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Wang J, Li K, Hao D, Li X, Zhu Y, Yu H, Chen H. Pulmonary fibrosis: pathogenesis and therapeutic strategies. MedComm (Beijing) 2024; 5:e744. [PMID: 39314887 PMCID: PMC11417429 DOI: 10.1002/mco2.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 09/25/2024] Open
Abstract
Pulmonary fibrosis (PF) is a chronic and progressive lung disease characterized by extensive alterations of cellular fate and function and excessive accumulation of extracellular matrix, leading to lung tissue scarring and impaired respiratory function. Although our understanding of its pathogenesis has increased, effective treatments remain scarce, and fibrotic progression is a major cause of mortality. Recent research has identified various etiological factors, including genetic predispositions, environmental exposures, and lifestyle factors, which contribute to the onset and progression of PF. Nonetheless, the precise mechanisms by which these factors interact to drive fibrosis are not yet fully elucidated. This review thoroughly examines the diverse etiological factors, cellular and molecular mechanisms, and key signaling pathways involved in PF, such as TGF-β, WNT/β-catenin, and PI3K/Akt/mTOR. It also discusses current therapeutic strategies, including antifibrotic agents like pirfenidone and nintedanib, and explores emerging treatments targeting fibrosis and cellular senescence. Emphasizing the need for omni-target approaches to overcome the limitations of current therapies, this review integrates recent findings to enhance our understanding of PF and contribute to the development of more effective prevention and management strategies, ultimately improving patient outcomes.
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Affiliation(s)
- Jianhai Wang
- Department of Respiratory MedicineHaihe HospitalTianjin UniversityTianjinChina
- Department of TuberculosisHaihe HospitalTianjin UniversityTianjinChina
- Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese MedicineTianjin Institute of Respiratory DiseasesTianjinChina
- Tianjin Key Laboratory of Lung Regenerative Medicine, Haihe HospitalTianjin UniversityTianjinChina
| | - Kuan Li
- Department of Respiratory MedicineHaihe HospitalTianjin UniversityTianjinChina
- Department of TuberculosisHaihe HospitalTianjin UniversityTianjinChina
- Tianjin Key Laboratory of Lung Regenerative Medicine, Haihe HospitalTianjin UniversityTianjinChina
| | - De Hao
- Department of Respiratory MedicineHaihe HospitalTianjin UniversityTianjinChina
| | - Xue Li
- Department of Respiratory MedicineHaihe HospitalTianjin UniversityTianjinChina
- Department of TuberculosisHaihe HospitalTianjin UniversityTianjinChina
- Tianjin Key Laboratory of Lung Regenerative Medicine, Haihe HospitalTianjin UniversityTianjinChina
| | - Yu Zhu
- Department of Clinical LaboratoryNankai University Affiliated Third Central HospitalTianjinChina
- Department of Clinical LaboratoryThe Third Central Hospital of TianjinTianjin Key Laboratory of Extracorporeal Life Support for Critical DiseasesArtificial Cell Engineering Technology Research Center of TianjinTianjin Institute of Hepatobiliary DiseaseTianjinChina
| | - Hongzhi Yu
- Tianjin Key Laboratory of Lung Regenerative Medicine, Haihe HospitalTianjin UniversityTianjinChina
| | - Huaiyong Chen
- Department of Respiratory MedicineHaihe HospitalTianjin UniversityTianjinChina
- Department of TuberculosisHaihe HospitalTianjin UniversityTianjinChina
- Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese MedicineTianjin Institute of Respiratory DiseasesTianjinChina
- Tianjin Key Laboratory of Lung Regenerative Medicine, Haihe HospitalTianjin UniversityTianjinChina
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Eichstaedt CA, Haas SO, Shaukat M, Grünig E. Genetic background of pulmonary (vascular) diseases - how much is written in the codes? Curr Opin Pulm Med 2024; 30:429-436. [PMID: 38913028 DOI: 10.1097/mcp.0000000000001090] [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: 06/25/2024]
Abstract
PURPOSE OF REVIEW To provide a comprehensive overview of the underlying genetic defects of pulmonary (vascular) diseases and novel treatment avenues. RECENT FINDINGS Pulmonary arterial hypertension (PAH) is the prime example of a pulmonary vascular disease, which can be caused by genetic mutations in some patients. Germline mutations in the BMPR2 gene and further genes lead to vessel remodelling, increase of pulmonary vascular resistance and onset of heritable PAH. The PAH genes with the highest evidence and strategies for genetic testing and counselling have been assessed and evaluated in 2023 by international expert consortia. Moreover, first treatment options have just arisen targeting the molecular basis of PAH. SUMMARY Apart from PAH, this review touches on the underlying genetic causes of further lung diseases including alpha 1 antitrypsin deficiency, cystic fibrosis, familial pulmonary fibrosis and lymphangioleiomyomatosis. We point out the main disease genes, the underlying pathomechanisms and novel therapies trying not only to relieve symptoms but to treat the molecular causes of the diseases.
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Affiliation(s)
- Christina A Eichstaedt
- Center for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Germany and Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL)
- Laboratory for Molecular Diagnostics, Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Simon O Haas
- Center for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Germany and Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL)
| | - Memoona Shaukat
- Center for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Germany and Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL)
- Laboratory for Molecular Diagnostics, Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Ekkehard Grünig
- Center for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Germany and Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL)
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3
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Borie R, Ba I, Debray MP, Kannengiesser C, Crestani B. Syndromic genetic causes of pulmonary fibrosis. Curr Opin Pulm Med 2024; 30:473-483. [PMID: 38896087 DOI: 10.1097/mcp.0000000000001088] [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: 06/21/2024]
Abstract
PURPOSE OF REVIEW The identification of extra-pulmonary symptoms plays a crucial role in diagnosing interstitial lung disease (ILD). These symptoms not only indicate autoimmune diseases but also hint at potential genetic disorders, suggesting a potential overlap between genetic and autoimmune origins. RECENT FINDINGS Genetic factors contributing to ILD are predominantly associated with telomere (TRG) and surfactant-related genes. While surfactant-related gene mutations typically manifest with pulmonary involvement alone, TRG mutations were initially linked to syndromic forms of pulmonary fibrosis, known as telomeropathies, which may involve hematological and hepatic manifestations with variable penetrance. Recognizing extra-pulmonary signs indicative of telomeropathy should prompt the analysis of TRG mutations, the most common genetic cause of familial pulmonary fibrosis. Additionally, various genetic diseases causing ILD, such as alveolar proteinosis, alveolar hemorrhage, or unclassifiable pulmonary fibrosis, often present as part of syndromes that include hepatic, hematological, or skin disorders. SUMMARY This review explores the main genetic conditions identified over the past two decades.
