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Shrine N, Guyatt AL, Erzurumluoglu AM, Jackson VE, Hobbs BD, Melbourne CA, Batini C, Fawcett KA, Song K, Sakornsakolpat P, Li X, Boxall R, Reeve NF, Obeidat M, Zhao JH, Wielscher M, Weiss S, Kentistou KA, Cook JP, Sun BB, Zhou J, Hui J, Karrasch S, Imboden M, Harris SE, Marten J, Enroth S, Kerr SM, Surakka I, Vitart V, Lehtimäki T, Allen RJ, Bakke PS, Beaty TH, Bleecker ER, Bossé Y, Brandsma CA, Chen Z, Crapo JD, Danesh J, DeMeo DL, Dudbridge F, Ewert R, Gieger C, Gulsvik A, Hansell AL, Hao K, Hoffman JD, Hokanson JE, Homuth G, Joshi PK, Joubert P, Langenberg C, Li X, Li L, Lin K, Lind L, Locantore N, Luan J, Mahajan A, Maranville JC, Murray A, Nickle DC, Packer R, Parker MM, Paynton ML, Porteous DJ, Prokopenko D, Qiao D, Rawal R, Runz H, Sayers I, Sin DD, Smith BH, Artigas MS, Sparrow D, Tal-Singer R, Timmers PRHJ, Van den Berge M, Whittaker JC, Woodruff PG, Yerges-Armstrong LM, Troyanskaya OG, Raitakari OT, Kähönen M, Polašek O, Gyllensten U, Rudan I, Deary IJ, Probst-Hensch NM, Schulz H, James AL, Wilson JF, Stubbe B, Zeggini E, Jarvelin MR, Wareham N, Silverman EK, Hayward C, Morris AP, Butterworth AS, Scott RA, Walters RG, Meyers DA, Cho MH, Strachan DP, Hall IP, Tobin MD, Wain LV. Author Correction: New genetic signals for lung function highlight pathways and chronic obstructive pulmonary disease associations across multiple ancestries. Nat Genet 2024; 56:1032-1033. [PMID: 38641645 DOI: 10.1038/s41588-024-01752-4] [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: 04/21/2024]
Affiliation(s)
- Nick Shrine
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anna L Guyatt
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Victoria E Jackson
- Department of Health Sciences, University of Leicester, Leicester, UK
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Brian D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Carl A Melbourne
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Chiara Batini
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Kijoung Song
- Target Sciences, GlaxoSmithKline, Collegeville, PA, USA
| | - Phuwanat Sakornsakolpat
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Xingnan Li
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Ruth Boxall
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Nicola F Reeve
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Ma'en Obeidat
- The University of British Columbia Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jing Hua Zhao
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matthias Wielscher
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London, London, UK
| | - Stefan Weiss
- Interfaculty Institute for Genetics and Functional Genomics, Department of Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Katherine A Kentistou
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - James P Cook
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Benjamin B Sun
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jian Zhou
- Flatiron Institute, Simons Foundation, New York, NY, USA
| | - Jennie Hui
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
- PathWest Laboratory Medicine of WA, Sir Charles Gairdner Hospital, Crawley, Western Australia, Australia
- School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Stefan Karrasch
- Institute of Epidemiology, Helmholtz Zentrum Muenchen-German Research Center for Environmental Health, Neuherberg, Germany
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sarah E Harris
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Jonathan Marten
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Stefan Enroth
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala Universitet, Uppsala, Sweden
| | - Shona M Kerr
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Ida Surakka
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- The National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Veronique Vitart
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Richard J Allen
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Per S Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Yohan Bossé
- Department of Molecular Medicine, Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada
| | - Corry-Anke Brandsma
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
| | - Zhengming Chen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - James D Crapo
- National Jewish Health, Denver, CO, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cambridge Centre of Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, UK
- Department of Human Genetics, Wellcome Trust Sanger Institute, Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank Dudbridge
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Ralf Ewert
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany
| | - Christian Gieger
- Research Unit of Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum Muenchen - German Research Center for Environmental Health, Neuherberg, Germany
| | - Amund Gulsvik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anna L Hansell
- Centre for Environmental Health & Sustainability, University of Leicester, Leicester, UK
