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Oates GR, Schechter MS. Aiming to Improve Equity in Pulmonary Health: Cystic Fibrosis. Clin Chest Med 2023; 44:555-573. [PMID: 37517835 PMCID: PMC10458995 DOI: 10.1016/j.ccm.2023.03.011] [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] [Indexed: 08/01/2023]
Abstract
This review summarizes the evidence of health disparities in cystic fibrosis (CF), an autosomal recessive genetic disorder with substantial variation in disease progression and outcomes. We review disparities by race, ethnicity, socioeconomic status, geographic location, gender identity, or sexual orientation documented in the literature. We outline the mechanisms that generate and perpetuate such disparities across levels and domains of influence and assess the implications of this evidence. We then recommend strategies for improving equity in CF outcomes, drawing on recommendations for the general population and considering approaches specific to people living with CF.
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Affiliation(s)
- Gabriela R Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond at VCU, Richmond, VA, USA
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2
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Oates GR, Schechter MS. Socioeconomic determinants of respiratory health in patients with cystic fibrosis: implications for treatment strategies. Expert Rev Respir Med 2022; 16:637-650. [PMID: 35705523 DOI: 10.1080/17476348.2022.2090928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Great variation exists in the progression and outcomes of cystic fibrosis (CF) lung disease, due to both genetic and environmental influences. Social determinants mediate environmental exposures and treatment success; people with CF from socioeconomically disadvantaged backgrounds have worse health and die younger than those in more advantaged positions. AREAS COVERED This paper reviews the literature on the mechanisms that are responsible for generating and sustaining disparities in CF health, and the ways by which social determinants translate into health advantages or disadvantages in people with CF. The authors make recommendations for addressing social risk factors in CF clinical practice. EXPERT OPINION Socioeconomic factors are not dichotomous and their impact is felt at every step of the social ladder. CF care programs need to adopt a systematic protocol to screen for health-related social risk factors, and then connect patients to available resources to meet individual needs. Considerations such as daycare, schooling options, living and working conditions, and opportunities for physical exercise and recreation as well as promotion of self-efficacy are often overlooked. In addition, advocacy for changes in public policies on health insurance, environmental regulations, social welfare, and education would all help address the root causes of CF health inequities.
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Affiliation(s)
- Gabriela R Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond at VCU, USA
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McGarry ME, Gibb ER, Oates GR, Schechter MS. Left behind: The potential impact of CFTR modulators on racial and ethnic disparities in cystic fibrosis. Paediatr Respir Rev 2022; 42:35-42. [PMID: 35277357 PMCID: PMC9356388 DOI: 10.1016/j.prrv.2021.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 12/16/2022]
Abstract
The advent of CFTR modulators, a genomic specific medication, revolutionized the treatment of CF for many patients. However, given that these therapeutics were only developed for specific CFTR mutations, not all people with CF have access to such disease-modifying drugs. Racial and ethnic minority groups are less likely to have CFTR mutations that are approved for CFTR modulators. This exclusion has the potential to widen existing health disparities.
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Affiliation(s)
- Meghan E. McGarry
- Division of Pulmonary Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Elizabeth R. Gibb
- Division of Pulmonary Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Gabriela R. Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Michael S. Schechter
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Virginia Commonwealth University and Children’s Hospital of Richmond at VCU, Richmond, VA
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Csekő K, Hargitai D, Draskóczi L, Kéri A, Jaikumpun P, Kerémi B, Helyes Z, Zsembery Á. Safety of chronic hypertonic bicarbonate inhalation in a cigarette smoke-induced airway irritation guinea pig model. BMC Pulm Med 2022; 22:131. [PMID: 35392868 PMCID: PMC8991956 DOI: 10.1186/s12890-022-01919-x] [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: 12/03/2021] [Accepted: 03/29/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are often associated with airway fluid acidification. Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene leads to impaired bicarbonate secretion contributing to CF airway pathology. Chronic cigarette smoke (CS) -the major cause of COPD- is reported to induce acquired CFTR dysfunction underlying airway acidification and inflammation. We hypothesize that bicarbonate-containing aerosols could be beneficial for patients with CFTR dysfunctions. Thus, we investigated the safety of hypertonic sodium bicarbonate (NaHCO3) inhalation in CS-exposed guinea pigs. METHODS Animals were divided into groups inhaling hypertonic NaCl (8.4%) or hypertonic NaHCO3 (8.4%) aerosol for 8 weeks. Subgroups from each treatment groups were further exposed to CS. Respiratory functions were measured at 0 and after 2, 4, 6 and 8 weeks. After 8 weeks blood tests and pulmonary histopathological assessment were performed. RESULTS Neither smoking nor NaHCO3-inhalation affected body weight, arterial and urine pH, or histopathology significantly. NaHCO3-inhalation did not worsen respiratory parameters. Moreover, it normalized the CS-induced transient alterations in frequency, peak inspiratory flow, inspiratory and expiratory times. CONCLUSION Long-term NaHCO3-inhalation is safe in chronic CS-exposed guinea pigs. Our data suggest that bicarbonate-containing aerosols might be carefully applied to CF patients.
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Affiliation(s)
- Kata Csekő
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, 7624, Hungary
- Molecular Pharmacology Research Group, Szentágothai Research Centre, Pécs, 7624, Hungary
| | - Dóra Hargitai
- 2nd Department of Pathology, Semmelweis University, Budapest, 1091, Hungary
| | - Lilla Draskóczi
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, 7624, Hungary
- Molecular Pharmacology Research Group, Szentágothai Research Centre, Pécs, 7624, Hungary
| | - Adrienn Kéri
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Nagyvárad tér 4, Budapest, 1089, Hungary
- Heim Pál Children Hospital, Budapest, 1089, Hungary
| | - Pongsiri Jaikumpun
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Nagyvárad tér 4, Budapest, 1089, Hungary
| | - Beáta Kerémi
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Nagyvárad tér 4, Budapest, 1089, Hungary
- Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, 7624, Hungary
- Molecular Pharmacology Research Group, Szentágothai Research Centre, Pécs, 7624, Hungary
- PharmInVivo Ltd, Pécs, 7629, Hungary
| | - Ákos Zsembery
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Nagyvárad tér 4, Budapest, 1089, Hungary.
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Baker E, Harris WT, Rowe SM, Rutland SB, Oates GR. Tobacco smoke exposure limits the therapeutic benefit of tezacaftor/ivacaftor in pediatric patients with cystic fibrosis. J Cyst Fibros 2020; 20:612-617. [PMID: 33023836 DOI: 10.1016/j.jcf.2020.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/19/2020] [Accepted: 09/13/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Tobacco smoke exposure reduces CFTR functional expression in vitro and contributes to acquired CFTR dysfunction. We investigated whether it also inhibits the clinical benefit of CFTR modulators, focusing on tezacaftor/ivacaftor, approved in February 2018 for individuals with CF age ≥12 years. METHODS A retrospective longitudinal analysis of encounter-based data from the CF Foundation Patient Registry (2016-2018) compared the slope of change in lung function (GLI FEV1% predicted) before and after tezacaftor/ivacaftor initiation in smoke-exposed vs unexposed age-eligible pediatric patients. Tobacco smoke exposure (Ever/Never) was determined from caregiver self-report. Statistical analyses used hierarchical linear mixed modeling and fixed effects regression modeling. RESULTS The sample included 6,653 individuals with a total of 105,539 person-period observations. Tezacaftor/ivacaftor was prescribed to 19% (1,251) of individuals, mean age 17 years, mean baseline ppFEV1 83%, 28% smoke-exposed. Tezacaftor/ivacaftor users who were smoke-exposed had a lower baseline ppFEV1 and experienced a greater lung function decline. Over two years, the difference in ppFEV1 by smoke exposure among tezacaftor/ivacaftor users increased by 1.2% (7.6% to 8.8%, p<0.001). In both mixed effects and fixed effects regression models, tezacaftor/ivacaftor use was associated with improved ppFEV1 among unexposed individuals (1.2% and 1.7%, respectively; p<0.001 for both) but provided no benefit among smoke-exposed counterparts (0.3%, p = 0.5 and 0.6%, p = 0.07, respectively). CONCLUSION Tobacco smoke exposure nullifies the therapeutic benefit of tezacaftor/ivacaftor among individuals with CF aged 12-20 years old. To maximize the therapeutic opportunity of CFTR modulators, every effort must be taken to eliminate smoke exposure in CF.
