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Pendleton KM, Fiocchi J, Meyer J, Fuher A, Green S, LeTourneau WM, Reilkoff RA. High PEEP extubation as guided by esophageal manometry. Respir Med Case Rep 2024; 48:101985. [PMID: 38357549 PMCID: PMC10865048 DOI: 10.1016/j.rmcr.2024.101985] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
The ventilatory management of morbidly obese patients presents an ongoing challenge in the Intensive Care Unit (ICU) as multiple physiologic changes in the respiratory system complicate weaning efforts and make extubation more difficult, often leading to increased time on the ventilator. We report the case of a young adult male who presented to our ICU on two separate occasions with hypoxemic respiratory failure requiring intubation. Esophageal manometry (EM) guided positive end expiratory pressure (PEEP) titration was utilized during both ICU admissions to improve oxygenation and aid in extubation with spontaneous breathing trials performed on higher-than-normal PEEP settings and successful liberation on both occasions.
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Affiliation(s)
- Kathryn M. Pendleton
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jacob Fiocchi
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Julia Meyer
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Alexandra Fuher
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Sarah Green
- MHealth-Fairview Southdale Hospital, Edina, MN, USA
| | - William M. LeTourneau
- Department of Anesthesiology and Perioperative Medicine, Respiratory Therapy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ronald A. Reilkoff
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Valencia Morales DJ, Bansal V, Heavner SF, Castro JC, Sharma M, Tekin A, Bogojevic M, Zec S, Sharma N, Cartin-Ceba R, Nanchal RS, Sanghavi DK, La Nou AT, Khan SA, Belden KA, Chen JT, Melamed RR, Sayed IA, Reilkoff RA, Herasevich V, Domecq Garces JP, Walkey AJ, Boman K, Kumar VK, Kashyap R. Validation of automated data abstraction for SCCM discovery VIRUS COVID-19 registry: practical EHR export pathways (VIRUS-PEEP). Front Med (Lausanne) 2023; 10:1089087. [PMID: 37859860 PMCID: PMC10583598 DOI: 10.3389/fmed.2023.1089087] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
Background The gold standard for gathering data from electronic health records (EHR) has been manual data extraction; however, this requires vast resources and personnel. Automation of this process reduces resource burdens and expands research opportunities. Objective This study aimed to determine the feasibility and reliability of automated data extraction in a large registry of adult COVID-19 patients. Materials and methods This observational study included data from sites participating in the SCCM Discovery VIRUS COVID-19 registry. Important demographic, comorbidity, and outcome variables were chosen for manual and automated extraction for the feasibility dataset. We quantified the degree of agreement with Cohen's kappa statistics for categorical variables. The sensitivity and specificity were also assessed. Correlations for continuous variables were assessed with Pearson's correlation coefficient and Bland-Altman plots. The strength of agreement was defined as almost perfect (0.81-1.00), substantial (0.61-0.80), and moderate (0.41-0.60) based on kappa statistics. Pearson correlations were classified as trivial (0.00-0.30), low (0.30-0.50), moderate (0.50-0.70), high (0.70-0.90), and extremely high (0.90-1.00). Measurements and main results The cohort included 652 patients from 11 sites. The agreement between manual and automated extraction for categorical variables was almost perfect in 13 (72.2%) variables (Race, Ethnicity, Sex, Coronary Artery Disease, Hypertension, Congestive Heart Failure, Asthma, Diabetes Mellitus, ICU admission rate, IMV rate, HFNC rate, ICU and Hospital Discharge Status), and substantial in five (27.8%) (COPD, CKD, Dyslipidemia/Hyperlipidemia, NIMV, and ECMO rate). The correlations were extremely high in three (42.9%) variables (age, weight, and hospital LOS) and high in four (57.1%) of the continuous variables (Height, Days to ICU admission, ICU LOS, and IMV days). The average sensitivity and specificity for the categorical data were 90.7 and 96.9%. Conclusion and relevance Our study confirms the feasibility and validity of an automated process to gather data from the EHR.
