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Sridhar M, Bodduluri S, O'Hare L, Blumhoff S, Acosta Lara MDP, de Andrade JA, Kim YI, Luckhardt T, McDonald M, Kulkarni T. Association of musculoskeletal involvement with lung function and mortality in patients with idiopathic pulmonary fibrosis. Respir Res 2024; 25:81. [PMID: 38326848 PMCID: PMC10851557 DOI: 10.1186/s12931-024-02705-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive disease associated with high mortality. Low muscle mass, frailty and sarcopenia lead to functional impairment that negatively impact quality of life and survival but are not used in clinical practice. We aimed to determine the association of Fat-free mass index (FFMI) and frailty with lung function, exercise tolerance and survival in patients with IPF. In this study, 70 patients with IPF underwent assessment of body composition, lung function, 6-min walk distance (6MWD) testing, hand grip strength, quality of life (QoL) assessment by St. George's Respiratory questionnaire (SGRQ) and frailty assessment using the SHARE-FI tool. FFMI was calculated using pectoralis muscle cross-sectional area (PM-CSA) on CT chest images and the lowest quartile defined reduced muscle mass. Sarcopenia was defined as low FFMI and handgrip strength. Regression analyses were conducted to determine predictive value of frailty, low FFMI and sarcopenia on clinical outcomes. The Cox proportional hazards model was used to analyze the impact of FFMI and frailty score on survival. The mean age was 70 years with moderate impairment in lung function (mean ppFVC 68.5%, ppDLCO 45.6%). Baseline forced vital capacity (p < 0.001), diffusion capacity of lung for carbon monoxide (p = < 0.01), 6WMD (p < 0.05) were significantly lower in frail patients compared to non-frail patients. BMI was found to closely correlate with FFMI (r = 0.79, p < 0.001), but not with frailty score (r = - 0.2, p = 0.07). Frailty was a significant predictor of FVC, DLCO, 6MWD, SGRQ scores when adjusted for age and gender. Muscle mass and sarcopenia were significant predictors of FVC, DLCO, but not 6MWD or QoL scores. Multivariate cox-proportional hazards ratio model adjusting for age and gender showed that frailty was significantly associated with increased mortality (HR = 2.6, 95% CI 1.1-6.1). Low FFMI (HR = 1.3, 95% CI 0.6-2.8), and sarcopenia (HR = 2.1, 95% CI 0.8-5.3), though associated with a trend to increased mortality, were not statistically significant. Frailty is associated with lower lung function and higher mortality in patients with IPF. Longitudinal evaluations are necessary to further determine the associations between low FFMI, sarcopenia and frailty with outcomes in IPF.
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Affiliation(s)
- Meenakshi Sridhar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandeep Bodduluri
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lanier O'Hare
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maria Del Pilar Acosta Lara
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joao A de Andrade
- Division of Pulmonary, Allergy and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA
| | - Young-Il Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tracy Luckhardt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - MerryLynn McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Genetics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tejaswini Kulkarni
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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2
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Case AH, Beegle S, Hotchkin DL, Kaelin T, Kim HJ, Podolanczuk AJ, Ramaswamy M, Remolina C, Salvatore MM, Tu C, de Andrade JA. Defining the pathway to timely diagnosis and treatment of interstitial lung disease: a US Delphi survey. BMJ Open Respir Res 2023; 10:e001594. [PMID: 38007235 PMCID: PMC10680004 DOI: 10.1136/bmjresp-2022-001594] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 10/31/2023] [Indexed: 11/27/2023] Open
Abstract
INTRODUCTION Timely diagnosis of interstitial lung disease (ILD) is limited by obstacles in the current patient pathway. Misdiagnosis and delays are common and may lead to a significant burden of diagnostic procedures and worse outcomes. This Delphi survey aimed to identify consensus on the key steps that facilitate the patient journey to an accurate ILD diagnosis and appropriate management in the US. METHODS A modified Delphi analysis was conducted, comprising three online surveys based on a comprehensive literature search. The surveys spanned five domains (guidelines, community screening, diagnosis, management and specialist referral) and were completed by a panel of US physicians, including primary care physicians and pulmonologists practising in community or academic settings. A priori definitions of consensus agreement were median scores of 2-3 (agree strongly/agree), with an IQR of 0-1 for questions on a 7-point Likert scale from -3 to 3, or ≥80% agreement for binary questions. RESULTS Forty-nine panellists completed the surveys and 62 statements reached consensus agreement. There was consensus agreement on what should be included in the primary care evaluation of patients with suspected ILD and the next steps following workup. Regarding diagnosis in community pulmonology care, consensus agreement was reached on the requisition and reporting of high-resolution CT scans and the appropriate circumstances for holding multidisciplinary discussions. Additionally, there was consensus agreement on which symptoms and comorbidities should be monitored, the frequency of consultations and the assessment of disease progression. Regarding specialist referral, consensus agreement was reached on which patients should receive priority access to ILD centres and the contents of the referral package. CONCLUSIONS These findings clarify the most common issues that should merit further evaluation for ILD and help define the steps for timely, accurate diagnosis and appropriate collaborative specialty management of patients with ILD.
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Affiliation(s)
- Amy Hajari Case
- Pulmonary, Critical Care, and Sleep Medicine, Piedmont Healthcare Inc, Atlanta, Georgia, USA
| | - Scott Beegle
- Division of Pulmonary & Critical Care Medicine, Albany Medical College, Albany, New York, USA
| | - David L Hotchkin
- Division of Pulmonary, Critical Care & Sleep Medicine, The Oregon Clinic, Portland, Oregon, USA
| | - Thomas Kaelin
- Lowcountry Lung and Critical Care, Charleston, South Carolina, USA
| | - Hyun Joo Kim
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, Minnesota, USA
| | - Anna J Podolanczuk
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Murali Ramaswamy
- LeBauer Pulmonary and Critical Care and PulmonIx, LLC at Cone Health, Greensboro, North Carolina, USA
| | - Carlos Remolina
- Department of Pulmonology, Trinitas Regional Medical Center, Elizabeth, New Jersey, USA
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Conan Tu
- Internal Medicine, ProHEALTH, part of Optum, New York, New York, USA
| | - Joao A de Andrade
- Medicine, Div. of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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de Andrade JA, Neely ML, Hellkamp AS, Culver DA, Kim HJ, Liesching T, Lobo LJ, Ramaswamy M, Safdar Z, Bender S, Conoscenti CS, Leonard TB, Palmer SM, Snyder LD. Effect of Antifibrotic Therapy on Survival in Patients With Idiopathic Pulmonary Fibrosis. Clin Ther 2023; 45:306-315. [PMID: 36997445 DOI: 10.1016/j.clinthera.2023.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/20/2023] [Accepted: 03/04/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Real-world studies have reported reduced mortality in patients with idiopathic pulmonary fibrosis (IPF) treated with antifibrotic therapy; however, the initiation or discontinuation of therapy during these studies may have introduced bias. This study investigated the effect of antifibrotic therapy on mortality and other outcomes in patients with IPF using causal inference methodology. METHODS Data from a multicenter US registry of patients with IPF were used to assess the effect of antifibrotic therapy (nintedanib or pirfenidone) on death, death or lung transplant, respiratory-related hospitalization, and acute worsening of IPF (defined as any health care encounter deemed due to acute worsening of IPF). This study used the Gran method, which accounts for differences in patient characteristics and for treatment initiations and discontinuations during follow-up. The analysis cohort was limited to patients who started antifibrotic therapy on or after the day of enrollment or had never taken it. FINDINGS Among the 499 patients analyzed, 352 (70.5%) received antifibrotic therapy. Estimated event rates of death at 1 year were 6.6% (95% CI, 6.1-7.1) for treated patients and 10.2% (95% CI, 9.5-10.9) for control patients. There was a numerical reduction in the risk of death (hazard ratio [HR], 0.53; 95% CI, 0.28-1.03; P = 0.060) but numerical increases in risks of respiratory-related hospitalization (HR, 1.88; 95% CI, 0.90-3.92; P = 0.091) and acute worsening of IPF (HR, 1.71; 95% CI, 0.36-8.09; P = 0.496) in treated versus control patients. IMPLICATIONS Analyses based on causal inference methodology suggest that patients with IPF who receive antifibrotic therapy have improved survival.
