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Knudsen KS, Lehmann S, Nielsen R, Tangedal S, Paytuvi-Gallart A, Sanseverino W, Martinsen EMH, Hiemstra PS, Eagan TM. The lower airways microbiota and antimicrobial peptides indicate dysbiosis in sarcoidosis. Microbiome 2022; 10:175. [PMID: 36258251 PMCID: PMC9580159 DOI: 10.1186/s40168-022-01362-4] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/30/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND The role of the pulmonary microbiome in sarcoidosis is unknown. The objectives of this study were the following: (1) examine whether the pulmonary fungal and bacterial microbiota differed in patients with sarcoidosis compared with controls; (2) examine whether there was an association between the microbiota and levels of the antimicrobial peptides (AMPs) in protected bronchoalveolar lavage (PBAL). METHODS Thirty-five sarcoidosis patients and 35 healthy controls underwent bronchoscopy and were sampled with oral wash (OW), protected BAL (PBAL), and left protected sterile brushes (LPSB). The fungal ITS1 region and the V3V4 region of the bacterial 16S rRNA gene were sequenced. Bioinformatic analyses were performed with QIIME 2. The AMPs secretory leucocyte protease inhibitor (SLPI) and human beta defensins 1 and 2 (hBD-1 and hBD-2), were measured in PBAL by enzyme-linked immunosorbent assay (ELISA). RESULTS Aspergillus dominated the PBAL samples in sarcoidosis. Differences in bacterial taxonomy were minor. There was no significant difference in fungal alpha diversity between sarcoidosis and controls, but the bacterial alpha diversity in sarcoidosis was significantly lower in OW (p = 0.047) and PBAL (p = 0.03) compared with controls. The beta diversity for sarcoidosis compared with controls differed for both fungi and bacteria. AMP levels were significantly lower in sarcoidosis compared to controls (SLPI and hBD-1: p < 0.01). No significant correlations were found between alpha diversity and AMPs. CONCLUSIONS The pulmonary fungal and bacterial microbiota in sarcoidosis differed from in controls. Lower antimicrobial peptides levels were seen in sarcoidosis, indicating an interaction between the microbiota and the innate immune system. Whether this dysbiosis represents a pathogenic mechanism in sarcoidosis needs to be confirmed in experimental studies. Video Abstract.
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Affiliation(s)
| | - Sverre Lehmann
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Rune Nielsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Solveig Tangedal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | | | - Pieter S. Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | - Tomas M. Eagan
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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2
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Svendsen CD, Kuiper KKJ, Ostridge K, Larsen TH, Nielsen R, Hodneland V, Nordeide E, Bakke PS, Eagan TM. Factors associated with coronary heart disease in COPD patients and controls. PLoS One 2022; 17:e0265682. [PMID: 35476713 PMCID: PMC9045629 DOI: 10.1371/journal.pone.0265682] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background COPD and coronary heart disease (CHD) frequently co-occur, yet which COPD phenotypes are most prone to CHD is poorly understood. The aim of this study was to see whether COPD patients did have a true higher risk for CHD than subjects without COPD, and to examine a range of potential factors associated with CHD in COPD patients and controls. Methods 347 COPD patients and 428 non-COPD controls, were invited for coronary computed tomography angiography (CCTA) and pulmonary CT. Arterial blood gas, bioelectrical impedance and lung function was measured, and a detailed medical history taken. The CCTA was evaluated for significant coronary stenosis and calcium score (CaSc), and emphysema defined as >10% of total area <-950 Hounsfield units. Results 12.6% of the COPD patients and 5.7% of the controls had coronary stenosis (p<0.01), whereas 55.9% of the COPD patients had a CaSc>100 compared to 31.6% of the controls (p<0.01). In a multivariable model adjusting for sex, age, body composition, pack-years, CRP, cholesterol/blood pressure lowering medication use and diabetes mellitus, the OR (95% CI) for having significant stenosis was 1.80 (0.86–3.78) in COPD patients compared with controls. In a similar model, the OR (95% CI) for having CaSc>100 was 1.68 (1.12–2.53) in COPD patients compared with controls. Examining the risk of significant stenosis and CaSc>100 among COPD patients, no variable was associated with significant stenosis, whereas male sex [OR 2.85 (1.56–5.21)], age [OR 3.74 (2.42–5.77)], statin use [OR 2.23 (1.23–4.50)] were associated with CaSc>100, after adjusting for body composition, pack-years, C-reactive protein, use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), diabetes, emphysema score, GOLD category, exacerbation frequency, eosinophilia, and hypoxemia. Conclusion COPD patients were more likely to have CHD, but neither emphysema score, lung function, exacerbation frequency, nor hypoxemia predicted presence of either coronary stenosis or CaSc>100.
