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Biji CA, Balde A, Nazeer RA. Anti-inflammatory peptide therapeutics and the role of sulphur containing amino acids (cysteine and methionine) in inflammation suppression: A review. Inflamm Res 2024; 73:1203-1221. [PMID: 38769154 DOI: 10.1007/s00011-024-01893-6] [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: 02/01/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Inflammation serves as our body's immune response to combat infections, pathogens, viruses, and external stimuli. Inflammation can be classified into two types: acute inflammation and chronic inflammation. Non-steroidal anti-inflammatory medications (NSAIDs) are used to treat both acute and chronic inflammatory disorders. However, these treatments have various side effects such as reduced healing efficiency, peptic ulcers, gastrointestinal toxicities, etc. METHOD: This review assesses the potential of anti-inflammatory peptides (AIPs) derived from various natural sources, such as algae, fungi, plants, animals, and marine organisms. Focusing on peptides rich in cysteines and methionine, sulphur-containing amino acids known for their role in suppression of inflammation. RESULT Due to their varied biological activity, ability to penetrate cells, and low cytotoxicity, bioactive peptides have garnered interest as possible therapeutic agents. The utilisation of AIPs has shown great potential in the treatment of disorders associated with inflammation. AIPs can be obtained from diverse natural sources such as algae, fungi, plants, and animals. Cysteine and methionine are sulphur-containing amino acids that aid in the elimination of free radicals, hence assisting in the treatment of inflammatory diseases. CONCLUSION This review specifically examines several sources of AIPs including peptides that contain numerous cysteines and methionine. In addition, the biological characteristics of these amino acids and advancements in peptide delivery are also discussed.
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Affiliation(s)
- Catherin Ann Biji
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Chennai, 603 203, Tamilnadu, India
| | - Akshad Balde
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Chennai, 603 203, Tamilnadu, India
| | - Rasool Abdul Nazeer
- Biopharmaceuticals Lab, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Chennai, 603 203, Tamilnadu, India.
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Cai C, Zeng W, Wang H, Ren S. Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Monocyte-to-Lymphocyte Ratio (MLR) as Biomarkers in Diagnosis Evaluation of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective, Observational Study. Int J Chron Obstruct Pulmon Dis 2024; 19:933-943. [PMID: 38646605 PMCID: PMC11027921 DOI: 10.2147/copd.s452444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/06/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose Hierarchical management is advocated in China to effectively manage chronic obstructive pulmonary disease (COPD) patients and reduce the incidence and mortality of acute exacerbation of COPD (AE-COPD). However, primary and community hospitals often have limited access to advanced equipment and technology. Complete blood count (CBC), which is commonly used in these hospitals, offers the advantages of being cost-effective and easily accessible. This study aims to evaluate the significance of routine blood indicators in aiding of diagnosing AE-COPD. Patients and Methods In this research, we enrolled a total of 112 patients diagnosed with AE-COPD, 92 patients with stable COPD, and a control group comprising 60 healthy individuals. Clinical characteristics, CBC parameters, and serum CRP levels were collected within two hours. To assess the associations between NLR/PLR/MLR and CRP by Spearman correlation test. The diagnostic accuracy of NLR, PLR and MLR in AE-COPD was assessed using Receiver Operating Characteristic Curve (ROC) and the area under the curve (AUC). Binary Logistic Regression analysis was conducted for the indicators of NLR, PLR and MLR. Results We found that patients with AE-COPD had significantly higher levels of NLR, PLR and MLR in contrast to patients with stable COPD. Additionally, the study revealed a noteworthy correlation between CRP and NLR (rs=0.5319, P<0.001), PLR (rs=0.4424, P<0.001), and MLR (rs=0.4628, P<0.001). By utilizing specific cut-off values, the amalgamation of NLR, PLR and MLR augmented diagnostic sensitivity. Binary logistic regression analysis demonstrated that heightened NLR and MLR act as risk factors for the progression of AE-COPD. Conclusion The increasing levels of NLR, PLR and MLR could function as biomarkers, akin to CRP, for diagnosis and assessment of acute exacerbations among COPD patients. Further research is required to validate this concept.
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Affiliation(s)
- Chuang Cai
- Cancer Research Institute of Zhongshan City, Zhongshan City People’s Hospital, Zhongshan City, Guangdong Province, People’s Republic of China
| | - Wentan Zeng
- Department of Laboratory Medicine, Tanzhou People’s Hospital of Zhongshan, Zhongshan City Hospital of Integration of TCM & Western Medicine, Zhongshan City, Guangdong Province, People’s Republic of China
| | - Hongwei Wang
- Department of Pediatrics, Tanzhou People’s Hospital of Zhongshan, Zhongshan City hospital of integration of TCM & western medicine, Zhongshan City, Guangdong Province, People’s Republic of China
| | - Shuqi Ren
- Department of Laboratory Medicine, Tanzhou People’s Hospital of Zhongshan, Zhongshan City Hospital of Integration of TCM & Western Medicine, Zhongshan City, Guangdong Province, People’s Republic of China
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Anzueto A, Cohen M, Echazarreta AL, Elassal G, Godoy I, Paramo R, Sayiner A, Torres-Duque CA, Acharya S, Aggarwal B, Erkus H, Levy G. Delphi Consensus on Clinical Applications of GOLD 2023 Recommendations in COPD Management: How Aligned are Recommendations with Clinical Practice? Pulm Ther 2024; 10:69-84. [PMID: 38112909 PMCID: PMC10881920 DOI: 10.1007/s41030-023-00248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION The objective of this Delphi study was to understand and assess the level of consensus among respiratory experts on the clinical application of GOLD 2023 recommendations in management of patients with chronic obstructive pulmonary disease (COPD). METHODS The study comprised two online surveys and a participant meeting with 34 respiratory experts from 16 countries. Responses of 73 questions were recorded using a Likert scale ranging from 0 (disagreement) to 9 (agreement). The consensus threshold was 75%. RESULTS Survey 1 and survey 2 had 34 and 32 participants, respectively; and 25 attended the participant meeting. Consensus was reached on survey 1: 28/42; survey 2: 18/30 close-ended questions. A consensus was reached on the clinical relevance of most updates in definitions and diagnosis of COPD. Mixed results for the treatment recommendations by GOLD were noted: 74% agreed with the recommendation to initiate treatment with dual bronchodilators for group E patients; 63% agreed for including inhaled corticosteroids (ICS)/long-acting β2 agonist(LABA)/ Long-acting muscarinic receptor antagonists (LAMA) as a treatment option for GOLD B patients. Also, consensus lacked on removing ICS + LABA as an initial therapeutic option, in countries with challenges in access to other treatment option;. 88% agreed that they use GOLD recommendations in their daily clinical practice. CONCLUSIONS This Delphi study demonstrated a high level of consensus regarding key concepts of GOLD 2023 report, with most participants favoring recent updates in definitions, diagnosis, management, and prevention of COPD. More evidence on the etiotype based management and treatment options for group B and E are required which could further strengthen clinical application of the GOLD report.
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Affiliation(s)
- Antonio Anzueto
- University of Texas Health and South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Mark Cohen
- Hospital Centro Medico, Guatemala City, Guatemala
| | | | - Gehan Elassal
- Department of Pulmonology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Irma Godoy
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu Campus, Pneumology Area, São Paulo, Brazil
| | | | - Abdullah Sayiner
- Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | | | | | | | - Gur Levy
- Emerging Markets, GSK, Panama City, Panama
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Davies HJ, Hammour G, Xiao H, Bachtiger P, Larionov A, Molyneaux PL, Peters NS, Mandic DP. Physically Meaningful Surrogate Data for COPD. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2024; 5:148-156. [PMID: 38487098 PMCID: PMC10939325 DOI: 10.1109/ojemb.2024.3360688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/23/2023] [Accepted: 01/26/2024] [Indexed: 03/17/2024] Open
Abstract
The rapidly increasing prevalence of debilitating breathing disorders, such as chronic obstructive pulmonary disease (COPD), calls for a meaningful integration of artificial intelligence (AI) into respiratory healthcare. Deep learning techniques are "data hungry" whilst patient-based data is invariably expensive and time consuming to record. To this end, we introduce a novel COPD-simulator, a physical apparatus with an easy to replicate design which enables rapid and effective generation of a wide range of COPD-like data from healthy subjects, for enhanced training of deep learning frameworks. To ensure the faithfulness of our domain-aware COPD surrogates, the generated waveforms are examined through both flow waveforms and photoplethysmography (PPG) waveforms (as a proxy for intrathoracic pressure) in terms of duty cycle, sample entropy, FEV1/FVC ratios and flow-volume loops. The proposed simulator operates on healthy subjects and is able to generate FEV1/FVC obstruction ratios ranging from greater than 0.8 to less than 0.2, mirroring values that can observed in the full spectrum of real-world COPD. As a final stage of verification, a simple convolutional neural network is trained on surrogate data alone, and is used to accurately detect COPD in real-world patients. When training solely on surrogate data, and testing on real-world data, a comparison of true positive rate against false positive rate yields an area under the curve of 0.75, compared with 0.63 when training solely on real-world data.
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Affiliation(s)
- Harry J. Davies
- Department of Electrical and Electronic EngineeringImperial College LondonSW7 2BXLondonU.K.
| | - Ghena Hammour
- Department of Electrical and Electronic EngineeringImperial College LondonSW7 2BXLondonU.K.
| | - Hongjian Xiao
- Department of Electrical and Electronic EngineeringImperial College LondonSW7 2BXLondonU.K.
| | - Patrik Bachtiger
- National Heart and Lung InstituteImperial College LondonSW7 2BXLondonU.K.
| | | | | | - Nicholas S. Peters
- National Heart and Lung InstituteImperial College LondonSW7 2BXLondonU.K.
| | - Danilo P. Mandic
- Department of Electrical and Electronic EngineeringImperial College LondonSW7 2BXLondonU.K.
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Arnaert A, Sumbly P, da Costa D, Liu Y, Debe Z, Charbonneau S. Acceptance of the Apple Watch Series 6 for Telemonitoring of Older Adults With Chronic Obstructive Pulmonary Disease: Qualitative Descriptive Study Part 1. JMIR Aging 2023; 6:e41549. [PMID: 38147371 PMCID: PMC10777278 DOI: 10.2196/41549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 05/30/2023] [Accepted: 10/09/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND The Apple Watch is not a medical device per se; it is a smart wearable device that is increasingly being used for health monitoring. Evidence exists that the Apple Watch Series 6 can reliably measure blood oxygen saturation (SpO2) in patients with chronic obstructive pulmonary disease under controlled circumstances. OBJECTIVE This study aimed to better understand older adults' acceptance of the Watch as a part of telemonitoring, even with these advancements. METHODS This study conducted content analysis on data collected from 10 older adults with chronic obstructive pulmonary disease who consented to wear the Watch. RESULTS Using the Extended Unified Theory of Acceptance and Use of Technology model, results showed that participants experienced potential health benefits; however, the inability of the Watch to reliably measure SpO2 when in respiratory distress was concerning. Participants' level of tech savviness varied, which caused some fear and frustration at the start, yet all felt supported by family and would have explored more features if they owned the Watch. All agreed that the Watch is mainly a medical tool and not a gadget. CONCLUSIONS To conclude, although the Watch may enhance their physical health and well-being, results indicated that participants are more likely to accept the Watch if it ultimately proves to be useful when experiencing respiratory distress.
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Affiliation(s)
- Antonia Arnaert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Pia Sumbly
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Daniel da Costa
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Yuxin Liu
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Zoumanan Debe
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Sylvain Charbonneau
- Academic Affairs, Teaching and Research Directorate, Montreal West Island Integrated University Health and Social Service Centre, Montreal, QC, Canada
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Xu W, He G, Shen D, Xu B, Jiang P, Liu F, Lou X, Guo L, Ma L. A noval pulmonary function evaluation method based on ResNet50 + SVR model and cough. Sci Rep 2023; 13:22065. [PMID: 38087014 PMCID: PMC10716123 DOI: 10.1038/s41598-023-49334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
Traditionally, the clinical evaluation of respiratory diseases was pulmonary function testing, which can be used for the detection of severity and prognosis through pulmonary function parameters. However, this method is limited by the complex process, which is impossible for patients to monitor daily. In order to evaluate pulmonary function parameters conveniently with less time and location restrictions, cough sound is the substitute parameter. In this paper, 371 cough sounds segments from 150 individuals were separated into 309 and 62 as the training and test samples. Short-time Fourier transform (STFT) was applied to transform cough sound into spectrogram, and ResNet50 model was used to extract 2048-dimensional features. Through support vector regression (SVR) model with biological attributes, the data were regressed with pulmonary function parameters, FEV1, FEV1%, FEV1/FVC, FVC, FVC%, and the performance of this models was evaluated with fivefold cross-validation. Combines with deep learning and machine learning technologies, the better results in the case of small samples were achieved. Using the coefficient of determination (R2), the ResNet50 + SVR model shows best performance in five basic pulmonary function parameters evaluation as FEV1(0.94), FEV1%(0.84), FEV1/FVC(0.68), FVC(0.92), and FVC%(0.72). This ResNet50 + SVR hybrid model shows excellent evaluation of pulmonary function parameters during coughing, making it possible to realize a simple and rapid evaluation for pneumonia patients. The technology implemented in this paper is beneficial in judge the patient's condition, realize early screening of respiratory diseases, evaluate postoperative disease changes and detect respiratory infectious diseases without time and location restrictions.
