth, but vascular endothelial growth factor inhibitors have limited effect in most tumors. This limited effect may be explained by an additional, less vascular endothelial growth factor-driven form of angiogenesis known as intussusceptive angiogenesis. The importance of intussusceptive angiogenesis in human tumors is not known. Epifluorescence and confocal microscopy was used to visualize intravascular pillars, the hallmark structure of intussusceptive angiogenesis, in tumors. Human malignant melanoma metastases, patient-derived melanoma xenografts in mice (PDX), and genetically engineered v-raf murine sarcoma viral oncogene homolog B1 (BRAF)-induced, phosphatase and TENsin homolog deleted on chromosome 10 (PTEN)-deficient (BPT) mice (BrafCA/+Ptenf/fTyr-Cre+/0-mice) were analyzed for pillars. Gene expression in human melanoma metastases and PDXs was analyzed by RNA sequencing. Matrix metalloproteinase 9 (MMP9) protein expression and T-cell and macrophage infiltration in tumor sections were determined with multiplex immunostaining. Intravascular pillars were detected in human metastases but rarely in PDXs and not in BPT mice. The expression of MMP9 mRNA was higher in human metastases compared with PDXs. High expression of MMP9 protein as well as infiltration of macrophages and T-cells were detected in proximity to intravascular pillars. MMP inhibition blocked formation of pillars, but not tubes or tip cells, in vitro. In conclusion, intussusceptive angiogenesis may contribute to the growth of human melanoma metastases. MMP inhibition blocked pillar formation in vitro and should be further investigated as a potential anti-angiogenic drug target in metastatic melanoma.
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Affiliation(s)
- Ankur Pandita
- Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matias Ekstrand
- Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sara Bjursten
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zhiyuan Zhao
- Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Fogelstrand
- Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kristell Le Gal
- Sahlgrenska Center for Cancer Research, University of Gothenburg, Gothenburg, Sweden
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgrenska Center for Cancer Research, University of Gothenburg, Gothenburg, Sweden
| | - Martin O Bergo
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Karlsson
- Sahlgrenska Center for Cancer Research, University of Gothenburg, Gothenburg, Sweden
| | - Jonas A Nilsson
- Sahlgrenska Center for Cancer Research, University of Gothenburg, Gothenburg, Sweden
| | - Levent M Akyürek
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Malin C Levin
- Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jan Borén
- Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Andrew J Ewald
- Department of Cell Biology, Johns Hopkins University, Baltimore, Maryland; Department of Oncology, Cancer Invasion and Metastasis Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Keith E Mostov
- Departments of Anatomy and Biochemistry/Biophysics, University of California, San Francisco, California
| | - Max Levin
- Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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22
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Jadaun PK, Chatterjee S. COVID-19 and dys-regulation of pulmonary endothelium: implications for vascular remodeling. Cytokine Growth Factor Rev 2021; 63:69-77. [PMID: 34728151 PMCID: PMC9611904 DOI: 10.1016/j.cytogfr.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease-2019 (COVID-19),
the disease caused by severe acute respiratory syndrome-coronavirus-2,
has claimed more than 4.4 million lives worldwide (as of 20 August 2021).
Severe cases of the disease often result in respiratory distress due to
cytokine storm, and mechanical ventilation is required. Although, the
lungs are the primary organs affected by the disease, more evidence on
damage to the heart, kidney, and liver is emerging. A common link in
these connections is the cardiovascular network. Inner lining of the
blood vessels, called endothelium, is formed by a single layer of
endothelial cells. Several clinical manifestations involving the
endothelium have been reported, such as its activation via
immunomodulation, endotheliitis, thrombosis, vasoconstriction, and
distinct intussusceptive angiogenesis (IA), a unique and rapid process of
blood-vessel formation by splitting a vessel into two lumens. In fact,
the virus directly infects the endothelium via TMPRSS2 spike glycoprotein
priming to facilitate ACE-2-mediated viral entry. Recent studies have
indicated a significant increase in remodeling of the pulmonary vascular
bed via intussusception in patients with COVID-19. However, the lack of
circulatory biomarkers for IA limits its detection in COVID-19
pathogenesis. In this review, we describe the implications of
angiogenesis in COVID-19, unique features of the pulmonary vascular bed
and its remodeling, and a rapid and non-invasive assessment of IA to
overcome the technical limitations in patients with
COVID-19.
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Affiliation(s)
- Pavitra K Jadaun
- Hepatology, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Suvro Chatterjee
- Department of Biotechnology, University of Burdwan, Golap Bag Campus, Burdwan, India.
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23
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Smadja DM, Philippe A, Bory O, Gendron N, Beauvais A, Gruest M, Peron N, Khider L, Guerin CL, Goudot G, Levavasseur F, Duchemin J, Pene F, Cheurfa C, Szwebel TA, Sourdeau E, Planquette B, Hauw-Berlemont C, Hermann B, Gaussem P, Samama CM, Mirault T, Terrier B, Sanchez O, Rance B, Fontenay M, Diehl JL, Chocron R. Placental growth factor level in plasma predicts COVID-19 severity and in-hospital mortality. J Thromb Haemost 2021; 19:1823-1830. [PMID: 33830623 PMCID: PMC8250221 DOI: 10.1111/jth.15339] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/17/2021] [Accepted: 03/25/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a respiratory disease associated with vascular inflammation and endothelial injury. OBJECTIVES To correlate circulating angiogenic markers vascular endothelial growth factor A (VEGF-A), placental growth factor (PlGF), and fibroblast growth factor 2 (FGF-2) to in-hospital mortality in COVID-19 adult patients. METHODS Consecutive ambulatory and hospitalized patients with COVID-19 infection were enrolled. VEGF-A, PlGF, and FGF-2 were measured in each patient ≤48 h following admission. RESULTS The study enrolled 237 patients with suspected COVID-19: 208 patients had a positive diagnostic for COVID-19, of whom 23 were mild outpatients and 185 patients hospitalized after admission. Levels of VEGF-A, PlGF, and FGF-2 significantly increase with the severity of the disease (P < .001). Using a logistic regression model, we found a significant association between the increase of FGF-2 or PlGF and mortality (odds ratio [OR] 1.11, 95% confidence interval [CI; 1.07-1.16], P < .001 for FGF-2 and OR 1.07 95% CI [1.04-1.10], P < .001 for PlGF) while no association were found for VEGF-A levels. Receiver operating characteristic curve analysis was performed and we identified PlGF above 30 pg/ml as the best predictor of in-hospital mortality in COVID-19 patients. Survival analysis for PlGF confirmed its interest for in-hospital mortality prediction, by using a Kaplan-Meier survival curve (P = .001) and a Cox proportional hazard model adjusted to age, body mass index, D-dimer, and C-reactive protein (3.23 95% CI [1.29-8.11], P = .001). CONCLUSION Angiogenic factor PlGF is a relevant predictive factor for in-hospital mortality in COVID-19 patients. More than a biomarker, we hypothesize that PlGF blocking strategies could be a new interesting therapeutic approach in COVID-19.
