1
|
Rose CS, Zell-Baran LM, Cool C, Moore CM, Wolff J, Oh AS, Koelsch T, Richards JC, Krefft SD, Wilson CG, Lynch DA. Findings on High Resolution Computed Tomography in Symptomatic Veterans with Deployment-Related Lung Disease. J Thorac Imaging 2023; 38:00005382-990000000-00093. [PMID: 37732711 PMCID: PMC10940183 DOI: 10.1097/rti.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE Military deployment to dusty, austere environments in Southwest Asia and Afghanistan is associated with symptomatic airways diseases including asthma and bronchiolitis. The utility of chest high-resolution computed tomographic (HRCT) imaging in lung disease diagnosis in this population is poorly understood. We investigated visual assessment of HRCT for identifying deployment-related lung disease compared with healthy controls. MATERIALS AND METHODS Chest HRCT images from 46 healthy controls and 45 symptomatic deployed military personnel with clinically confirmed asthma and/or biopsy-confirmed distal lung disease were scored by 3 independent thoracic radiologists. We compared demographic and clinical characteristics and frequency of imaging findings between deployers and controls, and between deployers with asthma and those with biopsy-confirmed distal lung disease, using χ2, Fisher exact or t tests, and logistic regression where appropriate. We also analyzed inter-rater agreement for imaging findings. RESULTS Expiratory air trapping was the only chest CT imaging finding that was significantly more frequent in deployers compared with controls. None of the 24 deployers with biopsy-confirmed bronchiolitis and/or granulomatous pneumonitis had HRCT findings of inspiratory mosaic attenuation or centrilobular nodularity. Only 2 of 21 with biopsy-proven emphysema had emphysema on HRCT. CONCLUSIONS Compared with surgical lung biopsy, visual assessment of HRCT showed few abnormalities in this small cohort of previously deployed symptomatic veterans with normal or near-normal spirometry.
Collapse
Affiliation(s)
- Cecile S Rose
- National Jewish Health, Division of Environmental and Occupational Health Sciences
- School of Medicine, University of Colorado
| | - Lauren M Zell-Baran
- National Jewish Health, Division of Environmental and Occupational Health Sciences
| | - Carlyne Cool
- National Jewish Health, Division of Environmental and Occupational Health Sciences
- School of Medicine, University of Colorado
| | - Camille M Moore
- National Jewish Health, Center for Genes, Environment and Health
- Department of Biostatistics and Informatics, University of Colorado
| | - Jenna Wolff
- National Jewish Health, Division of Environmental and Occupational Health Sciences
| | - Andrea S Oh
- National Jewish Health, Department of Radiology
| | | | - John C Richards
- National Jewish Health, Department of Radiology
- Radiology Imaging Associates
| | - Silpa D Krefft
- National Jewish Health, Division of Environmental and Occupational Health Sciences
- Veterans Administration Eastern Colorado Health Care System, Division of Pulmonary and Critical Care Medicine, Aurora, CO
| | - Carla G Wilson
- National Jewish Health, Research Informatics Services, Denver
| | - David A Lynch
- National Jewish Health, Department of Radiology
- School of Medicine, University of Colorado
| |
Collapse
|
2
|
Zell-Baran LM, Go LH, Sarver E, Almberg KS, Iwaniuk C, Green FH, Abraham JL, Cool C, Franko A, Hubbs AF, Murray J, Orandle MS, Sanyal S, Vorajee N, Cohen RA, Rose CS. Mining Tenure and Job Duties Differ Among Contemporary and Historic Underground Coal Miners With Progressive Massive Fibrosis. J Occup Environ Med 2023; 65:315-320. [PMID: 36730599 PMCID: PMC10081940 DOI: 10.1097/jom.0000000000002746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize differences in mining jobs and tenure between contemporary (born 1930+, working primarily with modern mining technologies) and historic coal miners with progressive massive fibrosis (PMF). METHODS We classified jobs as designated occupations (DOs) and non-DOs based on regulatory sampling requirements. Demographic, occupational characteristics, and histopathological PMF type were compared between groups. RESULTS Contemporary miners ( n = 33) had significantly shorter mean total (30.4 years vs 37.1 years, P = 0.0006) and underground (28.8 years vs 35.8 years, P = 0.001) mining tenure compared with historic miners ( n = 289). Silica-type PMF was significantly more common among miners in non-DOs (30.1% vs 15.8%, P = 0.03) and contemporary miners (58.1% vs 15.2%, P < 0.0001). CONCLUSIONS Primary jobs changed over time with the introduction of modern mining technologies and likely changed exposures for workers. Elevated crystalline silica exposures are likely in non-DOs and require attention.
Collapse
|
3
|
Ravikumar V, Cool C, Jing J. The Spectrum of Pulmonary Histomorphology Changes in COVID-19 Cases. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction/Objective
Pulmonary specimens following COVID-19 virus infection demonstrate a spectrum of pulmonary histomorphology. Six patients with a history of COVID-19 infection are summarized in this review. The purpose of our study is to elucidate any possible correlations between clinical, laboratory, radiographic, and pathologic findings in COVID-19 patients. Further, we aim to characterize both non-specific and specific histomorphology and cytomorphology in COVID-19 patients.
Methods/Case Report
Six patients with known COVID-19 infection and lung biopsies/resections are identified. A chart review is performed to collect clinical histories, the results of COVID-19 PCR testing, radiographic impressions, pathologic interpretations of histology, and clinical outcomes. Information is summarized and tabulated.
Results (if a Case Study enter NA)
The most common, non-specific histological findings are focal/diffuse acute lung injury, organizing lung injury, or a combination of both patterns. Unique features of COVID-19 infection are identified in three cases, which illustrate viral cytopathic changes within hyperplastic pneumocytes. These include basophilic, vacuolated, granular cytoplasm and variably sized cytoplasmic/nuclear inclusions. Virus-loaded pneumocytes are typically identified in the organizing phase, and rarely in the acute lung injury phase. Immunohistochemical staining of anti-nuclear capsule antibody with appropriate controls shows focal positive staining in one case. SARS-CoV-2 PCR is positive in formalin-fixed paraffin-embedded (FFPE) tissue, while a serum PCR assay is negative.
Conclusion
The severity of clinical symptoms and clinical outcome are unrelated to the degree of lung involvement. Viral cytopathic changes are identified in three cases, with these specific findings associated with the organizing phase of lung injury, and either concurrent PCR positivity or positive immunohistochemical staining.
Collapse
Affiliation(s)
- V Ravikumar
- Pathology, University Of Colorado, Denver , Aurora, Colorado , United States
| | - C Cool
- Pathology, University Of Colorado, Denver , Aurora, Colorado , United States
| | - J Jing
- Pathology, University Of Colorado, Denver , Aurora, Colorado , United States
| |
Collapse
|
4
|
Smirnova NF, Riemondy K, Bueno M, Collins S, Suresh P, Wang X, Patel KN, Cool C, Königshoff M, Sharma NS, Eickelberg O. Single-cell transcriptome mapping identifies a local, innate B cell population driving chronic rejection after lung transplantation. JCI Insight 2022; 7:156648. [PMID: 36134664 PMCID: PMC9675462 DOI: 10.1172/jci.insight.156648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Bronchiolitis obliterans syndrome (BOS) is the main reason for poor outcomes after lung transplantation (LTx). We and others have recently identified B cells as major contributors to BOS after LTx. The extent of B cell heterogeneity and the relative contributions of B cell subpopulations to BOS, however, remain unclear. Here, we provide a comprehensive analysis of cell population changes and their gene expression patterns during chronic rejection after orthotopic LTx in mice. Of 11 major cell types, Mzb1-expressing plasma cells (PCs) were the most prominently increased population in BOS lungs. These findings were validated in 2 different cohorts of human BOS after LTx. A Bhlhe41, Cxcr3, and Itgb1 triple-positive B cell subset, also expressing classical markers of the innate-like B-1 B cell population, served as the progenitor pool for Mzb1+ PCs. This subset accounted for the increase in IgG2c production within BOS lung grafts. A genetic lack of Igs decreased BOS severity after LTx. In summary, we provide a detailed analysis of cell population changes during BOS. IgG+ PCs and their progenitors — an innate B cell subpopulation — are the major source of local Ab production and a significant contributor to BOS after LTx.
