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Gao J, Um-Bergström P, Pourbazargan M, Berggren-Broström E, Li C, Merikallio H, Kaarteenaho R, Reinke NS, Wheelock CE, Melén E, Anders L, Wheelock ÅM, Rassidakis G, Ortiz-Villalon C, Sköld MC. Large airway T cells in adults with former bronchopulmonary dysplasia. Respir Res 2024; 25:86. [PMID: 38336805 PMCID: PMC10858477 DOI: 10.1186/s12931-024-02717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Bronchopulmonary Dysplasia (BPD) in infants born prematurely is a risk factor for chronic airway obstruction later in life. The distribution of T cell subtypes in the large airways is largely unknown. OBJECTIVE To characterize cellular and T cell profiles in the large airways of young adults with a history of BPD. METHODS Forty-three young adults born prematurely (preterm (n = 20), BPD (n = 23)) and 45 full-term-born (asthma (n = 23), healthy (n = 22)) underwent lung function measurements, and bronchoscopy with large airway bronchial wash (BW). T-cells subsets in BW were analyzed by immunocytochemistry. RESULTS The proportions of both lymphocytes and CD8 + T cells in BW were significantly higher in BPD (median, 6.6%, and 78.0%) when compared with asthma (3.4% and 67.8%, p = 0.002 and p = 0.040) and healthy (3.8% and 40%, p < 0.001 and p < 0.001). In all adults born prematurely (preterm and BPD), lymphocyte proportion correlated negatively with forced vital capacity (r= -0.324, p = 0.036) and CD8 + T cells correlated with forced expiratory volume in one second, FEV1 (r=-0.448, p = 0.048). Correlation-based network analysis revealed that lung function cluster and BPD-birth cluster were associated with lymphocytes and/or CD4 + and CD8 + T cells. Multivariate regression analysis showed that lymphocyte proportions and BPD severity qualified as independent factors associated with FEV1. CONCLUSIONS The increased cytotoxic T cells in the large airways in young adults with former BPD, suggest a similar T-cell subset pattern as in the small airways, resembling features of COPD. Our findings strengthen the hypothesis that mechanisms involving adaptive and innate immune responses are involved in the development of airway disease due to preterm birth.
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Affiliation(s)
- Jing Gao
- Respiratory Medicine Division, Department of Medicine Solna, Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, 171 76, Sweden.
| | - Petra Um-Bergström
- Respiratory Medicine Division, Department of Medicine Solna, Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, 171 76, Sweden
- Department of Pediatrics, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Melvin Pourbazargan
- Respiratory Medicine Division, Department of Medicine Solna, Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, 171 76, Sweden
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Berggren-Broström
- Department of Pediatrics, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - ChuanXing Li
- Respiratory Medicine Division, Department of Medicine Solna, Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, 171 76, Sweden
| | - Heta Merikallio
- Respiratory Medicine Division, Department of Medicine Solna, Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, 171 76, Sweden
- Research Unit of Internal Medicine and Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Riitta Kaarteenaho
- Research Unit of Internal Medicine and Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Nichole Stacey Reinke
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Integrative Metabolomics and Computational Biology, School of Science, Edith Cowan University, Perth, Australia
| | - Craig E Wheelock
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
- Gunma University Initiative for Advanced Research (GIAR), Gunma University, Maebashi, Japan
| | - Erik Melén
- Department of Pediatrics, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lindén Anders
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Åsa M Wheelock
- Respiratory Medicine Division, Department of Medicine Solna, Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, 171 76, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Georgios Rassidakis
- Department of Oncology and Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Cristian Ortiz-Villalon
- Department of Oncology and Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Carl Sköld
- Respiratory Medicine Division, Department of Medicine Solna, Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, 171 76, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
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2