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Affiliation(s)
- Wenlong Xu
- College of Information Engineering, China Jiliang University, Hangzhou, China
| | - Guoqiang He
- College of Information Engineering, China Jiliang University, Hangzhou, China
| | - Dan Shen
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Bingqiao Xu
- College of Information Engineering, China Jiliang University, Hangzhou, China
| | | | - Feng Liu
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Xiaomin Lou
- Hangzhou Chest Hospital Affiliated, Zhejiang University Medical College, Hangzhou, China
| | - Lingling Guo
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, China.
| | - Li Ma
- Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
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Xia J, Hu C, Wang L, Zhang Y. Association between statin use on delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit. Eur J Med Res 2023; 28:572. [PMID: 38062497 PMCID: PMC10704755 DOI: 10.1186/s40001-023-01551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Delirium occurs frequently in patients with chronic obstructive pulmonary disease in the intensive care unit. Effective prevention and treatment strategies for delirium remain limited. We aimed to assess delirium and 30-day mortality in patients with chronic obstructive pulmonary disease who were statin and non-statin users. METHODS In this retrospective study, patients with chronic obstructive pulmonary disease were identified from the Medical Information Mart for Intensive Care database (MIMIC-IV). The primary exposure variable was the use of statins 3 days after entering the intensive care unit and the primary outcome measure was the presence of delirium. The secondary outcome measure was 30-day mortality. Since the cohort study was retrospective, we used an inverse probability weighting derived from the propensity score matching to balance different variables. RESULTS Among a cohort of 2725 patients, 1484 (54.5%) were statin users. Before propensity score matching, the prevalence of delirium was 16% and the 30-day mortality was 18% in patients with chronic obstructive pulmonary disease. Statin use was significantly negatively correlated with delirium, with an odds ratio of 0.69 (95% CI 0.56-0.85, p < 0.001) in the inverse probability weighted cohort and 30-day mortality of 0.7 (95% CI 0.57-0.85, p < 0.001). CONCLUSIONS Statin use is associated with a lower incidence of delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit.
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Affiliation(s)
- Jiangling Xia
- Department of Anesthesiology, Zibo Central Hospital, No. 54 Gongqingtuan Road, Zibo, Shandong, China
| | - Chunhuan Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Mudanjiang Medical College, Mudanjiang, Heilongjiang, China
| | - Leilei Wang
- School of Architecture and Engineering, Zibo Vocational Institute, Zibo, Shandong, China
| | - Yuzhu Zhang
- Department of Anesthesiology, Zibo Central Hospital, No. 54 Gongqingtuan Road, Zibo, Shandong, China.
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Farag A, Abass W, Qassem H. Evaluation of the antioxidant and anti-inflammatory effect of sublingual glutathione on COPD patients. J Med Life 2023; 16:1796-1801. [PMID: 38585534 PMCID: PMC10994624 DOI: 10.25122/jml-2023-0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/09/2023] [Indexed: 04/09/2024] Open
Abstract
Glutathione (GSH) is a potent antioxidant and anti-inflammatory, proven effective in reducing treatment duration, prescribed doses, and hospitalization for several diseases. This study assessed the therapeutic response of chronic obstructive pulmonary disease (COPD) patients by measuring oxidative superoxide dismutase (SOD3), glutathione peroxidase 1 (GPX1), and inflammatory biomarkers such as tumor necrosis factor-alpha (TNF-α) and Interleukin-8 (IL-8) after sublingual administration of glutathione supplements. A cohort of 50 COPD individuals was involved and divided into two groups of 25 each. The first group received conventional therapy involving the administration of formoterol fumarate (12 µg inhaler) twice daily. The second group received the conventional treatment alongside sublingual glutathione (300 mg twice daily) for two months. The levels of serum IL-8, TNF-α, SOD3, and GPX1 were assessed before therapy, as well as at one and two months after treatment, in both cohorts. Both groups exhibited a notable reduction in the inflammatory mediators IL-8 and TNF-α when compared to their respective pre-treatment levels (P value <0.05). However, it is worth noting that the observed difference between the groups was not statistically significant (P value >0.05). The levels of SOD3 and GPX1 exhibited a substantial rise in both groups; however, they were found to be greater in group 2 compared to group 1 (P value >0.05). The administration of glutathione resulted in enhanced levels of antioxidant biomarkers among individuals diagnosed with COPD, accompanied by a minor and statistically insignificant decrease in the levels of the anti-inflammatory mediators IL-8 and TNF-alpha.
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Affiliation(s)
- Ali Farag
- Department of Clinical Pharmacy, College of Pharmacy, Mustansiriyah University, Baghdad, Iraq
| | - Wassan Abass
- Department of Clinical Pharmacy, College of Pharmacy, Mustansiriyah University, Baghdad, Iraq
| | - Hyder Qassem
- Department of Medicine, College of Medicine, Maysan University, Maysan, Iraq
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Kanwal H, Khan S, Eldesoky GE, Mushtaq S, Khan A. Management of COPD and Comorbidities in COPD patients by Dispensing Pharmaceutical Care following Global Initiative for chronic Obstructive Lung Disease-Guidelines (GOLD guidelines 2020): A study protocol for a Prospective Randomized Clinical Trial. Heliyon 2023; 9:e21539. [PMID: 37942165 PMCID: PMC10628705 DOI: 10.1016/j.heliyon.2023.e21539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
COPD (chronic obstructive pulmonary disease) is a medical condition that encompasses several chronic, progressive, and severe respiratory illnesses, such as emphysema and chronic bronchitis. COPD is the 4th most deadly disease in the world and its prevalence is expected to increase. Despite the abundance of information on the disease's etiology, pathophysiology, and treatment possibilities, it has long been underdiagnosed and underreported for a long time, particularly in developing countries. The symptoms of COPD result in significant impairments and significant impact on quality of life. COPD is the third leading cause of death in Pakistan. According to the published literature, COPD has been found to be associated with a serious economic burden, either the direct cost to healthcare systems in the form of frequent hospital admissions or indirect costs to patients suffering from COPD. Despite the availability of excellent medication, COPD treatment goals are frequently not achieved resulting in poor management of COPD. The recent studies revealed that due to the missing role of Pharmacists in most of the public sector hospitals of Pakistan, the COPD disease management protocols are not being properly followed. Pharmacists can help the healthcare system by implementing these management protocols that focus on patient education about the disease, prescribed medications, and proper inhalation techniques. Furthermore, the pharmacists as an effective healthcare's team member properly educate the patients about the ongoing assessments and their willingness to follow treatment recommendations and quit smoking, while referring them to smoking cessation programs as needed, following the GOLD guidelines. This aim of this clinical trial is to evaluate the impact of implementing standard treatment guidelines and the role of pharmacists in implementing GOLD guidelines for COPD management.
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Affiliation(s)
- Hafsa Kanwal
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Shahzeb Khan
- Centre for Pharmaceutical Engineering, Faculty of Life Sciences, School of Pharmacy and Medical Sciences, University of Bradford, West Yorkshire, BD7, 1DP, UK
| | - Gaber E. Eldesoky
- Department of Chemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Saima Mushtaq
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Alabi FO, Alkhateeb HA, Zibanayi MT, Garces J, DeBarros KM, Barletti PSB, Garcia K, James RK. The adherence to and utility of the Global Initiative for Chronic Obstructive Lung Disease guidelines for treating COPD among pulmonary specialists: a retrospective analysis. BMC Pulm Med 2023; 23:216. [PMID: 37337205 PMCID: PMC10280890 DOI: 10.1186/s12890-023-02503-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Despite the evidence-based guidelines promoted by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the overuse of prescription drugs to manage COPD, particularly inhaled corticosteroids (ICS), remains a persistent challenge. In this real-world study, we evaluated how patients with COPD were divided into ABCD groups based on the 2017 GOLD guidelines, determined the rate of adherence to the GOLD treatment recommendations, described the rate of ICS usage, and determined the rate of triple therapy (TT) prescription. METHODS The charts of 2291 patients diagnosed with COPD were retrospectively analyzed, of which 1438 matched the eligibility criteria. RESULTS The average patient age was 69.6 ± 10.9 years; 52% of patients were female. The average COPD assessment test (CAT) score was 18.3 ± 9.1. The ABCD breakdown was as follows: group A 19.5%, group B 64.1%, group C 1.8%, and group D 14.6%. All groups, except group D, showed discordance in COPD treatment relative to the proposed GOLD guidelines. Only 18.9% of group A and 26% of group B were treated in concordance with the guidelines. TT was primarily used in group D (63.3%) and overused in groups A (30.6%) and B (47.8%). ICS was overused in all groups, particularly in groups A (56.2%) and B (67.3%). CONCLUSION Studies from the last decade have consistently revealed a lack of conformity between what physicians prescribe and what GOLD guidelines recommend. The excessive usage of ICS, which continues despite all the associated adverse effects and the attributable costs, is concerning. The awareness of GOLD guidelines among primary care physicians (PCPs) and respiratory specialists needs to be improved.
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Affiliation(s)
- Fortune O Alabi
- Florida Lung Asthma and Sleep Specialists, Kissimmee, FL, USA.
| | | | | | - Jica Garces
- Florida Lung Asthma and Sleep Specialists, Kissimmee, FL, USA
| | | | | | - Kayla Garcia
- Florida Lung Asthma and Sleep Specialists, Kissimmee, FL, USA
| | - Randall K James
- Florida Lung Asthma and Sleep Specialists, Kissimmee, FL, USA
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Xu SW, Zhang YJ, Liu WM, Zhang XF, Wang Y, Xiang SY, Su JC, Liu ZB. Cigarette smoke extract-induced inflammatory response via inhibition of the TFEB-mediated autophagy in NR8383 cells. Exp Lung Res 2023:1-10. [PMID: 36636918 DOI: 10.1080/01902148.2022.2164674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective: Chronic pulmonary inflammation caused by long-term smoking is the core pathology of COPD. Alveolar macrophages (AMs) are involved in the pulmonary inflammation of COPD. The accumulation of damaged materials caused by impaired autophagy triggers inflammatory response in macrophages. As a key transcription regulator, transcription factor EB (TFEB) activates the transcription of target genes related autophagy and lysosome by binding to promoters, whereas it is unclarified for the relationship between inflammatory response induced by cigarette smoke extract (CSE) and TFEB-mediated autophagy. Thus, we investigated the role of TFEB-mediated autophagy in inflammatory response induced by CSE in NR8383 cells, and to explore its potential mechanism. Methods: Based on cell viability and autophagy, cells treated with 20% concentration of CSE for 24 h were selected for further studies. Cells were divided into control group, chloroquine (CQ, the autophagy inhibitor) group, CSE group, CSE + rapamycin (the autophagy inducer) group and CSE + fisetin (the TFEB inducer) group. The levels of tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6 in supernatant were detected by ELISA kits. The protein expressions were tested by western blot. The intensity of fluorescence of Lysosome-associated membrane protein 1 (LAMP1) and TFEB was detected by immunofluorescence. Lyso-Tracker Red staining was applied to detect the lysosome environment. Results: CSE inhibited the cell viability, increased the contents of TNF-α, IL-1β, IL-6, the ratio of LC3II/I, and the level of P62 protein. Besides, CSE decreased the fluorescence intensity of LAMP1 protein and Lyso-Tracker Red staining, as well as the ratio of nucleus/cytosol of TFEB protein. Activating autophagy with rapamycin alleviated CSE-induced inflammatory response. The activation of TFEB via fisetin alleviated CSE-induced autophagy impairment and lysosomal dysfunction, thus alleviated inflammatory response in NR8383 cells. Conclusion: CSE-induced inflammatory response in NR8383 cells, which may be related to the inhibition of TFEB-mediated autophagy.
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Affiliation(s)
- Shu-Wen Xu
- College of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Yu-Jie Zhang
- College of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Wen-Mei Liu
- College of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Xin-Fang Zhang
- Physiology Department, College of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Yuan Wang
- Physiology Department, College of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Shui-Ying Xiang
- College of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Jing-Chao Su
- Physiology Department, College of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Zi-Bing Liu
- College of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, Anhui, China.,Physiology Department, College of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
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12
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Ambrosino P, Fuschillo S, Accardo M, Mosella M, Molino A, Spedicato GA, Motta A, Maniscalco M. Fractional Exhaled Nitric Oxide (FeNO) in Patients with Stable Chronic Obstructive Pulmonary Disease: Short-Term Variability and Potential Clinical Implications. J Pers Med 2022; 12:1906. [PMID: 36422082 PMCID: PMC9699194 DOI: 10.3390/jpm12111906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The use of fractional exhaled nitric oxide (FeNO) has been proposed for identifying and monitoring eosinophilic airway inflammation in chronic obstructive pulmonary disease (COPD). To explore the clinical utility of FeNO in COPD, we aimed to assess its short-term variability in a clinically stable COPD cohort. METHODS Consecutive COPD patients, formerly smokers, underwent FeNO assessment at the baseline and six time-points through serial sampling spaced 3 days apart. RESULTS A total of 41 patients (mean age 72.9, 87.8% males) showed a median baseline value of FeNO of 11.7 (8.0-16.8) ppb. A weak linear relationship was documented between baseline FeNO values and both eosinophil counts (r = 0.341, p = 0.029) and the percentage of eosinophils (r = 0.331, p = 0.034), confirmed in multiple linear regressions after adjusting for steroid use. The overall individual variability of FeNO between time-points was 3.90 (2.53-7.29) ppb, with no significant difference in the distribution of FeNO values measured at different time-points (p = 0.204). A total of 28 (68.3%) patients exhibited FeNO always below the 25 ppb cut-off at all determinations, while the remining 13 (31.7%) had at least one value above the established limit. Interestingly, none of these 13 participants had FeNO stably above 25 ppb, all showing at least one normal value during serial sampling. Compared to these patients with more fluctuating values, the 28 with stably normal FeNO only exhibited a significantly higher body weight (80.0 ± 18.2 kg vs. 69.0 ± 8.8 kg, p = 0.013) and body mass index (29.7 ± 6.5 kg/m2 vs. 25.9 ± 3.7 kg/m2, p = 0.026), confirmed in multiple logistic regressions after adjusting for major potential confounders. CONCLUSIONS A certain degree of FeNO variability, apparently unrelated to eosinophil counts but somehow influenced by body weight, must be considered in COPD patients. Further studies are needed to clarify whether this biomarker may be effectively used to plan more personalized pharmacological and rehabilitation strategies in this clinical setting.