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Affiliation(s)
| | | | - Steven M Rowe
- University of Alabama at Birmingham, Birmingham, AL, USA
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Lin VY, Fain MD, Jackson PL, Berryhill TF, Wilson LS, Mazur M, Barnes SJ, Blalock JE, Raju SV, Rowe SM. Vaporized E-Cigarette Liquids Induce Ion Transport Dysfunction in Airway Epithelia. Am J Respir Cell Mol Biol 2020; 61:162-173. [PMID: 30576219 DOI: 10.1165/rcmb.2017-0432oc] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cigarette smoking is associated with chronic obstructive pulmonary disease and chronic bronchitis. Acquired ion transport abnormalities, including cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction, caused by cigarette smoking have been proposed as potential mechanisms for mucus obstruction in chronic bronchitis. Although e-cigarette use is popular and perceived to be safe, whether it harms the airways via mechanisms altering ion transport remains unclear. In the present study, we sought to determine if e-cigarette vapor, like cigarette smoke, has the potential to induce acquired CFTR dysfunction, and to what degree. Electrophysiological methods demonstrated reduced chloride transport caused by vaporized e-cigarette liquid or vegetable glycerin at various exposures (30 min, 57.2% and 14.4% respectively, vs. control; P < 0.0001), but not by unvaporized liquid (60 min, 17.6% vs. untreated), indicating that thermal degradation of these products is required to induce the observed defects. We also observed reduced ATP-dependent responses (-10.8 ± 3.0 vs. -18.8 ± 5.1 μA/cm2 control) and epithelial sodium channel activity (95.8% reduction) in primary human bronchial epithelial cells after 5 minutes, suggesting that exposures dramatically inhibit epithelial ion transport beyond CFTR, even without diminished transepithelial resistance or cytotoxicity. Vaporizing e-cigarette liquid produced reactive aldehydes, including acrolein (shown to induce acquired CFTR dysfunction), as quantified by mass spectrometry, demonstrating that respiratory toxicants in cigarette smoke can also be found in e-cigarette vapor (30 min air, 224.5 ± 15.99; unvaporized liquid, 284.8 ± 35.03; vapor, 54,468 ± 3,908 ng/ml; P < 0.0001). E-cigarettes can induce ion channel dysfunction in airway epithelial cells, partly through acrolein production. These findings indicate a heretofore unknown toxicity of e-cigarette use known to be associated with chronic bronchitis onset and progression, as well as with chronic obstructive pulmonary disease severity.
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Affiliation(s)
| | | | | | - Taylor F Berryhill
- 2Pharmacology/Toxicology and Targeted Metabolomics and Proteomics Laboratory
| | - Landon S Wilson
- 2Pharmacology/Toxicology and Targeted Metabolomics and Proteomics Laboratory
| | | | - Stephen J Barnes
- 2Pharmacology/Toxicology and Targeted Metabolomics and Proteomics Laboratory
| | | | | | - Steven M Rowe
- 1Department of Medicine.,3Gregory J. Fleming Cystic Fibrosis Center.,4Department of Pediatrics, and.,5Department of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
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Rasmussen LW, Stanford D, Patel K, Raju SV. Evaluation of secondhand smoke effects on CFTR function in vivo. Respir Res 2020; 21:70. [PMID: 32192506 PMCID: PMC7082971 DOI: 10.1186/s12931-020-1324-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/17/2020] [Indexed: 01/01/2023] Open
Affiliation(s)
- Lawrence W Rasmussen
- Departments of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- Environmental Health Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Denise Stanford
- Departments of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Krina Patel
- Departments of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - S Vamsee Raju
- Departments of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, USA.
- Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, USA.
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8
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Fernandez Fernandez E, De Santi C, De Rose V, Greene CM. CFTR dysfunction in cystic fibrosis and chronic obstructive pulmonary disease. Expert Rev Respir Med 2018; 12:483-492. [PMID: 29750581 DOI: 10.1080/17476348.2018.1475235] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Obstructive lung diseases such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are causes of high morbidity and mortality worldwide. CF is a multiorgan genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and is characterized by progressive chronic obstructive lung disease. Most cases of COPD are a result of noxious particles, mainly cigarette smoke but also other environmental pollutants. Areas covered: Although the pathogenesis and pathophysiology of CF and COPD differ, they do share key phenotypic features and because of these similarities there is great interest in exploring common mechanisms and/or factors affected by CFTR mutations and environmental insults involved in COPD. Various molecular, cellular and clinical studies have confirmed that CFTR protein dysfunction is common in both the CF and COPD airways. This review provides an update of our understanding of the role of dysfunctional CFTR in both respiratory diseases. Expert commentary: Drugs developed for people with CF to improve mutant CFTR function and enhance CFTR ion channel activity might also be beneficial in patients with COPD. A move toward personalized therapy using, for example, microRNA modulators in conjunction with CFTR potentiators or correctors, could enhance treatment of both diseases.
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Affiliation(s)
- Elena Fernandez Fernandez
- a Lung Biology Group, Department of Clinical Microbiology , RCSI Education & Research Centre, Beaumont Hospital , Dublin 9 , Ireland
| | - Chiara De Santi
- a Lung Biology Group, Department of Clinical Microbiology , RCSI Education & Research Centre, Beaumont Hospital , Dublin 9 , Ireland
| | - Virginia De Rose
- b Department of Clinical and Biological Sciences , University of Torino , Torino , Italy
| | - Catherine M Greene
- a Lung Biology Group, Department of Clinical Microbiology , RCSI Education & Research Centre, Beaumont Hospital , Dublin 9 , Ireland
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9
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Wong FH, AbuArish A, Matthes E, Turner MJ, Greene LE, Cloutier A, Robert R, Thomas DY, Cosa G, Cantin AM, Hanrahan JW. Cigarette smoke activates CFTR through ROS-stimulated cAMP signaling in human bronchial epithelial cells. Am J Physiol Cell Physiol 2018; 314:C118-C134. [PMID: 28978522 PMCID: PMC5866379 DOI: 10.1152/ajpcell.00099.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 11/22/2022]
Abstract
Air pollution stimulates airway epithelial secretion through a cholinergic reflex that is unaffected in cystic fibrosis (CF), yet a strong correlation is observed between passive smoke exposure in the home and impaired lung function in CF children. Our aim was to study the effects of low smoke concentrations on cystic fibrosis transmembrane conductance regulator (CFTR) function in vitro. Cigarette smoke extract stimulated robust anion secretion that was transient, mediated by CFTR, and dependent on cAMP-dependent protein kinase activation. Secretion was initiated by reactive oxygen species (ROS) and mediated by at least two distinct pathways: autocrine activation of EP4 prostanoid receptors and stimulation of Ca2+ store-operated cAMP signaling. The response was absent in cells expressing the most common disease-causing mutant F508del-CFTR. In addition to the initial secretion, prolonged exposure of non-CF bronchial epithelial cells to low levels of smoke also caused a gradual decline in CFTR functional expression. F508del-CFTR channels that had been rescued by the CF drug combination VX-809 (lumacaftor) + VX-770 (ivacaftor) were more sensitive to this downregulation than wild-type CFTR. The results suggest that CFTR-mediated secretion during acute cigarette smoke exposure initially protects the airway epithelium while prolonged exposure reduces CFTR functional expression and reduces the efficacy of CF drugs.