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Ke Hao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - John E Hokanson
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, Department of Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Peter K Joshi
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Philippe Joubert
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Laval University, Québec, Canada
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Xuan Li
- The University of British Columbia Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Liming Li
- Department of Epidemiology & Biostatistics, Peking University Health Science Center, Beijing, China
| | - Kuang Lin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | | | - Jian'an Luan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | - Alison Murray
- The Institute of Medical Sciences, Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK
| | - David C Nickle
- MRL, Merck & Co., Inc, Kenilworth, NJ, USA
- Gossamer Bio, San Diego, CA, USA
| | - Richard Packer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Margaret M Parker
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Megan L Paynton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David J Porteous
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Dmitry Prokopenko
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dandi Qiao
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rajesh Rawal
- Research Unit of Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum Muenchen - German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Heiko Runz
- MRL, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Ian Sayers
- Division of Respiratory Medicine and NIHR-Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Don D Sin
- The University of British Columbia Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, British Columbia, Canada
- Respiratory Division, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Blair H Smith
- Division of Population Health and Genomics, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - María Soler Artigas
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - David Sparrow
- VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Paul R H J Timmers
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Maarten Van den Berge
- University of Groningen, University Medical Center Groningen, Department of Pulmonology, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
| | - John C Whittaker
- Target Sciences - R&D, GSK Medicines Research Centre, Stevenage, UK
| | - Prescott G Woodruff
- UCSF Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, CA, USA
| | | | - Olga G Troyanskaya
- Department of Computer Science, Princeton University, Princeton, NJ, USA
- Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Olli T Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ozren Polašek
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- University of Split School of Medicine, Split, Croatia
| | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala Universitet, Uppsala, Sweden
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Nicole M Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Holger Schulz
- Institute of Epidemiology, Helmholtz Zentrum Muenchen-German Research Center for Environmental Health, Neuherberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Alan L James
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - James F Wilson
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Beate Stubbe
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany
| | - Eleftheria Zeggini
- Wellcome Sanger Institute, Hinxton, UK
- Institute of Translational Genomics, Helmholtz Zentrum Muenchen - German Research Center for Environmental Health, Neuherberg, Germany
| | - Marjo-Riitta Jarvelin
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Caroline Hayward
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Andrew P Morris
- Department of Biostatistics, University of Liverpool, Liverpool, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Adam S Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Robert A Scott
- Target Sciences - R&D, GSK Medicines Research Centre, Stevenage, UK
| | - Robin G Walters
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Deborah A Meyers
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David P Strachan
- Population Health Research Institute, St George's, University of London, London, UK
| | - Ian P Hall
- Division of Respiratory Medicine and NIHR-Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Martin D Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK.
- National Institute for Health Research, Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
| | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, UK.
- National Institute for Health Research, Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
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Casaburi R, Crapo JD. Should the Term "PRISm" Be Restricted to Use in Evaluating Smokers? Am J Respir Crit Care Med 2024. [PMID: 38324051 DOI: 10.1164/rccm.202401-0042ed] [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: 01/05/2024] [Accepted: 02/06/2024] [Indexed: 02/08/2024] Open
