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Luo T, Wang L, Fu D, Hu R, Kong C, Chen Y, Li X. Good's syndrome with diffuse panbronchiolitis as the prominent manifestation: A case and literature review. Respirol Case Rep 2021; 9:e0873. [PMID: 34765226 PMCID: PMC8573544 DOI: 10.1002/rcr2.873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/01/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Good's syndrome (GS) is characterized by thymoma combined with adult-onset immunodeficiency. Diffuse panbronchiolitis (DPB) is a chronic inflammatory airway disease, which predominantly affects East Asians. Japanese scholars have reported extensively about GS combined with DPB or DPB-like pulmonary manifestation. However, such reports are rare in China. We report here a case of GS in China with DPB as the prominent manifestation and carry out a literature review accordingly. Our review indicates that in adults with DPB-like clinical manifestations, thymic lesions should be excluded and related immune function tests should be performed to exclude GS to avoid missed diagnosis and misdiagnosis.
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Affiliation(s)
- Tian Luo
- The Third Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
- The Third Department of Pulmonary and Critical Care MedicineHunan Provincial People's HospitalChangshaChina
| | - Lile Wang
- The Third Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
- The Third Department of Pulmonary and Critical Care MedicineHunan Provincial People's HospitalChangshaChina
| | - Daiyan Fu
- The Third Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
- The Third Department of Pulmonary and Critical Care MedicineHunan Provincial People's HospitalChangshaChina
| | - Ruicheng Hu
- The Third Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
- The Third Department of Pulmonary and Critical Care MedicineHunan Provincial People's HospitalChangshaChina
| | - Chunchu Kong
- The Third Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
- The Third Department of Pulmonary and Critical Care MedicineHunan Provincial People's HospitalChangshaChina
| | - Yunrong Chen
- The Third Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Hunan Normal UniversityChangshaChina
- The Third Department of Pulmonary and Critical Care MedicineHunan Provincial People's HospitalChangshaChina
| | - Xi Li
- Department of Pulmonary and Critical Care MedicineSixth People's Hospital of ChengduChengduChina
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2
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Carnevale A, Lucioni E, Daniele MM, Contoli M, Giganti M, Marku B. Diffuse panbronchiolitis as parathymic syndrome in a Caucasian man previously treated for thymoma. Radiol Case Rep 2021; 16:3029-3033. [PMID: 34408804 PMCID: PMC8361232 DOI: 10.1016/j.radcr.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 11/16/2022] Open
Abstract
Diffuse panbronchiolitis (DPB) is a rare disease characterized by bronchiolitis and chronic sinusitis. Being largely restricted to East Asia, its actual incidence in Caucasian patients is probably underestimated. DPB has been described in association with thymic neoplasms, mainly arising as a consequence of immune dysregulation. We present a rare case of DPB diagnosed in a 69-year-old Caucasian man who had undergone surgery for stage 2A thymoma a year before. The patient came to our hospital complaining of exertional dyspnea and productive cough, with a persistent lung consolidation described at chest X-rays. High resolution computed tomography (CT) showed diffuse centrilobular micronodules and solid nodules, tree-in-bud opacities, peripheral consolidations and cylindrical bronchiectasis. Sinus disease was also demonstrated by CT. Analysis of bronchoalveolar lavage showed marked granulocyte inflammation and allowed the isolation of Haemophilus Influenzae. Consequently, the diagnosis of DPB was reached by integrating clinical, and radiological data. Long-term therapy with azithromycin was prescribed, and was found to be effective in controlling symptoms and reducing radiological abnormalities at 6-month clinical and CT follow-up. Confidence with the radiological presentation and clinical significance of DPB is necessary, since the condition is responsive and reversible to long-term macrolide treatment, the effect of which is mainly attributed to an anti-inflammatory, and immunoregulatory action.
