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McCullough MJ, Bose PG, Mock JR. Regulatory T cells: Supporting lung homeostasis and promoting resolution and repair after lung injury. Int J Biochem Cell Biol 2024; 170:106568. [PMID: 38518980 PMCID: PMC11031275 DOI: 10.1016/j.biocel.2024.106568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
Regulatory T cells, characterized by their expression of the transcription factor Forkhead box P3, are indispensable in maintaining immune homeostasis. The respiratory system is constantly exposed to many environmental challenges, making it susceptible to various insults and infections. Regulatory T cells play essential roles in maintaining homeostasis in the lung and promoting repair after injury. Regulatory T cell function dysregulation can lead to inflammation, tissue damage, or aberrant repair. Research on regulatory T cell mechanisms in the lung has unveiled their influence on lung inflammation and repair mechanisms. In this review, our goal is to highlight the advances in regulatory T cell biology with respect to lung injury and resolution. We further provide a perspective that a deeper understanding of regulatory T cell interactions in the lung microenvironment in health and disease states offers opportunities for therapeutic interventions as treatments to promote lung health.
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Affiliation(s)
- Morgan J McCullough
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina Chapel Hill, NC, USA; Marsico Lung Institute, School of Medicine, University of North Carolina Chapel Hill, NC, USA
| | - Pria G Bose
- Marsico Lung Institute, School of Medicine, University of North Carolina Chapel Hill, NC, USA; Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina Chapel Hill, NC, USA
| | - Jason R Mock
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina Chapel Hill, NC, USA; Marsico Lung Institute, School of Medicine, University of North Carolina Chapel Hill, NC, USA; Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine School of Medicine, University of North Carolina Chapel Hill, NC, USA.
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McCullough MJ, Tune MK, Cabrera JC, Torres-Castillo J, He M, Feng Y, Doerschuk CM, Dang H, Beltran AS, Hagan RS, Mock JR. Characterization of the MT-2 Treg-like cell line in the presence and absence of forkhead box P3 (FOXP3). Immunol Cell Biol 2024; 102:211-224. [PMID: 38288547 DOI: 10.1111/imcb.12725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/24/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024]
Abstract
CD4+ forkhead box P3 (FOXP3)+ regulatory T cells (Tregs) are essential in maintaining immune tolerance and suppressing excessive immune responses. Tregs also contribute to tissue repair processes distinct from their roles in immune suppression. For these reasons, Tregs are candidates for targeted therapies for inflammatory and autoimmune diseases, and in diseases where tissue damage occurs. MT-2 cells, an immortalized Treg-like cell line, offer a model to study Treg biology and their therapeutic potential. In the present study, we use clustered regularly interspaced palindromic repeats (CRISPR)-mediated knockdown of FOXP3 in MT-2 cells to understand the transcriptional and functional changes that occur when FOXP3 is lost and to compare MT-2 cells with primary human Tregs. We demonstrate that loss of FOXP3 affects the transcriptome of MT-2 cells and that FOXP3's potential downstream targets include a wide range of transcripts that participate in the cell cycle, promote growth and contribute to inflammatory processes, but do not wholly simulate previously reported human primary Treg transcriptional changes in the absence of FOXP3. We also demonstrate that FOXP3 regulates cell cycling and proliferation, expression of molecules crucial to Treg function and MT-2 cell-suppressive activities. Thus, MT-2 cells offer opportunities to address regulatory T-cell functions in vitro.
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Affiliation(s)
- Morgan J McCullough
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA
| | - Miriya K Tune
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA
| | | | - Jose Torres-Castillo
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Minghong He
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yongqiang Feng
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Claire M Doerschuk
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Center for Airways Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Hong Dang
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Adriana S Beltran
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Robert S Hagan
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Jason R Mock
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA
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3
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Wei Y, Li T, Zhao D, Sun T, Ma C, Zhang L, Lv S, Li J, Tan J, Li W. Sodium butyrate ameliorates sepsis-associated lung injury by enhancing gut and lung barrier function in combination with modulation of CD4 +Foxp3 + regulatory T cells. Eur J Pharmacol 2024; 963:176219. [PMID: 38040079 DOI: 10.1016/j.ejphar.2023.176219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/04/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023]
Abstract
Sepsis-associated lung injury often coexists with intestinal dysfunction. Butyrate, an essential gut microbiota metabolite, participates in gut-lung crosstalk and has immunoregulatory effects. This study aims to investigate the effect and mechanism of sodium butyrate (NaB) on lung injury. Sepsis-associated lung injury was established in mice by cecal ligation and puncture (CLP). Mice in treatment groups received NaB gavage after surgery. The survival rate, the oxygenation index and the lung wet-to-dry weight (W/D) ratio were calculated respectively. Pulmonary and intestinal histologic changes were observed. The total protein concentration in bronchoalveolar lavage fluid (BALF) was measured, and inflammatory factors in serum and BALF were examined. Diamine oxidase (DAO), lipopolysaccharide (LPS), and surfactant-associated protein D (SP-D) levels in serum and amphiregulin in lung tissue were assessed. Intercellular junction protein expression in the lung and intestinal tissues were examined. Changes in immune cells were analyzed. NaB treatment improved the survival rate, the oxygenation index and the histologic changes. NaB decreased the W/D ratio, total protein concentration, and the levels of proinflammatory cytokines, as well as SP-D, DAO and LPS, while increased the levels of anti-inflammatory cytokines and amphiregulin. The intercellular junction protein expression were improved by NaB. Furthermore, the CD4+/CD8+ T-cell ratio and the proportion of CD4+Foxp3+ regulatory T cells (Tregs) were increased by NaB. Our data suggested that NaB gavage effectively improved the survival rate and mitigated lung injury in CLP mice. The possible mechanism was that NaB augmented CD4+Foxp3+ Tregs and enhanced the barrier function of the gut and the lung.