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Simpson SJ, Du Berry C, Evans DJ, Gibbons JTD, Vollsæter M, Halvorsen T, Gruber K, Lombardi E, Stanojevic S, Hurst JR, Um-Bergström P, Hallberg J, Doyle LW, Kotecha S. Unravelling the respiratory health path across the lifespan for survivors of preterm birth. Lancet Respir Med 2024; 12:167-180. [PMID: 37972623 DOI: 10.1016/s2213-2600(23)00272-2] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/19/2023] [Accepted: 07/19/2023] [Indexed: 11/19/2023]
Abstract
Many survivors of preterm birth will have abnormal lung development, reduced peak lung function and, potentially, an increased rate of physiological lung function decline, each of which places them at increased risk of chronic obstructive pulmonary disease across the lifespan. Current rates of preterm birth indicate that by the year 2040, around 50 years since the introduction of surfactant therapy, more than 700 million individuals will have been born prematurely-a number that will continue to increase by about 15 million annually. In this Personal View, we describe current understanding of the impact of preterm birth on lung function through the life course, with the aim of putting this emerging health crisis on the radar for the respiratory community. We detail the potential underlying mechanisms of prematurity-associated lung disease and review current approaches to prevention and management. Furthermore, we propose a novel way of considering lung disease after preterm birth, using a multidimensional model to determine individual phenotypes of lung disease-a first step towards optimising management approaches for prematurity-associated lung disease.
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Affiliation(s)
- Shannon J Simpson
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
| | - Cassidy Du Berry
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Respiratory Group, Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Denby J Evans
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - James T D Gibbons
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Allied Health, Curtin University, Perth, WA, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Karl Gruber
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | - Petra Um-Bergström
- Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden; Lung and Allergy Unit, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Jenny Hallberg
- Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden; Lung and Allergy Unit, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Lex W Doyle
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Newborn Services, The Royal Women's Hospital, Melbourne, VIC, Australia
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
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Lundberg B, Merid SK, Um-Bergström P, Wang G, Bergström A, Ekström S, Kull I, Melén E, Hallberg J. Lung function in young adulthood in relation to moderate-to-late preterm birth. ERJ Open Res 2024; 10:00701-2023. [PMID: 38259815 PMCID: PMC10801715 DOI: 10.1183/23120541.00701-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/14/2023] [Indexed: 01/24/2024] Open
Abstract
Background Moderate-to-late preterm birth (32 to <37 weeks of gestation) has been associated with impaired lung function in adolescence, but data in adulthood and physiological phenotyping beyond spirometry are scarce. We aimed to investigate lung function development from adolescence into young adulthood and to provide physiological phenotyping in individuals born moderate-to-late preterm. Methods Lung function data from individuals born moderate-to-late preterm (n=110) and term (37 to <42 weeks of gestation, n=1895) in the Swedish birth cohort BAMSE were used for analysis and included dynamic spirometry, fractional exhaled nitric oxide and multiple breath nitrogen wash-out. Data from 16- and 24-year follow-ups were analysed using regression models stratified on sex and adjusted for smoking. Data-driven latent class analysis was used to phenotype moderate-to-late preterm individuals at 24 years, and groups were related to background factors. Results Males born moderate-to-late preterm had lower forced expiratory volume in 1 s (FEV1) at 24 years of age (-0.28 z-score, p=0.045), compared to males born term. In females, no difference was seen at 24 years, partly explained by a significant catch up in FEV1 between 16 and 24 years (0.18 z-score, p=0.01). Lung function phenotypes described as "asthma-like", "dysanapsis-like" and "preterm reference" were identified within the preterm group. Maternal overweight in early pregnancy was associated with "asthma-like" group membership (OR 3.59, p=0.02). Conclusion Our results show impaired FEV1 at peak lung function in males born moderate-to-late preterm, while females born moderate-to-late preterm had significant catch up between the ages of 16 and 24 years. Several phenotypes of lung function impairment exist in individuals born moderate-to-late preterm.
