1
|
Fagiola M, Reznik S, Riaz M, Qyang Y, Lee S, Avella J, Turino G, Cantor J. The relationship between elastin cross linking and alveolar wall rupture in human pulmonary emphysema. Am J Physiol Lung Cell Mol Physiol 2023; 324:L747-L755. [PMID: 37014816 DOI: 10.1152/ajplung.00284.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/28/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023] Open
Abstract
To better define the role of mechanical forces in pulmonary emphysema, we employed methods recently developed in our laboratory to identify microscopic level relationships between airspace size and elastin-specific desmosine and isodesmosine (DID) cross links in normal and emphysematous human lungs. Free DID in wet tissue (a biomarker for elastin degradation) and total DID in formalin-fixed, paraffin-embedded (FFPE) tissue sections were measured using liquid chromatography-tandem mass spectrometry and correlated with alveolar diameter, as determined by the mean linear intercept (MLI) method. There was a positive correlation between free lung DID and MLI (P < 0.0001) in formalin-fixed lungs, and elastin breakdown was greatly accelerated when airspace diameter exceeded 400 µm. In FFPE tissue, DID density was markedly increased beyond 300 µm (P < 0.0001) and leveled off around 400 µm. Elastic fiber surface area similarly peaked at around 400 µm, but to a much lesser extent than DID density, indicating that elastin cross linking is markedly increased in response to early changes in airspace size. These findings support the hypothesis that airspace enlargement is an emergent phenomenon in which initial proliferation of DID cross links to counteract alveolar wall distention is followed by a phase transition involving rapid acceleration of elastin breakdown, alveolar wall rupture, and progression to an active disease state that is less amenable to therapeutic intervention.NEW & NOTEWORTHY The current findings support the hypothesis that airspace enlargement is an emergent phenomenon in which initial proliferation of DID cross links to counteract alveolar wall distention is followed by a phase transition involving rapid acceleration of elastin breakdown, alveolar wall rupture, and progression to an active disease state that is less amenable to therapeutic intervention.
Collapse
Affiliation(s)
- Michael Fagiola
- Department of Pharmaceutical Sciences, St. John's University, Queens, New York, United States
- Nassau County Medical Examiner, Department of Forensic Toxicology, East Meadow, New York, United States
| | - Sandra Reznik
- Department of Pharmaceutical Sciences, St. John's University, Queens, New York, United States
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Muhammad Riaz
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Yibing Qyang
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Seoyeon Lee
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Joseph Avella
- Nassau County Medical Examiner, Department of Forensic Toxicology, East Meadow, New York, United States
| | - Gerard Turino
- Department of Medicine, Mount Sinai - St. Luke's Medical Center, New York, New York, United States
| | - Jerome Cantor
- Department of Pharmaceutical Sciences, St. John's University, Queens, New York, United States
| |
Collapse
|
2
|
Fagiola M, Gu G, Avella J, Cantor J. Free Lung Desmosine: A Potential Biomarker for Elastic Fiber Injury in Pulmonary Emphysema. Biomarkers 2022; 27:319-324. [PMID: 35170389 DOI: 10.1080/1354750x.2022.2043443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Desmosine and isodesmosine (DID) are biomarkers for elastic fiber damage in pulmonary emphysema. However, current methods for measuring lung DID involve tissue hydrolysis and lack specificity for those fibers undergoing breakdown. To address this limitation, free (nonpeptide-bound) DID content in unhydrolyzed tissues was evaluated as a more accurate biomarker in an animal model of pulmonary emphysema. METHODS Hamsters were treated with either cigarette smoke and lipopolysaccharide (LPS), room air and LPS, or room air alone (controls). Free DID levels in fresh and formalin-fixed lungs were measured by LC-MS/MS and correlated with the mean linear intercept (MLI) measure of airspace size. RESULTS There was no significant difference in free DID between fresh and formalin-fixed lungs. Animals treated with smoke and LPS had significantly higher levels of free DID than the LPS only group (359 vs. 93.1 ng/g wet lung, respectively; p = 0.0012) and room air controls (undetectable levels; p = 0.0002). There was a significant positive correlation between free DID and MLI (p < 0.0001). CONCLUSIONS The results support the hypothesis that free lung DID is a sensitive indicator of alveolar wall injury that may be used to study the development of pulmonary emphysema in both animal models and post-mortem human lung tissue.
Collapse
Affiliation(s)
- Michael Fagiola
- St. John's University, Department of Pharmaceutical Sciences, 8000 Utopia Parkway, Queens, NY, USA, 11439.,Nassau County Medical Examiner, Department of Forensic Toxicology, East Meadow, NY, USA, 11554
| | - George Gu
- St. John's University, Department of Pharmaceutical Sciences, 8000 Utopia Parkway, Queens, NY, USA, 11439
| | - Joseph Avella
- Nassau County Medical Examiner, Department of Forensic Toxicology, East Meadow, NY, USA, 11554
| | - Jerome Cantor
- St. John's University, Department of Pharmaceutical Sciences, 8000 Utopia Parkway, Queens, NY, USA, 11439
| |
Collapse
|
3
|
Cantor JO, Ma S, Liu X, Campos MA, Strange C, Stocks JM, Devine MS, El Bayadi SG, Lipchik RJ, Sandhaus RA, Turino GM. A 28-day clinical trial of aerosolized hyaluronan in alpha-1 antiprotease deficiency COPD using desmosine as a surrogate marker for drug efficacy. Respir Med 2021; 182:106402. [PMID: 33906126 DOI: 10.1016/j.rmed.2021.106402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION A previous 2-week clinical trial of aerosolized hyaluronan (HA) in COPD showed a rapid reduction in lung elastic fiber breakdown, as measured by sputum levels of the unique elastin crosslinks, desmosine and isodesmosine (DID). To further assess the therapeutic efficacy of HA and the utility of DID as surrogate markers for the development of pulmonary emphysema, we have conducted a 28-day randomized, double-blind, placebo-controlled, phase 2 trial of HA involving 27 subjects with alpha-1 antiprotease deficiency COPD. METHODS The study drug consisted of a 3 ml inhalation solution containing 0.03% HA with an average molecular weight of 150 kDa that was self-administered twice daily. DID levels were measured in urine, sputum, and plasma using tandem mass spectrometry. RESULTS Free urine DID in the HA group showed a significant negative correlation with time between days 14 and 35 (r = -1.0, p = 0.023) and was statistically significantly decreased from baseline at day 35 (15.4 vs 14.2 ng/mg creatinine, p = 0.035). A marked decrease in sputum DID was also seen in the HA group between days 1 and 28 (0.96 vs 0.18 ng/mg protein), but the difference was not significant, possibly due to the small number of adequate specimens. Plasma DID remained unchanged following HA treatment and no significant reductions in urine, sputum, or plasma DID were seen in the placebo group. CONCLUSIONS The results support additional clinical trials to further evaluate the therapeutic effect of HA and the use of DID as a real-time marker of drug efficacy.