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Rahaghi FF, Kolaitis NA, Adegunsoye A, de Andrade JA, Flaherty KR, Lancaster LH, Lee JS, Levine DJ, Preston IR, Safdar Z, Saggar R, Sahay S, Scholand MB, Shlobin OA, Zisman DA, Nathan SD. Screening Strategies for Pulmonary Hypertension in Patients With Interstitial Lung Disease: A Multidisciplinary Delphi Study. Chest 2022; 162:145-155. [PMID: 35176276 PMCID: PMC9993339 DOI: 10.1016/j.chest.2022.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 11/08/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a common complication of interstitial lung disease (ILD) and is associated with worse outcomes and increased mortality. Evaluation of PH is recommended in lung transplant candidates, but there are currently no standardized screening approaches. Trials have identified therapies that are effective in this setting, providing another rationale to routinely screen patients with ILD for PH. RESEARCH QUESTION What screening strategies for identifying PH in patients with ILD are supported by expert consensus? STUDY DESIGN AND METHODS The study convened a panel of 16 pulmonologists with expertise in PH and ILD, and used a modified Delphi consensus process with three surveys to identify PH screening strategies. Survey 1 consisted primarily of open-ended questions. Surveys 2 and 3 were developed from responses to survey 1 and contained statements about PH screening that panelists rated from -5 (strongly disagree) to 5 (strongly agree). RESULTS Panelists reached consensus on several triggers for suspicion of PH including the following: symptoms, clinical signs, findings on chest CT scan or other imaging, abnormalities in pulse oximetry, elevations in brain natriuretic peptide (BNP) or N-terminal pro-brain natriuretic peptide (NT-proBNP), and unexplained worsening in pulmonary function tests or 6-min walk distance. Echocardiography and BNP/NT-proBNP were identified as screening tools for PH. Right heart catheterization was deemed essential for confirming PH. INTERPRETATION Many patients with ILD may benefit from early evaluation of PH now that an approved therapy is available. Protocols to evaluate patients with ILD often overlap with evaluations for pulmonary hypertension-interstitial lung disease and can be used to assess the risk of PH. Because standardized approaches are lacking, this consensus statement is intended to aid physicians in the identification of patients with ILD and possible PH, and provide guidance for timely right heart catheterization.
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Affiliation(s)
- Franck F Rahaghi
- Advanced Lung Disease Clinic, Cleveland Clinic Florida, Weston, FL
| | | | - Ayodeji Adegunsoye
- Section of Pulmonary & Critical Care, The University of Chicago School of Medicine, Chicago, IL
| | - Joao A de Andrade
- Vanderbilt Lung Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Kevin R Flaherty
- Michigan Medicine Interstitial Lung Disease Program, University of Michigan, Ann Arbor, MI
| | | | - Joyce S Lee
- Pulmonary Sciences & Critical Care, University of Colorado School of Medicine, Aurora, CO
| | - Deborah J Levine
- Pulmonary Hypertension Center, UT Health San Antonio, San Antonio, TX
| | - Ioana R Preston
- Pulmonary Hypertension Center, Tufts Medical Center, Boston, MA
| | | | - Rajan Saggar
- Pulmonary and Critical Care Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | | | | | - Oksana A Shlobin
- Inova Fairfax Heart & Lung Transplant Program, Inova Medical Group, Falls Church, VA
| | | | - Steven D Nathan
- Advanced Lung Disease Program, Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA.
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Hunninghake GM, Goldin JG, Kadoch MA, Kropski JA, Rosas IO, Wells AU, Yadav R, Lazarus HM, Abtin FG, Corte TJ, de Andrade JA, Johannson KA, Kolb MR, Lynch DA, Oldham JM, Spagnolo P, Strek ME, Tomassetti S, Washko GR, White ES. Detection and Early Referral of Patients With Interstitial Lung Abnormalities: An Expert Survey Initiative. Chest 2022; 161:470-482. [PMID: 34197782 PMCID: PMC10624930 DOI: 10.1016/j.chest.2021.06.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Interstitial lung abnormalities (ILA) may represent undiagnosed early-stage or subclinical interstitial lung disease (ILD). ILA are often observed incidentally in patients who subsequently develop clinically overt ILD. There is limited information on consensus definitions for, and the appropriate evaluation of, ILA. Early recognition of patients with ILD remains challenging, yet critically important. Expert consensus could inform early recognition and referral. RESEARCH QUESTION Can consensus-based expert recommendations be identified to guide clinicians in the recognition, referral, and follow-up of patients with or at risk of developing early ILDs? STUDY DESIGN AND METHODS Pulmonologists and radiologists with expertise in ILD participated in two iterative rounds of surveys. The surveys aimed to establish consensus regarding ILA reporting, identification of patients with ILA, and identification of populations that might benefit from screening for ILD. Recommended referral criteria and follow-up processes were also addressed. Threshold for consensus was defined a priori as ≥ 75% agreement or disagreement. RESULTS Fifty-five experts were invited and 44 participated; consensus was reached on 39 of 85 questions. The following clinically important statements achieved consensus: honeycombing and traction bronchiectasis or bronchiolectasis indicate potentially progressive ILD; honeycombing detected during lung cancer screening should be reported as potentially significant (eg, with the Lung CT Screening Reporting and Data System "S-modifier" [Lung-RADS; which indicates clinically significant or potentially significant noncancer findings]), recommending referral to a pulmonologist in the radiology report; high-resolution CT imaging and full pulmonary function tests should be ordered if nondependent subpleural reticulation, traction bronchiectasis, honeycombing, centrilobular ground-glass nodules, or patchy ground-glass opacity are observed on CT imaging; patients with honeycombing or traction bronchiectasis should be referred to a pulmonologist irrespective of diffusion capacity values; and patients with systemic sclerosis should be screened with pulmonary function tests for early-stage ILD. INTERPRETATION Guidance was established for identifying clinically relevant ILA, subsequent referral, and follow-up. These results lay the foundation for developing practical guidance on managing patients with ILA.
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Affiliation(s)
- Gary M Hunninghake
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Boston, MA.
| | - Jonathan G Goldin
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA
| | - Michael A Kadoch
- Department of Radiology, University of California at Davis, Davis, CA
| | | | - Ivan O Rosas
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
| | - Ruchi Yadav
- Imaging Institute, Cleveland Clinic, Cleveland, OH
| | | | - Fereidoun G Abtin
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA; Division of Interventional Radiology, University of California at Los Angeles, Los Angeles, CA
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, and University of Sydney, Sydney NSW, Australia
| | | | | | - Martin R Kolb
- Firestone Institute for Respiratory Health, Research Institute at St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Justin M Oldham
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, Davis, CA; Department of Veterans Affairs Northern California, Sacramento, CA
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Mary E Strek
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - George R Washko
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Boston, MA
| | - Eric S White
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
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6
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Todd JL, Neely ML, Overton R, Mulder H, Roman J, Lasky JA, de Andrade JA, Gulati M, Huang H, Leonard TB, Hesslinger C, Noth I, Belperio JA, Flaherty KR, Palmer SM. Association of Circulating Proteins with Death or Lung Transplant in Patients with Idiopathic Pulmonary Fibrosis in the IPF-PRO Registry Cohort. Lung 2022; 200:11-18. [PMID: 35066606 PMCID: PMC8881240 DOI: 10.1007/s00408-021-00505-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 07/28/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive and ultimately fatal disease with a variable clinical course. Biomarkers that predict patient outcomes are needed. We leveraged data from 300 patients in the multicenter IPF-PRO Registry to determine associations between circulating proteins and the composite outcome of respiratory death or lung transplant. Plasma collected at enrollment was analyzed using aptamer-based proteomics (1305 proteins). Over a median follow-up of 30.4 months, there were 76 respiratory deaths and 26 lung transplants. In unadjusted univariable analyses, 61 proteins were significantly associated with the outcome (hazard ratio > 2 or < 0.5, corrected p ≤ 0.05). In multivariable analyses, a set of 4 clinical measures and 47 unique proteins predicted the probability of respiratory death or lung transplant with an optimism-corrected C-index of 0.76. Our results suggest that select circulating proteins strongly associate with the risk of mortality in patients with IPF and confer information independent of clinical measures.