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Affiliation(s)
- David M Smadja
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Aurélien Philippe
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Olivier Bory
- Université de Paris, Emergency Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Nicolas Gendron
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Agathe Beauvais
- Université de Paris, Emergency Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Maxime Gruest
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Nicolas Peron
- Université de Paris, Intensive Care Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Lina Khider
- Université de Paris, Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Coralie L Guerin
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Curie Institute, Cytometry Department, Paris, France
| | - Guillaume Goudot
- Université de Paris, Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Françoise Levavasseur
- Université de Paris, Institut Cochin, INSERM, Paris, France
- Hematology Department Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Jérome Duchemin
- Université de Paris, Institut Cochin, INSERM, Paris, France
- Hematology Department Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Frédéric Pene
- Internal Medicine Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Cherifa Cheurfa
- Intensive Care Medicine and Reanimation Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Tali-Anne Szwebel
- Internal Medicine Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Elise Sourdeau
- Emergency Unit, Hôpital Hôtel-Dieu, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Benjamin Planquette
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Caroline Hauw-Berlemont
- Université de Paris, Intensive Care Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Bertrand Hermann
- Université de Paris, Intensive Care Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Pascale Gaussem
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Charles-Marc Samama
- Intensive Care Medicine and Reanimation Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Tristan Mirault
- Université de Paris, PARCC, INSERM, Paris, France
- Vascular Medicine Department, Assistance Publique - Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Benjamin Terrier
- Internal Medicine Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
- Université de Paris, PARCC, INSERM, Paris, France
| | - Olivier Sanchez
- Emergency Unit, Hôpital Hôtel-Dieu, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Bastien Rance
- Université de Paris, Department of Medical Informatics, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Michaela Fontenay
- Université de Paris, Institut Cochin, INSERM, Paris, France
- Hematology Department Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Jean-Luc Diehl
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Intensive Care Unit and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique - Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Richard Chocron
- Université de Paris, PARCC, INSERM U970, Paris, France
- Emergency Department, AH-HP-Centre Université de Paris (APHP-CUP), Paris, France
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24
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Collie D, Wright SH, Del-Pozo J, Kay E, Schwarz T, Parys M, Lawrence J. Regional and organ-level responses to local lung irradiation in sheep. Sci Rep 2021; 11:9553. [PMID: 33953285 PMCID: PMC8099861 DOI: 10.1038/s41598-021-88863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Lung is a dose-limiting organ in radiotherapy. This may limit tumour control when effort is made in planning to limit the likelihood of radiation-induced lung injury (RILI). Understanding the factors that dictate susceptibility to radiation-induced pulmonary fibrosis will aid in the prevention and management of RILI, and may lead to more effective personalized radiotherapy treatment. As the interaction of regional and organ-level responses may shape the chronic consequences of RILI, we sought to characterise both aspects of the response in an ovine model. A defined volume of left pulmonary parenchyma was prescribed 5 fractions of 6 Gy within 14 days while the contralateral lung dose was constrained. Radiographic changes via computed tomography (CT) were documented to define differences in radio-exposed lung relative to non-exposed lung at d21, d63 and d171 (n = 2), and at d21, d147 and d227 (n = 2). Gross and histologic lung changes were evaluated in samples derived at necropsy examination to define the chronic pulmonary response to radiation. Irradiated lung demonstrated reduced radio-density and increased homogeneity as evidenced from texture based radiomic feature analysis, relative to the control lung. At necropsy, the radiation field was readily defined by pallor on the pleural surface, which was also evident on the cut surface of fixed lung specimens. The degree and homogeneity of pallor reflected the sparse presence of erythrocytes in alveolar septal capillaries of radiation-exposed lung. These changes contrasted with dilated and congested microvasculature in the contralateral control lung. Referencing data to measurements made in control lung volumes of sheep experiencing acute RILI indicated that interstitial collagen continues to deposit in the radio-exposed lung field. Overall lung vascularity increased during the chronic response, as evidenced by increased expression of endothelial cell marker (CD31); however, vascularity was consistently decreased in irradiated lung and was negatively correlated with lung collagen. Other organ-level responses included increased expression of alpha smooth muscle actin (ASMA), increased numbers of proliferating cells (Ki67 positive), and cells expressing the dendritic cell-lysosomal associated membrane protein (DC-LAMP) antigen. The chronic response to RILI in this model is effected at both the whole organ and local lung level. Whilst the long-term consequences of exposure to radiation involved the continued deposition of collagen in the radiation field, organ-level responses also included increased vascularization and increased expression of ASMA, Ki67 and DC-LAMP. Interrupting the interplay between these aspects may influence susceptibility to pulmonary fibrosis after radiotherapy. We advocate for the importance of large animal model systems in pursuing these opportunities to target local, organ-level and systemic mechanisms in parallel within the same subject over time.