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Affiliation(s)
- Björn Lundberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Simon Kebede Merid
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Petra Um-Bergström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Gang Wang
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Sandra Ekström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Jenny Hallberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Challis P, Källén K, Björklund L, Elfvin A, Farooqi A, Håkansson S, Ley D, Norman M, Normann E, Serenius F, Sävman K, Hellström-Westas L, Um-Bergström P, Ådén U, Abrahamsson T, Domellöf M. Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016). Arch Dis Child Fetal Neonatal Ed 2023; 109:87-93. [PMID: 37788898 PMCID: PMC10804036 DOI: 10.1136/archdischild-2023-325784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/28/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants. DESIGN Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage ≥II) were validated against hospital records. PATIENTS All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden. MAIN OUTCOME MEASURES NEC incidence. RESULTS The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047). CONCLUSIONS The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.
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Affiliation(s)
- Pontus Challis
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Obstetrics and Gynecology, Lund University Faculty of Medicine, Lund, Sweden
| | - Lars Björklund
- Department of Clinical Sciences, Lund, Paediatrics, Lund University, Lund, Sweden
| | - Anders Elfvin
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Department of Pediatrics, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Aijaz Farooqi
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Stellan Håkansson
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - David Ley
- Department of Clinical Sciences, Lund, Paediatrics, Lund University, Lund, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Normann
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Fredrik Serenius
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Karin Sävman
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Petra Um-Bergström
- Department of Pediatrics, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Clinical Science and Education at Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Ulrika Ådén
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Departments of Biomedical and Clinical Sciences and Pediatrics, Linköping University, Linköping, Sweden
| | - Thomas Abrahamsson
- Departments of Biomedical and Clinical Sciences and Pediatrics, Linköping University, Linköping, Sweden
- Department of Pediatrics, Linköping University Hospital, Linköping, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Stern R, Um-Bergström P, Sköld M. [Lung complications in adults due to premature birth: an increasint patient population that needs to be followed up]. Lakartidningen 2022; 119:21214. [PMID: 35532140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Infants born prematurely are susceptible for respiratory disease later in life. In particular, children born before 32 gestational weeks, treated with oxygen or respiratory support and diagnosed with bronchopulmonary dysplasia (BPD) have the highest risk. Airways obstruction is the major lung function impairment, and it can be aggravated in adult life when age-related loss of lung function takes place. Events both in the neonatal period but also during childhood may, at least partly, explain the relatively large proportion of neversmokers with chronic obstructive pulmonary disease (COPD). Individuals born prematurely, specifically those with previous BPD, should have regular follow-ups in order to detect respiratory impairment.
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Affiliation(s)
- Rebecka Stern
- specialistläkare, ME lung-allergisjukdomar, Karolins-ka universitetssjukhuset, Stockholm
| | - Petra Um-Bergström
- med dr, överläkare, Sachsska barn- och ungdomssjukhuset, Södersjukhuset, Stockholm
| | - Magnus Sköld
- professor, överläkare, ME lung- och allergisjukdomar, Karolins-ka universitetssjukhuset; institutionen för medicin Solna, Karolinska institutet, Stockholm
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Um-Bergström P, Pourbazargan M, Brundin B, Ström M, Ezerskyte M, Gao J, Berggren Broström E, Melén E, Wheelock ÅM, Lindén A, Sköld CM. Increased cytotoxic T-cells in the airways of adults with former bronchopulmonary dysplasia. Eur Respir J 2022; 60:13993003.02531-2021. [PMID: 35210327 PMCID: PMC9520031 DOI: 10.1183/13993003.02531-2021] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 09/20/2021] [Accepted: 02/04/2022] [Indexed: 11/29/2022]
Abstract