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Affiliation(s)
- Jamie L Todd
- Duke Clinical Research Institute, DUMC Box 103002, Durham, NC, 27710, USA. .,Duke University Medical Center, Durham, NC, USA.
| | - Megan L Neely
- Duke Clinical Research Institute, DUMC Box 103002, Durham, NC, 27710, USA.,Duke University Medical Center, Durham, NC, USA
| | - Robert Overton
- Duke Clinical Research Institute, DUMC Box 103002, Durham, NC, 27710, USA
| | - Hillary Mulder
- Duke Clinical Research Institute, DUMC Box 103002, Durham, NC, 27710, USA
| | - Jesse Roman
- Jane and Leonard Korman Respiratory Institute, Philadelphia, PA, USA
| | - Joseph A Lasky
- School of Medicine, Tulane University, New Orleans, LA, USA
| | | | | | | | | | | | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - John A Belperio
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Scott M Palmer
- Duke Clinical Research Institute, DUMC Box 103002, Durham, NC, 27710, USA.,Duke University Medical Center, Durham, NC, USA
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7
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Li FJ, Surolia R, Li H, Wang Z, Liu G, Kulkarni T, Massicano AVF, Mobley JA, Mondal S, de Andrade JA, Coonrod SA, Thompson PR, Wille K, Lapi SE, Athar M, Thannickal VJ, Carter AB, Antony VB. Citrullinated vimentin mediates development and progression of lung fibrosis. Sci Transl Med 2021; 13:13/585/eaba2927. [PMID: 33731433 DOI: 10.1126/scitranslmed.aba2927] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/06/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
The mechanisms by which environmental exposures contribute to the pathogenesis of lung fibrosis are unclear. Here, we demonstrate an increase in cadmium (Cd) and carbon black (CB), common components of cigarette smoke (CS) and environmental particulate matter (PM), in lung tissue from subjects with idiopathic pulmonary fibrosis (IPF). Cd concentrations were directly proportional to citrullinated vimentin (Cit-Vim) amounts in lung tissue of subjects with IPF. Cit-Vim amounts were higher in subjects with IPF, especially smokers, which correlated with lung function and were associated with disease manifestations. Cd/CB induced the secretion of Cit-Vim in an Akt1- and peptidylarginine deiminase 2 (PAD2)-dependent manner. Cit-Vim mediated fibroblast invasion in a 3D ex vivo model of human pulmospheres that resulted in higher expression of CD26, collagen, and α-SMA. Cit-Vim activated NF-κB in a TLR4-dependent fashion and induced the production of active TGF-β1, CTGF, and IL-8 along with higher surface expression of TLR4 in lung fibroblasts. To corroborate ex vivo findings, mice treated with Cit-Vim, but not Vim, independently developed a similar pattern of fibrotic tissue remodeling, which was TLR4 dependent. Moreover, wild-type mice, but not PAD2-/- and TLR4 mutant (MUT) mice, exposed to Cd/CB generated high amounts of Cit-Vim, in both plasma and bronchoalveolar lavage fluid, and developed lung fibrosis in a stereotypic manner. Together, these studies support a role for Cit-Vim as a damage-associated molecular pattern molecule (DAMP) that is generated by lung macrophages in response to environmental Cd/CB exposure. Furthermore, PAD2 might represent a promising target to attenuate Cd/CB-induced fibrosis.
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Affiliation(s)
- Fu Jun Li
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ranu Surolia
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Huashi Li
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Zheng Wang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Gang Liu
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Tejaswini Kulkarni
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Adriana V F Massicano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - James A Mobley
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Santanu Mondal
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Joao A de Andrade
- Vanderbilt Lung Institute, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Scott A Coonrod
- Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Paul R Thompson
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Keith Wille
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Suzanne E Lapi
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Mohammad Athar
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Victor J Thannickal
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Birmingham VA Medical Center, Birmingham, AL 35294, USA
| | - A Brent Carter
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Birmingham VA Medical Center, Birmingham, AL 35294, USA
| | - Veena B Antony
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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8
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Snyder LD, Mosher C, Holtze CH, Lancaster LH, Flaherty KR, Noth I, Neely ML, Hellkamp AS, Bender S, Conoscenti CS, de Andrade JA, Whelan TP. Time to diagnosis of idiopathic pulmonary fibrosis in the IPF-PRO Registry. BMJ Open Respir Res 2021; 7:7/1/e000567. [PMID: 32624493 PMCID: PMC7337884 DOI: 10.1136/bmjresp-2020-000567] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Received: 01/23/2020] [Revised: 05/12/2020] [Accepted: 06/04/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a progressive disease with high mortality. Patient characteristics associated with diagnostic delays are not well described. METHODS Subjects who had not been diagnosed with IPF prior to referral and received a new diagnosis of IPF at an enrolling centre for the IPF-PRO (Idiopathic Pulmonary Fibrosis Prospective Outcomes) Registry were characterised as having a longer (>1 year) or shorter (≤1 year) time from symptom onset to diagnosis and from first imaging evidence of fibrosis to diagnosis. Patient characteristics, evaluations and time to death or lung transplant were compared between these cohorts. RESULTS Among 347 patients with a symptom onset date, 49% were diagnosed with IPF >1 year after symptom onset. These patients were slightly younger and had more cardiac comorbidities than patients diagnosed ≤1 year after symptom onset. Among 454 patients with a date for imaging evidence of fibrosis, 78% were diagnosed with IPF ≤1 year later. A greater proportion of patients with >1 year versus ≤1 year from imaging evidence of fibrosis to diagnosis had cardiac comorbidities and gastro-oesophageal reflux. There was no significant difference in time to death or lung transplant between groups by time to diagnosis. CONCLUSIONS The time from symptom onset to diagnosis remains over 1 year in approximately half of the patients with IPF, but once imaging evidence is obtained, most of the patients are diagnosed within a year. Cardiac conditions and gastro-oesophageal disorders were more commonly reported in patients with a longer time to diagnosis.
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Affiliation(s)
- Laurie D Snyder
- Duke Clinical Research Institute, Durham, North Carolina, USA .,Duke University Medical Center, Durham, North Carolina, USA
| | | | - Colin H Holtze
- University of Michigan Health System, Ann Arbor, Michigan, USA
| | | | | | - Imre Noth
- University of Virginia, Charlottesville, Virginia, USA
| | - Megan L Neely
- Duke Clinical Research Institute, Durham, North Carolina, USA.,Duke University Medical Center, Durham, North Carolina, USA
| | - Anne S Hellkamp
- Duke Clinical Research Institute, Durham, North Carolina, USA.,Duke University Medical Center, Durham, North Carolina, USA
| | - Shaun Bender
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut, USA
| | | | | | - Timothy Pm Whelan
- Medical University of South Carolina, Charleston, South Carolina, USA
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9
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de Andrade JA, Owens GM, Tolle L. Idiopathic pulmonary fibrosis: exploring the clinical and economic implications of the evolving treatment landscape. Am J Manag Care 2021; 27:S131-S137. [PMID: 34003616 DOI: 10.37765/ajmc.2021.88655] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common idiopathic interstitial pneumonia, a form of interstitial lung disease characterized by abnormal wound healing in the lung that leads to progressive scarring and loss of lung function. Comorbidities are highly prevalent in IPF and often lead to further complications and worse outcomes. In fact, undetected and untreated comorbidities are independently associated with poor outcomes. IPF not only affects patient quality of life (QOL) but also requires significant cost for delivering care. Given the potential for rapid progression of IPF and the associated risk for mortality, early diagnosis is critical for retaining the highest lung function and QOL for as long as possible. Delayed diagnosis of IPF is associated with increased costs in terms of investigations performed, and delayed referral can result in lower survival rates independent of disease severity or associated prognostic factors. Significant progress has been made in understanding IPF pathogenesis, which has, in turn, led to the development of novel therapeutic options that improve outcomes, extend life, and minimize disease burden on patients' daily lives. For patients with IPF in the absence of underlying liver disease, pirfenidone and nintedanib are licensed for the treatment of IPF. Additionally, a number of investigational therapeutic options are currently in development. The extent of clinical effectiveness compared with the cost of therapy has led to a lack of consensus on the cost-vs-benefit analyses for the drugs.
