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Goleij P, Rahimi M, Pourshahroudi M, Tabari MAK, Muhammad S, Suteja RC, Daglia M, Majma Sanaye P, Hadipour M, Khan H, Sadeghi P. The role of IL-2 cytokine family in asthma. Cytokine 2024; 180:156638. [PMID: 38761716 DOI: 10.1016/j.cyto.2024.156638] [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: 03/09/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The interleukin-2 (IL-2) family of cytokines, including IL-2, IL-4, IL-7, IL-9, IL-15, and IL-21, are pivotal regulators of the immune response, impacting both innate and adaptive immunity. Understanding their molecular characteristics, receptor interactions, and signalling pathways is essential for elucidating their roles in health and disease. OBJECTIVES This review provides a comprehensive overview of the IL-2 family of cytokines, highlighting their molecular biology, receptor interactions, and signalling mechanisms. Furthermore, it explores the involvement of IL-2 family cytokines in the pathogenesis of chronic respiratory diseases, with a specific focus on chronic obstructive pulmonary disease (COPD) and asthma. METHODS A thorough literature review was conducted to gather insights into the molecular biology, receptor interactions, and signalling pathways of IL-2 family cytokines. Additionally, studies investigating the roles of these cytokines in chronic respiratory diseases, particularly COPD and asthma, were analysed to discern their implications in wider pathophysiology of disease. RESULTS IL-2 family cytokines exert pleiotropic effects on immune cells, modulating cellular proliferation, differentiation, and survival. Dysregulation of IL-2 family cytokines has been implicated in the pathogenesis of chronic respiratory illnesses, including COPD and asthma. Elevated levels of IL-2 and IL-9 have been associated with disease severity in COPD, while IL-4 and IL-9 play crucial roles in asthma pathogenesis by promoting airway inflammation and remodelling. CONCLUSION Understanding the intricate roles of IL-2 family cytokines in chronic respiratory diseases provides valuable insights into potential therapeutic targets for these conditions. Targeting specific cytokines or their receptors may offer novel treatment modalities to attenuate disease progression and improve clinical outcomes in patients with COPD and asthma.
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Affiliation(s)
- Pouya Goleij
- USERN Office, Kermanshah University of Medical Sciences, Kermanshah, Iran; Immunology Board for Transplantation and Cell-Based Therapeutics (ImmunoTACT), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Mohammad Rahimi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Iran.
| | - Motahareh Pourshahroudi
- Department of Public Health, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, United Kingdom.
| | - Mohammad Amin Khazeei Tabari
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Iran; Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Syed Muhammad
- Farooqia College of Pharmacy, Mysuru, Karnataka, India.
| | | | - Maria Daglia
- Department of Pharmacy, University of Naples "Federico II", Via D. Montesano 49, 80131 Naples, Italy; International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China.
| | | | - Mahboube Hadipour
- Department of Biochemistry, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Haroon Khan
- Department of Pharmacy, Faculty of Chemical and Life Sciences, Abdul Wali Khan University Mardan, Mardan 23200, Pakistan.
| | - Parniyan Sadeghi
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Effect of lung protective ventilation on perioperative pulmonary infection in elderly patients with mild to moderate COPD under general anesthesia. J Infect Public Health 2020; 13:281-286. [DOI: 10.1016/j.jiph.2019.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022] Open
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Zhang H, Zhou X, Chen X, Lin Y, Qiu S, Zhao Y, Tang Q, Liang Y, Zhong X. Rapamycin attenuates Tc1 and Tc17 cell responses in cigarette smoke-induced emphysema in mice. Inflamm Res 2019; 68:957-968. [PMID: 31468083 DOI: 10.1007/s00011-019-01278-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/02/2019] [Accepted: 08/19/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE AND DESIGN Chronic exposure to cigarette smoke promotes airway inflammation and emphysema accompanied by enhanced CD8+ interferon (IFN)-γ+ T(Tc1) and CD8+ interleukin (IL)-17+ T(Tc17) cell responses. The mammalian target of rapamycin (mTOR) has been involved in the pathogenesis of emphysema. Inhibiting mTOR by rapamycin has been reported to alleviate emphysema, but the mechanism is not fully understood. We aimed to explore the effect of rapamycin on Tc1 and Tc17 cell responses induced by cigarette smoke exposure. MATERIALS Male C57BL/6 mice were exposed to cigarette smoke or room air for 24 weeks. Half of the smoke-exposed mice received rapamycin in the last 12 weeks. The severity of emphysema in those mice was evaluated by mean linear intercept (MLI), mean alveolar airspace area (MAA) and destructive index (DI). Bronchoalveolar lavage was collected and analyzed. Phosphorylated (p-) mTOR in CD8+ T cells, Tc1 and Tc17 cells were detected by flow cytometry. The relative expression of p-mTOR in lungs was determined by western blot analysis. IFN-γ and IL-17A levels were detected by enzyme-linked immunosorbent assays. IFN-γ, mTOR and RAR-related orphan receptor (ROR)γt mRNA levels were evaluated by the real-time polymerase chain reaction. RESULTS Elevated p-mTOR expression in CD8+ T cells and lung tissue was accompanied by the enhanced Tc1 and Tc17 cell responses in lungs of mice exposed to cigarette smoke. Rapamycin reduced inflammatory cells in BALF and decreased MLI, DI and MAA in lungs. Rapamycin decreased p-mTOR expression, and down-regulation of mTOR and RORγt mRNA levels along with the attenuation of Tc1 and Tc17 cell responses in mice with emphysema. CONCLUSIONS The mTOR was activated in CD8+ T cells accompanied by the enhanced Tc1 and Tc17 cell responses in cigarette smoke-related pulmonary inflammation. Rapamycin ameliorated emphysema and attenuated Tc1 and Tc17 cell responses probably caused by inhibiting mTOR in cigarette smoke-exposed mice.