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Affiliation(s)
- Francis H Wong
- Department of Physiology, McGill University , Montreal, Quebec , Canada
- Cystic Fibrosis Translational Research Centre, McGill University , Montreal, Quebec , Canada
| | - Asmahan AbuArish
- Department of Physiology, McGill University , Montreal, Quebec , Canada
- Cystic Fibrosis Translational Research Centre, McGill University , Montreal, Quebec , Canada
| | - Elizabeth Matthes
- Department of Physiology, McGill University , Montreal, Quebec , Canada
- Cystic Fibrosis Translational Research Centre, McGill University , Montreal, Quebec , Canada
| | - Mark J Turner
- Department of Physiology, McGill University , Montreal, Quebec , Canada
- Cystic Fibrosis Translational Research Centre, McGill University , Montreal, Quebec , Canada
| | - Lana E Greene
- Department of Chemistry, McGill University , Montreal, Quebec , Canada
| | - Alexandre Cloutier
- Pulmonary Division, Faculty of Medicine, Université de Sherbrooke , Sherbrooke, Quebec , Canada
| | - Renaud Robert
- Department of Physiology, McGill University , Montreal, Quebec , Canada
- Cystic Fibrosis Translational Research Centre, McGill University , Montreal, Quebec , Canada
- Department of Biochemistry, McGill University , Montreal, Quebec , Canada
| | - David Y Thomas
- Cystic Fibrosis Translational Research Centre, McGill University , Montreal, Quebec , Canada
- Department of Biochemistry, McGill University , Montreal, Quebec , Canada
| | - Gonzalo Cosa
- Department of Chemistry, McGill University , Montreal, Quebec , Canada
| | - André M Cantin
- Cystic Fibrosis Translational Research Centre, McGill University , Montreal, Quebec , Canada
- Pulmonary Division, Faculty of Medicine, Université de Sherbrooke , Sherbrooke, Quebec , Canada
| | - John W Hanrahan
- Department of Physiology, McGill University , Montreal, Quebec , Canada
- Cystic Fibrosis Translational Research Centre, McGill University , Montreal, Quebec , Canada
- Research Institute of McGill Univ. Hospital Centre , Montreal, Quebec , Canada
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10
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Raju SV, Lin VY, Liu L, McNicholas CM, Karki S, Sloane PA, Tang L, Jackson PL, Wang W, Wilson L, Macon KJ, Mazur M, Kappes JC, DeLucas LJ, Barnes S, Kirk K, Tearney GJ, Rowe SM. The Cystic Fibrosis Transmembrane Conductance Regulator Potentiator Ivacaftor Augments Mucociliary Clearance Abrogating Cystic Fibrosis Transmembrane Conductance Regulator Inhibition by Cigarette Smoke. Am J Respir Cell Mol Biol 2017; 56:99-108. [PMID: 27585394 DOI: 10.1165/rcmb.2016-0226oc] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Acquired cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction may contribute to chronic obstructive pulmonary disease pathogenesis and is a potential therapeutic target. We sought to determine the acute effects of cigarette smoke on ion transport and the mucociliary transport apparatus, their mechanistic basis, and whether deleterious effects could be reversed with the CFTR potentiator ivacaftor (VX-770). Primary human bronchial epithelial (HBE) cells and human bronchi were exposed to cigarette smoke extract (CSE) and/or ivacaftor. CFTR function and expression were measured in Ussing chambers and by surface biotinylation. CSE-derived acrolein modifications on CFTR were determined by mass spectroscopic analysis of purified protein, and the functional microanatomy of the airway epithelia was measured by 1-μm resolution optical coherence tomography. CSE reduced CFTR-dependent current in HBE cells (P < 0.05) and human bronchi (P < 0.05) within minutes of exposure. The mechanism involved CSE-induced reduction of CFTR gating, decreasing CFTR open-channel probability by approximately 75% immediately after exposure (P < 0.05), whereas surface CFTR expression was partially reduced with chronic exposure, but was stable acutely. CSE treatment of purified CFTR resulted in acrolein modifications on lysine and cysteine residues that likely disrupt CFTR gating. In primary HBE cells, CSE reduced airway surface liquid depth (P < 0.05) and ciliary beat frequency (P < 0.05) within 60 minutes that was restored by coadministration with ivacaftor (P < 0.005). Cigarette smoking transmits acute reductions in CFTR activity, adversely affecting the airway surface. These effects are reversible by a CFTR potentiator in vitro, representing a potential therapeutic strategy in patients with chronic obstructive pulmonary disease with chronic bronchitis.
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Affiliation(s)
- S Vamsee Raju
- Departments of 1 Medicine.,2 the Cystic Fibrosis Research Center
| | | | - Limbo Liu
- 3 Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Carmel M McNicholas
- 2 the Cystic Fibrosis Research Center.,4 Cell Developmental and Integrative Biology
| | | | | | - Liping Tang
- Departments of 1 Medicine.,2 the Cystic Fibrosis Research Center
| | | | - Wei Wang
- 2 the Cystic Fibrosis Research Center.,4 Cell Developmental and Integrative Biology
| | | | | | | | - John C Kappes
- Departments of 1 Medicine.,2 the Cystic Fibrosis Research Center
| | | | - Stephen Barnes
- 5 Targeted Metabolomics and Proteomics Laboratory.,7 Pharmacology, and
| | - Kevin Kirk
- 2 the Cystic Fibrosis Research Center.,4 Cell Developmental and Integrative Biology
| | - Guillermo J Tearney
- 3 Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven M Rowe
- Departments of 1 Medicine.,2 the Cystic Fibrosis Research Center.,4 Cell Developmental and Integrative Biology.,8 Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; and
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11
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Adappa ND, Truesdale CM, Workman AD, Doghramji L, Mansfield C, Kennedy DW, Palmer JN, Cowart BJ, Cohen NA. Correlation of T2R38 taste phenotype and in vitro biofilm formation from nonpolypoid chronic rhinosinusitis patients. Int Forum Allergy Rhinol 2016; 6:783-91. [PMID: 27309535 PMCID: PMC5500301 DOI: 10.1002/alr.21803] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 04/21/2016] [Accepted: 04/29/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sinonasal biofilms have been demonstrated in specimens collected from chronic rhinosinusitis (CRS) patients. Mounting evidence suggests that biofilms contribute to therapeutically recalcitrant CRS. Recently, the bitter taste receptor T2R38 has been implicated in the regulation of the sinonasal mucosal innate immune response. TAS2R38 gene polymorphisms affect receptor functionality and contribute to variations seen in sinonasal innate defense as well as taste perception reflected in gustatory sensitivity to the bitter compound phenylthiocarbamide (PTC). In a population of CRS patients with active infection or inflammation, we sought to determine if a correlation between T2R38 phenotype and in vitro biofilm formation existed. METHODS Endoscopically guided sinonasal swabs were obtained prospectively from CRS (±polyp) patients with evidence of persistent inflammation or mucopurulence. In vitro biofilm formation was assessed with a modified Calgary Biofilm Detection Assay. Patients' phenotypic (functional) expression of the bitter taste receptor T2R38 was evaluated with a taste test including the compound PTC. Linear regression was used to determine the level of significance between mean in vitro biofilm formation levels and mean PTC taste test intensity ratings across CRS patients. RESULTS Sinonasal swabs were obtained from 59 patients, with 42 of the 59 samples demonstrating in vitro biofilm formation. Analysis revealed an inverse linear association between in vitro biofilm formation and PTC taste intensity ratings (p = 0.019) for all patients. This association was exclusively driven by nonpolypoid CRS patients (p = 0.0026). CONCLUSION In vitro biofilm formation from sinonasal clinical isolates is inversely correlated with PTC taste sensitivity in nonpolypoid CRS patients.
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Affiliation(s)
- Nithin D. Adappa
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Carl M. Truesdale
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alan D. Workman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Laurel Doghramji
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - David W. Kennedy
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - James N. Palmer
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Noam A. Cohen
- Department of Otorhinolaryngology–Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Monell Chemical Senses Center, Philadelphia, PA
- Surgical Service, Philadelphia Veterans Administration Medical Center, Philadelphia, PA
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12
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Raju SV, Solomon GM, Dransfield MT, Rowe SM. Acquired Cystic Fibrosis Transmembrane Conductance Regulator Dysfunction in Chronic Bronchitis and Other Diseases of Mucus Clearance. Clin Chest Med 2015; 37:147-58. [PMID: 26857776 DOI: 10.1016/j.ccm.2015.11.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major public health problem. No therapies alter the natural history of the disease. Chronic bronchitis is perhaps the most clinically troublesome phenotype. Emerging data strongly suggest that cigarette smoke and its components can lead to acquired cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction. Findings in vitro, in animal models, and in smokers with and without COPD also show acquired CFTR dysfunction, which is associated with chronic bronchitis. This abnormality is also present in extrapulmonary organs, suggesting that CFTR dysfunction may contribute to smoking-related systemic diseases.