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Affiliation(s)
- Yuting Wei
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150080, Heilongjiang, PR China
| | - Tingting Li
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, Guangdong, PR China
| | - Dengming Zhao
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150080, Heilongjiang, PR China
| | - Tian Sun
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150080, Heilongjiang, PR China
| | - Can Ma
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150080, Heilongjiang, PR China
| | - Lijuan Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150080, Heilongjiang, PR China
| | - Shihua Lv
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150080, Heilongjiang, PR China
| | - Jingbo Li
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150080, Heilongjiang, PR China
| | - Jing Tan
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150080, Heilongjiang, PR China
| | - Wenzhi Li
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150080, Heilongjiang, PR China.
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Mikacenic C, Fussner LA, Simpson AJ, Singer BD, Files DC. Reply: Research Bronchoscopy Standards and the Need for Noninvasive Sampling of the Failing Lungs. Ann Am Thorac Soc 2024; 21:184-185. [PMID: 37776284 PMCID: PMC10867905 DOI: 10.1513/annalsats.202309-811le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 09/29/2023] [Indexed: 10/02/2023] Open
Affiliation(s)
| | | | - A. John Simpson
- Newcastle UniversityNewcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals National Health Service Foundation TrustNewcastle upon Tyne, United Kingdom
| | | | - D. Clark Files
- Wake Forest School of MedicineWinston-Salem, North Carolina
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Lee J, Jang J, Cha SR, Lee SB, Hong SH, Bae HS, Lee YJ, Yang SR. Recombinant Human Bone Morphogenetic Protein-2 Priming of Mesenchymal Stem Cells Ameliorate Acute Lung Injury by Inducing Regulatory T Cells. Immune Netw 2023; 23:e48. [PMID: 38188599 PMCID: PMC10767548 DOI: 10.4110/in.2023.23.e48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Mesenchymal stromal/stem cells (MSCs) possess immunoregulatory properties and their regulatory functions represent a potential therapy for acute lung injury (ALI). However, uncertainties remain with respect to defining MSCs-derived immunomodulatory pathways. Therefore, this study aimed to investigate the mechanism underlying the enhanced effect of human recombinant bone morphogenic protein-2 (rhBMP-2) primed ES-MSCs (MSCBMP2) in promoting Tregs in ALI mice. MSC were preconditioned with 100 ng/ml rhBMP-2 for 24 h, and then administrated to mice by intravenous injection after intratracheal injection of 1 mg/kg LPS. Treating MSCs with rhBMP-2 significantly increased cellular proliferation and migration, and cytokines array reveled that cytokines release by MSCBMP2 were associated with migration and growth. MSCBMP2 ameliorated LPS induced lung injury and reduced myeloperoxidase activity and permeability in mice exposed to LPS. Levels of inducible nitric oxide synthase were decreased while levels of total glutathione and superoxide dismutase activity were further increased via inhibition of phosphorylated STAT1 in ALI mice treated with MSCBMP2. MSCBMP2 treatment increased the protein level of IDO1, indicating an increase in Treg cells, and Foxp3+CD25+ Treg of CD4+ cells were further increased in ALI mice treated with MSCBMP2. In co-culture assays with MSCs and RAW264.7 cells, the protein level of IDO1 was further induced in MSCBMP2. Additionally, cytokine release of IL-10 was enhanced while both IL-6 and TNF-α were further inhibited. In conclusion, these findings suggest that MSCBMP2 has therapeutic potential to reduce massive inflammation of respiratory diseases by promoting Treg cells.