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Affiliation(s)
| | | | - Leslie Tolle
- Cleveland Clinic Respiratory Institute, Cleveland, OH.
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10
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Rahaghi F, Belperio JA, Fitzgerald J, Gulati M, Hallowell R, Highland KB, Huie TJ, Kim HJ, Kolb M, Lasky JA, Southern BD, Swigris JJ, de Andrade JA. Delphi Consensus Recommendations on Management of Dosing, Adverse Events, and Comorbidities in the Treatment of Idiopathic Pulmonary Fibrosis with Nintedanib. Clin Med Insights Circ Respir Pulm Med 2021; 15:11795484211006050. [PMID: 33854398 PMCID: PMC8013629 DOI: 10.1177/11795484211006050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 11/16/2022]
Abstract
Purpose: Nintedanib is an approved treatment for idiopathic pulmonary fibrosis (IPF), which slows disease progression. Management of patients with IPF receiving nintedanib can be complicated by tolerability issues, comorbidities, and concomitant medications. We developed consensus recommendations on the management of dosing, adverse events and comorbidities in patients with IPF treated with nintedanib. Methods: A modified Delphi process using 3 questionnaires was used to survey 14 pulmonologists experienced in using nintedanib. Panelists rated their agreement with statements on a Likert scale from −5 (strongly disagree) to +5 (strongly agree). Consensus was predefined as a mean score of ⩽−2.5 or ⩾+2.5 with a standard deviation not crossing zero. Results: The panelists’ recommendations were largely aligned with clinical trial data, real-world evidence, and the prescribing information, and provided additional guidance regarding minimizing gastrointestinal effects, periodic monitoring for liver dysfunction, caution with respect to concomitant administration of cytochrome P450 3A4 and P-glycoprotein 1 inhibitors and inducers and anticoagulants, and management of comorbidities. The panelists unanimously agreed that adverse event management should be individualized, based on careful consideration of the risks and benefits of each possible intervention and discussion with the patient. Conclusions: These consensus recommendations provide additional guidance on the appropriate management of IPF with nintedanib, for use alongside evidence-based literature and the prescribing information.
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Affiliation(s)
| | | | - John Fitzgerald
- University of Texas (UT) Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | - Hyun J Kim
- University of Minnesota, Minneapolis, MN, USA
| | - Martin Kolb
- McMaster University Firestone Institute for Respiratory Health (FIRH), Hamilton, ON, Canada
| | - Joseph A Lasky
- Tulane University School of Medicine, New Orleans, LA, USA
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11
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Rahaghi FF, Safdar Z, Brown AW, de Andrade JA, Flaherty KR, Kaner RJ, King CS, Padilla ML, Noth I, Scholand MB, Shifren A, Nathan SD. Expert consensus on the management of adverse events and prescribing practices associated with the treatment of patients taking pirfenidone for idiopathic pulmonary fibrosis: a Delphi consensus study. BMC Pulm Med 2020; 20:191. [PMID: 32664913 PMCID: PMC7362639 DOI: 10.1186/s12890-020-01209-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 12/03/2019] [Accepted: 06/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background In patients with idiopathic pulmonary fibrosis (IPF) treated with pirfenidone (Esbriet®, Genentech USA, Inc. South San Francisco, CA.), effectively managing treatment-related adverse events (AEs) may improve adherence. Due to a lack of clinical evidence and expertise, managing these AEs can be challenging for patients and physicians alike. In the absence of evidence, consensus recommendations from physicians experienced in using pirfenidone to treat IPF are beneficial. Methods Using a modified Delphi process, expert recommendations were developed by a panel of physicians experienced with using pirfenidone for IPF. Over three iterations, panelists developed and refined a series of statements on the use of pirfenidone in IPF. Their agreement on each statement was ranked using a Likert scale. Results A panel of 12 physicians participated and developed a total of 286 statements on dosing and administration, special populations, drug-drug interactions, laboratory analysis, warnings and precautions, and AE management. Expert recommendations were achieved with regard to slower initial titrations and slower titrations for AEs, dosing with meal(s) or substantial meals, and adding other prescribed pharmacological agents for AEs. Conclusion Until there is further clinical evidence, the resulting consensus recommendations are intended to provide direction on the practical management of IPF with pirfenidone, by encompassing a broad experience from the real world to complement data gleaned from clinical trials.
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Affiliation(s)
- Franck F Rahaghi
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
| | | | | | | | | | - Robert J Kaner
- Weill Cornell Medicine Pulmonary & Critical Care Medicine, New York, NY, USA
| | | | | | - Imre Noth
- The University of Chicago Medicine, Chicago, IL, USA
| | | | - Adrian Shifren
- Washington University School of Medicine, St. Louis, MO, USA
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12
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Yin Q, Strong MJ, Zhuang Y, Flemington EK, Kaminski N, de Andrade JA, Lasky JA. Assessment of viral RNA in idiopathic pulmonary fibrosis using RNA-seq. BMC Pulm Med 2020; 20:81. [PMID: 32245461 PMCID: PMC7119082 DOI: 10.1186/s12890-020-1114-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 07/16/2019] [Accepted: 03/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background Numerous publications suggest an association between herpes virus infection and idiopathic pulmonary fibrosis (IPF). These reports have employed immunohistochemistry, in situ hybridization and/or PCR, which are susceptible to specificity artifacts. Methods We investigated the possible association between IPF and viral RNA expression using next-generation sequencing, which has the potential to provide a high degree of both sensitivity and specificity. We quantified viral RNA expression for 740 viruses in 28 IPF patient lung biopsy samples and 20 controls. Key RNA-seq results were confirmed using Real-time RT-PCR for select viruses (EBV, HCV, herpesvirus saimiri and HERV-K). Results We identified sporadic low-level evidence of viral infections in our lung tissue specimens, but did not find a statistical difference for expression of any virus, including EBV, herpesvirus saimiri and HERV-K, between IPF and control lungs. Conclusions To the best of our knowledge, this is the first publication that employs RNA-seq to assess whether viral infections are linked to the pathogenesis of IPF. Our results do not address the role of viral infection in acute exacerbations of IPF, however, this analysis patently did not support an association between herpes virus detection and IPF.