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Affiliation(s)
- S Vamsee Raju
- Department of Medicine, Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Cell Developmental and Integrative Biology, The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George M Solomon
- Department of Medicine, Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Department of Medicine, The UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven M Rowe
- Department of Medicine, Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Cell Developmental and Integrative Biology, The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Pediatrics, The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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Chinnapaiyan S, Unwalla HJ. Mucociliary dysfunction in HIV and smoked substance abuse. Front Microbiol 2015; 6:1052. [PMID: 26528246 PMCID: PMC4604303 DOI: 10.3389/fmicb.2015.01052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/14/2015] [Indexed: 12/12/2022] Open
Abstract
Impaired mucociliary clearance (MCC) is a hallmark of acquired chronic airway diseases like chronic bronchitis associated with chronic obstructive pulmonary disease (COPD) and asthma. This manifests as microbial colonization of the lung consequently leading to recurrent respiratory infections. People living with HIV demonstrate increased incidence of these chronic airway diseases. Bacterial pneumonia continues to be an important comorbidity in people living with HIV even though anti-retroviral therapy has succeeded in restoring CD4+ cell counts. People living with HIV demonstrate increased microbial colonization of the lower airways. The microbial flora is similar to that observed in diseases like cystic fibrosis and COPD suggesting that mucociliary dysfunction could be a contributing factor to the increased incidence of chronic airway diseases in people living with HIV. The three principal components of the MCC apparatus are, a mucus layer, ciliary beating, and a periciliary airway surface liquid (ASL) layer that facilitates ciliary beating. Cystic fibrosis transmembrane conductance regulator (CFTR) plays a pivotal role in regulating the periciliary ASL. HIV proteins can suppress all the components of the MCC apparatus by increasing mucus secretion and suppressing CFTR function. This can decrease ASL height leading to suppressed ciliary beating. The effects of HIV on MCC are exacerbated when combined with other aggravating factors like smoking or inhaled substance abuse, which by themselves can suppress one or more components of the MCC system. This review discusses the pathophysiological mechanisms that lead to MCC suppression in people living with HIV who also smoke tobacco or abuse illicit drugs.
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Affiliation(s)
- Srinivasan Chinnapaiyan
- Department of Immunology, Herbert Wertheim College of Medicine, Florida International University Miami, FL, USA
| | - Hoshang J Unwalla
- Department of Immunology, Herbert Wertheim College of Medicine, Florida International University Miami, FL, USA
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Unwalla HJ, Ivonnet P, Dennis JS, Conner GE, Salathe M. Transforming growth factor-β1 and cigarette smoke inhibit the ability of β2-agonists to enhance epithelial permeability. Am J Respir Cell Mol Biol 2015; 52:65-74. [PMID: 24978189 DOI: 10.1165/rcmb.2013-0538oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Chronic bronchitis, caused by cigarette smoke exposure, is characterized by mucus hypersecretion and reduced mucociliary clearance (MCC). Effective MCC depends, in part, on adequate airway surface liquid. Cystic fibrosis transmembrane conductance regulator (CFTR) provides the necessary osmotic gradient for serosal to mucosal fluid transport through its ability to both secrete Cl(-) and regulate paracellular permeability, but CFTR activity is attenuated in chronic bronchitis and in smokers. β2-adrenergic receptor (β2-AR) agonists are widely used for managing chronic obstructive pulmonary disease, and can activate CFTR, stimulate ciliary beat frequency, and increase epithelial permeability, thereby stimulating MCC. Patients with chronic airway diseases and cigarette smokers demonstrate increased transforming growth factor (TGF)-β1 signaling, which suppresses β2-agonist-mediated CFTR activation and epithelial permeability increases. Restoring CFTR function in these diseases can restore the ability of β2-agonists to enhance epithelial permeability. Human bronchial epithelial cells, fully redifferentiated at the air-liquid interface, were used for (14)C mannitol flux measurements, Ussing chamber experiments, and quantitative RT-PCR. β2-agonists enhance epithelial permeability by activating CFTR via the β2-AR/adenylyl cyclase/cAMP/protein kinase A pathway. TGF-β1 inhibits β2-agonist-mediated CFTR activation and epithelial permeability enhancement. Although TGF-β1 down-regulates both β2-AR and CFTR mRNA, functionally it only decreases CFTR activity. Cigarette smoke exposure inhibits β2-agonist-mediated epithelial permeability increases, an effect reversed by blocking TGF-β signaling. β2-agonists enhance epithelial permeability via CFTR activation. TGF-β1 signaling inhibits β2-agonist-mediated CFTR activation and subsequent increased epithelial permeability, potentially limiting the ability of β2-agonists to facilitate paracellular transport in disease states unless TGF-β1 signaling is inhibited.
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Affiliation(s)
- Hoshang J Unwalla
- 1 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, and
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15
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Brown MB, Hunt WR, Noe JE, Rush NI, Schweitzer KS, Leece TC, Moldobaeva A, Wagner EM, Dudek SM, Poirier C, Presson RG, Gulbins E, Petrache I. Loss of cystic fibrosis transmembrane conductance regulator impairs lung endothelial cell barrier function and increases susceptibility to microvascular damage from cigarette smoke. Pulm Circ 2014; 4:260-8. [PMID: 25006445 DOI: 10.1086/675989] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/07/2014] [Indexed: 11/04/2022] Open
Abstract
Abnormal lung microvascular endothelial vascular barrier function may contribute to pulmonary inflammation, such as that occurring during inhalation of cigarette smoke (CS). Cystic fibrosis transmembrane conductance regulator (CFTR), an anion channel expressed in both epithelial and endothelial cells, regulates the organization of tight junctions between epithelial cells and has also been implicated in the transport of sphingosine-1 phosphate (S1P), a vascular barrier-enhancing sphingolipid. Because CS has been shown to affect CFTR function, we hypothesized that CFTR function contributes to lung endothelial cell barrier and that CFTR dysfunction worsens CS-induced injury. CFTR inhibitors GlyH-101 or CFTRinh172 caused a dose-dependent increase in pulmonary or bronchial endothelial monolayer permeability, which peaked after 4 hours. CFTR inhibition was associated with both intercellular gaps and actin stress fiber formation compared with vehicle-treated cells. Increasing endothelial S1P, either by exogenous treatment or by inhibition of its degradation, significantly improved the barrier function in CFTR-inhibited monolayers. Both cultured lung endothelia and the lung microcirculation visualized in vivo with intravital two-photon imaging of transgenic mice deficient in CFTR showed that CFTR dysfunction increased susceptibility to CS-induced permeability. These results suggested that CFTR function might be required for lung endothelial barrier, including adherence junction stability. Loss of CFTR function, especially concomitant to CS exposure, might promote lung inflammation by increasing endothelial cell permeability, which could be ameliorated by S1P.