Collapse
Affiliation(s)
- Natalia F Smirnova
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Institut des Maladies Métaboliques et Cardiovasculaires (I2MC) - INSERM U1297, University of Toulouse III, Toulouse, France
| | - Kent Riemondy
- RNA Bioscience Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marta Bueno
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan Collins
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Pavan Suresh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xingan Wang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kapil N Patel
- Center for Advanced Lung Disease and Lung Transplantation, University of South Florida/Tampa General Hospital, Tampa, Florida, USA
| | - Carlyne Cool
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Melanie Königshoff
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nirmal S Sharma
- Center for Advanced Lung Disease and Lung Transplantation, University of South Florida/Tampa General Hospital, Tampa, Florida, USA.,Division of Pulmonary & Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Oliver Eickelberg
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
5
|
Rose CS, Moore CM, Zell-Baran LM, Krefft S, Wolff J, Pang K, Parr J, Cool C. Small airways and airspace inflammation and injury distinguish lung histopathology in deployed military personnel from healthy and diseased lungs. Hum Pathol 2022; 124:56-66. [PMID: 35240130 DOI: 10.1016/j.humpath.2022.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/29/2023]
Abstract
The link between military deployment to Southwest Asia and Afghanistan and risk for lung disease, including bronchiolitis, is increasingly well-recognized. However, histopathologic features that distinguish deployment-related lung diseases from other diseases affecting the small airways and airspaces are uncertain. A computer-based scoring system was developed to characterize surgical lung biopsy findings in 65 soldiers with persistent respiratory symptoms following military deployment ('deployers'). Deployer lung biopsies were compared to those from eight patients with chronic hypersensitivity pneumonitis (cHP), 10 with smoking-related respiratory bronchiolitis, 11 with autoimmune or post-transplant obliterative bronchiolitis, and 10 normal donor lungs. Upper, middle, and lower lobe-specific findings in deployer samples were analyzed to inform optimum biopsy location choice for future patients.
Collapse
Affiliation(s)
- Cecile S Rose
- National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA; University of Colorado, School of Medicine, Aurora, CO, USA.
| | - Camille M Moore
- National Jewish Health, Center for Genes, Environment and Health, Denver, CO, USA; University of Colorado, Department of Biostatistics and Informatics, Aurora, CO, USA
| | - Lauren M Zell-Baran
- National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA
| | - Silpa Krefft
- National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA; Veterans Administration Eastern Colorado Health Care System, Division of Pulmonary and Critical Care Medicine, Aurora, CO, USA
| | - Jenna Wolff
- National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA
| | - Kathy Pang
- National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA
| | - Jane Parr
- National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA
| | - Carlyne Cool
- National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA; University of Colorado, School of Medicine, Aurora, CO, USA; University of Colorado, Department of Pathology, Aurora, CO, USA
| |
Collapse
|
6
|
Cool C, Feng C, Wade S, Rau R, Ching K, Nyamutswa L, Viswanathan H, Kharabi B, Duvall A. HEALTHCARE RESOURCE UTILIZATION IN PATIENTS WITH RELAPSED OR REFRACTORY ACUTE LYMPHOBLASTIC LEUKEMIA USING REAL‐WORLD DATA FROM FIVE COUNTRIES. Hematol Oncol 2021. [DOI: 10.1002/hon.106_2881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- C. Cool
- Precision Value & Health PRECISIONheor New York New York USA
| | - C. Feng
- Kite Pharma A Gilead Company Global Health Economics and Outcomes Research Santa Monica California USA
| | - S. Wade
- Wade Outcomes Research and Consulting, Health Economics Salt Lake City Utah USA
| | - R. Rau
- Precision Value & Health PRECISIONheor New York New York USA
| | - K. Ching
- Precision Value & Health PRECISIONheor New York New York USA
| | - L. Nyamutswa
- Kite Pharma A Gilead Company Global Health Economics and Outcomes Research Santa Monica California USA
| | - H. Viswanathan
- Precision Value & Health PRECISIONheor New York New York USA
| | - B. Kharabi
- Kite Pharma A Gilead Company Global Health Economics and Outcomes Research Santa Monica California USA
| | - A. Duvall
- University of Chicago Department of Medicine Section of Hematology/Oncology Chicago Illinois USA
| |
Collapse
|
7
|
Sanchez F, Gutierrez JM, Kha LC, Jimenez-Juan L, Cool C, Vargas D, Oikonomou A. Pathological entities that may affect the lungs and the myocardium. Evaluation with chest CT and cardiac MR. Clin Imaging 2020; 70:124-135. [PMID: 33157369 DOI: 10.1016/j.clinimag.2020.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/19/2020] [Accepted: 10/17/2020] [Indexed: 12/19/2022]
Abstract
Certain entities may simultaneously involve the lungs and the myocardium. Knowing their cardiac and thoracic manifestations enhances the understanding of those conditions and increases awareness and suspicion for possible concurrent cardiothoracic involvement. Entities that can present with pulmonary and myocardial involvement include infiltrative diseases like sarcoidosis and amyloidosis, eosinophil-associated conditions including eosinophilic granulomatosis with polyangiitis (EGPA) and hypereosinophilic syndrome (HES), connective tissue diseases such as systemic sclerosis (SSc) and lupus erythematosus and genetic disorders like Fabry disease (FD). Lung involvement in sarcoidosis is almost universal. While cardiac involvement is less common, concurrent cardiothoracic involvement can often be seen. Pulmonary amyloidosis is more often a localized process and generally occurs separately from cardiac involvement, except for diffuse alveolar-septal amyloidosis. EGPA and HES can present with consolidative or ground glass opacities, cardiac inflammation and endomyocardial fibrosis. Manifestations of SSc include interstitial lung disease, pulmonary hypertension and cardiomyopathy. Lupus can present with serositis, pneumonitis and cardiac inflammation. FD causes left ventricular thickening and fibrosis, and small airways disease. This article aims to review the clinicopathological features of chest and cardiac involvement of these entities and describe their main findings on chest CT and cardiac MR.
Collapse
Affiliation(s)
- Felipe Sanchez
- University of Toronto - Toronto General Hospital, Department of Medical Imaging, 585 University Ave., Toronto, ON M5G 2N2, Canada.
| | - Jose M Gutierrez
- Hospital Barros Luco Trudeau, Department of Medical Imaging, Gran Avenida Jose Miguel Carrera 3204, Santiago 8431657, Chile
| | - Lan-Chau Kha
- University of Toronto - Sunnybrook Health Sciences Centre, Department of Medical Imaging, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.
| | - Laura Jimenez-Juan
- University of Toronto- St. Michael's Hospital, Department of Medical Imaging, 30 Bond St., Toronto, ON M5B 1W8, Canada.
| | - Carlyne Cool
- University of Colorado - Anschutz Medical Campus, Department of Pathology, 12605 East 16th Avenue, Campus Box F768, Aurora, CO 80045, United States of America
| | - Daniel Vargas
- University of Colorado - Anschutz Medical Campus, Department of Radiology, Leprino Building, 5th Floor, 12401 E. 17th Ave., Mail Stop L954, Aurora, CO 80045, United States of America.
| | - Anastasia Oikonomou
- University of Toronto - Sunnybrook Health Sciences Centre, Department of Medical Imaging, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.
| |
Collapse
|
8
|
Solomon JJ, Matson S, Kelmenson LB, Chung JH, Hobbs SB, Rosas IO, Dellaripa PF, Doyle TJ, Poli S, Esposito AJ, Visser A, Marin AI, Amigues I, Fernández Pérez ER, Brown KK, Mahler M, Heinz D, Cool C, Deane KD, Swigris JJ, Demoruelle MK. IgA Antibodies Directed Against Citrullinated Protein Antigens Are Elevated in Patients With Idiopathic Pulmonary Fibrosis. Chest 2019; 157:1513-1521. [PMID: 31877269 DOI: 10.1016/j.chest.2019.12.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/23/2019] [Accepted: 12/09/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The etiology of idiopathic pulmonary fibrosis (IPF) is unknown. Because it shares genetic, histopathologic, and radiographic features with the fibrosing interstitial lung disease seen in rheumatoid arthritis (RA), the goal of this study was to investigate RA-related autoantibodies in IPF. METHODS The study included patients with IPF from two separate cohorts at National Jewish Health and Brigham Women's Hospital (n = 181), general population control subjects (n = 160), and control subjects with disease (n = 86 [40 with RA-usual interstitial pneumonia and 46 with hypersensitivity pneumonitis]). Serum was tested for RA-associated antibodies (including IgG and IgA) to citrullinated protein antigens (ACPA). Lung tissue in 11 patients with IPF was examined for ectopic lymphoid aggregates. RESULTS An increased prevalence of ACPA positivity was found in two separate IPF cohorts. In particular, positivity for IgA-ACPA was increased in these two IPF cohorts compared with general population control subjects (21.3% and 24.8% vs 5.6%; P < .01). Patients with IPF were more likely to be IgA-ACPA-positive than IgG-ACPA-positive (23.2% vs 8.3%; P < .01), whereas patients with RA were more likely to be IgG-ACPA-positive than IgA-ACPA-positive (72.5% vs 52.5%; P = .04). There was a strong correlation between IgA-ACPA level and the number of ectopic lymphoid aggregates on lung histologic examination in IPF (r = 0.72; P = .01). CONCLUSIONS In this study, IgA-ACPA was elevated in patients with IPF and correlated with lymphoid aggregates in the lung, supporting the theory that IgA-ACPA may play a role in lung disease pathogenesis in a subset of individuals with IPF. Future studies are needed to determine whether this subset of ACPA-positive patients with IPF is distinct from patients with IPF but without antibodies.