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Affiliation(s)
- Qinyan Yin
- Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Michael J Strong
- Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Yan Zhuang
- Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Erik K Flemington
- Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Naftali Kaminski
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, 300 Cedar Street, Ste S441D, New Haven, CT, 06519, USA
| | - Joao A de Andrade
- Division of Allergy, Pulmonary, Critical Care Medicine, Department of Medicine, Vanderbilt University, 1161 21st Avenue South, B1317 MCN, Nashville, TN, 37232-2650, USA
| | - Joseph A Lasky
- Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
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13
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Fan Y, Bender SD, Conoscenti CS, Davidson-Ray L, Cowper PA, Palmer SM, de Andrade JA. Hospital-Based Resource Use and Costs Among Patients With Idiopathic Pulmonary Fibrosis Enrolled in the Idiopathic Pulmonary Fibrosis Prospective Outcomes (IPF-PRO) Registry. Chest 2020; 157:1522-1530. [PMID: 32004554 DOI: 10.1016/j.chest.2019.12.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 07/26/2019] [Revised: 12/04/2019] [Accepted: 12/14/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a rare and serious condition that is associated with high health-care resource use. The goal of this study was to estimate hospital-related resource use and costs by using a national, prospective registry of patients who were diagnosed with IPF or who had their diagnosis confirmed at the enrolling center in the past 6 months in the United States. METHODS Participants enrolled between June 5, 2014, and April 12, 2016, in the ongoing Idiopathic Pulmonary Fibrosis Prospective Outcomes Registry were included (N = 300). Time to first hospitalization was analyzed by using Kaplan-Meier methods. Annualized costs were estimated for hospitalizations, ICU admissions, and ED visits. RESULTS At enrollment, most participants were male (75%), white (95%), commercially insured (64%), smokers (68%), had an FVC between 50% and 80% predicted (66%), and received antifibrotic drugs (55%). During the first 12 months of follow-up, participants averaged 0.11 ED visit, 0.42 hospitalization, 0.08 ICU admission, 2.18 hospital days, and 0.45 ICU day. Probability of hospitalization was 18% and 30% at 6 and 12 months, respectively, and was highest for those with FVC < 50% predicted/diffusing lung capacity for carbon monoxide < 30% predicted. Mean annual costs (95% CI) for ICU admission and inpatient care were $10,098 ($4,732-$16,662) and $13,975 ($8,482-$20,918), respectively, per patient. CONCLUSIONS IPF is associated with a substantial economic burden incurred by patients requiring hospital care. Future research in IPF should focus on improving clinical outcomes while reducing cost of care in hospitals. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01915511; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Yanni Fan
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT
| | - Shaun D Bender
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT
| | | | - Linda Davidson-Ray
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Patricia A Cowper
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Scott M Palmer
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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14
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Kulkarni T, Yuan K, Tran-Nguyen TK, Kim YI, de Andrade JA, Luckhardt T, Valentine VG, Kass DJ, Duncan SR. Decrements of body mass index are associated with poor outcomes of idiopathic pulmonary fibrosis patients. PLoS One 2019; 14:e0221905. [PMID: 31584949 PMCID: PMC6777779 DOI: 10.1371/journal.pone.0221905] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The processes that result in progression of idiopathic pulmonary fibrosis (IPF) remain enigmatic. Moreover, the course of this disease can be highly variable and difficult to accurately predict. We hypothesized analyses of body mass index (BMI), a simple, routine clinical measure, may also have prognostic value in these patients, and might provide mechanistic insights. We investigated the associations of BMI changes with outcome, plasma adipokines, and adaptive immune activation among IPF patients. METHODS Data were analyzed in an IPF discovery cohort (n = 131) from the University of Pittsburgh, and findings confirmed in patients from the University of Alabama at Birmingham (n = 148). Plasma adipokines were measured by ELISA and T-cell phenotypes determined by flow cytometry. RESULTS Transplant-free one-year survivals in subjects with the greatest rates of BMI decrements, as percentages of initial BMI (>0.68%/month), were worse than among those with more stable BMI in both discovery (HR = 1.8, 95%CI = 1.1-3.2, p = 0.038) and replication cohorts (HR = 2.5, 95%CI = 1.2-5.2, p = 0.02), when adjusted for age, baseline BMI, and pulmonary function. BMI decrements >0.68%/month were also associated with greater mortality after later lung transplantations (HR = 4.6, 95%CI = 1.7-12.5, p = 0.003). Circulating leptin and adiponectin levels correlated with BMI, but neither adipokine was prognostic per se. BMI decrements were significantly associated with increased proportions of circulating end-differentiated (CD28null) CD4 T-cells (CD28%), a validated marker of repetitive T-cell activation and IPF prognoses. CONCLUSIONS IPF patients with greatest BMI decrements had worse outcomes, and this effect persisted after lung transplantation. Weight loss in these patients is a harbinger of poor prognoses, and may reflect an underlying systemic process, such as adaptive immune activation.
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Affiliation(s)
- Tejaswini Kulkarni
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kaiyu Yuan
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Thi K. Tran-Nguyen
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Young-il Kim
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Joao A. de Andrade
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Birmingham VA Medical Center, Birmingham, Alabama, United States of America
| | - Tracy Luckhardt
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Vincent G. Valentine
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Daniel J. Kass
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Steven R. Duncan
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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15
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Culver DA, Behr J, Belperio JA, Corte TJ, de Andrade JA, Flaherty KR, Gulati M, Huie TJ, Lancaster LH, Roman J, Ryerson CJ, Kim HJ. Patient Registries in Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2019; 200:160-167. [PMID: 31034241 PMCID: PMC6635784 DOI: 10.1164/rccm.201902-0431ci] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/24/2019] [Indexed: 01/06/2023] Open
Abstract
Over the past decade, several large registries of patients with idiopathic pulmonary fibrosis (IPF) have been established. These registries are collecting a wealth of longitudinal data on thousands of patients with this rare disease. The data collected in these registries will be complementary to data collected in clinical trials because the patient populations studied in registries have a broader spectrum of disease severity and comorbidities and can be followed for a longer period of time. Maintaining the quality and completeness of registry databases presents administrative and resourcing challenges, but it is important to ensuring the robustness of the analyses. Data from patient registries have already helped improve understanding of the clinical characteristics of patients with IPF, the impact that the disease has on their quality of life and survival, and current practices in diagnosis and management. In the future, analyses of biospecimens linked to detailed patient profiles will provide the opportunity to identify biomarkers linked to disease progression, facilitating the development of precision medicine approaches for prognosis and therapy in patients with IPF.
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Affiliation(s)
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilians University of Munich, Munich, Germany
- Asklepios Clinic Gauting, Member of the German Center for Lung Research, Gauting, Germany
| | - John A. Belperio
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Tamera J. Corte
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Kevin R. Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mridu Gulati
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Jesse Roman
- Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Hyun J. Kim
- University of Minnesota, Minneapolis, Minnesota
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16
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Moore C, Blumhagen RZ, Yang IV, Walts A, Powers J, Walker T, Bishop M, Russell P, Vestal B, Cardwell J, Markin CR, Mathai SK, Schwarz MI, Steele MP, Lee J, Brown KK, Loyd JE, Crapo JD, Silverman EK, Cho MH, James JA, Guthridge JM, Cogan JD, Kropski JA, Swigris JJ, Bair C, Kim DS, Ji W, Kim H, Song JW, Maier LA, Pacheco KA, Hirani N, Poon AS, Li F, Jenkins RG, Braybrooke R, Saini G, Maher TM, Molyneaux PL, Saunders P, Zhang Y, Gibson KF, Kass DJ, Rojas M, Sembrat J, Wolters PJ, Collard HR, Sundy JS, O’Riordan T, Strek ME, Noth I, Ma SF, Porteous MK, Kreider ME, Patel NB, Inoue Y, Hirose M, Arai T, Akagawa S, Eickelberg O, Fernandez IE, Behr J, Mogulkoc N, Corte TJ, Glaspole I, Tomassetti S, Ravaglia C, Poletti V, Crestani B, Borie R, Kannengiesser C, Parfrey H, Fiddler C, Rassl D, Molina-Molina M, Machahua C, Worboys AM, Gudmundsson G, Isaksson HJ, Lederer DJ, Podolanczuk AJ, Montesi SB, Bendstrup E, Danchel V, Selman M, Pardo A, Henry MT, Keane MP, Doran P, Vašáková M, Sterclova M, Ryerson CJ, Wilcox PG, Okamoto T, Furusawa H, Miyazaki Y, Laurent G, Baltic S, Prele C, Moodley Y, Shea BS, Ohta K, Suzukawa M, Narumoto O, Nathan SD, Venuto DC, Woldehanna ML, Kokturk N, de Andrade JA, Luckhardt T, Kulkarni T, Bonella F, Donnelly SC, McElroy A, Armstong ME, Aranda A, Carbone RG, Puppo F, Beckman KB, Nickerson DA, Fingerlin TE, Schwartz DA. Resequencing Study Confirms That Host Defense and Cell Senescence Gene Variants Contribute to the Risk of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2019; 200:199-208. [PMID: 31034279 PMCID: PMC6635791 DOI: 10.1164/rccm.201810-1891oc] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/22/2019] [Indexed: 12/20/2022] Open
Abstract
Rationale: Several common and rare genetic variants have been associated with idiopathic pulmonary fibrosis, a progressive fibrotic condition that is localized to the lung. Objectives: To develop an integrated understanding of the rare and common variants located in multiple loci that have been reported to contribute to the risk of disease. Methods: We performed deep targeted resequencing (3.69 Mb of DNA) in cases (n = 3,624) and control subjects (n = 4,442) across genes and regions previously associated with disease. We tested for associations between disease and 1) individual common variants via logistic regression and 2) groups of rare variants via sequence kernel association tests. Measurements and Main Results: Statistically significant common variant association signals occurred in all 10 of the regions chosen based on genome-wide association studies. The strongest risk variant is the MUC5B promoter variant rs35705950, with an odds ratio of 5.45 (95% confidence interval, 4.91-6.06) for one copy of the risk allele and 18.68 (95% confidence interval, 13.34-26.17) for two copies of the risk allele (P = 9.60 × 10-295). In addition to identifying for the first time that rare variation in FAM13A is associated with disease, we confirmed the role of rare variation in the TERT and RTEL1 gene regions in the risk of IPF, and found that the FAM13A and TERT regions have independent common and rare variant signals. Conclusions: A limited number of common and rare variants contribute to the risk of idiopathic pulmonary fibrosis in each of the resequencing regions, and these genetic variants focus on biological mechanisms of host defense and cell senescence.