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Affiliation(s)
- Hui Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Xiu Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Xin Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Yuanzhen Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Shilin Qiu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Yun Zhao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Qiya Tang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Yi Liang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Xiaoning Zhong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China.
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ILC2s Induce Adaptive Th2-Type Immunity in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Mediators Inflamm 2019; 2019:3140183. [PMID: 31320835 PMCID: PMC6610743 DOI: 10.1155/2019/3140183] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/20/2019] [Indexed: 12/21/2022] Open
Abstract
To investigate the effect of ILC2s on Th2-type adaptive immunity during the acute exacerbation of chronic obstructive pulmonary disease (AECOPD), the study enrolled healthy people, stable COPD patients, and AECOPD patients. Flow cytometry was used to detect Th1, Th2, and ILC2 in the peripheral blood and CD80 and MHC II levels on ILC2. The mRNA levels of GATA3, RORα, and CRTH2 of ILC2s were detected by RT-PCR. In addition, ILC2s from the peripheral blood of AECOPD patients were cocultured with CD4+ T cells from the peripheral blood of healthy controls. Cytokine levels in serum of the three groups and the in vitro coculture supernatants were measured by ELISA. Compared with the stable COPD group or the healthy control group, Th2 in the peripheral blood of AECOPD group increased dramatically, inducing an increase of Th2/Th1 ratio in AECOPD patients. Meanwhile, the level of IL-4 in the serum of this group was also increased. However, we also detected ILC2s in the peripheral blood of the AECOPD group and found that it was also increased, alone with the increased GATA3, RORα, and CRTH2 mRNA levels. We also found that the CD80 and MHC II on ILC2 were significantly upregulated and the proportion of MHC II+ ILC2 cells was significantly positively correlated with the proportion of Th2 cells in AECOPD patients. To further demonstrate the effect of ILC2 on Th2 cells, we cocultured ILC2 with CD4+ T cells in vitro, which also showed a significant increase of Th2 ratio as well as Th2-associated cytokines IL-4, IL-5, and IL-13. However, we found that this effect of ILC2s on Th2 cells could be inhibited by the addition of anti-MHC II. The Th2/Th1 balance shifts to Th2 in AECOPD. ILC2s may function as APC by the upregulation of MHC II and regulate adaptive immunity shift to Th2-type response in AECOPD.
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Seyfarth J, Mütze N, Antony Cruz J, Kummer S, Reinauer C, Mayatepek E, Meissner T, Jacobsen M. CD4 + T-Cells With High Common γ Chain Expression and Disturbed Cytokine Production Are Enriched in Children With Type-1 Diabetes. Front Immunol 2019; 10:820. [PMID: 31110501 PMCID: PMC6499215 DOI: 10.3389/fimmu.2019.00820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/28/2019] [Indexed: 12/22/2022] Open
Abstract
The common gamma chain (γc) contributes to the formation of different cytokine receptors [e.g., IL-2 receptor (IL-2R), IL-7R, and IL-15R], which are important for generation of self-reactive T-cells in autoimmune diseases, like in type 1 diabetes (T1D). Whereas, the roles of membrane and soluble IL-2Rα and IL-7Rα variants in T1D disease pathogenesis are well-described, effects of γc expression and availability for dependent receptors remain elusive. We investigated expression of the γc and dependent receptors on T-cells and soluble γc concentrations in serum from patients with T1D (n = 34) and healthy controls (n = 27). Effector T-cell cytokines as well as IL-2, IL-7, and IL-15 induced STAT5 phosphorylation were analyzed to determine functional implications of differential γc expression of CD4+ T-cell subsets classified by t-distributed Stochastic Neighbor Embedding (t-SNE) analyses. We found increased γc and IL-7Rα expression of CD4+ T-cells from T1D patients as compared to controls. t-SNE analyses assigned differential expression to subsets of memory T-cells co-expressing γc and IL-7Rα. Whereas, γc expression was positively correlated with IL-2Rα in memory T-cells from healthy controls, no dependency was found for patients with T1D. Similarly, the effector T-cell cytokine, IL-21, correlated inversely with γc expression in healthy controls, but not in T1D patients. Finally, T1D patients with high γc expression had increased proportions of IL-2 sensitive pSTAT5+ effector T-cells. These results indicated aberrantly high γc expression of T-cells from T1D patients with implications on dependent cytokine receptor signaling and effector T-cell cytokine production.