Collapse
Affiliation(s)
| | - Shuren Ma
- Mt Sinai-St Luke's Hospital Center, NY, NY, USA
| | | | | | | | - James M Stocks
- University of Texas Health Science Center, Tyler, TX, USA
| | - Megan S Devine
- University of Texas Health Science Center, Tyler, TX, USA
| | | | | | | | | |
Collapse
|
4
|
Chukowry PS, Spittle DA, Turner AM. Small Airways Disease, Biomarkers and COPD: Where are We? Int J Chron Obstruct Pulmon Dis 2021; 16:351-365. [PMID: 33628018 PMCID: PMC7899307 DOI: 10.2147/copd.s280157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/11/2020] [Indexed: 11/23/2022] Open
Abstract
The response to treatment and progression of Chronic Obstructive Pulmonary Disease (COPD) varies significantly. Small airways disease (SAD) is being increasingly recognized as a key pathological feature of COPD. Studies have brought forward pathological evidence of small airway damage preceding the development of emphysema and the detection of obstruction using traditional spirometry. In recent years, there has been a renewed interest in the early detection of SAD and this has brought along an increased demand for physiological tests able to identify and quantify SAD. Early detection of SAD allows early targeted therapy and this suggests the potential for altering the course of disease. The aim of this article is to review the evidence available on the physiological testing of small airways. The first half will focus on the role of lung function tests such as maximum mid-expiratory flow, impulse oscillometry and lung clearance index in detecting and quantifying SAD. The role of Computed Tomography (CT) as a radiological biomarker will be discussed as well as the potential of recent CT analysis software to differentiate normal aging of the lungs to pathology. The evidence behind SAD biomarkers sourced from blood as well as biomarkers sourced from sputum and broncho-alveolar lavage (BAL) will be reviewed. This paper focuses on CC-16, sRAGE, PAI-1, MMP-9 and MMP-12.
Collapse
Affiliation(s)
- Priyamvada S Chukowry
- Respiratory Research Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Daniella A Spittle
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
| | - Alice M Turner
- Institute for Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| |
Collapse
|
5
|
Ambrose JA, Najafi A, Jain V, Muller JE, Ranka S, Barua RS. Reducing Tobacco-Related Disability in Chronic Smokers. Am J Med 2020; 133:908-915. [PMID: 32325048 DOI: 10.1016/j.amjmed.2020.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 02/02/2023]
Abstract
Tobacco consumption (predominantly cigarettes) is the leading preventable cause of mortality worldwide. Although the major focus of strategies to reduce mortality from tobacco must include prevention of future generations from initially gaining access, some smokers are unwilling or unable to quit. Can the higher risk chronic smoker be identified and can their risk be reduced? The risk of adverse events in cigarette smokers is influenced by the intensity and duration of cigarette smoking or secondhand exposure, associated conventional risk factors, environmental stressors, and certain genetic variants and epigenetic modifiers. Recent data suggest that inflammatory markers such as high-sensitivity C-reactive protein (hs CRP) and targeted imaging can identify some smokers at higher risk. As smoking is prothrombotic, aspirin initiation and expanded statin use might reduce cardiovascular risk in those who do not presently meet criteria for these therapies, but further study is required. Thus, although advocacy for smoking cessation should always be the primary approach, increased efforts are needed to identify and potentially treat those who are unable or unwilling to quit.
Collapse
Affiliation(s)
- John A Ambrose
- University of California, San Francisco, Fresno Medical Education Program, Fresno, Calif.
| | - Amir Najafi
- University of California, San Francisco, Fresno Medical Education Program, Fresno, Calif
| | - Vipul Jain
- University of California, San Francisco, Fresno Medical Education Program, Fresno, Calif
| | | | - Sagar Ranka
- University of Kansas Medical Center, Kansas City Veterans' Administration, Kansas City, Mo
| | - Rajat S Barua
- University of Kansas Medical Center, Kansas City Veterans' Administration, Kansas City, Mo
| |
Collapse
|
6
|
Zhang J, Wang Y, Zhang S, Li J, Fang H. Effects of tetrandrine combined with acetylcysteine on exercise tolerance, pulmonary function and serum TNF-β1 and MMP-7 in silicosis patients. Exp Ther Med 2020; 19:2195-2201. [PMID: 32104284 PMCID: PMC7027229 DOI: 10.3892/etm.2020.8431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of the study was to investigate the effects of tetrandrine combined with acetylcysteine on exercise tolerance, pulmonary function, transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase 7 (MMP-7) in silicosis patients. A retrospective analysis was performed on 149 silicosis patients admitted to the Maternal and Child Health Care Hospital of Zhangqiu District between August, 2015 and September, 2017. Of the 149 patients, 70 patients treated with acetylcysteine comprised the control group, and 79 treated with tetrandrine combined with acetylcysteine constituted the study group. The concentrations of serum TGF-β1 and MMP-7 before and after treatment were detected by enzyme-linked immunosorbent assay (ELISA), and the exercise tolerance and pulmonary function were compared. Chest distress, chest pain, cough, expectoration and dyspnea in the two groups were relieved after treatment, and the improvement rates of chest distress, chest pain and dyspnea in the study group were significantly higher than those in the control group (P<0.05). Before treatment, there was no significant difference in the results of the 6-minute walk test (6MWT) between the two groups (P>0.05). After treatment, the 6MWT in the two groups was significantly increased (P<0.05), and the improvement effect in the study group was more marked than that in the control group (P<0.05). There was no significant difference in the pulmonary function indexes between the two groups before treatment (P>0.05). Before treatment, there was no significant difference in serum TGF-β1 and MMP-7 expression levels between the two groups (P>0.05). By contrast, after treatment, the levels in the two groups were significantly decreased, with the levels in the study group being significantly lower than that the control group (P<0.05). In conclusion, tetrandrine combined with acetylcysteine can improve pulmonary function and exercise tolerance of patients with silicosis by inhibiting the expressions of TGF-β1 and MMP-7, thus improving clinical efficacy.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Pharmacy, Maternal and Child Health Care Hospital of Zhangqiu District, Jinan 250200, P.R. China