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Affiliation(s)
- Aldo Carnevale
- Section of Radiology, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Elisa Lucioni
- Section of Radiology, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Marta Maria Daniele
- Research Centre on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Contoli
- Research Centre on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Melchiore Giganti
- Section of Radiology, Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Brunilda Marku
- Research Centre on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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3
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Venditto VJ, Haydar D, Abdel-Latif A, Gensel JC, Anstead MI, Pitts MG, Creameans J, Kopper TJ, Peng C, Feola DJ. Immunomodulatory Effects of Azithromycin Revisited: Potential Applications to COVID-19. Front Immunol 2021; 12:574425. [PMID: 33643308 PMCID: PMC7906979 DOI: 10.3389/fimmu.2021.574425] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/22/2021] [Indexed: 12/14/2022] Open
Abstract
The rapid advancement of the COVID-19 pandemic has prompted an accelerated pursuit to identify effective therapeutics. Stages of the disease course have been defined by viral burden, lung pathology, and progression through phases of the immune response. Immunological factors including inflammatory cell infiltration and cytokine storm have been associated with severe disease and death. Many immunomodulatory therapies for COVID-19 are currently being investigated, and preliminary results support the premise of targeting the immune response. However, because suppressing immune mechanisms could also impact the clearance of the virus in the early stages of infection, therapeutic success is likely to depend on timing with respect to the disease course. Azithromycin is an immunomodulatory drug that has been shown to have antiviral effects and potential benefit in patients with COVID-19. Multiple immunomodulatory effects have been defined for azithromycin which could provide efficacy during the late stages of the disease, including inhibition of pro-inflammatory cytokine production, inhibition of neutrophil influx, induction of regulatory functions of macrophages, and alterations in autophagy. Here we review the published evidence of these mechanisms along with the current clinical use of azithromycin as an immunomodulatory therapeutic. We then discuss the potential impact of azithromycin on the immune response to COVID-19, as well as caution against immunosuppressive and off-target effects including cardiotoxicity in these patients. While azithromycin has the potential to contribute efficacy, its impact on the COVID-19 immune response requires additional characterization so as to better define its role in individualized therapy.
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Affiliation(s)
- Vincent J. Venditto
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, United States
| | - Dalia Haydar
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Ahmed Abdel-Latif
- Gill Heart Institute and Division of Cardiovascular Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - John C. Gensel
- Department of Physiology, Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Michael I. Anstead
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Michelle G. Pitts
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, United States
| | - Jarrod Creameans
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, United States
| | - Timothy J. Kopper
- Department of Physiology, Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Chi Peng
- Gill Heart Institute and Division of Cardiovascular Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - David J. Feola
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, United States
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4
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Dhar R, Talwar D, Singh V, Dumra H, Rajan S, Jindal SK. Expert recommendations on the role of macrolides in chronic respiratory diseases. Lung India 2021; 38:174-182. [PMID: 33687013 PMCID: PMC8098884 DOI: 10.4103/lungindia.lungindia_498_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: India contributes to 32% of the total global disability-adjusted life years, due to chronic respiratory diseases. This has led to a high rate of health loss from these diseases. Antibiotics are commonly used in the management of respiratory disorders. With excellent tissue penetration, prolonged tissue persistence, and favorable side effect profile, macrolides are one of the best treatment options being