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Affiliation(s)
- Julia Seyfarth
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Düsseldorf, Germany
| | - Nathalie Mütze
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Düsseldorf, Germany
| | - Jennifer Antony Cruz
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Düsseldorf, Germany
| | - Sebastian Kummer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Düsseldorf, Germany
| | - Christina Reinauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Düsseldorf, Germany
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Düsseldorf, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Marc Jacobsen
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Düsseldorf, Germany
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Ren X, Wu J, Levin D, Santos S, de Faria RL, Zhang M, Lin F. Sputum from chronic obstructive pulmonary disease patients inhibits T cell migration in a microfluidic device. Ann N Y Acad Sci 2019; 1445:52-61. [PMID: 30891781 DOI: 10.1111/nyas.14029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/25/2019] [Indexed: 12/29/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by narrowed airways, resulting in serious breathing difficulty. Previous studies have demonstrated that inflammatory infiltration of leukocytes in the airway is associated with the pathogenesis of COPD. In the present study, we employed a microfluidic approach to assess the effect of COPD sputum on activated human peripheral blood T cell migration and chemotaxis under well-controlled gradient conditions. Our results showed considerable basal migration of T cells derived from peripheral blood of COPD patients and healthy controls in the medium control groups. By contrast, the migration of T cells from COPD patients and healthy controls was significantly inhibited in the presence of a gradient of sputum supernatant from COPD patients. Furthermore, chemotaxis of T cells from COPD patients or healthy subjects toward an SDF-1α gradient was clearly inhibited by sputum samples from the COPD patients. The inhibition effect revealed by the microfluidic cell migration experiments provides new information about the complex involvement of T cell trafficking in COPD.
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Affiliation(s)
- Xiaoou Ren
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Biosystems Engineering, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jiandong Wu
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Levin
- Department of Biosystems Engineering, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Susy Santos
- The Victoria Institute of Clinical Research & Evaluation, Victoria General Hospital, Winnipeg, Manitoba, Canada
| | - Ricardo Lobato de Faria
- Department of Emergency and Wellness Institute, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Michael Zhang
- Department of Emergency and Wellness Institute, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Francis Lin
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Biosystems Engineering, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
Patients with chronic obstructive pulmonary disease (COPD) show a persistent local and systemic inflammatory pattern which stimulates negative remodeling of the airways. Globally, chronic respiratory disease is the third leading cause of death. One of the rehabilitative strategies used to improve the symptoms of COPD patients is the use of lymphatic pump manipulation; this procedure aims to reduce the concentration of pro-inflammatory substances. However, research results relating to this technique are contradictory. This article reviews the mechanisms that determine lymphatic flow, lymphatic lung anatomy, and the lymphatic response to respiratory pathology. Also highlighted is the manual approach to the mediastinum which can be used to improve the lymphatic and inflammatory response in COPD. Finally, new manual strategies have been discussed with which lymphatic flow in patients with COPD can be improved.