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Affiliation(s)
- Raphaël Borie
- Service de Pneumologie A Hôpital Bichat, APHP, Paris, France, Université Paris Cité, Inserm, PHERE, Université Paris Cité
| | | | | | | | - Bruno Crestani
- Service de Pneumologie A Hôpital Bichat, APHP, Paris, France, Université Paris Cité, Inserm, PHERE, Université Paris Cité
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4
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Adegunsoye A, Kropski JA, Behr J, Blackwell TS, Corte TJ, Cottin V, Glanville AR, Glassberg MK, Griese M, Hunninghake GM, Johannson KA, Keane MP, Kim JS, Kolb M, Maher TM, Oldham JM, Podolanczuk AJ, Rosas IO, Martinez FJ, Noth I, Schwartz DA. Genetics and Genomics of Pulmonary Fibrosis: Charting the Molecular Landscape and Shaping Precision Medicine. Am J Respir Crit Care Med 2024; 210:401-423. [PMID: 38573068 PMCID: PMC11351799 DOI: 10.1164/rccm.202401-0238so] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/04/2024] [Indexed: 04/05/2024] Open
Abstract
Recent genetic and genomic advancements have elucidated the complex etiology of idiopathic pulmonary fibrosis (IPF) and other progressive fibrotic interstitial lung diseases (ILDs), emphasizing the contribution of heritable factors. This state-of-the-art review synthesizes evidence on significant genetic contributors to pulmonary fibrosis (PF), including rare genetic variants and common SNPs. The MUC5B promoter variant is unusual, a common SNP that markedly elevates the risk of early and established PF. We address the utility of genetic variation in enhancing understanding of disease pathogenesis and clinical phenotypes, improving disease definitions, and informing prognosis and treatment response. Critical research gaps are highlighted, particularly the underrepresentation of non-European ancestries in PF genetic studies and the exploration of PF phenotypes beyond usual interstitial pneumonia/IPF. We discuss the role of telomere length, often critically short in PF, and its link to progression and mortality, underscoring the genetic complexity involving telomere biology genes (TERT, TERC) and others like SFTPC and MUC5B. In addition, we address the potential of gene-by-environment interactions to modulate disease manifestation, advocating for precision medicine in PF. Insights from gene expression profiling studies and multiomic analyses highlight the promise for understanding disease pathogenesis and offer new approaches to clinical care, therapeutic drug development, and biomarker discovery. Finally, we discuss the ethical, legal, and social implications of genomic research and therapies in PF, stressing the need for sound practices and informed clinical genetic discussions. Looking forward, we advocate for comprehensive genetic testing panels and polygenic risk scores to improve the management of PF and related ILDs across diverse populations.
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Affiliation(s)
- Ayodeji Adegunsoye
- Pulmonary/Critical Care, and
- Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois
| | - Jonathan A. Kropski
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee
- Department of Veterans Affairs Medical Center, Nashville, Tennessee
| | - Juergen Behr
- Department of Medicine V, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
- Comprehensive Pneumology Center Munich, member of the German Center for Lung Research (DZL), Munich, Germany
| | - Timothy S. Blackwell
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee
- Department of Veterans Affairs Medical Center, Nashville, Tennessee
| | - Tamera J. Corte
- Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases (OrphaLung), Louis Pradel Hospital, Hospices Civils de Lyon, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Lyon, France
- Claude Bernard University Lyon, Lyon, France
| | - Allan R. Glanville
- Lung Transplant Unit, St. Vincent’s Hospital Sydney, Sydney, New South Wales, Australia
| | - Marilyn K. Glassberg
- Department of Medicine, Loyola Chicago Stritch School of Medicine, Chicago, Illinois
| | - Matthias Griese
- Department of Pediatric Pneumology, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University, German Center for Lung Research, Munich, Germany
| | - Gary M. Hunninghake
- Harvard Medical School, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Michael P. Keane
- Department of Respiratory Medicine, St. Vincent’s University Hospital and School of Medicine, University College Dublin, Dublin, Ireland
| | - John S. Kim
- Department of Medicine, School of Medicine, and
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Toby M. Maher
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Justin M. Oldham
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | | | | | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York; and
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia
| | - David A. Schwartz
- Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado
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Zamora AC, Ortega VE, Carmona EM. When the Third Time Is Not the Charm-Trial Outcomes in Idiopathic Pulmonary Fibrosis. JAMA 2024; 332:374-376. [PMID: 38762799 DOI: 10.1001/jama.2024.8776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Affiliation(s)
- Ana C Zamora
- Department of Internal Medicine, Division of Respiratory Medicine, Mayo Clinic, Phoenix, Arizona
- Interstitial Lung Disease Clinic, Mayo Clinic, Phoenix, Arizona
| | - Victor E Ortega
- Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona
- Associate Editor, JAMA
| | - Eva M Carmona
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
- Interstitial Lung Disease Clinic, Mayo Clinic, Rochester, Minnesota
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Villeneuve J, Tremblay É, Gaudreault N, Saavedra Armero V, Boudreau DK, Li Z, Renaut S, Dion G, Bossé Y. A Test to Comprehensively Capture the Known Genetic Component of Familial Pulmonary Fibrosis. Am J Respir Cell Mol Biol 2024; 70:437-445. [PMID: 38363828 PMCID: PMC11160413 DOI: 10.1165/rcmb.2024-0009ma] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/15/2024] [Indexed: 02/18/2024] Open
Abstract
The recent European Respiratory Society statement on familial pulmonary fibrosis supports the need for genetic testing in the care of patients and their relatives. However, no solution (i.e., a concrete test) was provided to implement genetic testing in daily practice. Herein, we tabulated and standardized the nomenclature of 128 genetic variants in 20 genes implicated in adult-onset pulmonary fibrosis. The objective was to develop a laboratory-developed test (LDT) on the basis of standard Sanger sequencing to capture all known familial pulmonary fibrosis-associated variants. Targeted DNA fragments were amplified using harmonized PCR conditions to perform the LDT in a single 96-well plate. The new genetic test was evaluated in 62 sporadic cases of idiopathic pulmonary fibrosis. As expected in this population, we observed a low yield of disease-causing mutations. More important, 100% of targeted variants by the LDT were successfully evaluated. Furthermore, four variants of uncertain significance with in silico-predicted deleterious scores were identified in three patients, suggesting novel pathogenic variants in genes known to cause idiopathic pulmonary fibrosis. Finally, the MUC5B promoter variant rs35705950 was strongly enriched in these patients with a minor allele frequency of 41.1% compared with 10.6% in a matched population-based cohort (n = 29,060), leading to an estimation that this variant may explain up to 35% of the population-attributable risk. This LDT provides a solution for rapid clinical translation. Technical laboratory details are provided so that specialized pulmonary centers can implement the LDT in house to expedite the clinical recommendations of expert panels.
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Affiliation(s)
- Judith Villeneuve
- Institut Universitaire de Cardiologie et de Pneumologie de Québec and
| | - Élody Tremblay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec and
| | | | | | | | - Zhonglin Li
- Institut Universitaire de Cardiologie et de Pneumologie de Québec and
| | - Sébastien Renaut
- Institut Universitaire de Cardiologie et de Pneumologie de Québec and
| | - Geneviève Dion
- Institut Universitaire de Cardiologie et de Pneumologie de Québec and
| | - Yohan Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec and
- Département de Médecine Moléculaire, Université Laval, Québec, Québec, Canada
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7
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Hurley K, Ozaki M, Philippot Q, Galvin L, Crosby D, Kirwan M, Gill DR, Alysandratos KD, Jenkins G, Griese M, Nathan N, Borie R. A roadmap to precision treatments for familial pulmonary fibrosis. EBioMedicine 2024; 104:105135. [PMID: 38718684 PMCID: PMC11096859 DOI: 10.1016/j.ebiom.2024.105135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
Interstitial lung diseases (ILDs) in adults and children (chILD) are a heterogeneous group of lung disorders leading to inflammation, abnormal tissue repair and scarring of the lung parenchyma often resulting in respiratory failure and death. Inherited factors directly cause, or contribute significantly to the risk of developing ILD, so called familial pulmonary fibrosis (FPF), and monogenic forms may have a poor prognosis and respond poorly to current treatments. Specific, variant-targeted or precision treatments are lacking. Clinical trials of repurposed drugs, anti-fibrotic medications and specific treatments are emerging but for many patients no interventions exist. We convened an expert working group to develop an overarching framework to address the existing research gaps in basic, translational, and clinical research and identified areas for future development of preclinical models, candidate medications and innovative clinical trials. In this Position Paper, we summarise working group discussions, recommendations, and unresolved questions concerning precision treatments for FPF.