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Affiliation(s)
- Mary Beth Brown
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA ; Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana, USA
| | - William R Hunt
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Julie E Noe
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Natalia I Rush
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Kelly S Schweitzer
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Thomas C Leece
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Aigul Moldobaeva
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth M Wagner
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven M Dudek
- Department of Medicine, University of Illinois, Chicago, Illinois, USA
| | - Christophe Poirier
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Robert G Presson
- Department of Anesthesia, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Erich Gulbins
- Department of Anesthesia, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Irina Petrache
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA ; Richard L. Roudebush Veteran Affairs Medical Center, Indianapolis, Indiana, USA
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16
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Lambert JA, Raju SV, Tang LP, McNicholas CM, Li Y, Courville CA, Farris RF, Coricor GE, Smoot LH, Mazur MM, Dransfield MT, Bolger GB, Rowe SM. Cystic fibrosis transmembrane conductance regulator activation by roflumilast contributes to therapeutic benefit in chronic bronchitis. Am J Respir Cell Mol Biol 2014; 50:549-58. [PMID: 24106801 DOI: 10.1165/rcmb.2013-0228oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cigarette smoking causes acquired cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction and is associated with delayed mucociliary clearance and chronic bronchitis. Roflumilast is a clinically approved phosphodiesterase 4 inhibitor that improves lung function in patients with chronic bronchitis. We hypothesized that its therapeutic benefit was related in part to activation of CFTR. Primary human bronchial epithelial (HBE) cells, Calu-3, and T84 monolayers were exposed to whole cigarette smoke (WCS) or air with or without roflumilast treatment. CFTR-dependent ion transport was measured in modified Ussing chambers. Airway surface liquid (ASL) was determined by confocal microscopy. Intestinal fluid secretion of ligated murine intestine was monitored ex vivo. Roflumilast activated CFTR-dependent anion transport in normal HBE cells with a half maximal effective concentration of 2.9 nM. Roflumilast partially restored CFTR activity in WCS-exposed HBE cells (5.3 ± 1.1 μA/cm(2) vs. 1.2 ± 0.2 μA/cm(2) [control]; P < 0.05) and was additive with ivacaftor, a specific CFTR potentiator approved for the treatment of CF. Roflumilast improved the depleted ASL depth of HBE monolayers exposed to WCS (9.0 ± 3.1 μm vs. 5.6 ± 2.0 μm [control]; P < 0.05), achieving 79% of that observed in air controls. CFTR activation by roflumilast also induced CFTR-dependent fluid secretion in murine intestine, increasing the wet:dry ratio and the diameter of ligated murine segments. Roflumilast activates CFTR-mediated anion transport in airway and intestinal epithelia via a cyclic adenosine monophosphate-dependent pathway and partially reverses the deleterious effects of WCS, resulting in augmented ASL depth. Roflumilast may benefit patients with chronic obstructive pulmonary disease with chronic bronchitis by activating CFTR, which may also underlie noninfectious diarrhea caused by roflumilast.
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Courville CA, Tidwell S, Liu B, Accurso FJ, Dransfield MT, Rowe SM. Acquired defects in CFTR-dependent β-adrenergic sweat secretion in chronic obstructive pulmonary disease. Respir Res 2014; 15:25. [PMID: 24568560 PMCID: PMC4015030 DOI: 10.1186/1465-9921-15-25] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
RATIONALE Smoking-induced chronic obstructive pulmonary disease (COPD) is associated with acquired systemic cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction. Recently, sweat evaporimetry has been shown to efficiently measure β-adrenergic sweat rate and specifically quantify CFTR function in the secretory coil of the sweat gland. OBJECTIVES To evaluate the presence and severity of systemic CFTR dysfunction in smoking-related lung disease using sweat evaporimetry to determine CFTR-dependent sweat rate. METHODS We recruited a cohort of patients consisting of healthy never smokers (N = 18), healthy smokers (12), COPD smokers (25), and COPD former smokers (12) and measured β-adrenergic sweat secretion rate with evaporative water loss, sweat chloride, and clinical data (spirometry and symptom questionnaires). MEASUREMENTS AND MAIN RESULTS β-adrenergic sweat rate was reduced in COPD smokers (41.9 ± 3.4, P < 0.05, ± SEM) and COPD former smokers (39.0 ± 5.4, P < 0.05) compared to healthy controls (53.6 ± 3.4). Similarly, sweat chloride was significantly greater in COPD smokers (32.8 ± 3.3, P < 0.01) and COPD former smokers (37.8 ± 6.0, P < 0.01) vs. healthy controls (19.1 ± 2.5). Univariate analysis revealed a significant association between β-adrenergic sweat rate and female gender (β = 0.26), age (-0.28), FEV1% (0.35), dyspnea (-0.3), and history of smoking (-0.27; each P < 0.05). Stepwise multivariate regression included gender (0.39) and COPD (-0.43) in the final model (R()2 = 0.266, P < 0.0001). CONCLUSIONS β-adrenergic sweat rate was significantly reduced in COPD patients, regardless of smoking status, reflecting acquired CFTR dysfunction and abnormal gland secretion in the skin that can persist despite smoking cessation. β-adrenergic sweat rate and sweat chloride are associated with COPD severity and clinical symptoms, supporting the hypothesis that CFTR decrements have a causative role in COPD pathogenesis.
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Affiliation(s)
| | | | | | | | | | - Steven M Rowe
- Department of Medicine, MCLM 706, 1918 University Blvd, University of Alabama at Birmingham, Birmingham, AL, USA.
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Lee RJ, Kofonow JM, Rosen PL, Siebert AP, Chen B, Doghramji L, Xiong G, Adappa ND, Palmer JN, Kennedy DW, Kreindler JL, Margolskee RF, Cohen NA. Bitter and sweet taste receptors regulate human upper respiratory innate immunity. J Clin Invest 2014; 124:1393-405. [PMID: 24531552 DOI: 10.1172/jci72094] [Citation(s) in RCA: 287] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 12/11/2013] [Indexed: 12/11/2022] Open
Abstract
Bitter taste receptors (T2Rs) in the human airway detect harmful compounds, including secreted bacterial products. Here, using human primary sinonasal air-liquid interface cultures and tissue explants, we determined that activation of a subset of airway T2Rs expressed in nasal solitary chemosensory cells activates a calcium wave that propagates through gap junctions to the surrounding respiratory epithelial cells. The T2R-dependent calcium wave stimulated robust secretion of antimicrobial peptides into the mucus that was capable of killing a variety of respiratory pathogens. Furthermore, sweet taste receptor (T1R2/3) activation suppressed T2R-mediated antimicrobial peptide secretion, suggesting that T1R2/3-mediated inhibition of T2Rs prevents full antimicrobial peptide release during times of relative health. In contrast, during acute bacterial infection, T1R2/3 is likely deactivated in response to bacterial consumption of airway surface liquid glucose, alleviating T2R inhibition and resulting in antimicrobial peptide secretion. We found that patients with chronic rhinosinusitis have elevated glucose concentrations in their nasal secretions, and other reports have shown that patients with hyperglycemia likewise have elevated nasal glucose levels. These data suggest that increased glucose in respiratory secretions in pathologic states, such as chronic rhinosinusitis or hyperglycemia, promotes tonic activation of T1R2/3 and suppresses T2R-mediated innate defense. Furthermore, targeting T1R2/3-dependent suppression of T2Rs may have therapeutic potential for upper respiratory tract infections.