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Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Salvatore Fuschillo
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Mariasofia Accardo
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Marco Mosella
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Antonio Molino
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | | | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli, Italy
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
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13
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Yang HJ, Tsou WH, Shen MC, Liu CY, Saunders HM, Wang KY, Douglas FL. The effects of hydrogen treatment in a cigarette smoke solution-induced chronic obstructive pulmonary disease-like changes in an animal model. J Thorac Dis 2022; 14:4246-4255. [PMID: 36524091 PMCID: PMC9745525 DOI: 10.21037/jtd-22-324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022]
Abstract
Background Molecular hydrogen, with its antioxidant and anti-inflammatory properties, may be suitable for the prevention and treatment of chronic obstructive pulmonary disease (COPD). This study aims to investigate the therapeutic efficacy of hydrogen-oxygen (H2/O2) treatment in cigarette smoke solution (CSS)-induced COPD-like injury in a female BALB/c mouse model. Methods Thirty mice were randomly assigned to three groups: Control (n=8), COPD (n=10), and COPD + H2/O2 (n=12). CSS was administered by intraperitoneal (IP) injection twice weekly for 6 weeks during the COPD induction phase. Simultaneously, the COPD + H2/O2 group started received 75 minutes of inhalation therapy (42% H2) delivered by the Oxy-Hydrogen Generator twice daily for 9 weeks. Mice body weights and survival were measured throughout the study period. Neutrophil elastase (NE) activity and lung histopathological changes were also evaluated. Results The results showed a higher survival rate in the COPD + H2/O2 group compared to the COPD group (100% vs. 80%) during the induction phase. Slight decreases in body weight gains were observed in the COPD and COPD + H2/O2 groups during the first 15 days of the induction phase, but there was no significant difference in mean body weights among the three groups throughout the study period. NE activity was numerically lower in the COPD + H2/O2 group compared to the COPD group. The histopathological evaluation showed significant improvements in the H2/O2-treated mice with respect to mean linear intercept (MLI) and lesion (inflammation and emphysema) scores. Improvements in goblet cell hypertrophy and hyperplasia of airway epithelium were not significant. Conclusions A 9-week H2/O2 inhalation therapy delivered by the Oxy-Hydrogen Generator to CSS-induced COPD-like injury in mice showed improvement in survival rate, alveolar structural changes, and histopathological lesion scores of the lung.
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Affiliation(s)
| | | | | | | | - Hsiu-Ming Saunders
- HOHO Biotech Co., Ltd., Taipei.,IPC Intellectual Property Connections, Inc., Palo Alto, CA, USA
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14
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Chen S, Miravitlles M, Rhee CK, Pavord ID, Jones R, Carter V, Emmanuel B, Alacqua M, Price DB. Patients with Chronic Obstructive Pulmonary Disease and Evidence of Eosinophilic Inflammation Experience Exacerbations Despite Receiving Maximal Inhaled Maintenance Therapy. Int J Chron Obstruct Pulmon Dis 2022; 17:2187-2200. [PMID: 36110306 PMCID: PMC9470244 DOI: 10.2147/copd.s378649] [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: 06/28/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Some patients with chronic obstructive pulmonary disease (COPD) experience frequent exacerbations despite maximal inhaled therapy (“triple therapy”), possibly leading to high health care resource utilization (HCRU). Aim Describe characteristics, future HCRU, and mortality of patients with COPD who experience frequent exacerbations despite triple therapy; characterize individuals who may be candidates for biologic therapies. Methods This descriptive observational study used primary care data of patients aged ≥40 years in the United Kingdom receiving maintenance therapy for COPD who had ≥1 year of data prior to index date and ≥1 year of follow-up data. We described these patients’ clinical and demographic characteristics, including blood eosinophil counts (BEC), pattern of exacerbations, hospitalizations, and corticosteroid exposure, as well as future exacerbations, hospitalizations, and death. Results Of 43,753 patients with maintenance-treated COPD, 6480 experienced exacerbations despite ≥3 months of triple therapy. Of these, 5669 had available BEC: 1287 (22.7%) had BEC ≥250 cells/µL and ≥3 exacerbations in the year prior to the index date; 471 (36.6%) received ≥4 acute courses of oral corticosteroids. Patients with a pattern of high disease burden continued to have high disease burden: 51.1% experienced ≥3 exacerbations and 2.6% experienced ≥3 hospitalizations. Patients who experienced exacerbations despite triple therapy had a significantly higher risk of COPD-related death than other maintenance-treated patients (5.8% vs 2.1%). Conclusion Nearly one-quarter of patients receiving triple therapy for COPD who experienced frequent exacerbations had elevated BEC and ≥3 exacerbations, suggesting a potential mechanism of persistent eosinophilic inflammation that could be a target for eosinophil-depleting biologic therapy.
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Affiliation(s)
- Stephanie Chen
- BioPharmaceuticals Medical, Respiratory & Immunology, AstraZeneca, Gaithersburg, MD, USA
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Chin Kook Rhee
- College of Medicine, Seoul St Mary's Hospital, the Catholic University of Korea, Seoul, South Korea
| | - Ian D Pavord
- Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rupert Jones
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Benjamin Emmanuel
- BioPharmaceuticals Medical, Respiratory & Immunology, AstraZeneca, Gaithersburg, MD, USA
| | - Marianna Alacqua
- BioPharmaceuticals Medical, Respiratory & Immunology, AstraZeneca, Cambridge, UK
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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15
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Baicalin Inhibits Inflammation in Rats with Chronic Obstructive Pulmonary Disease by the TLR2/MYD88/NF- κBp65 Signaling Pathway. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7273387. [PMID: 35911168 PMCID: PMC9337931 DOI: 10.1155/2022/7273387] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Abstract
Objective Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease with a relatively high morbidity and death rate. This study aimed to investigate the inhibitory effect of baicalin (BA) on inflammation in COPD rats and its possible mechanism. Methods The experimental COPD of SD rats were induced by LPS, smoking, and cold stimulation, and they were randomly divided into the control group, COPD group, COPD + LB group, COPD + MB group, and COPD + HB group. The test of pulmonary function and the HE staining were carried out in COPD rats. The levels of TNF-α, IL-1β, IL-6, IL-10, and IL-8, as well as GSH, SOD, and MDA in serum, were detected by ELISA. The levels of TLR2, MYD88, TNF-α, and IL-1β mRNA in BALF were detected by qPCR. The expression of TLR2/MYD88/NF-κBp65 pathway-related proteins was also detected by the Western blot and immunohistochemistry assays. Results Compared to the COPD model group, BA treatment significantly improved the pulmonary function and pathologic changes, reduced the levels of TNF-α, IL-1β, IL-6, IL-10, IL-8, and MDA, and increased the levels of IL-10, SOD, and GSH in COPD rats. In addition, BA could also decrease the protein levels of MYD88, p–NF–κBp65/NF-κBp65, TLR2, and TLR4 but increase the protein level of p-IκBa/IκB in lung tissue of COPD rats. Conclusion BA ameliorated inflammatory response and oxidative stress in COPD rats by regulating the TLR2/MYD88/NF-κBp65 signaling pathway.
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16
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Clinical significance of serum HMGB1 in COPD and correlation with severity of airflow restriction and immune function. REV ROMANA MED LAB 2022. [DOI: 10.2478/rrlm-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background: To explore the serum HMGB1 levels in patients with smoking-induced chronic obstructive pulmonary disease (COPD) and the correlations with airflow restriction and immune function.
Methods: A total of 136 COPD patients were divided into mild, moderate and severe + extremely severe groups. Thirty-five healthy subjects were selected as control group. Serum HMGB1 levels were measured by ELISA, and the correlations with pulmonary and immune function indices were analyzed. Receiver operating characteristic (ROC) curve was plotted.
Results: PaO2, eosinophil count, FEV1/FVC, FEV1% pred, and IgA, IgM, IgG levels of COPD patients were lower than those of control group, and decreased with airflow restriction aggravation. PaCO2, leukocyte count, neutrophil percentage, modified British Medical Research Council (mMRC) scale and COPD Assessment Test (CAT) scores, D-Dimer (D-D), PCT, CRP and HMGB1 levels, myeloid dendritic cell (mDC) and plasmacytoid dendritic cell (pDC) counts, and mDCs/pDCs of COPD patients exceeded those of control group, and increased with airflow restriction aggravation (P<0.05). HMGB1 levels of COPD patients were negatively correlated with FEV1/FVC, FEV1% pred, IgA, IgM and IgG levels and positively correlated with mDC count, pDC count and mDCs/pDCs (P<0.0001). The area under ROC curve was 0.883, the optimal cutoff value was 3.63 ng/mL, and sensitivity and specificity were 86.7% and 85.9%, respectively.
Conclusions: Serum HMGB1 level in patients with smoking-induced COPD rises with airflow restriction aggravation and has significant correlations with the decline of pulmonary and immune functions, with high predictive value for COPD. HMGB1 is a potential biomarker for evaluating COPD progression.
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17
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Zhen G, Yingying L, Jingcheng D. Drug Therapies for COPD: A Bibliometric Review From 1980 to 2021. Front Pharmacol 2022; 13:820086. [PMID: 35517825 PMCID: PMC9065605 DOI: 10.3389/fphar.2022.820086] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/23/2022] [Indexed: 01/03/2023] Open
Abstract
Objective: To analyze all chronic obstructive pulmonary disease (COPD) drugs-related articles that were indexed in the Web of Science Core Collection (WOSCC) database until August 28, 2021 using bibliometric analysis, in order to provide a reliable reference for the treatment of COPD. Methods: A comprehensive search was conducted to analyze all COPD drugs-related articles using WOSCC database from inception to August 28, 2021. Abstracts and potentially eligible articles, which were retrieved during literature search, were screened by two reviewers. Besides, the CiteSpace (5.8.R1) software was utilized to analyze the overall structure of the network, the network clusters, the links between clusters, the key nodes or pivot points, and the pathways. Results: A total of 2552 COPD-drugs related articles were retrieved. From the perspective of categorization of published articles based on country, the United States is the country with the largest number of published articles and completed clinical trials, highlighting the important role of this country in the treatment of COPD. However, in terms of the proportion of ongoing clinical trials, China has the highest proportion, suggesting that China will play a more pivotal role in the medication of COPD in the future. From the perspective of cooperation among countries, the cooperation among European countries was closer than that among Asian countries. In the recent three decades, the top 20 institutions, with a particular concentration on the treatment of COPD, were from North America and Europe. The co-citation analysis showed that, among 2,552 articles, 53154 citations were recorded, and the co-citation network indicated that 24 clusters could be achieved. Conclusion: The administration of bronchodilators and pulmonary drug delivery systems, as well as consideration of elderly COPD patients remained the hotspots, while triple therapy and comorbidity of COPD, as well as the prevention and treatment of elderly COPD patients had been frontiers in recent years.
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Affiliation(s)
- Gao Zhen
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Liu Yingying
- Department of Retired Veteran Cadres, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dong Jingcheng
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, China
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18
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Zhang K, Yao E, Chen B, Chuang E, Wong J, Seed RI, Nishimura SL, Wolters PJ, Chuang PT. Acquisition of cellular properties during alveolar formation requires differential activity and distribution of mitochondria. eLife 2022; 11:e68598. [PMID: 35384838 PMCID: PMC9183236 DOI: 10.7554/elife.68598] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Alveolar formation requires coordinated movement and interaction between alveolar epithelial cells, mesenchymal myofibroblasts, and endothelial cells/pericytes to produce secondary septa. These processes rely on the acquisition of distinct cellular properties to enable ligand secretion for cell-cell signaling and initiate morphogenesis through cellular contraction, cell migration, and cell shape change. In this study, we showed that mitochondrial activity and distribution play a key role in bestowing cellular functions on both alveolar epithelial cells and mesenchymal myofibroblasts for generating secondary septa to form alveoli in mice. These results suggest that mitochondrial function is tightly regulated to empower cellular machineries in a spatially specific manner. Indeed, such regulation via mitochondria is required for secretion of ligands, such as platelet-derived growth factor, from alveolar epithelial cells to influence myofibroblast proliferation and contraction/migration. Moreover, mitochondrial function enables myofibroblast contraction/migration during alveolar formation. Together, these findings yield novel mechanistic insights into how mitochondria regulate pivotal steps of alveologenesis. They highlight selective utilization of energy in cells and diverse energy demands in different cellular processes during development. Our work serves as a paradigm for studying how mitochondria control tissue patterning.