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Affiliation(s)
- Camille Moore
- National Jewish Health, Denver, Colorado
- School of Public Health
| | | | | | | | | | | | | | | | | | | | - Cheryl R. Markin
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | | | | | - James E. Loyd
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - James D. Crapo
- National Jewish Health, Denver, Colorado
- Department of Medicine, and
| | - Edwin K. Silverman
- Brigham and Women’s Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Michael H. Cho
- Brigham and Women’s Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Judith A. James
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
| | | | - Joy D. Cogan
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jonathan A. Kropski
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Carol Bair
- National Jewish Health, Denver, Colorado
| | - Dong Soon Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonjun Ji
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hocheol Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Woo Song
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Lisa A. Maier
- National Jewish Health, Denver, Colorado
- School of Public Health
- Department of Medicine, and
| | | | - Nikhil Hirani
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- Respiratory Medicine Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Azin S. Poon
- Respiratory Medicine Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Feng Li
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - R. Gisli Jenkins
- Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Rebecca Braybrooke
- Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Gauri Saini
- Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Toby M. Maher
- Royal Brompton Hospital and Imperial College, London, United Kingdom
| | | | - Peter Saunders
- Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Yingze Zhang
- Simmons Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin F. Gibson
- Simmons Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel J. Kass
- Simmons Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mauricio Rojas
- Simmons Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Sembrat
- Simmons Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul J. Wolters
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Harold R. Collard
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | | | - Mary E. Strek
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Imre Noth
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Shwu-Fan Ma
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Mary K. Porteous
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maryl E. Kreider
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Namrata B. Patel
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yoshikazu Inoue
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Masaki Hirose
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Toru Arai
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Shinobu Akagawa
- National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Oliver Eickelberg
- Department of Medicine, and
- Helmholtz Zentrum München, Neuherberg, Germany
| | | | | | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Bornova, Izmir, Turkey
| | - Tamera J. Corte
- Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Ian Glaspole
- Alfred Hospital and Monash University, Melbourne, Australia
| | | | - Claudia Ravaglia
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
| | - Bruno Crestani
- Université Paris Diderot and Hôpital Bichat, Paris, France
| | - Raphael Borie
- Université Paris Diderot and Hôpital Bichat, Paris, France
| | | | - Helen Parfrey
- Royal Papworth Hospital and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Christine Fiddler
- Royal Papworth Hospital and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Doris Rassl
- Royal Papworth Hospital and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Maria Molina-Molina
- Respiratory Department, University Hospital of Bellvitge, University of Barcelona, Barcelona, Spain
| | - Carlos Machahua
- Respiratory Department, University Hospital of Bellvitge, University of Barcelona, Barcelona, Spain
| | - Ana Montes Worboys
- Respiratory Department, University Hospital of Bellvitge, University of Barcelona, Barcelona, Spain
| | - Gunnar Gudmundsson
- National University Hospital of Iceland, University of Iceland, Reykjavik, Iceland
| | - Helgi J. Isaksson
- National University Hospital of Iceland, University of Iceland, Reykjavik, Iceland
| | - David J. Lederer
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Anna J. Podolanczuk
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sydney B. Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Vivi Danchel
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas,” México City, México
| | - Annie Pardo
- Universidad Nacional Autónoma de México, México City, México
| | - Michael T. Henry
- Cork University Hospital and University College Cork, Cork, Ireland
| | - Michael P. Keane
- St. Vincent’s University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Peter Doran
- St. Vincent’s University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Martina Vašáková
- Department of Respiratory Medicine, First Faculty of Medicine Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Martina Sterclova
- Department of Respiratory Medicine, First Faculty of Medicine Charles University and Thomayer Hospital, Prague, Czech Republic
| | | | | | - Tsukasa Okamoto
- Department of Medicine, and
- Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruhiko Furusawa
- Department of Medicine, and
- Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Geoffrey Laurent
- Institute for Respiratory Health and
- Centre for Cell Therapy and Regenerative Medicine, School of Biomedical Sciences, The University of Western Australia, Perth, Australia
| | | | - Cecilia Prele
- Institute for Respiratory Health and
- Centre for Cell Therapy and Regenerative Medicine, School of Biomedical Sciences, The University of Western Australia, Perth, Australia
| | | | - Barry S. Shea
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ken Ohta
- National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Maho Suzukawa
- National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Osamu Narumoto
- National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Steven D. Nathan
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, Virginia
| | - Drew C. Venuto
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, Virginia
| | - Merte L. Woldehanna
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, Virginia
| | - Nurdan Kokturk
- Department of Pulmonary Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Joao A. de Andrade
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tracy Luckhardt
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tejaswini Kulkarni
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Francesco Bonella
- Ruhrlandklinik, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Seamus C. Donnelly
- Department of Medicine, Tallaght University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Aoife McElroy
- Department of Medicine, Tallaght University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Michelle E. Armstong
- Department of Medicine, Tallaght University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Alvaro Aranda
- CardioPulmonary Reserach Center, Alliance Pulmonary Group, Guaynabo, Puerto Rico
| | | | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Kenneth B. Beckman
- Biomedical Genomics Center, University of Minnesota; Minneapolis, Minnesota; and
| | | | - Tasha E. Fingerlin
- National Jewish Health, Denver, Colorado
- School of Public Health
- Department of Medicine, and
| | - David A. Schwartz
- National Jewish Health, Denver, Colorado
- Department of Medicine, and
- Department of Immunology, University of Colorado Denver, Denver, Colorado
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Jagpal A, Crowe DR, de Andrade JA, Del Pilar Acosta Lara M, Navarro-Millan I. More than meets the eye: IgG4-related disease presenting as isolated interstitial lung disease. Rheumatology (Oxford) 2018; 56:1630-1631. [PMID: 28582539 DOI: 10.1093/rheumatology/kex146] [Citation(s) in RCA: 2] [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: 12/24/2022] Open
Affiliation(s)
| | | | - Joao A de Andrade
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama.,Birmingham VA Medical Center, Birmingham, AL, USA
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de Andrade JA, Luckhardt T. What Is in a Pattern? That Which We Call Idiopathic Pulmonary Fibrosis by Any Other Pattern Would Behave Alike! Am J Respir Crit Care Med 2017; 195:10-12. [PMID: 28035849 DOI: 10.1164/rccm.201606-1277ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Joao A de Andrade
- 1 Department of Medicine University of Alabama at Birmingham Birmingham, Alabama and.,2 Birmingham Veterans Affairs Medical Center Birmingham, Alabama
| | - Tracy Luckhardt
- 1 Department of Medicine University of Alabama at Birmingham Birmingham, Alabama and
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Lancaster LH, de Andrade JA, Zibrak JD, Padilla ML, Albera C, Nathan SD, Wijsenbeek MS, Stauffer JL, Kirchgaessler KU, Costabel U. Pirfenidone safety and adverse event management in idiopathic pulmonary fibrosis. Eur Respir Rev 2017; 26:26/146/170057. [PMID: 29212837 PMCID: PMC9488585 DOI: 10.1183/16000617.0057-2017] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [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: 05/12/2017] [Accepted: 09/07/2017] [Indexed: 12/31/2022] Open
