1
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Larsson P, Holz O, Koster G, Postle A, Olin AC, Hohlfeld JM. Exhaled breath particles as a novel tool to study lipid composition of epithelial lining fluid from the distal lung. BMC Pulm Med 2023; 23:423. [PMID: 37924084 PMCID: PMC10623716 DOI: 10.1186/s12890-023-02718-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/27/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Surfactant phospholipid (PL) composition plays an important role in lung diseases. We compared the PL composition of non-invasively collected exhaled breath particles (PEx) with bronchoalveolar lavage (BAL) and induced sputum (ISP) at baseline and following endotoxin (LPS) challenges. METHODS PEx and BAL were collected from ten healthy nonsmoking participants before and after segmental LPS challenge. Four weeks later, PEx and ISP were sampled in the week before and after a whole lung LPS inhalation challenge. PL composition was analysed using mass spectrometry. RESULTS The overall PL composition of BAL, ISP and PEx was similar, with PC(32:0) and PC(34:1) representing the largest fractions in all three sample types (baseline PC(32:0) geometric mean mol%: 52.1, 56.9, and 51.7, PC(34:1) mol%: 11.7, 11.9 and 11.4, respectively). Despite this similarity, PEx PL composition was more closely related to BAL than to ISP. For most lipids comparable inter-individual differences in BAL, ISP, and PEx were found. PL composition of PEx was repeatable. The most pronounced increase following segmental LPS challenge was detected for SM(d34:1) in BAL (0.24 to 0.52 mol%) and following inhalation LPS challenge in ISP (0.45 to 0.68 mol%). An increase of SM(d34:1) following segmental LPS challenge was also detectable in PEx (0.099 to 0.103 mol%). The inhalation challenge did not change PL composition of PEx. CONCLUSION Our data supports the peripheral origin of PEx. The lack of PL changes in PEx after inhalation challenge might to be due to the overall weaker response of inhaled LPS which primarily affects the larger airways. Compared with BAL, which always contains lining fluid from both peripheral lung and central airways, PEx analysis might add value as a selective and non-invasive method to investigate peripheral airway PL composition. TRIAL REGISTRATION NCT03044327, first posted 07/02/2017.
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Affiliation(s)
- Per Larsson
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olaf Holz
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany.
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.
| | - Grielof Koster
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anthony Postle
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jens M Hohlfeld
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Hannover Medical School, Department of Respiratory Medicine, Hannover, Germany
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2
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Shahrokny P, Maison N, Riemann L, Ehrmann M, DeLuca D, Schuchardt S, Thiele D, Weckmann M, Dittrich AM, Schaub B, Brinkmann F, Hansen G, Kopp MV, von Mutius E, Rabe KF, Bahmer T, Hohlfeld JM, Grychtol R, Holz O. Increased breath naphthalene in children with asthma and wheeze of the All Age Asthma Cohort (ALLIANCE). J Breath Res 2023; 18:016003. [PMID: 37604132 DOI: 10.1088/1752-7163/acf23e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/21/2023] [Indexed: 08/23/2023]
Abstract
Exhaled breath contains numerous volatile organic compounds (VOCs) known to be related to lung disease like asthma. Its collection is non-invasive, simple to perform and therefore an attractive method for the use even in young children. We analysed breath in children of the multicenter All Age Asthma Cohort (ALLIANCE) to evaluate if 'breathomics' have the potential to phenotype patients with asthma and wheeze, and to identify extrinsic risk factors for underlying disease mechanisms. A breath sample was collected from 142 children (asthma: 51, pre-school wheezers: 55, healthy controls: 36) and analysed using gas chromatography-mass spectrometry (GC/MS). Children were diagnosed according to Global Initiative for Asthma guidelines and comprehensively examined each year over up to seven years. Forty children repeated the breath collection after 24 or 48 months. Most breath VOCs differing between groups reflect the exposome of the children. We observed lower levels of lifestyle-related VOCs and higher levels of the environmental pollutants, especially naphthalene, in children with asthma or wheeze. Naphthalene was also higher in symptomatic patients and in wheezers with recent inhaled corticosteroid use. No relationships with lung function or TH2 inflammation were detected. Increased levels of naphthalene in asthmatics and wheezers and the relationship to disease severity could indicate a role of environmental or indoor air pollution for the development or progress of asthma. Breath VOCs might help to elucidate the role of the exposome for the development of asthma. The study was registered at ClinicalTrials.gov (NCT02496468).
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Affiliation(s)
- P Shahrokny
- Fraunhofer ITEM, Department of Clinical Airway Research, German Center for Lung Research (BREATH, DZL), Hannover, Germany
| | - N Maison
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Germany German Center for Lung Research (CPC-M, DZL), Munich, Germany
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - L Riemann
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (BREATH, DZL), Hannover, Germany
- Clinician Scientist Program TITUS, Else-Kröner-Fresenius-Stiftung, Hannover Medical School, Hannover, Germany
- Institute of Immunology, Hannover Medical School, Hannover, Germany
| | - M Ehrmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Germany German Center for Lung Research (CPC-M, DZL), Munich, Germany
| | - D DeLuca
- German Center for Lung Research (BREATH, DZL), Hannover, Germany
| | - S Schuchardt
- Fraunhofer ITEM, Bio- and Environmental Analytics, Hannover, Germany
| | - D Thiele
- Division of Pediatric Pulmonology and Allergology, University Children's Hospital, German Center for Lung Research (ARCN, DZL), Luebeck, Germany
- Institute of Medical Biometry and Statistics (IMBS), University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - M Weckmann
- Division of Pediatric Pulmonology and Allergology, University Children's Hospital, German Center for Lung Research (ARCN, DZL), Luebeck, Germany
- Epigenetics of Chronic Lung Disease, Priority Research Area Chronic Lung Diseases, Leibniz Lung Research Center Borstel, Borstel, Germany
| | - A M Dittrich
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (BREATH, DZL), Hannover, Germany
| | - B Schaub
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Germany German Center for Lung Research (CPC-M, DZL), Munich, Germany
| | - F Brinkmann
- Division of Pediatric Pulmonology and Allergology, University Children's Hospital, German Center for Lung Research (ARCN, DZL), Luebeck, Germany
| | - G Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (BREATH, DZL), Hannover, Germany
| | - M V Kopp
- Division of Pediatric Pulmonology and Allergology, University Children's Hospital, German Center for Lung Research (ARCN, DZL), Luebeck, Germany
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - E von Mutius
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Germany German Center for Lung Research (CPC-M, DZL), Munich, Germany
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - K F Rabe
- LungenClinic Grosshansdorf and Department of Medicine, Christian-Albrechts-University Kiel, German Center for Lung Research (ARCN, DZL), Grosshansdorf, Germany
| | - T Bahmer
- LungenClinic Grosshansdorf and Department of Medicine, Christian-Albrechts-University Kiel, German Center for Lung Research (ARCN, DZL), Grosshansdorf, Germany
- Internal Medicine Department I, University Hospital Schleswig-Holstein, UKSH - Campus Kiel, German Center for Lung Research (ARCN, DZL), Kiel, Germany
| | - J M Hohlfeld
- Fraunhofer ITEM, Department of Clinical Airway Research, German Center for Lung Research (BREATH, DZL), Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - R Grychtol
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (BREATH, DZL), Hannover, Germany
| | - O Holz
- Fraunhofer ITEM, Department of Clinical Airway Research, German Center for Lung Research (BREATH, DZL), Hannover, Germany
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Pham YL, Holz O, Beauchamp JD. Emissions and uptake of volatiles by sampling components in breath analysis. J Breath Res 2023; 17. [PMID: 37074671 DOI: 10.1088/1752-7163/acce34] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/19/2023] [Indexed: 04/20/2023]
Abstract
The first and most crucial step in breath research is adequate sampling, which plays a pivotal role in quality assurance of breath datasets. In particular, the emissions or uptake of volatile organic compounds (VOCs) by sampling interface materials present a risk of disrupting breath gas samples. This study investigated emissions and uptake by three interface components, namely a silicon facemask, a reusable 3D-printed mouthpiece adapter, and a pulmonary function test filter compatible with the commercial ReCIVA breath sampling device. Emissions were examined before and after (hydro-)thermal treatment of the components, and uptake was assessed by exposing each material to 12 representative breath VOCs comprising alcohols, aldehydes, ketones, carboxylic acids, terpenes, sulphurous and nitrogenous compounds at different target concentration ranges (10 ppbV and 100 ppbV). Chemical analyses of VOCs were performed using proton transfer reaction-time-of-flight-mass spectrometry (PTR-TOFMS) with supporting analyses via thermal desorption comprehensive two-dimensional gas chromatography-time-of-flight-mass spectrometry (TD-GC×GC-TOFMS). The filter exhibited the lowest overall emissions compared to the mask or adapter, which both had equivalently high emissions (albeit for different compounds). Treatment of the materials reduced the total VOC emissions by 63 % in the mask, 90 % in the filter and 99 % in the adapter. Uptakes of compounds were lowest for the adapter and most pronounced in the mask. In particular, 1-butanol, acetone, 2-butanone, 1,8-cineole and dimethyl sulphide showed negligible uptake across all materials, whereas ethanol, nonanal, acetic acid, butanoic acid, limonene and indole exhibited marked reductions. Knowledge of emissions and/or uptake by sampling components is key to reducing the likelihood of erroneous data interpretation that will ultimately expedite progress in the field of breath test development.
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Affiliation(s)
- Y Lan Pham
- Sensory Analytics and Technologies, Fraunhofer-Institut für Verfahrenstechnik und Verpackung IVV, Fraunhofer Institute for Process Engineering and Packaging IVV, Freising, 85354, GERMANY
| | - Olaf Holz
- Clinical Airway Research, Fraunhofer-Institut für Toxikologie und Experimentelle Medizin ITEM, Feodor-Lynen-Str. 15, Hannover, Niedersachsen, 30625, GERMANY
| | - Jonathan D Beauchamp
- Sensory Analytics and Technologies, Fraunhofer-Institut für Verfahrenstechnik und Verpackung IVV, Giggenhauser Strasse 35, Freising, Bayern, 85354, GERMANY
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4
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Haase LM, Birk T, Poland CA, Holz O, Müller M, Bachand AM, Mundt KA. Cross-sectional Study of Workers Employed at a Copper Smelter-Effects of Long-term Exposures to Copper on Lung Function and Chronic Inflammation. J Occup Environ Med 2022; 64:e550-e558. [PMID: 35902212 PMCID: PMC9426729 DOI: 10.1097/jom.0000000000002610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the effect of exposure to copper-containing dust on lung function and inflammatory endpoints among workers of a German copper plant, effects rarely studied before. METHODS One hundred four copper-exposed smelter workers and 70 referent workers from the precious metal and lead facilities were included, with different metal exposures in both groups due to the different process materials. Body plethysmography, exhaled nitric oxide (FeNO) measurements, and blood sampling were conducted in all workers. Smoking status and the use of respiratory protective equipment were considered. In a subgroup of 40 nonsmoking volunteers (28 copper-exposed and 12 referents), sputum biomarkers were assessed. RESULTS Median lung function values of both copper-exposed and the referent groups were within reference ranges of "healthy" individuals, and statistical differences between the groups were mostly not evident. Similarly, differences in blood and sputum biomarkers were too small to be biologically relevant. CONCLUSION The results suggest the absence of the detectable effects of copper-containing dust exposure on lung function or chronic inflammation within the investigated cohort.
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5
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Pham YL, Beauchamp J, Clement A, Wiegandt F, Holz O. 3D-printed mouthpiece adapter for sampling exhaled breath in medical applications. 3D Print Med 2022; 8:27. [PMID: 35943600 PMCID: PMC9364600 DOI: 10.1186/s41205-022-00150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
The growing use of 3D printing in the biomedical sciences demonstrates its utility for a wide range of research and healthcare applications, including its potential implementation in the discipline of breath analysis to overcome current limitations and substantial costs of commercial breath sampling interfaces. This technical note reports on the design and construction of a 3D-printed mouthpiece adapter for sampling exhaled breath using the commercial respiration collector for in-vitro analysis (ReCIVA) device. The paper presents the design and digital workflow transition of the adapter and its fabrication from three commercial resins (Surgical Guide, Tough v5, and BioMed Clear) using a Formlabs Form 3B stereolithography (SLA) printer. The use of the mouthpiece adapter in conjunction with a pulmonary function filter is appraised in comparison to the conventional commercial silicon facemask sampling interface. Besides its lower cost - investment cost of the printing equipment notwithstanding - the 3D-printed adapter has several benefits, including ensuring breath sampling via the mouth, reducing the likelihood of direct contact of the patient with the breath sampling tubes, and being autoclaveable to enable the repeated use of a single adapter, thereby reducing waste and associated environmental burden compared to current one-way disposable facemasks. The novel adapter for breath sampling presented in this technical note represents an additional field of application for 3D printing that further demonstrates its widespread applicability in biomedicine.
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Affiliation(s)
- Y Lan Pham
- Fraunhofer Institute for Process Engineering and Packaging IVV, Giggenhauser Straße 35, 85354, Freising, Germany.,Department of Chemistry and Pharmacy, Chair of Aroma and Smell Research, Friedrich-Alexander-Universität Erlangen-Nürnberg, Henkestraße 9, 91054, Erlangen, Germany
| | - Jonathan Beauchamp
- Fraunhofer Institute for Process Engineering and Packaging IVV, Giggenhauser Straße 35, 85354, Freising, Germany
| | - Alexander Clement
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Feodor-Lynen-Str. 15, 30625, Hannover, Germany
| | - Felix Wiegandt
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Feodor-Lynen-Str. 15, 30625, Hannover, Germany
| | - Olaf Holz
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Feodor-Lynen-Str. 15, 30625, Hannover, Germany. .,Member of the German Centre of Lung Research DZL (BREATH), Hannover, Germany.
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6
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Rothbart N, Stanley V, Koczulla R, Jarosch I, Holz O, Schmalz K, Hübers HW. Millimeter-wave gas spectroscopy for breath analysis of COPD patients in comparison to GC-MS. J Breath Res 2022; 16. [PMID: 35688126 DOI: 10.1088/1752-7163/ac77aa] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/14/2022] [Accepted: 06/10/2022] [Indexed: 01/12/2023]
Abstract
The analysis of human breath is a very active area of research, driven by the vision of a fast, easy, and non-invasive tool for medical diagnoses at the point of care. Millimeter-wave gas spectroscopy (MMWGS) is a novel, well-suited technique for this application as it provides high sensitivity, specificity and selectivity. Most of all, it offers the perspective of compact low-cost systems to be used in doctors' offices or hospitals. In this work, we demonstrate the analysis of breath samples acquired in a medical environment using MMWGS and evaluate validity, reliability, as well as limitations and perspectives of the method. To this end, we investigated 28 duplicate samples from chronic obstructive lung disease patients and compared the results to gas chromatography-mass spectrometry (GC-MS). The quantification of the data was conducted using a calibration-free fit model, which describes the data precisely and delivers absolute quantities. For ethanol, acetone, and acetonitrile, the results agree well with the GC-MS measurements and are as reliable as GC-MS. The duplicate samples deviate from the mean values by only 6% to 18%. Detection limits of MMWGS depend strongly on the molecular species. For example, acetonitrile can be traced down to 1.8 × 10-12mol by the MMWGS system, which is comparable to the GC-MS system. We observed correlations of abundances between formaldehyde and acetaldehyde as well as between acetonitrile and acetaldehyde, which demonstrates the potential of MMWGS for breath research.