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Affiliation(s)
- Kuan Zhang
- Cardiovascular Research Institute, University of CaliforniaSan FranciscoUnited States
| | - Erica Yao
- Cardiovascular Research Institute, University of CaliforniaSan FranciscoUnited States
| | - Biao Chen
- Cardiovascular Research Institute, University of CaliforniaSan FranciscoUnited States
| | - Ethan Chuang
- Cardiovascular Research Institute, University of CaliforniaSan FranciscoUnited States
| | - Julia Wong
- Cardiovascular Research Institute, University of CaliforniaSan FranciscoUnited States
| | - Robert I Seed
- Department of Pathology, University of CaliforniaSan FranciscoUnited States
| | | | - Paul J Wolters
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of CaliforniaSan FranciscoUnited States
| | - Pao-Tien Chuang
- Cardiovascular Research Institute, University of CaliforniaSan FranciscoUnited States
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19
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Hanson C, Ponce J, Isaak M, Heires A, Nordgren T, Wichman C, Furtado JD, LeVan T, Romberger D. Fatty Acids, Amphiregulin Production, and Lung Function in a Cohort of Midwestern Veterans. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:773835. [PMID: 36188926 PMCID: PMC9397678 DOI: 10.3389/fresc.2022.773835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
Rationale The relationship between many fatty acids and respiratory outcomes remains unclear, especially with regard to mechanistic actions. Altered regulation of the process of lung repair is a key feature of chronic lung disease and may impact the potential for pulmonary rehabilitation, but underlying mechanisms of lung repair following injury or inflammation are not well-studied. The epidermal growth factor receptor agonist amphiregulin (AREG) has been demonstrated to promote lung repair following occupational dust exposure in animals. Studies suggest the polyunsaturated fatty acid (PUFA) docosahexaenoic acid (DHA) may enhance the production of AREG. The objective of this study was to determine the relationship between fatty acids and lung function in a population of veterans and determine if fatty acid status is associated with concentrations of AREG. Materials and Methods Data were collected from a cross-sectional study of veterans within the Nebraska-Western Iowa Health Care System. Whole blood assays were performed to quantify AREG concentrations via a commercially available ELISA kit. Fatty acids from plasma samples from the same patients were measured using gas-liquid chromatography. Intakes of fatty acids were quantified with a validated food frequency questionnaire. Linear regression models were used to determine whether plasma fatty acids or intakes of fatty acids predicted lung function or AREG concentrations. A p < 0.05 was considered statistically significant. Results Ninety participants were included in this analysis. In fully adjusted models, plasma fatty acids were associated with AREG production, including the PUFA eicosapentaenoic acid (EPA) (β = 0.33, p = 0.03) and the monounsaturated fatty acid octadecenoic acid: (β = −0.56, p = 0.02). The omega-3 PUFA docosapentaenoic acid (DPA) was positively associated with lung function (β = 0.28, p = 0.01; β = 26.5, p = 0.05 for FEV1/FVC ratio and FEV1 % predicted, respectively), as were the omega-6 PUFAs eicosadienoic acid (β = 1.13, p < 0.001; β = 91.2, p = 0.005 for FEV1/FVC ratio and FEV1 % predicted, respectively) and docosadienoic acid (β = 0.29, p = 0.01 for FEV1/FVC ratio). Plasma monounsaturated and saturated fatty acids were inversely associated with lung function. Conclusion Opposing anti- and pro-inflammatory properties of different fatty acids may be associated with lung function in this population, in part by regulating AREG induction.
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Affiliation(s)
- Corrine Hanson
- Department of Medical Sciences, Division of Medical Nutrition, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States
- *Correspondence: Corrine Hanson
| | - Jana Ponce
- Department of Medical Sciences, Division of Medical Nutrition, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States
| | - Mia Isaak
- Department of Medical Sciences, Division of Medical Nutrition, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States
| | - Art Heires
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
- VA Nebraska Western Iowa Healthcare System, Omaha, NE, United States
| | - Tara Nordgren
- Colorado State University, Fort Collins, CO, United States
| | - Chris Wichman
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jeremy D. Furtado
- Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Tricia LeVan
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
- VA Nebraska Western Iowa Healthcare System, Omaha, NE, United States
| | - Debra Romberger
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
- VA Nebraska Western Iowa Healthcare System, Omaha, NE, United States
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20
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Voss A, Schroeder R, Schulz S, Haueisen J, Vogler S, Horn P, Stallmach A, Reuken P. Detection of Liver Dysfunction Using a Wearable Electronic Nose System Based on Semiconductor Metal Oxide Sensors. BIOSENSORS 2022; 12:bios12020070. [PMID: 35200331 PMCID: PMC8869535 DOI: 10.3390/bios12020070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 05/04/2023]
Abstract
The purpose of this exploratory study was to determine whether liver dysfunction can be generally classified using a wearable electronic nose based on semiconductor metal oxide (MOx) gas sensors, and whether the extent of this dysfunction can be quantified. MOx gas sensors are attractive because of their simplicity, high sensitivity, low cost, and stability. A total of 30 participants were enrolled, 10 of them being healthy controls, 10 with compensated cirrhosis, and 10 with decompensated cirrhosis. We used three sensor modules with a total of nine different MOx layers to detect reducible, easily oxidizable, and highly oxidizable gases. The complex data analysis in the time and non-linear dynamics domains is based on the extraction of 10 features from the sensor time series of the extracted breathing gas measurement cycles. The sensitivity, specificity, and accuracy for distinguishing compensated and decompensated cirrhosis patients from healthy controls was 1.00. Patients with compensated and decompensated cirrhosis could be separated with a sensitivity of 0.90 (correctly classified decompensated cirrhosis), a specificity of 1.00 (correctly classified compensated cirrhosis), and an accuracy of 0.95. Our wearable, non-invasive system provides a promising tool to detect liver dysfunctions on a functional basis. Therefore, it could provide valuable support in preoperative examinations or for initial diagnosis by the general practitioner, as it provides non-invasive, rapid, and cost-effective analysis results.
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Affiliation(s)
- Andreas Voss
- Institute of Innovative Health Technologies IGHT, Ernst-Abbe-Hochschule Jena, 07745 Jena, Germany; (R.S.); (S.S.)
- Institute of Biomedical Engineering and Informatics (BMTI), Technische Universität Ilmenau, 98693 Ilmenau, Germany;
- Correspondence: ; Tel.: +49-3677-69-2861
| | - Rico Schroeder
- Institute of Innovative Health Technologies IGHT, Ernst-Abbe-Hochschule Jena, 07745 Jena, Germany; (R.S.); (S.S.)
- UST Umweltsensortechnik GmbH, 99331 Geratal, Germany
| | - Steffen Schulz
- Institute of Innovative Health Technologies IGHT, Ernst-Abbe-Hochschule Jena, 07745 Jena, Germany; (R.S.); (S.S.)
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics (BMTI), Technische Universität Ilmenau, 98693 Ilmenau, Germany;
| | - Stefanie Vogler
- Clinic for Internal Medicine IV, University Hospital Jena, 07747 Jena, Germany; (S.V.); (P.H.); (A.S.); (P.R.)
| | - Paul Horn
- Clinic for Internal Medicine IV, University Hospital Jena, 07747 Jena, Germany; (S.V.); (P.H.); (A.S.); (P.R.)
| | - Andreas Stallmach
- Clinic for Internal Medicine IV, University Hospital Jena, 07747 Jena, Germany; (S.V.); (P.H.); (A.S.); (P.R.)
| | - Philipp Reuken
- Clinic for Internal Medicine IV, University Hospital Jena, 07747 Jena, Germany; (S.V.); (P.H.); (A.S.); (P.R.)
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21
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Yu H, Zhao J, Liu D, Chen Z, Sun J, Zhao X. Multi-channel lung sounds intelligent diagnosis of chronic obstructive pulmonary disease. BMC Pulm Med 2021; 21:321. [PMID: 34654400 PMCID: PMC8518292 DOI: 10.1186/s12890-021-01682-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that seriously threatens people's health, with high morbidity and mortality worldwide. At present, the clinical diagnosis methods of COPD are time-consuming, invasive, and radioactive. Therefore, it is urgent to develop a non-invasive and rapid COPD severity diagnosis technique suitable for daily screening in clinical practice. RESULTS This study established an effective model for the preliminary diagnosis of COPD severity using lung sounds with few channels. Firstly, the time-frequency-energy features of 12 channels lung sounds were extracted by Hilbert-Huang transform. And then, channels and features were screened by the reliefF algorithm. Finally, the feature sets were input into a support vector machine to diagnose COPD severity, and the performance with Bayes, decision tree, and deep belief network was compared. Experimental results show that high classification performance using only 4-channel lung sounds of L1, L2, L3, and L4 channels can be achieved by the proposed model. The accuracy, sensitivity, and specificity of mild COPD and moderate + severe COPD were 89.13%, 87.72%, and 91.01%, respectively. The classification performance rates of moderate COPD and severe COPD were 94.26%, 97.32%, and 89.93% for accuracy, sensitivity, and specificity, respectively. CONCLUSION This model provides a standardized evaluation with high classification performance rates, which can assist doctors to complete the preliminary diagnosis of COPD severity immediately, and has important clinical significance.
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Affiliation(s)
- Hui Yu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072 China
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, 300072 China
| | - Jing Zhao
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072 China
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, 300072 China
| | - Dongyi Liu
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, 300072 China
| | - Zhen Chen
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, 300072 China
| | - Jinglai Sun
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, 300072 China
| | - Xiaoyun Zhao
- Chest Hospital of Tianjin University, Tianjin, 300051 China
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22
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Yu S, Zhang C, Yan Z, Fang Q, Gao X. Tiotropium Bromide Attenuates Mucus Hypersecretion in Patients with Stable Chronic Obstructive Pulmonary Disease. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:1341644. [PMID: 34650619 PMCID: PMC8510842 DOI: 10.1155/2021/1341644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with stable chronic obstructive pulmonary disease (COPD) have been observed to benefit from tiotropium bromide. However, there are few studies of tiotropium bromide on sputum and sputum viscosity. To evaluate the effect of tiotropium bromide on mucus hypersecretion, a randomized, double-blind controlled trial was performed. METHODS 120 cases of patients with pulmonary function grade II were divided into two groups, which include the treatment group given tiotropium bromide powder inhalation (18 μg, inhalation, QD) and the control group given formoterol fumarate powder inhalation (12 μg, inhalation, BID) plus ambroxol hydrochloride tablets (60 mg, oral, TID). After 3 months of treatment, the pulmonary function and α 1-acid glycoprotein (α 1-AGP) in sputum were detected, and the changes of glycoprotein and Ca2+ content were evaluated by Miller classification. RESULTS Three patients (2 cases in the treatment group and 1 case in the control group) were dropped due to loss of follow-up, and 117 cases of patients were enrolled in this study. After 3 months of treatment, the sputum character score, α1-acid glycoprotein, Ca2+ content, and lung function of the two groups were significantly improved; group comparison analyses revealed that there was no significant difference in the content of α 1-AGP, Ca2+ in sputum, and lung function between the two groups (P > 0.05), but the improvement of sputum properties was significant (P < 0.05), and the treatment group was better than the control group (t = -2.77; P = 0.007). CONCLUSIONS Inhaled tiotropium bromide can effectively inhibit the mucus hypersecretion in stable COPD patients, improve the sputum properties and lung function of patients, and improve the quality of life of patients.
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Affiliation(s)
- Suyun Yu
- Department of Respiratory Medicine, Minhang Hospital Affiliated to Fudan University, Minhang District Central Hospital, Shanghai 201199, China
| | - Caili Zhang
- Minhang Qibao Community Health Service Center, Shanghai 201108, China
| | - Zhijun Yan
- Department of Respiratory Medicine, Minhang Hospital Affiliated to Fudan University, Minhang District Central Hospital, Shanghai 201199, China
| | - Qingqing Fang
- Department of Gastroenterology, Minhang Hospital Affiliated to Fudan University, Minhang District Central Hospital, Shanghai 201199, China
| | - Xiwen Gao
- Department of Respiratory Medicine, Minhang Hospital Affiliated to Fudan University, Minhang District Central Hospital, Shanghai 201199, China
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Role of new digital technologies and telemedicine in pulmonary rehabilitation : Smart devices in the treatment of chronic respiratory diseases. Wien Klin Wochenschr 2021; 133:1201-1207. [PMID: 34460006 PMCID: PMC8599213 DOI: 10.1007/s00508-021-01930-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/23/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary diseases are conditions characterized by a variable progression. Some individuals experience longer asymptomatic periods while others acute worsening periods and/or exacerbations triggered by symptom multiplication factors. Medications are adjusted to the patients' respiratory function, self-assessment of health and emerging certain physical changes. A more effective treatment may be applied by real-time data registered during the patient's everyday life. AIM AND METHODS Introducing new modern digital technology in pulmonary rehabilitation (PR) to help tracking the patients' medication, thus we systematically reviewed the latest publications on telemedicine and pulmonary telerehabilitation. CONCLUSION The use of the latest digital technologies in PR is very exciting and offers great opportunities while treating patients affected by specific conditions. On the one hand, adherence to medication can be improved in patients with chronic respiratory diseases by using these new state of the art devices; on the other hand, digital devices will also be able to monitor various physiological parameters of patients during their usual everyday activities. Data can be stored on a smartphone and shared with the provider. Relying on this information, physicians will be able to tailor medications and dosage to the specific needs of individual patients. Telerehabilitation may be a sustainable solution to the growing burden of chronic respiratory disease worldwide. However, PR must keep its cornerstones, such as education and motivations, which are most successful when conducted in person. Many issues remain to be resolved in the future, e.g. cybersecurity while using smart devices since they offer unique opportunities for PR.