Affiliation(s)
- Richard Casaburi
- The Lundquist Institute for Biomedical Innovation, 117316, Respiratory Research Center, Torrance, California, United States;
| | - James D Crapo
- National Jewish Health, 2930, Department of Medicine, Denver, Colorado, United States
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Regan EA, Lowe ME, Make BJ, Curtis JL, Chen Q(G, Crooks JL, Wilson C, Oates GR, Gregg RW, Baldomero AK, Bhatt SP, Diaz AA, Benos PV, O’Brien JK, Young KA, Kinney GL, Conrad DJ, Lowe KE, DeMeo DL, Non A, Cho MH, Kallet J, Foreman MG, Westney GE, Hoth K, MacIntyre NR, Hanania NA, Wolfe A, Amaza H, Han M, Beaty TH, Hansel NN, McCormack MC, Balasubramanian A, Crapo JD, Silverman EK, Casaburi R, Wise RA. Early Evidence of Chronic Obstructive Pulmonary Disease Obscured by Race-Specific Prediction Equations. Am J Respir Crit Care Med 2024; 209:59-69. [PMID: 37611073 PMCID: PMC10870894 DOI: 10.1164/rccm.202303-0444oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/23/2023] [Indexed: 08/25/2023] Open
Abstract
Rationale: The identification of early chronic obstructive pulmonary disease (COPD) is essential to appropriately counsel patients regarding smoking cessation, provide symptomatic treatment, and eventually develop disease-modifying treatments. Disease severity in COPD is defined using race-specific spirometry equations. These may disadvantage non-White individuals in diagnosis and care. Objectives: Determine the impact of race-specific equations on African American (AA) versus non-Hispanic White individuals. Methods: Cross-sectional analyses of the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) cohort were conducted, comparing non-Hispanic White (n = 6,766) and AA (n = 3,366) participants for COPD manifestations. Measurements and Main Results: Spirometric classifications using race-specific, multiethnic, and "race-reversed" prediction equations (NHANES [National Health and Nutrition Examination Survey] and Global Lung Function Initiative "Other" and "Global") were compared, as were respiratory symptoms, 6-minute-walk distance, computed tomography imaging, respiratory exacerbations, and St. George's Respiratory Questionnaire. Application of different prediction equations to the cohort resulted in different classifications by stage, with NHANES and Global Lung Function Initiative race-specific equations being minimally different, but race-reversed equations moving AA participants to more severe stages and especially between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0 and preserved ratio impaired spirometry groups. Classification using the established NHANES race-specific equations demonstrated that for each of GOLD stages 1-4, AA participants were younger, had fewer pack-years and more current smoking, but had more exacerbations, shorter 6-minute-walk distance, greater dyspnea, and worse BODE (body mass index, airway obstruction, dyspnea, and exercise capacity) scores and St. George's Respiratory Questionnaire scores. Differences were greatest in GOLD stages 1 and 2. Race-reversed equations reclassified 774 AA participants (43%) from GOLD stage 0 to preserved ratio impaired spirometry. Conclusions: Race-specific equations underestimated disease severity among AA participants. These effects were particularly evident in early disease and may result in late detection of COPD.
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Affiliation(s)
| | - Melissa E. Lowe
- Biostatistics, Duke Cancer Center, Duke University Medical Center, Durham, North Carolina
| | - Barry J. Make
- Division of Pulmonary, Critical Care and Sleep Medicine
| | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
- Medical Service, Veterans Affairs Medical Center, Ann Arbor, Michigan
| | | | - James L. Crooks
- Division of Biostatistics and Bioinformatics
- Department of Immunology and Genomic Medicine, and
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Carla Wilson
- Research Informatics Services, National Jewish Health, Denver, Colorado
| | | | - Robert W. Gregg
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Arianne K. Baldomero
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | - Kendra A. Young
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Gregory L. Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | | | - Katherine E. Lowe
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Dawn L. DeMeo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy Non
- Department of Anthropology, University of California, San Diego, La Jolla, California
| | - Michael H. Cho
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Marilyn G. Foreman
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Morehouse College, Atlanta, Georgia
| | - Gloria E. Westney
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Morehouse College, Atlanta, Georgia
| | - Karin Hoth
- Department of Psychiatry and
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa
| | - Neil R. MacIntyre
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, North Carolina
| | - Nicola A. Hanania
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, College of Medicine, Baylor University, Houston, Texas