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Affiliation(s)
- David Collie
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK.
| | - Steven H Wright
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
| | - Jorge Del-Pozo
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
| | - Elaine Kay
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
- Small Animal Clinical Sciences, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Tobias Schwarz
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
| | - Magdalena Parys
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
| | - Jessica Lawrence
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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25
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Pasut A, Becker LM, Cuypers A, Carmeliet P. Endothelial cell plasticity at the single-cell level. Angiogenesis 2021; 24:311-326. [PMID: 34061284 PMCID: PMC8169404 DOI: 10.1007/s10456-021-09797-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 02/08/2023]
Abstract
The vascular endothelium is characterized by a remarkable level of plasticity, which is the driving force not only of physiological repair/remodeling of adult tissues but also of pathological angiogenesis. The resulting heterogeneity of endothelial cells (ECs) makes targeting the endothelium challenging, no less because many EC phenotypes are yet to be identified and functionally inventorized. Efforts to map the vasculature at the single-cell level have been instrumental to capture the diversity of EC types and states at a remarkable depth in both normal and pathological states. Here, we discuss new EC subtypes and functions emerging from recent single-cell studies in health and disease. Interestingly, such studies revealed distinct metabolic gene signatures in different EC phenotypes, which deserve further consideration for therapy. We highlight how this metabolic targeting strategy could potentially be used to promote (for tissue repair) or block (in tumor) angiogenesis in a tissue or even vascular bed-specific manner.
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Affiliation(s)
- Alessandra Pasut
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Center, VIB, K.U.Leuven, Campus Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Lisa M Becker
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Center, VIB, K.U.Leuven, Campus Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Anne Cuypers
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Center, VIB, K.U.Leuven, Campus Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Center, VIB, K.U.Leuven, Campus Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium.
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven, Leuven, Belgium.
- Laboratory of Angiogenesis and Vascular Heterogeneity, Department of Biomedicine, Aarhus University, 8000, Aarhus C, Denmark.
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China.
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26
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Chioh FW, Fong SW, Young BE, Wu KX, Siau A, Krishnan S, Chan YH, Carissimo G, Teo LL, Gao F, Tan RS, Zhong L, Koh AS, Tan SY, Tambyah PA, Renia L, Ng LF, Lye DC, Cheung C. Convalescent COVID-19 patients are susceptible to endothelial dysfunction due to persistent immune activation. eLife 2021; 10:64909. [PMID: 33752798 PMCID: PMC7987341 DOI: 10.7554/elife.64909] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
Numerous reports of vascular events after an initial recovery from COVID-19 form our impetus to investigate the impact of COVID-19 on vascular health of recovered patients. We found elevated levels of circulating endothelial cells (CECs), a biomarker of vascular injury, in COVID-19 convalescents compared to healthy controls. In particular, those with pre-existing conditions (e.g., hypertension, diabetes) had more pronounced endothelial activation hallmarks than non-COVID-19 patients with matched cardiovascular risk. Several proinflammatory and activated T lymphocyte-associated cytokines sustained from acute infection to recovery phase, which correlated positively with CEC measures, implicating cytokine-driven endothelial dysfunction. Notably, we found higher frequency of effector T cells in our COVID-19 convalescents compared to healthy controls. The activation markers detected on CECs mapped to counter receptors found primarily on cytotoxic CD8+ T cells, raising the possibility of cytotoxic effector cells targeting activated endothelial cells. Clinical trials in preventive therapy for post-COVID-19 vascular complications may be needed.
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Affiliation(s)
- Florence Wj Chioh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Siew-Wai Fong
- A*STAR ID Labs, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Barnaby E Young
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kan-Xing Wu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Anthony Siau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Shuba Krishnan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, ANA Futura, Campus Flemingsberg, Stockholm, Sweden
| | - Yi-Hao Chan
- A*STAR ID Labs, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Guillaume Carissimo
- A*STAR ID Labs, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Louis Ly Teo
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Fei Gao
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ru San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Angela S Koh
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Seow-Yen Tan
- Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore
| | - Paul A Tambyah
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Laurent Renia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,A*STAR ID Labs, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Lisa Fp Ng
- A*STAR ID Labs, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - David C Lye
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christine Cheung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
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27
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Scharm SC, Vogel-Claussen J, Schaefer-Prokop C, Dettmer S, Knudsen L, Jonigk D, Fuge J, Apel RM, Welte T, Wacker F, Prasse A, Shin HO. Quantification of dual-energy CT-derived functional parameters as potential imaging markers for progression of idiopathic pulmonary fibrosis. Eur Radiol 2021; 31:6640-6651. [PMID: 33725189 PMCID: PMC8379131 DOI: 10.1007/s00330-021-07798-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/04/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The individual course of disease in idiopathic pulmonary fibrosis (IPF) is highly variable. Assessment of disease activity and prospective estimation of disease progression might have the potential to improve therapy management and indicate the onset of treatment at an earlier stage. The aim of this study was to evaluate whether regional ventilation, lung perfusion, and late enhancement can serve as early imaging markers for disease progression in patients with IPF. METHODS In this retrospective study, contrast-enhanced dual-energy CT scans of 32 patients in inspiration and delayed expiration were performed at two time points with a mean interval of 15.4 months. The pulmonary blood volume (PBV) images obtained in the arterial and delayed perfusion phase served as a surrogate for arterial lung perfusion and parenchymal late enhancement. The virtual non-contrast (VNC) images in inspiration and expiration were non-linearly registered to provide regional ventilation images. Image-derived parameters were correlated with longitudinal changes of lung function (FVC%, DLCO%), mean lung density in CT, and CT-derived lung volume. RESULTS Regional ventilation and late enhancement at baseline preceded future change in lung volume (R - 0.474, p 0.006/R - 0.422, p 0.016, respectively) and mean lung density (R - 0.469, p 0.007/R - 0.402, p 0.022, respectively). Regional ventilation also correlated with a future change in FVC% (R - 0.398, p 0.024). CONCLUSION CT-derived functional parameters of regional ventilation and parenchymal late enhancement are potential early imaging markers for idiopathic pulmonary fibrosis progression. KEY POINTS • Functional CT parameters at baseline (regional ventilation and late enhancement) correlate with future structural changes of the lung as measured with loss of lung volume and increase in lung density in serial CT scans of patients with idiopathic pulmonary fibrosis. • Functional CT parameter measurements in high-attenuation areas (- 600 to - 250 HU) are significantly different from normal-attenuation areas (- 950 to - 600 HU) of the lung. • Mean regional ventilation in functional CT correlates with a future change in forced vital capacity (FVC) in pulmonary function tests.