| | - Yingchun Wang
- Department of Pharmacy, Yantaishan Hospital, Yantai 264000, P.R. China
| | - Shujuan Zhang
- Occupational Disease Department, Branch of Tai'an City Central Hospital, Tai'an 271000, P.R. China
| | - Jing Li
- Department of Surgery, The People's Hospital of Zhangqiu Area, Jinan 250200, P.R. China
| | - Hong Fang
- Department of Hepatobiliary Surgery, Weifang Traditional Chinese Hospital, Weifang 261041, P.R. China
- Correspondence to: Dr Hong Fang, Department of Hepatobiliary Surgery, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen, Weifang 261041, P.R. China, E-mail:
| |
Collapse
|
7
|
Acanfora D, Fuschillo S, Provitera V, Motta A, Maniscalco M. Biomarkers in cardiac rehabilitation: can they be applied in clinical practice? Biomark Med 2019; 13:701-705. [PMID: 31157979 DOI: 10.2217/bmm-2019-0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Domenico Acanfora
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Benevento, Italy
| | - Salvatore Fuschillo
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Benevento, Italy
| | - Vincenzo Provitera
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Benevento, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli, Naples, Italy
| | - Mauro Maniscalco
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Benevento, Italy
| |
Collapse
|
8
|
Sood S, Russell TD, Shifren A. Biomarkers in Idiopathic Pulmonary Fibrosis. Respir Med 2019. [DOI: 10.1007/978-3-319-99975-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
9
|
Free Desmosine is a Sensitive Marker of Smoke-Induced Emphysema. Lung 2018; 196:659-663. [DOI: 10.1007/s00408-018-0163-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
|
10
|
Maniscalco M, Paris D, Carone M, Spanevello A, Vitacca M, Motta A. Is there a role for biomarkers in pulmonary rehabilitation? Biomark Med 2018; 12:1069-1072. [PMID: 30191733 DOI: 10.2217/bmm-2018-0219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Mauro Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, 82037 Telese Terme (Benevento), Italy
| | - Debora Paris
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli (Naples), Italy
| | - Mauro Carone
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Cassano delle Murge (Bari), Italy
| | | | - Michele Vitacca
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Lumezzane, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli (Naples), Italy
| |
Collapse
|
11
|
Cantor JO, Turino GM. COPD Pathogenesis: Finding the Common in the Complex. Chest 2018; 155:266-271. [PMID: 30080996 DOI: 10.1016/j.chest.2018.07.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 01/21/2023] Open
Abstract
Developing an effective treatment for COPD, and especially pulmonary emphysema, will require an understanding of how fundamental changes at the molecular level affect the macroscopic structure of the lung. Currently, there is no accepted model that encompasses the biochemical and mechanical processes responsible for pulmonary airspace enlargement. We propose that pulmonary emphysematous changes may be more accurately described as an emergent phenomenon, involving alterations at the molecular level that eventually reach a critical structural threshold where uneven mechanical forces produce alveolar wall rupture, accompanied by advanced clinical signs of COPD. The coupling of emergent morphologic changes with biomarkers to detect the process, and counteract it therapeutically, represents a practical approach to the disease.
Collapse
Affiliation(s)
- Jerome O Cantor
- Department of Pharmaceutical and Allied Health Sciences, St. John's University and St. Luke's-Mount Sinai Hospital Center, New York, NY.
| | - Gerard M Turino
- Department of Pharmaceutical and Allied Health Sciences, St. John's University and St. Luke's-Mount Sinai Hospital Center, New York, NY
| |
Collapse
|
12
|
López-Ramírez C, Suarez Valdivia L, Rodríguez Portal JA. Causes of Pulmonary Fibrosis in the Elderly. Med Sci (Basel) 2018; 6:medsci6030058. [PMID: 30042329 PMCID: PMC6164854 DOI: 10.3390/medsci6030058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 01/19/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common and most lethal type of idiopathic interstitial pneumonia. It is a chronic, aging-associated lung disease characterized by fibrotic foci and inflammatory infiltrates, with no cure and very limited therapeutic options. Although its etiology is unknown, several pathogenic pathways have been described that could explain this process, involving aging, environmental factors, genomic instability, loss of proteostasis, telomere attrition, epigenetic changes, mitochondrial dysfunction, cell senescence, and altered intercellular communication. One of the main prognostic factors for the development of IPF in broad epidemiological studies is age. The incidence increases with age, making this a disease that predominantly affects the elderly population, being exceptional under 45 years of age. However, the degree to which each of these mechanisms is involved in the etiology of the uncontrolled fibrogenesis that defines IPF is still unknown. Clarifying these questions is crucial to the development of points of intervention in the pathogenesis of the disease. This review briefly summarizes what is known about each possible etiological factor, and the questions that most urgently need to be addressed.
Collapse
Affiliation(s)
- Cecilia López-Ramírez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, 41013 Sevilla, Spain.
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Lionel Suarez Valdivia
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, 41013 Sevilla, Spain.
| | - Jose Antonio Rodríguez Portal
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, 41013 Sevilla, Spain.