| | - Amy Wolfe
- Section of Pulmonology and Critical Care, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | | | - MeiLan Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Terri H. Beaty
- Department of Epidemiology, Bloomberg School of Public Health, and
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Meredith C. McCormack
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | | | - Edwin K. Silverman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Robert A. Wise
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
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Higbee DH, Lirio A, Hamilton F, Granell R, Wyss AB, London SJ, Bartz TM, Gharib SA, Cho MH, Wan E, Silverman E, Crapo JD, Lominchar JVT, Hansen T, Grarup N, Dantoft T, Kårhus L, Linneberg A, O'Connor GT, Dupuis J, Xu H, De Vries MM, Hu X, Rich SS, Barr RG, Manichaikul A, Wijnant SRA, Brusselle GG, Lahousse L, Li X, Hernández Cordero AI, Obeidat M, Sin DD, Harris SE, Redmond P, Taylor AM, Cox SR, Williams AT, Shrine N, John C, Guyatt AL, Hall IP, Davey Smith G, Tobin MD, Dodd JW. Genome-wide association study of preserved ratio impaired spirometry (PRISm). Eur Respir J 2024; 63:2300337. [PMID: 38097206 PMCID: PMC10765494 DOI: 10.1183/13993003.00337-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) is defined as a forced expiratory volume in 1 s (FEV1) <80% predicted and FEV1/forced vital capacity ≥0.70. PRISm is associated with respiratory symptoms and comorbidities. Our objective was to discover novel genetic signals for PRISm and see if they provide insight into the pathogenesis of PRISm and associated comorbidities. METHODS We undertook a genome-wide association study (GWAS) of PRISm in UK Biobank participants (Stage 1), and selected single nucleotide polymorphisms (SNPs) reaching genome-wide significance for replication in 13 cohorts (Stage 2). A combined meta-analysis of Stage 1 and Stage 2 was done to determine top SNPs. We used cross-trait linkage disequilibrium score regression to estimate genome-wide genetic correlation between PRISm and pulmonary and extrapulmonary traits. Phenome-wide association studies of top SNPs were performed. RESULTS 22 signals reached significance in the joint meta-analysis, including four signals novel for lung function. A strong genome-wide genetic correlation (rg) between PRISm and spirometric COPD (rg=0.62, p<0.001) was observed, and genetic correlation with type 2 diabetes (rg=0.12, p=0.007). Phenome-wide association studies showed that 18 of 22 signals were associated with diabetic traits and seven with blood pressure traits. CONCLUSION This is the first GWAS to successfully identify SNPs associated with PRISm. Four of the signals, rs7652391 (nearest gene MECOM), rs9431040 (HLX), rs62018863 (TMEM114) and rs185937162 (HLA-B), have not been described in association with lung function before, demonstrating the utility of using different lung function phenotypes in GWAS. Genetic factors associated with PRISm are strongly correlated with risk of both other lung diseases and extrapulmonary comorbidity.
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Affiliation(s)
- Daniel H Higbee
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Alvin Lirio
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Fergus Hamilton
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Raquel Granell
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Annah B Wyss
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Stephanie J London
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Traci M Bartz
- Cardiovascular Health Research Unit, Departments of Biostatistics and Medicine, University of Washington, Seattle, WA, USA
| | - Sina A Gharib
- Computational Medicine Core, Center for Lung Biology, UW Medicine Sleep Center, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Emily Wan
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Pulmonary and Critical Care Section, Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
| | - Edwin Silverman
- Pulmonary and Critical Care Section, Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
| | - James D Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Jesus V T Lominchar
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Line Kårhus
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - George T O'Connor
- Pulmonary Center, School of Medicine, Boston University, Boston, MA, USA
- Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston Medical Center, Boston, MA, USA
| | - Josée Dupuis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Hanfie Xu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Maaike M De Vries
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Xiaowei Hu
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ani Manichaikul
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Sara R A Wijnant
- Department of Bioanalysis, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Epidemiology, Department of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Bioanalysis, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Xuan Li
- Centre for Heart Lung Innovation, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Ana I Hernández Cordero