recommended for respiratory, urogenital, dermal, and other bacterial infections. Still, there is a lack of clinical trial data on the use of macrolides in the management of respiratory chronic disease, and hence, there is a need for clinical guidance on their use in Indian setting. Methods: A systematic review of the literature was conducted on PubMed, Cochrane database, and Google Scholar. Existing guidelines, meta-analyses, systematic reviews, randomized controlled trials (RCTs), non-RCTs, landmark studies, and key-cited articles were selected. Recommendations were based on available evidence and expert panel's logical empiricism and consensus. Results and Discussion: This article discusses evidence-based and clinical practice based management of chronic respiratory conditions including chronic obstructive pulmonary disease, asthma, bronchiectasis, diffusive panbronchiolitis, and organizing pneumonia. The authors reviewed different respiratory conditions, role of macrolides in their management, adverse events and antimicrobial resistance associated with macrolides, evidence review of various clinical trials, guideline recommendations, and clinical recommendations.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, Fortis Hospital, Kolkata, West Bengal, India
| | - Deepak Talwar
- Respiratory Center, Pulmonology and Sleep Medicine, Metro Group of Hospitals, Noida, Uttar Pradesh, India
| | | | - Harjit Dumra
- "Sparsh" Chest Diseases Center, Ahmedabad, Gujarat, India
| | - Sujeet Rajan
- Respiratory Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - S K Jindal
- Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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5
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Hinks TSC, Barber VS, Black J, Dutton SJ, Jabeen M, Melhorn J, Rahman NM, Richards D, Lasserson D, Pavord ID, Bafadhel M. A multi-centre open-label two-arm randomised superiority clinical trial of azithromycin versus usual care in ambulatory COVID-19: study protocol for the ATOMIC2 trial. Trials 2020; 21:718. [PMID: 32807209 PMCID: PMC7429453 DOI: 10.1186/s13063-020-04593-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Background Azithromycin is an orally active synthetic macrolide antibiotic with a wide range of anti-bacterial, anti-inflammatory and antiviral properties. It is a safe, inexpensive, generic licenced drug available worldwide and manufactured to scale and is a potential candidate therapy for pandemic coronavirus disease 2019 (COVID-19). Azithromycin was widely used to treat severe SARS-CoV and MERS-CoV, but to date, no randomised data are available in any coronavirus infections. Other ongoing trials are exploring short courses of azithromycin either in early disease, within the first 7 days of symptoms, when azithromycin’s antiviral properties may be important, or late in disease when anti-bacterial properties may reduce the risk of secondary bacterial infection. However, the molecule’s anti-inflammatory properties, including suppression of pulmonary macrophage-derived pro-inflammatory cytokines such as interleukins-1β, -6, -8, and -18 and cytokines G-CSF and GM-CSF may provide a distinct therapeutic benefit if given in as a prolonged course during the period of progression from moderate to severe disease. Methods ATOMIC2 is a phase II/III, multi-centre, prospective, open-label, two-arm randomised superiority clinical trial of azithromycin versus standard care for adults presenting to hospital with COVID-19 symptoms who are not admitted at initial presentation. We will enrol adults, ≥ 18 years of age assessed in acute hospitals in the UK with clinical diagnosis of COVID-19 infection where management on an ambulatory care pathway is deemed appropriate. Participants will be randomised in a 1:1 ratio to usual care or to azithromycin 500 mg orally daily for 14 days with telephone follow-up at days 14 and 28. The primary objective is to compare the proportion with either death or respiratory failure requiring invasive or non-invasive mechanical ventilation over 28 days from randomisation. Secondary objectives include mortality/respiratory failure in those with a PCR-confirmed diagnosis; all-cause mortality; progression to pneumonia; progression to severe pneumonia; peak severity of illness and mechanistic analysis of blood and nasal biomarkers. Discussion This trial will determine the clinical utility of azithromycin in patients with moderately severe, clinically diagnosed COVID-19 and could be rapidly applicable worldwide. Trial registration ClinicalTrials.gov NCT04381962. Registered on 11 May 2020. EudraCT identifier 2020-001740-26. Opened for accrual on 29 May 2020.