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| |
Collapse
|
13
|
Doyle TJ, Dellaripa PF, Rosas IO. Risk Factors and Biomarkers of RA-ILD. LUNG DISEASE IN RHEUMATOID ARTHRITIS 2018. [DOI: 10.1007/978-3-319-68888-6_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
14
|
Ho JE, Gao W, Levy D, Santhanakrishnan R, Araki T, Rosas IO, Hatabu H, Latourelle JC, Nishino M, Dupuis J, Washko GR, O'Connor GT, Hunninghake GM. Galectin-3 Is Associated with Restrictive Lung Disease and Interstitial Lung Abnormalities. Am J Respir Crit Care Med 2017; 194:77-83. [PMID: 26771117 DOI: 10.1164/rccm.201509-1753oc] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Galectin-3 (Gal-3) has been implicated in the development of pulmonary fibrosis in experimental studies, and Gal-3 levels have been found to be elevated in small studies of human pulmonary fibrosis. OBJECTIVES We sought to study whether circulating Gal-3 concentrations are elevated early in the course of pulmonary fibrosis. METHODS We examined 2,596 Framingham Heart Study participants (mean age, 57 yr; 54% women; 14% current smokers) who underwent Gal-3 assessment using plasma samples and pulmonary function testing between 1995 and 1998. Of this sample, 1,148 underwent subsequent volumetric chest computed tomography. MEASUREMENTS AND MAIN RESULTS Higher Gal-3 concentrations were associated with lower lung volumes (1.4% decrease in percentage of predicted FEV1 per 1 SD increase in log Gal-3; 95% confidence interval [CI], 0.8-2.0%; P < 0.001; 1.2% decrease in percentage of predicted FVC; 95% CI, 0.6-1.8%; P < 0.001) and decreased diffusing capacity of the lung for carbon monoxide (2.1% decrease; 95% CI, 1.3-2.9%; P < 0.001). These associations remained significant after multivariable adjustment (P ≤ 0.008 for all). Compared with the lowest quartile, participants in the highest Gal-3 quartile were more than twice as likely to have interstitial lung abnormalities visualized by computed tomography (multivariable-adjusted odds ratio, 2.67; 95% CI, 1.49-4.76; P < 0.001). CONCLUSIONS Elevated Gal-3 concentrations are associated with interstitial lung abnormalities coupled with a restrictive pattern, including decreased lung volumes and altered gas exchange. These findings suggest a potential role for Gal-3 in early stages of pulmonary fibrosis.
Collapse
Affiliation(s)
- Jennifer E Ho
- 1 Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,2 Framingham Heart Study, NHLBI, Framingham, Massachusetts
| | - Wei Gao
- 3 Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Daniel Levy
- 2 Framingham Heart Study, NHLBI, Framingham, Massachusetts.,4 Population Sciences Branch, Division of Intramural Research, NHLBI, Bethesda, Maryland
| | | | - Tetsuro Araki
- 6 Center for Pulmonary Functional Imaging.,7 Department of Radiology, and
| | - Ivan O Rosas
- 8 Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hiroto Hatabu
- 6 Center for Pulmonary Functional Imaging.,7 Department of Radiology, and
| | - Jeanne C Latourelle
- 9 Pulmonary Center, Department of Medicine, and.,10 Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; and
| | - Mizuki Nishino
- 6 Center for Pulmonary Functional Imaging.,7 Department of Radiology, and
| | - Josée Dupuis
- 2 Framingham Heart Study, NHLBI, Framingham, Massachusetts.,3 Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - George R Washko
- 6 Center for Pulmonary Functional Imaging.,8 Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - George T O'Connor
- 2 Framingham Heart Study, NHLBI, Framingham, Massachusetts.,9 Pulmonary Center, Department of Medicine, and
| | - Gary M Hunninghake
- 6 Center for Pulmonary Functional Imaging.,8 Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
Aksoy MO, Kim V, Cornwell WD, Rogers TJ, Kosmider B, Bahmed K, Barrero C, Merali S, Shetty N, Kelsen SG. Secretion of the endoplasmic reticulum stress protein, GRP78, into the BALF is increased in cigarette smokers. Respir Res 2017; 18:78. [PMID: 28464871 PMCID: PMC5414124 DOI: 10.1186/s12931-017-0561-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/21/2017] [Indexed: 01/22/2023] Open
Abstract
Background Identification of biomarkers of cigarette smoke –induced lung damage and early COPD is an area of intense interest. Glucose regulated protein of 78 kD (i.e., GRP78), a multi-functional protein which mediates cell responses to oxidant stress, is increased in the lungs of cigarette smokers and in the serum of subjects with COPD. We have suggested that secretion of GRP78 by lung cells may explain the increase in serum GRP78 in COPD. To assess GRP78 secretion by the lung, we assayed GRP78 in bronchoalveolar lavage fluid (BALF) in chronic smokers and non-smokers. We also directly assessed the acute effect of cigarette smoke material on GRP78 secretion in isolated human airway epithelial cells (HAEC). Methods GRP78 was measured in BALF of smokers (S; n = 13) and non-smokers (NS; n = 11) by Western blotting. GRP78 secretion by HAEC was assessed by comparing its concentration in cell culture medium and cell lysates. Cells were treated for 24 h with either the volatile phase of cigarette smoke (cigarette smoke extract (CSE) or the particulate phase (cigarette smoke condensate (CSC)). Results GRP78 was present in the BALF of both NS and S but levels were significantly greater in S (p = 0.04). GRP78 was secreted constitutively in HAEC. CSE 15% X 24 h increased GRP78 in cell-conditioned medium without affecting its intracellular concentration. In contrast, CSC X 24 h increased intracellular GRP78 expression but did not affect GRP78 secretion. Brefeldin A, an inhibitor of classical Golgi secretion pathways, did not inhibit GRP78 secretion indicating that non-classical pathways were involved. Conclusion The present study indicates that GRP78 is increased in BALF in cigarette smokers; that HAEC secrete GRP78; and that GRP78 secretion by HAEC is augmented by cigarette smoke particulates. Enhanced secretion of GRP78 by lung cells makes it a potential biomarker of cigarette smoke–induced lung injury.
Collapse
Affiliation(s)
- Mark O Aksoy
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA, 19140, USA. .,761 Parkinson Pavilion, Temple University Hospital, 3401 N. Broad St., Philadelphia, PA, 19140, USA.