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi, Milan, ITA
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Lee B, Kim G, Jo Y, Lee B, Shin YI, Hong C. Aquatic Exercise at Thermoneutral Water Temperature Enhances Antitumor Immune Responses. Immune Netw 2019; 19:e10. [PMID: 31089437 PMCID: PMC6494765 DOI: 10.4110/in.2019.19.e10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 12/16/2022] Open
Abstract
Despite the broad rehabilitative potential of aquatic exercises, the relationship between aquatic exercise and the immune system has not been fully elucidated to date. In particular, there are few specific and delicate immunological approaches to the effect of water temperature on immunity. Thus, we examined the effect of water temperature on immunity during aquatic exercise. The animal tumor model was adopted to examine the impact of aquatic exercise at thermoneutral temperature (TT; 29°C) on immunity compared with aquatic exercise at body temperature (BT; 36°C). Tumor-bearing mice were made to swim in TT water or in BT water for 3 wk and immune cells and their functional activity were analyzed using FACS. Tumor growth was significantly suppressed in mice that exercised in TT than in BT water. The tumor control correlated with the increased number of NK (2-fold), γδT cells (2.5-fold), NKT (2.5-fold), and cytotoxic CD8+ T cells (1.6-fold), which play a critical role in anti-tumor immune responses. Furthermore, the functional activity was dramatically improved in the TT group, showing enhanced production of IFNγ in CD8+ T cells compared with the BT group. This study demonstrates that aquatic exercise in TT water may improve protective immune responses more effectively than in BT water. Although the effects of water temperature on immune function need further verification in humans, this study suggests that water temperature in human hydrotherapy may be important for improving immune function.
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Affiliation(s)
- Boae Lee
- Department of Anatomy and Cell Biology, Pusan National University School of Medicine, Yangsan 50612, Korea.,Department of Rehabilitation Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea
| | - Geona Kim
- Department of Anatomy and Cell Biology, Pusan National University School of Medicine, Yangsan 50612, Korea
| | - Yuna Jo
- Department of Anatomy and Cell Biology, Pusan National University School of Medicine, Yangsan 50612, Korea
| | - Byunghyuk Lee
- Department of Anatomy and Cell Biology, Pusan National University School of Medicine, Yangsan 50612, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea
| | - Changwan Hong
- Department of Anatomy and Cell Biology, Pusan National University School of Medicine, Yangsan 50612, Korea
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Zhao H, Gu H, Liu T, Ge J, Shi G. Analysis of curative effect of adjuvant therapy with bronchoalveolar lavage on COPD patients complicated with pneumonia. Exp Ther Med 2018; 16:3799-3804. [PMID: 30344655 PMCID: PMC6176127 DOI: 10.3892/etm.2018.6662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 07/03/2018] [Indexed: 12/22/2022] Open
Abstract
Clinical effect of adjuvant therapy with bronchoalveolar lavage on chronic obstructive pulmonary disease (COPD) patients complicated with pneumonia and its influence on the expression levels of inflammatory factors were studied. One hundred and twenty mild-moderate COPD patients complicated with pneumonia treated in the Department of Respiratory Medicine, The Sixth People's Hospital of Nantong from February 2016 to February 2017 were selected and randomly divided into three groups: One-time lavage group (n=40), two-time lavage group (n=40) and control group (n=40). Fasting peripheral blood was collected from all the patients in the morning. The lung function and blood gas analyses, and the detection of peripheral white blood cells (WBC), procalcitonin (PCT) and C-reactive protein (CRP) were performed. Moreover, the messenger RNA (mRNA) levels of interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α) and leukotriene B4 (LTB4) in lavage fluid were detected via reverse transcription-quantitative polymerase chain reaction. The lung functions of patients in the two-time lavage group were significantly improved compared with that in the one-time lavage group (p<0.01). pH and PaO2 in two-time lavage group were higher than those in the one-time lavage group (p<0.01). Peripheral WBC, PCT and CRP levels in the two-time lavage group were lower than those in the one-time lavage group (p<0.05). The mRNA levels of IL-6, IL-8, TNF-α and LTB4 in lavage fluid in two-time lavage group were lower than those in one-time lavage group (p<0.01). IL-6, IL-8, TNF-α and LTB4 expression levels in lavage fluid in two-time lavage group were lower than those in one-time lavage group (p<0.01). In conclusion, the adjuvant therapy with bronchoalveolar lavage improves the therapeutic effect on COPD patients complicated with pneumonia, which can significantly reduce the expression levels of inflammatory factors, and facilitate the control of pulmonary infection and recovery of lung function.
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Affiliation(s)
- Huan Zhao
- Department of Respiratory Medicine, The Sixth People's Hospital of Nantong, Nantong, Jiangsu 226011, P.R. China
| | - Hongyan Gu
- Department of Respiratory Medicine, The Sixth People's Hospital of Nantong, Nantong, Jiangsu 226011, P.R. China
| | - Tongmiao Liu
- The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161000, P.R. China
| | - Juan Ge
- Department of Respiratory Medicine, The Sixth People's Hospital of Nantong, Nantong, Jiangsu 226011, P.R. China
| | - Guanglin Shi
- Department of Respiratory Medicine, The Sixth People's Hospital of Nantong, Nantong, Jiangsu 226011, P.R. China
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