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Affiliation(s)
- Timothy S C Hinks
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Nuffield Department of Medicine Experimental Medicine, University of Oxford, Oxfordshire, OX3 9DU, UK.
| | - Vicki S Barber
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Joanna Black
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Maisha Jabeen
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Nuffield Department of Medicine Experimental Medicine, University of Oxford, Oxfordshire, OX3 9DU, UK
| | - James Melhorn
- University Hospital Llandough, Cardiff, CF64 2XX, UK
| | - Najib M Rahman
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Nuffield Department of Medicine Experimental Medicine, University of Oxford, Oxfordshire, OX3 9DU, UK
| | - Duncan Richards
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Daniel Lasserson
- Nuffield Department of Medicine, Oxford University, Oxford, UK.,Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Ian D Pavord
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Nuffield Department of Medicine Experimental Medicine, University of Oxford, Oxfordshire, OX3 9DU, UK
| | - Mona Bafadhel
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Nuffield Department of Medicine Experimental Medicine, University of Oxford, Oxfordshire, OX3 9DU, UK
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6
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Rello J, Tejada S, Userovici C, Arvaniti K, Pugin J, Waterer G. Coronavirus Disease 2019 (COVID-19): A critical care perspective beyond China. Anaesth Crit Care Pain Med 2020; 39:167-169. [PMID: 32142972 PMCID: PMC7129309 DOI: 10.1016/j.accpm.2020.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jordi Rello
- Centro de Investigación Biomedica en Red de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos III, Madrid, Spain; Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain; Anaesthesiology and Critical Care Division, CHU Nîmes, University Montpellier-Nîmes, Nîmes, France.
| | - Sofia Tejada
- Centro de Investigación Biomedica en Red de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos III, Madrid, Spain; Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
| | - Caroline Userovici
- Département Anesthésie Réanimation, Hôpital Pitié-Salpêtrière, Paris, France; Junior Group of the French Society of Anaesthesia and Intensive Care Medicine (SFAR), Paris, France
| | - Kostoula Arvaniti
- Critical Care Department, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Jérôme Pugin
- Division of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Grant Waterer
- School of Medicine, University of Western Australia, Perth, Australia
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7
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Suhas HS, Utpat K, Desai U, Joshi JM. The clinico-radiological profile of obliterative bronchiolitis in a tertiary care center. Lung India 2019; 36:313-318. [PMID: 31290416 PMCID: PMC6625238 DOI: 10.4103/lungindia.lungindia_499_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Obliterative bronchiolitis (OB) forms a major proportion of chronic airway diseases (CADs). OB is often misdiagnosed and included under the umbrella term 'chronic obstructive pulmonary disease'. We set out to identify the proportion of OB cases among the CADs and study the clinical profile of OB. Materials and Methods This prospective, observational study noted all patients with Chronic airway obstruction (CAO), of which patients with OB were included and the clinical profile was studied. Data were subjected to statistical analysis. Results Five hundred patients with CAO were noted in the study period, of which 115 patients were found to be OB amounting to a prevalence of 23%. The mean age of presentation was 51.8 years (standard deviation 12.1) with a male-female ratio of 1:1. The most common etiology for OB was as sequelae to past treated pulmonary tuberculosis (PTB) seen in 82 patients (71%) of cases. Dyspnea in 114 patients (99%) and productive cough in 110 patients (95%) were the predominant symptoms. Postexercise desaturation was seen in all 115 patients (100%). Forty-six patients (43%) presented with either Type 1 or Type 2 respiratory failure. Spirometry showed obstructive pattern in 68 patients (59%) with forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio of <70% and FEV1 <70% postbronchodilator and mixed pattern in 47 patients (41%) with a reduction in both FEV1 and FVC and normal FEV1/FVC ratio. There was the presence of mosaic attenuation on high-resolution computerized tomography (HRCT) of the chest with expiratory scans in all 115 patients (100%). Pulmonary hypertension was documented in 109 patients (95%). Conclusion OB is one of the major causes of CAO. HRCT of the chest with expiratory scans plays a important role in the diagnosis. Early diagnosis can prevent irrevocable complications.