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Affiliation(s)
- Sarah C Scharm
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Cornelia Schaefer-Prokop
- Department of Radiology, Radboud University, Nijmegen, The Netherlands.,Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Sabine Dettmer
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Lars Knudsen
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Rosa-Marie Apel
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Antje Prasse
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Hoen-Oh Shin
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany. .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.
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28
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Kant TA, Newe M, Winter L, Hoffmann M, Kämmerer S, Klapproth E, Künzel K, Kühnel MP, Neubert L, El-Armouche A, Künzel SR. Genetic Deletion of Polo-Like Kinase 2 Induces a Pro-Fibrotic Pulmonary Phenotype. Cells 2021; 10:617. [PMID: 33799608 PMCID: PMC8001503 DOI: 10.3390/cells10030617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023] Open
Abstract
Pulmonary fibrosis is the chronic-progressive replacement of healthy lung tissue by extracellular matrix, leading to the destruction of the alveolar architecture and ultimately death. Due to limited pathophysiological knowledge, causal therapies are still missing and consequently the prognosis is poor. Thus, there is an urgent clinical need for models to derive effective therapies. Polo-like kinase 2 (PLK2) is an emerging regulator of fibroblast function and fibrosis. We found a significant downregulation of PLK2 in four different entities of human pulmonary fibrosis. Therefore, we characterized the pulmonary phenotype of PLK2 knockout (KO) mice. Isolated pulmonary PLK2 KO fibroblasts displayed a pronounced myofibroblast phenotype reflected by increased expression of αSMA, reduced proliferation rates and enhanced ERK1/2 and SMAD2/3 phosphorylation. In PLK2 KO, the expression of the fibrotic cytokines osteopontin and IL18 was elevated compared to controls. Histological analysis of PLK2 KO lungs revealed early stage remodeling in terms of alveolar wall thickening, increased alveolar collagen deposition and myofibroblast foci. Our results prompt further investigation of PLK2 function in pulmonary fibrosis and suggest that the PLK2 KO model displays a genetic predisposition towards pulmonary fibrosis, which could be leveraged in future research on this topic.
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Affiliation(s)
- Theresa A. Kant
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Manja Newe
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Luise Winter
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Maximilian Hoffmann
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Susanne Kämmerer
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Erik Klapproth
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Karolina Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Mark P. Kühnel
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany; (M.P.K.); (L.N.)
| | - Lavinia Neubert
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany; (M.P.K.); (L.N.)
| | - Ali El-Armouche
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Stephan R. Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
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29
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Abstract
Viral respiratory diseases constitute the most common reasons for hospitalization with more than half of all acute illnesses worldwide. Progressive respiratory failure with pronounced diffuse alveolar damage has been identified as the primary cause of death in COVID-19. COVID-19 pneumonia shares common histopathological hallmarks with influenza (H1N1)-related ARDS, like diffuse alveolar damage (DAD) with edema, hemorrhage, and intra-alveolar fibrin deposition. The lungs with COVID-19 pneumonia revealed perivascular inflammation, an endothelial injury, microangiopathy, and an aberrant blood vessel neoformation by intussusceptive angiogenesis. While this pronounced angiocentric inflammation is likely be found - to varying degrees - in numerous other organs, e.g., the heart, COVID-19 is hypothesized to be not just a pulmonary, but rather a systemic "vascular disease."
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30
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Wagner WL, Föhst S, Hock J, Kim YO, Popov Y, Schuppan D, Schladitz K, Redenbach C, Ackermann M. 3D analysis of microvasculature in murine liver fibrosis models using synchrotron radiation-based microtomography. Angiogenesis 2021; 24:57-65. [PMID: 33037487 PMCID: PMC7920893 DOI: 10.1007/s10456-020-09751-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022]
Abstract
Cirrhosis describes the development of excess fibrous tissue around regenerative nodules in response to chronic liver injury and usually leads to irreversible organ damage and end-stage liver disease. During the development of cirrhosis, the formation of collagenous scar tissue is paralleled by a reorganization and remodeling of the hepatic vascular system. To date, macrovascular remodeling in various cirrhosis models has been examined using three-dimensional (3D) imaging modalities, while microvascular changes have been studied mainly by two-dimensional (2D) light microscopic and electron microscopic imaging. Here, we report on the application of high-resolution 3D synchrotron radiation-based microtomography (SRμCT) for the study of the sinusoidal and capillary blood vessel system in three murine models of advanced parenchymal and biliary hepatic fibrosis. SRμCT facilitates the characterization of microvascular architecture and identifies features of intussusceptive angiogenesis in progressive liver fibrosis in a non-destructive 3D manner.
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Affiliation(s)
- Willi L Wagner
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Heidelberg, Germany
| | - Sonja Föhst
- Mathematics Department, Technische Universität Kaiserslautern, Kaiserslautern, Germany
| | - Jessica Hock
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Johann-Joachim-Becher-Weg 13, 55128, Mainz, Germany
| | - Yong Ook Kim
- Institute of Translational Immunology and Research Center for Immune Therapy (FZI), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Yury Popov
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Detlef Schuppan
- Institute of Translational Immunology and Research Center for Immune Therapy (FZI), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Katja Schladitz
- Image Processing Department, Fraunhofer ITWM, Kaiserslautern, Germany
| | - Claudia Redenbach
- Mathematics Department, Technische Universität Kaiserslautern, Kaiserslautern, Germany
| | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Johann-Joachim-Becher-Weg 13, 55128, Mainz, Germany.
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal, Germany.