- Centre for Heart Lung Innovation, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Ma'en Obeidat
- Centre for Heart Lung Innovation, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah E Harris
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Paul Redmond
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Adele M Taylor
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Alexander T Williams
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Nick Shrine
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Catherine John
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Anna L Guyatt
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Ian P Hall
- University of Nottingham and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Martin D Tobin
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- Leicester NIHR Biomedical Research Centre, Leicester, UK
- Joint senior authors
| | - James W Dodd
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- Joint senior authors
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5
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Vegas Sánchez-Ferrero G, Díaz AA, Ash SY, Baraghoshi D, Strand M, Crapo JD, Silverman EK, Humphries SM, Washko GR, Lynch DA, San José Estépar R. Quantification of Emphysema Progression at CT Using Simultaneous Volume, Noise, and Bias Lung Density Correction. Radiology 2024; 310:e231632. [PMID: 38165244 PMCID: PMC10831481 DOI: 10.1148/radiol.231632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
Background CT attenuation is affected by lung volume, dosage, and scanner bias, leading to inaccurate emphysema progression measurements in multicenter studies. Purpose To develop and validate a method that simultaneously corrects volume, noise, and interscanner bias for lung density change estimation in emphysema progression at CT in a longitudinal multicenter study. Materials and Methods In this secondary analysis of the prospective Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study, lung function data were obtained from participants who completed baseline and 5-year follow-up visits from January 2008 to August 2017. CT emphysema progression was measured with volume-adjusted lung density (VALD) and compared with the joint volume-noise-bias-adjusted lung density (VNB-ALD). Reproducibility was studied under change of dosage protocol and scanner model with repeated acquisitions. Emphysema progression was visually scored in 102 randomly selected participants. A stratified analysis of clinical characteristics was performed that considered groups based on their combined lung density change measured by VALD and VNB-ALD. Results A total of 4954 COPDGene participants (mean age, 60 years ± 9 [SD]; 2511 male, 2443 female) were analyzed (1329 with repeated reduced-dose acquisition in the follow-up visit). Mean repeatability coefficients were 30 g/L ± 0.46 for VALD and 14 g/L ± 0.34 for VNB-ALD. VALD measurements showed no evidence of differences between nonprogressors and progressors (mean, -5.5 g/L ± 9.5 vs -8.6 g/L ± 9.6; P = .11), while VNB-ALD agreed with visual readings and showed a difference (mean, -0.67 g/L ± 4.8 vs -4.2 g/L ± 5.5; P < .001). Analysis of progression showed that VNB-ALD progressors had a greater decline in forced expiratory volume in 1 second (-42 mL per year vs -32 mL per year; Tukey-adjusted P = .002). Conclusion Simultaneously correcting volume, noise, and interscanner bias for lung density change estimation in emphysema progression at CT improved repeatability analyses and agreed with visual readings. It distinguished between progressors and nonprogressors and was associated with a greater decline in lung function metrics. Clinical trial registration no. NCT00608764 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Goo in this issue.
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Affiliation(s)
- Gonzalo Vegas Sánchez-Ferrero
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Alejandro A. Díaz
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Samuel Y. Ash
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - David Baraghoshi
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Matthew Strand
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - James D. Crapo
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Edwin K. Silverman
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Stephen M. Humphries
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - George R. Washko
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - David A. Lynch
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
| | - Raúl San José Estépar
- From the Applied Chest Imaging Laboratory, Department of Radiology
(G.V.S.F., R.S.J.E.), Applied Chest Imaging Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine (A.A.D., S.Y.A., G.R.W.), and
Channing Division of Network Medicine and Division of Pulmonary and Critical
Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's
Hospital, 75 Francis St, Boston, MA 02115; and Division of Biostatistics and
Bioinformatics (D.B., M.S.), Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), and Department of Radiology (S.M.H., D.A.L.),