Collapse
Affiliation(s)
- Joshua J Solomon
- Interstitial Lung Disease Program & Autoimmune Lung Center, National Jewish Health, Denver, CO.
| | - Scott Matson
- Division of Pulmonary and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | | | | | - Stephen B Hobbs
- Department of Radiology, University of Kentucky, Lexington, KY
| | - Ivan O Rosas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Paul F Dellaripa
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA
| | - Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sergio Poli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Anthony J Esposito
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ashley Visser
- Division of Rheumatology, University of Colorado Denver, Aurora, CO
| | - A Itzam Marin
- Division of Rheumatology, University of Colorado Denver, Aurora, CO
| | | | - Evans R Fernández Pérez
- Interstitial Lung Disease Program & Autoimmune Lung Center, National Jewish Health, Denver, CO
| | - Kevin K Brown
- Interstitial Lung Disease Program & Autoimmune Lung Center, National Jewish Health, Denver, CO
| | | | - David Heinz
- Department of Pathology, National Jewish Health, Denver, CO
| | - Carlyne Cool
- Department of Pathology, National Jewish Health, Denver, CO; Department of Pathology, University of Colorado Denver, Aurora, CO
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado Denver, Aurora, CO
| | - Jeffrey J Swigris
- Interstitial Lung Disease Program & Autoimmune Lung Center, National Jewish Health, Denver, CO
| | | |
Collapse
|
9
|
Rouch L, Farbos F, Cool C, McCambridge C, Hein C, Elmalem S, Rolland Y, Vellas B, Cestac P. Hospitalization Drug Regimen Changes in Geriatric Patients and Adherence to Modifications by General Practitioners in Primary Care. J Nutr Health Aging 2018; 22:328-334. [PMID: 29484345 DOI: 10.1007/s12603-017-0940-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the overall rate of adherence by general practitioners (GPs) to treatment modifications suggested at discharge from hospital and to assess the way communication between secondary and primary care could be improved. DESIGN Observational prospective cohort study. SETTING Patients hospitalized from the emergency department to the acute geriatric care unit of a university hospital. PARTICIPANTS 206 subjects with a mean age of 85 years. MEASUREMENTS Changes in drug regimen undertaken during hospitalization were collected with the associated justifications. Adherence at one month by GPs to treatment modifications was assessed as well as modifications implemented in primary care with their rationale in case of non-adherence. Community pharmacists' and GPs' opinions about quality of communication and information transfer at hospital-general practice interface were investigated. RESULTS 5.5 ± 2.8 drug regimen changes were done per patient during hospitalization. The rate of adherence by GPs to treatment modifications suggested at discharge from hospital was 83%. In most cases, non-adherence by GPs to treatment modifications done during hospitalization was due to dosage adjustments, symptoms resolution but also worsening of symptoms. The last of which was particularly true for psychotropic drugs. All GPs received their patients' discharge letters but the timely dissemination still needs to be improved. Only 6.6% of community pharmacists were informed of treatment modifications done during their patients' hospitalization. CONCLUSION Our findings showed a successful rate of adherence by GPs to treatment modifications suggested at discharge from hospital, due to the fact that optimization was done in a collaborative way between geriatricians and hospital pharmacists and that justifications for drug regimen changes were systematically provided in discharge letters. Communication processes at the interface between secondary and primary care, particularly with community pharmacists, must be strengthened to improve seamless care.
Collapse
Affiliation(s)
- L Rouch
- Laure Rouch,Toulouse University Hospital, Department of Pharmacy, France,
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Rougé Bugat ME, Bourgouin M, Gérard S, Lozano S, Brechemier D, Cestac P, Cool C, Balardy L. Drug Prescription Including Interactions with Anticancer Treatments in the Elderly: A Global Approach. J Nutr Health Aging 2017; 21:849-854. [PMID: 28972235 DOI: 10.1007/s12603-017-0946-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Consequences of inappropriate prescriptions and polymedication in patients suffering from cancer are beginning to be well documented. However, the methods used to evaluate these consequences are often discussed. Few studies evaluate the risk of interaction with anticancer drugs in elderly patients suffering from cancer. OBJECTIVES To describe the prevalence (i) of polypharmacy, (ii) of potentially inappropriate drug prescriptions and (iii) of drug interactions involving anticancer treatments, using a multiple reference tools. DESIGN A retrospective, cross-sectional, multicenter study performed from January to December 2012. PARTICIPANTS Patients aged 65 years or older suffering from cancer presented at the oncogeriatric multidisciplinary meeting. MEASUREMENTS Polymedication (>6 drugs), potentially inappropriate prescriptions and drug interactions involving anticancer treatment were analyzed in combination with explicit and implicit criteria within a global approach. RESULTS Among the 106 patients included in this study, polypharmacy was present in 60.4% of cases, potentially inappropriate drug prescription in 63.1% and drug interactions in 16% of case, of which 47% involved anti-cancer treatments. Twenty-seven major drug interactions were identified and eight interactions involved chemotherapy. CONCLUSION Polymedication, inappropriate prescribing and drug interactions involving anti-cancer drugs are common and largely underestimated in elderly cancer patients.
Collapse
Affiliation(s)
- M-E Rougé Bugat
- Marie-Eve Rougé Bugat, MD PhD, DESC Oncology, 59 rue de la Providence, 31500 Toulouse, France, +33561800123, +33683058806,
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Lafaurie M, Cool C, Gougeon M, Sémély D, Urtubia N, Porte L, Segonds C, Duhalde V. BU-32 - Péritonites en chirurgie digestive : un traitement anti-infectieux probabiliste adapté à l’écologie microbienne locale ? Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30356-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
12
|
Gougeon M, Lafaurie M, Vancassel M, Segonds C, Cestac P, Cool C, Duhalde V. CP-188 Intra-abdominal infections in digestive surgery wards: Is empiric antibiotic treatment in accordance with local microbiological ecology? Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
13
|
Mikolajczak AL, Bellon B, Calmels V, Cestac P, Cool C, Duhalde V. OHP-009 How hospital pharmacists can promote proper use of breath tests beyond buying medical devices? Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
14
|
Steele MP, Luna LG, Coldren CD, Murphy E, Hennessy CE, Heinz D, Evans CM, Groshong S, Cool C, Cosgrove GP, Brown KK, Fingerlin TE, Schwarz MI, Schwartz DA, Yang IV. Relationship between gene expression and lung function in Idiopathic Interstitial Pneumonias. BMC Genomics 2015; 16:869. [PMID: 26503507 PMCID: PMC4621862 DOI: 10.1186/s12864-015-2102-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/16/2015] [Indexed: 12/30/2022] Open
Abstract
Background Idiopathic interstitial pneumonias (IIPs) are a group of heterogeneous, somewhat unpredictable diseases characterized by progressive scarring of the interstitium. Since lung function is a key determinant of survival, we reasoned that the transcriptional profile in IIP lung tissue would be associated with measures of lung function, and could enhance prognostic approaches to IIPs. Results Using gene expression profiling of 167 lung tissue specimens with IIP diagnosis and 50 control lungs, we identified genes whose expression is associated with changes in lung function (% predicted FVC and % predicted DLCO) modeled as categorical (severe vs mild disease) or continuous variables while adjusting for smoking status and IIP subtype; false discovery rate (FDR) approach was used to correct for multiple comparisons. This analysis identified 58 transcripts that are associated with mild vs severe disease (categorical analysis), including those with established role in fibrosis (ADAMTS4, ADAMTS9, AGER, HIF-1α, SERPINA3, SERPINE2, and SELE) as well as novel IIP candidate genes such as rhotekin 2 (RTKN2) and peptidase inhibitor 15 (PI15). Protein-protein interactome analysis of 553 genes whose expression is significantly associated with lung function when modeled as continuous variables demonstrates that more severe presentation of IIPs is characterized by an increase in cell cycle progression and apoptosis, increased hypoxia, and dampened innate immune response. Our findings were validated in an independent cohort of 131 IIPs and 40 controls at the mRNA level and for one gene (RTKN2) at the protein level by immunohistochemistry in a subset of samples. Conclusions We identified commonalities and differences in gene expression among different subtypes of IIPs. Disease progression, as characterized by lower measures of FVC and DLCO, results in marked changes in expression of novel and established genes and pathways involved in IIPs. These genes and pathways represent strong candidates for biomarker studies and potential therapeutic targets for IIP severity. Electronic supplementary material The online version of this article (doi:10.1186/s12864-015-2102-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mark P Steele
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Leah G Luna
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA
| | | | - Elissa Murphy
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Corinne E Hennessy
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - David Heinz
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christopher M Evans
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Steve Groshong
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Carlyne Cool
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Gregory P Cosgrove
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Kevin K Brown
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Tasha E Fingerlin
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA.,Department of Biostatistics and Bioinformatics, Colorado School of Public Health, Aurora, CO, USA
| | - Marvin I Schwarz
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - David A Schwartz
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Ivana V Yang
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA. .,Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA. .,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
| |
Collapse
|
15
|
VanHook C, Cool C, DeBoom T, Fisher R, Tangel D. Medical image of the week: leukemic infiltrates. Southwest J Pulm Crit Care 2015. [DOI: 10.13175/swjpcc043-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
16
|
Noll B, Pan Z, Cool C. Pulmonary Myeloid Sarcoma With Monocytic Differentiation: A Rare Entity. Am J Clin Pathol 2014. [DOI: 10.1093/ajcp/142.suppl1.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Promis A, Bigot A, Cool C, Lebaudy C, Irazusta O, Le Floch Meunier B, Massip P, Cestac P. PS-078 Impact of the certification process on the assessment of the medication system at a University Hospital. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
18
|
Cool C, Lebaudy C, Rouch L, Rolland Y, Lapeyre-Mestre M, Cestac P. CP-042 Inappropriate drug prescriptions and associated factors in Nursing Homes. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
19
|
Kratzer A, Salys J, Nold-Petry C, Cool C, Zamora M, Bowler R, Koczulla AR, Janciauskiene S, Edwards MG, Dinarello CA, Taraseviciene-Stewart L. Role of IL-18 in second-hand smoke-induced emphysema. Am J Respir Cell Mol Biol 2013; 48:725-32. [PMID: 23392573 DOI: 10.1165/rcmb.2012-0173oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Chronic second-hand smoke (SHS) exposure comprises the main risk factor for nonsmokers to develop chronic obstructive pulmonary disease (COPD). However, the mechanisms behind the chronic inflammation and lung destruction remain incompletely understood. In this study, we show that chronic exposure of Sprague-Dawley rats to SHS results in a significant increase of proinflammatory cytokine IL-18 and chemokine (C-C motif) ligand 5 in the bronchoalveolar lavage fluid (BALF) and a significant decrease of vascular endothelial growth factor (VEGF) in the lung tissue. SHS exposure resulted in progressive alveolar airspace enlargement, cell death, pulmonary vessel loss, vessel muscularization, collagen deposition, and right ventricular hypertrophy. Alveolar macrophages displayed a foamy phenotype and a decreased expression of the natural inhibitor of IL-18, namely, IL-18 binding protein (IL-18BP). Moreover, IL-18 down-regulated the expression of VEGF receptor-1 and VEGFR receptor-2, and induced apoptosis in pulmonary microvascular endothelial cells in vitro. We also observed a trend toward increased concentrations of IL-18 in the BALF of patients with COPD. Our findings suggest that IL-18-mediated endothelial cell death may contribute to vascular destruction and disappearance in SHS-induced COPD. Moreover, IL-18 and IL-18BP are potential new targets for therapeutics.