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Raju SV, Tate JH, Peacock SKG, Fang P, Oster RA, Dransfield MT, Rowe SM. Impact of heterozygote CFTR mutations in COPD patients with chronic bronchitis. Respir Res 2014; 15:18. [PMID: 24517344 PMCID: PMC3925354 DOI: 10.1186/1465-9921-15-18] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 02/02/2014] [Indexed: 11/29/2022] Open
Abstract
Background Cigarette smoking causes Chronic Obstructive Pulmonary Disease (COPD), the 3rd leading cause of death in the U.S. CFTR ion transport dysfunction has been implicated in COPD pathogenesis, and is associated with chronic bronchitis. However, susceptibility to smoke induced lung injury is variable and the underlying genetic contributors remain unclear. We hypothesized that presence of CFTR mutation heterozygosity may alter susceptibility to cigarette smoke induced CFTR dysfunction. Consequently, COPD patients with chronic bronchitis may have a higher rate of CFTR mutations compared to the general population. Methods Primary human bronchial epithelial cells derived from F508del CFTR heterozygotes and mice with (CFTR+/-) and without (CFTR+/+) CFTR heterozygosity were exposed to whole cigarette smoke (WCS); CFTR-dependent ion transport was assessed by Ussing chamber electrophysiology and nasal potential difference measurements, respectively. Caucasians with COPD and chronic bronchitis, age 40 to 80 with FEV1/FVC < 0.70 and FEV1 < 60% predicted, were selected for genetic analysis from participants in the NIH COPD Clinical Research Network’s Azithromycin for Prevention of Exacerbations of COPD in comparison to 32,900 Caucasian women who underwent prenatal genetic testing. Genetic analysis involved an allele-specific genotyping of 89 CFTR mutations. Results Exposure to WCS caused a pronounced reduction in CFTR activity in both CFTR (+/+) cells and F508del CFTR (+/-) cells; however, neither the degree of decrement (44.7% wild-type vs. 53.5% F508del heterozygous, P = NS) nor the residual CFTR activity were altered by CFTR heterozygosity. Similarly, WCS caused a marked reduction in CFTR activity measured by NPD in both wild type and CFTR heterozygous mice, but the severity of decrement (91.1% wild type vs. 47.7% CF heterozygous, P = NS) and the residual activity were not significantly affected by CFTR genetic status. Five of 127 (3.9%) COPD patients with chronic bronchitis were heterozygous for CFTR mutations which was not significantly different from controls (4.5%) (P = NS). Conclusions The magnitude of WCS induced reductions in CFTR activity was not affected by the presence of CFTR mutation heterozygosity. CFTR mutations do not increase the risk of COPD with chronic bronchitis. CFTR dysfunction due to smoking is primarily an acquired phenomenon and is not affected by the presence of congenital CFTR mutations.
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Affiliation(s)
| | | | | | | | | | | | - Steven M Rowe
- Department of Medicine, University of Alabama at Birmingham, MCLM 706 1918 University Blvd,, Birmingham, AL, USA.
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Dransfield MT, Wilhelm AM, Flanagan B, Courville C, Tidwell SL, Raju SV, Gaggar A, Steele C, Tang LP, Liu B, Rowe SM. Acquired cystic fibrosis transmembrane conductance regulator dysfunction in the lower airways in COPD. Chest 2014; 144:498-506. [PMID: 23538783 DOI: 10.1378/chest.13-0274] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cigarette smoke and smoking-induced inflammation decrease cystic fibrosis transmembrane conductance regulator (CFTR) activity and mucociliary transport in the nasal airway and cultured bronchial epithelial cells. This raises the possibility that lower airway CFTR dysfunction may contribute to the pathophysiology of COPD. We compared lower airway CFTR activity in current and former smokers with COPD, current smokers without COPD, and lifelong nonsmokers to examine the relationships between clinical characteristics and CFTR expression and function. METHODS Demographic, spirometry, and symptom questionnaire data were collected. CFTR activity was determined by nasal potential difference (NPD) and lower airway potential difference (LAPD) assays. The primary measure of CFTR function was the total change in chloride transport (Δchloride-free isoproterenol). CFTR protein expression in endobronchial biopsy specimens was measured by Western blot. RESULTS Compared with healthy nonsmokers (n = 11), current smokers (n = 17) showed a significant reduction in LAPD CFTR activity (Δchloride-free isoproterenol, -8.70 mV vs -15.9 mV; P = .003). Similar reductions were observed in smokers with and without COPD. Former smokers with COPD (n = 7) showed a nonsignificant reduction in chloride conductance (-12.7 mV). A similar pattern was observed for CFTR protein expression. Univariate analysis demonstrated correlations between LAPD CFTR activity and current smoking, the presence of chronic bronchitis, and dyspnea scores. CONCLUSIONS Smokers with and without COPD have reduced lower airway CFTR activity compared with healthy nonsmokers, and this finding correlates with disease phenotype. Acquired CFTR dysfunction may contribute to COPD pathogenesis.
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Affiliation(s)
- Mark T Dransfield
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL.
| | - Andrew M Wilhelm
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL
| | - Brian Flanagan
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Clifford Courville
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Sherry L Tidwell
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - S Vamsee Raju
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - Amit Gaggar
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - Chad Steele
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - Li Ping Tang
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - Bo Liu
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - Steven M Rowe
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL; UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL
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Downs CA, Kreiner LH, Trac DQ, Helms MN. Acute effects of cigarette smoke extract on alveolar epithelial sodium channel activity and lung fluid clearance. Am J Respir Cell Mol Biol 2013; 49:251-9. [PMID: 23526224 DOI: 10.1165/rcmb.2012-0234oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cigarette smoke contains high levels of reactive species. Moreover, cigarette smoke can induce cellular production of oxidants. The purpose of this study was to determine the effect of cigarette smoke extract (CSE)-derived oxidants on epithelial sodium channel (ENaC) activity in alveolar type 1 (T1) and type 2 (T2) cells and to measure corresponding rates of fluid clearance in mice receiving a tracheal instillation of CSE. Single-channel patch clamp analysis of T1 and T2 cells demonstrate that CSE exposure increases ENaC activity (NPo), measured as the product of the number of channels (N) and a channels open probability (Po), from 0.17 ± 0.07 to 0.34 ± 0.10 (n = 9; P = 0.04) in T1 cells. In T2 cells, CSE increased NPo from 0.08 ± 0.03 to 0.35 ± 0.10 (n = 9; P = 0.02). In both cell types, addition of tetramethylpiperidine and glutathione attenuated CSE-induced increases in ENaC NPo. Biotinylation and cycloheximide chase assays indicate that CSE-derived ROS increases channel activity, in part, by maintaining cell surface expression of the α-ENaC subunit. In vivo studies show that tracheal instillation of CSE promoted alveolar fluid clearance after 105 minutes compared with vehicle control (n = 10/group; P < 0.05).
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Affiliation(s)
- Charles A Downs
- Nell Hodgson Woodruff School of Nursing, School of Medicine, Emory University, Atlanta, GA 30322, USA
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Susceptibility to viral infections in chronic obstructive pulmonary disease: role of epithelial cells. Curr Opin Pulm Med 2013; 19:125-32. [PMID: 23361194 DOI: 10.1097/mcp.0b013e32835cef10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The aim is to understand how airway epithelial cells with compromised innate defense mechanisms enhance susceptibility to respiratory virus infections in chronic obstructive pulmonary disease (COPD). RECENT FINDINGS Exacerbations associated with respiratory viruses are more severe and increase disease severity in COPD. Airway epithelial cells cultured from COPD patients show excessive innate immune response to viral infection and higher viral load compared with normal cells. SUMMARY Airway epithelial cells are the first line of defense in the lung and are equipped with several lines of innate defense mechanisms to fight against invading pathogens including viruses. Under normal conditions, mucociliary and barrier functions of airway epithelial cells prevent virus binding and entry into the cells. Virus-infected airway epithelial cells also express various cytokines, which recruit and activate innate and adaptive immune cells ultimately controlling the infection and tissue damage. In COPD however, compromised mucociliary and barrier functions may increase virus binding and allow virus entry into airway epithelial cells. Virus-infected COPD airway epithelial cells also show disproportionate cytokine expression leading to inappropriate recruitment and activation of innate and adaptive immune cells. COPD airway epithelial cells also show defective antiviral responses. Such defects in innate defense mechanisms may increase susceptibility to viral infections and disease severity in COPD.
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Kreindler JL, Chen B, Kreitman Y, Kofonow J, Adams KM, Cohen NA. The Novel Dry Extract BNO 1011 Stimulates Chloride Transport and Ciliary Beat Frequency in Human Respiratory Epithelial Cultures. Am J Rhinol Allergy 2012; 26:439-43. [DOI: 10.2500/ajra.2012.26.3821] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Herbal remedies predate written history and continue to be used more frequently than conventional pharmaceutical medications. The novel dry extract BNO 1011 is based on a combination of five herbs that is used to treat acute and chronic rhinosinusitis. We evaluated the pharmacologic effects of the novel dry extract BNO 1011 on human respiratory epithelial cultures specifically addressing electrolyte transport and cilia beat frequency (CBF). Methods Well-differentiated human bronchial epithelial cultures grown at an air–liquid interface were treated on the apical or basolateral surface with varying concentrations of dry extract BNO 1011. Changes in transepithelial sodium and chloride transport were determined in Ussing chambers under voltage-clamped conditions. Changes in CBF were determined using the Sissons-Ammons Video Analysis system (Ammons Engineering, Mt. Morris, MI). Results When applied to the apical surface, dry extract BNO 1011 activated forskolin-stimulated chloride secretion and ciliary beat in a dose-dependent fashion. Basolateral application of dry extract BNO 1011 did not alter the measured physiological properties. Conclusion Apical application of dry extract BNO 1011 stimulates both chloride secretion and CBF and therefore may augment mucociliary clearance.