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31
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Circulating Von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality. Angiogenesis 2021; 24:505-517. [PMID: 33449299 PMCID: PMC7809553 DOI: 10.1007/s10456-020-09762-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) is a respiratory disease associated with endotheliitis and microthrombosis. Objectives To correlate endothelial dysfunction to in-hospital mortality in a bi-centric cohort of COVID-19 adult patients. Methods Consecutive ambulatory and hospitalized patients with laboratory-confirmed COVID-19 were enrolled. A panel of endothelial biomarkers and von Willebrand factor (VWF) multimers were measured in each patient ≤ 48 h following admission. Results Study enrolled 208 COVID-19 patients of whom 23 were mild outpatients and 189 patients hospitalized after admission. Most of endothelial biomarkers tested were found increased in the 89 critical patients transferred to intensive care unit. However, only von Willebrand factor antigen (VWF:Ag) scaled according to clinical severity, with levels significantly higher in critical patients (median 507%, IQR 428–596) compared to non-critical patients (288%, 230–350, p < 0.0001) or COVID-19 outpatients (144%, 133–198, p = 0.007). Moreover, VWF high molecular weight multimers (HMWM) were significantly higher in critical patients (median ratio 1.18, IQR 0.86–1.09) compared to non-critical patients (0.96, 1.04–1.39, p < 0.001). Among all endothelial biomarkers measured, ROC curve analysis identified a VWF:Ag cut-off of 423% as the best predictor for in-hospital mortality. The accuracy of VWF:Ag was further confirmed in a Kaplan–Meier estimator analysis and a Cox proportional Hazard model adjusted on age, BMI, C-reactive protein and d-dimer levels. Conclusion VWF:Ag is a relevant predictive factor for in-hospital mortality in COVID-19 patients. More than a biomarker, we hypothesize that VWF, including excess of HMWM forms, drives microthrombosis in COVID-19.
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32
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Werlein C, Ackermann M, Hoffmann TL, Laenger F, Jonigk D. [Fibrotic remodeling of the lung following lung and stem-cell transplantation]. DER PATHOLOGE 2021; 42:17-24. [PMID: 33416936 DOI: 10.1007/s00292-020-00898-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Transplantation of solid organs and hematopoietic stem cells represents an important therapeutic option for a variety of end-stage pulmonary diseases, aggressive hematopoietic neoplasms, or severe immunodeficiencies. Although the overall survival following transplantation has generally improved over recent decades, long-time survival of lung and stem-cell transplant recipients is still alarmingly low with an average 5‑year survival rate of only 50-60%. Chronic allo-immunoreactions in general and pulmonary allo-immunoreactions with subsequent fibrosis in particular are major reasons for this poor outcome. Comparable patterns of fibrotic lung remodeling are observed following both lung and hematopoietic stem-cell transplantation. Besides the meanwhile well-established obliterative and functionally obstructive remodeling of the small airways - obliterative bronchiolitis - a specific restrictive subform of fibrosis, namely alveolar fibroelastosis, has been identified. Despite their crucial impact on patient outcome, both entities can be very challenging to detect by conventional histopathological analysis. Their underlying mechanisms are considered overreaching aberrant repair attempts to acute lung injuries with overactivation of (myo-) fibroblasts and excessive and irreversible deposition of extracellular matrix. Of note, the underlying molecular mechanisms are widely divergent between these two morphological entities and are independent of the underlying clinical setting.Further comprehensive investigations of these fibrotic alterations are key to the development of much-needed predictive diagnostics and curative concepts, considering the high mortality of pulmonary fibrosis following transplantation.
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Affiliation(s)
- Christopher Werlein
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, OE 5110, 30625, Hannover, Deutschland
| | - Max Ackermann
- Institut für Pathologie und Molekularpathologie, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Wuppertal, Deutschland.,Institut für Funktionelle und Klinische Anatomie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Thia Leandra Hoffmann
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, OE 5110, 30625, Hannover, Deutschland
| | - Florian Laenger
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, OE 5110, 30625, Hannover, Deutschland.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Standort Hannover, Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland
| | - Danny Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, OE 5110, 30625, Hannover, Deutschland. .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Standort Hannover, Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland.
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33
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Ellison-Hughes GM, Colley L, O'Brien KA, Roberts KA, Agbaedeng TA, Ross MD. The Role of MSC Therapy in Attenuating the Damaging Effects of the Cytokine Storm Induced by COVID-19 on the Heart and Cardiovascular System. Front Cardiovasc Med 2020; 7:602183. [PMID: 33363221 PMCID: PMC7756089 DOI: 10.3389/fcvm.2020.602183] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/17/2020] [Indexed: 01/08/2023] Open
Abstract
The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has led to 47 m infected cases and 1. 2 m (2.6%) deaths. A hallmark of more severe cases of SARS-CoV-2 in patients with acute respiratory distress syndrome (ARDS) appears to be a virally-induced over-activation or unregulated response of the immune system, termed a "cytokine storm," featuring elevated levels of pro-inflammatory cytokines such as IL-2, IL-6, IL-7, IL-22, CXCL10, and TNFα. Whilst the lungs are the primary site of infection for SARS-CoV-2, in more severe cases its effects can be detected in multiple organ systems. Indeed, many COVID-19 positive patients develop cardiovascular complications, such as myocardial injury, myocarditis, cardiac arrhythmia, and thromboembolism, which are associated with higher mortality. Drug and cell therapies targeting immunosuppression have been suggested to help combat the cytokine storm. In particular, mesenchymal stromal cells (MSCs), owing to their powerful immunomodulatory ability, have shown promise in early clinical studies to avoid, prevent or attenuate the cytokine storm. In this review, we will discuss the mechanistic underpinnings of the cytokine storm on the cardiovascular system, and how MSCs potentially attenuate the damage caused by the cytokine storm induced by COVID-19. We will also address how MSC transplantation could alleviate the long-term complications seen in some COVID-19 patients, such as improving tissue repair and regeneration.
