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Sevilla-Montero J, Munar-Rubert O, Pino-Fadón J, Aguilar-Latorre C, Villegas-Esguevillas M, Climent B, Agrò M, Choya-Foces C, Martínez-Ruiz A, Balsa E, Muñoz-Calleja C, Gómez-Punter RM, Vázquez-Espinosa E, Cogolludo A, Calzada MJ. Cigarette smoke induces pulmonary arterial dysfunction through an imbalance in the redox status of the soluble guanylyl cyclase. Free Radic Biol Med 2022; 193:9-22. [PMID: 36174878 DOI: 10.1016/j.freeradbiomed.2022.09.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/05/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), whose main risk factor is cigarette smoking (CS), is one of the most common diseases globally. Some COPD patients also develop pulmonary hypertension (PH), a severe complication that leads to premature death. Evidence suggests reactive oxygen species (ROS) involvement in COPD and PH, especially regarding pulmonary artery smooth muscle cells (PASMC) dysfunction. However, the effects of CS-driven oxidative stress on the pulmonary vasculature are not completely understood. Herein we provide evidence on the effects of CS extract (CSE) exposure on PASMC regarding ROS production, antioxidant response and its consequences on vascular tone dysregulation. Our results indicate that CSE exposure promotes mitochondrial fission, mitochondrial membrane depolarization and increased mitochondrial superoxide levels. However, this superoxide increase did not parallel a counterbalancing antioxidant response in human pulmonary artery (PA) cells. Interestingly, the mitochondrial superoxide scavenger mitoTEMPO reduced mitochondrial fission and membrane potential depolarization caused by CSE. As we have previously shown, CSE reduces PA vasoconstriction and vasodilation. In this respect, mitoTEMPO prevented the impaired nitric oxide-mediated vasodilation, while vasoconstriction remained reduced. Finally, we observed a CSE-driven downregulation of the Cyb5R3 enzyme, which prevents soluble guanylyl cyclase oxidation in PASMC. This might explain the CSE-mediated decrease in PA vasodilation. These results provide evidence that there might be a connection between mitochondrial ROS and altered vasodilation responses in PH secondary to COPD, and strongly support the potential of antioxidant strategies specifically targeting mitochondria as a new therapy for these diseases.
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Affiliation(s)
- J Sevilla-Montero
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid. Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - O Munar-Rubert
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid. Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - J Pino-Fadón
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid. Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - C Aguilar-Latorre
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid. Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - M Villegas-Esguevillas
- Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - B Climent
- Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - M Agrò
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa (CBMSO), Consejo Superior de Investigaciones Científicas (CSIC)-Universidad Autónoma de Madrid, Madrid, Spain
| | - C Choya-Foces
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - A Martínez-Ruiz
- Unidad de Investigación, Hospital Santa Cristina, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - E Balsa
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa (CBMSO), Consejo Superior de Investigaciones Científicas (CSIC)-Universidad Autónoma de Madrid, Madrid, Spain
| | - C Muñoz-Calleja
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid. Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - R M Gómez-Punter
- Servicio de Neumología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - E Vázquez-Espinosa
- Servicio de Neumología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - A Cogolludo
- Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - M J Calzada
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid. Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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Zorzo C, Girón RM, Hernández S, Gómez-Punter RM, Caballero P. Association Between Evolution of Mucus Plugging, Parenchymal Alterations and Air Trapping on Computed Tomography and Risk of Exacerbations in Adults With Cystic Fibrosis. Arch Bronconeumol 2022; 58:575-577. [PMID: 35312590 DOI: 10.1016/j.arbres.2021.08.005] [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] [Received: 07/28/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/02/2022]
Affiliation(s)
- Cristina Zorzo
- Department of Radiology, Hospital Universitario La Princesa, Calle Diego de León, 52, 28006 Madrid, Spain; Universidad Autónoma de Madrid, Spain.
| | - Rosa María Girón
- Department of Respiratory Medicine, Hospital Universitario La Princesa, Calle Diego de León, 52, 28006 Madrid, Spain; Universidad Autónoma de Madrid, Spain
| | - Susana Hernández
- Department of Radiology, Hospital Universitario La Princesa, Calle Diego de León, 52, 28006 Madrid, Spain; Universidad Autónoma de Madrid, Spain
| | - Rosa Mar Gómez-Punter
- Department of Respiratory Medicine, Hospital Universitario La Princesa, Calle Diego de León, 52, 28006 Madrid, Spain; Universidad Autónoma de Madrid, Spain
| | - Paloma Caballero
- Department of Radiology, Hospital Universitario La Princesa, Calle Diego de León, 52, 28006 Madrid, Spain; Universidad Autónoma de Madrid, Spain
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Abstract
Imipenem combined with beta-lactamase inhibitor relebactam (IMI/REL) has an extensive bactericidal activity against Gram-negative pathogens producing class A or class C beta-lactamases, not active against class B and class D. The phase 3 clinical trial (RESTORE-IMI-2), double-blind, randomized, evaluated IMI/REL vs. piperacillin-tazobactam (PIP/TAZ) for treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), demonstrated non-inferiority at all-cause mortality at 28 days (15.9% vs 21.3%), favorable clinical response at 7-14 days end of treatment (61% vs 59.8%) and with minor serious adverse effects (26.7% vs 32%). IMI/REL is a therapeutic option in HAP and VAP at approved dosage imipenem 500 mg, cilastatin 500 mg and relebactam 250 mg once every 6h, by an IV infusion over 30 min.
