An advanced stochastic model for mucociliary particle clearance in cystic fibrosis lungs

Translational Research in Cystic Fibrosis: From Bench to Beside

Cystic fibrosis is the most common life-limiting recessive genetic disorder in Caucasian populations, characterized by the involvement of exocrine glands, causing multisystemic comorbidities. Since the first descriptions of pancreatic and pulmonary involvement in children, technological development and basic science research have allowed great advances in the diagnosis and treatment of cystic fibrosis. The great search for treatments that acted at the genetic level, despite not having found a cure for this disease, culminated in the creation of CFTR modulators, highly effective medications for certain groups of patients. However, there are still many obstacles behind the treatment of the disease to be discussed, given the wide variety of mutations and phenotypes involved and the difficulty of access that permeate these new therapies around the world.

Bioaerosols in the lungs of subjects with different ages-Part 2: clearance modeling

BACKGROUND

The present contribution deals with theoretical aspects regarding biogenic particle clearance from various lung structures of probands with different ages (1, 5, 15, 20 y). With reference to part 1 of the study, particles varying in size and shape are subject to a detailed analysis. The main goal of the investigation consists in an increase of our knowledge concerning the clearance behaviour of bioparticles and its dependence upon various physiological and anatomical factors.

METHODS

Theoretical clearance of biogenic particles was subdivided into four main phases, namely fast bronchial clearance, slow bronchial clearance, fast alveolar clearance, and slow alveolar clearance. All of these phases were simulated by using a well validated stochastic modeling approach, where the main focus is set on the randomly varied particle mass transfer between main compartments of the human respiratory tract. Whilst effects of particle geometry on clearance were approximated by application of the projective-diameter concept, age dependence of the particle removal process was expressed by the experimentally proven relationship between bronchial mucus velocities and morphometry of the airway tree.

RESULTS

According to the results of the theoretical simulations efficiency of fast bronchial clearance, expressed by the 24-h-retention value, exhibits a negative correlation with proband's age, whereas the other clearance phases are characterized by a rather conservative behaviour among the different age categories. Highest clearance rates may be observed for very fine (<0.01 µm) and very coarse particles (>5 µm) preferentially deposited in the upper bronchial airways, whilst large particles accumulated in the alveoli may be stored there for several months to years.

CONCLUSIONS

The study comes to the conclusion that infants and children dispose of an enhanced bronchial clearance efficiency with respect to adolescents and adults, which results in a faster removal of particulate substances accumulated in the upper bronchial regions. Particles escaping from the natural filtering process in the upper airways and undergoing alveolar deposition are subject to identical clearance scenarios among the age groups and may represent remarkable health hazards.

Local lung deposition of ultrafine particles in healthy adults: experimental results and theoretical predictions

BACKGROUND

Ultrafine particles (UFP) of biogenic and anthropogenic origin occur in high numbers in the ambient atmosphere. In addition, aerosols containing ultrafine powders are used for the inhalation therapy of various diseases. All these facts make it necessary to obtain comprehensive knowledge regarding the exact behavior of UFP in the respiratory tract.

METHODS

Theoretical simulations of local UFP deposition are based on previously conducted inhalation experiments, where particles with various sizes (0.04, 0.06, 0.08, and 0.10 µm) were administered to the respiratory tract by application of the aerosol bolus technique. By the sequential change of the lung penetration depth of the inspired bolus, different volumetric lung regions could be generated and particle deposition in these regions could be evaluated. The model presented in this contribution adopted all parameters used in the experiments. Besides the obligatory comparison between practical and theoretical data, also advanced modeling predictions including the effect of varying functional residual capacity (FRC) and respiratory flow rate were conducted.

RESULTS

Validation of the UFP deposition model shows that highest deposition fractions occur in those volumetric lung regions corresponding to the small and partly alveolated airways of the tracheobronchial tree. Particle deposition proximal to the trachea is increased in female probands with respect to male subjects. Decrease of both the FRC and the respiratory flow rate results in an enhancement of UFP deposition.

CONCLUSIONS

The study comes to the conclusion that deposition of UFP taken up via bolus inhalation is influenced by a multitude of factors, among which lung morphometry and breathing conditions play a superior role.