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Affiliation(s)
- H S Suhas
- Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India
| | - Ketaki Utpat
- Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India
| | - Unnati Desai
- Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India
| | - Jyotsna M Joshi
- Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India
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8
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Baines KJ, Wright TK, Gibson PG, Powell H, Hansbro PM, Simpson JL. Azithromycin treatment modifies airway and blood gene expression networks in neutrophilic COPD. ERJ Open Res 2018; 4:00031-2018. [PMID: 30406125 PMCID: PMC6215914 DOI: 10.1183/23120541.00031-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/07/2018] [Indexed: 01/06/2023] Open
Abstract
Long-term, low-dose azithromycin reduces exacerbation frequency in chronic obstructive pulmonary disease (COPD), yet the mechanism remains unclear. This study characterised genome-wide gene expression changes in patients with neutrophilic COPD following long-term, low-dose azithromycin treatment. Patients with neutrophilic COPD (>61% or >162×104 cells per mL sputum neutrophils) were randomised to receive either azithromycin or placebo for 12 weeks. Sputum and blood were obtained before and after 12 weeks of treatment. Gene expression was defined using microarrays. Networks were analysed using the Search Tool for the Retrieval of Interacting Gene database. In sputum, 403 genes were differentially expressed following azithromycin treatment (171 downregulated and 232 upregulated), and three following placebo treatment (one downregulated and two upregulated) compared to baseline (adjusted p<0.05 by paired t-test, fold-change >1.5). In blood, 138 genes were differentially expressed with azithromycin (121 downregulated and 17 upregulated), and zero with placebo compared to baseline (adjusted p<0.05 by paired t-test, fold-change >1.3). Network analysis revealed one key network in both sputum (14 genes) and blood (46 genes), involving interferon-stimulated genes, human leukocyte antigens and genes regulating T-cell responses. Long-term, low-dose azithromycin is associated with downregulation of genes regulating antigen presentation, interferon and T-cell responses, and numerous inflammatory pathways in the airways and blood of neutrophilic COPD patients.
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Affiliation(s)
- Katherine J Baines
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Thomas K Wright
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Dept of Respiratory and Sleep Medicine, Hunter New England Area Health Service, Newcastle, Australia
| | - Heather Powell
- Dept of Respiratory and Sleep Medicine, Hunter New England Area Health Service, Newcastle, Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
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Petitpierre N, Cottin V, Marchand-Adam S, Hirschi S, Rigaud D, Court-Fortune I, Jouneau S, Israël-Biet D, Molard A, Cordier JF, Lazor R. A 12-week combination of clarithromycin and prednisone compared to a 24-week prednisone alone treatment in cryptogenic and radiation-induced organizing pneumonia. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2018; 35:230-238. [PMID: 32476907 DOI: 10.36141/svdld.v35i3.6547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 02/06/2018] [Indexed: 11/02/2022]
Abstract
Background: Some data suggest that anti-inflammatory macrolides may be effective to treat organizing pneumonia (OP) and prevent relapses, but no formal comparison with prednisone alone is available. To explore this issue, we retrospectively compared the efficacy of a 12-week combined regimen of clarithromycin and prednisone with a 24-week prednisone alone regimen in OP. Methods: A standard 12-week regimen of combined clarithromycin and prednisone was designed for the treatment of cryptogenic or radiation-induced OP, aiming at reducing the cumulated prednisone dose and the relapse rate. Its use was left to the discretion of the treating physicians, members of the Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires. Data were compared to a historical control group treated with a standard 24-week prednisone alone regimen. Results: 16 patients were treated with combined therapy and 21 with prednisone alone. Complete radiological remission was achieved in 63% of the combined therapy group and 81% of the prednisone alone group (p=0.38). Symptomatic relapses occurred in 81% of the combined therapy group, and 52% of the prednisone alone group (p=0.14). No side effect of clarithromycin was reported. Conclusions: In patients with cryptogenic or radiation-induced OP, a 12-week regimen of clarithromycin and prednisone showed no benefit on remission rate and relapse rate as compared to a 24-week prednisone only regimen. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 230-238).