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Affiliation(s)
- R M Girón
- Rosa Mª Girón, Servicio de Neumología, Hospital Universitario de la Princesa. Madrid. Spain.
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Diab-Cáceres L, Girón-Moreno RM, García-Castillo E, Pastor-Sanz MT, Olveira C, García-Clemente MM, Nieto-Royo R, Prados-Sánchez C, Caballero-Sánchez P, Olivera-Serrano MJ, Padilla-Galo A, Nava-Tomas E, Esteban-Peris A, Fernández-Velilla M, Torres M, Gómez-Punter RM, Ancochea J. Predictive value of the modified Bhalla score for assessment of pulmonary exacerbations in adults with cystic fibrosis. Eur Radiol 2020; 31:112-120. [PMID: 32740815 DOI: 10.1007/s00330-020-07095-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/19/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The objective of this study was to analyze the predictive value of the modified Bhalla score in high-resolution computed tomography (HRCT) for assessment of pulmonary exacerbations (PEx) in cystic fibrosis (CF) patients. We also describe the relationship between this score and pulmonary function test results. METHODS We performed a multicenter and prospective study where adult patients with CF were included consecutively over 18 months. All patients underwent HRCT with acquisition in inspiration and expiration. The results were analyzed by an expert radiologist who assigned a modified Bhalla score value. Lung function was also assessed, and clinical variables were collected. Follow-up lasted approximately 1 year, and PEx were registered. RESULTS The study population comprised 160 subjects selected from 360 CF patients monitored in the participating CF units. The mean age was 28 years, 47.5% were women, and mean forced expiratory volume in 1 s (FEV1) was 67.5%. The mean global modified Bhalla score was 14.5 ± 0.31 points. Pulmonary function test (PFT) results and the modified Bhalla score correlated well, mainly forced vital capacity (FVC) and FEV1. We constructed a statistical model based on the overall Bhalla score to predict the number of PEx. CONCLUSIONS The overall modified Bhalla score can predict future PEx in CF patients. This useful tool can help to prevent PEx in higher risk patients. KEY POINTS • Pulmonary function test results and the modified Bhalla score correlated well with FVC and FEV1. • The total modified Bhalla score can predict the number of exacerbations in adult CF patients. • Our findings highlight the need to establish a unified protocol for chest HRCT during the follow-up of adult patients with CF in order to anticipate possible complications and determine their impact on pulmonary function.
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Affiliation(s)
| | | | | | | | - Casilda Olveira
- Respirology Service, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Rosa Nieto-Royo
- Respirology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Alicia Padilla-Galo
- Radiodiagnostic Service, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | | | - Maribel Torres
- Radiodiagnostic Service, Hospital Universitario La Paz, Madrid, Spain
| | | | - Julio Ancochea
- Respirology Service, Hospital Universitario La Princesa, Madrid, Spain
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Vázquez-Espinosa E, Girón RM, Gómez-Punter RM, García-Castillo E, Valenzuela C, Cisneros C, Zamora E, García-Pérez FJ, Ancochea J. Long-term safety and efficacy of tobramycin in the management of cystic fibrosis. Ther Clin Risk Manag 2015; 11:407-15. [PMID: 25792839 PMCID: PMC4362982 DOI: 10.2147/tcrm.s75208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/13/2023] Open
Abstract
Cystic fibrosis (CF) is a fatal inherited disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene whose mortality is conditioned by a progressive decline in lung function. Bacterial infections play a key role in this decline. Chronic bacterial infection in CF patients varies over time and the presence of Pseudomonas aeruginosa in sputum is a marker of poor prognosis. P. aeruginosa is eradicated from the airways using inhaled antibiotics administered in various formulations and devices. Antipseudomonal antibiotics have extended the survival of CF patients to 40 years. Tobramycin is a bactericidal aminoglycoside antibiotic with demonstrated activity against gram-negative microorganisms. Initially, the drug was administered as an inhaled parenteral solution. Subsequently, a specific tobramycin inhalation solution was developed. PulmoSphere™ technology enables dry tobramycin powder to be formulated for inhalation (tobramycin inhalation powder) using a small and portable capsule-based breath-activated device (T-326). Chronic colonization by P. aeruginosa is the main indication for aerosol antibiotic therapy. The American Cystic Fibrosis Foundation, European guidelines, and Spanish consensus guidelines provide different recommendations for eradication.