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Affiliation(s)
- Nick Rothbart
- Institute of Optical Sensor Systems, German Aerospace Center (DLR), Berlin, Germany.,Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Victoria Stanley
- Institute of Optical Sensor Systems, German Aerospace Center (DLR), Berlin, Germany.,Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Rembert Koczulla
- Schön Klinik Berchtesgadener Land, Research Institute for Pulmonary Rehabilitation, Schönau am Königssee, Germany.,Philipps-University of Marburg, Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Inga Jarosch
- Schön Klinik Berchtesgadener Land, Research Institute for Pulmonary Rehabilitation, Schönau am Königssee, Germany.,Philipps-University of Marburg, Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Olaf Holz
- Fraunhofer ITEM, German Center for Lung Research (BREATH, DZL), Clinical Airway Research, Hannover, Germany
| | - Klaus Schmalz
- IHP-Leibniz-Institut für Innovative Mikroelektronik, Frankfurt (Oder), Germany
| | - Heinz-Wilhelm Hübers
- Institute of Optical Sensor Systems, German Aerospace Center (DLR), Berlin, Germany.,Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
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Holz O, Müller M, Carstensen S, Olin AC, Hohlfeld JM. Inflammatory cytokines can be monitored in exhaled breath particles following segmental and inhalation endotoxin challenge in healthy volunteers. Sci Rep 2022; 12:5620. [PMID: 35379863 PMCID: PMC8979977 DOI: 10.1038/s41598-022-09399-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Particles in exhaled air (PEx) are generated when collapsed small airways reopen during breathing. PEx can be noninvasively collected by particle impaction, allowing the analysis of undiluted epithelial lining fluid (ELF). We used the endotoxin (LPS) challenge model to proof the concept that PEx can be used to monitor inflammatory changes in the lung. In this pilot study PEx were collected from ten healthy nonsmoking subjects using the PExA® instrument twice before and twice after a segmental LPS challenge (5, 21 h). Following a 4-week washout period, PEx were collected during the week before and 5 h after a whole lung LPS inhalation challenge. PEx biomarkers were compared to blood, bronchoalveolar lavage (BAL) following segmental challenge and induced sputum (ISP) following inhalation challenge. A clear LPS-induced inflammatory response was detectable in BAL fluid, ISP and blood. Albumin and surfactant-protein D were detectable in all PEx samples. While most baseline cytokines were close to or below the detection limit, the median (IQR) IL-6 and IL-8 concentrations in PEx increased significantly after segmental (0.04 (0.03; 0.06) fg/ng PEx; 0.10 (0.08; 0.17) fg/ng PEx) and inhalation LPS challenge (0.19 (0.15; 0.23) fg/ng PEx; 0.32 (0.23; 0.42) fg/ng PEx). Using a highly sensitive analysis platform, we were able to detect a cytokine response in PEx during the early phase of LPS-induced inflammation. This will broaden the spectrum of applications for this noninvasive method to monitor inflammatory processes in the lung, including its use in clinical trials for respiratory drug development.Trial registration: The study has been registered on 07.02.2017 at Clinicaltrials.gov (NCT03044327).
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Affiliation(s)
- Olaf Holz
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 30625, Hannover, Germany. .,German Center for Lung Research (BREATH), Hannover, Germany.
| | - Meike Müller
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 30625, Hannover, Germany
| | - Saskia Carstensen
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 30625, Hannover, Germany
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Jens M Hohlfeld
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, 30625, Hannover, Germany.,German Center for Lung Research (BREATH), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
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Holz O, van Vorstenbosch R, Günther F, Schuchardt S, Trinkmann F, van Schooten FJ, Smolinska A, Hohlfeld J. Changes of breath volatile organic compounds in healthy volunteers following segmental and inhalation endotoxin challenge. J Breath Res 2022; 16. [PMID: 35366648 DOI: 10.1088/1752-7163/ac6359] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/26/2021] [Accepted: 04/01/2022] [Indexed: 11/11/2022]
Abstract
Background It is still unclear how airway inflammation affects the breath volatile organic compounds (VOC) profile in exhaled air. We therefore analyzed breath following well-defined pulmonary endotoxin (lipopolysaccharide, LPS) challenges. Methods Breath was collected from 10 healthy non-smoking subjects at eight time points before and after segmental and whole lung LPS inhalation challenge. Four Tenax-TA® adsorption tubes were simultaneously loaded from an aluminum reservoir cylinder and independently analyzed by two research groups using gas chromatography - mass spectrometry. Airway inflammation was assessed in bronchoalveolar lavage (BAL) and in sputum after segmental and inhaled LPS challenge, respectively. Results Segmental LPS challenge significantly increased the median (interquartile range, IQR) percentage of neutrophils in BAL from 3.0 (4.2) % to 64.0 (7.3) %. The inhalation challenge increased sputum neutrophils from 33.9 (26.8) % to 78.3 (13.5) %. We observed increases in breath aldehydes at both time points after segmental and inhaled LPS challenge. These results were confirmed by an independent laboratory. The longitudinal breath analysis also revealed distinct VOC patterns related to environmental exposures, clinical procedures, and to metabolic changes after food intake. Conclusions Changes in breath aldehydes suggest a relationship to LPS induced inflammation compatible with lipid peroxidation processes within the lung. Findings from our longitudinal data highlight the need for future studies to better consider the potential impact of the multiple VOCs from detergents, hygiene or lifestyle products a subject is continuously exposed to. We suspect that this very individual "owncloud" exposure is contributing to an increased variability of breath aldehydes, which might limit a use as inflammatory markers in daily clinical practice.
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Affiliation(s)
- Olaf Holz
- Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Feodor-Lynen-Str. 15, Hannover, 30625, GERMANY
| | | | - Frank Günther
- Bio- and Environmental Analytics, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Feodor-Lynen-Str. 15, Hannover, 30625, GERMANY
| | - Sven Schuchardt
- Bio- and Environmental Analytics, Fraunhofer-Institut fur Toxikologie und Experimentelle Medizin, Feodor-Lynen-Str. 15, Hannover, Niedersachsen, 30625, GERMANY
| | - Frederik Trinkmann
- Pneumology and Critical Care Medicine, Thoraxklinik at University Hospital Heidelberg, Röntgenstraße 1, Heidelberg, 69126, GERMANY
| | - Frederik Jan van Schooten
- Department of Toxicology, University of Maastricht, Universiteitssingel 50, THE NETHERLANDS, Maastricht, 6229 ER, NETHERLANDS
| | - Agnieszka Smolinska
- Toxicology Department, Maastricht University, Universiteitssingel 50, Maastricht, 6229 ER, NETHERLANDS
| | - Jens Hohlfeld
- ITEM, Fraunhofer Institute for Toxicology and Experimental Medicine, Nikolai-Fuchs-Str. 1, Hannover, 30625, GERMANY
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9
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Sadiq MW, Holz O, Ellinghusen BD, Faulenbach C, Müller M, Badorrek P, Eriksson UG, Fridén M, Stomilovic S, Lundqvist AJ, Hohlfeld JM. Lung pharmacokinetics of inhaled and systemic drugs: A clinical evaluation. Br J Pharmacol 2021; 178:4440-4451. [PMID: 34250588 DOI: 10.1111/bph.15621] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/09/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Human pharmacokinetic studies of lung-targeted drugs are typically limited to measurements of systemic plasma concentrations, which provide no direct information on lung target-site concentrations. We aimed to evaluate lung pharmacokinetics of commonly prescribed drugs by sampling different lung compartments after inhalation and oral administration. EXPERIMENTAL APPROACH Healthy volunteers received single, sequential doses of either inhaled salbutamol, salmeterol and fluticasone propionate (n = 12), or oral salbutamol and propranolol (n = 6). Each participant underwent bronchoscopies and gave breath samples for analysis of particles in exhaled air at two points after drug administration (1 and 6, 2 and 9, 3 and 12, or 4 and 18 h). Lung samples were taken via bronchosorption, bronchial brush, mucosal biopsy and bronchoalveolar lavage during each bronchoscopy. Blood samples were taken during the 24 h after administration. Pharmacokinetic profiles were generated by combining data from multiple individuals, covering all sample timings. KEY RESULTS Pharmacokinetic profiles were obtained for each drug in lung epithelial lining fluid, lung tissue and plasma. Inhalation of salbutamol resulted in approximately 100-fold higher concentrations in lung than in plasma. Salmeterol and fluticasone concentration ratios in lung versus plasma were higher still. Bronchosorption- and bronchoalveolar-lavage-generated profiles of inhaled drugs in epithelial lining fluid were comparable. For orally administered drugs, epithelial-lining-fluid concentrations were overestimated in bronchoalveolar-lavage-generated profiles. CONCLUSION AND IMPLICATIONS Combining pharmacokinetic data derived from several individuals and techniques sampling different lung compartments enabled generation of pharmacokinetic profiles for evaluation of lung targeting after inhaled and oral drug delivery.
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Affiliation(s)
- Muhammad Waqas Sadiq
- Clinical and Quantitative Pharmacology, AstraZeneca, Gothenburg, Sweden.,Clinical Pharmacology and Safety Sciences, AstraZeneca, Gothenburg, Sweden.,R&D, AstraZeneca, Gothenburg, Sweden
| | - Olaf Holz
- Division of Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany.,Biomedical Research in End-stage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Birthe D Ellinghusen
- Division of Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Cornelia Faulenbach
- Division of Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Meike Müller
- Division of Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Philipp Badorrek
- Division of Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Ulf G Eriksson
- Clinical and Quantitative Pharmacology, AstraZeneca, Gothenburg, Sweden.,Clinical Pharmacology and Safety Sciences, AstraZeneca, Gothenburg, Sweden.,R&D, AstraZeneca, Gothenburg, Sweden
| | - Markus Fridén
- Drug Metabolism and Pharmacokinetics, AstraZeneca, Gothenburg, Sweden.,Research and Early Development, AstraZeneca, Gothenburg, Sweden.,Respiratory and Immunology, AstraZeneca, Gothenburg, Sweden.,BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.,Department of Pharmaceutical Biosciences, Division of Pharmacokinetics and Drug Therapy, Uppsala University, Uppsala, Sweden
| | - Stina Stomilovic
- Drug Metabolism and Pharmacokinetics, AstraZeneca, Gothenburg, Sweden.,Research and Early Development, AstraZeneca, Gothenburg, Sweden.,Respiratory and Immunology, AstraZeneca, Gothenburg, Sweden.,BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anders J Lundqvist
- Drug Metabolism and Pharmacokinetics, AstraZeneca, Gothenburg, Sweden.,Research and Early Development, AstraZeneca, Gothenburg, Sweden.,Respiratory and Immunology, AstraZeneca, Gothenburg, Sweden.,BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Jens M Hohlfeld
- Division of Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany.,Biomedical Research in End-stage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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10
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Abdo M, Uddin M, Goldmann T, Marwitz S, Bahmer T, Holz O, Kirsten AM, Trinkmann F, von Mutius E, Kopp M, Hansen G, Rabe KF, Watz H, Pedersen F. Raised sputum extracellular DNA confers lung function impairment and poor symptom control in an exacerbation-susceptible phenotype of neutrophilic asthma. Respir Res 2021; 22:167. [PMID: 34082773 PMCID: PMC8173872 DOI: 10.1186/s12931-021-01759-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Extracellular DNA (e-DNA) and neutrophil extracellular traps (NETs) are linked to asthmatics airway inflammation. However, data demonstrating the characterization of airway inflammation associated with excessive e-DNA production and its impact on asthma outcomes are limited. Objective To characterize the airway inflammation associated with excessive e-DNA production and its association with asthma control, severe exacerbations and pulmonary function, particularly, air trapping and small airway dysfunction. Methods We measured e-DNA concentrations in induced sputum from 134 asthma patients and 28 healthy controls. We studied the correlation of e-DNA concentrations with sputum neutrophils, eosinophils and macrophages and the fractional exhaled nitric oxide (FeNO). Lung function was evaluated using spirometry, body plethysmography, impulse oscillometry and inert gas multiple breath washout. We stratified patients with asthma into low-DNA and high-DNA to compare lung function impairments and asthma outcomes. Results Patients with severe asthma had higher e-DNA concentration (54.2 ± 42.4 ng/µl) than patients with mild-moderate asthma (41.0 ± 44.1 ng/µl) or healthy controls (26.1 ± 16.5 ng/µl), (all p values < 0.05). E-DNA concentrations correlated directly with sputum neutrophils (R = 0.49, p < 0.0001) and negatively with sputum macrophages (R = − 0.36, p < 0.0001), but neither with sputum eosinophils (R = 0.10, p = 0.26), nor with FeNO (R = − 0.10, p = 0.22). We found that 29% of asthma patients (n = 39) had high e-DNA concentrations above the upper 95th percentile value in healthy controls (55.6 ng /μl). High-DNA was associated with broad lung function impairments including: airflow obstruction of the large (FEV1) and small airways (FEF50%, FEF25–75), increased air trapping (RV, RV/TLC), increased small airway resistance (R5-20, sReff), decreased lung elasticity (X5Hz) and increased ventilation heterogeneity (LCI), (all P values < 0.05). We also found that high e-DNA was associated with nearly three-fold greater risk of severe exacerbations (OR 2·93 [95% CI 1.2–7.5]; p = 0·012), worse asthma control test (p = 0.03), worse asthma control questionnaire scores (p = 0.01) and higher doses of inhaled corticosteroids (p = 0.026). Conclusion Increased production of extracellular DNA in the airway characterizes a subset of neutrophilic asthma patients who have broad lung function impairments, poor symptom control and increased risk of severe exacerbations.
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Affiliation(s)
- Mustafa Abdo
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany
| | - Mohib Uddin
- Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Torsten Goldmann
- Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
| | - Sebastian Marwitz
- Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
| | - Thomas Bahmer
- Department for Internal Medicine I, Airway Research Center North (ARCN), German Center for Lung Research (DZL), University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Olaf Holz
- Fraunhofer ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Anne-Marie Kirsten
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Frederik Trinkmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Biomedical Informatics, Heinrich-Lanz-Center, University Medical Center Mannheim, Mannheim, Germany
| | - Erika von Mutius
- Dr Von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Matthias Kopp
- Department of Pediatric Pneumology, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.,Division of Pediatric Pneumology and Allergology, University Hospital Schleswig-Holstein-Campus Luebeck, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany
| | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany
| | - Henrik Watz
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Frauke Pedersen
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany. .,Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.