Collapse
Affiliation(s)
- Adelheid Kratzer
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado at Denver, Aurora, CO 80045, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Kratzer A, Chu HW, Salys J, Moumen Z, Leberl M, Bowler R, Cool C, Zamora M, Taraseviciene-Stewart L. Endothelial cell adhesion molecule CD146: implications for its role in the pathogenesis of COPD. J Pathol 2013; 230:388-98. [DOI: 10.1002/path.4197] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 02/25/2013] [Accepted: 03/30/2013] [Indexed: 01/15/2023]
Affiliation(s)
- Adelheid Kratzer
- University of Colorado Denver; Department of Medicine; Denver CO 80045 USA
| | | | - Jonas Salys
- University of Colorado Denver; Department of Medicine; Denver CO 80045 USA
| | - Zakaria Moumen
- University of Colorado Denver; Department of Medicine; Denver CO 80045 USA
| | - Maike Leberl
- University of Colorado Denver; Department of Medicine; Denver CO 80045 USA
| | | | - Carlyne Cool
- University of Colorado Denver; Department of Medicine; Denver CO 80045 USA
| | - Martin Zamora
- University of Colorado Denver; Department of Medicine; Denver CO 80045 USA
| | | |
Collapse
|
21
|
Yang IV, Coldren CD, Leach SM, Seibold MA, Murphy E, Lin J, Rosen R, Neidermyer AJ, McKean DF, Groshong SD, Cool C, Cosgrove GP, Lynch DA, Brown KK, Schwarz MI, Fingerlin TE, Schwartz DA. Expression of cilium-associated genes defines novel molecular subtypes of idiopathic pulmonary fibrosis. Thorax 2013; 68:1114-21. [PMID: 23783374 DOI: 10.1136/thoraxjnl-2012-202943] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is an untreatable lung disease with a median survival of only 3-5 years that is diagnosed using a combination of clinical, radiographic and pathologic criteria. Histologically, IPF is characterised by usual interstitial pneumonia (UIP), a fibrosing interstitial pneumonia with a pattern of heterogeneous, subpleural regions of fibrotic and remodelled lung. We hypothesised that gene expression profiles of lung tissue may identify molecular subtypes of disease that could classify subtypes of IPF/UIP that have clinical implications. METHODS AND FINDINGS We collected transcriptional profiles on lung tissue from 119 patients with IPF/UIP and 50 non-diseased controls. Differential expression of individual transcripts was identified using an analysis of covariance (ANCOVA) model incorporating the clinical diagnosis of each patient as well as age, gender and smoking status. Validation was performed in an independent cohort of 111 IPF/UIP and 39 non-diseased controls. Our analysis identified two subtypes of IPF/UIP based on a strong molecular signature associated with expression of genes previously associated with fibrosis (matrix metalloproteinases, osteopontin, keratins), cilium genes and genes with unknown function. We demonstrate that elevated expression of cilium genes is associated with more extensive microscopic honeycombing and higher expression of both the airway mucin gene MUC5B and the metalloproteinase MMP7, a gene recently implicated in attenuating ciliated cell differentiation during wound repair. CONCLUSIONS Expression of cilium genes appears to identify two unique molecular phenotypes of IPF/UIP. The different molecular profiles may be relevant to therapeutic responsiveness in patients with IPF/UIP.
Collapse
Affiliation(s)
- Ivana V Yang
- Department of Medicine, University of Colorado School of Medicine, , Aurora, Colorado, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Rudloff I, Zepp J, Dinkel H, Palmer B, Farkas L, Cool C, Taraseviciene-Stewart L, Kim SH, Dinarello C, Voelkel N, Nold C, Nold M. Interleukin 32 promotes angiogenesis: a new role for a versatile cytokine. (P6266). The Journal of Immunology 2013. [DOI: 10.4049/jimmunol.190.supp.46.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
IL-32 is a multi-faceted cytokine with roles in infection, autoimmunity and cancer. It aggravates inflammation, inhibits virus propagation and acts as a critical regulator of endothelial cell (EC) function. We now discovered that IL-32 also possesses angiogenic properties. The hyperproliferative EC of pulmonary hypertension and glioblastoma multiforme exhibited a markedly increased abundance of IL-32, and the cytokine colocalized with integrin αVβ3. In vitro, VEGF receptor blockade resulted in hyperproliferation of EC and a 3.4-fold increase in IL-32. When IL-32 was silenced by siRNA, the proliferation of adult and fetal EC was reduced (change in cell number +58% vs -15%). Mechanistic studies revealed that siIL-32-transfected EC produced 3-fold more activin A and angiopoietin 2, but 61% less NO, whereas neither apoptosis nor the abundance of VEGF or TGF-β were affected. Interestingly, pre-treatment with IFNγ was required to render EC responsive to exogenous IL-32γ. To obtain in vivo evidence for these angiogenic effects, we injected mice with matrigel plugs loaded with IL-32γ, VEGF or vehicle, and performed CD31- and H&E-staining after 14d. As anticipated, 25 ng/ml of VEGF increased neocapillarization 8-fold, but unexpectedly the effect of 100 ng/ml IL-32γ was even stronger (8.5-fold). In summary, we add VEGF-independent angiogenic properties to the portfolio of IL-32, implicating a role in pulmonary hypertension and neoplastic diseases that is possibly exerted via αVβ3.
Collapse
Affiliation(s)
- Ina Rudloff
- 1Monash Institute of Medical Research - Ritchie Centre, Monash Univ., Melbourne, VIC, Australia
| | - Jarod Zepp
- 2Department of Medicine, Univ. of Colorado Denver, Denver, CO
| | - Hannah Dinkel
- 2Department of Medicine, Univ. of Colorado Denver, Denver, CO
| | - Brent Palmer
- 2Department of Medicine, Univ. of Colorado Denver, Denver, CO
| | - Laszlo Farkas
- 5Department of Pulmonary Medicine, Medical College of Virginia, Richmond, VA
| | - Carlyne Cool
- 3Department of Pathology, Univ. of Colorado Denver, Denver, CO
| | | | - Soo-Hyun Kim
- 2Department of Medicine, Univ. of Colorado Denver, Denver, CO
- 4Department of Biomedical Science and Technology, Konkuk University, Seoul, Republic of Korea
| | | | - Norbert Voelkel
- 5Department of Pulmonary Medicine, Medical College of Virginia, Richmond, VA
| | - Claudia Nold
- 2Department of Medicine, Univ. of Colorado Denver, Denver, CO
- 1Monash Institute of Medical Research - Ritchie Centre, Monash Univ., Melbourne, VIC, Australia
| | - Marcel Nold
- 2Department of Medicine, Univ. of Colorado Denver, Denver, CO
- 1Monash Institute of Medical Research - Ritchie Centre, Monash Univ., Melbourne, VIC, Australia
| |
Collapse
|
23
|
Cool C, Lebaudy C, Laborde C, Cestac P. GRP-042 Computerized Physician Order Entry in the Geriatric Center: Collection and Analysis of Prescribing Errors Made Over a 5-Month Period. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
24
|
Affiliation(s)
- Madison Macht
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado at Denver, Anschutz Medical Campus, Research 2, Box C272, 9th Floor 12700 E 19th Ave, Aurora, CO 80045, USA.
| | | | | | | | | | | |
Collapse
|
25
|
Bowler RP, Ellison MC, Duda B, Tran K, Nicks M, Cool C, Greene K, Crapo JD. LUNG INFLATION WITH DIRECT INJECTION OF AGAROSE: A TECHNIQUE FOR SIMULTANEOUS MOLECULAR AND MORPHOMETRIC MEASUREMENTS. Exp Lung Res 2009; 30:673-86. [PMID: 15700546 DOI: 10.1080/01902140490517845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The usual methods for preparing lungs for morphologic study involve the instillation of fixatives that modifyproteins and RNA such that the tissue is unsuitable for molecular studies. To develop a technique suitable for molecular studies, pieces of adult rat lungs were infiltrated with agarose, glutaraldehyde, or paraformaldehyde and the consistency of alveolar inflation was compared to lungs inflated with 10% formalin. Only direct injection with 1% agarose resulted in comparable inflation of lung tissue and preserved RNA and protein. Thus, this technique enables simultaneous molecular and morphometric analysis of the lung on small pieces of lung tissue in heterogeneous lung diseases.