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Affiliation(s)
- Emma Vázquez-Espinosa
- Pulmonology Department, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Rosa María Girón
- Pulmonology Department, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Rosa Mar Gómez-Punter
- Pulmonology Department, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Elena García-Castillo
- Pulmonology Department, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Claudia Valenzuela
- Pulmonology Department, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Carolina Cisneros
- Pulmonology Department, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Enrique Zamora
- Pulmonology Department, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - F Javier García-Pérez
- Pulmonology Department, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Julio Ancochea
- Pulmonology Department, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, Spain
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Girón-Moreno RM, Justicia JL, Yamamoto S, Valenzuela C, Cisneros C, Gómez-Punter RM, Fernandes-Vasconcelos G, Ancochea J. Role of C-reactive protein as a biomarker for prediction of the severity of pulmonary exacerbations in patients with cystic fibrosis. BMC Pulm Med 2014; 14:150. [PMID: 25248567 PMCID: PMC4193132 DOI: 10.1186/1471-2466-14-150] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/10/2014] [Indexed: 11/28/2022] Open
Abstract
Background Pulmonary exacerbation is one of the main risk factors for death in patients with cystic fibrosis. Several biomarkers have proven useful in the diagnosis and treatment of pulmonary exacerbations, although none has been associated with severity. The objective of the present study was to investigate whether C-reactive protein (CRP) level was associated with the severity of pulmonary exacerbation requiring admission to hospital in patients with cystic fibrosis. Methods We designed a severity index for exacerbations based on 4 clinical parameters and determined whether there was an association between CRP levels and severity of the exacerbation. We also investigated the association between CRP and baseline functional and clinical variables. Results Twenty-seven patients with cystic fibrosis required 62 admissions to hospital. CRP levels were not significantly associated with the severity index, although they were associated with specific patient characteristics: colonization by Pseudomonas aeruginosa, allergic bronchopulmonary aspergillosis, treatment with oral corticosteroids, and number of severe exacerbations treated with intravenous antibiotics during the previous year. Conclusions CRP level is not associated with the severity of pulmonary exacerbations, but it is associated with specific clinical characteristics. This simple scoring system (severity index) could prove very useful for evaluating the severity of exacerbations.
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Affiliation(s)
- Rosa Maria Girón-Moreno
- Pulmonology Department, la Princesa Institute for Health Research (IP), Hospital Universitario de la Princesa, Madrid, Spain.
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Girón Moreno RM, Fernandes Vasconcelos G, Cisneros C, Gómez-Punter RM, Segrelles Calvo G, Ancochea J. Presence of Anxiety and Depression in Patients With Bronchiectasis Unrelated to Cystic Fibrosis. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Girón Moreno RM, Fernandes Vasconcelos G, Cisneros C, Gómez-Punter RM, Segrelles Calvo G, Ancochea J. Presence of anxiety and depression in patients with bronchiectasis unrelated to cystic fibrosis. Arch Bronconeumol 2013; 49:415-20. [PMID: 24008154 DOI: 10.1016/j.arbres.2013.01.012] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/25/2013] [Accepted: 01/26/2013] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Patients with chronic bronchiectasis (BQ) may suffer from psychological disorders. The objective of this study was to assess the presence of anxiety and depression in patients from a specialised BQ Unit, using validated questionnaires. PATIENTS AND METHODS We included patients consecutively diagnosed with BQ (unrelated to cystic fibrosis) by high resolution computed tomography in the study. Patients were clinically stable in the previous three weeks and voluntarily completed the Beck Depression Inventory, State-Trait Anxiety Inventory and St. George's Respiratory Questionnaire, after signing the informed consent. They were classified according to their scores on the psychological screening questionnaires, and their results were compared with the clinical, radiological and functional parameters and Quality of Life. RESULTS Seventy patients were included, 48 women and 22 men, with a mean age of 64.19years. Thirty-four percent (34%) of patients showed symptoms of depression, and around 55% had scores above the 50th percentile in trait and state anxiety. The amount of sputum was associated with trait anxiety. Bacterial colonization was related to anxiety (trait and state), especially Pseudomonas aeruginosa colonization. Female patients showed a higher risk of depression. There was no relationship between the Quality of Life scores and the established classifications of anxiety and depression. CONCLUSIONS A high percentage of patients with BQ presented anxiety (trait and state) and depression. The daily sputum production and bacterial colonization (especially with P. aeruginosa) were the variables most related to anxiety; depression was more common in women. We believe that the presence of psychological disorders should be evaluated, especially in patients with this profile.
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Affiliation(s)
- Rosa María Girón Moreno
- Servicio de Neumología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, España.
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