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11
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Carstensen S, Holz O, Hohlfeld JM, Müller M. Quantitative analysis of endotoxin-induced inflammation in human lung cells by Chipcytometry. Cytometry A 2021; 99:967-976. [PMID: 33860615 DOI: 10.1002/cyto.a.24352] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/07/2022]
Abstract
Chipcytometry is a tool that uses iterative staining cycles with multiple antibodies for a detailed characterization of cells. Cell recognition is based on morphological features. Cells fixed on microfluidic chips can be stored and shipped enabling a centralized analysis, which is important for assessments in multi-center clinical trials. The method was initially implemented for the analysis of cells from peripheral blood. We adapted it to more heterogeneous human lung cells from bronchoalveolar lavage (BAL) fluid and induced sputum (IS). We aimed to assess the performance of Chipcytometry to detect and quantify the endotoxin induced inflammatory response in healthy subjects. BAL and IS samples of 10 healthy subjects were collected prior to and following segmental and inhaled endotoxin challenge. Samples were analyzed by Chipcytometry and were compared with flow cytometry, and differential cell count (DCC). Chipcytometry clearly detected the endotoxin induced inflammatory response which was characterized by a massive increase of neutrophils (BAL: 2.5% to 54.7%; IS: 40.5% to 71.1%) and monocytes (BAL: 7.7% to 24.7%; IS: 8.0% to 14.5%). While some differences between detection methods exist, the overall results were comparable. The ability of Chipcytometry to verify fluorescent signals with morphological features improved the precision of rare cell analysis such as of induced sputum lymphocytes. In conclusion, Chipcytometry enables the quantitative analysis of cells from BAL fluid and IS. Advantages over DCC and flow cytometry include the storage of cells on chips, the ability for re-analysis and the mapping of surface marker binding to morphological information. It therefore appears to be a promising method for use in clinical respiratory drug development.
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Affiliation(s)
- Saskia Carstensen
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - Olaf Holz
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Jens M Hohlfeld
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
- German Center for Lung Research (BREATH), Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Meike Müller
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
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12
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Pedersen F, Trinkmann F, Abdo M, Kirsten AM, Rabe KF, Watz H, Baraldo S, Saetta M, Hohlfeld JM, Holz O. Influence of Cell Quality on Inflammatory Biomarkers in COPD Sputum Supernatant. Int J Chron Obstruct Pulmon Dis 2021; 16:487-493. [PMID: 33688174 PMCID: PMC7935341 DOI: 10.2147/copd.s284938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/04/2020] [Accepted: 02/07/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose We recently introduced a sputum cell quality score to rate how cell morphology, cellular debris and squamous cell contamination influence inflammatory cell identification during microscopic evaluation. However, sputum cell quality is generally not considered for the interpretation of sputum fluid phase biomarkers. Therefore, we compared the soluble protein concentrations between sputum samples with different cell quality. The impact of cell quality was compared to other factors potentially affecting soluble biomarker concentrations. Methods A comprehensive sputum dataset from 154 clinically stable COPD patients was used to analyse the differences and the variability of sputum supernatant concentrations for 23 proteins between low, medium, and high sputum cell quality samples. A model was developed and tested to compare the impact of different factors on sputum supernatant protein levels. Results Mean percentages of sputum macrophages, neutrophils, eosinophils, monocytes and lymphocytes showed no significant differences between low, medium and high cell quality levels. The mean percentage of squamous cells were lower, while total cell count/mL sputum and cell viability were significantly higher in sputum samples with higher cell quality. The concentrations of Interleukin-6, Interleukin-8 and Tumor Necrosis Factor Receptor 2 were significantly increased in sputum samples of higher cell quality. The variability of most protein concentrations declined with increasing cell quality levels. Sixteen proteins showed significantly negative correlations with the percentage of squamous cells. For 14 proteins we observed a positive correlation with cell number/mL sputum. Multiple regression analysis shows that generally less than 30% of the protein variability can be explained by the included factors. Conclusion Sputum cell quality has a significant impact on some soluble biomarker concentrations in sputum supernatant. Sputum samples with low sputum cell quality show a higher variability of fluid phase proteins in comparison to medium and high sputum cell quality levels.
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Affiliation(s)
- Frauke Pedersen
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.,LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Frederik Trinkmann
- Pneumology and Critical Care Medicine, Thoraxklinik at University Hospital Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Mustafa Abdo
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Anne-Marie Kirsten
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Simonetta Baraldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Respiratory Diseases Clinic, University of Padova, Padova, Italy
| | - Marina Saetta
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Respiratory Diseases Clinic, University of Padova, Padova, Italy
| | - Jens M Hohlfeld
- Fraunhofer ITEM, Clinical Airway Research - Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School (MHH), Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Olaf Holz
- Fraunhofer ITEM, Clinical Airway Research - Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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13
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Holz O, Waschki B, Watz H, Kirsten A, Abdo M, Pedersen F, Weckmann M, Fuchs O, Dittrich AM, Hansen G, Kopp MV, von Mutius E, Rabe KF, Hohlfeld JM, Bahmer T. Breath volatile organic compounds and inflammatory markers in adult asthma patients: negative results from the ALLIANCE cohort. Eur Respir J 2021; 57:13993003.02127-2020. [PMID: 33008938 PMCID: PMC7876421 DOI: 10.1183/13993003.02127-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Olaf Holz
- Fraunhofer ITEM, Hannover, Germany.,German Center for Lung Research, BREATH.,O. Holz and B. Waschki contributed equally
| | - Benjamin Waschki
- University Hospital Hamburg-Eppendorf, Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,LungenClinic Grosshansdorf, Grosshansdorf, Germany.,German Center for Lung Research, ARCN.,O. Holz and B. Waschki contributed equally
| | - Henrik Watz
- German Center for Lung Research, ARCN.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Anne Kirsten
- German Center for Lung Research, ARCN.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Mustafa Abdo
- LungenClinic Grosshansdorf, Grosshansdorf, Germany.,German Center for Lung Research, ARCN
| | - Frauke Pedersen
- German Center for Lung Research, ARCN.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Markus Weckmann
- German Center for Lung Research, ARCN.,Division of Pediatric Pulmonology and Allergology, University Children's Hospital, Luebeck, Germany
| | - Oliver Fuchs
- Dept of Paediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.,German Center for Lung Research, CPC-M
| | - Anna-Maria Dittrich
- German Center for Lung Research, BREATH.,Dept of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- German Center for Lung Research, BREATH.,Dept of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Matthias V Kopp
- German Center for Lung Research, ARCN.,Division of Pediatric Pulmonology and Allergology, University Children's Hospital, Luebeck, Germany
| | - Erika von Mutius
- German Center for Lung Research, CPC-M.,Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Grosshansdorf, Germany.,German Center for Lung Research, ARCN
| | - Jens M Hohlfeld
- Fraunhofer ITEM, Hannover, Germany.,German Center for Lung Research, BREATH.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,J.M. Hohlfeld and T. Bahmer contributed equally
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Grosshansdorf, Germany.,University Hospital Schleswig-Holstein, Campus Kiel, Internal Medicine Department I, Pneumology, Kiel, Germany.,J.M. Hohlfeld and T. Bahmer contributed equally
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14
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Kenn K, Gloeckl R, Leitl D, Schneeberger T, Jarosch I, Hitzl W, Alter P, Sczepanski B, Winterkamp S, Boensch M, Schade-Brittinger C, Skevaki C, Holz O, Jones PW, Vogelmeier CF, Koczulla AR. Protocol for an observational study to identify potential predictors of an acute exacerbation in patients with chronic obstructive pulmonary disease (the PACE Study). BMJ Open 2021; 11:e043014. [PMID: 33558356 PMCID: PMC7871687 DOI: 10.1136/bmjopen-2020-043014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the most critical events for patients with COPD that have a negative impact on patients' quality of life, accelerate disease progression, and can result in hospital admissions and death. Although there is no distinct definition or detailed knowledge about AECOPD, it is commonly used as primary outcome in clinical studies. Furthermore, it may be difficult in clinical practice to differentiate the worsening of symptoms due to an AECOPD or to the development of heart failure. Therefore, it is of major clinical importance to investigate the underlying pathophysiology, and if possible, predictors of an AECOPD and thus to identify patients who are at high risk for developing an acute exacerbation. METHODS AND ANALYSIS In total, 355 patients with COPD will be included prospectively to this study during a 3-week inpatient pulmonary rehabilitation programme at the Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee (Germany). All patients will be closely monitored from admission to discharge. Lung function, exercise tests, clinical parameters, quality of life, physical activity and symptoms will be recorded, and blood samples and exhaled air will be collected. If a patient develops an AECOPD, there will be additional comprehensive diagnostic assessments to differentiate between cardiac, pulmonary or cardiopulmonary causes of worsening. Follow-up measures will be performed at 6, 12 and 24 months.Exploratory data analyses methods will be used for the primary research question (screening and identification of possible factors to predict an AECOPD). Regression analyses and a generalised linear model with a binomial outcome (AECOPD) will be applied to test if predictors are significant. ETHICS AND DISSEMINATION This study has been approved by the Ethical Committee of the Philipps University Marburg, Germany (No. 61/19). The results will be presented in conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04140097.
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Affiliation(s)
- Klaus Kenn
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Rainer Gloeckl
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Daniela Leitl
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Tessa Schneeberger
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Inga Jarosch
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University Salzburg, Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria
- Research Program Experimental Ophtalmology and Glaucoma Reserach, Paracelsus Medical University, Salzburg, Austria
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
| | - Bernd Sczepanski
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Sandra Winterkamp
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Martina Boensch
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Carmen Schade-Brittinger
- Coordinating Centre for Clinical Trials, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Olaf Holz
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Paul W Jones
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
| | - Andreas R Koczulla
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Medicine, Paracelsus Medical University, Salzburg, Austria
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15
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Wilkinson M, White IR, Hamshere K, Holz O, Schuchardt S, Bellagambi FG, Lomonaco T, Biagini D, Di Francesco F, Fowler SJ. The peppermint breath test: a benchmarking protocol for breath sampling and analysis using GC-MS. J Breath Res 2020; 15. [PMID: 33302258 DOI: 10.1088/1752-7163/abd28c] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/10/2020] [Indexed: 11/11/2022]
Abstract
Exhaled breath contains hundreds of volatile organic compounds (VOCs) which offers the potential for diagnosing and monitoring a wide range of diseases. As the breath research field has grown, sampling and analytical practices have become highly varied between groups. Standardisation would allow meta-analyses of data from multiple studies and greater confidence in published results. The Peppermint Consortium has been formed to address this task of standardisation. In the current study we aimed to generate initial benchmark values for thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS) analysis of breath samples containing peppermint-derived VOCs. Headspace analysis of peppermint oil capsules was performed to determine compounds of interest. Ten healthy participants were recruited by three groups. Each participant provided a baseline breath sample prior to taking a peppermint capsule, with further samples collected at 60, 90, 165, 285 and 360 min following ingestion. Sampling and analytical protocols were different for each institution, in line with their usual practice. Samples were analysed by TD-GC-MS and benchmarking values determined for the time taken for detected peppermint VOCs to return to baseline values. Sixteen compounds were identified in the capsule headspace. Additionally, 2,3-dehydro-1,8-cineole was uniquely found in the breath samples, with a washout profile that suggested it was a product of peppermint metabolism. Five compounds (α-pinene, β-pinene, eucalyptol, menthol and menthone) were quantified by all three groups. Differences in recovery were observed between the groups, particularly for menthone and menthol. The average time taken for VOCs to return to baseline was selected as the benchmark and were 441, 648, 1736, 643 and 375 min for α-pinene, β-pinene, eucalyptol, menthone and menthol respectively. An initial set of easy-to-measure benchmarking values for assessing the performance of TD-GC-MS systems for the analysis of VOCs in breath is presented. These values will be updated when more groups provide additional data.
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Affiliation(s)
- Maxim Wilkinson
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Iain R White
- Laboratory of Environmental and Life Sciences, University of Nova Gorica, Nova Gorica, 5000, SLOVENIA
| | - Katie Hamshere
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Olaf Holz
- Member of the German Center for Lung Research (BREATH), Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover, GERMANY
| | - Sven Schuchardt
- Member of the German Center for Lung Research (BREATH), Fraunhofer-Institut fur Toxikologie und Experimentelle Medizin, Hannover, GERMANY
| | - Francesca G Bellagambi
- Institut des Sciences Analytiques, Université Claude Bernard Lyon 1, 5, rue de la Doua, Villeurbanne, FRANCE, 69100, FRANCE
| | - Tommaso Lomonaco
- Universita degli Studi di Pisa Dipartimento di Chimica e Chimica Industriale, Pisa, ITALY
| | - Denise Biagini
- Universita degli Studi di Pisa Dipartimento di Chimica e Chimica Industriale, Pisa, ITALY
| | - Fabio Di Francesco
- Universita degli Studi di Pisa Dipartimento di Chimica e Chimica Industriale, Pisa, ITALY
| | - Stephen J Fowler
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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Henderson B, Ruszkiewicz DM, Wilkinson M, Beauchamp JD, Cristescu SM, Fowler SJ, Salman D, Francesco FD, Koppen G, Langejürgen J, Holz O, Hadjithekli A, Moreno S, Pedrotti M, Sinues P, Slingers G, Wilde M, Lomonaco T, Zanella D, Zenobi R, Focant JF, Grassin-Delyle S, Franchina FA, Malásková M, Stefanuto PH, Pugliese G, Mayhew C, Thomas CLP. A benchmarking protocol for breath analysis: the peppermint experiment. J Breath Res 2020; 14:046008. [PMID: 32604084 DOI: 10.1088/1752-7163/aba130] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sampling of volatile organic compounds (VOCs) has shown promise for detection of a range of diseases but results have proved hard to replicate due to a lack of standardization. In this work we introduce the 'Peppermint Initiative'. The initiative seeks to disseminate a standardized experiment that allows comparison of breath sampling and data analysis methods. Further, it seeks to share a set of benchmark values for the measurement of VOCs in breath. Pilot data are presented to illustrate the standardized approach to the interpretation of results obtained from the Peppermint experiment. This pilot study was conducted to determine the washout profile of peppermint compounds in breath, identify appropriate sampling time points, and formalise the data analysis. Five and ten participants were recruited to undertake a standardized intervention by ingesting a peppermint oil capsule that engenders a predictable and controlled change in the VOC profile in exhaled breath. After collecting a pre-ingestion breath sample, five further samples are taken at 2, 4, 6, 8, and 10 h after ingestion. Samples were analysed using ion mobility spectrometry coupled to multi-capillary column and thermal desorption gas chromatography mass spectrometry. A regression analysis of the washout data was used to determine sampling times for the final peppermint protocol, and the time for the compound measurement to return to baseline levels was selected as a benchmark value. A measure of the quality of the data generated from a given technique is proposed by comparing data fidelity. This study protocol has been used for all subsequent measurements by the Peppermint Consortium (16 partners from seven countries). So far 1200 breath samples from 200 participants using a range of sampling and analytical techniques have been collected. The data from the consortium will be disseminated in subsequent technical notes focussing on results from individual platforms.