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Affiliation(s)
- Killian Hurley
- Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland; Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
| | - Mari Ozaki
- Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland; Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Quentin Philippot
- Université Paris Cité, Inserm, PHERE, Hôpital Bichat, AP-HP, Service de Pneumologie A, Centre Constitutif du Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Paris, France; Physiopathology and Epidemiology of Respiratory Diseases, Inserm U1152, UFR de Médecine, Université Paris Cité, 75018, Paris, France
| | - Liam Galvin
- European Pulmonary Fibrosis Federation, Overijse, Belgium
| | | | - Mary Kirwan
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deborah R Gill
- UK Respiratory Gene Therapy Consortium, London, United Kingdom; Gene Medicine Research Group, Radcliffe Department of Medicine (NDCLS), University of Oxford, Oxford, United Kingdom
| | - Konstantinos-Dionysios Alysandratos
- Center for Regenerative Medicine, Boston University and Boston Medical Center, Boston, MA, 02118, USA; The Pulmonary Center and Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Gisli Jenkins
- Imperial College London, 4615, National Heart & Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Matthias Griese
- Department of Pediatric Pneumology, German Center for Lung Research (DZL), Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Nadia Nathan
- Sorbonne Université, Pediatric Pulmonology and Reference Center for Rare Lung Diseases RespiRare, Inserm U933 Laboratory of Childhood Genetic Diseases, Armand Trousseau Hospital, APHP, Paris, France
| | - Raphael Borie
- Université Paris Cité, Inserm, PHERE, Hôpital Bichat, AP-HP, Service de Pneumologie A, Centre Constitutif du Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Paris, France
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8
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Raghu G, Torres JM, Bennett RL. Genetic factors for ILD-the path of precision medicine. THE LANCET. RESPIRATORY MEDICINE 2024; 12:350-352. [PMID: 38521082 DOI: 10.1016/s2213-2600(24)00071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Ganesh Raghu
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA 98195, USA.
| | - Juliet M Torres
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Robin L Bennett
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA 98195, USA
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9
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Brudon A, Legendre M, Mageau A, Bermudez J, Bonniaud P, Bouvry D, Cadranel J, Cazes A, Crestani B, Dégot T, Delestrain C, Diesler R, Epaud R, Philippot Q, Théou-Anton N, Kannengiesser C, Ba I, Debray MP, Fanen P, Manali E, Papiris S, Nathan N, Amselem S, Gondouin A, Guillaumot A, Andréjak C, Jouneau S, Beltramo G, Uzunhan Y, Galodé F, Westeel V, Mehdaoui A, Hirschi S, Leroy S, Marchand-Adam S, Nunes H, Picard C, Prévot G, Reynaud-Gaubert M, De Vuyst P, Wemeau L, Defossez G, Zalcman G, Cottin V, Borie R. High risk of lung cancer in surfactant-related gene variant carriers. Eur Respir J 2024; 63:2301809. [PMID: 38575158 PMCID: PMC11063619 DOI: 10.1183/13993003.01809-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Several rare surfactant-related gene (SRG) variants associated with interstitial lung disease are suspected to be associated with lung cancer, but data are missing. We aimed to study the epidemiology and phenotype of lung cancer in an international cohort of SRG variant carriers. METHODS We conducted a cross-sectional study of all adults with SRG variants in the OrphaLung network and compared lung cancer risk with telomere-related gene (TRG) variant carriers. RESULTS We identified 99 SRG adult variant carriers (SFTPA1 (n=18), SFTPA2 (n=31), SFTPC (n=24), ABCA3 (n=14) and NKX2-1 (n=12)), including 20 (20.2%) with lung cancer (SFTPA1 (n=7), SFTPA2 (n=8), SFTPC (n=3), NKX2-1 (n=2) and ABCA3 (n=0)). Among SRG variant carriers, the odds of lung cancer was associated with age (OR 1.04, 95% CI 1.01-1.08), smoking (OR 20.7, 95% CI 6.60-76.2) and SFTPA1/SFTPA2 variants (OR 3.97, 95% CI 1.39-13.2). Adenocarcinoma was the only histological type reported, with programmed death ligand-1 expression ≥1% in tumour cells in three samples. Cancer staging was localised (I/II) in eight (40%) individuals, locally advanced (III) in two (10%) and metastatic (IV) in 10 (50%). We found no somatic variant eligible for targeted therapy. Seven cancers were surgically removed, 10 received systemic therapy, and three received the best supportive care according to their stage and performance status. The median overall survival was 24 months, with stage I/II cancers showing better survival. We identified 233 TRG variant carriers. The comparative risk (subdistribution hazard ratio) for lung cancer in SRG patients versus TRG patients was 18.1 (95% CI 7.1-44.7). CONCLUSIONS The high risk of lung cancer among SRG variant carriers suggests specific screening and diagnostic and therapeutic challenges. The benefit of regular computed tomography scan follow-up should be evaluated.