Collapse
Affiliation(s)
- Russell P Bowler
- Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado 80206, USA.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Coffinet L, Chan KH, Abzug MJ, Simões EAF, Cool C, Liu AH. Immunopathology of chronic rhinosinusitis in young children. J Pediatr 2009; 154:754-8. [PMID: 19159906 DOI: 10.1016/j.jpeds.2008.11.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 09/29/2008] [Accepted: 11/17/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous investigation demonstrated predominantly lymphocytic inflammation in sinus mucosa of young children with chronic rhinosinusitis (CRS) rather than eosinophilic inflammation typical of adult CRS. Immunohistopathological study was undertaken to define further the cellular response in pediatric CRS. STUDY DESIGN Maxillary mucosal biopsies from children and adults with CRS were stained for CD3 (T lymphocytes), CD4 (helper T lymphocytes), CD8 (cytotoxic T lymphocytes), CD20 (B lymphocytes), CD68 (monocytes/macrophages), CD56 (natural killer cells), kappa and lambda (plasma cells), and myeloperoxidase (MPO; neutrophils). RESULTS Nineteen children with CRS (median age, 3.0 years; range, 1.4-8.2 years) had more CD8+, MPO+, and CD68+ cells (P < or = .03) and a trend toward more CD3+ and CD4+ cells (P = .06) in their epithelium and more CD20+, kappa+ and lambda+, MPO+, and CD68+ cells (P < or = .05) and a trend toward more CD4+ cells (P = .06) in their submucosa compared with adult control subjects. Immunostains from children with positive sinus cultures were similar to those with negative cultures except for more MPO+ cells in the submucosa (P = .04). CONCLUSION The inflammatory response of young children with CRS is characterized by a mixed lymphocyte population, macrophages, and neutrophils. Differences between pediatric and adult CRS suggest differing pathogenic mechanisms or progression in the inflammatory response with protracted disease.
Collapse
|
27
|
|
28
|
Affiliation(s)
- Robert L Young
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado at Denver, 4200 East Ninth Ave, Box C272, Denver, CO 80262, USA.
| | | | | | | |
Collapse
|
29
|
Taraseviciene-Stewart L, Nicolls MR, Kraskauskas D, Scerbavicius R, Burns N, Cool C, Wood K, Parr JE, Boackle SA, Voelkel NF. Absence of T cells confers increased pulmonary arterial hypertension and vascular remodeling. Am J Respir Crit Care Med 2007; 175:1280-9. [PMID: 17413127 PMCID: PMC2176089 DOI: 10.1164/rccm.200608-1189oc] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Severe pulmonary arterial hypertension (SPH) is a frequently lethal condition characterized by pulmonary vascular remodeling and right heart strain or failure. SPH is also often associated with autoimmune and collagen vascular disorders. OBJECTIVES To study the effects of T cells on the development of experimental SPH. METHODS Athymic nude rats lacking T cells were treated with a single subcutaneous injection of vascular endothelial growth factor (VEGF) receptor blocker SU5416 (20 mg/kg) to induce pulmonary vascular endothelial cell apoptosis. Immunohistochemical analysis and IL-4 levels of the lung tissue were performed. Cell death and proliferation were assessed by Western blot and immunohistochemistry. MEASUREMENTS AND MAIN RESULTS In contrast to SU5416-treated euthymic rats that develop SPH only in combination with chronic hypoxia, athymic nude rats developed SPH and vascular remodeling (similar to clinical SPH) at normoxic conditions as demonstrated by measurements of pulmonary artery pressure and right ventricle hypertrophy. Pulmonary arterioles became occluded with proliferating endothelial cells and were surrounded by mast cells, B cells, and macrophages. IL-4, proliferating cell nuclear antigen, and collagen type I levels were markedly increased in SU5416-treated athymic rat lungs. Antibody deposition was noted along the vascular endothelium in rats with SPH. Finally, protection from SPH was conferred by immune challenge with spleen cells from euthymic nude rats. CONCLUSIONS These studies demonstrate the importance of a complete, intact immune system in protecting against pulmonary angioproliferation in this new model of SPH as well as the importance of intact VEGF receptor signaling for lung endothelial cell homeostasis.
Collapse
Affiliation(s)
- Laimute Taraseviciene-Stewart
- Division of Pulmonary Sciences, Department of Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Nana-Sinkam SP, Lee JD, Sotto-Santiago S, Stearman RS, Keith RL, Choudhury Q, Cool C, Parr J, Moore MD, Bull TM, Voelkel NF, Geraci MW. Prostacyclin prevents pulmonary endothelial cell apoptosis induced by cigarette smoke. Am J Respir Crit Care Med 2007; 175:676-85. [PMID: 17255567 PMCID: PMC1899287 DOI: 10.1164/rccm.200605-724oc] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Impaired endothelial cell-dependent vasodilation, inflammation, apoptosis, and proliferation are manifestations of endothelial dysfunction in chronic obstructive pulmonary disease (COPD). Prostacyclin (PGI(2)) is a major product of the cyclooxygenase pathway with potent vasodilatory and antimitogenic properties and may be relevant to endothelial dysfunction in COPD. OBJECTIVES To determine if PGI(2) expression is altered in smoking-related lung disease and if it may be protective in COPD-associated endothelial dysfunction. METHODS We evaluated, by immunohistochemistry, Western blotting, and polymerase chain reaction, human emphysema tissue compared with normal tissue for expression of prostacyclin synthase (PGI(2)S). We examined the effects of cigarette smoke extract (CSE) and aldehyde components on eicosanoid expression in primary human pulmonary microvascular endothelial cells. Finally, we used a murine model of lung-specific PGI(2)S overexpression and in vitro studies to determine if PGI(2) expression has protective effects on cigarette smoke-induced endothelial apoptosis. MEASUREMENTS AND MAIN RESULTS Human emphysema lung tissue exhibited lower PGI(2)S expression within the pulmonary endothelium than in normal lung. In vitro studies demonstrated that CSE, and in particular the alpha,beta unsaturated aldehyde acrolein, suppressed PGI(2)S gene expression, whereas CSE significantly induced the upstream mediators COX-2 and cytosolic phospholipase A2 in human pulmonary microvascular endothelial cells. Mice with lung-specific PGI(2)S overexpression exhibited less endothelial apoptosis after chronic smoke exposure. In vitro, iloprost exhibited protective effects on CSE-induced apoptosis. CONCLUSIONS PGI(2) has protective effects in the pulmonary vasculature after acute and chronic cigarette smoke exposure. An imbalance in eicosanoid expression may be important to COPD-associated endothelial dysfunction.
Collapse
Affiliation(s)
- S Patrick Nana-Sinkam
- The Ohio State University, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, 201 Davis Heart and Lung Research Institute, 473 West 12th Avenue, Columbus, OH 43210, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Singhania N, Liang Q, Cool C, Tate R, Alam R. Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) in a Patient with Cough and Dyspnea Resistant to Standard Therapy. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.12.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
32
|
Taraseviciene-Stewart L, Scerbavicius R, Choe KH, Cool C, Wood K, Tuder RM, Burns N, Kasper M, Voelkel NF. Simvastatin causes endothelial cell apoptosis and attenuates severe pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol 2006; 291:L668-76. [PMID: 16698853 DOI: 10.1152/ajplung.00491.2005] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Severe pulmonary hypertension (SPH) is characterized by precapillary arteriolar lumen obliteration, dramatic right ventricular hypertrophy, and pericardial effusion. Our recently published rat model of SPH recapitulates major components of the human disease. We used this model to develop new treatment strategies for SPH. SPH in rats was induced using VEGF receptor blockade in combination with chronic hypoxia. A large variety of drugs used in this study, including anticancer drugs (cyclophosphamide and paclitaxel), the angiotensin-converting enzyme inhibitor lisinopril, the antiangiogenic agent thalidomide, and the peroxisome proliferator-actived receptor-gamma agonist PGJ2, failed to decrease mean pulmonary artery pressure (PAP) or right ventricular hypertrophy. In contrast, treatment of rats with established SPH with simvastatin markedly reduced mean PAP and right ventricular hypertrophy, and this reduction was associated with caspase-3 activation and pulmonary microvascular endothelial cell apoptosis. Simvastatin partially restored caveolin-1, caveolin-2, and phospho-caveolin expression in vessel walls. In rat primary pulmonary microvascular endothelial cells, simvastatin induced caspase 3 activation and Rac 1 expression while suppressing Rho A and attenuated levels of Akt and ERK phosphorylation. We conclude that simvastatin is effective in inducing apoptosis in hyperproliferative pulmonary vascular lesions and could be considered as a potential drug for treatment of human SPH.