Abstract
Pirfenidone is one of two approved therapies for the treatment of idiopathic pulmonary fibrosis (IPF). Randomised controlled clinical trials and subsequent post hoc analyses have demonstrated that pirfenidone reduces lung function decline, decreases mortality and improves progression-free survival. Long-term extension trials, registries and real-world studies have also shown similar treatment effects with pirfenidone. However, for patients with IPF to obtain the maximum benefits of pirfenidone treatment, the potential adverse events (AEs) associated with pirfenidone need to be managed. This review highlights the well-known and established safety profile of pirfenidone based on randomised controlled clinical trials and real-world data. Key strategies for preventing and managing the most common pirfenidone-related AEs are described, with the goal of maximising adherence to pirfenidone with minimal AEs. Using key strategies to prevent and manage pirfenidone-related AEs can help maximise adherence to pirfenidonehttp://ow.ly/Veyk30gsFTs
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Affiliation(s)
| | | | | | - Maria L Padilla
- Mount Sinai - National Jewish Health Respiratory Institute, New York, NY, USA
| | | | | | | | | | | | - Ulrich Costabel
- Ruhrlandklinik, University of Duisberg-Essen, Essen, Germany
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20
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Li FJ, Surolia R, Li H, Wang Z, Kulkarni T, Liu G, de Andrade JA, Kass DJ, Thannickal VJ, Duncan SR, Antony VB. Autoimmunity to Vimentin Is Associated with Outcomes of Patients with Idiopathic Pulmonary Fibrosis. J Immunol 2017; 199:1596-1605. [PMID: 28754682 DOI: 10.4049/jimmunol.1700473] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/06/2017] [Indexed: 02/02/2023]
Abstract
Autoimmunity has been implicated in the pathogenesis of idiopathic pulmonary fibrosis (IPF); however, the repertoire of autoantigens involved in this disease and the clinical relevance of these autoimmune responses are still being explored. Our initial discovery assays demonstrated that circulating and intrapulmonary vimentin levels are increased in IPF patients. Subsequent studies showed native vimentin induced HLA-DR-dependent in vitro proliferation of CD4 T cells from IPF patients and enhanced the production of IL-4, IL-17, and TGF-β1 by these lymphocytes in contrast to normal control specimens. Vimentin supplementation of IPF PBMC cultures also resulted in HLA-DR-dependent production of IgG with anti-vimentin specificities. Circulating anti-vimentin IgG autoantibody levels were much greater in IPF subjects from the University of Alabama at Birmingham (n = 102) and the University of Pittsburgh (U. Pitt., n = 70) than in normal controls. Anti-vimentin autoantibody levels in IPF patients were HLA biased and inversely correlated with physiological measurements of lung function (i.e., forced expiratory volumes and diffusing capacities). Despite considerable intergroup differences in transplant-free survival between these two independent IPF cohorts, serious adverse outcomes were most frequent among the patients within each population that had the highest anti-vimentin autoantibody levels (University of Alabama at Birmingham: hazard ratio 2.5, 95% confidence interval 1.2-5.3, p = 0.012; University of Pittsburgh: hazard ratio 2.7, 95% confidence interval 1.3-5.5, p = 0.006). These data show that anti-vimentin autoreactivity is prevalent in IPF patients and is strongly associated with disease manifestations. These findings have implications with regard to the pathogenesis of this enigmatic disease and raise the possibility that therapies specifically directed at these autoimmune processes could have therapeutic efficacy.
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Affiliation(s)
- Fu Jun Li
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Ranu Surolia
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Huashi Li
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Zheng Wang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Tejaswini Kulkarni
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Gang Liu
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Joao A de Andrade
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294.,Birmingham VA Medical Center, Birmingham, AL 35233; and
| | - Daniel J Kass
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213
| | - Victor J Thannickal
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294.,Birmingham VA Medical Center, Birmingham, AL 35233; and
| | - Steven R Duncan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Veena B Antony
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294;
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21
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Pennathur S, Vivekanandan-Giri A, Locy ML, Kulkarni T, Zhi D, Zeng L, Byun J, de Andrade JA, Thannickal VJ. Oxidative Modifications of Protein Tyrosyl Residues Are Increased in Plasma of Human Subjects with Interstitial Lung Disease. Am J Respir Crit Care Med 2016; 193:861-8. [PMID: 26575972 DOI: 10.1164/rccm.201505-0992oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 11/16/2022] Open
Abstract
RATIONALE Interstitial lung diseases (ILDs) are associated with oxidative stress. Plasma biomarkers that are directly linked to oxidative stress responses in this disease have not been identified. Stable oxidation products of tyrosine residues in proteins may reflect the oxidative microenvironment in the lung or a systemic inflammatory state. OBJECTIVES To determine if levels of protein tyrosine oxidation are elevated in plasma of patients with ILD compared with an age- and sex-matched healthy control cohort. METHODS Three tyrosine oxidation products (3-chlorotyrosine, 3-nitrotyrosine, and o,o'-dityrosine) were quantified by tandem mass spectrometry in cellular models, a mouse model of injury-induced fibrosis, and in plasma of healthy control subjects and patients with ILD (n = 42 in each group). MEASUREMENTS AND MAIN RESULTS Plasma levels of 3-chlorotyrosine, 3-nitrotyrosine, and o,o'-dityrosine were markedly elevated in patients with ILD compared with control subjects with receiver operating characteristic curves separating these groups of 0.872, 0.893, and 0.997, respectively. In a murine model of lung fibrosis, levels of all three oxidative tyrosine modifications were increased in plasma and lung tissue. Cellular models support a critical role for a heme peroxidase and enzymatic sources of reactive oxygen species in the generation of these oxidized products. CONCLUSIONS We demonstrate an increase in oxidized tyrosine moieties within proteins in the circulating plasma of patients with ILD. These data support the potential for development of oxidative stress-related biomarkers in early diagnosis, prognostication, and/or in evaluating responsiveness to emerging therapies for ILD.
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Affiliation(s)
- Subramaniam Pennathur
- 1 Division of Nephrology.,Department of Internal Medicine, and 2 Computational Medicine and Biology, University of Michigan, Ann Arbor, Michigan; and
| | | | - Morgan L Locy
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Tejaswini Kulkarni
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Degui Zhi
- 4 Department of Biostatistics, University of Alabama, Birmingham, Alabama
| | | | | | - Joao A de Andrade
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Victor J Thannickal
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
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22
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Schwiebert LM, Estell K, Meadows T, Thannickal VJ, Rowe S, Sorscher EJ, Harris WT, Gaggar A, Dransfield M, de Andrade JA. Development and maintenance of a biospecimen repository for clinical samples derived from pulmonary patients. Clin Transl Sci 2014; 7:336-41. [PMID: 24889057 DOI: 10.1111/cts.12161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The Pulmonary Biospecimen Repository (PBR) at the University of Alabama at Birmingham (UAB) was launched in 2009. The purpose of the UAB PBR is to provide investigators within the pulmonary community at UAB and elsewhere with clinical samples derived from multiple lung diseases, including transplant recipients, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, cystic fibrosis, and asthma. Cell and fluid samples isolated from bronchoalveolar lavage (BAL), plasma, and serum are collected and stored; samples are assessed routinely for viability. Each sample is linked directly with the respective patient information via the Pulmonary Translational Research and Clinical Database, a Health Insurance Portability and Accountability Act compliant database that includes detailed information allowing for the study of specific patient cohorts. To access samples, investigators must complete a request form, which is reviewed by the UAB PBR Steering Committee. To date, more than 800 patients have provided approximately 7,000 BAL, serum and plasma fluid, and cell samples. Over the past 4 years, nearly 800 of these samples have been distributed to investigators at UAB and elsewhere. Future plans for the UAB PBR include expanding sample collection to additional pulmonary diseases, such as mycobacterial infections, increasing the number of sample users and obtaining external funding to ensure its continued sustainability.