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Affiliation(s)
- Alexandre Brudon
- Service d'Oncologie Thoracique, Hôpital Bichat, AP-HP, Institut du Cancer AP-HP Nord, Paris, France
- Université Paris Cité, Inserm CIC-EC 1425, Paris, France
- A. Brudon and M. Legendre contributed equally to this work
| | - Marie Legendre
- UF de Génétique Moléculaire, Hôpital Armand Trousseau, AP-HP, Paris, France
- Sorbonne Université, Inserm UMR-S 933, Maladies Génétiques d'Expression Pédiatrique, Paris, France
- A. Brudon and M. Legendre contributed equally to this work
| | - Arthur Mageau
- Département de Médecine Interne, Hôpital Bichat, AP-HP, Paris, France
- Université Paris Cité, Inserm IAME UMR 1137 Team Descid, Paris, France
| | - Julien Bermudez
- Service de Pneumologie, Centre de Compétences de Maladies Pulmonaires Rares et de Transplantation Pulmonaire, CHU Nord, AP-HM, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Philippe Bonniaud
- Department of Respiratory Diseases and Intensive Care, Reference Constitutive Center for Adult Rare Pulmonary Diseases, Dijon-Bourgogne University Hospital, University of Burgundy, Inserm UMR1231, Dijon, France
| | - Diane Bouvry
- Département de Pneumologie, Hôpital Avicenne, AP-HP, Bobigny, France
- Université Paris 13, Inserm UMR U1272, Bobigny, France
| | - Jacques Cadranel
- Service de Pneumologie et Oncologie Thoracique, DMU APPROCHES, Hôpital Tenon, AP-HP, Paris, France
- Sorbonne Université, GRC04 Theranoscan, Paris, France
| | - Aurélie Cazes
- Département d'Anatomie Pathologique, Hôpital Bichat, AP-HP, Paris, France
- Université Paris Cité, Inserm UMR-S 1152 PHERE, Paris, France
| | - Bruno Crestani
- Université Paris Cité, Inserm UMR-S 1152 PHERE, Paris, France
- Service de Pneumologie A, Hôpital Bichat, AP-HP, Paris, France
| | - Tristan Dégot
- Centre de Référence pour les Maladies Respiratoires Rares RespiRare, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Céline Delestrain
- Université de Paris Est Créteil, Inserm IMRB, Créteil, France
- Service de Pneumologie, Centre National Coordinateur de Référence des Pathologies Pulmonaires Rares, ERN-LUNG, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Rémi Diesler
- Université Claude Bernard Lyon 1, Lyon, France
- Département de Génétique, Hôpital Bichat, AP-HP, Institut du Cancer AP-HP Nord, Paris, France
| | - Ralph Epaud
- Centre de Référence pour les Maladies Respiratoires Rares RespiRare, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Université de Paris Est Créteil, Inserm IMRB, Créteil, France
| | - Quentin Philippot
- Université Paris Cité, Inserm UMR-S 1152 PHERE, Paris, France
- Service de Pneumologie A, Hôpital Bichat, AP-HP, Paris, France
| | - Nathalie Théou-Anton
- Université Paris Cité, Paris, France
- Service de Radiologie, Hôpital Bichat, AP-HP, Paris, France
| | - Caroline Kannengiesser
- Département de Génétique, Hôpital Bichat, AP-HP, Institut du Cancer AP-HP Nord, Paris, France
- Université Paris Cité, Paris, France
| | - Ibrahima Ba
- Département de Génétique, Hôpital Bichat, AP-HP, Institut du Cancer AP-HP Nord, Paris, France
- Université Paris Cité, Paris, France
| | - Marie-Pierre Debray
- Université Paris Cité, Paris, France
- Service de Radiologie, Hôpital Bichat, AP-HP, Paris, France
| | - Pascale Fanen
- Université de Paris Est Créteil, Inserm IMRB, Créteil, France
- Service de Radiologie, Hôpital Bichat, AP-HP, Paris, France
| | - Efrosine Manali
- Département de Pneumologie Pédiatrique, Centre de Référence des Maladies Respiratoires Rares RespiRare, Paris, France
| | - Spyros Papiris
- General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nadia Nathan
- Sorbonne Université, Inserm UMR-S 933, Maladies Génétiques d'Expression Pédiatrique, Paris, France
- Service de Pneumologie, Centre des Maladies Pulmonaires Rares, Hôpital de Besançon, Besançon, France
| | - Serge Amselem
- UF de Génétique Moléculaire, Hôpital Armand Trousseau, AP-HP, Paris, France
- Sorbonne Université, Inserm UMR-S 933, Maladies Génétiques d'Expression Pédiatrique, Paris, France
| | - Antoine Gondouin
- Service de Pneumologie, Hôpital de Brabois, Vandoeuvre-les-Nancy, France
| | - Anne Guillaumot
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, France
| | - Claire Andréjak
- EA 4294, AGIR, Jules Verne Picardy University, Amiens, France
- Service de Pneumologie, Centre de Référence Maladies Pulmonaires Rares, Hôpital Pontchaillou, CHU Rennes, Inserm UMR1085 IRSET, Université de Rennes 1, EHESP, Rennes, France
| | - Stephane Jouneau
- Pediatrics Department, Pediatric Pulmonology, CHU Bordeaux, Bordeaux, France
| | - Guillaume Beltramo
- Department of Respiratory Diseases and Intensive Care, Reference Constitutive Center for Adult Rare Pulmonary Diseases, Dijon-Bourgogne University Hospital, University of Burgundy, Inserm UMR1231, Dijon, France
| | - Yurdagul Uzunhan
- Département de Pneumologie, Hôpital Avicenne, AP-HP, Bobigny, France
| | - François Galodé
- Pneumonology and Thoracic Oncology Department, Eure-Seine Hospital Center, Évreux, France
| | - Virginie Westeel
- Service de Pneumologie, Centre des Maladies Pulmonaires Rares, Hôpital de Besançon, Besançon, France
| | - Anas Mehdaoui
- Service de pneumologie, FHU Oncoage, Hôpital Pasteur - CHU Nice, Nice, France
| | - Sandrine Hirschi
- Service de Pneumologie, Groupe de Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sylvie Leroy
- Université Nice Côte d'Azur, Nice, France
- Service de Pneumologie, Hôpital de Tours, Tours, France
| | - Sylvain Marchand-Adam
- Université de Tours, Inserm U1100, Tours, France
- Service de Pneumologie et de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Hilario Nunes
- Département de Pneumologie, Hôpital Avicenne, AP-HP, Bobigny, France
- Université Paris 13, Inserm UMR U1272, Bobigny, France
| | - Clément Picard
- Service de Pneumologie, Hôpital Larrey, Toulouse, France
| | | | - Martine Reynaud-Gaubert
- Service de Pneumologie, Centre de Compétences de Maladies Pulmonaires Rares et de Transplantation Pulmonaire, CHU Nord, AP-HM, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Paul De Vuyst
- Service de Pneumologie et Immuno-allergie, Institut Coeur-Poumon, Lille, France
| | | | | | - Gérard Zalcman
- Service d'Oncologie Thoracique, Hôpital Bichat, AP-HP, Institut du Cancer AP-HP Nord, Paris, France
- Université Paris Cité, Inserm CIC-EC 1425, Paris, France
| | - Vincent Cottin
- Service de Pneumologie, Centre National Coordinateur de Référence des Pathologies Pulmonaires Rares, ERN-LUNG, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
| | - Raphael Borie
- Université Paris Cité, Inserm UMR-S 1152 PHERE, Paris, France
- Service de Pneumologie A, Hôpital Bichat, AP-HP, Paris, France
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10
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Dickinson JL, Lucas SEM. Familial pulmonary fibrosis: Defining inherited fibrotic lung disease in the era of clinical genetic testing. Respirology 2024; 29:271-273. [PMID: 38302099 DOI: 10.1111/resp.14668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
See related article
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Affiliation(s)
- Joanne L Dickinson
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Sionne E M Lucas
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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11
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Alrehaili G, Kemppainen J, Kalra S, Pinto E Vairo F, Moua T, Yi ES, Ferrer A, Patnaik MM, Carmona EM. Genetic Testing Goes Beyond Imaging and Histological Evaluation in Pleuroparenchymal Fibroelastosis. Lung 2024; 202:151-156. [PMID: 38461429 PMCID: PMC11009725 DOI: 10.1007/s00408-024-00685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/17/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Lung biopsy remains the gold standard in the diagnosis of fibrotic interstitial lung disease (F-ILD), but there is a growing appreciation of the role of pathogenic gene variants in telomere and surfactant protein genes, especially in familial pulmonary fibrosis (FPF). Pleuroparenchymal fibroelastosis (PPFE) is a rare disease that can coexist with different patterns of F-ILD, including FPF. It can be progressive and often leads to respiratory failure and death. This study tested the hypothesis that genetic testing goes beyond radiological and histological findings in PPFE and other F-ILD further informing clinical decision-making for patients and affected family members by identifying pathological gene variants in telomere and surfactant protein genes. METHODS This is a retrospective review of 70 patients with F-ILD in the setting of FPF or premature lung fibrosis. Six out of 70 patients were diagnosed with PPFE based on radiological or histological characteristics. All patients underwent telomere length evaluation in peripheral blood by Flow-FISH or genetic testing using a customized exome-based panel that included telomere and surfactant protein genes associated with lung fibrosis. RESULTS Herein, we identified six individuals where radiographic or histopathological analyses of PPFE were linked with telomere biology disorders (TBD) or variants in surfactant protein genes. Each case involved individuals with either personal early-onset lung fibrosis or a family history of the disease. Assessments of telomere length and genetic testing offered insights beyond traditional radiological and histopathological evaluations. CONCLUSION Detecting anomalies in TBD-related or surfactant protein genes can significantly refine the diagnosis and treatment strategies for individuals with PPFE and other F-ILD.