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Affiliation(s)
- Ben Henderson
- Exhaled Biomarkers and Exposure, Department of Molecular and Laser Physics, IMM, Radboud University, Nijmegen, The Netherlands
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17
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Kern AL, Biller H, Klimeš F, Voskrebenzev A, Gutberlet M, Renne J, Müller M, Holz O, Wacker F, Hohlfeld JM, Vogel‐Claussen J. Noninvasive Monitoring of the Response of Human Lungs to Low‐Dose Lipopolysaccharide Inhalation Challenge Using MRI: A Feasibility Study. J Magn Reson Imaging 2020. [DOI: 10.1002/jmri.27206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Agilo L. Kern
- Institute of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Heike Biller
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
- Department of Clinical Airway ResearchFraunhofer Institute for Toxicology and Experimental Medicine Hannover Germany
| | - Filip Klimeš
- Institute of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Andreas Voskrebenzev
- Institute of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Marcel Gutberlet
- Institute of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Julius Renne
- Institute of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Meike Müller
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
- Department of Clinical Airway ResearchFraunhofer Institute for Toxicology and Experimental Medicine Hannover Germany
| | - Olaf Holz
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
- Department of Clinical Airway ResearchFraunhofer Institute for Toxicology and Experimental Medicine Hannover Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Jens M. Hohlfeld
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
- Department of Clinical Airway ResearchFraunhofer Institute for Toxicology and Experimental Medicine Hannover Germany
- Department of Respiratory MedicineHannover Medical School Hannover Germany
| | - Jens Vogel‐Claussen
- Institute of Diagnostic and Interventional RadiologyHannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)Member of the German Center for Lung Research (DZL) Hannover Germany
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Holz O, DeLuca DS, Roepcke S, Illig T, Weinberger KM, Schudt C, Hohlfeld JM. Smokers with COPD Show a Shift in Energy and Nitrogen Metabolism at Rest and During Exercise. Int J Chron Obstruct Pulmon Dis 2020; 15:1-13. [PMID: 32021139 PMCID: PMC6956026 DOI: 10.2147/copd.s217474] [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: 05/28/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose There is an ongoing demand for easily accessible biomarkers that reflect the physiological and pathophysiological mechanisms of COPD. To test if an exercise challenge could help to identify clinically relevant metabolic biomarkers in COPD. Patients and Methods We performed two constant-load exercise challenges separated by 4 weeks including smokers with COPD (n=23/19) and sex- and age-matched healthy smokers (n=23/20). Two hours after a standardized meal venous blood samples were obtained before, 5 mins after the start, at the end of submaximal exercise, and following a recovery of 20 mins. Data analysis was performed using mixed- effects model, with the metabolite level as a function of disease, time point and interaction terms and using each individual's resting level as reference. Results Exercise duration was longer in healthy smokers but lactate levels were comparable between groups at all four time points. Glucose levels were increased in COPD. Glutamine was lower, while glutamate and arginine were higher in COPD. Branched-chain amino acids showed a stronger decline during exercise in healthy smokers. Carnitine and the acyl-carnitines C16 and C18:1 were increased in COPD. These metabolite levels and changes were reproducible in the second challenge. Conclusion Higher serum glucose, evidence for impaired utilization of amino acids during exercise and a shift of energy metabolism to enhanced consumption of lipids could be early signs for a developing metabolic syndrome in COPD. In COPD patients, deviations of energy and nitrogen metabolism are amplified by an exercise challenge.
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Affiliation(s)
- Olaf Holz
- Fraunhofer ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - David S DeLuca
- Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Stefan Roepcke
- Department of Biomarker Development, Takeda Pharmaceuticals International GmbH, Zürich, Switzerland
| | - Thomas Illig
- Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Klaus M Weinberger
- Biocrates Life Sciences AG, Innsbruck, Austria.,Research Group for Clinical Bioinformatics, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,sAnalytiCo Ltd, Belfast, Ireland
| | | | - Jens M Hohlfeld
- Fraunhofer ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany.,Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
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19
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Kern AL, Biller H, Klimeš F, Voskrebenzev A, Gutberlet M, Renne J, Müller M, Holz O, Wacker F, Hohlfeld JM, Vogel-Claussen J. Noninvasive Monitoring of the Response of Human Lungs to Low-Dose Lipopolysaccharide Inhalation Challenge Using MRI: A Feasibility Study. J Magn Reson Imaging 2019; 51:1669-1676. [PMID: 31729119 DOI: 10.1002/jmri.27000] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Development of antiinflammatory drugs for lung diseases demands novel methods for noninvasive assessment of inflammatory processes in the lung. PURPOSE To investigate the feasibility of hyperpolarized 129 Xe MRI, 1 H T1 time mapping, and dynamic contrast-enhanced (DCE) perfusion MRI for monitoring the response of human lungs to low-dose inhaled lipopolysaccharide (LPS) challenge compared to inflammatory cell counts from induced-sputum analysis. STUDY TYPE Prospective feasibility study. POPULATION Ten healthy volunteers underwent MRI before and 6 hours after inhaled LPS challenge with subsequent induced-sputum collection. FIELD STRENGTH/SEQUENCES 1.5T/hyperpolarized 129 Xe MRI: Interleaved multiecho imaging of dissolved and gas phase, ventilation imaging, dissolved-phase spectroscopy, and chemical shift saturation recovery spectroscopy. 1 H MRI: Inversion recovery fast low-angle shot imaging for T1 mapping, time-resolved angiography with stochastic trajectories for DCE MRI. ASSESSMENT Dissolved-phase ratios of 129 Xe in red blood cells (RBC), tissue/plasma (TP) and gas phase (GP), ventilation defect percentage, septal wall thickness, surface-to-volume ratio, capillary transit time, lineshape parameters in dissolved-phase spectroscopy, 1 H T1 time, blood volume, flow, and mean transit time were determined and compared to cell counts. STATISTICAL TESTS Wilcoxon signed-rank test, Pearson correlation. RESULTS The percentage of neutrophils in sputum was markedly increased after LPS inhalation compared to baseline, P = 0.002. The group median RBC-TP ratio was significantly reduced from 0.40 to 0.31, P = 0.004, and 1 H T1 was significantly elevated from 1157.6 msec to 1187.8 msec after LPS challenge, P = 0.027. DCE MRI exhibited no significant changes in blood volume, P = 0.64, flow, P = 0.17, and mean transit time, P = 0.11. DATA CONCLUSION Hyperpolarized 129 Xe dissolved-phase MRI and 1 H T1 mapping may provide biomarkers for noninvasive assessment of the response of human lungs to LPS inhalation. By its specificity to the alveolar region, hyperpolarized 129 Xe MRI together with 1 H T1 mapping adds value to sputum analysis. LEVEL OF EVIDENCE 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1669-1676.
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Affiliation(s)
- Agilo L Kern
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Heike Biller
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Filip Klimeš
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Andreas Voskrebenzev
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Marcel Gutberlet
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Julius Renne
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Meike Müller
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Olaf Holz
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Jens M Hohlfeld
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
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20
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Rothbart N, Holz O, Koczulla R, Schmalz K, Hübers HW. Analysis of Human Breath by Millimeter-Wave/Terahertz Spectroscopy. Sensors (Basel) 2019; 19:E2719. [PMID: 31212999 PMCID: PMC6630364 DOI: 10.3390/s19122719] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022]
Abstract
Breath gas analysis is a promising tool for medical research and diagnosis. A particularly powerful technological approach is millimeter-wave/terahertz (mmW/THz) spectroscopy, because it is a very sensitive and highly selective technique. In addition, it offers the potential for compact and affordable sensing systems for wide use. In this work, we demonstrate the capability of a mmW/THz spectrometer for breath analysis. Samples from three volunteers and a sample from ambient air were analyzed with respect to 31 different molecular species. High-resolution absorption spectra were measured by scanning two absorption lines from each species. Out of the 31, a total of 21 species were detected. The results demonstrate the potential of mmW/THz spectroscopy for breath analysis.
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Affiliation(s)
- Nick Rothbart
- Institute of Optical Sensor Systems, German Aerospace Center (DLR), 12489 Berlin, Germany.
- Department of Physics, Humboldt-Universität zu Berlin, 12489 Berlin, Germany.
| | - Olaf Holz
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), 30625 Hannover, Germany.
- The German Center for Lung Research (DZL), 35392 Giessen, Germany.
| | - Rembert Koczulla
- The German Center for Lung Research (DZL), 35392 Giessen, Germany.
- Department of Pulmonology, Institute for Internal Medicine, Philipps-University of Marburg, 35043 Marburg, Germany.
- Schön Klinik Berchtesgadener Land, Department for Pulmonology, Teaching Hospital of the Philipps-University, 35043 Marburg, Germany.
- Teaching Department of the Paracelsus University Salzburg, 5020 Salzburg, Austria.
| | - Klaus Schmalz
- IHP-Leibniz-Institut für innovative Mikroelektronik, 15236 Frankfurt (Oder), Germany.
| | - Heinz-Wilhelm Hübers
- Institute of Optical Sensor Systems, German Aerospace Center (DLR), 12489 Berlin, Germany.
- Department of Physics, Humboldt-Universität zu Berlin, 12489 Berlin, Germany.
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21
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Pedersen F, Zissler UM, Watz H, Rabe KF, Hohlfeld JM, Holz O. Rating sputum cell quality in clinical trials for asthma and COPD treatment. Int J Chron Obstruct Pulmon Dis 2019; 14:195-198. [PMID: 30662260 PMCID: PMC6329344 DOI: 10.2147/copd.s188033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Frauke Pedersen
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany, .,Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany,
| | - Ulrich M Zissler
- Center of Allergy & Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany,
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany,
| | - Jens M Hohlfeld
- Fraunhofer ITEM, Clinical Airway Research - Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School (MHH), Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Olaf Holz
- Fraunhofer ITEM, Clinical Airway Research - Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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22
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Küppers L, Holz O, Schuchardt S, Gottlieb J, Fuge J, Greer M, Hohlfeld JM. Breath volatile organic compounds of lung transplant recipients with and without chronic lung allograft dysfunction. J Breath Res 2018; 12:036023. [PMID: 29771243 DOI: 10.1088/1752-7163/aac5af] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Chronic lung allograft dysfunction with its clinical correlative of bronchiolitis obliterans syndrome (BOS) remains the major limiting factor for long-term graft survival. Currently there are no established methods for the early diagnosis or prediction of BOS. To assess the feasibility of breath collection as a non-invasive tool and the potential of breath volatile organic compounds (VOC) for the early detection of BOS, we compared the breath VOC composition between transplant patients without and different stages of BOS. METHODS 75 outpatients (25 BOS stage 0, 25 BOS stage 1 + 2, 25 BOS stage 3) after bilateral lung transplantation were included. Exclusion criteria were active smoking, oxygen therapy and acute infection. Patients inhaled room air through a VOC and sterile filter and exhaled into an aluminum reservoir tube. Breath was loaded directly onto Tenax® TA adsorption tubes and was subsequently analyzed by gas-chromatography/mass-spectrometry. RESULTS The three groups were age and gender matched, but differed with respect to time since transplantation, the spectrum of underlying disease, and treatment regimes. Relative to patients without BOS, BOS stage 3 patients showed a larger number of different VOCs, and more pronounced differences in the level of VOCs as compared to BOS stage 1 + 2 patients. Logistic regression analysis found no differences between controls and BOS 1 + 2, but four VOCs (heptane, isopropyl-myristate, ethyl-acetate, ionone) with a significant contribution to the discrimination between controls and BOS stage 3. A combination of these four VOCs separated these groups with an area under the curve of 0.87. CONCLUSION Breath sample collection using our reservoir sampler in the clinical environment was feasible. Our results suggest that breath VOCs can discriminate severe BOS. However, convincing evidence for VOCs with a potential to detect early onset BOS is lacking.
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Affiliation(s)
- L Küppers
- Fraunhofer ITEM, Clinical Airway Research-Hannover, Germany
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23
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Holz O, Heusser K, Müller M, Windt H, Schwarz K, Schindler C, Tank J, Hohlfeld JM, Jordan J. Airway and systemic inflammatory responses to ultrafine carbon black particles and ozone in older healthy subjects. J Toxicol Environ Health A 2018; 81:576-588. [PMID: 29693510 DOI: 10.1080/15287394.2018.1463331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/06/2018] [Indexed: 06/08/2023]
Abstract
Increased adverse health effects in older subjects due to exposure to ambient air pollutants may be related to the inflammatory response induced by these contaminants. The aim of this study was to assess airway and systemic inflammatory responses in older healthy subjects to a controlled experimental exposure with spark-generated elemental carbon black ultrafine particles (cbUFPs) and ozone (O3). Twenty healthy subjects, age 52-75 years, were exposed on three occasions separated by at least 8 weeks. The exposures to filtered air (FA), to cbUFP (50 μg/m3), or to cbUFP in combination with 250 ppb ozone (cbUFP + O3) for 3 h with intermittent exercise were performed double blind, and in random order. Sputum and blood samples were collected 3.5 h after each exposure. Exposure to cbUFP + O3 significantly increased plasma club cell protein 16 (CC16), the number of sputum cells, the number and percent of sputum neutrophils, and sputum interleukin 6 and matrix metalloproteinase 9. Exposure to cbUFP alone exerted no marked effect, except for an elevation in sputum neutrophils in a subgroup of 13 subjects that displayed less than 65% sputum neutrophils after FA exposure. None of the inflammatory markers was correlated with age, and serum cardiovascular risk markers were not markedly affected by cbUFP or cbUFP + O3. Exposure to cbUFP+O3 induced a significant airway and systemic inflammatory response in older healthy volunteer subjects. The effects induced by cbUFP alone suggest that the inflammation was predominantly mediated by O3, although one cannot rule out that the interaction of cbUFP and O3 played a role.