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA, 19140, USA
| | - William D Cornwell
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA, 19140, USA.,Center for Inflammation, Translational and Clinical Lung Research, Temple University School of Medicine, Philadelphia, PA, 19140, USA
| | - Thomas J Rogers
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA, 19140, USA.,Center for Inflammation, Translational and Clinical Lung Research, Temple University School of Medicine, Philadelphia, PA, 19140, USA
| | - Beata Kosmider
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA, 19140, USA.,Department of Physiology, Temple University School of Medicine, Philadelphia, PA, 19140, USA.,Center for Inflammation, Translational and Clinical Lung Research, Temple University School of Medicine, Philadelphia, PA, 19140, USA
| | - Karim Bahmed
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA, 19140, USA.,Center for Inflammation, Translational and Clinical Lung Research, Temple University School of Medicine, Philadelphia, PA, 19140, USA
| | - Carlos Barrero
- Temple University School of Pharmacy, Philadelphia, PA, 19140, USA
| | - Salim Merali
- Temple University School of Pharmacy, Philadelphia, PA, 19140, USA
| | - Neena Shetty
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA, 19140, USA
| | - Steven G Kelsen
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA, 19140, USA
| |
Collapse
|
16
|
Dilektasli AG, Demirdogen Cetinoglu E, Uzaslan E, Budak F, Coskun F, Ursavas A, Ercan I, Ege E. Serum CCL-18 level is a risk factor for COPD exacerbations requiring hospitalization. Int J Chron Obstruct Pulmon Dis 2017; 12:199-208. [PMID: 28115842 PMCID: PMC5221541 DOI: 10.2147/copd.s118424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Chemokine (C-C motif) ligand 18 (CCL-18) has been shown to be elevated in chronic obstructive pulmonary disease (COPD) patients. This study primarily aimed to evaluate whether the serum CCL-18 level differentiates the frequent exacerbator COPD phenotype from infrequent exacerbators. The secondary aim was to investigate whether serum CCL-18 level is a risk factor for exacerbations requiring hospitalization. Materials and methods Clinically stable COPD patients and participants with smoking history but normal spirometry (NSp) were recruited for the study. Modified Medical Research Council Dyspnea Scale, COPD Assessment Test, spirometry, and 6-min walking test were performed. Serum CCL-18 levels were measured with a commercial ELISA Kit. Results Sixty COPD patients and 20 NSp patients were recruited. Serum CCL-18 levels were higher in COPD patients than those in NSp patients (169 vs 94 ng/mL, P<0.0001). CCL-18 level was significantly correlated with the number of exacerbations (r=0.30, P=0.026), although a difference in CCL-18 values between infrequent and frequent exacerbator COPD (168 vs 196 ng/mL) subgroups did not achieve statistical significance (P=0.09). Serum CCL-18 levels were significantly higher in COPD patients who had experienced at least one exacerbation during the previous 12 months. Overall, ROC analysis revealed that a serum CCL-18 level of 181.71 ng/mL could differentiate COPD patients with hospitalized exacerbations from those who were not hospitalized with a 88% sensitivity and 88.2% specificity (area under curve: 0.92). Serum CCL-18 level had a strong correlation with the frequency of exacerbations requiring hospitalization (r=0.68, P<0.0001) and was found to be an independent risk factor for hospitalized exacerbations in the multivariable analysis. Conclusion CCL-18 is a promising biomarker in COPD, as it is associated with frequency of exacerbations, particularly with severe COPD exacerbations requiring hospitalization, as well as with functional parameters and symptom scores.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ilker Ercan
- Department of Biostatistics, Uludag University Faculty of Medicine, Bursa, Turkey
| | | |
Collapse
|
17
|
The Pattern of Elastic Fiber Breakdown in Bleomycin-Induced Pulmonary Fibrosis May Reflect Microarchitectural Changes. Lung 2016; 195:93-99. [PMID: 27761647 DOI: 10.1007/s00408-016-9956-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Desmosine and isodesmosine (DID) are unique elastin crosslinks that may serve as biomarkers for elastic fiber degradation in chronic obstructive pulmonary disease. Previously, our laboratory found that the ratio of free to peptide-bound DID in bronchoalveolar lavage fluid (BALF) showed a significant positive correlation with the extent of airspace enlargement in an elastase model of pulmonary emphysema. To further evaluate this hypothesis, our laboratory measured this ratio in a bleomycin (BLM) model of pulmonary fibrosis, which involved different microarchitectural changes than those associated with pulmonary emphysema. METHODS Syrian hamsters were instilled intratracheally with 1.0 unit BLM in 0.2 ml of normal saline (controls received the vehicle alone), and BALF was analyzed for both free and total DID, using a combination of liquid chromatography and tandem mass spectrometry. RESULTS Total BALF DID was significantly increased in hamsters receiving BLM at 1 week post-treatment (92 vs 13 pg/ml; p < 0.001), consistent with elastic fiber degradation. However, in contrast to elastase-induced emphysema, free/bound DID was lower in BLM-treated animals compared to controls at both 1 week (0.76 vs 0.84) and 2 weeks post-treatment (0.69 vs 0.86), though the differences were not statistically significant. CONCLUSIONS These results indicate that it may be possible to identify specific pulmonary microarchitecture changes, based on the ratio of free to peptide-bound DID. It is speculated that the proportionate decrease in free DID in BLM-induced fibrosis may be due to preservation of intact elastic fibers as the lung injury progresses.
Collapse
|
18
|
Doyle TJ, Patel AS, Hatabu H, Nishino M, Wu G, Osorio JC, Golzarri MF, Traslosheros A, Chu SG, Frits ML, Iannaccone CK, Koontz D, Fuhrman C, Weinblatt ME, El-Chemaly SY, Washko GR, Hunninghake GM, Choi AMK, Dellaripa PF, Oddis CV, Shadick NA, Ascherman DP, Rosas IO. Detection of Rheumatoid Arthritis-Interstitial Lung Disease Is Enhanced by Serum Biomarkers. Am J Respir Crit Care Med 2015; 191:1403-12. [PMID: 25822095 DOI: 10.1164/rccm.201411-1950oc] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
RATIONALE Interstitial lung disease (ILD), a leading cause of morbidity and mortality in rheumatoid arthritis (RA), is highly prevalent, yet RA-ILD is underrecognized. OBJECTIVES To identify clinical risk factors, autoantibodies, and biomarkers associated with the presence of RA-ILD. METHODS Subjects enrolled in Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS) and American College of Rheumatology (ACR) cohorts were evaluated for ILD. Regression models were used to assess the association between variables of interest and RA-ILD. Receiver operating characteristic curves were generated in BRASS to determine if a combination of clinical risk factors and autoantibodies can identify RA-ILD and if the addition of investigational biomarkers is informative. This combinatorial signature was subsequently tested in ACR. MEASUREMENTS AND MAIN RESULTS A total of 113 BRASS subjects with clinically indicated chest computed tomography scans (41% with a spectrum of clinically evident and subclinical RA-ILD) and 76 ACR subjects with research or clinical scans (51% with a spectrum of RA-ILD) were selected. A combination of age, sex, smoking, rheumatoid factor, and anticyclic citrullinated peptide antibodies was strongly associated with RA-ILD (areas under the curve, 0.88 for BRASS and 0.89 for ACR). Importantly, a combinatorial signature including matrix metalloproteinase 7, pulmonary and activation-regulated chemokine, and surfactant protein D significantly increased the areas under the curve to 0.97 (P = 0.002, BRASS) and 1.00 (P = 0.016, ACR). Similar trends were seen for both clinically evident and subclinical RA-ILD. CONCLUSIONS Clinical risk factors and autoantibodies are strongly associated with the presence of clinically evident and subclinical RA-ILD on computed tomography scan in two independent RA cohorts. A biomarker signature composed of matrix metalloproteinase 7, pulmonary and activation-regulated chemokine, and surfactant protein D significantly strengthens this association. These findings may facilitate identification of RA-ILD at an earlier stage, potentially leading to decreased morbidity and mortality.