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Affiliation(s)
- Christina D. Svendsen
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Karel K. J. Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kristoffer Ostridge
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Terje H. Larsen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Rune Nielsen
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Vidar Hodneland
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eli Nordeide
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Per S. Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tomas M. Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Knudsen KS, Lehmann S, Nielsen R, Tangedal S, Haaland I, Hiemstra PS, Eagan TM. The lower airways microbiome and antimicrobial peptides in idiopathic pulmonary fibrosis differ from chronic obstructive pulmonary disease. PLoS One 2022; 17:e0262082. [PMID: 34990493 PMCID: PMC8735599 DOI: 10.1371/journal.pone.0262082] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 12/19/2021] [Indexed: 01/04/2023] Open
Abstract
Background The lower airways microbiome and host immune response in chronic pulmonary diseases are incompletely understood. We aimed to investigate possible microbiome characteristics and key antimicrobial peptides and proteins in idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD). Methods 12 IPF patients, 12 COPD patients and 12 healthy controls were sampled with oral wash (OW), protected bronchoalveolar lavage (PBAL) and right lung protected sterile brushings (rPSB). The antimicrobial peptides and proteins (AMPs), secretory leucocyte protease inhibitor (SLPI) and human beta defensins 1 and 2 (hBD-1 & hBD-2), were measured in PBAL by enzyme linked immunosorbent assay (ELISA). The V3V4 region of the bacterial 16S rDNA gene was sequenced. Bioinformatic analyses were performed with QIIME 2. Results hBD-1 levels in PBAL for IPF were lower compared with COPD. The predominant phyla in IPF were Firmicutes, Bacteroides and Actinobacteria; Proteobacteria were among top three in COPD. Differential abundance analysis at genus level showed significant differences between study groups for less abundant, mostly oropharyngeal, microbes. Alpha diversity was lower in IPF in PBAL compared to COPD (p = 0.03) and controls (p = 0.01), as well as in rPSB compared to COPD (p = 0.02) and controls (p = 0.04). Phylogenetic beta diversity showed significantly more similarity for IPF compared with COPD and controls. There were no significant correlations between alpha diversity and AMPs. Conclusions IPF differed in microbial diversity from COPD and controls, accompanied by differences in antimicrobial peptides. Beta diversity similarity between OW and PBAL in IPF may indicate that microaspiration contributes to changes in its microbiome.
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Affiliation(s)
- Kristel S. Knudsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Sverre Lehmann
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Rune Nielsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Solveig Tangedal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ingvild Haaland
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Pieter S. Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | - Tomas M. Eagan
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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4
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Durheim MT, Hoffmann-Vold AM, Eagan TM, Hovden AO, Lund MB, Bjerke G, Birring SS, Jonassen TM, Johansen OE, Sjåheim T. ILD-specific health-related quality of life in systemic sclerosis-associated ILD compared with IPF. BMJ Open Respir Res 2021; 7:7/1/e000598. [PMID: 32576559 PMCID: PMC7312324 DOI: 10.1136/bmjresp-2020-000598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/25/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Idiopathic pulmonary fibrosis (IPF) and systemic sclerosis-associated interstitial lung disease (SSc-ILD) are fibrotic ILDs with divergent disease populations. Little is known about health-related quality of life (HRQL) in SSc-ILD relative to IPF. Methods We used the Kings Brief Interstitial Lung Disease Questionnaire (K-BILD) to compare HRQL in a cross-sectional study of 57 patients with IPF and 29 patients with SSc-ILD. Analysis of covariance was used to adjust for age, gender and lung function. Results The unadjusted mean K-BILD score was 63.1 (95% CI 57.1 to 69.1) among patients with SSc-ILD, as compared with 54.7 (51.8–57.5) among those with IPF (p=0.005). However, this difference in HRQL was attenuated after adjustment for age, gender and lung function. In a multivariable model, only forced vital capacity was associated with K-BILD scores. K-BILD scores were correlated with both forced vital capacity and with other relevant HRQL measures, regardless of ILD diagnosis. Discussion Patients with SSc-ILD may have better ILD-specific quality of life than patients with IPF, but this difference appears to be driven primarily by better lung function. These results underscore the impact of lung function on HRQL in fibrotic ILD and the utility of K-BILD to assess HRQL in SSc-ILD.