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Affiliation(s)
- Diana J. Valencia Morales
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
| | - Vikas Bansal
- Division of Nephrology and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Smith F. Heavner
- CURE Drug Repurposing Collaboratory, Critical Path Institute, Tucson, AZ, United States
| | - Janna C. Castro
- Department of Information Technology, Mayo Clinic, Scottsdale, AZ, United States
| | - Mayank Sharma
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
| | - Aysun Tekin
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
| | - Marija Bogojevic
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
| | - Simon Zec
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
| | - Nikhil Sharma
- Division of Nephrology and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Rodrigo Cartin-Ceba
- Division of Critical Care Medicine, Department of Pulmonary Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Rahul S. Nanchal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Devang K. Sanghavi
- Department of Critical Care Medicine, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Abigail T. La Nou
- Department of Critical Care Medicine, Mayo Clinic Health System, Eau Claire, WI, United States
| | - Syed A. Khan
- Department of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, United States
| | - Katherine A. Belden
- Division of Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Jen-Ting Chen
- Division of Critical Care Medicine, Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Roman R. Melamed
- Department of Critical Care Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN, United States
| | - Imran A. Sayed
- Department of Pediatrics, Children’s Hospital of Colorado, University of Colorado Anschutz Medical Campus, Colorado Springs, CO, United States
| | - Ronald A. Reilkoff
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Minnesota Medical School, Edina, MN, United States
| | - Vitaly Herasevich
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
| | - Juan Pablo Domecq Garces
- Division of Nephrology and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Allan J. Walkey
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Evans Center of Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, United States
| | - Karen Boman
- Society of Critical Care Medicine, Mount Prospect, IL, United States
| | - Vishakha K. Kumar
- Society of Critical Care Medicine, Mount Prospect, IL, United States
| | - Rahul Kashyap
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
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Hilliard B, Reilkoff RA, Baum KD. Rapid implementation of a medical student rotation in health systems operations and remote patient care in response to COVID-19. Med Educ Online 2022; 27:2067024. [PMID: 35509248 PMCID: PMC9090420 DOI: 10.1080/10872981.2022.2067024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Medical schools initially removed students from clinical rotations at the outset of COVID-19 for safety reasons when students were eager to help and health systems needed personnel. In response, we rapidly implemented an innovative 2-week rotation for medical students to participate in health systems operations and care through remote efforts including triage and resource allocation. The curriculum also contained online self-paced educational modules covering topics including ethics, crisis standards of care, and modeling. As the health system needs shifted, so too did learners' work. One hundred and twenty-five 3rd and 4th-year students completed the experience over 10 months. Learner satisfaction, confidence, and knowledge assessed through pre- and post-rotation surveys showed statistically significant and educationally meaningful improvement. A near uniform change greater than 1 point (on a 5-point scale) was demonstrated upon rotation completion. Blending health systems and educational structures to meet the needs of both creates unique opportunities to educate students in new ways.
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Affiliation(s)
- Brian Hilliard
- Medicine and Pediatrics, Division of General Internal Medicine, Department of Medicine, Uniersity of Minnesota Medical School, Minneapolis, Minnesota
- CONTACT Brian Hilliard Brian Hilliard Assistant Professor of Medicine and Pediatrics, Division of General Internal Medicine, Department of Medicine, Uniersity of Minnesota Medical School,,420 Delaware St SE, MMC 741, Minneapolis, Mennesota
| | - Ronald A Reilkoff
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Karyn D. Baum
- Essentia Health and Adjunct Professor of Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Reilkoff RA, Proper J, Wacker DA. The authors reply. Crit Care Med 2022; 50:e612-e613. [PMID: 35612460 DOI: 10.1097/ccm.0000000000005544] [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: 11/26/2022]
Affiliation(s)
- Ronald A Reilkoff
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Jennifer Proper
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - David A Wacker
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN
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Puskarich MA, Cummins NW, Ingraham NE, Wacker DA, Reilkoff RA, Driver BE, Biros MH, Bellolio F, Chipman JG, Nelson AC, Beckman K, Langlois R, Bold T, Aliota MT, Schacker TW, Voelker HT, Murray TA, Koopmeiners JS, Tignanelli CJ. A multi-center phase II randomized clinical trial of losartan on symptomatic outpatients with COVID-19. EClinicalMedicine 2021; 37:100957. [PMID: 34195577 PMCID: PMC8225661 DOI: 10.1016/j.eclinm.2021.100957] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 virus enters cells via Angiotensin-converting enzyme 2 (ACE2), disrupting the renin-angiotensin-aldosterone axis, potentially contributing to lung injury. Treatment with angiotensin receptor blockers (ARBs), such as losartan, may mitigate these effects, though induction of ACE2 could increase viral entry, replication, and worsen disease. METHODS This study represents a placebo-controlled blinded randomized clinical trial (RCT) to test the efficacy of losartan on outpatients with COVID-19 across three hospital systems with numerous community sites in Minnesota, U.S. Participants included symptomatic outpatients with COVID-19 not already taking ACE-inhibitors or ARBs, enrolled within 7 days of symptom onset. Patients were randomized to 1:1 losartan (25 mg orally twice daily unless estimated glomerular filtration rate, eGFR, was reduced, when dosing was reduced to once daily) versus placebo for 10 days, and all patients and outcome assesors were blinded. The primary outcome was all-cause hospitalization within 15 days. Secondary outcomes included functional status, dyspnea, temperature, and viral load. (clinicatrials.gov, NCT04311177, closed to new participants). FINDINGS From April to November 2020, 117 participants were randomized 58 to losartan and 59 to placebo, and all were analyzed under intent to treat principles. The primary outcome did not differ significantly between the two arms based on Barnard's test [losartan arm: 3 events (5.2% 95% CI 1.1, 14.4%) versus placebo arm: 1 event (1.7%; 95% CI 0.0, 9.1%)]; proportion difference -3.5% (95% CI -13.2, 4.8%); p = 0.32]. Viral loads were not statistically different between treatment groups at any time point. Adverse events per 10 patient days did not differ signifcantly [0.33 (95% CI 0.22-0.49) for losartan vs. 0.37 (95% CI 0.25-0.55) for placebo]. Due to a lower than expected hospitalization rate and low likelihood of a clinically important treatment effect, the trial was terminated early. INTERPRETATION In this multicenter blinded RCT for outpatients with mild symptomatic COVID-19 disease, losartan did not reduce hospitalizations, though assessment was limited by low event rate. Importantly, viral load was not statistically affected by treatment. This study does not support initiation of losartan for low-risk outpatients.