Collapse
Affiliation(s)
- Tracy J Doyle
- 1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Avignat S Patel
- 1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hiroto Hatabu
- 2 Center for Pulmonary Functional Imaging.,3 Department of Radiology
| | - Mizuki Nishino
- 2 Center for Pulmonary Functional Imaging.,3 Department of Radiology
| | - Guodong Wu
- 4 Lovelace Respiratory Research Institute, Albuquerque, New Mexico
| | - Juan C Osorio
- 1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria F Golzarri
- 1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andres Traslosheros
- 1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah G Chu
- 1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Diane Koontz
- 6 Division of Rheumatology and Clinical Immunology and
| | - Carl Fuhrman
- 7 Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Souheil Y El-Chemaly
- 1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - George R Washko
- 1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gary M Hunninghake
- 1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,8 Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts
| | - Augustine M K Choi
- 9 Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York; and
| | | | | | | | - Dana P Ascherman
- 10 Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ivan O Rosas
- 1 Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,4 Lovelace Respiratory Research Institute, Albuquerque, New Mexico
| |
Collapse
|
19
|
Leung J, Cho Y, Lockey RF, Kolliputi N. The Role of Aging in Idiopathic Pulmonary Fibrosis. Lung 2015; 193:605-10. [DOI: 10.1007/s00408-015-9729-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/15/2015] [Indexed: 01/07/2023]
|
20
|
Chen J, Doyle TJ, Liu Y, Aggarwal R, Wang X, Shi Y, Ge SX, Huang H, Lin Q, Liu W, Cai Y, Koontz D, Fuhrman CR, Golzarri MF, Liu Y, Hatabu H, Nishino M, Araki T, Dellaripa PF, Oddis CV, Rosas IO, Ascherman DP. Biomarkers of rheumatoid arthritis-associated interstitial lung disease. Arthritis Rheumatol 2015; 67:28-38. [PMID: 25302945 DOI: 10.1002/art.38904] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/30/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Interstitial lung disease (ILD) is a relatively common extraarticular manifestation of rheumatoid arthritis (RA) that contributes significantly to disease burden and excess mortality. The purpose of this study was to identify peripheral blood markers of RA-associated ILD that can facilitate earlier diagnosis and provide insight regarding the pathogenesis of this potentially devastating disease complication. METHODS Patients with RA who were enrolled in a well-characterized Chinese identification cohort or a US replication cohort were subclassified as having RA-no ILD, RA-mild ILD, or RA-advanced ILD, based on high-resolution computed tomography scans of the chest. Multiplex enzyme-linked immunosorbent assays (ELISAs) and Luminex xMAP technology were used to assess 36 cytokines/chemokines, matrix metalloproteinases (MMPs), and acute-phase proteins in the identification cohort. Unadjusted and adjusted logistic regression models were used to quantify the strength of association between RA-ILD and biomarkers of interest. RESULTS MMP-7 and interferon-γ-inducible protein 10 (IP-10)/CXCL10 were identified by multiplex ELISA as potential biomarkers for RA-ILD in 133 RA patients comprising the Chinese identification cohort (50 RA-no ILD, 41 RA-ILD, 42 RA-indeterminate ILD). The findings were confirmed by standard solid-phase sandwich ELISA in the Chinese identification cohort as well as an independent cohort of US patients with RA and different stages of ILD (22 RA-no ILD, 49 RA-ILD, 15 RA-indeterminate ILD), with statistically significant associations in both unadjusted and adjusted logistic regression analyses. CONCLUSION Levels of MMP-7 and IP-10/CXCL10 are elevated in the serum of RA patients with ILD, whether mild or advanced, supporting their value as pathogenically relevant biomarkers that can contribute to noninvasive detection of this extraarticular disease complication.
Collapse
Affiliation(s)
- Juan Chen
- First Hospital of Xiamen University, Xiamen, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Liu X, Ma S, Liu S, Liu M, Turino G, Cantor J. The Ratio of Free to Bound Desmosine and Isodesmosine May Reflect Emphysematous Changes in COPD. Lung 2015; 193:329-34. [PMID: 25762453 DOI: 10.1007/s00408-015-9712-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 03/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The unique elastin crosslinks, desmosine and isodesmosine (DID) are significantly elevated in blood, urine, and sputum from patients with COPD, and may decline following treatment of the disease. However, the large degree of variance in this biomarker among COPD patients with similar levels of disease suggests that it has limited prognostic value with regard to the degree of lung disease in a given individual. As an alternative to measuring the total amount of DID, we propose using the ratio of free to peptide-bound DID, which may provide a better indication of overall lung disease. METHODS To test this hypothesis, the free/bound DID ratio was measured in bronchoalveolar lavage fluid (BALF) from both hamsters with elastase-induced emphysema and controls not given the enzyme, using a combination of liquid chromatography and tandem mass spectroscopy. This ratio was then correlated with airspace enlargement, as measured by the mean percentage of lung surface area at ×100 microscopic magnification. RESULTS There was a significant negative correlation between the free/bound DID ratio in BALF and lung surface area. However, there was no correlation between this ratio and total BALF DID, suggesting that free/bound DID is unrelated to the immediate rate of breakdown of elastic fibers, and may instead measure the cumulative effect of elastase injury in the lung. CONCLUSIONS The free/bound DID ratio may be a useful measure of emphysematous changes in the lung and might also serve as a screening procedure for healthy smokers and other individuals at risk for developing COPD.