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Mekanimitdee P, Morasert T, Patumanond J, Phinyo P. The MAGENTA model for individual prediction of in-hospital mortality in chronic obstructive pulmonary disease with acute exacerbation in resource-limited countries: A development study. PLoS One 2021; 16:e0256866. [PMID: 34449823 PMCID: PMC8396787 DOI: 10.1371/journal.pone.0256866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common undesirable event associated with significant morbidity and mortality. Several clinical prediction tools for predicting in-hospital mortality in patients with AECOPD have been developed in the past decades. However, some issues concerning the validity and availability of some predictors in the existing models may undermine their clinical applicability in resource-limited clinical settings. METHODS We developed a multivariable model for predicting in-hospitality from a retrospective cohort of patients admitted with AECOPD to one tertiary care center in Thailand from October 2015 to September 2017. Multivariable logistic regression with fractional polynomial algorithms and cluster variance correction was used for model derivation. RESULTS During the study period, 923 admissions from 600 patients with AECOPD were included. The in-hospital mortality rate was 1.68 per 100 admission-day. Eleven potential predictors from the univariable analysis were included in the multivariable logistic regression. The reduced model, named MAGENTA, incorporated seven final predictors: age, body temperature, mean arterial pressure, the requirement of endotracheal intubation, serum sodium, blood urea nitrogen, and serum albumin. The model discriminative ability based on the area under the receiver operating characteristic curve (AuROC) was excellent at 0.82 (95% confidence interval 0.77, 0.86), and the calibration was good. CONCLUSION The MAGENTA model consists of seven routinely available clinical predictors upon patient admissions. The model can be used as an assisting tool to aid clinicians in accurate risk stratification and making appropriate decisions to admit patients for intensive care.
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Affiliation(s)
| | - Thotsaporn Morasert
- Department of Internal Medicine, Surat Thani Hospital, Surat Thani, Thailand
- Pulmonary and Critical Care Medicine, Department of Internal Medicine, Surat Thani Hospital, Surat Thani, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translation Research (MSTR) Cluster, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
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25
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Yi M, Jiang D, Jia Y, Xu W, Wang H, Li Y, Zhang Z, Wang J, Chen O. Impact of Caregiving Burden on Quality of Life of Caregivers of COPD Patients: The Chain Mediating Role of Social Support and Negative Coping Styles. Int J Chron Obstruct Pulmon Dis 2021; 16:2245-2255. [PMID: 34376977 PMCID: PMC8349532 DOI: 10.2147/copd.s311772] [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: 03/19/2021] [Accepted: 07/19/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Caregivers of COPD patients experience various caregiving burden, which is related to their quality of life. We aimed to explicitly explore whether social support and negative coping styles play the chain mediating roles in the relationship between the caregiving burden of caregivers of COPD patients and their health-related quality of life. Methods We conducted a multicenter cross-sectional survey in four hospitals using a convenience sample. Participants who met the inclusion criteria completed five relevant scales, including a sociodemographic scale. One-way ANOVA and Pearson’s method were used to analyze the data accordingly, and chain mediated effect values were estimated by bootstrap method to determine whether the model holds. Results Among the 201 caregivers who participated in this study, the mean age was 55.94 years, most of them were female (61.2%), the mean caregiving burden score was 52.39 ± 14.65, and the quality of life score was 37.97 ± 3.55. Among them, age, gender, education, relationship with the patient, and the number of chronic diseases were the main factors affecting the quality of life score of the caregivers. According to Pearson results, there was a negative correlation between quality of life and caregiving burden, and negative coping styles. The model result showed that caregiving burden could directly and negatively predict quality of life, and also predict quality of life through the chain mediation of social support and negative coping styles. Conclusion In China, caregivers of patients with COPD experience severe levels of caregiving burden and low quality of life. The combination of adequate perceived social support and lower negative coping can be effective in alleviating caregiving burden and improving their quality of life. Therefore, healthcare professionals should provide targeted guidance to caregivers with the help of social support and interventions that regulate negative coping styles.
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Affiliation(s)
- Mo Yi
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Di Jiang
- Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Yuanmin Jia
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Wei Xu
- Department of Psychology, Shanghai Normal University, Shanghai, 200234, People's Republic of China
| | - Haixia Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Yizhang Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Zeyi Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Jingjing Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Ou Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
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26
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Zou Y, Bhat OM, Yuan X, Li G, Huang D, Guo Y, Zhou D, Li PL. Release and Actions of Inflammatory Exosomes in Pulmonary Emphysema: Potential Therapeutic Target of Acupuncture. J Inflamm Res 2021; 14:3501-3521. [PMID: 34335040 PMCID: PMC8318722 DOI: 10.2147/jir.s312385] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/03/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Exosomes have been reported to mediate activation of the inflammatory response by secretion of inflammasome products such as IL-1β or IL-18 and that changes in exosomes production or secretion may be a therapeutic target for treatment of a variety of different chronic diseases. The present study tested the hypothesis that exosome-mediated release of NLRP3 inflammasome products instigates the inflammatory response in the lung during emphysema, a type of chronic obstructive pulmonary disease (COPD) and that electroacupuncture (EA) may attenuate emphysema by inhibition of NLRP3 inflammasome activation and consequent inflammation. METHODS The COPD mice model was developed by injecting porcine pancreatic elastase (PPE) via puncture tracheotomy and instillation. EA (4 Hz/20 Hz, 1 to 3 mA) was applied to the bilateral BL13 and ST36 for 30 min, once every other day for 2 weeks. Micro computed tomography (micro-CT) was performed to measure lung function. Histopathological changes in the lungs were displayed by HE staining. RESULTS In a mouse model of porcine pancreatic elastase (PPE)-induced emphysema, the lung tissue was found to display several key features of emphysema, including alveolar septal thickening, enlarged alveoli, interstitial edema, and inflammatory cells infiltration. Lungs of mice receiving PPE exhibited substantially increased low attenuation area (LAA) in micro-CT images. The colocalization of NLRP3 vs ASC or caspase-1 detected by confocal microscopy was shown to increase in both bronchial and alveolar walls, indicating the increased formation of NLRP3 inflammasomes. IL-1β, a prototype NLRP3 inflammasome activating product, was also found to have increased in the lung during emphysema, which was colocalized with CD63 (an exosome marker), an indicative of inflammatory exosome formation. By nanoparticle tracking analysis (NTA), IL-1β-containing exosomes were shown to significantly increase in the bronchoalveolar lavage (BAL) from mice with emphysema. Therapeutically, IL-1β production in the lung during emphysema was significantly reduced by EA at the acupoint Feishu (BL13) and Zusanli (ST36), accompanied by decreased colocalization of NLRP3 vs ASC or caspase-1. Increased exosome release into BAL during emphysema was shown to be significantly attenuated in EA-treated mice compared to their controls. However, EA of non-specific BL23 together with ST36 acupoint had no effects on NLRP3 inflammasome activation, exosome release and associated lung pathology during emphysema. CONCLUSION NLRP3 inflammasome activation in concert with increased release of exosomes containing IL-1β or other inflammasome products contributes to the development of lung inflammation and injury during PPE-induced emphysema and that EA of lung-specific acupoints attenuates inflammasome activation and exosome release, thereby reducing inflammatory response in the lung of mice with emphysema.
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Affiliation(s)
- Yao Zou
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Owais M Bhat
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Xinxu Yuan
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Guangbi Li
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Dandan Huang
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Yi Guo
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
| | - Dan Zhou
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
| | - Pin-Lan Li
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
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27
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Kim TW, Choi ES, Kim WJ, Jo HS. The Association with COPD Readmission Rate and Access to Medical Institutions in Elderly Patients. Int J Chron Obstruct Pulmon Dis 2021; 16:1599-1606. [PMID: 34113092 PMCID: PMC8184368 DOI: 10.2147/copd.s302631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Up to 20% of patients with chronic obstructive pulmonary disease (COPD) require re-admission within 30 days of discharge after hospitalization for acute exacerbations of the disease. These re-admissions can increase morbidity and the economic burden of COPD. Reducing re-admissions has become a policy target in many developed countries. We investigated the risk factors for COPD re-admissions among older adults with COPD. Patients and Methods Data obtained from the National Health Insurance Service-Senior Cohort (NHIS-SC) in Korea were analyzed. The subjects included 558,147 patients aged ≥70 who had been admitted for COPD between 2013 and 2015. Re-admission was defined as being re-hospitalized within 30 days after discharge. The key variables selected from the database included income-based insurance contributions, demographical variables, information on inpatient medical services, types of healthcare facilities, and emergency time relevance index (TRI). The TRI is a regional medical-use analysis index that evaluates whether the capacity of the medical services available is appropriate for the medical needs of the target residents. Results In 814 COPD re-admission cases among 4867 total admissions due to COPD in elderly subjects, higher re-admission rates were associated with male sex, admission to district hospitals, medical aid recipients, and a longer hospital stay. When additionally adjusting the TRI to identify the difference in re-admission rates due to medical service accessibility, the same results were found, except for the areas of residence. The TRI was lower in re-admission cases (odds ratio 0.991 [95% CI, 0.984‒0.998], P = 0.013). Conclusion In this study, COPD re-admission rates among older adults were significantly associated with sex, length of hospital stay, and the type of hospital. The capacity of the medical services provided was also related to the COPD re-admission rate. Better access to appropriate emergency services is associated with reduction of COPD re-admission rates.
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Affiliation(s)
- Tae Wan Kim
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, South Korea
| | - Eun Sil Choi
- Gangwon Public Health Policy Institute, Chuncheon, South Korea
| | - Woo Jin Kim
- Department of Internal Medicine, Kangwon National University, Chuncheon, South Korea
| | - Heui Sug Jo
- Department of Health Policy & Management, Kangwon National University, Chuncheon, South Korea
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Xue H, Xie B, Xu N, Li H, Chen Q, Xie W, Wang H. Etanercept Protected Against Cigarette Smoke Extract-Induced Inflammation and Apoptosis of Human Pulmonary Artery Endothelial Cells via Regulating TNFR1. Int J Chron Obstruct Pulmon Dis 2021; 16:1329-1345. [PMID: 34007171 PMCID: PMC8123949 DOI: 10.2147/copd.s295580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Etanercept (ETN), a tumor necrosis factor-α (TNF-α) inhibitor, has been applied in the treatment of many diseases. However, whether it has effects on chronic obstructive pulmonary disease (COPD) and its interaction with tumor necrosis factor receptor 1 (TNFR1) remained unknown. Methods Histopathological analysis of lung tissues from non-smokers and smokers with or without COPD was conducted using hematoxylin–eosin (H&E) staining, Van Gieson (VG) staining, and terminal transferase-mediated biotin dUTP nick end labeling (TUNEL). TNF-α content was measured using Immunohistochemistry. Correlation analysis among apoptosis rate, smoke index, the FEV1/FVC ratio, and TNF-α-positive cells was performed. After ETN treatment and transfection of overexpressed or silenced TNFR1, levels of inflammatory cytokines, apoptosis and related genes expressions in cigarette smoke extract (CSE)-treated human pulmonary artery endothelial cells (HPAECs) were detected using enzyme-linked immunosorbent assay (ELISA), Hoechst 33342 staining, flow cytometry, quantitative real-time PCR (qRT-PCR) and Western blot. Results Pulmonary arterial remodeling and increased apoptotic and TNF-α+ HPAECs were found in lung tissue of smokers with or without COPD, with higher degrees in smokers with COPD. The numbers of apoptotic and TNF-α+ HPAECs were positively correlated with smoke index, while the FEV1/FVC ratio was negatively correlated with apoptotic HPAECs. In HPAECs, ETN downregulated the expressions of proteins related to CSE-induced apoptosis and the TNF receptor family, decreased CSE-induced cell apoptosis and inflammatory cytokine levels, and inhibited TNFR1 expression and p65 phosphorylation. Overexpressed TNFR1 reversed the effects of ETN on CSE-treated HPAECs, whereas silencing TNFR1 did the opposite. Conclusion ETN protected HPAECs against CSE-induced inflammation and apoptosis via downregulating TNFR1, thus providing a potential therapy for smoking-induced COPD.
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Affiliation(s)
- Hong Xue
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China.,Provincial School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Baosong Xie
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China.,Provincial School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Nengluan Xu
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China.,Provincial School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Hongru Li
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China.,Provincial School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Qianshun Chen
- Provincial School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China
| | - Weiping Xie
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Hong Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
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Karnati S, Seimetz M, Kleefeldt F, Sonawane A, Madhusudhan T, Bachhuka A, Kosanovic D, Weissmann N, Krüger K, Ergün S. Chronic Obstructive Pulmonary Disease and the Cardiovascular System: Vascular Repair and Regeneration as a Therapeutic Target. Front Cardiovasc Med 2021; 8:649512. [PMID: 33912600 PMCID: PMC8072123 DOI: 10.3389/fcvm.2021.649512] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and encompasses chronic bronchitis and emphysema. It has been shown that vascular wall remodeling and pulmonary hypertension (PH) can occur not only in patients with COPD but also in smokers with normal lung function, suggesting a causal role for vascular alterations in the development of emphysema. Mechanistically, abnormalities in the vasculature, such as inflammation, endothelial dysfunction, imbalances in cellular apoptosis/proliferation, and increased oxidative/nitrosative stress promote development of PH, cor pulmonale, and most probably pulmonary emphysema. Hypoxemia in the pulmonary chamber modulates the activation of key transcription factors and signaling cascades, which propagates inflammation and infiltration of neutrophils, resulting in vascular remodeling. Endothelial progenitor cells have angiogenesis capabilities, resulting in transdifferentiation of the smooth muscle cells via aberrant activation of several cytokines, growth factors, and chemokines. The vascular endothelium influences the balance between vaso-constriction and -dilation in the heart. Targeting key players affecting the vasculature might help in the development of new treatment strategies for both PH and COPD. The present review aims to summarize current knowledge about vascular alterations and production of reactive oxygen species in COPD. The present review emphasizes on the importance of the vasculature for the usually parenchyma-focused view of the pathobiology of COPD.