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Affiliation(s)
- Nicolas Petitpierre
- Interstitial and rare lung diseases Unit, Department of Respiratory Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Cottin
- Department of Respiratory Medicine and Reference Center for rare lung diseases, Lyon University Hospital, Lyon, France
| | | | - Sandrine Hirschi
- Department of Respiratory Medicine, Strasbourg University Hospital, Strasbourg, France
| | | | | | - Stéphane Jouneau
- Department of Respiratory Medicine, Competences center for rare pulmonary diseases, IRSET UMR 1085, Rennes 1 University, Rennes University Hospital, Rennes, France
| | - Dominique Israël-Biet
- Department of Respiratory Medicine, Georges-Pompidou European Hospital, Paris, France
| | - Anita Molard
- Department of Respiratory Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Jean-François Cordier
- Department of Respiratory Medicine and Reference Center for rare lung diseases, Lyon University Hospital, Lyon, France
| | - Romain Lazor
- Interstitial and rare lung diseases Unit, Department of Respiratory Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Department of Respiratory Medicine and Reference Center for rare lung diseases, Lyon University Hospital, Lyon, France
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10
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Scambler T, Holbrook J, Savic S, McDermott MF, Peckham D. Autoinflammatory disease in the lung. Immunology 2018; 154:563-573. [PMID: 29676014 PMCID: PMC6050210 DOI: 10.1111/imm.12937] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 01/11/2023] Open
Abstract
Ascertaining the dominant cell type driving an immunological disease is essential to understanding the causal pathology and, therefore, selecting or developing an effective treatment. Classifying immunological diseases in this way has led to successful treatment regimens for many monogenic diseases; however, when the dominant cell type is unclear and there is no obvious causal genetic mutation, then identifying the correct disease classification and appropriate therapy can be challenging. In this review we focus on pulmonary immunological diseases where an innate immune signature has been identified as a predominant aspect of the immunopathology. We describe the molecular pathology of 'autoinflammatory diseases of the lung' and propose that small molecule and biological therapies, including recombinant interleukin-1 receptor antagonist, that target key innate immune pathways, are likely be beneficial in the control of pulmonary and systemic inflammation in these conditions. In addition, the successful use of macrolide antibiotics to treat lung infections in these conditions further confirms that the innate immune system is the key conductor of inflammation in these pulmonary diseases, as there is a strong body of evidence that macrolides are able to modulate the NLRP3 inflammasome and interleukin-1β and interleukin-18 secretion, both of which are central players in the innate immune response. Throughout this review we highlight the published evidence of autoinflammatory disease in chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis and rheumatoid lung disease and suggest that the fundamental pathology of these diseases places them towards the autoinflammatory pole of the immunological disease continuum.