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Affiliation(s)
- Olaf Holz
- a Clinical Airway Research , Fraunhofer ITEM , Hannover , Germany
- b Member of the German Center for Lung Research (BREATH) , Hannover , Germany
| | - Karsten Heusser
- c Hannover Medical School , Institute of Clinical Pharmacology , Hannover , Germany
| | - Meike Müller
- a Clinical Airway Research , Fraunhofer ITEM , Hannover , Germany
| | - Horst Windt
- a Clinical Airway Research , Fraunhofer ITEM , Hannover , Germany
| | | | | | - Jens Tank
- c Hannover Medical School , Institute of Clinical Pharmacology , Hannover , Germany
| | - Jens M Hohlfeld
- a Clinical Airway Research , Fraunhofer ITEM , Hannover , Germany
- b Member of the German Center for Lung Research (BREATH) , Hannover , Germany
- e Hannover Medical School , Clinic for Respiratory Medicine , Hannover , Germany
| | - Jens Jordan
- c Hannover Medical School , Institute of Clinical Pharmacology , Hannover , Germany
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24
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Ikari J, Nelson AJ, Obaid J, Giron-Martinez A, Ikari K, Makino F, Iwasawa S, Gunji Y, Farid M, Wang X, Basma H, Demeo D, Feghali-Bostwick C, Holz O, Rabe K, Liu X, Rennard SI. Reduced microRNA-503 expression augments lung fibroblast VEGF production in chronic obstructive pulmonary disease. PLoS One 2017; 12:e0184039. [PMID: 28880936 PMCID: PMC5589164 DOI: 10.1371/journal.pone.0184039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/16/2017] [Indexed: 12/27/2022] Open
Abstract
Alterations in microRNA (miRNA) expression may contribute to COPD pathogenesis. In COPD, lung fibroblast repair functions are altered in multiple ways, including extracellular mediator release. Our prior study revealed miR-503 expression is decreased in COPD lung fibroblasts, although the exact role played by miR-503 is undetermined. The current study examined a role of miR-503 in cytokine, growth factor and fibronectin production by lung fibroblasts from patients with and without COPD. Primary adult lung fibroblasts were isolated from patients with or without COPD. MiR-503 expression and interleukin (IL)-6, -8, PGE2, HGF, KGF, VEGF and fibronectin release were examined with or without inflammatory cytokines, IL-1β and tumor necrosis factor (TNF)-α. MiR-503 expression was decreased in COPD lung fibroblasts. The expression of miR-503 was positively correlated with %FVC, %FEV1, and %DLco as well as IL-6, -8, PGE2, HGF, KGF, and VEGF in the absence or presence of IL-1ß/TNF-α. In addition, IL-8 and VEGF release from COPD lung fibroblasts were increased compared to those from control. Exogenous miR-503 inhibited VEGF release from primary adult and fetal lung fibroblasts but not IL-8 release. As expected, COPD fibroblasts proliferated more slowly than control fibroblasts. MiR-503 did not affect proliferation of either control or COPD lung fibroblasts. MiR-503 inhibition of VEGF protein production and mRNA was mediated by direct binding to the 3' untranslated region of VEGF mRNA. Endogenous miR-503 was differently regulated by exogenous stimulants associated with COPD pathogenesis, including IL-1ß/TNF-α, TGF-ß1 and PGE2. Endogenous miR-503 inhibition augmented VEGF release by IL-1ß/TNF-α and TGF-ß1 but not by PGE2, demonstrating selectivity of miR-503 regulation of VEGF. In conclusions, reduced miR-503 augments VEGF release from lung fibroblasts from patients with COPD. Since VEGF contributes to disturbed vasculature in COPD, altered miR-503 production might play a role in modulating fibroblast-mediated vascular homeostasis in COPD.
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Affiliation(s)
- Jun Ikari
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Amy J. Nelson
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Jannah Obaid
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Alvaro Giron-Martinez
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Kumiko Ikari
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Fumihiko Makino
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Shunichiro Iwasawa
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Yoko Gunji
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Maha Farid
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Xingqi Wang
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Hesham Basma
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Dawn Demeo
- Channing Laboratory, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Carol Feghali-Bostwick
- Division of Rheumatology & Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Olaf Holz
- Fraunhofer ITEM, Member of the German Center for Lung Research (DZL, BREATH), Hannover, Germany
| | - Klaus Rabe
- Airway Research Center North (ARCN), Lungen Clinic Grosshansdorf, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Xiangde Liu
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Stephen I. Rennard
- Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail:
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Horváth I, Barnes PJ, Loukides S, Sterk PJ, Högman M, Olin AC, Amann A, Antus B, Baraldi E, Bikov A, Boots AW, Bos LD, Brinkman P, Bucca C, Carpagnano GE, Corradi M, Cristescu S, de Jongste JC, Dinh-Xuan AT, Dompeling E, Fens N, Fowler S, Hohlfeld JM, Holz O, Jöbsis Q, Van De Kant K, Knobel HH, Kostikas K, Lehtimäki L, Lundberg J, Montuschi P, Van Muylem A, Pennazza G, Reinhold P, Ricciardolo FLM, Rosias P, Santonico M, van der Schee MP, van Schooten FJ, Spanevello A, Tonia T, Vink TJ. A European Respiratory Society technical standard: exhaled biomarkers in lung disease. Eur Respir J 2017; 49:49/4/1600965. [PMID: 28446552 DOI: 10.1183/13993003.00965-2016] [Citation(s) in RCA: 358] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/09/2017] [Indexed: 12/19/2022]
Abstract
Breath tests cover the fraction of nitric oxide in expired gas (FeNO), volatile organic compounds (VOCs), variables in exhaled breath condensate (EBC) and other measurements. For EBC and for FeNO, official recommendations for standardised procedures are more than 10 years old and there is none for exhaled VOCs and particles. The aim of this document is to provide technical standards and recommendations for sample collection and analytic approaches and to highlight future research priorities in the field. For EBC and FeNO, new developments and advances in technology have been evaluated in the current document. This report is not intended to provide clinical guidance on disease diagnosis and management.Clinicians and researchers with expertise in exhaled biomarkers were invited to participate. Published studies regarding methodology of breath tests were selected, discussed and evaluated in a consensus-based manner by the Task Force members.Recommendations for standardisation of sampling, analysing and reporting of data and suggestions for research to cover gaps in the evidence have been created and summarised.Application of breath biomarker measurement in a standardised manner will provide comparable results, thereby facilitating the potential use of these biomarkers in clinical practice.
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Affiliation(s)
- Ildiko Horváth
- Dept of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | | | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieann Högman
- Centre for Research & Development, Uppsala University/Gävleborg County Council, Gävle, Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital, Goteborg, Sweden
| | - Anton Amann
- Innsbruck Medical University, Innsbruck, Austria
| | - Balazs Antus
- Dept of Pathophysiology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Andras Bikov
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Agnes W Boots
- Dept of Pharmacology and Toxicology, University of Maastricht, Maastricht, The Netherlands
| | - Lieuwe D Bos
- Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Brinkman
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Caterina Bucca
- Biomedical Sciences and Human Oncology, Universita' di Torino, Turin, Italy
| | | | | | - Simona Cristescu
- Dept of Molecular and Laser Physics, Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - Johan C de Jongste
- Dept of Pediatrics/Respiratory Medicine, Erasmus MC-Sophia Childrens' Hospital, Rotterdam, The Netherlands
| | | | - Edward Dompeling
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Niki Fens
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephen Fowler
- Respiratory Research Group, University of Manchester Wythenshawe Hospital, Manchester, UK
| | - Jens M Hohlfeld
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany.,Medizinische Hochschule Hannover, Hannover, Germany
| | - Olaf Holz
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Quirijn Jöbsis
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kim Van De Kant
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hugo H Knobel
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
| | | | | | - Jon Lundberg
- Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Montuschi
- Pharmacology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alain Van Muylem
- Hopital Erasme Cliniques Universitaires de Bruxelles, Bruxelles, Belgium
| | - Giorgio Pennazza
- Faculty of Engineering, University Campus Bio-Medico, Rome, Italy
| | - Petra Reinhold
- Institute of Molecular Pathogenesis, Friedrich Loeffler Institut, Jena, Germany
| | - Fabio L M Ricciardolo
- Clinic of Respiratory Disease, Dept of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Philippe Rosias
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Pediatrics, Maasland Hospital, Sittard, The Netherlands
| | - Marco Santonico
- Faculty of Engineering, University Campus Bio-Medico, Rome, Italy
| | - Marc P van der Schee
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Thomy Tonia
- European Respiratory Society, Lausanne, Switzerland
| | - Teunis J Vink
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
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Waschki B, Watz H, Holz O, Magnussen H, Olejnicka B, Welte T, Rabe KF, Janciauskiene S. Plasminogen activator inhibitor-1 is elevated in patients with COPD independent of metabolic and cardiovascular function. Int J Chron Obstruct Pulmon Dis 2017; 12:981-987. [PMID: 28356730 PMCID: PMC5367764 DOI: 10.2147/copd.s128689] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Plasminogen activator inhibitor-1 (PAI-1), a major inhibitor of fibrinolysis, is associated with thrombosis, obesity, insulin resistance, dyslipidemia, and premature aging, which all are coexisting conditions of chronic obstructive pulmonary disease (COPD). The role of PAI-1 in COPD with respect to metabolic and cardiovascular functions is unclear. METHODS In this study, which was nested within a prospective cohort study, the serum levels of PAI-1 were cross-sectionally measured in 74 stable COPD patients (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Stages I-IV) and 18 controls without lung disease. In addition, triglycerides, high-density lipoprotein cholesterol, fasting plasma glucose, waist circumference, blood pressure, smoking status, high-sensitive C-reactive protein (hs-CRP), adiponectin, ankle-brachial index, N-terminal pro-B-type natriuretic peptide, and history of comorbidities were also determined. RESULTS The serum levels of PAI-1 were significantly higher in COPD patients than in controls, independent of a broad spectrum of possible confounders including metabolic and cardiovascular dysfunction. A multivariate regression analysis revealed triglyceride and hs-CRP levels to be the best predictors of PAI-1 within COPD. GOLD Stages II and III remained independently associated with higher PAI-1 levels in a final regression analysis. CONCLUSION The data from the present study showed that the serum levels of PAI-1 are higher in patients with COPD and that moderate-to-severe airflow limitation, hypertriglyceridemia, and systemic inflammation are independent predictors of an elevated PAI-1 level. PAI-1 may be a potential biomarker candidate for COPD-specific and extra-pulmonary manifestations.
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Affiliation(s)
- Benjamin Waschki
- Pneumology, LungenClinic Grosshansdorf, Grosshansdorf, Germany; Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany; Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany; Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Olaf Holz
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Helgo Magnussen
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany; Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Beata Olejnicka
- Department of Medicine, Trelleborg Hospital, Trelleborg, Sweden
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Klaus F Rabe
- Pneumology, LungenClinic Grosshansdorf, Grosshansdorf, Germany; Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Sabina Janciauskiene
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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Waschki B, Kirsten AM, Holz O, Meyer T, Lichtinghagen R, Rabe KF, Magnussen H, Welte T, Watz H, Janciauskiene S. Angiopoietin-like protein 4 and cardiovascular function in COPD. BMJ Open Respir Res 2016; 3:e000161. [PMID: 27933182 PMCID: PMC5133419 DOI: 10.1136/bmjresp-2016-000161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 08/25/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 02/05/2023] Open
Abstract
Introduction The coexistence of chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) is frequent and might be inter-related through inflammation-related processes reflected by specific markers. Here, we studied angiopoietin-like protein 4 (ANGPTL4), an upcoming cardiovascular marker, in stable COPD, and its relationship to cardiovascular function with respect to well-known CVD risk factors. Methods In a prospective COPD cohort study, we investigated serum ANGPTL4 levels, vascular status (ankle–brachial index (ABI)) and cardiac function (N-terminal pro-B-type natriuretic peptide (NT-proBNP)) as well as airflow limitation, objectively measured physical activity, the metabolic syndrome, high-sensitive C reactive protein (hs-CRP) and other CVD risk factors at 2 time points. We initially studied 74 stable COPD patients and 18 controls. For internal validation, we additionally studied 160 COPD patients of a former visit. Results ANGPTL4 was significantly elevated in COPD patients compared with controls (p=0.026). After correction for traditional CVD risk factors, including hs-CRP, higher levels of ANGPTL4 were independently associated with lower ABI (p=0.023) and higher NT-proBNP (p<0.001). These findings were confirmed in the internal validation analysis, which included echocardiographic assessments. Conclusions Serum ANGPTL4 is independently associated with cardiovascular function in COPD and might qualify as a biomarker reflecting a pathogenic link between COPD and CVD.
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Affiliation(s)
- B Waschki
- LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany; Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - A M Kirsten
- Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL) , Grosshansdorf , Germany
| | - O Holz
- Fraunhofer Institute for Toxicology and Experimental Medicine, Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL) , Hannover , Germany
| | - T Meyer
- Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School , Hannover , Germany
| | - R Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School , Hannover , Germany
| | - K F Rabe
- LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL) , Grosshansdorf , Germany
| | - H Magnussen
- Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL) , Grosshansdorf , Germany
| | - T Welte
- Department of Respiratory Medicine , Hannover Medical School, BREATH, German Center for Lung Research (DZL) , Hannover , Germany
| | - H Watz
- Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL) , Grosshansdorf , Germany
| | - S Janciauskiene
- Department of Respiratory Medicine , Hannover Medical School, BREATH, German Center for Lung Research (DZL) , Hannover , Germany
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Gaida A, Holz O, Nell C, Schuchardt S, Lavae-Mokhtari B, Kruse L, Boas U, Langejuergen J, Allers M, Zimmermann S, Vogelmeier C, Koczulla AR, Hohlfeld JM. A dual center study to compare breath volatile organic compounds from smokers and non-smokers with and without COPD. J Breath Res 2016; 10:026006. [PMID: 27082437 DOI: 10.1088/1752-7155/10/2/026006] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
There is increasing evidence that breath volatile organic compounds (VOC) have the potential to support the diagnosis and management of inflammatory diseases such as COPD. In this study we used a novel breath sampling device to search for COPD related VOCs. We included a large number of healthy controls and patients with mild to moderate COPD, recruited subjects at two different sites and carefully controlled for smoking. 222 subjects were recruited in Hannover and Marburg, and inhaled cleaned room air before exhaling into a stainless steel reservoir under exhalation flow control. Breath samples (2.5 l) were continuously drawn onto two Tenax(®) TA adsorption tubes and analyzed in Hannover using thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS). Data of 134 identified VOCs from 190 subjects (52 healthy non-smokers, 52 COPD ex-smokers, 49 healthy smokers, 37 smokers with COPD) were included into the analysis. Active smokers could be clearly discriminated by higher values for combustion products and smoking related VOCs correlated with exhaled carbon monoxide (CO), indicating the validity of our data. Subjects from the study sites could be discriminated even after exclusion of cleaning related VOCs. Linear discriminant analysis correctly classified 89.4% of COPD patients in the non/ex-smoking group (cross validation (CV): 85.6%), and 82.6% of COPD patients in the actively smoking group (CV: 77.9%). We extensively characterized 134 breath VOCs and provide evidence for 14 COPD related VOCs of which 10 have not been reported before. Our results show that, for the utilization of breath VOCs for diagnosis and disease management of COPD, not only the known effects of smoking but also site specific differences need to be considered. We detected novel COPD related breath VOCs that now need to be tested in longitudinal studies for reproducibility, response to treatment and changes in disease severity.