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Affiliation(s)
- Srikanth Karnati
- Institute of Anatomy and Cell Biology, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Michael Seimetz
- Excellence Cluster Cardio-Pulmonary System (ECCPS), Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Florian Kleefeldt
- Institute of Anatomy and Cell Biology, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Avinash Sonawane
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - Thati Madhusudhan
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Akash Bachhuka
- UniSA Science, Technology, Engineering and Mathematics, University of South Australia, Mawson Lakes Campus, Adelaide, SA, Australia
| | - Djuro Kosanovic
- Excellence Cluster Cardio-Pulmonary System (ECCPS), Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany.,Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Norbert Weissmann
- Excellence Cluster Cardio-Pulmonary System (ECCPS), Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, University of Giessen, Giessen, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, Julius-Maximilians-University Würzburg, Würzburg, Germany
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30
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Majorski DS, Callegari JC, Schwarz SB, Magnet FS, Majorski R, Storre JH, Schmoor C, Windisch W. Oronasal versus Nasal Masks for Non-Invasive Ventilation in COPD: A Randomized Crossover Trial. Int J Chron Obstruct Pulmon Dis 2021; 16:771-781. [PMID: 33814901 PMCID: PMC8009345 DOI: 10.2147/copd.s289755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The impact of oronasal and nasal masks on the quality of nocturnal non-invasive ventilation (NIV) needs to be clarified. This trial was designed to compare the impact of oronasal and nasal masks on the objective quality and subjective acceptance of nocturnal NIV in COPD-patients. Patients and Methods In a randomized crossover trial, 30 COPD-patients with well-established high-intensity NIV (mean inspiratory/expiratory positive airway pressure 26±3/5±1 cmH2O, mean respiratory back-up rate 17±1/min) were ventilated for two consecutive nights on oronasal and nasal masks, respectively. Results Full polysomnography, nocturnal blood gas measurements, and subjective assessments were performed. There was a tendency towards improved sleep efficiency (primary outcome) when an oronasal mask was worn (+9.9%; 95% CI:-0.2%-20.0%; P=0.054). Sleep stages 3/4 were favored by the oronasal mask (+12.7%; 95% CI: 6.0%-19.3%; P=<0.001). Subjective assessments were comparable with the exception of items related to leakage (P<0.05 in favor of nasal masks). The mean transcutaneous PCO2 value for oronasal masks (47.7±7.4 mmHg) was comparable to that of nasal masks (48.9±6.6 mmHg) (P=0.11). There was considerable diversity amongst individual patients in terms of sleep quality and gas exchange following mask exchange. Subjective mask preference was not associated with sleep quality, but with nocturnal dyspnea. Over 40% of patients subsequently switched to the mask that they were not previously accustomed to. Conclusion In general, oronasal and nasal masks are each similarly capable of successfully delivering NIV in COPD-patients. However, the individual response to different interfaces is extremely heterogeneous, while subjective mask preference is independent from objective measures, but associated with dyspnea. Trial Registration German Clinical Trials Registry (DRKS00007741).
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Affiliation(s)
- Daniel S Majorski
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Jens C Callegari
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Sarah B Schwarz
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Friederike S Magnet
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Rodion Majorski
- Department of Neurology and Neurophysiology, Helios Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Jan H Storre
- Praxis Pneumologie Solln, Munich, Germany.,Department of Pneumology, University Medical Hospital, Freiburg, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Medical Center - University Medical Hospital, Freiburg, Germany
| | - Wolfram Windisch
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
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van Bakel SIJ, Gosker HR, Langen RC, Schols AMWJ. Towards Personalized Management of Sarcopenia in COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:25-40. [PMID: 33442246 PMCID: PMC7800429 DOI: 10.2147/copd.s280540] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
The awareness of the presence and consequences of sarcopenia has significantly increased over the past decade. Sarcopenia is defined as gradual loss of muscle mass and strength and ultimately loss of physical performance associated with aging and chronic disease. The prevalence of sarcopenia is higher in chronic obstructive pulmonary disease (COPD) compared to age-matched controls. Current literature suggests that next to physical inactivity, COPD-specific alterations in physiological processes contribute to accelerated development of sarcopenia. Sarcopenia in COPD can be assessed according to current guidelines, but during physical performance testing, ventilatory limitation should be considered. Treatment of muscle impairment can halt or even reverse sarcopenia, despite respiratory impairment. Exercise training and protein supplementation are currently at the basis of sarcopenia treatment. Furthermore, effective current and new interventions targeting the pulmonary system (eg, smoking cessation, bronchodilators and lung volume reduction surgery) may also facilitate muscle maintenance. Better understanding of disease-specific pathophysiological mechanisms involved in the accelerated development of sarcopenia in COPD will provide new leads to refine nutritional, exercise and physical activity interventions and develop pharmacological co-interventions.
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Affiliation(s)
- Sophie I J van Bakel
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, Department of Respiratory Medicine, Maastricht, The Netherlands
| | - Harry R Gosker
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, Department of Respiratory Medicine, Maastricht, The Netherlands
| | - Ramon C Langen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, Department of Respiratory Medicine, Maastricht, The Netherlands
| | - Annemie M W J Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, Department of Respiratory Medicine, Maastricht, The Netherlands
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32
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Mao J, Li Y, Feng S, Liu X, Tian Y, Bian Q, Li J, Hu Y, Zhang L, Ji H, Li S. Bufei Jianpi Formula Improves Mitochondrial Function and Suppresses Mitophagy in Skeletal Muscle via the Adenosine Monophosphate-Activated Protein Kinase Pathway in Chronic Obstructive Pulmonary Disease. Front Pharmacol 2021; 11:587176. [PMID: 33390958 PMCID: PMC7773703 DOI: 10.3389/fphar.2020.587176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/24/2020] [Indexed: 12/18/2022] Open
Abstract
Skeletal muscle dysfunction, a striking systemic comorbidity of chronic obstructive pulmonary disease (COPD), is associated with declines in activities of daily living, reductions in health status and prognosis, and increases in mortality. Bufei Jianpi formula (BJF), a traditional Chinese herbal formulation, has been shown to improve skeletal muscle tension and tolerance via inhibition of cellular apoptosis in COPD rat models. This study aimed to investigate the mechanisms by which BJF regulates the adenosine monophosphate-activated protein kinase (AMPK) pathway to improve mitochondrial function and to suppress mitophagy in skeletal muscle cells. Our study showed that BJF repaired lung function and ameliorated pathological impairment in rat lung and skeletal muscle tissues. BJF also improved mitochondrial function and reduced mitophagy via the AMPK signaling pathway in rat skeletal muscle tissue. In vitro, BJF significantly improved cigarette smoke extract-induced mitochondrial functional impairment in L6 skeletal muscle cells through effects on mitochondrial membrane potential, mitochondrial permeability transition pores, adenosine triphosphate production, and mitochondrial respiration. In addition, BJF led to upregulated expression of mitochondrial biogenesis markers, including AMPK-α, PGC-1α, and TFAM and downregulation of mitophagy markers, including LC3B, ULK1, PINK1, and Parkin, with increased expression of downstream markers of the AMPK pathway, including mTOR, PPARγ, and SIRT1. In conclusion, BJF significantly improved skeletal muscle and mitochondrial function in COPD rats and L6 cells by promoting mitochondrial biogenesis and suppressing mitophagy via the AMPK pathway. This study suggests that BJF may have therapeutic potential for prophylaxis and treatment of skeletal muscle dysfunction in patients with COPD.
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Affiliation(s)
- Jing Mao
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Ya Li
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Institute for Respiratory Diseases, The First Affiliated Hospital, Henan University of Chinese Medicine, Zhengzhou, China.,Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Disease by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Suxiang Feng
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Disease by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xuefang Liu
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Disease by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yange Tian
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Disease by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Qingqing Bian
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Institute for Respiratory Diseases, The First Affiliated Hospital, Henan University of Chinese Medicine, Zhengzhou, China.,Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Disease by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Junzi Li
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Disease by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yuanyuan Hu
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Disease by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Lanxi Zhang
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Disease by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Huige Ji
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Disease by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Suyun Li
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Institute for Respiratory Diseases, The First Affiliated Hospital, Henan University of Chinese Medicine, Zhengzhou, China.,Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Disease by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
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Naderi N, Farias R, Abou Rjeili M, Mostafavi-Pour-Manshadi SMY, Krishnan S, Li PZ, Baglole CJ, Bourbeau J. Investigating the effect of pretreatment with azithromycin on inflammatory mediators in bronchial epithelial cells exposed to cigarette smoke. Exp Lung Res 2020; 47:98-109. [PMID: 33336605 DOI: 10.1080/01902148.2020.1857470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose of the study: Macrolide therapy is effective in reducing chronic obstructive pulmonary disease (COPD) exacerbations. Our recent study has shown the effectiveness of taking azithromycin in COPD patients, not only ex-smokers but also current smokers. Beyond their anti-microbial effects, macrolides have anti-inflammatory and immunomodulatory properties. The aim of this study was to determine if pretreatment with azithromycin modulates cigarette smoke-induced inflammation in airway epithelial cells. We hypothesized that pretreatment with azithromycin decreases exacerbation frequency by modulating inflammation in human airway epithelial cells exposed to cigarette smoke. Materials and methods: BEAS-2B bronchial epithelial cells were incubated with 5% cigarette smoke extract (CSE) for 3 h, 6 h, and 24 h. Then, airway epithelial cells were pretreated with azithromycin and exposed to 5% CSE. In each stage, the expression and release of IL-6 and IL-8 mRNA were analyzed by quantitative real-time PCR (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. Results: There was a significant increase of IL-6 and IL-8 mRNA, as well as an increase in extracellular IL-8 protein following exposure to 5% CSE. When cells were pretreated with azithromycin and exposed to 5% CSE for 3 h, there was a significant dose-dependent decrease in the expression of IL-6 mRNA. A final concentration of 9 µg/mL of azithromycin was sufficient to decrease IL-6, IL-8 mRNA, and extracellular IL-8 levels. Conclusion: Pretreatment with azithromycin decreased the expression of IL-6 and IL-8 mRNA and the release of IL-8 in bronchial epithelial cells exposed to cigarette smoke. These results demonstrate the direct effect of azithromycin on inflammatory mediators in bronchial epithelial cells exposed to cigarette smoke.
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Affiliation(s)
- Nafiseh Naderi
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Center, McGill University, Montréal, Canada
| | - Raquel Farias
- Snyder Institute for Chronic Diseases, Department of Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Mira Abou Rjeili
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Center, McGill University, Montréal, Canada
| | | | - Suurya Krishnan
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Center, McGill University, Montréal, Canada
| | - Pei Zhi Li
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Center, McGill University, Montréal, Canada
| | - Carolyn J Baglole
- Departments of Medicine, Pathology & Pharmacology & Therapeutics, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Center, Montreal, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Center, McGill University, Montréal, Canada.,Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Canada
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Chernetska NV, Stupnytska HY, Fediv OI. The Role of MDR1 (C3435T) Gene Polymorphism in Patients with Chronic Obstructive Pulmonary Disease Associated with Type 2 Diabetes Mellitus. J Med Life 2020; 13:349-355. [PMID: 33072207 PMCID: PMC7550143 DOI: 10.25122/jml-2020-0139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Chronic obstructive pulmonary disease is a multifactorial disease characterized by gene-gene interaction as well as environmental effects. The incidence of type 2 diabetes mellitus is proved to be higher in the presence of chronic obstructive pulmonary disease than in the case of its absence. We aimed to study the genotypes of MDR1 (C3435T) gene polymorphism and its relationship with clinical, instrumental, and laboratory parameters in chronic obstructive pulmonary disease associated with type 2 diabetes mellitus. All the patients were divided into two groups. The first group included 53 patients with chronic obstructive pulmonary disease, and the second group included 49 patients with chronic obstructive pulmonary disease with comorbid type 2 diabetes mellitus. The COPD assessment test (CAT), 6-minute walk test, BODE integral index, spirometry, and bioimpedansometry were used for examination. Lipid spectrum, carbohydrate metabolism, endothelial functional status, leptin, adiponectin, and serum levels were also determined by means of enzyme immunoassay. Our study results showed no significant difference between the genotypes of the control group of healthy individuals and patients with chronic obstructive pulmonary disease and comorbid type 2 diabetes mellitus. Though, a certain association of this gene polymorphism with clinical findings by CAT-test, specific parameters of carbohydrate (fasting glucose) and lipid metabolism (total cholesterol and low-density cholesterol lipoproteins), endothelial functional state (nitrate/nitrite level) with the minor allele T available was found.