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Affiliation(s)
- Michael T Durheim
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway .,Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anna-Maria Hoffmann-Vold
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Rheumatology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Tomas M Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - May Brit Lund
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Gisle Bjerke
- Department of Pulmonary Medicine, Akershus University Hospital, Lorenskog, Norway
| | | | - Trygve M Jonassen
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Tone Sjåheim
- Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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5
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van Rijn AL, van Boheemen S, Sidorov I, Carbo EC, Pappas N, Mei H, Feltkamp M, Aanerud M, Bakke P, Claas ECJ, Eagan TM, Hiemstra PS, Kroes ACM, de Vries JJC. The respiratory virome and exacerbations in patients with chronic obstructive pulmonary disease. PLoS One 2019; 14:e0223952. [PMID: 31647831 PMCID: PMC6812800 DOI: 10.1371/journal.pone.0223952] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/02/2019] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Exacerbations are major contributors to morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD), and respiratory bacterial and viral infections are an important trigger. However, using conventional diagnostic techniques, a causative agent is not always found. Metagenomic next-generation sequencing (mNGS) allows analysis of the complete virome, but has not yet been applied in COPD exacerbations. OBJECTIVES To study the respiratory virome in nasopharyngeal samples during COPD exacerbations using mNGS. STUDY DESIGN 88 nasopharyngeal swabs from 63 patients from the Bergen COPD Exacerbation Study (2006-2010) were analysed by mNGS and in-house qPCR for respiratory viruses. Both DNA and RNA were sequenced simultaneously using an Illumina library preparation protocol with in-house adaptations. RESULTS By mNGS, 24/88 samples tested positive. Sensitivity and specificity, as compared with PCR, were 96% and 98% for diagnostic targets (23/24 and 1093/1120, respectively). Additional viral pathogens detected by mNGS were herpes simplex virus type 1 and coronavirus OC43. A positive correlation was found between Cq value and mNGS viral normalized species reads (log value) (p = 0.002). Patients with viral pathogens had lower percentages of bacteriophages (p<0.001). No correlation was found between viral reads and clinical markers. CONCLUSIONS The mNGS protocol used was highly sensitive and specific for semi-quantitative detection of respiratory viruses. Excellent negative predictive value implicates the power of mNGS to exclude any pathogenic respiratory viral infectious cause in one test, with consequences for clinical decision making. Reduced abundance of bacteriophages in COPD patients with viral pathogens implicates skewing of the virome during infection, with potential consequences for the bacterial populations, during infection.
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Affiliation(s)
- Anneloes L. van Rijn
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sander van Boheemen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Igor Sidorov
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen C. Carbo
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nikos Pappas
- Sequencing Analysis Support Core, Department of Medical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Hailiang Mei
- Sequencing Analysis Support Core, Department of Medical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Mariet Feltkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marianne Aanerud
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Per Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Eric C. J. Claas
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tomas M. Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Pieter S. Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Aloys C. M. Kroes
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jutte J. C. de Vries
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
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6
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Tangedal S, Nielsen R, Aanerud M, Persson LJ, Wiker HG, Bakke PS, Hiemstra PS, Eagan TM. Sputum microbiota and inflammation at stable state and during exacerbations in a cohort of chronic obstructive pulmonary disease (COPD) patients. PLoS One 2019; 14:e0222449. [PMID: 31527888 PMCID: PMC6748569 DOI: 10.1371/journal.pone.0222449] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 08/30/2019] [Indexed: 11/25/2022] Open
Abstract
Background Exacerbations of chronic obstructive pulmonary disease (COPD) are debilitating events and spur disease progression. Infectious causes are frequent; however, it is unknown to what extent exacerbations are caused by larger shifts in the airways’ microbiota. The aim of the current study was to analyse the changes in microbial composition between stable state and during exacerbations, and the corresponding immune response. Methods The study sample included 36 COPD patients examined at stable state and exacerbation from the Bergen COPD Cohort and Exacerbations studies, and one patient who delivered sputum on 13 different occasions during the three-year study period. A physician examined the patients at all time points, and sputum induction was performed by stringent protocol. Only induced sputum samples were used in the current study, not spontaneously expectorated sputum. Sputum inflammatory markers (IL-6, IL-8, IL-18, IP-10, MIG, TNF-α) and antimicrobial peptides (AMPs, i.e. LL-37/hCAP-18, SLPI) were measured in supernatants, whereas target gene sequencing (16S rRNA) was performed on corresponding cell pellets. The microbiome bioinformatics platform QIIME2TM and the statistics environment R were applied for bioinformatics analyses. Results Levels of IP-10, MIG, TNF-α and AMPs were significantly different between the two disease states. Of 36 sample pairs, 24 had significant differences in the 12 most abundant genera between disease states. The diversity was significantly different in several individuals, but not when data was analysed on a group level. The one patient case study showed longitudinal dynamics in microbiota unrelated to disease state. Conclusion Changes in the sputum microbiota with changing COPD disease states are common, and are accompanied by changes in inflammatory markers. However, the changes are highly individual and heterogeneous events.