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Affiliation(s)
- Thomas Scambler
- Leeds Institute of Rheumatic and Musculoskeletal MedicineSt James's University HospitalLeedsUK
- Cystic Fibrosis Trust Strategic Research CentreSt James's University HospitalLeedsUK
| | - Jonathan Holbrook
- Leeds Institute of Rheumatic and Musculoskeletal MedicineSt James's University HospitalLeedsUK
- Cystic Fibrosis Trust Strategic Research CentreSt James's University HospitalLeedsUK
- Leeds Institute of Biomedical and Clinical SciencesSt James's University HospitalLeedsUK
| | - Sinisa Savic
- Leeds Institute of Rheumatic and Musculoskeletal MedicineSt James's University HospitalLeedsUK
- Cystic Fibrosis Trust Strategic Research CentreSt James's University HospitalLeedsUK
- Department of Clinical Immunology and AllergySt James's University HospitalLeedsUK
| | - Michael F. McDermott
- Leeds Institute of Rheumatic and Musculoskeletal MedicineSt James's University HospitalLeedsUK
- Cystic Fibrosis Trust Strategic Research CentreSt James's University HospitalLeedsUK
| | - Daniel Peckham
- Cystic Fibrosis Trust Strategic Research CentreSt James's University HospitalLeedsUK
- Leeds Institute of Biomedical and Clinical SciencesSt James's University HospitalLeedsUK
- Leeds Centre for Cystic FibrosisSt James's University HospitalLeedsUK
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Watanabe Y, Kawabata Y, Iwai Y, Kudo F, Kawamura R, Miwa C, Nagai Y, Koyama S. Early-stage diffuse panbronchiolitis in a young patient confirmed by video-assisted lung biopsy: A case report. J Gen Fam Med 2017; 18:411-413. [PMID: 29264074 PMCID: PMC5729367 DOI: 10.1002/jgf2.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/12/2016] [Indexed: 11/11/2022] Open
Abstract
A 29-year-old man presented with sputum and cough, which were pointed out by his neighbors. A high-resolution chest computed tomography scan showed well-defined multiple centrilobular nodules and a tree-in-bud pattern. Chest auscultation revealed coarse crackles. He did not report any nasal sinus symptoms. We subsequently performed a video-assisted lung biopsy; the specimen confirmed diffuse panbronchiolitis. Subsequently, sinusitis was confirmed by an otolaryngologist. His symptoms gradually improved following treatment with erythromycin. We report a case of early-stage diffuse panbronchiolitis in a young patient, with multiple intralobular nodules, no bronchiectasis, and a good clinical course.
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Affiliation(s)
- Yasutaka Watanabe
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Yoshinori Kawabata
- Division of Diagnostic Pathology Saitama Prefectural Cardiovascular and Respiratory Center Kumagaya City Saitama Japan
| | - Yuki Iwai
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Fumiaki Kudo
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Rumi Kawamura
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Chihiro Miwa
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Yoshiaki Nagai
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
| | - Shinichiro Koyama
- Division of Pulmonary Medicine Saitama Medical Center Jichi Medical University Omiya City Saitama Japan
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Lendermon EA, Coon TA, Bednash JS, Weathington NM, McDyer JF, Mallampalli RK. Azithromycin decreases NALP3 mRNA stability in monocytes to limit inflammasome-dependent inflammation. Respir Res 2017; 18:131. [PMID: 28659178 PMCID: PMC5490165 DOI: 10.1186/s12931-017-0608-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Azithromycin, an antibiotic used for multiple infectious disorders, exhibits anti-inflammatory effects, but the molecular basis for this activity is not well characterized. Azithromycin inhibits IL-1β-mediated inflammation that is dependent, in part, on inflammasome activity. Here, we investigated the effects of azithromycin on the NACHT, LRR, and PYD domains-containing protein 3 (NALP3) protein, which is the sensing component of the NALP3 inflammasome, in human monocytes. METHODS THP-1 cells were treated with azithromycin alone, LPS alone, or both. NALP3 and IL-1β protein levels were determined by immunoblotting. NLRP3 gene (encoding NALP3) transcript levels were determined by quantitative qPCR. In order to measure NLRP3 transcript decay, actinomycin D was used to impair gene transcription. THP-1 Lucia cells which contain an NF-κB responsive luciferase element were used to assess NF-κB activity in response to azithromycin, LPS, and azithromycin/LPS by measuring luminescence. To confirm azithromycin's effects on NLRP3 mRNA and promoter activity conclusively, HEK cells were lipofected with luciferase reporter constructs harboring either the 5' untranslated region (UTR) of the NLRP3 gene which included the promoter, the 3' UTR of the gene, or an empty plasmid prior to treatment with azithromycin and/or LPS, and luminescence was measured. RESULTS Azithromycin decreased IL-1β levels and reduced NALP3 protein levels in LPS-stimulated THP-1 monocytes through a mechanism involving decreased mRNA stability of the NALP3 - coding NLRP3 gene transcript as well as by decreasing NF-κB activity. Azithromycin accelerated NLRP3 transcript decay confirmed by mRNA stability and 3'UTR luciferase reporter assays, and yet the antibiotic had no effect on NLRP3 promoter activity in cells containing a 5' UTR reporter. CONCLUSIONS These studies provide a unique mechanism whereby azithromycin exerts immunomodulatory actions in monocytes by destabilizing mRNA levels for a key inflammasome component, NALP3, leading to decreased IL-1β-mediated inflammation.