Rationale Bronchopulmonary dysplasia (BPD) in preterm-born infants is a risk factor for chronic airway obstruction in adulthood. Cytotoxic T-cells are implicated in COPD, but their involvement in BPD is not known. Objectives To characterise the distribution of airway T-cell subsets in adults with a history of BPD. Methods Young adults with former BPD (n=22; median age 19.6 years), age-matched adults born preterm (n=22), patients with allergic asthma born at term (n=22) and healthy control subjects born at term (n=24) underwent bronchoalveolar lavage (BAL). T-cell subsets in BAL were analysed using flow cytometry. Results The total number of cells and the differential cell counts in BAL were similar among the study groups. The percentage of CD3+CD8+ T-cells was higher (p=0.005) and the proportion of CD3+CD4+ T-cells was reduced (p=0.01) in the BPD group, resulting in a lower CD4/CD8 ratio (p=0.007) compared to the healthy controls (median 2.2 versus 5.3). In BPD and preterm-born study subjects, both CD3+CD4+ T-cells (rs=0.38, p=0.03) and CD4/CD8 ratio (rs=0.44, p=0.01) correlated positively with forced expiratory volume in 1 s (FEV1). Furthermore, CD3+CD8+ T-cells were negatively correlated with both FEV1 and FEV1/forced vital capacity (rs= −0.44, p=0.09 and rs= −0.41, p=0.01, respectively). Conclusions Young adults with former BPD have a T-cell subset pattern in the airways resembling features of COPD. Our findings are compatible with the hypothesis that CD3+CD8+ T-cells are involved in mechanisms behind chronic airway obstruction in these patients. Young adults with former BPD display more cytotoxic T-cells in the airways than healthy subjects. These T-cells correlate with FEV1. Thus, cytotoxic T-cells may contribute to the pathology behind chronic airway obstruction in adults with former BPD.https://bit.ly/3soI4lK
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Affiliation(s)
- Petra Um-Bergström
- Sachs' Children and Youth Hospital, Department of Pediatrics, Södersjukhuset, Stockholm, Sweden petra.um.bergstrom@ki.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Melvin Pourbazargan
- Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Bettina Brundin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marika Ström
- Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Monika Ezerskyte
- Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jing Gao
- Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Berggren Broström
- Sachs' Children and Youth Hospital, Department of Pediatrics, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Erik Melén
- Sachs' Children and Youth Hospital, Department of Pediatrics, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Åsa M Wheelock
- Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Lindén
- Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - C Magnus Sköld
- Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
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Pourbazargan M, Nyren S, Um-Bergström P, Berggren-Broström E, Melén E, Steern R, Wheelock ÅM, Lindén A, Karimi R, Sköld CM. Structural changes on high resolution computed tomography (HRCT) in adult individuals with a history of bronchopulmonary dysplasia (BPD). Imaging 2020. [DOI: 10.1183/13993003.congress-2020.3371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Um-Bergström P, Hallberg J, Pourbazargan M, Berggren-Broström E, Ferrara G, Eriksson MJ, Nyrén S, Gao J, Lilja G, Lindén A, Wheelock ÅM, Melén E, Sköld CM. Pulmonary outcomes in adults with a history of Bronchopulmonary Dysplasia differ from patients with asthma. Respir Res 2019; 20:102. [PMID: 31126291 PMCID: PMC6534852 DOI: 10.1186/s12931-019-1075-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 12/13/2018] [Accepted: 05/16/2019] [Indexed: 12/23/2022] Open
Abstract
Background Bronchopulmonary dysplasia (BPD) is a risk factor for respiratory disease in adulthood. Despite the differences in underlying pathology, patients with a history of BPD are often treated as asthmatics. We hypothesized that pulmonary outcomes and health-related quality of life (HRQoL) were different in adults born preterm with and without a history of BPD compared to asthmatics and healthy individuals. Methods We evaluated 96 young adults from the LUNAPRE cohort (clinicaltrials.gov/ct2/show/NCT02923648), including 26 individuals born preterm with a history of BPD (BPD), 23 born preterm without BPD (preterm), 23 asthmatics and 24 healthy controls. Extensive lung function testing and HRQoL were assessed. Results The BPD group had more severe airway obstruction compared to the preterm-, (FEV1− 0.94 vs. 0.28 z-scores; p ≤ 0.001); asthmatic- (0.14 z-scores, p ≤ 0.01) and healthy groups (0.78 z-scores, p ≤ 0.001). Further, they had increased ventilation inhomogeneity compared to the preterm- (LCI 6.97 vs. 6.73, p ≤ 0.05), asthmatic- (6.75, p = 0.05) and healthy groups (6.50 p ≤ 0.001). Both preterm groups had lower DLCO compared to healthy controls (p ≤ 0.001 for both). HRQoL showed less physical but more psychological symptoms in the BPD group compared to asthmatics. Conclusions Lung function impairment and HRQoL in adults with a history of BPD differed from that in asthmatics highlighting the need for objective assessment of lung health. Electronic supplementary material The online version of this article (10.1186/s12931-019-1075-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Petra Um-Bergström
- Sachs' Children and Youth Hospital, Department of Pediatrics, Södersjukhuset, 118 83, Stockholm, Sweden. .,Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden.