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Affiliation(s)
- Michael A. Puskarich
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Nathan W. Cummins
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicholas E. Ingraham
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - David A. Wacker
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ronald A. Reilkoff
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Michelle H. Biros
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Fernanda Bellolio
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew C. Nelson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth Beckman
- University of Minnesota Genomics Center, University of Minnesota, Minneapolis, MN, USA
| | - Ryan Langlois
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Tyler Bold
- Division of Infectious Diseases, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Matthew T. Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, MN, USA
| | - Timothy W. Schacker
- Division of Infectious Diseases, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Helen T. Voelker
- Department of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Thomas A Murray
- Department of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph S. Koopmeiners
- Department of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Christopher J. Tignanelli
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Abstract
Alpha-1 Antitrypsin Deficiency (A1AD) is a hereditary condition characterized by low levels of circulating alpha-antitrypsin (AAT) in plasma. It is the best understood genetic risk factor for the development of chronic obstructive pulmonary disease (COPD). The diagnosis of A1AD is under-recognized. While there is a significant heterogeneity in disease presentation in relation to the severity of symptoms and prognosis, it is not uncommon for young individuals, including pregnant women to already have moderate to advanced lung disease at the time of diagnosis. Reductions in AAT levels may have unique implications for a gravid patient beyond that of lung disease. Care of the pregnant A1AD patient with chronic lung disease follows the principles of care for the management of airways disease in general with control of symptoms and reduction in exacerbation risk the main tenets of treatment. The effect of A1AD and augmentation in pregnancy has not been studied and thus care is reliant on expert opinion and clinical experience. Providers caring for pregnant patients with A1AD should consider referral to health care systems and providers with specific expertise in A1AD. Ultimately the decision is left to the individual patient and their physician to weigh the risk benefit of cessation or continuation of therapies. In this review, we present the perinatal course of a woman with A1AD and review the available literature pertaining to AAT and pregnancy and discuss the clinical implications.
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Affiliation(s)
- Nate T Gaeckle
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laurel Stephenson
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ronald A Reilkoff
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Johnson K, McEvoy CE, Naqvi S, Wendt C, Reilkoff RA, Kunisaki KM, Wetherbee EE, Nelson D, Tirouvanziam R, Niewoehner DE. High-dose oral N-acetylcysteine fails to improve respiratory health status in patients with chronic obstructive pulmonary disease and chronic bronchitis: a randomized, placebo-controlled trial. Int J Chron Obstruct Pulmon Dis 2016; 11:799-807. [PMID: 27143871 PMCID: PMC4846045 DOI: 10.2147/copd.s102375] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Clinical outcomes are worse in patients with COPD and chronic bronchitis. N-acetylcysteine (NAC) is commonly prescribed for such patients but with uncertain clinical benefits. We postulated that oral NAC, at much larger doses than those ordinarily prescribed, would improve clinical outcomes in a subset of patients with COPD and chronic bronchitis. Objective The aim of this study was to determine whether very high-dose NAC would improve respiratory health status in patients with COPD and chronic bronchitis. Methods Patients with COPD and chronic bronchitis were enrolled in a randomized, controlled, double-blinded trial. Patients received oral NAC (1,800 mg) or matching placebo twice daily for 8 weeks in addition to their usual respiratory medications. The primary outcome, respiratory health status, was assessed by changes in the St George’s Respiratory Questionnaire. The effects of NAC on lung function and circulating markers of oxidative stress and inflammation were also evaluated. Results We terminated the study prematurely because new external information suggested the possibility of a safety issue. Of the planned 130 patients, 51 were randomized and 45 (22 in the placebo arm and 23 in the NAC arm) completed the study. There was no statistically significant difference between changes in the St George’s Respiratory Questionnaire total score, comparing NAC to placebo (adjusted mean difference, 0.1 U; 95% CI, −7.8 to 8.18 U; P=0.97). There were also no significant NAC-related improvements in any of the secondary outcomes. Conclusion In this 8-week trial, we were unable to show any clinical benefit from a very high dose of NAC in patients with COPD and chronic bronchitis.