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Affiliation(s)
- Natalia Vasylivna Chernetska
- Department of Internal Medicine and Infectious Diseases, Higher State Educational Establishment of Ukraine "Bukovinian State Medical University", Chernivtsi, Ukraine
| | - Hanna Yaroslavivna Stupnytska
- Department of Propaedeutic of Internal diseases, Higher State Educational Establishment of Ukraine "Bukovinian State Medical University", Chernivtsi, Ukraine
| | - Oleksandr Ivanovich Fediv
- Department of Internal Medicine and Infectious Diseases, Higher State Educational Establishment of Ukraine "Bukovinian State Medical University", Chernivtsi, Ukraine
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Aghili M, Vahidi E, Mohammadrezaei N, Mirrajei T, Abedini A. Effectivness of Nebulized Budesonide for COPD Exacerbation Management in Emergency Department; a Randomized Clinical Trial. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2020; 8:e85. [PMID: 33244520 PMCID: PMC7682631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Nebulized budesonide has been long used in chronic obstructive pulmonary disease (COPD) exacerbation. This study aimed to compare the effectiveness of nebulized budesonide (NB) versus oral prednisolone (OP) in increasing peak expiratory flow rate (PEFR) of COPD patients in emergency department (ED). METHODS Patients with COPD exacerbation, referring to ED were enrolled in this randomized trial study. In the first group, NB 0.5 mg every 30 minutes till three doses, placebo tablet, and standard treatment was administered. In the second group, nebulized normal saline, OP tablet 50 mg, and standard treatment were administered. Patients' demographic data, vital signs, PEFR, venous blood gas (VBG) analysis, disposition, and patient and physician satisfaction were all collected and compared between the two groups. RESULTS 43 patients in the NB group and 41 patients in the OP group were evaluated. The two groups had similar age (p=0.544) and gender (p=0.984) distribution, duration of illness (p=0.458), and baseline PEFR (p=0.400). 12 and 24 hours after treatment, significant increase in PEFR in the NB and OP groups were observed (p=0.032 and 0.008; respectively). The upward trend of PEFR in NB group was significantly better than that of OP group during 24 hours of treatment (p=0.005). Vital signs and VBG results showed no significant differences between the two groups during the studied time interval. CONCLUSION NB, compared to OP, could more effectively increase PEFR and ameliorate disease severity of patients with COPD exacerbation at 12 and 24 hours after treatment in ED.
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Affiliation(s)
- Mehrad Aghili
- Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Vahidi
- Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding author: Elnaz Vahidi; Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel: +989125948762; ,
| | - Narges Mohammadrezaei
- Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tina Mirrajei
- Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences
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36
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Zafiraki VK, Kosmacheva ED, Shulzhenko LV, Kizhvatova NV, Nemtsova EA, Pershukov IV. [3-years outcome of follow-up of patients with chronic obstructive pulmonary disease successfully treated by percutaneous coronary intervention due to acute coronary syndrome]. ACTA ACUST UNITED AC 2020; 60:84-91. [PMID: 33131479 DOI: 10.18087/cardio.2020.9.n1263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate results of three-year follow-up in patients after acute coronary syndrome (ACS) associated with chronic obstructive pulmonary disease (COPD) and to identify predictors for delayed serious cardiovascular adverse (SCVAE) events.Material and methods This prospective cohort study included 119 patients with verified COPD who had ACS after a successful urgent percutaneous coronary intervention and were discharged from the hospital without in-hospital complications. Incidence of and time to SCVAE (cardiovascular death, myocardial infarction, stroke, repeated unscheduled myocardial revascularization) were recorded. SCVAE predictors were identified with the Cox regression by stepwise inclusion of variables into the model.Results SCVAE occurred in 33.6 % of ACS patients with COPD. The high rate of repeated myocardial revascularization mostly contributed to the development of delayed SCVAEs (19.3 % of patients). Independent predictors of SCVAE included the total number of stenoses in major coronary artery branches; ankle-brachial index; glomerular filtration rate calculated with the CKD-EPI equation; frequent COPD exacerbations; functional residual capacity of the lungs; and 6-min walk distance.Conclusion New independent predictors of SCVAE were identified in COPD patients after ACS with percutaneous coronary intervention and stenting, including distance in the 6-min walk test, frequent COPD exacerbations, and functional residual volume of the lungs as an index of pulmonary hyperinflation.
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Affiliation(s)
- V K Zafiraki
- «Kuban State Medical University» of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia Regional Clinical Hospital #1, Krasnodar, Russia
| | - E D Kosmacheva
- «Kuban State Medical University» of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia Scientific Research Institution - Ochapovsky S.V. Regional Clinical Hospital #1, Krasnodar, Russia
| | - L V Shulzhenko
- «Kuban State Medical University» of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia Scientific Research Institution - Ochapovsky S.V. Regional Clinical Hospital #1, Krasnodar, Russia
| | - N V Kizhvatova
- Scientific Research Institution - Ochapovsky S.V. Regional Clinical Hospital #1, Krasnodar, Russia
| | - E A Nemtsova
- Scientific Research Institution - Ochapovsky S.V. Regional Clinical Hospital #1, Krasnodar, Russia
| | - I V Pershukov
- Osh State University, Osh, Kyrgyzstan Voronezh Regional Clinical Hospital #1, Voronezh, Russia
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37
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Camargo PF, Ditomaso-Luporini L, de Carvalho LCS, Goulart CDL, Sebold R, Dos Santos PB, Roscani MG, Borghi-Silva A. Association Between the Predictors of Functional Capacity and Heart Rate Off-Kinetics in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:1977-1986. [PMID: 32884254 PMCID: PMC7438181 DOI: 10.2147/copd.s260284] [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: 04/28/2020] [Accepted: 07/21/2020] [Indexed: 01/10/2023] Open
Abstract
Background The heart rate (HR) kinetics as well as other predictors of functional capacity such as the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT), the Duke Activity Status Index (DASI) and the handgrip strength (HGS) represent important tools in assessing the impact of COPD on exercise performance and health status of individuals with COPD. Purpose To verify the relationship between functional capacity, measured using the six-minute walking test (6MWT), with the HR off-kinetics, HGS and the DASI and CAT scores. Methods For this cross-sectional study, 29 subjects with COPD underwent body composition, pulmonary function and cardiac function tests. Subsequently, the DASI and CAT questionnaires and HGS test were performed. The beat-to-beat R-R intervals (IRR) were collected in rest, during the test and in recovery after the 6MWT. The HR off-kinetics was obtained during a 360-second period in post-exercise recovery through the HR mono-exponential decay. Results Moderate correlations were observed between: 1) walked distance (WD) in the 6MWT and the CAT and DASI scores (r= −0.58, p=0.001 and r= 0.58, p=0.001, respectively); 2) WD and HGS (r=0.37, p=0.05); 3) and WD and HR off-kinetics (τ; r= −0.54, p=0.002 and MRT; r= −0.55, p=0.002, respectively). Conclusion The 6MWT performance is a direct measurement to evaluate functional capacity. Additionally, it is related to other direct and indirect markers for functional evaluation in patients with COPD. These results suggest the application of these tools in clinical practice, based on the accessibility, non-invasive character and easy applicability of these methods.
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Affiliation(s)
- Patrícia Faria Camargo
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Luciana Ditomaso-Luporini
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Luiz Carlos Soares de Carvalho
- Center for Science and Technology in Energy and Sustainability of Federal University of Reconcavo da Bahia, Feira de Santana, Bahia, Brazil
| | - Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Rayane Sebold
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil.,Course of Physiotherapy, Central Paulista University Center, Sao Carlos, Sao Paulo, Brazil
| | - Polliana Batista Dos Santos
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Meliza Goi Roscani
- Medicine Department, Federal University of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Paulo, Brazil
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Koné B, Pérez‐Cruz M, Porte R, Hennegrave F, Carnoy C, Gosset P, Trottein F, Sirard J, Pichavant M, Gosset P. Boosting the IL-22 response using flagellin prevents bacterial infection in cigarette smoke-exposed mice. Clin Exp Immunol 2020; 201:171-186. [PMID: 32324274 PMCID: PMC7366752 DOI: 10.1111/cei.13445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 12/29/2022] Open
Abstract
The progression of chronic obstructive pulmonary disease (COPD), a lung inflammatory disease being the fourth cause of death worldwide, is marked by acute exacerbations. These episodes are mainly caused by bacterial infections, frequently due to Streptococcus pneumoniae. This susceptibility to infection involves a defect in interleukin (IL)-22, which plays a pivotal role in mucosal defense mechanism. Administration of flagellin, a Toll-like receptor 5 (TLR-5) agonist, can protect mice and primates against respiratory infections in a non-pathological background. We hypothesized that TLR-5-mediated stimulation of innate immunity might improve the development of bacteria-induced exacerbations in a COPD context. Mice chronically exposed to cigarette smoke (CS), mimicking COPD symptoms, are infected with S. pneumoniae, and treated in a preventive and a delayed manner with flagellin. Both treatments induced a lower bacterial load in the lungs and blood, and strongly reduced the inflammation and lung lesions associated with the infection. This protection implicated an enhanced production of IL-22 and involved the recirculation of soluble factors secreted by spleen cells. This is also associated with higher levels of the S100A8 anti-microbial peptide in the lung. Furthermore, human mononuclear cells from non-smokers were able to respond to recombinant flagellin by increasing IL-22 production while active smoker cells do not, a defect associated with an altered IL-23 production. This study shows that stimulation of innate immunity by a TLR-5 ligand reduces CS-induced susceptibility to bacterial infection in mice, and should be considered in therapeutic strategies against COPD exacerbations.
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Affiliation(s)
- B. Koné
- Université de LilleCNRSInsermCHU LilleInstitut Pasteur de LilleLilleFrance
| | - M. Pérez‐Cruz
- Université de LilleCNRSInsermCHU LilleInstitut Pasteur de LilleLilleFrance
| | - R. Porte
- Université de LilleCNRSInsermCHU LilleInstitut Pasteur de LilleLilleFrance
| | - F. Hennegrave
- Université de LilleCNRSInsermCHU LilleInstitut Pasteur de LilleLilleFrance
| | - C. Carnoy
- Université de LilleCNRSInsermCHU LilleInstitut Pasteur de LilleLilleFrance
| | - P. Gosset
- Service d’Anatomo‐pathologieHôpital Saint Vincent de PaulLilleFrance
| | - F. Trottein
- Université de LilleCNRSInsermCHU LilleInstitut Pasteur de LilleLilleFrance
| | - J.‐C. Sirard
- Université de LilleCNRSInsermCHU LilleInstitut Pasteur de LilleLilleFrance
| | - M. Pichavant
- Université de LilleCNRSInsermCHU LilleInstitut Pasteur de LilleLilleFrance
| | - P. Gosset
- Université de LilleCNRSInsermCHU LilleInstitut Pasteur de LilleLilleFrance
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Mahros M, Hosny H, Ismail A, Moussa H. Airflow limitation: is there a correlation between spirometry and quantitative computed tomography measurements in patients with chronic obstructive pulmonary disease? THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The ability of computed tomography (CT) in illustrating the pathology of lung parenchyma in patients with chronic obstructive pulmonary disease (COPD) was discussed previously in many articles. However, the correlation between airflow limitation that is evaluated by spirometry and its corresponding airway diameter that is measured by multislice computed tomography (MSCT) still under investigation. Therefore, the objective of our study was to answer the questions about possible correlation between forced expiratory volume in first second (FEV1%), forced vital capacity (FVC%), FEV1/FVC, and peak expiratory flow25–75% (PEF25–75%), both before bronchodilator and post it with the diameters of airway at 3 different levels either during inspiratory or expiratory phase of respiration.
Results
The quantitative MSCT results at RB1 (apical bronchus of the right upper lobe), RB10 (the posterior basal bronchus of the right lower lobe), and LB3 (the anterior bronchus of the left upper lobe) showed weak positive correlation with FEV1% during inspiratory phase of respiration (r = 0.19, 0.20, and 0.18; P = 0.23, 0.22, and 0.26 respectively), but this correlation became more stronger and significant during expiratory phase of respiration (r = 0.76, 0.78, and 0.66; P < 0.001).
Conclusions
Expiratory CT parameters were significantly correlated with the predicted peak expiratory flow in 1 s.
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40
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Chen S, Huang M, Peng X, Yuan Y, Huang S, Ye Y, Zhao W, Li B, Han H, Yang S, Cai S, Zhao H. [Lung sounds can be used as an indicator for assessing severity of chronic obstructive pulmonary disease at the initial diagnosis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:177-182. [PMID: 32376545 DOI: 10.12122/j.issn.1673-4254.2020.02.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the value of pulmonary auscultation for evaluating the severity of chronic obstructive pulmonary disease (COPD) at the initial diagnosis. METHODS The patients with newly diagnosed COPD in our hospital between May, 2016 and May, 2019 were enrolled in this study. According to the findings of pulmonary auscultation, the lung sounds were classified into 5 groups: normal breathing sounds, weakened breathing sounds, weakened breathing sounds with wheezing, obviously weakened breathing sounds, and obviously weakened breathing sounds with wheezing. The pulmonary function of the patients was graded according to GOLD guidelines, and the differential diagnosis of COPD from asthmatic asthma COPD overlap (ACO) was made based on the GOLD guidelines and the European Respiratory Criteria. RESULTS A total of 1046 newly diagnosed COPD patients were enrolled, including 949 male and 97 female patients with a mean age of 62.6± 8.71. According to the GOLD criteria, 88.1% of the patients were identified to have moderate or above COPD, 50.0% to have severe or above COPD; a further diagnosis of ACO was made in 347 (33.2%) of the patients. ANOVA analysis showed significant differences in disease course, FEV1, FEV1%, FEV1/FVC, FVC, FVC% and mMRC among the 5 auscultation groups (P < 0.001), but FENO did not differ significantly among them (P=0.097). The percentage of patients with wheezing in auscultation was significantly greater in ACO group than in COPD group (P < 0.001). Spearman correlation analysis showed that lung sounds was significantly correlated with disease severity, FEV1, FEV1%, FVC and FVC% of the patients (P < 0.001); Multiple linear regression analysis showed that a longer disease course, a history of smoking and lung sounds were all associated with poorer lung functions and a greater disease severity. CONCLUSIONS Lung sounds can be used as an indicator for assessing the severity of COPD at the initial diagnosis.