National Jewish Health, Denver, Colo
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6
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Crapo JD, Gupta A, Lynch DA, Turner AM, Mroz RM, Janssens W, Ludwig-Sengpiel A, Koegler H, Eleftheraki A, Risse F, Diefenbach C. Baseline characteristics from a 3-year longitudinal study to phenotype subjects with COPD: the FOOTPRINTS study. Respir Res 2023; 24:290. [PMID: 37978492 PMCID: PMC10656819 DOI: 10.1186/s12931-023-02584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND FOOTPRINTS® is a prospective, longitudinal, 3-year study assessing the association between biomarkers of inflammation/lung tissue destruction and chronic obstructive pulmonary disease (COPD) severity and progression in ex-smokers with mild-to-severe COPD. Here, we present baseline characteristics and select biomarkers of study subjects. METHODS The methodology of FOOTPRINTS® has been published previously. The study population included ex-smokers with a range of COPD severities (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages 1-3), ex-smokers with COPD and alpha-1-antitrypsin deficiency (A1ATD) and a control group of ex-smokers without airflow limitation (EwAL). At study entry, data were collected for: demographics, disease characteristics, history of comorbidities and COPD exacerbations, symptoms, lung function and volume, exercise capacity, soluble biomarkers, and quantitative and qualitative computed tomography. Baseline data are presented with descriptive statistical comparisons for soluble biomarkers in the individual GOLD and A1ATD groups versus EwAL. RESULTS In total, 463 subjects were enrolled. The per-protocol set comprised 456 subjects, mostly male (64.5%). The mean (standard deviation) age was 60.7 (6.9) years. At baseline, increasing pulmonary symptoms, worse lung function, increased residual volume, reduced diffusing capacity of the lung for carbon monoxide (DLco) and greater prevalence of centrilobular emphysema were observed with increasing disease severity amongst GOLD 1-3 subjects. Subjects with A1ATD (n = 19) had similar lung function parameters to GOLD 2-3 subjects, a high residual volume comparable to GOLD 3 subjects, and similar air trapping to GOLD 2 subjects. Compared with EwAL (n = 61), subjects with A1ATD had worse lung function, increased residual volume, reduced DLco, and a greater prevalence of confluent or advanced destructive emphysema. The soluble inflammatory biomarkers white blood cell count, fibrinogen, high-sensitivity C-reactive protein and plasma surfactant protein were higher in GOLD 1-3 groups than in the EwAL group. Interleukin-6 was expressed less often in EwAL subjects compared with subjects in the GOLD and A1ATD groups. Soluble receptor for advanced glycation end product was lowest in GOLD 3 subjects, indicative of more severe emphysema. CONCLUSIONS These findings provide context for upcoming results from FOOTPRINTS®, which aims to establish correlations between biomarkers and disease progression in a representative COPD population. TRIAL REGISTRATION NUMBER NCT02719184, study start date 13/04/2016.
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Affiliation(s)
- James D Crapo
- Department of Medicine, National Jewish Health, Denver, CO, USA.
| | - Abhya Gupta
- TA Inflammation Medicine, Boehringer Ingelheim International GmbH, Biberach an Der Riss, Germany
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Robert M Mroz
- 2nd Department of Lung Diseases and Tuberculosis, Bialystok Medical University, Bialystok, Poland
| | - Wim Janssens
- Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATH), University Hospital Leuven, Louvain, KU, Belgium
| | | | - Harald Koegler
- TA Inflammation Medicine, Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Anastasia Eleftheraki
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Frank Risse
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Claudia Diefenbach
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
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7
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Baraghoshi D, Strand M, Humphries SM, Estépar RSJ, Sanchez-Ferrero GV, Charbonnier JP, Latisenko R, Silverman EK, Crapo JD, Lynch DA. Erratum for: Quantitative CT Evaluation of Emphysema Progression over 10 Years in the COPDGene Study. Radiology 2023; 309:e239028. [PMID: 38015087 PMCID: PMC11006018 DOI: 10.1148/radiol.239028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- David Baraghoshi
- Division of Biostatistics, Environment and Health, National
Jewish Health, Denver, Colorado, United States
| | - Matthew Strand
- Division of Biostatistics, Environment and Health, National
Jewish Health, Denver, Colorado, United States
| | - Stephen M Humphries
- Department of Radiology, National Jewish Health, Denver,
Colorado, United States
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and
Women's Hospital, Boston, Massachusetts, United States; Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, United
States
| | - Gonzalo Vegas Sanchez-Ferrero
- Applied Chest Imaging Laboratory, Brigham and
Women's Hospital, Boston, Massachusetts, United States; Department of