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Affiliation(s)
- Ghadah Alrehaili
- Department of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Kemppainen
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Sanjay Kalra
- Department of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Filippo Pinto E Vairo
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Teng Moua
- Department of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Eunhee S Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Alejandro Ferrer
- Hematology/Oncology Departments, Mayo Clinic, Rochester, MN, USA
| | - Mrinal M Patnaik
- Hematology/Oncology Departments, Mayo Clinic, Rochester, MN, USA
| | - Eva M Carmona
- Department of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA.
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12
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Froidure A, Bondue B, Dahlqvist C, Guiot J, Gusbin N, Wirtz G, Brusselle G, Strens D, Slabbynck H, Wuyts WA. Clinical course of suspected familial and sporadic idiopathic pulmonary fibrosis: Data from the PROOF-Next registry. Respirology 2024; 29:304-311. [PMID: 38123492 DOI: 10.1111/resp.14650] [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: 05/22/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Real-life data on suspected familial fibrosis, defined as the occurrence of the disease in a patient younger than 50 and/or having at least one relative affected by pulmonary fibrosis remain scarce. METHODS The Belgian and Luxembourg IPF registry (PROOF-Next) is a multicentric prospective longitudinal and observational study set in Belgium and Luxembourg. We compared characteristics and clinical course of patients with suspected familial pulmonary fibrosis (FPF) and sporadic IPF. RESULTS We included 618 patients in the analysis, of whom 76 (12%) fulfilled criteria for FPF. They were significantly younger than sIPF (median age (range) 65 (43-87), vs. 72 (51-98), p = 0.0001). Male gender proportion and smoking status did not differ between groups, but the number of pack-year among current and former smokers was lower in FPF (20 vs. 25, p = 0.02). Besides, 87% of FPF and 76% of sIPF were treated with antifibrotic (p = 0.047). Baseline pulmonary function tests were similar in both groups, as well as median time before progression and transplant-free survival. Finally, genetic testing, performed in a minority, led to the identification of 10 telomerase-related gene variants. CONCLUSION Although younger and exposed to less tobacco, patients with FPF show an equally aggressive progression as observed in sporadic IPF patients. These results warrant early referral of FPF patients to expert centres for optimal management.
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Affiliation(s)
- Antoine Froidure
- Pulmonology Department, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
- European Reference Network for Rare Pulmonary Diseases (ERN-LUNG)
| | - Benjamin Bondue
- European Reference Network for Rare Pulmonary Diseases (ERN-LUNG)
- Pulmonology Department, Hôpital Erasme, Bruxelles, Belgium
| | | | - Julien Guiot
- Pulmonology Department, CHU Liège, Liège, Belgium
| | | | - Gil Wirtz
- Pulmonology Department, CHL Luxembourg, Luxembourg, Luxembourg
| | - Guy Brusselle
- European Reference Network for Rare Pulmonary Diseases (ERN-LUNG)
- Pulmonology Department, Ghent University Hospital, Gent, Belgium
| | | | - Hans Slabbynck
- Pulmonology Department, ZNA Middelheim, Antwerpen, Belgium
| | - Wim A Wuyts
- European Reference Network for Rare Pulmonary Diseases (ERN-LUNG)
- Pulmonology Department, UZ Leuven, Leuven, Belgium
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13
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Bermudo G, Roman-Rodriguez M, Molina-Molina M. Interstitial lung diseases: never forget to think about it in primary care. Expert Rev Respir Med 2024; 18:9-15. [PMID: 38486433 DOI: 10.1080/17476348.2024.2331763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Guadalupe Bermudo
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- Respiratory Diseases Network Research Consortium (CIBERES), Spain
| | - Miguel Roman-Rodriguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma de Mallorca, Spain
- Son Pisa Primary Care health centre, Palma de Mallorca, Spain
| | - Maria Molina-Molina
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- Respiratory Diseases Network Research Consortium (CIBERES), Spain
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14
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Del Valle KT, Carmona EM. Diagnosis and Management of Pulmonary Manifestations of Telomere Biology Disorders. Curr Hematol Malig Rep 2023:10.1007/s11899-023-00720-9. [PMID: 38159192 DOI: 10.1007/s11899-023-00720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE OF REVIEW Telomere biology disorders (TBD) are a group of genetic disorders characterized by premature shortening of telomeres, resulting in accelerated aging of somatic cells. This often leads to major multisystem organ dysfunction, and TBDs have become increasingly recognized as a significant contributor to numerous disease processes within the past 10-15 years. Both research and clinical practice in this field are rapidly evolving. RECENT FINDINGS A subset of patients with TBD suffers from interstitial lung disease, most commonly pulmonary fibrosis. Often, the clinical presentation is indistinguishable from other forms of lung fibrosis. There are no pathognomonic radiographic or histological features, and a high level of suspicion is therefore required. Telomere evaluation is thus crucial to establishing the diagnosis. This review details the clinical presentation, objective evaluation, indicated genetic testing, and recommended management strategies for patients affected by interstitial lung disease associated with TBDs. Our goal is to empower pulmonologists and other healthcare professionals who care for these patients to provide appropriate and personalized care for this population.