Collapse
Affiliation(s)
- Laimute Taraseviciene-Stewart
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Pathology, University of Colorado Health Sciences Center, Denver, CO 80262, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Langston C, Patterson K, Dishop MK, Askin F, Baker P, Chou P, Cool C, Coventry S, Cutz E, Davis M, Deutsch G, Galambos C, Pugh J, Wert S, White F. A protocol for the handling of tissue obtained by operative lung biopsy: recommendations of the chILD pathology co-operative group. Pediatr Dev Pathol 2006; 9:173-80. [PMID: 16944976 DOI: 10.2350/06-03-0065.1] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 04/24/2006] [Indexed: 11/20/2022]
Abstract
This is the first of a series on pediatric pulmonary disease that will appear as Perspectives in Pediatric Pathology over the coming months. The series will include practical issues, such as this protocol for handling lung biopsies and another on bronchoalveolar lavage in childhood, as well as reviews of advances in various areas in pediatric pulmonary pathology. It has been 11 years since the last Perspectives on pulmonary disease. Much has happened since then in this area, and this collection will highlight some emerging and rapidly advancing areas in pediatric lung disease. These will include a review of molecular mechanisms of lung development, and another of mechanisms of pulmonary vascular development. The surfactant system and its disorders, as well as recent advances in the biology of the pulmonary neuroendocrine system and mechanisms of respiratory viral disease, will be addressed. Articles on pulmonary hypertension, pulmonary neoplasia, and pediatric lung transplantation, with their implications for the pediatric pathologist, are also planned. The contributors to this series are a diverse group with special interests and expertise in these areas. As Dr. William Thurlbeck noted in his foreword to the previous volume, Pulmonary Disease, volume 18 of Perspectives in Pediatric Pathology, pediatric pathology had been largely concerned with phenomenology, rather than with mechanisms, model systems, and experimental investigation. I think he would have been pleased to see the changes that have occurred over the past 10 years in pediatric lung biology and pathology in particular, because these were particularly favored interests of his later years.
Collapse
Affiliation(s)
- Claire Langston
- Department of Pathology, Texas Children's Hospital, Houston, and Division of Surgical Pathology, Washington University School of Medicine, St. Louis, MO, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Marecki J, Cool C, Voelkel N, Luciw P, Flores S. Evidence for vascular remodeling in the lungs of macaques infected with simian immunodeficiency virus/HIV NEF recombinant virus. Chest 2006; 128:621S-622S. [PMID: 16373878 DOI: 10.1378/chest.128.6_suppl.621s-a] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- John Marecki
- Cardiovascular Pulmonary Research Laboratory, Pulmonary Hypertensive Center, Denver, CO 80262, USA
| | | | | | | | | |
Collapse
|
35
|
Astor TL, Weill D, Cool C, Teitelbaum I, Schwarz MI, Zamora MR. Pulmonary Capillaritis in Lung Transplant Recipients: Treatment and Effect on Allograft Function. J Heart Lung Transplant 2005; 24:2091-7. [PMID: 16364855 DOI: 10.1016/j.healun.2005.05.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 05/19/2005] [Accepted: 05/22/2005] [Indexed: 10/25/2022] Open
Abstract
The clinical outcomes of lung transplant recipients presenting with post-transplant pulmonary capillaritis have not been well described. We retrospectively reviewed 40 cases of biopsy-proven pulmonary capillaritis in lung transplant recipients. Patients presented with a clinical syndrome characterized by dyspnea, hypoxemia, abnormal chest X-ray, and a decrease in forced expiratory volume in 1 second (FEV1); 25% presented with hemoptysis, and 18% with fulminant respiratory failure. Therapy with intravenous corticosteroids resulted in clinical improvement in 17 cases (43%). A response to plasmapheresis was seen in 12 (67%) of 18 cases refractory to corticosteroids. There were 5 deaths within 3 months of diagnosis. Nine (82%) of 11 lung transplant recipients who presented with capillaritis within 4 weeks post-transplant were alive at 1 year; all but 1 patient achieved expected percent predicted FEV1 values. Only 3 (14%) of 21 who presented with capillaritis > 1 month after transplant had a >20% decrease in the FEV1 after 12 months. These results suggest that post-transplant pulmonary capillaritis is (1) likely a form of acute allograft rejection clinically and histologically distinct from typical acute rejection, (2) less responsive to corticosteroid therapy than typical acute rejection, and (3) not associated with long-term adverse effects on allograft function.
Collapse
Affiliation(s)
- Todd L Astor
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA.
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE The purpose of this article is to describe and illustrate the clinical, pathologic, and imaging features of the inflammatory and fibrotic forms of bronchiolitis. The CT features presented in this article represent the typical features associated with each entity. CONCLUSION Direct signs of bronchiolitis include centrilobular nodules and tree-in-bud pattern. Indirect signs include mosaic attenuation and air trapping. Although classic examples of each entity exist, there can be substantial overlap in the appearances, and distinguishing among these entities is not always possible. When high-resolution CT features overlap, clinical details will usually help to narrow the differential diagnosis.
Collapse
|
37
|
Taraseviciene-Stewart L, Scerbavicius R, Stewart JM, Gera L, Demura Y, Cool C, Kasper M, Voelkel NF. Treatment of severe pulmonary hypertension: a bradykinin receptor 2 agonist B9972 causes reduction of pulmonary artery pressure and right ventricular hypertrophy. Peptides 2005; 26:1292-300. [PMID: 15878794 DOI: 10.1016/j.peptides.2005.03.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bradykinin is an important modulator of endothelial cell function and has also a powerful cardioprotective effect. Here we report that treatment of severely pulmonary hypertensive rats (that recapitulate several of the physiological and pathological characteristics of the human pulmonary vascular disease, including dramatic right ventricular hypertrophy, pericardial effusion and death) with a newly synthesized long-acting bradykinin B2 receptor agonist B9972 caused reduction of the pulmonary artery pressure (PAP=51+/-2.0 versus 68+/-2.8 of untreated animals) and of right ventricular hypertrophy (Rv/Lv+S=0.55+/-0.02 versus 0.73+/-0.03 of untreated rats) and activation of Akt. Long-term stimulation with B9972 in our animal model of SPH resulted in decreased expression of the B2 receptor in lung vasculature. Treatment with B9972 decreased the number of plexiform lesions in the lungs by inducing cell apoptosis in the obliterated vessels and by restoring caveolin-1 expression. B9972 also promoted eNOS activation. In vitro B9972 caused activation of caspase-3 as well as Erk and induction of prostacyclin production in rat pulmonary microvascular EC. Taken together our data suggest that a stable bradykinin B2 agonist B9972 demonstrates the capacity to reduce severe pulmonary hypertension, right ventricular hypertrophy and induce apoptosis of hyperproliferative cells in pre-capillary pulmonary arterioles.
Collapse
Affiliation(s)
- Laimute Taraseviciene-Stewart
- Pulmonary Hypertension Center, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Box C272, 4200 East Ninth Avenue, Denver, CO 80262, USA
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Elliot TL, Lynch DA, Newell JD, Cool C, Tuder R, Markopoulou K, Veve R, Brown KK. High-resolution computed tomography features of nonspecific interstitial pneumonia and usual interstitial pneumonia. J Comput Assist Tomogr 2005; 29:339-45. [PMID: 15891504 DOI: 10.1097/01.rct.0000162153.55253.d3] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the accuracy of high-resolution computed tomography (HRCT) in the diagnosis of nonspecific interstitial pneumonia (NSIP). We hypothesized that the computed tomography (CT) features of NSIP could be distinguished from those of usual interstitial pneumonia (UIP). METHODS The HRCT images of 47 patients with surgical lung biopsy-proven NSIP (n = 25) and UIP (n = 22) were independently reviewed by 2 thoracic radiologists. Predominant imaging patterns, most likely diagnosis, and diagnostic level of confidence were recorded. A confident HRCT diagnosis of NSIP was based on the presence of spatially uniform, bilateral, basal-predominant ground-glass and/or reticular opacities with little if any honeycombing, whereas UIP was confidently diagnosed if a spatially inhomogeneous, bilateral, peripheral, basal-predominant pattern of reticular opacities and honeycombing with little if any ground-glass attenuation was identified. RESULTS A predominant pattern of ground-glass and/or reticular opacity with minimal to no honeycombing was demonstrated in 48 (96%) of 50 readings in patients with NSIP. Conversely, the presence of honeycombing as a predominant feature had a predictive value of 90% for UIP (P < 0.001). Usual interstitial pneumonia was more likely than NSIP to be subpleural and patchy (P < 0.001). A confident CT diagnosis of NSIP and UIP was correct in 73% and 88% of cases, respectively. The correctness of a CT diagnosis made at intermediate or high confidence was 68% and 88%, respectively. The kappa value for distinction of NSIP from UIP was 0.72. CONCLUSION In contrast to previous reports, NSIP can be separated from UIP in most cases. The presence of honeycombing as a predominant imaging finding is highly specific for UIP and can be used to differentiate it from NSIP, particularly when the distribution is patchy and subpleural predominant. The presence of predominant ground-glass and reticular opacity is highly characteristic of NSIP, but there is a subset of patients with UIP who have this pattern and may require biopsy for differentiation from NSIP.