Radiology, Brigham and Women's Hospital, Boston, Massachusetts, United
States
| | | | | | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and
Women's Hospital, Boston, Massachusetts, United States. Division of Pulmonary
and Critical Care Medicine, Department of Medicine, Brigham and Women's
Hospital, Boston, Massachusetts, United States
| | - James D Crapo
- Division of Pulmonary and Critical Care Medicine,
Department of Medicine, National Jewish Health, Denver, Colorado, United
States
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver,
Colorado, United States
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8
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Silverman EK, Kim AY, Make BJ, Regan EA, Morrow JD, Hersh CP, O'Brien J, Crapo JD, Hansel NN, Criner G, Flenaugh EL, Conrad D, Casaburi R, Bowler RP, Hanania NA, Barr RG, Bhatt SP, Sciurba FC, Anzueto A, Han MK, McEvoy CE, Comellas AP, DeMeo DL, Rosiello R, Curtis JL, Uchida T, Wilson C, O'Rourke PP. Returning incidentally discovered Hepatitis C RNA-seq results to COPDGene study participants. NPJ Genom Med 2023; 8:36. [PMID: 37903807 PMCID: PMC10616181 DOI: 10.1038/s41525-023-00379-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/10/2023] [Indexed: 11/01/2023] Open
Abstract
The consequences of returning infectious pathogen test results identified incidentally in research studies have not been well-studied. Concerns include identification of an important health issue for individuals, accuracy of research test results, public health impact, potential emotional distress for participants, and need for IRB permissions. Blood RNA-sequencing analysis for non-human RNA in 3984 participants from the COPDGene study identified 228 participants with evidence suggestive for hepatitis C virus (HCV) infection. We hypothesized that incidentally discovered HCV results could be effectively returned to COPDGene participants with attention to the identified concerns. In conjunction with a COPDGene Participant Advisory Panel, we developed and obtained IRB approval for a process of returning HCV research results and an HCV Follow-Up Study questionnaire to capture information about previous HCV diagnosis and treatment information and participant reactions to return of HCV results. During phone calls following the initial HCV notification letter, 84 of 124 participants who could be contacted (67.7%) volunteered that they had been previously diagnosed with HCV infection. Thirty-one of these 124 COPDGene participants were enrolled in the HCV Follow-Up Study. Five of the 31 HCV Follow-Up Study participants did not report a previous diagnosis of HCV. For four of these participants, subsequent clinical HCV testing confirmed HCV infection. Thus, 30/31 Follow-Up Study participants had confirmed HCV diagnoses, supporting the accuracy of the HCV research test results. However, the limited number of participants in the Follow-Up Study precludes an accurate assessment of the false-positive and false-negative rates of the research RNA sequencing evidence for HCV. Most HCV Follow-Up Study participants (29/31) were supportive of returning HCV research results, and most participants found the process for returning HCV results to be informative and not upsetting. Newly diagnosed participants were more likely to be pleased to learn about a potentially curable infection (p = 0.027) and showed a trend toward being more frightened by the potential health risks of HCV (p = 0.11). We conclude that HCV results identified incidentally during transcriptomic research studies can be successfully returned to research study participants with a carefully designed process.
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Affiliation(s)
- Edwin K Silverman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Arthur Y Kim
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | | | - Jarrett D Morrow
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Craig P Hersh
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James O'Brien
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gerard Criner
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Eric L Flenaugh
- Pulmonary and Critical Care and Interventional Pulmonary Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Douglas Conrad
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - R Graham Barr
- Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Antonio Anzueto
- Pulmonary and Critical Care, University of Texas Health, and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Alejandro P Comellas
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Rosiello
- Department of Pulmonary and Critical Care, Reliant Medical Group, Worcester, MA, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Tricia Uchida
- Research Informatics Services, National Jewish Health, Denver, CO, USA
| | - Carla Wilson
- Research Informatics Services, National Jewish Health, Denver, CO, USA
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9