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Affiliation(s)
- Georgina M. Ellison-Hughes
- Faculty of Life Sciences & Medicine, Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London Guy's Campus, London, United Kingdom
| | - Liam Colley
- School of Sport, Health, and Exercise Sciences, Bangor University, Bangor, United Kingdom
| | - Katie A. O'Brien
- Department of Physiology, Development, and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Kirsty A. Roberts
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Thomas A. Agbaedeng
- Faculty of Health & Medical Sciences, Centre for Heart Rhythm Disorders, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Mark D. Ross
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
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34
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Combination of µCT and light microscopy for generation-specific stereological analysis of pulmonary arterial branches: a proof-of-concept study. Histochem Cell Biol 2020; 155:227-239. [PMID: 33263790 PMCID: PMC7709482 DOI: 10.1007/s00418-020-01946-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 12/21/2022]
Abstract
Various lung diseases, including pulmonary hypertension, chronic obstructive pulmonary disease or bronchopulmonary dysplasia, are associated with structural and architectural alterations of the pulmonary vasculature. The light microscopic (LM) analysis of the blood vessels is limited by the fact that it is impossible to identify which generation of the arterial tree an arterial profile within a LM microscopic section belongs to. Therefore, we established a workflow that allows for the generation-specific quantitative (stereological) analysis of pulmonary blood vessels. A whole left rabbit lung was fixed by vascular perfusion, embedded in glycol methacrylate and imaged by micro-computed tomography (µCT). The lung was then exhaustively sectioned and 20 consecutive sections were collected every 100 µm to obtain a systematic uniform random sample of the whole lung. The digital processing involved segmentation of the arterial tree, generation analysis, registration of LM sections with the µCT data as well as registration of the segmentation and the LM images. The present study demonstrates that it is feasible to identify arterial profiles according to their generation based on a generation-specific color code. Stereological analysis for the first three arterial generations of the monopodial branching of the vasculature included volume fraction, total volume, lumen-to-wall ratio and wall thickness for each arterial generation. In conclusion, the correlative image analysis of µCT and LM-based datasets is an innovative method to assess the pulmonary vasculature quantitatively.
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35
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Ackermann M, Mentzer SJ, Kolb M, Jonigk D. Inflammation and intussusceptive angiogenesis in COVID-19: everything in and out of flow. Eur Respir J 2020; 56:13993003.03147-2020. [PMID: 33008942 PMCID: PMC7530910 DOI: 10.1183/13993003.03147-2020] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Maximilian Ackermann
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Wuppertal, Germany .,Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Steven J Mentzer
- Laboratory of Adaptive and Regenerative Biology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Martin Kolb
- Firestone Institute for Respiratory Health, Research Institute at St Joseph's Healthcare, Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Danny Jonigk
- Institute of Pathology, 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
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36
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Verleden SE, Braubach P, Kuehnel M, Dickgreber N, Brouwer E, Tittmann P, Laenger F, Jonigk D. Molecular approach to the classification of chronic fibrosing lung disease-there and back again. Virchows Arch 2020; 478:89-99. [PMID: 33169196 DOI: 10.1007/s00428-020-02964-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022]
Abstract
Chronic diffuse parenchymal lung disease (DPLD) is an umbrella term for a very heterogeneous group of lung diseases. Over the last decades, clinical, radiological and histopathological criteria have been established to define and separate these entities. More recently the clinical utility of this approach has been challenged as a unifying concept of pathophysiological mechanisms and a shared response to therapy across the disease spectrum have been described. In this review, we discuss molecular motifs for subtyping and the prediction of prognosis focusing on genetics and markers found in the blood, lavage and tissue. As a purely molecular classification so far lacks sufficient sensitivity and specificity for subtyping, it is not routinely used and not implemented in international guidelines. However, a better molecular characterization of lung disease with a more precise identification of patients with, for example, a risk for rapid disease progression would facilitate more accurate treatment decisions and hopefully contribute to better patients' outcomes.
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Affiliation(s)
- Stijn E Verleden
- Institute of Pathology, Hannover Medical School, Hannover, Germany.
- BREATHE Lab, Department of CHROMETA, KU Leuven, Leuven, Belgium.
| | - Peter Braubach
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
| | - Mark Kuehnel
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
| | - Nicolas Dickgreber
- Department of Respiratory Medicine and Thoracic Oncology, Ibbenbueren General Hospital, Ibbenbueren, Germany
| | - Emily Brouwer
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
| | - Pauline Tittmann
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
| | - Florian Laenger
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover, Germany
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37
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Vaz de Paula CB, de Azevedo MLV, Nagashima S, Martins APC, Malaquias MAS, Miggiolaro AFRDS, da Silva Motta Júnior J, Avelino G, do Carmo LAP, Carstens LB, de Noronha L. IL-4/IL-13 remodeling pathway of COVID-19 lung injury. Sci Rep 2020; 10:18689. [PMID: 33122784 PMCID: PMC7596721 DOI: 10.1038/s41598-020-75659-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022] Open
Abstract
The COVID-19 fatality rate is high when compared to the H1N1pdm09 (pandemic Influenza A virus H1N1 subtype) rate, and although both cause an aggravated inflammatory response, the differences in the mechanisms of both pandemic pneumonias need clarification. Thus, our goal was to analyze tissue expression of interleukins 4, 13, (IL-4, IL-13), transforming growth factor-beta (TGF-β), and the number of M2 macrophages (Sphingosine-1) in patients who died by COVID-19, comparing with cases of severe pneumopathy caused by H1N1pdm09, and a control group without lung injury. Six lung biopsy samples of patients who died of SARS-CoV-2 (COVID-19 group) were used and compared with ten lung samples of adults who died from a severe infection of H1N1pdm09 (H1N1 group) and eleven samples of patients who died from different causes without lung injury (CONTROL group). The expression of IL-4, IL-13, TGF-β, and M2 macrophages score (Sphingosine-1) were identified through immunohistochemistry (IHC). Significantly higher IL-4 tissue expression and Sphingosine-1 in M2 macrophages were observed in the COVID-19 group compared to both the H1N1 and the CONTROL groups. A different mechanism of diffuse alveolar damage (DAD) in SARS-CoV-2 compared to H1N1pdm09 infections were observed. IL-4 expression and lung remodeling are phenomena observed in both SARS-CoV-2 and H1N1pdm09. However, SARS-CoV-2 seems to promote lung damage through different mechanisms, such as the scarce participation Th1/Th17 response and the higher participation of the Th2. Understanding and managing the aggravated and ineffective immune response elicited by SARS-CoV-2 merits further clarification to improve treatments propose.