Collapse
Affiliation(s)
- Tracy L Elliot
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
In general, asthma runs a variable course. However, there are children with asthma who are at risk for progressive disease that can lead to failure to attain peak lung growth and eventually can result in clinical and functional impairment. We present a case of a 14-year-old girl who has demonstrated a deterioration in lung function at least in the past 6 years. This has been associated with increasing medication requirements, including chronic oral corticosteroid and a steroid-sparing medication, the presence of comorbidities, and the occurrence of frequent exacerbations. The patient has evidence of airway inflammation and remodeling based on biomarkers and biopsy findings. It remains a challenge to determine patients at risk for irreversible airflow obstruction, presumably a result of airway remodeling. Histopathologic studies from biopsy samples provide the best evidence for this. However, bronchoscopy and biopsy require technical expertise and cannot be routinely used. Clinically, once a patient increases medication requirements, this should serve as a marker of disease progression. Biomarkers of airway inflammation such as exhaled nitric oxide, exhaled breath condensates, and induced sputum analysis may have the potential to monitor disease progression. Additional efforts are necessary to understand the mechanisms involved in this phenomenon and to discover specific modalities of treatment to target the structural changes of airway remodeling.
Collapse
Affiliation(s)
- Ronina A Covar
- Neimark Laboratory of Clinical Pharmacology, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA.
| | | | | |
Collapse
|
40
|
Rodman DM, Reese K, Harral J, Fouty B, Wu S, West J, Hoedt-Miller M, Tada Y, Li KX, Cool C, Fagan K, Cribbs L. Low-voltage-activated (T-type) calcium channels control proliferation of human pulmonary artery myocytes. Circ Res 2005; 96:864-72. [PMID: 15774856 DOI: 10.1161/01.res.0000163066.07472.ff] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While Ca2+ influx is essential for activation of the cell cycle machinery, the processes that regulate Ca2+ influx in this context have not been fully elucidated. Electrophysiological and molecular studies have identified multiple Ca2+ channel genes expressed in mammalian cells. Ca(v)3.x gene family members, encoding low voltage-activated (LVA) or T-type channels, were first identified in the central nervous system and subsequently in non-neuronal tissue. Reports of a potential role for T-type Ca2+ channels in controlling cell proliferation conflict. The present study tested the hypothesis that T-type Ca2+ channels, encoded by Ca(v)3.x genes, control pulmonary artery smooth muscle cell proliferation and cell cycle progression. Using quantitative RT/PCR, immunocytochemistry, and immunohistochemistry we found that Ca(v)3.1 was the predominant Ca(v)3.x channel expressed in early passage human pulmonary artery smooth muscle cells in vitro and in the media of human pulmonary arteries, in vivo. Selective blockade of Ca(v)3.1 expression with small interfering RNA (siRNA) and pharmacological blockade of T-type channels completely inhibited proliferation in response to 5% serum and prevented cell cycle entry. These studies establish that T-type voltage-operated Ca2+ channels are required for cell cycle progression and proliferation of human PA SMC.
Collapse
MESH Headings
- Calcium Channels, T-Type/analysis
- Calcium Channels, T-Type/genetics
- Calcium Channels, T-Type/physiology
- Cell Proliferation
- Cells, Cultured
- Diltiazem/pharmacology
- Humans
- Lung/metabolism
- Mibefradil/pharmacology
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/metabolism
- Myocytes, Smooth Muscle/cytology
- Myocytes, Smooth Muscle/metabolism
- Pulmonary Artery/cytology
- RNA, Small Interfering/pharmacology
- Reverse Transcriptase Polymerase Chain Reaction
Collapse
Affiliation(s)
- David M Rodman
- Center for Genetic Lung Disease, University of Colorado Health Sciences Center, Denver, Colo 80262, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
This article briefly discusses the traditional concepts of severe pulmonary hypertension and then details how the concept of severe pulmonary hypertension has moved from a vasoconstrictive to an angioproliferative disorder.
Collapse
Affiliation(s)
- Norbert F Voelkel
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Pathology, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262, USA.
| | | |
Collapse
|
42
|
Abstract
Severe pulmonary hypertension (PH) occurs in a primary or "unexplained" form and in a group of secondary forms associated with a number of diseases. Because the lung tissue from patients with severe PH demonstrates complex vascular lesions, which contain inflammatory cells, we wondered whether the lung tissue from patients with severe PH was "under oxidative stress." We used immunohistochemistry to localize nitrotyrosine and 8-hydroxy guanosine in the lung tissue sections from patients with primary and secondary PH. In some lung tissue extracts, the eicosanoid metabolites 5-oxo-eicosatetraenoic acid, leukotriene B4 5-hydroxyeicosatetraenoic acid (HETE), 12-HETE, and 15-HETE were measured using mass spectroscopy, and superoxide dismutase amount and activity were measured. Nitrotyrosine expression was ubiquitous in all PH lungs, and 5-oxo-eicosatetraenoic acid and HETE levels were elevated in the lungs of patients with severe PH but not in those lungs that were from the patients with severe PH treated chronically with prostacyclin. We conclude that indeed the lungs from patients with severe PH are under oxidative stress and that chronic prostacyclin infusion has an antiinflammatory effect on the lung tissue.
Collapse
Affiliation(s)
- Rebecca Bowers
- Pulmonary Hypertension Center, University of Colorado Health Sciences Center, National Jewish Medical and Research Center, Denver 80262, USA
| | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
BACKGROUND To date, little has been published describing the pathology of severe childhood asthma. The currently accepted model of asthma holds that persistent airway inflammation leads to various symptoms of asthma, airway hyperresponsiveness, and airway remodeling that ultimately results in permanent loss of lung function. METHODS Evaluation of six children referred to the National Jewish Medical and Research Center with difficult-to-control asthma, despite aggressive anti-inflammatory therapy, who underwent bronchoscopy with endobronchial biopsy to better characterize their disease. RESULTS In every case, endobronchial biopsies revealed changes consistent with airway remodeling characterized by thickening of the basement membrane, smooth-muscle hypertrophy, with varying degrees of goblet-cell and submucous gland hyperplasia. The degree of subbasement membrane thickening did not appear to correlate with baseline FEV(1), ultimate FEV(1) following aggressive therapy, or lability in lung function. In five of six cases, there was minimal to no histologic evidence for airway inflammation with mild and patchy submucosal lymphocytic infiltration noted; eosinophils and neutrophils were not present. Further, the majority of the patients achieved normal FEV(1) values despite significant subbasement membrane thickening, counter to the current beliefs regarding airway remodeling and irreversible loss of lung function. CONCLUSIONS This case report highlights some of the shortcomings of the current inflammatory paradigm for severe asthma. Despite little evidence of ongoing airway inflammation, many of the subjects displayed significant lung function lability. The lack of inflammation argues against steroid resistance at a cellular level, although it could be argued that inflammation may have been distal to the site sampled. Additionally, normal to nearly normal lung function was achieved despite the presence of significant remodeling. These findings suggest the need to look beyond inflammation to fully treat severe asthma and ultimately alter its progression.