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Affiliation(s)
- Solveig Tangedal
- Dept. of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Rune Nielsen
- Dept. of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marianne Aanerud
- Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Louise J. Persson
- Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Harald G. Wiker
- Dept. of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Dept. of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Per S. Bakke
- Dept. of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Pieter S. Hiemstra
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tomas M. Eagan
- Dept. of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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7
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van der Does AM, Heijink M, Mayboroda OA, Persson LJ, Aanerud M, Bakke P, Eagan TM, Hiemstra PS, Giera M. Dynamic differences in dietary polyunsaturated fatty acid metabolism in sputum of COPD patients and controls. Biochim Biophys Acta Mol Cell Biol Lipids 2019; 1864:224-233. [DOI: 10.1016/j.bbalip.2018.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/26/2018] [Accepted: 11/30/2018] [Indexed: 12/31/2022]
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Aardal ME, Svendsen LL, Lehmann S, Eagan TM, Haaland I. A pilot study of hot-wire, ultrasonic and wedge-bellows spirometer inter- and intra-variability. BMC Res Notes 2017; 10:497. [PMID: 29017612 PMCID: PMC5634838 DOI: 10.1186/s13104-017-2825-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 09/30/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this pilot study was to compare spirometric values obtained with different types of spirometers, spirometers of same type, and repeated measurements with the same spirometer in a pulmonary function laboratory setting. RESULTS 12 healthy volunteers performed spirometry on four hot-wire (SensorMedics), two ultrasonic (Spirare) and one wedge-bellows (Vitalograph S) spirometers, according to ATS/ERS (American Thoracic Society/European Respiratory Society) guidelines. Spirometric values were compared using linear mixed models analysis with a random intercept for subjects and a fixed effect for type of spirometer used. Confidence intervals and p values were adjusted for multiple comparisons. Mean ± SD (L) values for hot-wire, ultrasonic and wedge-bellows spirometers for FVC (forced vital capacity) were 4.02 ± 0.66, 3.69 ± 0.61 and 3.93 ± 0.69, and for FEV1 (forced expiratory volume in one second) 3.06 ± 0.44, 2.95 ± 0.44 and 3.10 ± 0.49. Significant differences were found between hot-wire and ultrasonic and between wedge-bellows and ultrasonic spirometers for FVC and FEV1, and between hot-wire and wedge-bellows spirometers for FVC but not for FEV1. There were no significant differences between spirometers of same type, and low mean differences in repeated measurements for all spirometers included. In conclusion, the pilot study shows systematically higher values for FVC and FEV1 for hot-wire and wedge-bellows compared to ultrasonic spirometers.