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Affiliation(s)
- Kathryn T Del Valle
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eva M Carmona
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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15
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Goos T, Dubbeldam A, Vermant M, Gogaert S, De Sadeleer LJ, De Crem N, De Langhe E, Yserbyt J, Weynand B, Carlon MS, Verschakelen J, Vermeer S, Verleden SE, Wuyts WA. Intrafamilial Correlation and Variability in the Clinical Evolution of Pulmonary Fibrosis. Chest 2023; 164:1476-1480. [PMID: 37437878 DOI: 10.1016/j.chest.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Tinne Goos
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Adriana Dubbeldam
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Marie Vermant
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Stefan Gogaert
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Laurens J De Sadeleer
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Institute of Lung Biology and Disease and Comprehensive Pneumology Center, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nico De Crem
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Ellen De Langhe
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Marianne S Carlon
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | | | - Sascha Vermeer
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Department of Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Edegem, Belgium; Department of Respiratory Medicine, University Hospital Antwerp, Edegem, Belgium
| | - Wim A Wuyts
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
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16
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Klay D, Kazemier KM, van der Vis JJ, Smits HM, Grutters JC, van Moorsel CHM. New Insights via RNA Profiling of Formalin-Fixed Paraffin-Embedded Lung Tissue of Pulmonary Fibrosis Patients. Int J Mol Sci 2023; 24:16748. [PMID: 38069069 PMCID: PMC10706203 DOI: 10.3390/ijms242316748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
In sporadic idiopathic pulmonary fibrosis (sIPF) and pulmonary fibrosis caused by a mutation in telomere (TRG-PF) or surfactant related genes (SRG-PF), there are a number of aberrant cellular processes known that can lead to fibrogenesis. We investigated whether RNA expression of genes involved in these processes differed between sIPF, TRG-PF, and SRG-PF and whether expression levels were associated with survival. RNA expression of 28 genes was measured in lung biopsies of 26 sIPF, 17 TRG-PF, and 6 SRG-PF patients. Significant differences in RNA expression of TGFBR2 (p = 0.02) and SFTPA2 (p = 0.02) were found between sIPF, TRG-PF, and SRG-PF. Patients with low (
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Affiliation(s)
- Dymph Klay
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Karin M. Kazemier
- Center of Translational Immunology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Division of Heart and Lungs, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Joanne J. van der Vis
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Department of Clinical Chemistry, ILD Center of Excellence, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Hidde M. Smits
- Center of Translational Immunology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Jan C. Grutters
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Division of Heart and Lungs, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Coline H. M. van Moorsel
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
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17
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Manali ED, Griese M, Papiris SA. Lung transplantation outcome in adult surfactant-related interstitial lung disease: first evidence to move on. ERJ Open Res 2023; 9:00646-2023. [PMID: 38020569 PMCID: PMC10658612 DOI: 10.1183/23120541.00646-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
A new study reports the first evidence to "move on" with lung transplantation in adult surfactant-related fibrotic ILDs. It highlights the need for better genetic characterisation of transplant candidates and cancer screening for these patients. https://bit.ly/3QxG73Z.
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Affiliation(s)
- Effrosyni D. Manali
- 2nd Pulmonary Department, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- These authors contributed equally
| | - Matthias Griese
- Department of Pediatric Pneumology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, German Center for Lung Research, Munich, Germany
- These authors contributed equally
| | - Spyros A. Papiris
- 2nd Pulmonary Department, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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18
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Bermudez J, Nathan N, Coiffard B, Roux A, Hirschi S, Degot T, Bunel V, Le Pavec J, Macey J, Le Borgne A, Legendre M, Cottin V, Thomas PA, Borie R, Reynaud-Gaubert M. Outcome of lung transplantation for adults with interstitial lung disease associated with genetic disorders of the surfactant system. ERJ Open Res 2023; 9:00240-2023. [PMID: 38020562 PMCID: PMC10658627 DOI: 10.1183/23120541.00240-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Interstitial lung disease associated with genetic disorders of the surfactant system is a rare entity in adults that can lead to lung transplantation. Our objective was to describe the outcome of these patients after lung transplantation. Methods We conducted a retrospective, multicentre study, on adults who underwent lung transplantation for such disease in the French lung transplant centres network, from 1997 to 2018. Results 20 patients carrying mutations in SFTPA1 (n=5), SFTPA2 (n=7) or SFTPC (n=8) were included. Median interquartile range (IQR) age at diagnosis was 45 (40-48) years, and median (IQR) age at lung transplantation was 51 (45-54) years. Median overall survival after transplantation was 8.6 years. Two patients had a pre-transplant history of lung cancer, and two developed post-transplant lung cancer. Female gender and a body mass index <25 kg·m-2 were significantly associated with a better prognosis, whereas transplantation in high emergency was associated with a worst prognosis. Conclusions Lung transplantation in adults with interstitial lung disease associated with genetic disorders of surfactant system may be a valid therapeutic option. Our data suggest that these patients may have a good prognosis. Immunosuppressive protocol was not changed for these patients, and close lung cancer screening is needed before and after transplantation.
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Affiliation(s)
- Julien Bermudez
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique – Hôpitaux de Marseille, Hôpital Nord; Aix-Marseille Université, Marseille, France
| | - Nadia Nathan
- Assistance Publique – Hôpitaux de Paris (APHP) – Sorbonne Université, Inserm Childhood Genetic Disorders and Reference Center for Rare Lung Diseases, Armand Trousseau Hospital, Paris, France
- APHP – Sorbonne Université, Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, Paris, France
| | - Benjamin Coiffard
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique – Hôpitaux de Marseille, Hôpital Nord; Aix-Marseille Université, Marseille, France
| | - Antoine Roux
- Department of Pulmonary Medicine, Foch Hospital, Suresnes, France
| | - Sandrine Hirschi
- Respiratory Medicine and Lung Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Tristan Degot
- Respiratory Medicine and Lung Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Bunel
- AP-HP, Bichat Claude Bernard Hospital, Pulmonology B and Lung Transplant Department, INSERM 1152, Paris, France
| | - Jérôme Le Pavec
- Service de Pneumologie et de Transplantation Pulmonaire, Hôpital Marie-Lannelongue, Groupe hospitalier Paris-Saint Joseph, Le Plessis-Robinson, France
- Université Paris–Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
- UMR_S 999, Université Paris–Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Julie Macey
- Respiratory Medicine and Cystic Fibrosis Center, University Hospital Center of Bordeaux, Bordeaux, France
| | - Aurélie Le Borgne
- Service de Pneumologie, Pôle des voies respiratoires, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Marie Legendre
- Assistance Publique – Hôpitaux de Paris (APHP) – Sorbonne Université, Inserm Childhood Genetic Disorders and Reference Center for Rare Lung Diseases, Armand Trousseau Hospital, Paris, France
- UF de Génétique moléculaire, APHP, Sorbonne Université, Hôpital Armand-Trousseau, Paris, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon; IVPC, INRAE, Claude Bernard University Lyon 1, member of ERN-LUNG, Lyons, France
| | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, North Hospital, Aix-Marseille University, CNRS, INSERM, CRCM, AP-HM, Chemin des Bourrely, Marseille, France
| | - Raphaël Borie
- Service de Pneumologie A, APHP, Hôpital Bichat, Université de Paris and INSERM U1152, Paris, France
| | - Martine Reynaud-Gaubert
- Department of Respiratory Medicine and Lung Transplantation, Assistance Publique – Hôpitaux de Marseille, Hôpital Nord; Aix-Marseille Université, Marseille, France
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19
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Tomos I, Roussis I, Matthaiou AM, Dimakou K. Molecular and Genetic Biomarkers in Idiopathic Pulmonary Fibrosis: Where Are We Now? Biomedicines 2023; 11:2796. [PMID: 37893169 PMCID: PMC10604739 DOI: 10.3390/biomedicines11102796] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) represents a chronic progressive fibrotic interstitial lung disease of unknown cause with an ominous prognosis. It remains an unprecedent clinical challenge due to its delayed diagnosis and unpredictable clinical course. The need for accurate diagnostic, prognostic and predisposition biomarkers in everyday clinical practice becomes more necessary than ever to ensure prompt diagnoses and early treatment. The identification of such blood biomarkers may also unravel novel drug targets against IPF development and progression. So far, the role of diverse blood biomarkers, implicated in various pathogenetic pathways, such as in fibrogenesis (S100A4), extracellular matrix remodelling (YKL-40, MMP-7, ICAM-1, LOXL2, periostin), chemotaxis (CCL-18, IL-8), epithelial cell injury (KL-6, SP-A, SP-D), autophagy and unfolded protein response has been investigated in IPF with various results. Moreover, the recent progress in genetics in IPF allows for a better understanding of the underlying disease mechanisms. So far, the causative mutations in pulmonary fibrosis include mutations in telomere-related genes and in surfactant-related genes, markers that could act as predisposition biomarkers in IPF. The aim of this review is to provide a comprehensive overview from the bench to bedside of current knowledge and recent insights on biomarkers in IPF, and to suggest future directions for research. Large-scale studies are still needed to confirm the exact role of these biomarkers.