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Affiliation(s)
- James L. Kreindler
- Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Bei Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yael Kreitman
- Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer Kofonow
- Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania
| | - Kelly M. Adams
- Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Noam A. Cohen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania
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Lee RJ, Xiong G, Kofonow JM, Chen B, Lysenko A, Jiang P, Abraham V, Doghramji L, Adappa ND, Palmer JN, Kennedy DW, Beauchamp GK, Doulias PT, Ischiropoulos H, Kreindler JL, Reed DR, Cohen NA. T2R38 taste receptor polymorphisms underlie susceptibility to upper respiratory infection. J Clin Invest 2012; 122:4145-59. [PMID: 23041624 PMCID: PMC3484455 DOI: 10.1172/jci64240] [Citation(s) in RCA: 406] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/02/2012] [Indexed: 12/13/2022] Open
Abstract
Innate and adaptive defense mechanisms protect the respiratory system from attack by microbes. Here, we present evidence that the bitter taste receptor T2R38 regulates the mucosal innate defense of the human upper airway. Utilizing immunofluorescent and live cell imaging techniques in polarized primary human sinonasal cells, we demonstrate that T2R38 is expressed in human upper respiratory epithelium and is activated in response to acyl-homoserine lactone quorum-sensing molecules secreted by Pseudomonas aeruginosa and other gram-negative bacteria. Receptor activation regulates calcium-dependent NO production, resulting in stimulation of mucociliary clearance and direct antibacterial effects. Moreover, common polymorphisms of the TAS2R38 gene were linked to significant differences in the ability of upper respiratory cells to clear and kill bacteria. Lastly, TAS2R38 genotype correlated with human sinonasal gram-negative bacterial infection. These data suggest that T2R38 is an upper airway sentinel in innate defense and that genetic variation contributes to individual differences in susceptibility to respiratory infection.
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Affiliation(s)
- Robert J. Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Guoxiang Xiong
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Jennifer M. Kofonow
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Bei Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Anna Lysenko
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Peihua Jiang
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Valsamma Abraham
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Laurel Doghramji
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - James N. Palmer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - David W. Kennedy
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Gary K. Beauchamp
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Paschalis-Thomas Doulias
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Harry Ischiropoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - James L. Kreindler
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Danielle R. Reed
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
| | - Noam A. Cohen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania, USA.
Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, USA
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25
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Sloane PA, Shastry S, Wilhelm A, Courville C, Tang LP, Backer K, Levin E, Raju SV, Li Y, Mazur M, Byan-Parker S, Grizzle W, Sorscher EJ, Dransfield MT, Rowe SM. A pharmacologic approach to acquired cystic fibrosis transmembrane conductance regulator dysfunction in smoking related lung disease. PLoS One 2012; 7:e39809. [PMID: 22768130 PMCID: PMC3387224 DOI: 10.1371/journal.pone.0039809] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/27/2012] [Indexed: 01/08/2023] Open
Abstract
Background Mucus stasis in chronic obstructive pulmonary disease (COPD) is a significant contributor to morbidity and mortality. Potentiators of cystic fibrosis transmembrane conductance regulator (CFTR) activity pharmacologically enhance CFTR function; ivacaftor is one such agent approved to treat CF patients with the G551D-CFTR gating mutation. CFTR potentiators may also be useful for other diseases of mucus stasis, including COPD. Methods and Findings In primary human bronchial epithelial cells, exposure to cigarette smoke extract diminished CFTR-mediated anion transport (65.8±0.2% of control, P<0.005) and mucociliary transport (0.17±0.05 µm/sec vs. 2.4±0.47 µm/sec control, P<0.05) by reducing airway surface liquid depth (7.3±0.6 µm vs. 13.0±0.6 µm control, P<0.005) and augmenting mucus expression (by 64%, P<0.05) without altering transepithelial resistance. Smokers with or without COPD had reduced CFTR activity measured by nasal potential difference compared to age-matched non-smokers (−6.3±1.4 and −8.0±2.0 mV, respectively vs. −15.2±2.7 mV control, each P<0.005, n = 12–14/group); this CFTR decrement was associated with symptoms of chronic bronchitis as measured by the Breathlessness Cough and Sputum Score (r = 0.30, P<0.05) despite controlling for smoking (r = 0.31, P<0.05). Ivacaftor activated CFTR-dependent chloride transport in non-CF epithelia and ameliorated the functional CFTR defect induced by smoke to 185±36% of non-CF control (P<0.05), thereby increasing airway surface liquid (from 7.3±0.6 µm to 10.1±0.4 µm, P<0.005) and mucociliary transport (from 0.27±0.11 µm/s to 2.7±0.28 µm/s, P<0.005). Conclusions Cigarette smoking reduces CFTR activity and is causally related to reduced mucus transport in smokers due to inhibition of CFTR dependent fluid transport. These effects are reversible by the CFTR potentiator ivacaftor, representing a potential therapeutic strategy to augment mucociliary clearance in patients with smoking related lung disease.
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Affiliation(s)
- Peter A. Sloane
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Suresh Shastry
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Andrew Wilhelm
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Clifford Courville
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Li Ping Tang
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kyle Backer
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Elina Levin
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - S. Vamsee Raju
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Yao Li
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Marina Mazur
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Suzanne Byan-Parker
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - William Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Eric J. Sorscher
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Physiology and Biophysics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mark T. Dransfield
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Steven M. Rowe
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Physiology and Biophysics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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26
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Antunes MB, Chi JJ, Liu Z, Goldstein-Daruech N, Palmer JN, Zhu J, Cohen NA. Molecular basis of tobacco-induced bacterial biofilms: an in vitro study. Otolaryngol Head Neck Surg 2012; 147:876-84. [PMID: 22597576 DOI: 10.1177/0194599812447263] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate changes in the expression of biofilm-related genes when exposed to tobacco smoke and oxidative stress. STUDY DESIGN Experimental, in vitro. Setting Laboratories of Rhinology and Microbiology, University of Pennsylvania. SUBJECTS AND METHODS Bacterial biofilm mass was measured using crystal violet staining and measurement of the optical density. Biofilm-related genes of the Pseudomonas aeruginosa PAO1 strain (pilF, flgK, lasI, lasB, rhlA, and algC) were studied following repetitive exposure to exogenous tobacco smoke and hydrogen peroxide. This was done using a reporter plasmid. RESULTS After 1 exposure to smoke, there was no change in biofilm formation. However, after 2 and 3 exposures, the biofilm formed had an increased mass (P < .05). With respect to oxidative stress in the form of H(2)O(2), bacterial cultures demonstrated a dose- and time-dependent induction of biofilm formation compared with control conditions. Gene expression following repetitive smoke exposure demonstrated an increase in expression of pilF, flgK, algC, and lasI genes (P < .05); a decrease in rhlA (P < .05); and no significant change in the lasB gene (P = 0.1). Gene expression following H(2)O(2) exposure demonstrated an increase in pilF (P < .05), whereas the other genes failed to demonstrate a statistical change. CONCLUSIONS Repetitive tobacco smoke exposure leads to molecular changes in biofilm-related genes, and exposure to oxidative stress in the form of H(2)O(2) induces biofilm growth in PAO1. This could represent adaptative changes due to oxidative stress or chemically mediated through any of the several chemicals encountered in tobacco smoke and may explain increased biofilm formation in microbes isolated from smokers.