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Affiliation(s)
- Kara Johnson
- Pulmonary Section, Minneapolis VA Health Care System, Minneapolis, MN, USA; Sanford Health, Fargo, ND, USA
| | - Charlene E McEvoy
- Pulmonary Section, HealthPartners Research Foundation, St Paul, Minneapolis, MN, USA
| | - Sakina Naqvi
- Pulmonary Section, Minneapolis VA Health Care System, Minneapolis, MN, USA; HealthEast Maplewood Clinic, Maplewood, Minneapolis, MN, USA
| | - Chris Wendt
- Pulmonary Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Ronald A Reilkoff
- HealthEast Maplewood Clinic, Maplewood, Minneapolis, MN, USA; Pulmonary Section, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Ken M Kunisaki
- Pulmonary Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Erin E Wetherbee
- Pulmonary Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - David Nelson
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Rabindra Tirouvanziam
- Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine, Atlanta, GA, USA
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Reilkoff RA, Peng H, Murray LA, Peng X, Russell T, Montgomery R, Feghali-Bostwick C, Shaw A, Homer RJ, Gulati M, Mathur A, Elias JA, Herzog EL. Semaphorin 7a+ regulatory T cells are associated with progressive idiopathic pulmonary fibrosis and are implicated in transforming growth factor-β1-induced pulmonary fibrosis. Am J Respir Crit Care Med 2012; 187:180-8. [PMID: 23220917 DOI: 10.1164/rccm.201206-1109oc] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Lymphocytes are increasingly associated with idiopathic pulmonary fibrosis (IPF). Semaphorin 7a (Sema 7a) participates in lymphocyte activation. OBJECTIVES To define the relationship between Sema 7a and lymphocytes in IPF. METHODS We characterized the significance of Sema 7a+ lymphocytes in humans with IPF and in a mouse model of lung fibrosis caused by lung-targeted, transgenic overexpression of TGF-β1. We determined the site of Sema 7a expression in human and murine lungs and circulation and used adoptive transfer approaches to define the relevance of lymphocytes coexpressing Sema7a and the markers CD19, CD4, or CD4+CD25+FoxP3+ in TGF-β1-induced murine lung fibrosis. MEASUREMENTS AND MAIN RESULTS Subjects with IPF show expression of Sema 7a on lung CD4+ cells and circulating CD4+ or CD19+ cells. Sema 7a expression is increased on CD4+ cells and CD4+CD25+FoxP3+ regulatory T cells, but not CD19+ cells, in subjects with progressive IPF. Sema 7a is expressed on lymphocytes expressing CD4 but not CD19 in the lungs and spleen of TGF-β1-transgenic mice. Sema 7a expressing bone marrow-derived cells induce lung fibrosis and alter the production of T-cell mediators, including IFN-γ, IL-4, IL-17A, and IL-10. These effects require CD4 but not CD19. In comparison to Sema 7a-CD4+CD25+FoxP3+ cells, Sema7a+CD4+CD25+FoxP3+ cells exhibit reduced expression of regulatory genes such as IL-10, and adoptive transfer of these cells induces fibrosis and remodeling in the TGF-β1-exposed murine lung. CONCLUSIONS Sema 7a+CD4+CD25+FoxP3+ regulatory T cells are associated with disease progression in subjects with IPF and induce fibrosis in the TGF-β1-exposed murine lung.
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Affiliation(s)
- Ronald A Reilkoff
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Abstract
Fibrocytes are mesenchymal cells that arise from monocyte precursors. They are present in injured organs and have both the inflammatory features of macrophages and the tissue remodelling properties of fibroblasts. Chronic inflammatory stimuli mediate the differentiation, trafficking and accumulation of these cells in fibrosing conditions associated with autoimmunity, cardiovascular disease and asthma. This Opinion article discusses the immunological mediators controlling fibrocyte differentiation and recruitment, describes the association of fibrocytes with chronic inflammatory diseases and compares the potential roles of fibrocytes in these disorders with those of macrophages and fibroblasts. It is hoped that this information prompts new opportunities for the study of these unique cells.
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Affiliation(s)
- Ronald A Reilkoff
- Yale University School of Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, Connecticut 06520, USA
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