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Affiliation(s)
- A Gaida
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Clinical Airway Research, Hannover, Germany. Leibniz Universität Hannover, Institute of Inorganic Chemistry, Research Group Analytical Chemistry, Hannover, Germany. Contributed equally
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Allers M, Langejuergen J, Gaida A, Holz O, Schuchardt S, Hohlfeld JM, Zimmermann S. Measurement of exhaled volatile organic compounds from patients with chronic obstructive pulmonary disease (COPD) using closed gas loop GC-IMS and GC-APCI-MS. J Breath Res 2016; 10:026004. [PMID: 27058460 DOI: 10.1088/1752-7155/10/2/026004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Due to its high sensitivity, compact size and low cost ion mobility spectrometry (IMS) has the potential to become a point-of-care breath analyzer. Therefore, we developed a prototype of a compact, closed gas loop IMS with gas chromatographic (GC) pre-separation and high resolving power of R = 90. In this study, we evaluated the performance of this GC-IMS under clinical conditions in a COPD study to find correlations between VOCs (10 ppbv to 1 ppmv) and COPD. Furthermore, in order to investigate possible correlations between ultra-low concentrated breath VOCs (0.1 pptv to 1 ppbv) and COPD, a modified mass spectrometer (MS) with atmospheric pressure chemical ionization (APCI) and GC pre-separation (GC-APCI-MS) was used. The GC-IMS has been used in 58 subjects (21 smokers with moderate COPD, 12 ex-smokers with COPD, 16 healthy smokers and 9 non-smokers). GC-APCI-MS data were available for 94 subjects (21 smokers with moderate COPD, 25 ex-smokers with COPD, 25 healthy smokers and 23 non-smokers). For 44 subjects, a comparison between GC-IMS and GC-APCI-MS data could be performed. Due to service intervals, subject availability and corrupt data, patient numbers were different for GC-APCI-MS and GC-IMS measurements. Using GC-IMS, three VOCs have been found showing a significant difference between healthy controls and patients with COPD. In the GC-APCI-MS data, we only observed one distinctive VOC, which has been identified as 2-pentanone. This proof-of-principle study shows the potential of our high-resolution GC-IMS in the clinical environment. Due to different linear dynamic response ranges, the data of GC-IMS and GC-APCI-MS were only comparable to a limited extent.
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Affiliation(s)
- M Allers
- Institute of Electrical Engineering and Measurement Technology, Leibniz Universität Hannover, Hannover, Germany
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Holz O, Tan L, Schaumann F, Müller M, Scholl D, Hidi R, McLeod A, Krug N, Hohlfeld JM. Inter- and intrasubject variability of the inflammatory response to segmental endotoxin challenge in healthy volunteers. Pulm Pharmacol Ther 2015; 35:50-9. [PMID: 26545873 DOI: 10.1016/j.pupt.2015.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/02/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
Segmental endotoxin challenge with lipopolysaccharide (LPS) can be used as a pharmacodynamic model to safely induce a transient airway inflammation in the peripheral lung of healthy subjects and to test the anti-inflammatory efficacy of investigational new drugs. In contrast to whole lung LPS challenge only a fraction of the dose is required that can be precisely administered to a specific lung region and a vehicle challenged segment as an intra-subject control can be included. The aim of this study was to assess the intra- and inter-individual variability of the response to segmental LPS challenge for the appropriate design and power calculation of future clinical trials. Two cohorts with 10 subjects each underwent two segmental LPS challenges within five weeks. The inflammatory response was evaluated in bronchoalveolar lavage (BAL) fluid at 6 (cohort 1) and 24 h (cohort 2) both in the LPS and in a vehicle challenged segment, as well as in plasma for up to 26 h post LPS challenge. While the cytokine response was more pronounced at 6 h, the influx of neutrophils and monocytes dominated at 24 h; e.g. neutrophils increased from a median (inter-quartile range, IQR) of 0.14 (0.16) and 0.09 (0.08)x10(4) cells/mL BAL fluid at baseline to 10.2 (17.1) and 19.3 (15.9)x10(4) cells/mL 24 h after the two separate challenges. The within-subject variability was higher than the between-subject variability for most of the markers. However, sample size estimations based on the variability of outcome variables found lower or equal numbers with cross-over designs compared to parallel group designs for cellular markers at 24 h and cytokine variables at 6 h. The segmental LPS challenge model was safe. Future study designs have to balance between burden to the study subjects (4 versus 2 bronchoscopies), variability (within-versus between-subject), and the desired outcome variable (cells versus chemo/cytokine).
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Affiliation(s)
- O Holz
- Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Clinical Airway Research, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
| | - L Tan
- Pfizer Ltd., Clinical Research, Sandwich, Kent, UK.
| | - F Schaumann
- Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Clinical Airway Research, Hannover, Germany.
| | - M Müller
- Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Clinical Airway Research, Hannover, Germany.
| | - D Scholl
- Pfizer Ltd., Clinical Research, Sandwich, Kent, UK.
| | - R Hidi
- Pfizer Ltd., Clinical Research, Sandwich, Kent, UK.
| | - A McLeod
- Pfizer Ltd., Clinical Research, Sandwich, Kent, UK.
| | - N Krug
- Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Clinical Airway Research, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
| | - J M Hohlfeld
- Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Clinical Airway Research, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
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Waschki B, Kirsten AM, Holz O, Mueller KC, Schaper M, Sack AL, Meyer T, Rabe KF, Magnussen H, Watz H. Disease Progression and Changes in Physical Activity in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2015; 192:295-306. [PMID: 26020495 DOI: 10.1164/rccm.201501-0081oc] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Little is known about the role of physical activity in the course of chronic obstructive pulmonary disease (COPD). OBJECTIVES To assess changes in physical activity in COPD in relation to severity stages and changes in other disease components, and to evaluate the longitudinal association between sustained physical inactivity and disease progression. METHODS In this prospective cohort study, we measured physical activity (multisensory armband), airflow obstruction (FEV1), health status (St. George's Respiratory Questionnaire), exercise capacity (6-min-walk distance [6MWD]), muscle mass (fat-free mass [FFM]), and systemic inflammation (fibrinogen and high-sensitivity C-reactive protein) over a 3-year period in 137 patients with COPD and 26 with chronic bronchitis (normal spirometry). MEASUREMENTS AND MAIN RESULTS Independent of baseline disease severity, steps per day, total daily energy expenditure, and (daily) physical activity level (PAL) decreased by 393, 76 kcal, and 0.04 per year, respectively. The decline in PAL was significantly associated with a decline in FEV1 and an increase in St. George's Respiratory Questionnaire total score. Changes in 6MWD, FFM, and inflammatory markers were not associated with changes in PAL. Independent of FEV1, sustained physical inactivity (i.e., PAL(T0andT1) < 1.40) was related to a greater decline in 6MWD and FFM compared with that in patients with some level of activity (i.e., PAL(T0and/orT1) ≥ 1.40; difference, 17 m/yr and 0.87 kg/yr, respectively). CONCLUSIONS Over time, physical activity substantially decreases across all severity stages of COPD, and this decline is paralleled by a worsening of lung function and health status. Sustained physical inactivity is associated with a progression of exercise intolerance and muscle depletion.
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Affiliation(s)
- Benjamin Waschki
- 1 Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany.,2 LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Anne M Kirsten
- 1 Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Olaf Holz
- 3 Fraunhofer Institute for Toxicology and Experimental Medicine, BREATH, Member of the German Center for Lung Research, Hannover, Germany; and
| | - Kai-Christian Mueller
- 2 LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Miriam Schaper
- 1 Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Anna-Lena Sack
- 1 Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Thorsten Meyer
- 4 Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
| | - Klaus F Rabe
- 2 LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Helgo Magnussen
- 1 Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Henrik Watz
- 1 Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
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Holz O, Biller H, Mueller M, Kane K, Rosano M, Hanrahan J, Hava DL, Hohlfeld JM. Efficacy and safety of inhaled calcium lactate PUR118 in the ozone challenge model--a clinical trial. BMC Pharmacol Toxicol 2015; 16:21. [PMID: 26265479 PMCID: PMC4533952 DOI: 10.1186/s40360-015-0021-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 03/13/2015] [Accepted: 07/24/2015] [Indexed: 12/03/2022] Open
Abstract
Background The ozone challenge model can be used to assess the efficacy of anti-inflammatory compounds in early phases of clinical drug development. PUR118, a calcium salt based formulation engineered in the iSPERSETM dry powder delivery technology, is a novel anti-inflammatory drug for COPD. Here we evaluated the efficacy and safety of three doses of PUR118 in attenuating ozone-induced airway inflammation in healthy volunteers. Methods In a single-blind, phase 1B proof of concept study, 24 subjects were enrolled to sequentially receive three doses of PUR118 (5.5 mg, n = 18; 11.0 mg, n = 18; 2.8 mg, n = 16). Each dose was inhaled 3 times (1, 13, 25 h, preceded by 2 puffs salbutamol) before the ozone exposure (250 ppb, 3 h intermittent exercise). Sputum was induced 3 h after the end of exposure. Results Sputum neutrophils, sputum CD14+ cells, as well as concentrations of IL1B, IL6, IL8, MMP9, and TNFA in sputum supernatant significantly increased after ozone exposure (n = 24). The percentage of sputum neutrophils (n = 12 who completed all treatments) did not change following treatment with different doses of PUR118. The high dose treatment group (n = 16) showed a decrease in the percentage and number of sputum macrophages (p ≤ 0.05) as well as a decrease in blood neutrophils (p = 0.04), and an increase in blood CD14 + cells (p = 0.04) compared to baseline. All dosages of PUR118 were safe and well tolerated. Conclusion Ozone challenge resulted in the expected and significant increase of sputum inflammatory parameters. Treatment with multiple rising doses of PUR118 was safe and three applications within 25 h prior to the ozone challenge had small effects on ozone-induced airway inflammation. Trial registration ClinicalTrials.gov: NCT01690949. Registered 12 September 2012. Electronic supplementary material The online version of this article (doi:10.1186/s40360-015-0021-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olaf Holz
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany. .,Member of the German Center for Lung Research (BREATH), Hannover, Germany.
| | - H Biller
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany
| | - M Mueller
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany
| | - K Kane
- Pulmatrix, Inc., Lexington, MA, USA
| | - M Rosano
- Pulmatrix, Inc., Lexington, MA, USA
| | | | - D L Hava
- Pulmatrix, Inc., Lexington, MA, USA
| | - J M Hohlfeld
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany.,Member of the German Center for Lung Research (BREATH), Hannover, Germany
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Holz O, Roepcke S, Watz H, Tegtbur U, Lahu G, Hohlfeld JM. Constant-load exercise decreases the serum concentration of myeloperoxidase in healthy smokers and smokers with COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:1393-402. [PMID: 26229458 PMCID: PMC4516189 DOI: 10.2147/copd.s83269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There is an ongoing demand for easily accessible biomarkers related to pathophysiological processes in chronic obstructive pulmonary disease (COPD). Short-term intense exercise is known to increase the peripheral blood levels of cytokines. Therefore, we tested the potential and the repeatability of an exercise challenge to amplify seven serum biomarkers (interleukin 6 [IL6], C-reactive protein [CRP], myeloperoxidase [MPO], leukotriene B4, soluble intercellular adhesion molecule 1, soluble vascular cell adhesion molecule 1, and von Willebrand factor [VWF]) in smokers with and without COPD. Twenty-three smokers with moderate COPD (GOLD 2) and 23 sex- and age-matched healthy smokers underwent up to 30-minute submaximal, constant-load exercise (75% of maximum work load) on two occasions separated by 4 weeks (second challenge n=19/20). Serum samples were obtained before, 5 minutes after the start, at the end of exercise (maximum 30 minutes or until exhaustion), and after additional 20 minutes of rest. The median (interquartile range) exercise time until exhaustion in the two challenges was 10.0 (4.0) minutes and 10.0 (8.0) minutes in smokers with COPD and 22.0 (16.0) minutes and 26.5 (14.5) minutes in healthy smokers. The exercise challenge significantly increased the serum concentrations of IL6 and VWF, but decreased the concentrations of MPO. Healthy smokers showed a significantly greater increase (at the end of exercise compared to before exercise) in IL6 (P=0.01) and a larger decline (P=0.03) in MPO. The overall profile of the serum markers during the exercise challenge was shown to be repeatable in the second challenge. In summary, intense load exercise is capable of changing the concentration of inflammatory and endothelial function markers. Especially, the decline in the level of MPO, a marker closely related to cardiovascular risk, appears to be of clinical interest, as the exercise-induced decline might be related to the beneficial effects of physical activity in general.
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Affiliation(s)
- Olaf Holz
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), German Center for Lung Research (DZL, BREATH), Hannover, Germany
| | - Stefan Roepcke
- Takeda Pharmaceuticals International GmbH, Glattpark-Opfikon, Switzerland
| | - Henrik Watz
- Pulmonary Research Institute at Lung Clinic Grosshansdorf, German Center for Lung Research (DZL, ARCN), Grosshansdorf, Germany
| | - Uwe Tegtbur
- Institute for Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Gezim Lahu
- Takeda Pharmaceuticals International GmbH, Glattpark-Opfikon, Switzerland
| | - Jens M Hohlfeld
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), German Center for Lung Research (DZL, BREATH), Hannover, Germany
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Pedersen F, Holz O, Lauer G, Quintini G, Kiwull-Schöne H, Kirsten AM, Magnussen H, Rabe KF, Goldmann T, Watz H. Multi-analyte profiling of inflammatory mediators in COPD sputum – The effects of processing. Cytokine 2015; 71:401-4. [DOI: 10.1016/j.cyto.2014.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 08/15/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
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Reither G, Heath N, Holz O, Kahn N, Hohlfeld J, Schultz C, Mall MA. Evaluation of small molecule FRET reporter for the diagnosis and monitoring of proteolytic activity in a chronic obstructive lung disease model. Pneumologie 2014. [DOI: 10.1055/s-0034-1376783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nagahama KY, Togo S, Holz O, Magnussen H, Liu X, Seyama K, Takahashi K, Rennard SI. Oncostatin M modulates fibroblast function via signal transducers and activators of transcription proteins-3. Am J Respir Cell Mol Biol 2014; 49:582-91. [PMID: 23668543 DOI: 10.1165/rcmb.2012-0460oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Oncostatin M (OSM), an inflammatory cytokine of the interleukin-6 (IL-6) superfamily, plays a key role in various biological processes such as modulation of extracellular matrix (ECM), cell proliferation, cell survival, and induction of inflammation. It has been reported that OSM was increased in asthma and pulmonary fibrosis, and thus OSM may play a role in airway remodeling and the development of lung parenchymal fibrosis. Recruitment of lung fibroblasts to the sites of airway injury and subsequent differentiation into myofibroblasts is believed to contribute to excess ECM deposition. In the current study, we assessed the ability of OSM to modulate fibroblast collagen gel contraction, migration toward fibronectin, and expression of α-smooth muscle actin (α-SMA). We demonstrated that OSM augments gel contraction, chemotaxis, and α-SMA expression. OSM-augmented fibroblast chemotaxis was mediated by the signal transducer and activator of transcription (STAT3) and p38 mitogen-activated protein kinase, while augmentation on gel contraction and α-SMA expression was mediated by STAT3. Neither transforming growth factor-β1 nor PGE2 was involved in mediating OSM effect on the cells. The Th2 cytokines IL-4 and IL-13, which also are believed to play an important role in promoting lung fibrosis and airway remodeling, act through STAT3, and we demonstrated the potential for additive effects of OSM with IL-4 and IL-13. The present study supports the concept that OSM may contribute to tissue remodeling, which may be additive with IL-4 or IL-13. Blockade of OSM or OSM-mediated STAT3 signaling could be a therapeutic target to regulate lung fibrotic mechanisms.