Collapse
Affiliation(s)
- Henry A Jenkins
- Ira J. and Jacqueline Neimark Laboratory of Clinical Pharmacology in Pediatrics, Division of Clinical Pharmacology, National Jewish Medical and Research Center, Denver, CO, USA
| | | | | | | | | | | | | |
Collapse
|
44
|
Chmura K, Cool C, Kircher T, Chan ED. Painful lymphadenopathy and fulminant sepsis in a previously healthy 16-year-old girl. Chest 2003; 124:379-82. [PMID: 12853549 DOI: 10.1378/chest.124.1.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kathryn Chmura
- Department of Medicine, Program in Cell Biology, National Jewish Medical and Research Center, Denver, CO 80206, USA
| | | | | | | |
Collapse
|
45
|
Chan K, Abzug M, Coffinet L, Simoes E, Cool C, Westcott J, Liu A. Chronic rhinosinusitis (CRS) in young children differs from CRS in adults: A histopathology study. J Allergy Clin Immunol 2003. [DOI: 10.1016/s0091-6749(03)80384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
46
|
Coffinet L, Chan K, Abzug M, Simoes E, Cool C, Liu A. Immunopathology of chronic rhinosinusitis in young children. J Allergy Clin Immunol 2003. [DOI: 10.1016/s0091-6749(03)80188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
47
|
Winn RA, Bremnes RM, Bemis L, Franklin WA, Miller YE, Cool C, Heasley LE. gamma-Catenin expression is reduced or absent in a subset of human lung cancers and re-expression inhibits transformed cell growth. Oncogene 2002; 21:7497-506. [PMID: 12386812 DOI: 10.1038/sj.onc.1205963] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2002] [Revised: 08/05/2002] [Accepted: 08/05/2002] [Indexed: 01/23/2023]
Abstract
Lung cancer is a heterogeneous disease categorized into multiple subtypes of cancers which likely arise from distinct patterns of genetic alterations and disruptions. Precedent exists for a role of beta-catenin, a downstream component of the Wnt signaling pathway that serves as a transcriptional co-activator with TCF/LEF, in several human cancers including colon carcinomas. In this study, we observed that beta-catenin was highly and uniformly expressed in a panel of NSCLC cell lines and primary lung tumors. By contrast, gamma-catenin was weakly expressed or absent in several NSCLC cell lines and immunohistochemical analysis of primary NSCLC tumors revealed negligible to weak gamma-catenin staining in approximately 30% of the specimens. Treatment of NSCLC cells expressing reduced gamma-catenin protein with 5-aza-2'-deoxycytidine (5aza2dc), a DNA methylation inhibitor, or trichostatin A (TSA), a histone deacetylase inhibitor, increased gamma-catenin protein content in NSCLC cells with low gamma-catenin expression. Significantly, the activity of a beta-catenin/TCF-dependent luciferase reporter was markedly elevated in the NSCLC cell lines that underexpressed gamma-catenin relative to those lines that highly expressed gamma-catenin. Moreover, transfection of these cells with a gamma-catenin expression plasmid reduced the elevated TCF activity by 85% and strongly inhibited cell growth on tissue culture plastic as well as anchorage-independent growth in soft agar. This study shows that gamma-catenin can function as an inhibitor of beta-catenin/TCF-dependent gene transcription and highlights gamma-catenin as a potentially novel tumor suppressor protein in a subset of human NSCLC cancers.
Collapse
Affiliation(s)
- Robert A Winn
- Veterans Administration Medical Center, Denver, Colorado, CO 80220, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Choi HS, Rai PR, Chu HW, Cool C, Chan ED. Analysis of nitric oxide synthase and nitrotyrosine expression in human pulmonary tuberculosis. Am J Respir Crit Care Med 2002; 166:178-86. [PMID: 12119230 DOI: 10.1164/rccm.2201023] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The role of nitric oxide (NO) in the host-defense against human tuberculosis (TB) is controversial. Although experimental evidence indicates that NO may play an important role in controlling TB, its expression in human tuberculous lungs has not been systematically characterized. We therefore investigated the expression of NO synthases (NOS) and of nitrotyrosine, the latter a marker of NO expression, in surgically resected lungs of eight patients with TB. Immunohistochemical and morphometric analyses revealed that, compared with control subjects, inducible NOS, endothelial NOS, and nitrotyrosine, but not neuronal NOS, were significantly elevated in the inflammatory zone of the tuberculous granulomas, and in the nongranulomatous pneumonitis zone. Tumor necrosis factor-alpha (TNF-alpha) was also significantly increased in tuberculous lungs and was principally localized to the necrotic, and to a lesser extent, the inflammatory and fibrotic areas of the granulomas. The NOS isoforms, nitrotyrosine, and TNF-alpha were expressed by the epithelioid macrophages and giant cells within the granulomas and in alveolar macrophages and epithelial cells in pneumonitis areas. This descriptive study provides evidence that in human TB, NOS isoenzymes and NO are present in specialized areas of the tuberculous granulomas; their precise role in human TB remains to be determined.
Collapse
Affiliation(s)
- Hyung-Seok Choi
- Department of Medicine, Program in Cell Biology, National Jewish Medical and Research Center, Denver, Colorado 80206, USA
| | | | | | | | | |
Collapse
|
49
|
Abstract
Surfactant protein D (SP-D) appears to play an important role in regulating local pulmonary inflammatory responses to pathogens. There is also in vitro evidence that SP-D may suppress local T cell responses. However, the role of SP-D in regulating T cell responses directly in the lung has not been previously evaluated in vivo. SP-D(-)(/-) mice demonstrate peribronchial and perivascular accumulations of lymphocytes. Therefore, we investigated the functional status and abundance of intrapulmonary lymphocytes in SP-D(-)(/-) mice. By morphometric analysis, SP-D(-)(/-) mice demonstrated increased numbers of airway- and vessel-associated lymphocytes without increases in interstitial lymphocytes. There was increased proliferative activity of lymphocytes isolated by enzymatic disassociation of minced lung. Flow cytometry was used to determine the number and functional activation status of intrapulmonary CD4(+) and CD8(+) T cells, as well as B cells and NK cells. Cytokine expression patterns in lung tissues were evaluated using RNase protection assays, reverse transcriptase/polymerase chain reaction, and enzyme-linked immunosorbent assay. There was marked T cell activation in the lungs of SP-D(-)(/-) mice, as reflected by an increased percentage of both CD4(+) and CD8(+) T cells expressing CD69 and CD25. BAL CD4 lymphocytes were increased and the fraction expressing CD69 was also increased. Although there were increases in BAL CD8 lymphocytes, apparent increases in CD69-positive CD8 lymphocytes did not reach statistical significance. In contrast, splenic T cells were not activated in SPD(-)(/-) mice. Of the proinflammatory cytokines evaluated, only interleukin (IL)-12 and IL-6 expression were consistently upregulated in the lungs of SPD(-)(/-) mice. Increased IL-2 expression was apparent but did not reach statistical significance. We conclude that the lack of local pulmonary production of SP-D leads to a state of persistent T cell activation, possibly in response to exogenous antigens. This study therefore provides further evidence of the important local immunoregulatory role of SP-D in vivo.
Collapse
MESH Headings
- Animals
- Antigens, CD/biosynthesis
- Antigens, CD/immunology
- Antigens, Differentiation, T-Lymphocyte/biosynthesis
- Antigens, Differentiation, T-Lymphocyte/immunology
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- Cell Division
- Glycoproteins/deficiency
- Glycoproteins/genetics
- Glycoproteins/physiology
- Interleukin-2/biosynthesis
- Interleukin-2/immunology
- Interleukin-6/biosynthesis
- Interleukin-6/immunology
- Lectins, C-Type
- Lung/immunology
- Lung/physiology
- Lymphocyte Activation/immunology
- Lymphocyte Activation/physiology
- Mice
- Mice, Transgenic
- Pulmonary Surfactant-Associated Protein D
- Pulmonary Surfactants/deficiency
- Pulmonary Surfactants/genetics
- Pulmonary Surfactants/physiology
- Receptors, Interleukin-2/biosynthesis
- Receptors, Interleukin-2/immunology
Collapse
Affiliation(s)
- James H Fisher
- Division of Pulmonary Sciences and Critical Care Medicine, Denver Health Medical Center, Colorado 80204-4507, USA.
| | | | | | | |
Collapse
|
50
|
Voelkel NF, Cool C, Taraceviene-Stewart L, Geraci MW, Yeager M, Bull T, Kasper M, Tuder RM. Janus face of vascular endothelial growth factor: the obligatory survival factor for lung vascular endothelium controls precapillary artery remodeling in severe pulmonary hypertension. Crit Care Med 2002; 30:S251-6. [PMID: 12004244 DOI: 10.1097/00003246-200205001-00013] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Vascular endothelial growth factor (VEGF) plays a central role in the life and death of pulmonary vascular endothelial cells. Treatment of neonatal or adult rats with a VEGF receptor blocker destroys lung capillaries by inducing endothelial cell apoptosis and causes emphysema. Human lung tissue samples from patients with endstage emphysema have decreased levels of VEGF messenger RNA and protein and have decreased expression of kinase insert domain-containing receptor (VEGF receptor II). These decreases are associated with a high rate of alveolar septal cell apoptosis, indicating perhaps that decreased VEGF and kinase insert domain-containing receptor expression impairs endothelial cell survival in emphysematous lungs. Combination of VEGF receptor blockade with chronic hypoxia (3-wk exposure) results in obliteration of small precapillary pulmonary arteries by proliferating endothelial cells, severe pulmonary hypertension, and death caused by right-side heart failure. We propose that 1) VEGF receptor blockade causes endothelial cell apoptosis, 2) hypoxic vasoconstriction (shear stress) selects apoptosis-resistant endothelial cells that proliferate and obliterate the lumen, and 3) the vascular remodeling observed is relevant to the structural alterations that characterize severe pulmonary hypertension (including primary pulmonary hypertension) in humans. The endovascular cell growth in human disease and in our model exhibits some similarities with neoplastic cell growth. Chemotherapy strategies can now be employed in the animal model in an attempt to treat established vascular-obliterative lung disease.
Collapse
Affiliation(s)
- Norbert F Voelkel
- University of Colorado Health Sciences Center, Denver, CO 80262, USA.
| | | | | | | | | | | | | | | |
Collapse
|