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Affiliation(s)
- Lisa M Schwiebert
- Department of Cell, Developmental and Integrative Biology; Department of Medicine - Division of Pulmonary, Allergy and Critical Care Medicine
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Abstract
BACKGROUND Acetylcysteine has been suggested as a beneficial treatment for idiopathic pulmonary fibrosis, although data from placebo-controlled studies are lacking. METHODS In our initial double-blind, placebo-controlled trial, we randomly assigned patients who had idiopathic pulmonary fibrosis with mild-to-moderate impairment in pulmonary function to receive a three-drug regimen of prednisone, azathioprine, and acetylcysteine; acetylcysteine alone; or placebo. The study was interrupted owing to safety concerns associated with the three-drug regimen. The trial continued as a two-group study (acetylcysteine vs. placebo) without other changes; 133 and 131 patients were enrolled in the acetylcysteine and placebo groups, respectively. The primary outcome was the change in forced vital capacity (FVC) over a 60-week period. RESULTS At 60 weeks, there was no significant difference in the change in FVC between the acetylcysteine group and the placebo group (-0.18 liters and -0.19 liters, respectively; P=0.77). In addition, there were no significant differences between the acetylcysteine group and the placebo group in the rates of death (4.9% vs. 2.5%, P=0.30 by the log-rank test) or acute exacerbation (2.3% in each group, P>0.99). CONCLUSIONS As compared with placebo, acetylcysteine offered no significant benefit with respect to the preservation of FVC in patients with idiopathic pulmonary fibrosis with mild-to-moderate impairment in lung function. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT00650091.).
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Affiliation(s)
- Fernando J. Martinez
- Weill Cornell Medical College, New York, NY
- University of Michigan, Ann Arbor, MI
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Sodré CP, Guilherme RS, Meloni VFA, Brunoni D, Juliano Y, Andrade JAD, Belangero SIN, Christofolini DM, Kulikowski LD, Melaragno MI. Ring chromosome instability evaluation in six patients with autosomal rings. Genet Mol Res 2010; 9:134-43. [PMID: 20198569 DOI: 10.4238/vol9-1gmr707] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Ring chromosomes are often associated with abnormal phenotypes due to loss of genomic material and also because of ring instability at mitosis after sister chromatid exchange events. We investigated ring chromosome instability in six patients with ring chromosomes 4, 14, 15, and 18 by examining 48- and 72-h lymphocyte cultures at the first, second and subsequent cell divisions after bromodeoxyuridine incorporation. Although most cells from all patients showed only one monocentric ring chromosome, ring chromosome loss and secondary aberrations were observed both in 48- and 72-h lymphocyte cultures and in metaphase cells of the different cell generations. We found no clear-cut correlation between ring size and ring instability; we also did not find differences between apparently complete rings and rings with genetic material loss. The cytogenetic findings revealed secondary aberrations in all ring chromosome patients. We concluded that cells with ring chromosome instability can multiply and survive in vivo, and that they can influence the patient's phenotype.
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Affiliation(s)
- C P Sodré
- Departamento de Morfologia e Genética da Universidade Federal de São Paulo, São Paulo, SP, Brasil
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25
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Krowka MJ, Ahmad S, de Andrade JA, Frost A, Glassberg MK, Lancaster LH, Lasky J, Mathier MA, Stocks J. A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY TO EVALUATE THE SAFETY AND EFFICACY OF ILOPROST INHALATION IN ADULTS WITH ABNORMAL PULMONARY ARTERIAL PRESSURE AND EXERCISE LIMITATION ASSOCIATED WITH IDIOPATHIC PULMONARY FIBROSIS. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.633a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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King TE, Behr J, Brown KK, du Bois RM, Lancaster L, de Andrade JA, Stähler G, Leconte I, Roux S, Raghu G. BUILD-1: a randomized placebo-controlled trial of bosentan in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2007; 177:75-81. [PMID: 17901413 DOI: 10.1164/rccm.200705-732oc] [Citation(s) in RCA: 355] [Impact Index Per Article: 20.9] [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: 02/03/2023] Open
Abstract
RATIONALE Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal lung disease lacking effective treatment. OBJECTIVES To determine the effects of bosentan on exercise capacity and time to disease progression in patients with IPF. METHODS In a double-blind, multicenter trial, patients with IPF were randomized to receive oral bosentan 62.5 mg twice daily for 4 weeks, increased to 125 mg twice daily thereafter, or placebo, for 12 months or longer. The primary efficacy endpoint was change from baseline up to Month 12 in exercise capacity, as measured by a modified six-minute-walk test. Secondary endpoints were time to death or disease progression (worsening pulmonary function tests [PFTs] or acute decompensation), change in PFT scores, and quality of life (QOL) assessed using Short-Form 36 and St. George's Respiratory Questionnaire. MEASUREMENTS AND MAIN RESULTS A total of 158 patients randomly received bosentan (n = 74) or placebo (n = 84). Bosentan showed no superiority over placebo in six-minute-walk distance (6MWD) up to Month 12, the primary efficacy endpoint. A trend in favor of bosentan was observed in the secondary endpoint of time to death or disease progression (hazard ratio [HR], 0.613; 95% confidence interval [CI], 0.328-1.144; P = 0.119), which was more pronounced in a patient subgroup diagnosed using surgical lung biopsy (post hoc analysis; HR, 0.315; 95% CI, 0.126-0.789; P = 0.009). Changes from baseline up to Month 12 in assessments of dyspnea and QOL favored treatment with bosentan. No unexpected adverse events were reported. CONCLUSIONS Bosentan treatment in patients with IPF did not show superiority over placebo on 6MWD. A trend in delayed time to death or disease progression, and improvement in QOL, was observed with bosentan. The more pronounced treatment effect in patients with biopsy-proven IPF warrants further investigation. Clinical trial registered with www.clinicaltrials.gov (NCT 00071461).
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Affiliation(s)
- Talmadge E King
- Department of Medicine, UCSF, 505 Parnassus Avenue, Room M994, San Francisco, CA 94110, USA.
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Takeno SS, Corbani M, Andrade JAD, Smith MDAC, Brunoni D, Melaragno MI. Duplication 4p and deletion 4p (Wolf-Hirschhorn syndrome) due to complementary gametes from a 3:1 segregation of a maternal balanced t(4;13)(p16;q11) translocation. ACTA ACUST UNITED AC 2004; 129A:180-3. [PMID: 15316961 DOI: 10.1002/ajmg.a.30224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We present clinical and cytogenetic data on a family with a t(4;13)(p16;q11) translocation present in four generations. The balanced translocation resulted in one individual with monosomy 4p and one individual with trisomy 4p, due to 3:1 segregation. The male patient with trisomy 4p was fertile and transmitted the extra chromosome to his daughter.
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Affiliation(s)
- S S Takeno
- Genetics Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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29
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Dalla Torre CA, Maciel RMB, Pinheiro NA, Andrade JAD, De Toledo SRC, Villa LL, Cerutti JM. TRAP-silver staining, a highly sensitive assay for measuring telomerase activity in tumor tissue and cell lines. Braz J Med Biol Res 2002; 35:65-8. [PMID: 11743616 DOI: 10.1590/s0100-879x2002000100009] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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: 11/22/2022] Open
Abstract
Measurement of telomerase activity in clinically obtained tumor samples may provide important information for use as both a diagnostic marker and a prognostic indicator for patient outcome. In order to evaluate telomerase activity in tumor tissue without radiolabeling the product, we developed a simple telomeric repeat amplification protocol-silver-staining assay that is less time-consuming, is safe and requires minimal equipment. In addition, we determined the sensitivity of the silver-staining method by using extracts of telomerase-positive thyroid carcinoma cell lines which were serially diluted from 5,000 to 10 cells. Telomerase activity was also assayed in 19 thyroid tumors, 2 normal controls and 27 bone marrow aspirates. The results indicate that the technique permits the detection of telomerase activity from 5000 to as few as 10 cells. We propose that it could be immediately applicable in many laboratories due to the minimal amount of equipment required.
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Affiliation(s)
- C A Dalla Torre
- Divisão de Genética, Departamento de Morfologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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