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Affiliation(s)
- Marit E. Aardal
- Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Lene L. Svendsen
- Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Sverre Lehmann
- Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tomas M. Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ingvild Haaland
- Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Persson LJP, Aanerud M, Hardie JA, Miodini Nilsen R, Bakke PS, Eagan TM, Hiemstra PS. Antimicrobial peptide levels are linked to airway inflammation, bacterial colonisation and exacerbations in chronic obstructive pulmonary disease. Eur Respir J 2017; 49:49/3/1601328. [PMID: 28298400 DOI: 10.1183/13993003.01328-2016] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/16/2016] [Indexed: 11/05/2022]
Abstract
Antimicrobial peptides (AMPs) are effectors of host defence against infection, inflammation and wound repair. We aimed to study AMP levels in stable chronic obstructive pulmonary disease (COPD) and during acute exacerbations of COPD (AECOPD), and to examine their relation to clinical parameters and inflammatory markers.The 3-year Bergen COPD Cohort Study included 433 COPD patients and 325 controls. Induced sputum was obtained and analysed for levels of the AMPs human cathelicidin (hCAP18/LL-37) and secretory leukocyte protease inhibitor (SLPI), and for the inflammatory markers interleukin (IL)-8, IL-6 and tumour necrosis factor-α (TNF-α) using immunoassays. Systemic hCAP18/LL-37 and vitamin D levels were also studied. Treating AMPs as response variables, non-parametric tests were applied for univariate comparison, and linear regression to obtain adjusted estimates. The risk of AECOPD was assessed by Cox proportional-hazard regression.Sputum AMP levels were higher in patients with stable COPD (n=215) compared to controls (n=45), and further changed during AECOPD (n=56), with increased hCAP18/LL-37 and decreased SLPI levels. Plasma hCAP18/LL-37 levels showed a similar pattern. In stable COPD, high sputum hCAP18/LL-37 levels were associated with increased risk of AECOPD, non-typeable Haemophilus influenzae colonisation, higher age, ex-smoking and higher levels of inflammatory markers.Altered levels of selected AMPs are linked to airway inflammation, infection and AECOPD, suggesting a role for these peptides in airway defence mechanisms in COPD.
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Affiliation(s)
- Louise J P Persson
- Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marianne Aanerud
- Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jon A Hardie
- Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Roy Miodini Nilsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Per S Bakke
- Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Tomas M Eagan
- Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Pieter S Hiemstra
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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10
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Husebø GR, Grønseth R, Lerner L, Gyuris J, Hardie J, Bakke PS, Eagan TM. Growth differentiation factor-15 is a predictor of important disease outcomes in patients with COPD. Eur Respir J 2017; 49:49/3/1601298. [DOI: 10.1183/13993003.01298-2016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/01/2016] [Indexed: 12/20/2022]
Abstract
Increased levels of growth differentiation factor-15 (GDF15) are associated with cachexia, cardiovascular disease and all-cause mortality. The role of GDF15 in chronic obstructive pulmonary disease (COPD) is unknown.The study included 413 patients with COPD from the Bergen COPD Cohort Study. All patients had a forced expiratory volume in 1 s (FEV1) <80% predicted, a FEV1 to forced vital capacity (FVC) ratio <0.7 and a history of smoking. Spirometry, fat free mass index, blood gases and plasma GDF15 were measured at baseline. Patients were followed for 3 years regarding exacerbations and changes in lung function, and 9 years for mortality. Yearly exacerbation rate, survival and yearly change in FEV1/FVC were evaluated with regression models.Median plasma GDF15 was 0.86 ng·mL−1 (interquartile range 0.64–1.12 ng·mL−1). The distribution was not normal and GDF15 was analysed as a categorical variable. High levels of GDF15 were associated with a higher exacerbation rate (incidence rate ratio 1.39, 95% CI 1.1–1.74, p=0.006, adjusted values). Furthermore, high levels of GDF15 were associated with higher mortality (hazard ratio 2.07, 95% CI 1.4–3.1, p<0.001) and an increased decline in both FEV1 (4.29% versus 3.25%) and FVC (2.63% versus 1.44%) in comparison to low levels (p<0.01 for both).In patients with COPD, high levels of GDF15 were independently associated with a higher yearly rate of exacerbations, higher mortality and increased decline in both FEV1 and FVC.