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Affiliation(s)
- Kumi Yoneda Nagahama
- 1 Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Winkler C, Witte L, Moraw N, Faulenbach C, Müller M, Holz O, Schaumann F, Hohlfeld JM. Impact of endobronchial allergen provocation on macrophage phenotype in asthmatics. BMC Immunol 2014; 15:12. [PMID: 24612750 PMCID: PMC4007705 DOI: 10.1186/1471-2172-15-12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 02/21/2014] [Indexed: 02/08/2023] Open
Abstract
Background The role of M2 polarized macrophages (MΦ) during the allergic airway inflammation has been discussed in various animal models. However, their presence and relevance during the chronic and acute phase of allergic airway inflammation in humans has not been fully elucidated so far. In the present study we phenotypically characterized macrophages with regard to M2 polarization in mice, a human in vitro and a human ex vivo model with primary lung cells after endobronchial provocation. Results Macrophages remained polarized beyond clearance of the acute allergic airway inflammation in mice. Alveolar macrophages of asthmatics revealed increased mRNA expression of CCL13, CCL17 and CLEC10A in response to allergen challenge as well as increased surface expression of CD86. Further, mRNA expression of CCL13, CCL17, and CLEC10A was increased in asthmatics at baseline compared to healthy subjects. The mRNA expression of CCL17 and CLEC10A correlated significantly with the degree of eosinophilia (each P < .01). Furthermore, macrophages from asthmatics released significant amounts of CCL17 protein in vitro which was also found increased in BAL fluid after allergen provocation. Conclusions This study supports previous findings of M2 macrophage polarization in asthmatic subjects during the acute course of the allergic inflammation and provides evidence for their contribution to the Th2 inflammation.
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Affiliation(s)
| | | | | | | | | | | | | | - Jens M Hohlfeld
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
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Holz O, Waschki B, Roepcke S, Watz H, Lauer G, Faulenbach C, Hohlfeld JM. Potential prognostic value of biomarkers in lavage, sputum and serum in a five year clinical follow-up of smokers with and without COPD. BMC Pulm Med 2014; 14:30. [PMID: 24581181 PMCID: PMC4021348 DOI: 10.1186/1471-2466-14-30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 11/12/2013] [Accepted: 02/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to test whether repeatable biomarkers collected from serum, bronchoalveolar lavage (BAL) and sputum of healthy smokers and smokers with COPD would have a prognostic value with respect to the decline in lung function over a 5 year period. Methods In 2006/2007 we had repeatedly collected serum, BAL and sputum of 23 healthy smokers and 24 smokers with COPD (GOLD II) and analysed a panel of more than 100 different parameters. In 2012 we reinvited these subjects to assess the change in lung function to enable the investigation of the potential prognostic value of the 2006/2007 markers and to determine the long-term repeatability of selected blood and serum markers. In this follow-up study we performed body-plethysmography, a blood gas analysis and collected blood and urine samples. The change in lung function was compared with 67 markers from BAL, sputum, serum and whole blood that were shown in the 2006/2007 assessment to be repeatable over a 6 week period. Results We were able to recruit 13 (54%) smokers with COPD and 11 (48%) former healthy smokers that participated in the 2006/2007 study. The decline in lung function was larger in COPD smokers; five of them changed to GOLD III, one to GOLD IV. Two healthy smokers changed to GOLD I. Blood cells, serum von Willebrand factor and alpha-1-antitrypsin showed a good repeatability over 5 years. In COPD smokers a weak correlation between 2006/2007 sputum markers of neutrophilic inflammation and the 5 year change in FEV1/FVC was found. Conclusions Our data suggests that inter-individual and group differences are maintained over a five year period. Despite the large panel of markers available for this analysis, a potential prognostic value appears to exist only for some sputum inflammatory markers. If these data can be confirmed in larger COPD cohorts, it would emphasize the value of sputum markers in clinical trials and support the assumption that an anti-inflammatory treatment can have long term benefits in COPD.
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Affiliation(s)
- Olaf Holz
- Department of Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover 30625, Germany.
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Basma H, Gunji Y, Iwasawa S, Nelson A, Farid M, Ikari J, Liu X, Wang X, Michalski J, Smith L, Iqbal J, El Behery R, West W, Yelamanchili S, Rennard D, Holz O, Mueller KC, Magnussen H, Rabe K, Castaldi PJ, Rennard SI. Reprogramming of COPD lung fibroblasts through formation of induced pluripotent stem cells. Am J Physiol Lung Cell Mol Physiol 2014; 306:L552-65. [PMID: 24487392 DOI: 10.1152/ajplung.00255.2013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Reprogramming somatic cells to induced pluripotent stem cells (iPSCs) eliminates many epigenetic modifications that characterize differentiated cells. In this study, we tested whether functional differences between chronic obstructive pulmonary disease (COPD) and non-COPD fibroblasts could be reduced utilizing this approach. Primary fibroblasts from non-COPD and COPD patients were reprogrammed to iPSCs. Reprogrammed iPSCs were positive for oct3/4, nanog, and sox2, formed embryoid bodies in vitro, and induced teratomas in nonobese diabetic/severe combined immunodeficient mice. Reprogrammed iPSCs were then differentiated into fibroblasts (non-COPD-i and COPD-i) and were assessed either functionally by chemotaxis and gel contraction or for gene expression by microarrays and compared with their corresponding primary fibroblasts. Primary COPD fibroblasts contracted three-dimensional collagen gels and migrated toward fibronectin less robustly than non-COPD fibroblasts. In contrast, redifferentiated fibroblasts from iPSCs derived from the non-COPD and COPD fibroblasts were similar in response in both functional assays. Microarray analysis identified 1,881 genes that were differentially expressed between primary COPD and non-COPD fibroblasts, with 605 genes differing by more than twofold. After redifferentiation, 112 genes were differentially expressed between COPD-i and non-COPD-i with only three genes by more than twofold. Similar findings were observed with microRNA (miRNA) expression: 56 miRNAs were differentially expressed between non-COPD and COPD primary cells; after redifferentiation, only 3 miRNAs were differentially expressed between non-COPD-i and COPD-i fibroblasts. Interestingly, of the 605 genes that were differentially expressed between COPD and non-COPD fibroblasts, 293 genes were changed toward control after redifferentiation. In conclusion, functional and epigenetic alterations of COPD fibroblasts can be reprogrammed through formation of iPSCs.
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Affiliation(s)
- Hesham Basma
- Univ. of Nebraska Medical Center, 985910 Nebraska Medical Center, Omaha, Nebraska 68198-5910.
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Wang X, Nelson A, Weiler ZM, Patil A, Sato T, Kanaji N, Nakanishi M, Michalski J, Farid M, Basma H, Levan TD, Miller-Larsson A, Wieslander E, Muller KC, Holz O, Magnussen H, Rabe KF, Liu X, Rennard SI. Anti-inflammatory effects of budesonide in human lung fibroblast are independent of histone deacetylase 2. J Inflamm Res 2013; 6:109-19. [PMID: 24062615 PMCID: PMC3780291 DOI: 10.2147/jir.s43736] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Indexed: 12/24/2022] Open
Abstract
Objective and design Reduced expression of histone deacetylase 2 (HDAC2) in alveolar macrophages and epithelial cells may account for reduced response of chronic obstructive pulmonary disease (COPD) patients to glucocorticoids. HDAC2 expression and its role in mediating glucocorticoid effects on fibroblast functions, however, has not been fully studied. This study was designed to investigate whether HDAC2 mediates glucocorticoid effects on release of inflammatory cytokines and matrix metalloproteinases (MMPs) from human lung fibroblasts. Methods Human lung fibroblasts (HFL-1 cells) were stimulated with interleukin (IL)-1 β plus tumor necrosis factor (TNF)-α in the presence or absence of the glucocorticoid budesonide. Cytokines (IL-6 and IL-8) were quantified by enzyme linked immunosorbent assay (ELISA) and MMPs (MMP-1 and MMP-3) by immunoblotting in culture medium. The role of HDAC2 was investigated using a pharmacologic inhibitor as well as a small interfering ribonucleic acid (siRNA) targeting HDAC2. Results We have demonstrated that budesonide concentration-dependently (10−10–10−7 M) inhibited IL-6, IL-8, MMP-1, and MMP-3 release by HFL-1 cells in response to IL-1β plus TNF-α. While an HDAC inhibitor significantly blocked the inhibitory effect of budesonide on human bronchial epithelial cells (HBECs) and monocytes (THP-1 cells), it did not block the inhibitory effect of budesonide on release of cytokines and MMPs from HFL-1 cells. Similarly, an HDAC2-siRNA blocked budesonide inhibition of cytokine release in HBECs, but it did not block the inhibitory effect of budesonide on HFL-1 cytokine and MMP release. Furthermore, budesonide significantly blocked release of cytokines and MMPs to a similar degree in normal and COPD lung fibroblasts as well as in HFL-1 cells exposed or not exposed to cigarette smoke extract. Conclusion These findings suggest that, in contrast to airway epithelial cells and monocytes/macrophages, HDAC2 is not required for budesonide to inhibit MMP and cytokine release by lung fibroblasts and this inhibitory pathway appears to be intact in cultured fibroblasts from COPD patients. These results also suggest that budesonide has the potential to modulate fibroblast-mediated tissue remodeling following airway inflammation in COPD, which is mediated via an HDAC2 independent pathway.
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Affiliation(s)
- Xingqi Wang
- Pulmonary, Critical Care, Sleep and Allergy Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Janssen O, Schaumann F, Holz O, Lavae-Mokhtari B, Welker L, Winkler C, Biller H, Krug N, Hohlfeld JM. Low-dose endotoxin inhalation in healthy volunteers--a challenge model for early clinical drug development. BMC Pulm Med 2013; 13:19. [PMID: 23537365 PMCID: PMC3635929 DOI: 10.1186/1471-2466-13-19] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 12/04/2012] [Accepted: 03/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inhalation of endotoxin (LPS) induces a predominantly neutrophilic airway inflammation and has been used as model to test the anti-inflammatory activity of novel drugs. In the past, a dose exceeding 15-50 μg was generally needed to induce a sufficient inflammatory response. For human studies, regulatory authorities in some countries now request the use of GMP-grade LPS, which is of limited availability. It was therefore the aim of this study to test the effect and reproducibility of a low-dose LPS challenge (20,000 E.U.; 2 μg) using a flow- and volume-controlled inhalation technique to increase LPS deposition. METHODS Two to four weeks after a baseline sputum induction, 12 non-smoking healthy volunteers inhaled LPS on three occasions, separated by at least 4 weeks. To modulate the inflammatory effect of LPS, a 5-day PDE4 inhibitor (Roflumilast) treatment preceded the last challenge. Six hours after each LPS inhalation, sputum induction was performed. RESULTS The low-dose LPS inhalation was well tolerated and increased the mean percentage of sputum neutrophils from 25% to 72%. After the second LPS challenge, 62% neutrophils and an increased percentage of monocytes were observed. The LPS induced influx of neutrophils and the cumulative inflammatory response compared with baseline were reproducible. Treatment with Roflumilast for 5 days did not have a significant effect on sputum composition. CONCLUSION The controlled inhalation of 2 μg GMP-grade LPS is sufficient to induce a significant neutrophilic airway inflammation in healthy volunteers. Repeated low-dose LPS challenges potentially result in a small shift of the neutrophil/monocyte ratio; however, the cumulative response is reproducible, enabling the use of this model for "proof-of-concept" studies for anti-inflammatory compounds during early drug development.
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Affiliation(s)
- Ole Janssen
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625 Hannover, Germany
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Holz O, Tal-Singer R, Kanniess F, Simpson KJ, Gibson A, Vessey RSJ, Janicki S, Magnussen H, Jörres RA, Richter K. Validation of the Human Ozone Challenge Model as a Tool for Assessing Anti-Inflammatory Drugs in Early Development. J Clin Pharmacol 2013; 45:498-503. [PMID: 15831772 DOI: 10.1177/0091270004273527] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 11/16/2022]
Abstract
This study aimed to test the utility of the ozone challenge model for profiling novel compounds designed to reduce airway inflammation. The authors used a randomized, double-dummy, double-blind, placebo-controlled 3-period crossover design alternating single orally inhaled doses of fluticasone propionate (inhaled corticosteroids, 2 mg), oral prednisolone (oral corticosteroids, 50 mg), or matched placebo. At a 2-week interval, 18 healthy ozone responders (>10% increase in sputum neutrophils) underwent a 3-hour ozone (250 ppb)/intermittent exercise challenge starting 1 hour after drug treatment. Airway inflammation was assessed at 2 hours (breath condensate) and 3 hours (induced sputum) after ozone challenge. Compared to placebo, pretreatment with inhaled corticosteroids or oral corticosteroids resulted in a significant reduction (mean [95% confidence interval]) of sputum neutrophils by 62% (35%, 77%) and 64% (39%, 79%) and of sputum supernatant myeloperoxidase by 55% (41%, 66%) and 42% (25%, 56%), respectively. The authors conclude that an optimized ozone challenge model (including ozone responders and ensuring adequate drug levels during exposure) may be useful for testing novel anti-inflammatory compounds in early development.