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Affiliation(s)
- Elizabeth A Lendermon
- Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Pittsburgh, UPMC Montefiore, NW 628, Pittsburgh, PA, 15213, USA
| | - Tiffany A Coon
- Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Pittsburgh, UPMC Montefiore, NW 628, Pittsburgh, PA, 15213, USA
| | - Joseph S Bednash
- Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Pittsburgh, UPMC Montefiore, NW 628, Pittsburgh, PA, 15213, USA
- Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nathaniel M Weathington
- Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Pittsburgh, UPMC Montefiore, NW 628, Pittsburgh, PA, 15213, USA
- Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA
| | - John F McDyer
- Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Pittsburgh, UPMC Montefiore, NW 628, Pittsburgh, PA, 15213, USA
| | - Rama K Mallampalli
- Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Pittsburgh, UPMC Montefiore, NW 628, Pittsburgh, PA, 15213, USA.
- Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA.
- Medical Specialty Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Wan KS, Liu YC, Huang CS, Su YM. Effects of low-dose clarithromycin added to fluticasone on inflammatory markers and pulmonary function among children with asthma: A randomized clinical trial. ALLERGY & RHINOLOGY 2016; 7:131-134. [PMID: 28107143 PMCID: PMC5244267 DOI: 10.2500/ar.2016.7.0168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Macrolides exert anti-inflammatory and immunomodulatory effects beyond their purely antibacterial action, as demonstrated by several bronchial inflammatory disorders, including asthma. METHODS Fifty-eight children with newly diagnosed mild persistent asthma were selected by using the Global Initiative for Asthma guidelines and were randomly divided into the study (group I) (n = 36) and control (group II) (n = 22) groups. Mycoplasma pneumonia-specific immunoglobulin G and -specific immunoglobulin M antibody levels of each participant were measured by enzyme-linked immunosorbent assay. Clarithromycin 5 mg/kg daily and placebo were given to groups I and II, respectively, for 4 weeks. All of the children had maintenance inhaled corticosteroid (fluticasone propionate, one puff twice [50 μg/puff] daily). Forced expiratory volume in 1 second, forced expiratory flow at 25-75% of the pulmonary volume, exhaled nitric oxide value, total IgE level, absolute eosinophil count, and eosinophilic cation protein value were measured at baseline and at the end of the treatment. RESULTS There are significantly increased forced expiratory volume in 1 second and forced expiratory flow at 25-75% of the pulmonary volume levels and decreased exhaled nitric oxide values after the 4-week clarithromycin treatment. The study group also had a decreased peripheral blood absolute eosinophil count and eosinophilic cation protein level, but not for the total IgE level, after the treatment. CONCLUSION Four weeks of sub-antimicrobial doses of clarithromycin may improve pulmonary function and decrease eosinophilic inflammation in children with asthma.
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Affiliation(s)
- Kong-Sang Wan
- From the Department of Pediatrics, Taipei City Hospital-Renai Branch, Taipei City, Taiwan
| | - Yu-Cheng Liu
- From the Department of Pediatrics, Taipei City Hospital-Renai Branch, Taipei City, Taiwan
| | - Che-Sheng Huang
- From the Department of Pediatrics, Taipei City Hospital-Renai Branch, Taipei City, Taiwan
| | - Yu-Mao Su
- From the Department of Pediatrics, Taipei City Hospital-Renai Branch, Taipei City, Taiwan
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