Collapse
|
22
|
Interstitial lung disease: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases. Ann Am Thorac Soc 2015; 11 Suppl 3:S169-77. [PMID: 24754826 DOI: 10.1513/annalsats.201312-429ld] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Population-based, longitudinal studies spanning decades linking risk factors in childhood, adolescence and early adulthood to incident clinical interstitial lung disease (ILD) events in late adulthood have not been performed. In addition, no observational or randomized clinical trials have been conducted; therefore, there is presently no evidence to support the notion that reduction of risk factor levels in early life prevents ILD events in adult life. Primary prevention strategies are host-directed interventions designed to modify adverse risk factors (i.e., smoking) with the goal of preventing the development of ILD, whereas primordial prevention for ILD can be defined as the elimination of external risk factors (i.e., environmental pollutants). As no ILD primary prevention studies have been previously conducted, we propose that research studies that promote implementation of primary prevention strategies could, over time, make a subset of ILD preventable. Herein, we provide a number of initial steps required for the future implementation of prevention strategies; this statement discusses the rationale and available evidence that support potential opportunities for primordial and primary prevention, as well as fertile areas for future research of preventive intervention in ILD.
Collapse
|
23
|
Abstract
Diseases and death caused by exposure to tobacco smoke have become the single most serious preventable public health concern. Thus, biomarkers that can monitor tobacco exposure and health effects can play a critical role in tobacco product regulation and public health policy. Biomarkers of exposure to tobacco toxicants are well established and have been used in population studies to establish public policy regarding exposure to second-hand smoke, an example being the nicotine metabolite cotinine, which can be measured in urine. Biomarkers of biological response to tobacco smoking range from those indicative of inflammation to mRNA and microRNA patterns related to tobacco use and/or disease state. Biomarkers identifying individuals with an increased risk for a pathological response to tobacco have also been described. The challenge for any novel technology or biomarker is its translation to clinical and/or regulatory application, a process that requires first technical validation of the assay and then careful consideration of the context the biomarker assay may be used in the regulatory setting. Nonetheless, the current efforts to investigate new biomarker of tobacco smoke exposure promise to offer powerful new tools in addressing the health hazards of tobacco product use. This review will examine such biomarkers, albeit with a focus on those related to cigarette smoking.
Collapse
Affiliation(s)
- William Mattes
- Division of Systems Biology, Food & Drug Administration, National Center for Toxicological Research, Jefferson, Arkansas, USA.
| | - Xi Yang
- Division of Systems Biology, Food & Drug Administration, National Center for Toxicological Research, Jefferson, Arkansas, USA
| | - Michael S Orr
- Office of Science, Food & Drug Administration, Center for Tobacco Products, Rockville, Maryland, USA
| | - Patricia Richter
- Office of Science, Food & Drug Administration, Center for Tobacco Products, Rockville, Maryland, USA
| | - Donna L Mendrick
- Division of Systems Biology, Food & Drug Administration, National Center for Toxicological Research, Jefferson, Arkansas, USA
| |
Collapse
|
24
|
Doyle TJ, Lee JS, Dellaripa PF, Lederer JA, Matteson EL, Fischer A, Ascherman DP, Glassberg MK, Ryu JH, Danoff SK, Brown KK, Collard HR, Rosas IO. A roadmap to promote clinical and translational research in rheumatoid arthritis-associated interstitial lung disease. Chest 2014; 145:454-463. [PMID: 24590021 DOI: 10.1378/chest.13-2408] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting approximately 1.3 million adults in the United States. Approximately 10% of these individuals with RA have clinically evident interstitial lung disease (RA-ILD), and an additional one-third demonstrate subclinical ILD on chest CT scan. The risk of death for individuals with RA-ILD is three times higher than for patients with RA without ILD, with a median survival after ILD diagnosis of only 2.6 years. Despite the high prevalence and mortality of RA-ILD, little is known about its molecular features and its natural history. At present, we lack a standard validated approach to the definition, diagnosis, risk stratification, and management of RA-ILD. In this perspective, we discuss the importance of clinical and translational research and how ongoing research efforts can address important gaps in our knowledge over the next few years. Furthermore, recommendations are made to design multicenter collaborative studies that will expedite the development of clinical trials designed to decrease the significant morbidity and mortality associated with RA-ILD.
Collapse
Affiliation(s)
- Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joyce S Lee
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Paul F Dellaripa
- Division of Rheumatology, Immunology, and Allergy Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James A Lederer
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN
| | - Aryeh Fischer
- Division of Rheumatology, National Jewish Health and University of Colorado, Denver, CO
| | - Dana P Ascherman
- Division of Rheumatology, University of Miami Miller School of Medicine, Miami, FL
| | - Marilyn K Glassberg
- Division of Pulmonary Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kevin K Brown
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO
| | - Harold R Collard
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Ivan O Rosas
- Lovelace Respiratory Research Institute, Albuquerque, NM.
| |
Collapse
|
25
|
Tu YH, Zhang Y, Fei GH. Utility of the CAT in the therapy assessment of COPD exacerbations in China. BMC Pulm Med 2014; 14:42. [PMID: 24618290 PMCID: PMC3995795 DOI: 10.1186/1471-2466-14-42] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 03/07/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) exacerbations are accompanied with increased systemic inflammation, which accelerate the pulmonary function injury and impair the quality of life. Prompt and effective treatments for COPD exacerbations slow down the disease progression, but an objective instrument to assess the efficacy of the treatments following COPD exacerbations is lacking nowadays. The COPD Assessment Test (CAT) is an 8-item questionnaire designed to assess and quantify health status and symptom burden in COPD patients. We hypothesize that the change in CAT score is related to the treatment response following COPD exacerbations. METHODS 78 inpatients with clinician-diagnosed acute exacerbation of COPD (AECOPD) completed the CAT, St George's Respiratory Questionnaire (SGRQ) and modified Medical Research Council (mMRC) Dyspnea Scale both at exacerbation and the 7th day of therapy, and a subgroup of 39 patients performed the pulmonary function test. Concentrations of serum C-reactive protein (CRP) and plasma fibrinogen were assayed at the same time. Correlations between the CAT and other measurements were examined. RESULTS After 7 days' therapy, the CAT and SGRQ scores, mMRC grades, as well as the concentrations of CRP and fibrinogen all decreased significantly (P < 0.001). Meanwhile, the FEV1% predicted had a significant improvement (P < 0.001). The CAT scores were significantly correlated with concurrent concentrations of CRP and fibrinogen, SGRQ scores, FEV1% predicted and mMRC grades (P < 0.05). The change in CAT score was positively correlated with the change of CRP (r = 0.286, P < 0.05), SGRQ score (r = 0.725, P < 0.001) and mMRC grades (r = 0.593, P < 0.001), but not with fibrinogen (r = 0.137, P > 0.05) or FEV1% predicted (r = -0.101, P > 0.05). No relationship was found between the changes of SGRQ score and CRP and fibrinogen (P>0.05). CONCLUSIONS The CAT is associate with the changes of systemic inflammation following COPD exacerbations. Moreover, the CAT is responsive to the treatments, similar to other measures such as SGRQ, mMRC dyspnea scale and pulmonary function. Therefore, the CAT is a potentially useful instrument to assess the efficacy of treatments following COPD exacerbations.