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Affiliation(s)
- Ioannis Tomos
- 5th Department of Respiratory Medicine, ‘SOTIRIA’ Chest Diseases Hospital of Athens, 11527 Athens, Greece; (I.R.); (A.M.M.); (K.D.)
| | - Ioannis Roussis
- 5th Department of Respiratory Medicine, ‘SOTIRIA’ Chest Diseases Hospital of Athens, 11527 Athens, Greece; (I.R.); (A.M.M.); (K.D.)
| | - Andreas M. Matthaiou
- 5th Department of Respiratory Medicine, ‘SOTIRIA’ Chest Diseases Hospital of Athens, 11527 Athens, Greece; (I.R.); (A.M.M.); (K.D.)
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 714 09 Heraklion, Greece
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia 2029, Cyprus
| | - Katerina Dimakou
- 5th Department of Respiratory Medicine, ‘SOTIRIA’ Chest Diseases Hospital of Athens, 11527 Athens, Greece; (I.R.); (A.M.M.); (K.D.)
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20
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Spagnolo P, Lee JS. Recent advances in the genetics of idiopathic pulmonary fibrosis. Curr Opin Pulm Med 2023; 29:399-405. [PMID: 37410458 PMCID: PMC10470435 DOI: 10.1097/mcp.0000000000000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
PURPOSE OF REVIEW Genetics contributes substantially to the susceptibility to idiopathic pulmonary fibrosis (IPF). Genetic studies in sporadic and familial disease have identified several IPF-associated variants, mainly in telomere-related and surfactant protein genes.Here, we review the most recent literature on genetics of IPF and discuss how it may contribute to disease pathogenesis. RECENT FINDINGS Recent studies implicate genes involved in telomere maintenance, host defence, cell growth, mammalian target of rapamycin signalling, cell-cell adhesion, regulation of TGF-β signalling and spindle assembly as biological processes involved in the pathogenesis of IPF. Both common and rare genetic variants contribute to the overall risk of IPF; however, while common variants (i.e. polymorphisms) account for most of the heritability of sporadic disease, rare variants (i.e. mutations), mainly in telomere-related genes, are the main contributors to the heritability of familial disease. Genetic factors are likely to also influence disease behaviour and prognosis. Finally, recent data suggest that IPF shares genetic associations - and probably some pathogenetic mechanisms - with other fibrotic lung diseases. SUMMARY Common and rare genetic variants are associated with susceptibility and prognosis of IPF. However, many of the reported variants fall in noncoding regions of the genome and their relevance to disease pathobiology remains to be elucidated.
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Affiliation(s)
- Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Joyce S Lee
- University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
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21
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Stanel SC, Callum J, Rivera-Ortega P. Genetic and environmental factors in interstitial lung diseases: current and future perspectives on early diagnosis of high-risk cohorts. Front Med (Lausanne) 2023; 10:1232655. [PMID: 37601795 PMCID: PMC10435297 DOI: 10.3389/fmed.2023.1232655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Within the wide scope of interstitial lung diseases (ILDs), familial pulmonary fibrosis (FPF) is being increasingly recognized as a specific entity, with earlier onset, faster progression, and suboptimal responses to immunosuppression. FPF is linked to heritable pathogenic variants in telomere-related genes (TRGs), surfactant-related genes (SRGs), telomere shortening (TS), and early cellular senescence. Telomere abnormalities have also been identified in some sporadic cases of fibrotic ILD. Air pollution and other environmental exposures carry additive risk to genetic predisposition in pulmonary fibrosis. We provide a perspective on how these features impact on screening strategies for relatives of FPF patients, interstitial lung abnormalities, ILD multi-disciplinary team (MDT) discussion, and disparities and barriers to genomic testing. We also describe our experience with establishing a familial interstitial pneumonia (FIP) clinic and provide guidance on how to identify patients with telomere dysfunction who would benefit most from genomic testing.
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Affiliation(s)
- Stefan Cristian Stanel
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jack Callum
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Pilar Rivera-Ortega
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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22
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Kung SC, Dixon O, Kentwell S, Vasireddy RS, Rodgers J, Ding Y, Rahman T, Tallis C, Yang IA, Mackintosh JA. Telomere biology disorder presenting acutely with pulmonary fibrosis and hepatopulmonary syndrome in a young adult male. Respirol Case Rep 2023; 11:e01182. [PMID: 37397566 PMCID: PMC10311130 DOI: 10.1002/rcr2.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
A 33-year-old man presented with acute dyspnoea and profound hypoxaemia, and had clubbing, greying of hair, orthodeoxia and fine inspiratory crackles. CT chest showed established pulmonary fibrosis in a usual interstitial pneumonia pattern. Additional investigations revealed a small patent foramen ovale, pancytopenia, and oesophageal varices and portal hypertensive gastropathy from liver cirrhosis. Telomere length testing demonstrated short telomeres (<1st percentile), confirming the diagnosis of a telomere biology disorder. An interstitial lung disease gene panel identified a pathogenic variant in TERT (c.1700C>T, p.(Thr567Met)) and a variant of uncertain significance in PARN (c.1159G>A, p.(Gly387Arg)). Combined lung and liver transplantation was deemed not suitable due to frailty and severe hepatopulmonary syndrome, and he died 56 days after presentation. Early recognition of the short telomere syndrome is important, and its multi-organ involvement poses challenges to management. Genetic screening may be important in younger patients with pulmonary fibrosis or in unexplained liver cirrhosis.
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Affiliation(s)
| | - Olivia Dixon
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Sarah Kentwell
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Raja S. Vasireddy
- Department of HaematologyThe Children's Hospital at Westmead, The Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Jonathan Rodgers
- Genetic Health QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Yuming Ding
- Gastroenterology and HepatologyThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Tony Rahman
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Gastroenterology and HepatologyThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Caroline Tallis
- Department of Gastroenterology and HepatologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Ian A. Yang
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - John A. Mackintosh
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
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23
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Le Guen P, Borie R, Legendre M, Dupin C, Dunogeant L, Ottaviani S, Debray MP, Cazes A, Dieudé P, Kannengiesser C, Crestani B. NKX2.1 mutation revealed by a lymphoid interstitial pneumonia in an adult with rheumatoid arthritis. ERJ Open Res 2023; 9:00682-2022. [PMID: 37228267 PMCID: PMC10204795 DOI: 10.1183/23120541.00682-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/02/2023] [Indexed: 05/27/2023] Open
Abstract
This is the first case of a 37-year-old female patient carrier of a heterozygous NKX2.1 mutation associated with RA-ILD with a histological pattern of LIP. This case illustrates the wide panel of ILD subtypes associated with NKX2.1 mutations. https://bit.ly/3F49OTS.