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Affiliation(s)
- Jooyeon Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Jimin Jang
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Sang-Ryul Cha
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Se Bi Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Seok-Ho Hong
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Han-Sol Bae
- Cellular Therapeutics Team, Daewoong Pharmaceutical, Yongin 17028, Korea
| | - Young Jin Lee
- Cellular Therapeutics Team, Daewoong Pharmaceutical, Yongin 17028, Korea
| | - Se-Ran Yang
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kangwon National University, Chuncheon 24341, Korea
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Gonçalves‐Pereira MH, Santiago L, Ravetti CG, Vassallo PF, de Andrade MVM, Vieira MS, de Fátima Souza de Oliveira F, Carobin NV, Li G, de Paula Sabino A, Nobre V, da Costa Santiago H. Dysfunctional phenotype of systemic and pulmonary regulatory T cells associate with lethal COVID-19 cases. Immunology 2023; 168:684-696. [PMID: 36349514 PMCID: PMC9877711 DOI: 10.1111/imm.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022] Open
Abstract
Severe cases of COVID-19 present hyperinflammatory condition that can be fatal. Little is known about the role of regulatory responses in SARS-CoV-2 infection. In this study, we evaluated the phenotype of regulatory T cells in the blood (peripheral blood mononuclear cell) and the lungs (broncho-alveolar) of adult patients with severe COVID-19 under invasive mechanical ventilation. Our results show important dynamic variation on Treg cells phenotype during COVID-19 with changes in number and functional parameters from the day of intubation (Day 1 of intensive care unit admission) to Day 7. We observed that compared with surviving patients, non-survivors presented lower numbers of Treg cells in the blood. In addition, lung Tregs of non-survivors also displayed higher PD1 and lower FOXP3 expressions suggesting dysfunctional phenotype. Further signs of Treg dysregulation were observed in non-survivors such as limited production of IL-10 in the lungs and higher production of IL-17A in the blood and in the lungs, which were associated with increased PD1 expression. These findings were also associated with lower pulmonary levels of Treg-stimulating factors like TNF and IL-2. Tregs in the blood and lungs are profoundly dysfunctional in non-surviving COVID-19 patients.
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Affiliation(s)
- Marcela Helena Gonçalves‐Pereira
- Departamento de Bioquímica e ImunologiaInstituto de Ciências Biológicas, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Luciana Santiago
- Departamento de Bioquímica e ImunologiaInstituto de Ciências Biológicas, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
- Núcleo Interdisciplinar de Investigação em Medicina IntensivaDepartamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Cecilia Gómez Ravetti
- Núcleo Interdisciplinar de Investigação em Medicina IntensivaDepartamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Paula Frizera Vassallo
- Núcleo Interdisciplinar de Investigação em Medicina IntensivaDepartamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Marcus Vinicius Melo de Andrade
- Núcleo Interdisciplinar de Investigação em Medicina IntensivaDepartamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Mariana Sousa Vieira
- Departamento de Bioquímica e ImunologiaInstituto de Ciências Biológicas, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | | | - Natália Virtude Carobin
- Departamento de Análises Clínicas e ToxicológicasFaculdade de Farmácia, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Guangzhao Li
- Department of MicrobiologyImmunology and Tropical Medicine, The George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Adriano de Paula Sabino
- Departamento de Análises Clínicas e ToxicológicasFaculdade de Farmácia, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Vandack Nobre
- Núcleo Interdisciplinar de Investigação em Medicina IntensivaDepartamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Helton da Costa Santiago
- Departamento de Bioquímica e ImunologiaInstituto de Ciências Biológicas, Universidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
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Singh G, Martin Rumende C, Sharma SK, Rengganis I, Amin Z, Loho T, Hermiyanti E, Harimurti K, Wibowo H. Low BALF CD4 T cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia. Ann Med 2022; 54:1894-1905. [PMID: 35786088 PMCID: PMC9258432 DOI: 10.1080/07853890.2022.2095012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Critically ill COVID-19 pneumonia is one of the main causes of extubation failure and mortality. Understanding clinical characteristics, laboratory profiles and bronchoalveolar lavage fluid (BALF) immunopathology may help improve outcomes in critically ill COVID-19 pneumonia. We aimed to describe clinical characteristics, laboratory profiles and BALF immunopathology based on lung severity in critically ill COVID-19 pneumonia patients. MATERIALS AND METHODS Forty critically ill severe pneumonia patients requiring invasive mechanical ventilation in Cipto Mangunkusumo General (National Tertiary Referral Hospital), Indonesia within November 2020-January 2021 were enrolled in this study. Early BALF collection was performed after patients' intubation. Clinical characteristics, laboratory profiles and BALF biomarkers (sTREM-1, alveolar macrophage amount and function, IL-6, IL-17, CD4 T-cells, Tregs, SP-A