Collapse
Affiliation(s)
| | | | - Guang-He Fei
- Pulmonary Department, First Affiliated Hospital of Anhui Medical University, Hefei, 230022 Anhui, China.
| |
Collapse
|
26
|
Borensztajn K, Crestani B, Kolb M. Idiopathic pulmonary fibrosis: from epithelial injury to biomarkers--insights from the bench side. ACTA ACUST UNITED AC 2013; 86:441-52. [PMID: 24356558 DOI: 10.1159/000357598] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most frequent fibrotic diffuse parenchymal lung disease. Its prognosis is devastating: >50% of the patients die within 3 years after diagnosis. Options for the treatment of IPF are limited and lung transplantation is the only 'curative' therapy. Currently, in the absence of validated indicators of disease progression/activity and diagnostic tools, the clinical management of IPF remains a major challenge. A better understanding of the pathogenesis of IPF is critical for the identification of new therapeutic targets as well as molecules that may serve as surrogate markers for clinically significant endpoints. The current paradigm on the mechanisms leading from a normal to a fibrotic lung postulates that chronic epithelial lesion leads to aberrant wound healing activation, which is characterized by deregulated fibroblast proliferation and activation together with an uncontrolled extracellular matrix synthesis. In this review, we shed light on the role of epithelial cell damage in the pathogenesis of fibrosis. Finally, we examine the markers of epithelial damage and their potential use as biomarkers and the future of this continuously expanding field.
Collapse
|
27
|
Ho G, Tang H, Robbins JA, Tong EK. Biomarkers of tobacco smoke exposure and asthma severity in adults. Am J Prev Med 2013; 45:703-9. [PMID: 24237911 DOI: 10.1016/j.amepre.2013.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/21/2013] [Accepted: 09/04/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Tobacco biomarkers including serum cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) have been used in research settings. PURPOSE The goal of the study was to examine the association of cotinine and NNAL with asthma outcomes in the U.S. adult population. METHODS A cross-sectional design was used, using data from the National Health and Nutrition Examination Survey, 2007-2008, with participants aged >20 years with self-reported asthma (N=456). Past-year asthma exacerbations and emergency room/urgent care visits for asthma were examined. Analyses were conducted in 2013. RESULTS Among adult asthmatics, 50.3% reported a past-year asthma attack (61.8% smokers, 46.6% nonsmokers, p=0.029). Among these, 24.7% reported a past-year emergency/urgent visit for asthma (34.7% smokers, 20.1% nonsmokers, p=0.034). Median concentrations of cotinine and creatinine-adjusted NNAL (NNAL/Cr) were significantly higher in those with a past-year asthma attack (0.43 ng/mL and 7.28 pg/mL) than in those without (0.06 ng/mL and 2.26 pg/mL), and highest in those with past-year emergency/urgent visits (0.93 ng/mL and 28.14 pg/mL). Among nonsmokers, increasing levels of log cotinine or log NNAL/Cr, adjusted for demographics, were significantly associated with past-year asthma exacerbation (log cotinine OR=1.46 [95% CI=1.1, 1.92]; log NNAL/Cr OR=1.42 [95% CI=1.07, 1.88]) and past-year emergency/urgent visit (log cotinine OR=1.95 [95% CI=1.32, 2.88]; log NNAL/Cr OR=1.58 [95% CI=1.23, 2.02]). Among smokers, increasing biomarker levels were not significantly associated with either outcome. CONCLUSIONS In a population-based cross-sectional analysis, increased cotinine and NNAL were found to be associated with asthma exacerbation and healthcare use in nonsmokers with asthma. If these findings are confirmed in prospective studies, these biomarkers might be candidates for clinical indicators of risk of asthma.
Collapse
Affiliation(s)
- Gwendolyn Ho
- Department of Internal Medicine, University of California, Davis, Sacramento
| | | | | | | |
Collapse
|
28
|
Cantor JO, Ma S, Turino GM. What percolation theory can tell us about COPD. Med Hypotheses 2013; 81:152-5. [PMID: 23759356 DOI: 10.1016/j.mehy.2013.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 05/19/2013] [Indexed: 10/26/2022]
Abstract
Damage to the lung elastic fiber network is largely responsible for the distention and rupture of alveolar walls in chronic obstructive pulmonary disease (COPD). It has therefore been suggested that blood or urine levels of the unique elastic fiber crosslinks, desmosine and isodesmosine (DID), may serve as a biomarker for the progression of the disease. The prognostic value of DID may be limited, however, by the large degree of variance associated with their measurement in patients with COPD. To overcome this problem, we propose that specific patterns of DID release from damaged elastic fibers, rather than their absolute quantity, may provide a better indication of morphological changes in the lungs of patients with COPD. Using percolation theory to model the elastic fiber network in the lung, it will be shown that the relative amounts of damaged and intact elastic fibers may be reflected at the molecular level by urinary levels of free and peptide-bound DID, respectively. The self-similar nature of percolation networks further suggests that detachment of crosslinks from elastic fibers may be analogous to the rupture of alveolar walls in COPD. Consequently, the ratio of free to bound DID may be a measure of emphysematous changes in this disease.
Collapse
Affiliation(s)
- J O Cantor
- St John's University, New York, NY, United States.
| | | | | |
Collapse
|
29
|
|
30
|
Hizawa N. Associating Serum Biomarkers with Genetic Susceptibility to Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2012; 186:1201-2. [DOI: 10.1164/rccm.201210-1898ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|