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Affiliation(s)
- Pierre Le Guen
- Université de Paris, INSERM 1152, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Pneumologie A, Centre de Référence des Maladies Pulmonaires Rares, DHU APOLLO, Paris, France
| | - Raphael Borie
- Université de Paris, INSERM 1152, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Pneumologie A, Centre de Référence des Maladies Pulmonaires Rares, DHU APOLLO, Paris, France
| | - Marie Legendre
- Sorbonne Université, INSERM U933 Maladies génétiques pédiatriques, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, Unité de Génétique moléculaire, Paris, France
| | - Clairelyne Dupin
- Université de Paris, INSERM 1152, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Pneumologie A, Centre de Référence des Maladies Pulmonaires Rares, DHU APOLLO, Paris, France
| | - Laetitia Dunogeant
- Centre hospitalier du pays d'Aix, Service de rhumatologie et médecine interne, Aix-en-Provence, France
| | - Sébastien Ottaviani
- Université de Paris, INSERM 1152, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Rhumatologie, DHU APOLLO, Paris, France
| | - Marie-Pierre Debray
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Radiologie, Paris, France
| | - Aurélie Cazes
- Université de Paris, INSERM 1152, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Département d'anatomie pathologique, DHU APOLLO, Paris, France
| | - Philippe Dieudé
- Université de Paris, INSERM 1152, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Rhumatologie, DHU APOLLO, Paris, France
| | - Caroline Kannengiesser
- Université de Paris, INSERM 1152, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de génétique, DHU APOLLO, Paris, France
| | - Bruno Crestani
- Université de Paris, INSERM 1152, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Pneumologie A, Centre de Référence des Maladies Pulmonaires Rares, DHU APOLLO, Paris, France
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24
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Berger K, Kaner RJ. Diagnosis and Pharmacologic Management of Fibrotic Interstitial Lung Disease. Life (Basel) 2023; 13:599. [PMID: 36983755 PMCID: PMC10055741 DOI: 10.3390/life13030599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
Interstitial lung disease is an umbrella term that encompasses a spectrum of parenchymal lung pathologies affecting the gas exchanging part of the lung. While many of these disease entities are not fibrotic in nature, a number can lead to pulmonary fibrosis which may or may not progress over time. Idiopathic pulmonary fibrosis is the prototypical, progressive fibrotic interstitial lung disease, which can lead to worsening hypoxemic respiratory failure and mortality within a number of years from the time of diagnosis. The importance of an accurate and timely diagnosis of interstitial lung diseases, which is needed to inform prognosis and guide clinical management, cannot be overemphasized. Developing a consensus diagnosis requires the incorporation of a variety of factors by a multidisciplinary team, which then may or may not determine a need for tissue sampling. Clinical management can be challenging given the heterogeneity of disease behavior and the paucity of controlled trials to guide decision making. This review addresses current paradigms and recent updates in the diagnosis and pharmacologic management of these fibrotic interstitial lung diseases.
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Affiliation(s)
- Kristin Berger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Robert J. Kaner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Genetic Medicine, Weill Cornell Medicine, New York, NY 10021, USA
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25
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Groen K, van der Vis JJ, van Batenburg AA, Kazemier KM, Grutters JC, van Moorsel CHM. Genetic Variant Overlap Analysis Identifies Established and Putative Genes Involved in Pulmonary Fibrosis. Int J Mol Sci 2023; 24:ijms24032790. [PMID: 36769106 PMCID: PMC9917193 DOI: 10.3390/ijms24032790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
In only around 40% of families with pulmonary fibrosis (PF) a suspected genetic cause can be found. Genetic overlap analysis of Whole Exome Sequencing (WES) data may be a powerful tool to discover new shared variants in novel genes for PF. As a proof of principle, we first selected unrelated PF patients for whom a genetic variant was detected (n = 125) in established PF genes and searched for overlapping variants. Second, we performed WES (n = 149) and identified novel potentially deleterious variants shared by at least two unrelated PF patients. These variants were genotyped in validation cohorts (n = 2748). In 125 unrelated patients, a potentially deleterious variant was detected in known PF genes of which 15 variants in six genes overlapped, involving 51 patients. Overlap analysis of WES data identified two novel variants of interest: TOM1L2 c.421T > C p.(Y141H) and TDP1c.1373dupG p.(S459fs*5), neither gene had been related to pulmonary fibrosis before. Both proteins were present in the alveolar epithelium. No apparent characteristics of telomere disease were observed. This study underlines the potential of searching for overlapping rare potentially deleterious variants to identify disease-associated variants and genes. A previously unreported variant was found in two putative new PF genes, but further research is needed to determine causality.
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Affiliation(s)
- Karlijn Groen
- Department of Pulmonology, St. Antonius ILD Center of Excellence, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Joanne J. van der Vis
- Department of Pulmonology, St. Antonius ILD Center of Excellence, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Department of Clinical Chemistry, St. Antonius ILD Center of Excellence, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Aernoud A. van Batenburg
- Department of Pulmonology, St. Antonius ILD Center of Excellence, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Karin M. Kazemier
- Center of Translational Immunology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
- Division of Hearts and Lungs, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Jan C. Grutters
- Department of Pulmonology, St. Antonius ILD Center of Excellence, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Division of Hearts and Lungs, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Coline H. M. van Moorsel
- Department of Pulmonology, St. Antonius ILD Center of Excellence, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Correspondence:
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26
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Alonso-Gonzalez A, Tosco-Herrera E, Molina-Molina M, Flores C. Idiopathic pulmonary fibrosis and the role of genetics in the era of precision medicine. Front Med (Lausanne) 2023; 10:1152211. [PMID: 37181377 PMCID: PMC10172674 DOI: 10.3389/fmed.2023.1152211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, rare progressive lung disease, characterized by lung scarring and the irreversible loss of lung function. Two anti-fibrotic drugs, nintedanib and pirfenidone, have been demonstrated to slow down disease progression, although IPF mortality remains a challenge and the patients die after a few years from diagnosis. Rare pathogenic variants in genes that are involved in the surfactant metabolism and telomere maintenance, among others, have a high penetrance and tend to co-segregate with the disease in families. Common recurrent variants in the population with modest effect sizes have been also associated with the disease risk and progression. Genome-wide association studies (GWAS) support at least 23 genetic risk loci, linking the disease pathogenesis with unexpected molecular pathways including cellular adhesion and signaling, wound healing, barrier function, airway clearance, and innate immunity and host defense, besides the surfactant metabolism and telomere biology. As the cost of high-throughput genomic technologies continuously decreases and new technologies and approaches arise, their widespread use by clinicians and researchers is efficiently contributing to a better understanding of the pathogenesis of progressive pulmonary fibrosis. Here we provide an overview of the genetic factors known to be involved in IPF pathogenesis and discuss how they will continue to further advance in this field. We also discuss how genomic technologies could help to further improve IPF diagnosis and prognosis as well as for assessing genetic risk in unaffected relatives. The development and validation of evidence-based guidelines for genetic-based screening of IPF will allow redefining and classifying this disease relying on molecular characteristics and contribute to the implementation of precision medicine approaches.
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Affiliation(s)
- Aitana Alonso-Gonzalez
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Eva Tosco-Herrera
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Maria Molina-Molina
- Servei de Pneumologia, Laboratori de Pneumologia Experimental, IDIBELL, Barcelona, Spain
- Campus de Bellvitge, Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Flores
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Genomics Division, Instituto Tecnológico y de Energías Renovables (ITER), Santa Cruz de Tenerife, Spain
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
- *Correspondence: Carlos Flores,
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