Systems Medicine for Lung Diseases: Phenotypes and Precision Medicine in Cancer, Infection, and Allergy

Lung diseases cause an enormous socioeconomic burden. Four of them are among the ten most important causes of deaths worldwide: Pneumonia has the highest death toll of all infectious diseases, lung cancer kills the most people of all malignant proliferative disorders, chronic obstructive pulmonary disease (COPD) ranks third in mortality among the chronic noncommunicable diseases, and tuberculosis is still one of the most important chronic infectious diseases. Despite all efforts, for example, by the World Health Organization and clinical and experimental researchers, these diseases are still highly prevalent and harmful. This is in part due to the specific organization of tissue homeostasis, architecture, and immunity of the lung. Recently, several consortia have formed and aim to bring together clinical and molecular data from big cohorts of patients with lung diseases with novel experimental setups, biostatistics, bioinformatics, and mathematical modeling. This "systems medicine" concept will help to match the different disease modalities with adequate therapeutic and possibly preventive strategies for individual patients in the sense of precision medicine.

A physiologically-motivated compartment-based model of the effect of inhaled hypertonic saline on mucociliary clearance and liquid transport in cystic fibrosis

Background

Cystic Fibrosis (CF) lung disease is characterized by liquid hyperabsorption, airway surface dehydration, and impaired mucociliary clearance (MCC). Herein, we present a compartment-based mathematical model of the airway that extends the resolution of functional imaging data.

Methods

Using functional imaging data to inform our model, we developed a system of mechanism-motivated ordinary differential equations to describe the mucociliary clearance and absorption of aerosolized radiolabeled particle and small molecules probes from human subjects with and without CF. We also utilized a novel imaging metric in vitro to gauge the fraction of airway epithelial cells that have functional ciliary activity.

Results

This model, and its incorporated kinetic rate parameters, captures the MCC and liquid dynamics of the hyperabsorptive state in CF airways and the mitigation of that state by hypertonic saline treatment.

Conclusions

We postulate, based on the model structure and its ability to capture clinical patient data, that patients with CF have regions of airway with diminished MCC function that can be recruited with hypertonic saline treatment. In so doing, this model structure not only makes a case for durable osmotic agents used in lung-region specific treatments, but also may provide a possible clinical endpoint, the fraction of functional ciliated airway.

Aerosol bolus dispersion in healthy and asthmatic children-theoretical and experimental results

INTRODUCTION

In the past decades, aerosol bolus inhalation increasingly came into the focus of medical interest due to its potential as a non-invasive technique for the diagnosis of lung diseases. The experimental studies were accompanied by the development of theoretical contributions dealing with aerosol bolus behaviour in healthy and diseased lungs. In this study, bolus dispersion in healthy and asthmatic children is subject to a theoretical approach. Model predictions are validated with related experimental findings.

METHODS

Aerosol bolus transport was simulated by using (I) a stochastic model of the human respiratory tract; (II) appropriate scaling procedures for the generation of healthy and asthmatic lungs of children; and (III) the concept of effective diffusivities (Deff) for the prediction of convective mixing processes in the conducting airways and alveoli. The aerosol injected into the inhalative air stream consisted of monodisperse particles with a diameter of 0.4 µm (ρ =1 g∙cm(-3)). Volumetric lung depth, being a measure for the position of the aerosol bolus within the inspired air stream, was varied from 95 mL (shallow bolus) to 540 mL (deep bolus). Half-width of the inhaled bolus was set to 50 mL.

RESULTS

According to the predictions provided by the model, dispersion of the exhaled aerosol bolus increases exponentially with volumetric lung depth in both asthmatic children and healthy controls. Asthmatics tend to develop higher bolus dispersion than healthy subjects, with significant differences between the two groups being noticeable at low volumetric lung depths (<300 mL). Skewness decreases with increasing volumetric lung depth, whereby respective values calculated for asthmatics exceed those values computed for healthy subjects. Theoretical results correspond very well with experimental findings.

DISCUSSION AND CONCLUSIONS

Results of experimental bolus studies may be approximated by theoretical models with high accuracy. Model predictions confirm the assumption that inhalation of aerosol boluses and dispersion measurements have only a limited diagnostic potential.