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Affiliation(s)
- Caroline Busatta Vaz de Paula
- School of Medicine, Postgraduate Program of Health Sciences, Pontifícia Universidade Católica do Paraná-PUCPR, Rua Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil.
| | - Marina Luise Viola de Azevedo
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Seigo Nagashima
- School of Medicine, Postgraduate Program of Health Sciences, Pontifícia Universidade Católica do Paraná-PUCPR, Rua Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Ana Paula Camargo Martins
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Mineia Alessandra Scaranello Malaquias
- School of Medicine, Postgraduate Program of Health Sciences, Pontifícia Universidade Católica do Paraná-PUCPR, Rua Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Anna Flavia Ribeiro Dos Santos Miggiolaro
- School of Medicine, Postgraduate Program of Health Sciences, Pontifícia Universidade Católica do Paraná-PUCPR, Rua Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Jarbas da Silva Motta Júnior
- School of Medicine, Postgraduate Program of Health Sciences, Pontifícia Universidade Católica do Paraná-PUCPR, Rua Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Gibran Avelino
- Hospital Marcelino Champagnat, School of Medicine, Pontifical Catholic University of Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Leticia Arianne Panini do Carmo
- School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Lucas Baena Carstens
- School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Lucia de Noronha
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
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38
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Billoir P, Blandinières A, Gendron N, Chocron R, Gunther S, Philippe A, Guerin CL, Israël-Biet D, Smadja DM. Endothelial Colony-Forming Cells from Idiopathic Pulmonary Fibrosis Patients Have a High Procoagulant Potential. Stem Cell Rev Rep 2020; 17:694-699. [PMID: 32970229 DOI: 10.1007/s12015-020-10043-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe, progressive and irreversible lung disease constantly associated with a major vascular remodeling process. Endothelial colony-forming cells (ECFCs) are human vasculogenic cells proposed as a cell therapy product or liquid biopsy in vascular disorders. Since the link between IPF and thrombosis has been largely proposed, the aim of our study was to explore hypercoagulability states in ECFCs from patients with IPF. We performed Thrombin generation assay (TGA) in cord blood (CB)-ECFCs, peripheral blood (PB)-ECFCs and IPF-ECFCs. Endogenous thrombin potential and peak were higher in IPF-ECFCs compared to CB-ECFCs and PB-ECFCs. As thrombin generation in ECFCs was increased, we evaluated anticoagulant proteins expressed on ECFCs membrane and identified thrombomodulin and EPCR. We found a significant decrease of both anticoagulant proteins at membrane using flow cytometry. This study is the first to examine ECFC thrombin generation in IPF. This new finding strongly argues for a role of ECFC in IPF pathophysiology and thrombotic related disorders in IPF. Graphical Abstract.
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Affiliation(s)
- Paul Billoir
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, AP-HP, Georges Pompidou European Hospital, F-75006 Paris, France, Service d'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), 75015, Paris, France.,Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Vascular Hemostasis Unit, 76000, Rouen, France
| | - Adeline Blandinières
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, AP-HP, Georges Pompidou European Hospital, F-75006 Paris, France, Service d'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), 75015, Paris, France
| | - Nicolas Gendron
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, AP-HP, Georges Pompidou European Hospital, F-75006 Paris, France, Service d'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), 75015, Paris, France
| | - Richard Chocron
- Université de Paris, PARCC, INSERM, 75015 Paris, France, AP-HP, Georges Pompidou European Hospital, Service d'accueil des urgences, 75015, Paris, France
| | - Sven Gunther
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, AP-HP, Georges Pompidou European Hospital, Service de physiologie respiratoire et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), F-75015, Paris, France
| | - Aurélien Philippe
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, AP-HP, Georges Pompidou European Hospital, F-75006 Paris, France, Service d'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), 75015, Paris, France
| | - Coralie L Guerin
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, France, Institut Curie, Cytometry Platform, 75006, Paris, France
| | - Dominique Israël-Biet
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, France, AP-HP, Georges Pompidou European Hospital, Service de pneumologie, 75015, Paris, France
| | - David M Smadja
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, AP-HP, Georges Pompidou European Hospital, F-75006 Paris, France, Service d'Hématologie et Laboratoire de Recherches Biochirugicales (Fondation Carpentier), 75015, Paris, France.
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39
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Intussusceptive angiogenesis in Covid-19: hypothesis on the significance and focus on the possible role of FGF2. Mol Biol Rep 2020; 47:8301-8304. [PMID: 32920756 PMCID: PMC7486971 DOI: 10.1007/s11033-020-05831-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
The interest on the role of angiogenesis in the pathogenesis and progression of human interstitial lung diseases is growing, with conventional sprouting (SA) and non-sprouting intussusceptive angiogenesis (IA) being differently represented in specific pulmonary injury patterns. The role of viruses as key regulators of angiogenesis is known for several years. A significantly enhanced amount of new vessel growth, through a mechanism of IA, has been reported in lungs of patients who died from Covid-19; among the angiogenesis-related genes, fibroblast growth factor 2 (FGF2) was found to be upregulated. These findings are intriguing. FGF2 plays a role in some viral infections: the upregulation is involved in the MERS-CoV-induced strong apoptotic response crucial for its highly lytic replication cycle in lung cells, whereas FGF2 is protective against the acute lung injury induced by H1N1 influenza virus, improving the lung wet-to-dry weight ratio. FGF2 plays a role also in regulating IA, acting on pericytes (crucial for the formation of intraluminal pillars), and endothelium, and FGF2-induced angiogenesis may be promoted by inflammation and hypoxia. IA is a faster and probably more efficient process than SA, able to modulate vascular remodeling through pruning of redundant or inefficient blood vessels. We can speculate that IA might have the function of restoring a functional vascular plexus consequently to extensive endothelialitis and alveolar capillary micro-thrombosis observed in Covid-19. Anti-Vascular endothelial growth factor (anti-VEGF) strategies are currently investigated for treatment of severe and critically ill Covid-19 patients, but also FGF2, and its expression and/or signaling, might represent a promising target.