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Eagan TM, Hardie JA, Jul-Larsen Å, Grydeland TB, Bakke PS, Cox RJ. Self-reported influenza vaccination and protective serum antibody titers in a cohort of COPD patients. Respir Med 2016; 115:53-9. [PMID: 27215504 DOI: 10.1016/j.rmed.2016.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 03/22/2016] [Accepted: 04/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND COPD patients are advised vaccination against seasonal influenza, yet few studies have evaluated the protective antibody titers obtained in this patient group. AIMS 1) To describe protective titers in COPD patients who self-reported influenza vaccination compared with vaccinated subjects without COPD and unvaccinated COPD patients, 2) analyze whether clinical parameters predicted influenza-specific antibody titers, and 3) whether antibody titers to influenza A at baseline could predict exacerbation risk or 5 years all-cause mortality. METHODS Influenza A (H1N1 and H3N2) titers were measured by haemagglutination inhibition assay in serum from 432 COPD patients and 77 controls in the Bergen COPD Cohort Study, at yearly visits between 2006/09. Titers of 40 or above were considered protective. We examined the variables sex, age, body composition, smoking, GOLD stage, yearly exacerbations, inhaled steroids, and Charlson score as predictive of titers, both univariately and in a multivariable model estimated by generalized estimating equations. The exacerbation incidence rate ratios and mortality hazard ratios were assessed by negative binominal and cox regression models respectively. RESULTS At baseline, 59% of COPD patients reported influenza vaccination during the last season. Levels of predictive titers varied considerably each season, but trended lower in COPD patients compared with controls. Neither sex, age, body composition, smoking, comorbidities, GOLD stage nor use of inhaled steroids consistently predicted titers. Having high titers at baseline did not impact later risk for exacerbations, but seemed to be associated with higher all-cause mortality, even after adjustment for COPD disease characteristics. CONCLUSION Vaccination coverage for influenza is imperfect for COPD patients in Norway, and there is a concern that immunization is suboptimal.
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Affiliation(s)
- T M Eagan
- Dept. of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Norway; Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
| | - J A Hardie
- Dept. of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Å Jul-Larsen
- Dept. of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - T B Grydeland
- Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - P S Bakke
- Dept. of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - R J Cox
- Dept. of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Norway; Dept of Research and Development, Haukeland University Hospital, Bergen, Norway; Jebsen Centre for Influenza Vaccine Research, University of Bergen, Bergen, Norway
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Grønseth R, Haaland I, Wiker HG, Martinsen EMH, Leiten EO, Husebø G, Svanes Ø, Bakke PS, Eagan TM. The Bergen COPD microbiome study (MicroCOPD): rationale, design, and initial experiences. Eur Clin Respir J 2014; 1:26196. [PMID: 26557236 PMCID: PMC4629717 DOI: 10.3402/ecrj.v1.26196] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/14/2014] [Indexed: 12/27/2022] Open
Abstract
Background Recent methodological developments, in particular new sequencing methods for bacterial RNA/DNA, have shown that microorganisms reside in airways that do not suffer from acute infection and that respiratory microbiota might vary according to airways disease status. We aim to establish high-quality sampling methods for lower airways microbiota as well as describe the respiratory microbiome in subjects with and without chronic obstructive pulmonary disease (COPD) and to relate the microbiome to disease development, progression, and the host immune system. Methods The Bergen COPD microbiome study (MicroCOPD) is a longitudinal study aiming to collect data from 200 subjects with COPD as well as 150 individuals without COPD. At baseline, subjects go through a bronchoscopy in which protected specimen brushes, small-volume lavage, bronchoalveolar lavage, and bronchial biopsies provide a unique chance to analyze the microbiota and the host immune system status. These variables will be related to baseline clinical parameters (lung function, smoking status, exacerbation frequency, arterial blood gases, comorbidities, and medications) as well as follow-up parameters (lung function changes, exacerbation frequency, mortality, and more). Results Per date more than 150 bronchoscopies have been performed, equally distributed between cases and controls, with a very low complication frequency. Conclusions MicroCOPD will provide unique data on a large material, with insight on a new field of respiratory research.