and Caspase-3) were observed and analysed. Outcomes were measured based on extubation failure (within 19 days) and 28-days mortality. Univariate and bivariate analyses were performed. RESULTS Early bronchoscopy was performed in an average of 4 h (SD = 0.82) after patients' intubation. Twenty-three and twenty-two patients had extubation failure (within 19 days) and 28-days mortality, respectively. In the baseline clinical characteristics of critically ill COVID-19 patients, we found no significant differences in the extubation and mortality status groups. In the laboratory profiles of critically ill COVID-19 patients, we found no significant differences in the extubation status groups. In critically ill COVID-19 pneumonia patients, there was a significant high D-dimer levels in survived group (p = .027), a significant low BALF CD4 T-cells count in the right lung (p = .001) and a significant low BALF CD4 T-cells count (p = .010 and p = .018) in severely affected lung with extubation failure and mortality. CONCLUSIONS BALF CD4 T-cells count evaluation of severely affected lung is associated with early extubation failure and mortality in critically ill COVID-19 pneumonia patients. KEY MESSAGEFew studies have been conducted during the peak COVID-19 period analysing combined bronchoalveolar lavage fluid (BALF) immunopathology biomarkers within four hours of intubation to assess extubation failure and mortality. In this study, we reported eight BALF immunopathology biomarkers (sTREM-1, alveolar macrophage, IL-6, IL-17, CD4 T-cells, Tregs, SP-A and Caspase-3).We found significantly low BALF CD4 T-cells count in the right lung, and low BALF CD4 T-cells count in severely affected lung of critically ill COVID-19 pneumonia patients in extubation failure and mortality.
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Affiliation(s)
- Gurmeet Singh
- Department of Internal Medicine, Faculty of Medicine, Division of Respirology and Critical Illness, Universitas Indonesia - Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Cleopas Martin Rumende
- Department of Internal Medicine, Faculty of Medicine, Division of Respirology and Critical Illness, Universitas Indonesia - Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Surendra K Sharma
- Department of Molecular Medicine, Jamia Hamdard Institute of Molecular Medicine, Hamdard University, New Delhi, India.,Department of General Medicine & Pulmonary Medicine, JNMC, Datta Meghe Institute of Medical Science, New Delhi, India
| | - Iris Rengganis
- Department of Internal Medicine, Faculty of Medicine, Division of Allergy and Clinical Immunology, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Zulkifli Amin
- Department of Internal Medicine, Faculty of Medicine, Division of Respirology and Critical Illness, Universitas Indonesia - Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Tonny Loho
- Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Emmy Hermiyanti
- Department of Internal Medicine, Faculty of Medicine, Division of Respirology and Critical Illness, Universitas Padjadjaran, Dr Hasan Sadikin Hospital Bandung, Bandung, Indonesia
| | - Kuntjoro Harimurti
- Department of Internal Medicine, Faculty of Medicine, Division of Geriatrics, Universitas Indonesia - Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Heri Wibowo
- Head of Integrated Laboratory, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Safety and harms of bronchoalveolar lavage (BAL) for acute respiratory failure. Respir Investig 2022; 60:861-862. [PMID: 35970713 DOI: 10.1016/j.resinv.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/22/2022] [Indexed: 10/31/2022]
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Safety and harms of bronchoalveolar lavage for acute respiratory failure: A systematic review and meta-analysis. Respir Investig 2021; 60:68-81. [PMID: 34489205 DOI: 10.1016/j.resinv.2021.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/01/2021] [Accepted: 07/28/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND This review aimed to investigate whether bronchoalveolar lavage (BAL) is safe in patients with severe acute respiratory failure (ARF). METHODS We searched the MEDLINE, CENTRAL, and other databases up to June 2, 2021 for studies that examined BAL for severe ARF. We included all cohort studies and randomized or non-randomized trials, while we excluded case-control studies, case reports, and case series. We evaluated the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS We included 17 studies (1085 patients) in the meta-analysis. The integrated frequency of death was 0.000% (95% confidence interval [CI]: 0.000-0.045%, I2 = 0.0%). The pooled risk of severe complications of respiratory system, cardiovascular system, and major bleeding was 1.32% (95% CI: 0.000-4.41%, I2 = 84.8%), 0.040% (95% CI: 0.000-0.71%, I2 = 9.3%), and 0.000% (95% CI: 0.000-0.27%, I2 = 0.0%), respectively. In the subgroup analysis with mechanical ventilation during BAL, there were few severe complications of the respiratory system (3/717 patients in 13 studies) and almost no heterogeneity (I2 = 0.0%). CONCLUSIONS Our study suggests that severe complications of BAL for severe ARF are probably rare, particularly in patients receiving mechanical ventilation. After considering the risks and benefits, it would be worthwhile to consider performing BAL in patients with severe ARF of unknown etiology to pursue its cause. TRIAL REGISTRATION The protocol was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000040600).
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