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Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, Vanstapel A, Werlein C, Stark H, Tzankov A, Li WW, Li VW, Mentzer SJ, Jonigk D. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med 2020; 383:120-128. [PMID: 32437596 PMCID: PMC7412750 DOI: 10.1056/nejmoa2015432] [Citation(s) in RCA: 3832] [Impact Index Per Article: 958.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (Covid-19) pandemic. Despite widespread interest in the pathophysiology of the disease, relatively little is known about the associated morphologic and molecular changes in the peripheral lung of patients who die from Covid-19. METHODS We examined 7 lungs obtained during autopsy from patients who died from Covid-19 and compared them with 7 lungs obtained during autopsy from patients who died from acute respiratory distress syndrome (ARDS) secondary to influenza A(H1N1) infection and 10 age-matched, uninfected control lungs. The lungs were studied with the use of seven-color immunohistochemical analysis, micro-computed tomographic imaging, scanning electron microscopy, corrosion casting, and direct multiplexed measurement of gene expression. RESULTS In patients who died from Covid-19-associated or influenza-associated respiratory failure, the histologic pattern in the peripheral lung was diffuse alveolar damage with perivascular T-cell infiltration. The lungs from patients with Covid-19 also showed distinctive vascular features, consisting of severe endothelial injury associated with the presence of intracellular virus and disrupted cell membranes. Histologic analysis of pulmonary vessels in patients with Covid-19 showed widespread thrombosis with microangiopathy. Alveolar capillary microthrombi were 9 times as prevalent in patients with Covid-19 as in patients with influenza (P<0.001). In lungs from patients with Covid-19, the amount of new vessel growth - predominantly through a mechanism of intussusceptive angiogenesis - was 2.7 times as high as that in the lungs from patients with influenza (P<0.001). CONCLUSIONS In our small series, vascular angiogenesis distinguished the pulmonary pathobiology of Covid-19 from that of equally severe influenza virus infection. The universality and clinical implications of our observations require further research to define. (Funded by the National Institutes of Health and others.).
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Affiliation(s)
- Maximilian Ackermann
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Stijn E Verleden
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Mark Kuehnel
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Axel Haverich
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Tobias Welte
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Florian Laenger
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Arno Vanstapel
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Christopher Werlein
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Helge Stark
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Alexandar Tzankov
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - William W Li
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Vincent W Li
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Steven J Mentzer
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
| | - Danny Jonigk
- From the Institute of Pathology and Department of Molecular Pathology, Helios University Clinic Wuppertal, University of Witten-Herdecke, Wuppertal (M.A.), the Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz (M.A.), the Institute of Pathology (M.K., F.L., C.W., H.S., D.J.), the Department of Cardiothoracic, Transplantation, and Vascular Surgery (A.H.), and the Clinic of Pneumology (T.W.), Hannover Medical School, and the German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) (M.K., A.H., T.W., F.L., C.W., H.S., D.J.), Hannover - all in Germany; the Laboratory of Respiratory Diseases, BREATH, Department of Chronic Diseases, Metabolism, and Aging, KU Leuven, Leuven, Belgium (S.E.V., A.V.); the Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland (A.T.); and the Angiogenesis Foundation, Cambridge (W.W.L., V.W.L.), and the Laboratory of Adaptive and Regenerative Biology and the Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston (S.J.M.) - all in Massachusetts
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De Sadeleer LJ, Goos T, Yserbyt J, Wuyts WA. Towards the Essence of Progressiveness: Bringing Progressive Fibrosing Interstitial Lung Disease (PF-ILD) to the Next Stage. J Clin Med 2020; 9:E1722. [PMID: 32503224 PMCID: PMC7355916 DOI: 10.3390/jcm9061722] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/19/2022] Open
Abstract
Although only recently introduced in the ILD community, the concept of progressive fibrosing interstitial lung disease (PF-ILD) has rapidly acquired an important place in the management of non-idiopathic pulmonary fibrosis fibrosing ILD (nonIPF fILD) patients. It confirms a clinical gut feeling that an important subgroup of nonIPF fILD portends a dismal prognosis despite therapeutically addressing the alleged triggering event. Due to several recently published landmark papers showing a treatment benefit with currently available antifibrotic drugs in PF-ILD patients, endorsing a PF-ILD phenotype has vital therapeutic consequences. Importantly, defining progressiveness is based on former progression, which has proven to be a rather moderate predictor of future progression. As fibrosis extent >20% and the presence of honeycombing have superior predictive properties regarding future progression, we advocate immediate initiation of antifibrotic treatment in the presence of these risk factors. In this perspective, we describe the historical context wherein PF-ILD has emerged, determine the currently employed PF-ILD criteria and their inherent limitations and propose new directions to mature its definition. Finally, while ascertaining progression in a nonIPF fILD patient clearly demonstrates the need for (additional) therapy, in the future, therapeutic decisions should be taken after assessing which pathway is ultimately driving the progression. Although not readily available, pathophysiological insight and diagnostic means are emergent to go full steam ahead in this novel direction.
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Affiliation(s)
- Laurens J. De Sadeleer
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, B-3000 Leuven, Belgium; (L.J.D.S.); (T.G.); (J.Y.)
- Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Tinne Goos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, B-3000 Leuven, Belgium; (L.J.D.S.); (T.G.); (J.Y.)
- Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Jonas Yserbyt
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, B-3000 Leuven, Belgium; (L.J.D.S.); (T.G.); (J.Y.)
| | - Wim A. Wuyts
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, B-3000 Leuven, Belgium; (L.J.D.S.); (T.G.); (J.Y.)
- Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, B-3000 Leuven, Belgium
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Yanagihara T, Jones KD. Demystifying morphomolecular alterations of vasculature in interstitial lung diseases. Eur Respir J 2020; 55:55/3/1902446. [PMID: 32165424 DOI: 10.1183/13993003.02446-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Toyoshi Yanagihara
- Firestone Institute for Respiratory Health, Research Institute at St Joseph's Healthcare, Dept of Medicine, McMaster University, Hamilton, ON, Canada .,Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kirk D Jones
- Dept of Pathology, University of California San Francisco, San Francisco, CA, USA
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