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Affiliation(s)
- Shifeng Chen
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Minyu Huang
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xianru Peng
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yafei Yuan
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Shuyu Huang
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yanmei Ye
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wenqu Zhao
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Bohou Li
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Huishan Han
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Shuluan Yang
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Shaoxi Cai
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Haijin Zhao
- Laboratory of Chronic Airway Diseases, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Abstract
Frailty is a clinical state of vulnerability to stressors resulting from cumulative alterations in multiple physiological and molecular systems. Frailty assessment in patients with chronic disease is useful for identifying those who are at increased risk for poor clinical and patient reported outcomes. Due to biobehavioral changes purported to cause both frailty and certain chronic lung diseases, patients with lung disease appear susceptible to frailty and prone to developing it decades earlier than community dwelling healthy populations. Herein, we review the literature and potential pathobiological mechanisms underpinning associations between frailty in lung disease and age, sex, comorbidity and symptom burden, severity of lung disease, inflammatory biomarkers, various clinical parameters, body composition measures, and physical activity levels. We also propose a multipronged program of future research focused on improving the accuracy and precision of frailty measurement in lung disease, identifying blood-based biomarkers and measures of body composition for frailty, determining whether subphenotypes of frailty with distinct pathobiology exist, and developing personalized interventions that target the specific underlying mechanisms causing frailty.
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Mechanism of YuPingFeng in the Treatment of COPD Based on Network Pharmacology. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1630102. [PMID: 32566658 PMCID: PMC7275212 DOI: 10.1155/2020/1630102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022]
Abstract
YuPingFeng (YPF) granules are a classic herbal formula extensively used in clinical practice in China for the treatment of COPD. However, the pathological mechanisms of YPF in COPD remain undefined. In the present research, a network pharmacology-based strategy was implemented to elucidate the underlying multicomponent, multitarget, and multipathway modes of action of YPF against COPD. First, we identified putative YPF targets based on TCMSP databases and constructed a network containing interactions between putative YPF targets and known therapeutic targets of COPD. Next, two topological parameters, “degree” and “closeness,” were calculated to identify target genes in the network. The major hubs were imported to the MetaCore database for pathway enrichment analysis. In total, 23 YPF active ingredients and 83 target genes associated with COPD were identified. Through protein interaction network analysis, 26 genes were identified as major hubs due to their topological importance. GO and KEGG enrichment analysis results revealed YPF to be mainly associated with the response to glucocorticoids and steroid hormones, with apoptotic and HIF-1 signalling pathways being dominant and correlative pathways. The promising utility of YPF in the treatment of COPD has been demonstrated by a network pharmacology approach.
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43
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Zhang K, Yao E, Lin C, Chou YT, Wong J, Li J, Wolters PJ, Chuang PT. A mammalian Wnt5a-Ror2-Vangl2 axis controls the cytoskeleton and confers cellular properties required for alveologenesis. eLife 2020; 9:e53688. [PMID: 32394892 PMCID: PMC7217702 DOI: 10.7554/elife.53688] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/13/2020] [Indexed: 12/18/2022] Open
Abstract
Alveolar formation increases the surface area for gas-exchange and is key to the physiological function of the lung. Alveolar epithelial cells, myofibroblasts and endothelial cells undergo coordinated morphogenesis to generate epithelial folds (secondary septa) to form alveoli. A mechanistic understanding of alveologenesis remains incomplete. We found that the planar cell polarity (PCP) pathway is required in alveolar epithelial cells and myofibroblasts for alveologenesis in mammals. Our studies uncovered a Wnt5a-Ror2-Vangl2 cascade that endows cellular properties and novel mechanisms of alveologenesis. This includes PDGF secretion from alveolar type I and type II cells, cell shape changes of type I cells and migration of myofibroblasts. All these cellular properties are conferred by changes in the cytoskeleton and represent a new facet of PCP function. These results extend our current model of PCP signaling from polarizing a field of epithelial cells to conferring new properties at subcellular levels to regulate collective cell behavior.
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Affiliation(s)
- Kuan Zhang
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoUnited States
| | - Erica Yao
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoUnited States
| | - Chuwen Lin
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoUnited States
| | - Yu-Ting Chou
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoUnited States
| | - Julia Wong
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoUnited States
| | - Jianying Li
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoUnited States
| | - Paul J Wolters
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoUnited States
| | - Pao-Tien Chuang
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoUnited States
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44
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Cairncross A, Jones RL, Elliot JG, McFawn PK, James AL, Noble PB. Airway narrowing and response to simulated deep inspiration in bronchial segments from subjects with fixed airflow obstruction. J Appl Physiol (1985) 2020; 128:757-767. [PMID: 32105523 DOI: 10.1152/japplphysiol.00439.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The volume fraction of extracellular matrix (ECM) within the layer of airway smooth muscle (ASM) is increased in subjects with fixed airflow obstruction. We postulated that changes in ECM within the ASM layer will impact force transmission during induced contraction and/or in response to externally applied stresses like a deep inspiration (DI). Subjects were patients undergoing lung resection surgery who were categorized as unobstructed (n = 12) or "fixed" obstructed (n = 6) on the basis of preoperative spirometry. The response to a DI, assessed by the ratio of isovolumic flows from maximal and partial inspirations (M/P), was also measured preoperatively. M/P was reduced in the obstructed group (P = 0.02). Postoperatively, bronchial segments were obtained from resected tissue, and luminal narrowing to acetylcholine and bronchodilation to simulated DI were assessed in vitro. Airway wall dimensions and the volume fraction of ECM within the ASM were quantified. Maximal airway narrowing to acetylcholine (P = 0.01) and the volume fraction of ECM within the ASM layer (P = 0.02) were increased in the obstructed group, without a change in ASM thickness. Whereas bronchodilation to simulated DI in vitro was not different between obstructed and unobstructed groups, it was correlated with increased M/P (bronchodilation/less bronchoconstriction) in vivo (P = 0.03). The volume fraction of ECM was inversely related to forced expiratory volume in 1 s FEV1 %predicted (P = 0.04) and M/P (P = 0.01). Results show that in subjects with fixed airflow obstruction the mechanical behavior of the airway wall is altered and there is a contemporaneous shift in the structural composition of the ASM layer.NEW & NOTEWORTHY Cartilaginous airways from subjects with fixed airflow obstruction have an increase in the volume fraction of extracellular matrix within the airway smooth muscle layer. These airways are also intrinsically more reactive to a contractile stimulus, which is expected to contribute to airway hyperresponsiveness in this population, often attributed to geometric mechanisms. In view of these results, we speculate on how changes in extracellular matrix may impact airway mechanics.
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Affiliation(s)
- Alvenia Cairncross
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Robyn L Jones
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - John G Elliot
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia.,Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Peter K McFawn
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - Peter B Noble
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
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45
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Gál Z, Gézsi A, Pállinger É, Visnovitz T, Nagy A, Kiss A, Sultész M, Csoma Z, Tamási L, Gálffy G, Szalai C. Plasma neutrophil extracellular trap level is modified by disease severity and inhaled corticosteroids in chronic inflammatory lung diseases. Sci Rep 2020; 10:4320. [PMID: 32152402 PMCID: PMC7062787 DOI: 10.1038/s41598-020-61253-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
A flow cytometry-based method was developed to quantify in vivo circulating neutrophil extracellular trap (NET) levels in plasma and compare them in patients with different chronic inflammatory lung diseases. Seventeen asthmatic and 11 control children, 12 adult controls, 46 asthmatic, 6 COPD and 6 adult patients with asthma-COPD overlap syndrome (ACOS) were recruited in the study. The presence of NETs in unstimulated cell-free plasma was confirmed and visualized by confocal laser-scanning microscopy. No significant differences were found in plasma NET levels between children and adults, children with or without asthma and adults with or without asthma, COPD or ACOS. When asthmatic patients were stratified according to their disease severity the average plasma NET level was significantly higher in asthmatic patients with more serious symptoms (adjusted p = 0.027). Patients with poorer pulmonary functions had higher plasma NET levels which negatively correlated with the FEV1 values (r = -0.39, p = 0.002). Patients who were medicated daily with inhaled corticosteroids (ICS) had significantly lower average plasma NET level than patients who did not or just occasionally used ICS (p = 0.027). If further studies confirm the NET-lowering effect of ICS in the circulation, it can be utilized in diseases where NETosis contributes to the pathogenesis.
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Affiliation(s)
- Zsófia Gál
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
| | - András Gézsi
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
- MTA-SE Immune-Proteogenomics Extracellular Vesicle Research Group, Semmelweis University, Budapest, Hungary
- Department of Measurement and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Éva Pállinger
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
| | - Tamás Visnovitz
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
| | - Adrienne Nagy
- Heim Pál Children's Hospital, Budapest, 1089, Hungary
| | - András Kiss
- Heim Pál Children's Hospital, Budapest, 1089, Hungary
| | | | - Zsuzsanna Csoma
- National Korányi Institute of TB and Pulmonology, Budapest, 1121, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, 1083, Hungary
| | | | - Csaba Szalai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary.
- Heim Pál Children's Hospital, Budapest, 1089, Hungary.
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46
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Balkissoon R. Journal Club-COPD2020 Update. Global Initiative for Chronic Obstructive Lung Disease 2020 Report and the Journal of the COPD Foundation Special Edition, Moving to a New Definition for COPD: "COPDGene ® 2019". CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2020; 6. [PMID: 31999904 DOI: 10.15326/jcopdf.7.1.2020.0133] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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47
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Kothekar E, Borja AJ, Gerke O, Werner TJ, Alavi A, Revheim ME. Assessing respitatory muscle activity with 18F-FDG-PET/CT in patients with COPD. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2019; 9:309-315. [PMID: 31976160 PMCID: PMC6971478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/20/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to investigate the metabolic activity of the respiratory muscles in patients with chronic obstructive pulmonary diseases (COPD) and correlate with pulmonary function test results. Thirty-three male patients with a past medical history of smoking and COPD referred to 2-deoxy-2-[18F]-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) because of clinical suspicion of pulmonary cancer were included. The degree of 18F-FDG uptake was visually quantified (grade 0-3) in the respiratory muscles of the neck, intercostal muscles, and abdominal muscles using mediastinal blood pool uptake and liver uptake as references. Visual grade of 18F-FDG uptake was compared to forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) and FEV1 percent predicted (FEV1 % pred) by the Wilcoxon-type test for trend. We found significant correlation between the visual grading score and both FEV1/FVC (P=0.017) and FEV1 % predicted (P=0.045) for the intercostal muscles. Grade was not significantly associated with pulmonary function tests in either the neck or abdominal muscle groups. 18F-FDG-PET/CT of the respiratory muscles may have potential in characterization of COPD. Future prospective studies with a larger number of subjects should be undertaken to better understand respiratory muscle physiology in patients with COPD.
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Affiliation(s)
- Esha Kothekar
- Department of Radiology, Hospital of University of PennsylvaniaPhiladelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, Hospital of University of PennsylvaniaPhiladelphia, PA, USA
- Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA, USA
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University HospitalOdense, Denmark
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern DenmarkOdense, Denmark
| | - Thomas J Werner
- Department of Radiology, Hospital of University of PennsylvaniaPhiladelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of University of PennsylvaniaPhiladelphia, PA, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of University of PennsylvaniaPhiladelphia, PA, USA
- Division of Radiology and Nuclear Medicine, Oslo University HospitalOslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of OsloOslo, Norway
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48
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Lee SY, Choi YJ, Seo JH, Lee SY, Kim JS, Kang EJ. Pulmonary function is implicated in the prognosis of metastatic non-small cell lung cancer but not in extended disease small cell lung cancer. J Thorac Dis 2019; 11:4562-4572. [PMID: 31903245 DOI: 10.21037/jtd.2019.10.77] [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] [Indexed: 12/17/2022]
Abstract
Background The impacts of pulmonary function in patients with metastatic non-small cell lung cancer (NSCLC) and extended disease stage small cell lung cancer (SCLC-ED) treated with palliative chemotherapy remain to still be determined. Methods Results of spirometry performed in 449 patients with either stage IV NSCLC (n=313) or SCLC-ED (n=136) at diagnosis were reviewed retrospectively. Overall survival (OS) was estimated using the Kaplan-Meier method and compared via a log-rank test. Multivariate analysis was performed using a Cox proportional hazards regression model. Results The presence of chronic obstructive pulmonary disease (COPD) was not a risk factor for OS in either NSCLC or SCLC. However, NSCLC patients with COPD with a forced expiratory volume in one second (FEV1) value of less than 80% predicted were associated with a worse OS in both univariate and multivariate analyses [hazard ratio (HR): 1.43; 95% confidence interval (CI): 1.04-1.97; P=0.03]. Intriguingly, only the OS of NSCLC patients treated with chemotherapeutic agents was affected by the airflow limitation FEV1 value of less than 80% predicted (P=0.02). Patients with an FEV1 value of less than 80% predicted treated with targeted agents were not associated with OS (P=0.24). On the other hand, NSCLC patients with COPD were significantly linked to the occurrence of pulmonary complications during palliative therapy (P=0.01) but not associated with death resulting from pulmonary complications (P=0.22). Conclusions Careful attention is required when chemotherapeutic agents are administered to patients with metastatic NSCLC with accompanying COPD with a FEV1 value of less than 80% predicted.
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Affiliation(s)
- Suk-Young Lee
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| | - Yoon Ji Choi
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| | - Jae Hong Seo
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| | - Sung Yong Lee
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| | - Jung Sun Kim
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| | - Eun Joo Kang
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
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