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Affiliation(s)
- Marcelo B Antunes
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
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27
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Habesoglu M, Demir K, Yumusakhuylu AC, Yilmaz AS, Oysu C. Does passive smoking have an effect on nasal mucociliary clearance? Otolaryngol Head Neck Surg 2012; 147:152-6. [PMID: 22383459 DOI: 10.1177/0194599812439004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is to review the literature about nasal mucociliary clearance (MCC) and passive smoking in otorhinolaryngology by clearly explaining their relationship in a cross-sectional study. STUDY DESIGN AND SETTING This cross-sectional study was conducted at the Umraniye Education and Research Hospital in Turkey. Umraniye Education and Research Hospital Ethical Committee approved the study, and informed consents of the patients were obtained. METHODS Our study consisted of patients who presented to the Ear-Nose-Throat Department of Istanbul Umraniye Education and Research Hospital between February 2011 and July 2011. Three groups of subjects were evaluated: 15 passive smokers (group 1), 17 active smokers (group 2), and 15 healthy matched controls (group 3). All patients were asked to answer our questions regarding their smoking history, and nasal MCC time was assessed for all individuals of the 3 groups. RESULTS The mean MCC value was 23.59 ± 12.41 in the smoking group, 12.6 ± 4.67 in the passive smoking group, and 6.4 ± 1.55 in the healthy group. The comparison of MCC values between the smoking group and passive smoking group and between the smoking group and healthy group revealed statistically significant differences (P < .01). There was also a significant difference between the MCC values of the passive smoking group and the healthy group (P < .01). In addition, we compared MCC values according to exposure number of cigarettes. CONCLUSION In this study, we conclude that passive smoking affects nasal MCC. Both active and passive smoking increases nasal MCC time when compared with healthy controls.
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Affiliation(s)
- Mehmet Habesoglu
- Department of Otolaryngology-Head and Neck Surgery, Umraniye Education and Research Hospital, Istanbul, Turkey.
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28
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Zhao KQ, Xiong G, Wilber M, Cohen NA, Kreindler JL. A role for two-pore K⁺ channels in modulating Na⁺ absorption and Cl⁻ secretion in normal human bronchial epithelial cells. Am J Physiol Lung Cell Mol Physiol 2011; 302:L4-L12. [PMID: 21964404 DOI: 10.1152/ajplung.00102.2011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mucociliary clearance is the primary innate physical defense mechanism against inhaled pathogens and toxins. Vectorial ion transport, primarily sodium absorption and anion secretion, by airway epithelial cells supports mucociliary clearance. This is evidenced by diseases of abnormal ion transport such as cystic fibrosis and pseudohypoaldosteronism that are characterized by changes in mucociliary clearance. Sodium absorption and chloride secretion in human bronchial epithelial cells depend on potassium channel activity, which creates a favorable electrochemical gradient for both by hyperpolarizing the apical plasma membrane. Although the role of basolateral membrane potassium channels is firmly established and extensively studied, a role for apical membrane potassium channels has also been described. Here, we demonstrate that bupivacaine and quinidine, blockers of four-transmembrane domain, two-pore potassium (K2P) channels, inhibit both amiloride-sensitive sodium absorption and forskolin-stimulated anion secretion in polarized, normal human bronchial epithelial cells at lower concentrations when applied to the mucosal surface than when applied to the serosal surface. Transcripts from four genes, KCNK1 (TWIK-1), KCNK2 (TREK-1), KCNK5 (TASK-2), and KCNK6 (TWIK-2), encoding K2P channels were identified by RT-PCR. Protein expression at the apical membrane was confirmed by immunofluorescence. Our data provide further evidence that potassium channels, in particular K2P channels, are expressed and functional in the apical membrane of airway epithelial cells where they may be targets for therapeutic manipulation.
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Affiliation(s)
- Ke-Qing Zhao
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye and Ear, Nose and Throat Hospital, School of Shanghai Medicine, Fudan University, Shanghai, Peoples Republic of China
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29
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Immediate and short-term consequences of secondhand smoke exposure on the respiratory system. Curr Opin Pulm Med 2011; 17:110-5. [PMID: 21178628 DOI: 10.1097/mcp.0b013e328343165d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW This review critically evaluates the existing biological evidence regarding the immediate and short-term respiratory consequences of secondhand smoke (SHS). RECENT FINDINGS A 1-h exposure to SHS at bar/restaurant levels generates a marked inflammatory reaction and significant decrements on lung function. These deleterious effects of SHS are exacerbated when physical activity follows the SHS exposure, particularly in less fit individuals. The main respiratory effect mechanisms of SHS include a direct induction of growth factors resulting in airway remodelling and alterations in nitric oxide regulation. Pharmacological agents that increase either apical membrane chloride conductance or basolateral membrane potassium conductance may be of therapeutic benefit in patients with diseases related to SHS exposure. Moreover, treatment with statins has shown beneficial effects towards preventing the SHS-induced pulmonary hypertension, vascular remodelling, and endothelial dysfunction. SUMMARY Based on recently discovered evidence, even brief and short-term exposures to SHS generate significant adverse effects on the human respiratory system. Future research directions in this area include the concentrations of tobacco smoke constituents in the alveolar milieu following SHS exposure, individual susceptibility to SHS, as well as pharmacological treatments for reversing the SHS-induced airway remodelling.
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30
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Goldstein-Daruech N, Cope EK, Zhao KQ, Vukovic K, Kofonow JM, Doghramji L, González B, Chiu AG, Kennedy DW, Palmer JN, Leid JG, Kreindler JL, Cohen NA. Tobacco smoke mediated induction of sinonasal microbial biofilms. PLoS One 2011; 6:e15700. [PMID: 21253587 PMCID: PMC3017060 DOI: 10.1371/journal.pone.0015700] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 11/30/2010] [Indexed: 02/07/2023] Open
Abstract
Cigarette smokers and those exposed to second hand smoke are more susceptible to life threatening infection than non-smokers. While much is known about the devastating effect tobacco exposure has on the human body, less is known about the effect of tobacco smoke on the commensal and commonly found pathogenic bacteria of the human respiratory tract, or human respiratory tract microbiome. Chronic rhinosinusitis (CRS) is a common medical complaint, affecting 16% of the US population with an estimated aggregated cost of $6 billion annually. Epidemiologic studies demonstrate a correlation between tobacco smoke exposure and rhinosinusitis. Although a common cause of CRS has not been defined, bacterial presence within the nasal and paranasal sinuses is assumed to be contributory. Here we demonstrate that repetitive tobacco smoke exposure induces biofilm formation in a diverse set of bacteria isolated from the sinonasal cavities of patients with CRS. Additionally, bacteria isolated from patients with tobacco smoke exposure demonstrate robust in vitro biofilm formation when challenged with tobacco smoke compared to those isolated from smoke naïve patients. Lastly, bacteria from smoke exposed patients can revert to a non-biofilm phenotype when grown in the absence of tobacco smoke. These observations support the hypothesis that tobacco exposure induces sinonasal biofilm formation, thereby contributing to the conversion of a transient and medically treatable infection to a persistent and therapeutically recalcitrant condition.
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Affiliation(s)
- Natalia Goldstein-Daruech
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- PhD Program Medical Science, Pontificia Universidad Católica de Chile, Santiago, Chile
- Facultad de Ingeniería y Ciencia, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Emily K. Cope
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Ke-Qing Zhao
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye & ENT Hospital, School of Shanghai Medicine, Fudan University, Shanghai, People's Republic of China
| | - Katarina Vukovic
- Department of Otorhonolaryngology - Head and Neck Surgery, University Hospital Centre, Zagreb, Croatia
| | - Jennifer M. Kofonow
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Laurel Doghramji
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Bernardo González
- Facultad de Ingeniería y Ciencia, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Alexander G. Chiu
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - David W. Kennedy
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - James N. Palmer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jeffery G. Leid
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - James L. Kreindler
- Children's Hospital of Philadelphia and Division of Pulmonary Medicine, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Noam A. Cohen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Philadelphia Veterans Affairs Medical Center, Surgical Services, Philadelphia, Pennsylvania, United States of America
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