| | - Jenny Hallberg
- Sachs' Children and Youth Hospital, Department of Pediatrics, Södersjukhuset, 118 83, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Melvin Pourbazargan
- Department of Respiratory Medicine & Allergy, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Eva Berggren-Broström
- Sachs' Children and Youth Hospital, Department of Pediatrics, Södersjukhuset, 118 83, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Giovanni Ferrara
- Department of Respiratory Medicine & Allergy, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Maria J Eriksson
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sven Nyrén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Thoracic Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jing Gao
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Gunnar Lilja
- Sachs' Children and Youth Hospital, Department of Pediatrics, Södersjukhuset, 118 83, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anders Lindén
- Department of Respiratory Medicine & Allergy, Karolinska University Hospital, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Åsa M Wheelock
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Erik Melén
- Sachs' Children and Youth Hospital, Department of Pediatrics, Södersjukhuset, 118 83, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C Magnus Sköld
- Department of Respiratory Medicine & Allergy, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
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9
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Norman M, Hallberg B, Abrahamsson T, Björklund LJ, Domellöf M, Farooqi A, Foyn Bruun C, Gadsbøll C, Hellström-Westas L, Ingemansson F, Källén K, Ley D, Maršál K, Normann E, Serenius F, Stephansson O, Stigson L, Um-Bergström P, Håkansson S. Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016. JAMA 2019; 321:1188-1199. [PMID: 30912837 PMCID: PMC6439685 DOI: 10.1001/jama.2019.2021] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
Importance Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown. Objective To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016. Design, Setting and Participants All births at 22-26 weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016. Exposures Delivery at 22-26 weeks' gestational age. Main Outcomes and Measures The primary outcome was infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia). Results During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P = .61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7% [95% CI, -11% to -2.2%], P = .003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6% [95% CI, -11% to -1.7%], P = .008). Conclusions and Relevance Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.
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Affiliation(s)
- Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - Boubou Hallberg
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Abrahamsson
- Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden
| | - Lars J. Björklund
- Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Magnus Domellöf
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
| | - Aijaz Farooqi
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
| | - Cathrine Foyn Bruun
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
| | - Christian Gadsbøll
- Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden
- Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Fredrik Ingemansson
- Department of Pediatrics, Ryhov County Hospital, Jönköping County Council, Jonkoping, Sweden
| | - Karin Källén
- Centre for Reproductive Epidemiology, Lund University, Lund, Sweden
| | - David Ley
- Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Karel Maršál
- Departments of Clinical Sciences and Obstetrics and Gynecology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Normann
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Fredrik Serenius
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Olof Stephansson
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Stigson
- Department of Pediatrics, Institute for Clinical Sciences, Queen Silvia Children’s Hospital, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
| | - Petra Um-Bergström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Department of Neonatal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Stellan Håkansson
- Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
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