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Affiliation(s)
- Rune Grønseth
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ingvild Haaland
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway ; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Harald G Wiker
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Elise O Leiten
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gunnar Husebø
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Øistein Svanes
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway ; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Per S Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tomas M Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway ; Department of Clinical Science, University of Bergen, Bergen, Norway
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Tangedal S, Aanerud M, Persson LJP, Brokstad KA, Bakke PS, Eagan TM. Comparison of inflammatory markers in induced and spontaneous sputum in a cohort of COPD patients. Respir Res 2014; 15:138. [PMID: 25398249 PMCID: PMC4237726 DOI: 10.1186/s12931-014-0138-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 04/14/2014] [Revised: 09/26/2014] [Accepted: 10/24/2014] [Indexed: 01/26/2024] Open
Abstract
Background Sputum induction is a non-invasive method for obtaining measurements of inflammation in the airways. Whether spontaneously sampled sputum can be a valid surrogate is unknown. The aim of this study was to compare levels of six inflammatory markers in sputum pairs consisting of induced and spontaneous sputum sampled on the same consultation either in a stable state or during exacerbations of chronic obstructive pulmonary disease (COPD). Methods 433 COPD patients aged 40–76, Global initiative for chronic Obstructive Lung Disease (GOLD) stage II-IV were enrolled in 2006/07 and followed every six months for three years. 356 patients were followed for potential exacerbations. Interleukin-6, interleukin-8, interleukin-18, interferon gamma-inducible protein-10, monokine induced by gamma interferon and tumor necrosis factor-alpha (IL-6, IL-8, IL-18, IP-10, MIG and TNF-α) were measured by bead based multiplex immunoassay in 60 paired sputum samples from 45 patients. Albumin was measured by enzyme immunoassay, for concentration correction. Culturing for bacterial growth was performed on 24 samples. Bland-Altman plots were used to assess agreement. The paired non-parametric Wilcoxon signed-rank test, the non-parametric Spearman’s rank correlation test and Kruskal-Wallis test were used for statistical analyses. For all analyses, a p-value < 0.05 was considered significant. Results Agreement between the two measurements was generally low for all six markers. TNF-α was significantly higher in spontaneous sputum at exacerbations (p = 0.002) and trending higher at the steady state (p = 0.06). Correlation coefficients between the levels of markers in induced and spontaneous sputum varied between 0.58 (IL-18) to 0.83 (IP-10). In spontaneous sputum IL-18 and MIG were higher in ex-smokers (p < 0.05). The levels of all markers were higher in GOLD stage III & IV except for IL-6 in spontaneous sputum and IL-18 in induced sputum, compared with GOLD stage II, although not statistically significant. In spontaneous sputum the levels of IL-6 were significantly higher if Haemophilus influenzae (HI) was not cultured. Conclusion We observed a low agreement and significant differences in inflammatory markers between induced and spontaneous sputum, both at steady state and exacerbations. We recommend considering sampling method when reporting on inflammatory markers in sputum.
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Affiliation(s)
- Solveig Tangedal
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Marianne Aanerud
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Louise J P Persson
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Karl A Brokstad
- Institute of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Per S Bakke
- Institute of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Tomas M Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway. .,Institute of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
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Eagan TM, Damås JK, Ueland T, Voll-Aanerud M, Mollnes TE, Hardie JA, Bakke PS, Aukrust P. Neutrophil gelatinase-associated lipocalin: a biomarker in COPD. Chest 2010; 138:888-95. [PMID: 20495108 DOI: 10.1378/chest.09-2718] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Neutrophil gelatinase-associated lipocalin (NGAL) is an antimicrobial peptide that could be involved in the pathogenesis of COPD. This study aimed to measure the plasma levels of NGAL in a large cohort of patients with COPD and control subjects and examine the levels of NGAL by COPD characteristics. METHODS The study included 402 patients with COPD and 229 control subjects aged 40 to 76 years from the Bergen COPD Cohort Study. All patients with COPD had an FEV(1)/FVC ratio of < 0.7, an FEV(1) < 80% predicted, and a smoking history of ≥ 10 pack-years. Plasma levels of NGAL were determined by enzyme immunoassay. Linear regression models were fitted with NGAL as the outcome variable. Confounders examined were sex, age, smoking, Charlson comorbidity score, use of inhaled steroids, neutrophil cell count, plasma creatinine and ferritin, and C-reactive protein. RESULTS Mean ± SD plasma concentrations of NGAL were 75.1 ± 31.8 ng/mL in patients with COPD and 56.5 ± 22.0 ng/mL in control subjects (P < .01). NGAL levels were bivariately associated with age, smoking, body composition, Charlson comorbidity score, neutrophil blood count, creatinine, and C-reactive protein but were significantly elevated in patients with COPD, even after adjustment for confounders. Frequent exacerbations and hypoxemia was associated with higher levels of NGAL, whereas increasing Global Initiative for Chronic Obstructive Lung Disease stage was associated with lower levels of NGAL among patients with COPD. CONCLUSIONS Plasma levels of NGAL were significantly higher in patients with COPD compared with control subjects. NGAL was related to important COPD characteristics.
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Affiliation(s)
- Tomas M Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
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