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Affiliation(s)
- Olaf Holz
- Hospital Grosshansdorf, Center for Pneumology and Thoracic Surgery, Wöhrendamm 80, D-22927 Grosshansdorf, Germany
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Kirsten A, Watz H, Pedersen F, Holz O, Smith R, Bruin G, Koehne-Voss S, Magnussen H, Waltz DA. The anti-IL-17A antibody secukinumab does not attenuate ozone-induced airway neutrophilia in healthy volunteers. Eur Respir J 2012; 41:239-41. [DOI: 10.1183/09031936.00123612] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Röpcke S, Holz O, Lauer G, Müller M, Rittinghausen S, Ernst P, Lahu G, Elmlinger M, Krug N, Hohlfeld JM. Repeatability of and relationship between potential COPD biomarkers in bronchoalveolar lavage, bronchial biopsies, serum, and induced sputum. PLoS One 2012; 7:e46207. [PMID: 23056262 PMCID: PMC3464239 DOI: 10.1371/journal.pone.0046207] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 08/30/2012] [Indexed: 11/19/2022] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease, primarily affecting the airways. Stable biomarkers characterizing the inflammatory phenotype of the disease, relevant for disease activity and suited to predict disease progression are needed to monitor the efficacy and safety of drug interventions. We therefore analyzed a large panel of markers in bronchoalveolar lavage, bronchial biopsies, serum and induced sputum of 23 healthy smokers and 24 smoking COPD patients (GOLD II) matched for age and gender. Sample collection was performed twice within a period of 6 weeks. Assays for over 100 different markers were validated for the respective matrices prior to analysis. In our study, we found 51 markers with a sufficient repeatability (intraclass correlation coefficient >0.6), most of these in serum. Differences between groups were observed for markers from all compartments, which extends (von-Willebrand-factor) and confirms (e.g. C-reactive-protein, interleukin-6) previous findings. No correlations between lung and serum markers were observed, including A1AT. Airway inflammation defined by sputum neutrophils showed only a moderate repeatability. This could be improved, when a combination of neutrophils and four sputum fluid phase markers was used to define the inflammatory phenotype.In summary, our study provides comprehensive information on the repeatability and interrelationship of pulmonary and systemic COPD-related markers. These results are relevant for ongoing large clinical trials and future COPD research. While serum markers can discriminate between smokers with and without COPD, they do not seem to sufficiently reflect the disease-associated inflammatory processes within the airways.
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Affiliation(s)
- Stefan Röpcke
- Department of Biomarker Development, Nycomed GmbH, Konstanz, Germany
| | - Olaf Holz
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
- * E-mail:
| | - Gereon Lauer
- Department of Biomarker Development, Nycomed GmbH, Konstanz, Germany
| | - Meike Müller
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Susanne Rittinghausen
- Department of Toxicology and Environmental Hygiene, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | | | - Gezim Lahu
- Department of Biomarker Development, Nycomed GmbH, Konstanz, Germany
| | - Martin Elmlinger
- Department of Biomarker Development, Nycomed GmbH, Konstanz, Germany
| | - Norbert Krug
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Jens M. Hohlfeld
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
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Michalski J, Kanaji N, Liu X, Nogel S, Wang X, Basma H, Nakanishi M, Sato T, Gunji Y, Fahrid M, Nelson A, Muller KC, Holz O, Magnussen H, Rabe KF, Toews ML, Rennard SI. Attenuation of inhibitory prostaglandin E2 signaling in human lung fibroblasts is mediated by phosphodiesterase 4. Am J Respir Cell Mol Biol 2012; 47:729-37. [PMID: 23043089 DOI: 10.1165/rcmb.2012-0057oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The etiology of chronic obstructive pulmonary disease (COPD) is complex and involves an aberrant inflammatory response. Prostaglandin (PG)E2 is elevated in COPD, is a key modulator of lung fibroblast functions, and may influence COPD progression. Most studies evaluating the effects of PGE2 on lung fibroblasts have used acute exposures. The current study evaluated whether longer-term exposure would induce attenuation of PGE2 signaling as part of an autoregulatory pathway. Human fetal lung fibroblasts were pretreated with PGE2 for 24 hours, and migration and cAMP accumulation in response to acute stimulation with PGE2 were assessed. Fibroblasts from adults with and without COPD were pretreated, and migration was assessed. PGE2 pretreatment attenuated subsequent PGE2-mediated inhibition of chemotaxis and cAMP stimulation. This attenuation was predominantly due to an increase in phosphodiesterase (PDE)4-mediated degradation of cAMP rather than to decreased activation of PGE2 receptors (receptor desensitization). Albuterol- and iloprost-mediated signaling were also attenuated after PGE2 pretreatment, suggesting that activation of PDE4 was able to broadly modulate multiple cAMP-coupled pathways. Lung fibroblasts from adult control subjects pretreated with PGE2 also developed attenuation of PGE2-mediated inhibition of chemotaxis. In contrast, fibroblasts obtained from patients with COPD maintained inhibitory PGE2 signaling after PGE2 pretreatment. These data identify a PDE4-mediated attenuation of PGE2 inhibitory signaling in normal fibroblasts that appears to be altered in COPD fibroblasts. These alterations may contribute to COPD pathogenesis and could provide novel therapeutic targets.
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Affiliation(s)
- Joel Michalski
- Department of Internal Medicine, Section of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, 985910 Nebraska Medical Center, Omaha, NE 68198-5910, USA
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Cockayne DA, Cheng DT, Waschki B, Sridhar S, Ravindran P, Hilton H, Kourteva G, Bitter H, Pillai SG, Visvanathan S, Müller KC, Holz O, Magnussen H, Watz H, Fine JS. Systemic biomarkers of neutrophilic inflammation, tissue injury and repair in COPD patients with differing levels of disease severity. PLoS One 2012; 7:e38629. [PMID: 22701684 PMCID: PMC3373533 DOI: 10.1371/journal.pone.0038629] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 05/08/2012] [Indexed: 12/21/2022] Open
Abstract
The identification and validation of biomarkers to support the assessment of novel therapeutics for COPD continues to be an important area of research. The aim of the current study was to identify systemic protein biomarkers correlated with measures of COPD severity, as well as specific protein signatures associated with comorbidities such as metabolic syndrome. 142 protein analytes were measured in serum of 140 patients with stable COPD, 15 smokers without COPD and 30 non-smoking controls. Seven analytes (sRAGE, EN-RAGE, NGAL, Fibrinogen, MPO, TGF-α and HB-EGF) showed significant differences between severe/very severe COPD, mild/moderate COPD, smoking and non-smoking control groups. Within the COPD subjects, univariate and multivariate analyses identified analytes significantly associated with FEV(1), FEV(1)/FVC and DLCO. Most notably, a set of 5 analytes (HB-EGF, Fibrinogen, MCP-4, sRAGE and Sortilin) predicted 21% of the variability in DLCO values. To determine common functions/pathways, analytes were clustered in a correlation network by similarity of expression profile. While analytes related to neutrophil function (EN-RAGE, NGAL, MPO) grouped together to form a cluster associated with FEV(1) related parameters, analytes related to the EGFR pathway (HB-EGF, TGF-α) formed another cluster associated with both DLCO and FEV(1) related parameters. Associations of Fibrinogen with DLCO and MPO with FEV(1)/FVC were stronger in patients without metabolic syndrome (r = -0.52, p = 0.005 and r = -0.61, p = 0.023, respectively) compared to patients with coexisting metabolic syndrome (r = -0.25, p = 0.47 and r = -0.15, p = 0.96, respectively), and may be driving overall associations in the general cohort. In summary, our study has identified known and novel serum protein biomarkers and has demonstrated specific associations with COPD disease severity, FEV(1), FEV(1)/FVC and DLCO. These data highlight systemic inflammatory pathways, neutrophil activation and epithelial tissue injury/repair processes as key pathways associated with COPD.
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Affiliation(s)
- Debra A. Cockayne
- Inflammation Disease Therapy Area, Hoffmann-La Roche, Nutley, New Jersey, United States of America
| | - Donavan T. Cheng
- Translational Research Sciences, Hoffmann-La Roche, Nutley, New Jersey, United States of America
| | - Benjamin Waschki
- Pulmonary Research Institute at Hospital Grosshansdorf, Grosshansdorf, Germany
- Center for Pneumology and Thoracic Surgery, Hospital Grosshandorf, Grosshansdorf, Germany
| | - Sriram Sridhar
- Translational Research Sciences, Hoffmann-La Roche, Nutley, New Jersey, United States of America
| | - Palanikumar Ravindran
- Translational Research Sciences, Hoffmann-La Roche, Nutley, New Jersey, United States of America
| | - Holly Hilton
- Translational Research Sciences, Hoffmann-La Roche, Nutley, New Jersey, United States of America
| | - Galina Kourteva
- Translational Research Sciences, Hoffmann-La Roche, Nutley, New Jersey, United States of America
| | - Hans Bitter
- Translational Research Sciences, Hoffmann-La Roche, Nutley, New Jersey, United States of America
| | - Sreekumar G. Pillai
- Inflammation Disease Therapy Area, Hoffmann-La Roche, Nutley, New Jersey, United States of America
| | - Sudha Visvanathan
- Inflammation Disease Therapy Area, Hoffmann-La Roche, Nutley, New Jersey, United States of America
| | - Kai-Christian Müller
- Center for Pneumology and Thoracic Surgery, Hospital Grosshandorf, Grosshansdorf, Germany
| | - Olaf Holz
- Center for Pneumology and Thoracic Surgery, Hospital Grosshandorf, Grosshansdorf, Germany
| | - Helgo Magnussen
- Pulmonary Research Institute at Hospital Grosshansdorf, Grosshansdorf, Germany
| | - Henrik Watz
- Pulmonary Research Institute at Hospital Grosshansdorf, Grosshansdorf, Germany
| | - Jay S. Fine
- Inflammation Disease Therapy Area, Hoffmann-La Roche, Nutley, New Jersey, United States of America
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Nakanishi M, Sato T, Li Y, Nelson AJ, Farid M, Michalski J, Kanaji N, Wang X, Basma H, Patil A, Goraya J, Liu X, Togo S, L Toews M, Holz O, Muller KC, Magnussen H, Rennard SI. Prostaglandin E2 stimulates the production of vascular endothelial growth factor through the E-prostanoid-2 receptor in cultured human lung fibroblasts. Am J Respir Cell Mol Biol 2012; 46:217-23. [PMID: 22298530 DOI: 10.1165/rcmb.2010-0115oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Fibroblasts are the major mesenchymal cells present within the interstitium of the lung and are a major source of vascular endothelial growth factor (VEGF), which modulates the maintenance of pulmonary microvasculature. Prostaglandin E(2) (PGE(2)) acts on a set of E-prostanoid (EP) receptors that activate multiple signal transduction pathways leading to downstream responses. We investigated the modulation by PGE(2) of VEGF release by human lung fibroblasts. Human lung fibroblasts were cultured until reaching 90% confluence in tissue culture plates, after which the culture media were changed to serum-free Dulbecco's modified Eagle's medium, with or without PGE(2), and with specific agonists or antagonists for each EP receptor. After 2 days, culture media were assayed for VEGF by ELISA. The results demonstrated that PGE(2) and the EP2 agonist ONO-AE1-259-01 significantly stimulated the release of VEGF in a concentration-dependent manner. Agonists for other EP receptors did not stimulate the release of VEGF. The stimulatory effect of PGE(2) was blocked by the EP2 antagonist AH6809, but was not blocked by antagonists for other EP receptors. The protein kinase-A (PKA) inhibitor KT-5720 also blocked the stimulatory effect of PGE(2). The increased release of VEGF induced by PGE(2) was accompanied by a transient increase in the concentration of VEGF mRNA. These findings demonstrate that PGE(2) can modulate the release of VEGF by human lung fibroblasts through its actions in the EP2 receptor/PKA pathway. This activity may contribute to the maintenance of pulmonary microvasculature in the alveolar wall.
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Affiliation(s)
- Masanori Nakanishi
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198-5910, USA.
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48
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Holz O, Schaumann F, Janssen O, Lavae-Mokhtari B, Witte L, Krug N, Biller H, Hohlfeld J. Neutrophile Atemwegsentzündung in gesunden Probanden nach niedrig dosierter inhalativer Endotoxin- (LPS) Provokation. Pneumologie 2012. [DOI: 10.1055/s-0032-1302717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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49
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Holz O, Schaumann F, Janssen O, Lavae-Mokhtari B, Witte L, Krug N, Heinrich JM, Hohlfeld J. Depletion von neutrophilen Granulozyten aus induziertem Sputum mittels Antikörper-gebundener Beads und Sieb-Trennsystem. Pneumologie 2012. [DOI: 10.1055/s-0032-1302716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tank J, Biller H, Heusser K, Holz O, Diedrich A, Framke T, Koch A, Grosshennig A, Koch W, Krug N, Jordan J, Hohlfeld JM. Effect of acute ozone induced airway inflammation on human sympathetic nerve traffic: a randomized, placebo controlled, crossover study. PLoS One 2011; 6:e18737. [PMID: 21494635 PMCID: PMC3073001 DOI: 10.1371/journal.pone.0018737] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 03/12/2011] [Indexed: 11/18/2022] Open
Abstract
Background Ozone concentrations in ambient air are related to cardiopulmonary
perturbations in the aging population. Increased central sympathetic nerve
activity induced by local airway inflammation may be one possible
mechanism. Methodology/Principal Findings To elucidate this issue further, we performed a randomized, double-blind,
cross-over study, including 14 healthy subjects (3 females, age 22–47
years), who underwent a 3 h exposure with intermittent exercise to either
ozone (250 ppb) or clean air. Induced sputum was collected 3 h after
exposure. Nineteen to 22 hours after exposure, we recorded ECG, finger blood
pressure, brachial blood pressure, respiration, cardiac output, and muscle
sympathetic nerve activity (MSNA) at rest, during deep breathing,
maximum-inspiratory breath hold, and a Valsalva maneuver. While the ozone
exposure induced the expected airway inflammation, as indicated by a
significant increase in sputum neutrophils, we did not detect a significant
estimated treatment effect adjusted for period on cardiovascular
measurements. Resting heart rate (clean air: 59±2, ozone 60±2
bpm), blood pressure (clean air: 121±3/71±2 mmHg; ozone:
121±2/71±2 mmHg), cardiac output (clean air: 7.42±0.29
mmHg; ozone: 7.98±0.60 l/min), and plasma norepinephrine levels
(clean air: 213±21 pg/ml; ozone: 202±16 pg/ml), were similar
on both study days. No difference of resting MSNA was observed between ozone
and air exposure (air: 23±2, ozone: 23±2 bursts/min). Maximum
MSNA obtained at the end of apnea (air: 44±4, ozone: 48±4
bursts/min) and during the phase II of the Valsalva maneuver (air:
64±5, ozone: 57±6 bursts/min) was similar. Conclusions/Significance Our study suggests that acute ozone-induced airway inflammation does not
increase resting sympathetic nerve traffic in healthy subjects, an
observation that is relevant for environmental health. However, we can not
exclude that chronic airway inflammation may contribute to sympathetic
activation.
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Affiliation(s)
- Jens Tank
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany.
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