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Li X, Duan W, Du L, Chu D, Wang P, Yang Z, Qu X, Yang Z, Batinic-Haberle I, Spasojevic I, Warner DS, Crapo JD, Treggiari MM, Sheng H. Intracarotid Infusion of Redox-Active Manganese Porphyrin, MnTnBuOE-2-PyP 5+, following Reperfusion Improves Long-Term, 28-Day Post-Stroke Outcomes in Rats. Antioxidants (Basel) 2023; 12:1861. [PMID: 37891940 PMCID: PMC10603962 DOI: 10.3390/antiox12101861] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Endovascular mechanical thrombectomy, combined with a tissue plasminogen activator (t-PA), is efficacious as a standard care for qualifying ischemic stroke patients. However, > 50% of thrombectomy patients still have poor outcomes. Manganese porphyrins, commonly known as mimics of superoxide dismutases, are potent redox-active catalytic compounds that decrease oxidative/nitrosative stress and in turn decrease inflammatory responses, mitigating therefore the secondary injury of the ischemic brain. This study investigates the effect of intracarotid MnTnBuOE-2-PyP5+ (BMX-001) administration on long-term, 28-day post-stroke recovery in a clinically relevant setting. The 90 min of transient middle cerebral artery occlusion was performed in young, aged, male, female, and spontaneous hypertension rats. All physiological parameters, including blood pressure, blood gas, glucose, and temperature, were well controlled during ischemia. Either BMX-001 or a vehicle solution was infused through the carotid artery immediately after the removal of filament, mimicking endovascular thrombectomy, and was followed by 7 days of subcutaneous injection. Neurologic deficits and infarct volume were assessed at 28 days in a blinded manner. The effects of BMX-001 on the carotid arterial wall and blood-brain barrier permeability and its interaction with t-PA were assessed in normal rats. There were no intra-group differences in physiological variables. BMX-001-treated stroke rats regained body weight earlier, performed better in behavioral tests, and had smaller brain infarct size compared to the vehicle-treated group. No vascular wall damage and blood-brain barrier permeability changes were detected after the BMX-001 infusion. There was no drug interaction between BMX-001 and t-PA. Intracarotid BMX-001 infusion was safe, and it significantly improved stroke outcomes in rats. These findings indicate that BMX-001 is a candidate drug as an adjunct treatment for thrombectomy procedure to further improve the neurologic outcomes of thrombectomy patients. This study warrants further clinical investigation of BMX-001 as a new stroke therapy.
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Affiliation(s)
- Xuan Li
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; (X.L.); (W.D.); (L.D.); (D.C.); (P.W.); (Z.Y.); (X.Q.); (D.S.W.); (M.M.T.)
| | - Weina Duan
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; (X.L.); (W.D.); (L.D.); (D.C.); (P.W.); (Z.Y.); (X.Q.); (D.S.W.); (M.M.T.)
| | - Li Du
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; (X.L.); (W.D.); (L.D.); (D.C.); (P.W.); (Z.Y.); (X.Q.); (D.S.W.); (M.M.T.)
| | - Dongmei Chu
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; (X.L.); (W.D.); (L.D.); (D.C.); (P.W.); (Z.Y.); (X.Q.); (D.S.W.); (M.M.T.)
| | - Peng Wang
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; (X.L.); (W.D.); (L.D.); (D.C.); (P.W.); (Z.Y.); (X.Q.); (D.S.W.); (M.M.T.)
| | - Zhong Yang
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; (X.L.); (W.D.); (L.D.); (D.C.); (P.W.); (Z.Y.); (X.Q.); (D.S.W.); (M.M.T.)
| | - Xingguang Qu
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; (X.L.); (W.D.); (L.D.); (D.C.); (P.W.); (Z.Y.); (X.Q.); (D.S.W.); (M.M.T.)
| | - Zhenxing Yang
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA;
| | - Ines Batinic-Haberle
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Ivan Spasojevic
- Pharmacokinetics and Pharmacodynamics Core, Duke Cancer Institute, and Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - David S. Warner
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; (X.L.); (W.D.); (L.D.); (D.C.); (P.W.); (Z.Y.); (X.Q.); (D.S.W.); (M.M.T.)
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA;
- Department of Neurobiology, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Miriam M. Treggiari
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; (X.L.); (W.D.); (L.D.); (D.C.); (P.W.); (Z.Y.); (X.Q.); (D.S.W.); (M.M.T.)
| | - Huaxin Sheng
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; (X.L.); (W.D.); (L.D.); (D.C.); (P.W.); (Z.Y.); (X.Q.); (D.S.W.); (M.M.T.)
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10
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Castaldi PJ, Xu Z, Young KA, Hokanson JE, Lynch DA, Humphries SM, Ross JC, Cho MH, Hersh CP, Crapo JD, Strand M, Silverman EK. Heterogeneity and Progression of Chronic Obstructive Pulmonary Disease: Emphysema-Predominant and Non-Emphysema-Predominant Disease. Am J Epidemiol 2023; 192:1647-1658. [PMID: 37160347 PMCID: PMC11063557 DOI: 10.1093/aje/kwad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/20/2022] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
While variation in emphysema severity between patients with chronic obstructive pulmonary disease (COPD) is well-recognized, clinically applicable definitions of the emphysema-predominant disease (EPD) and non-emphysema-predominant disease (NEPD) subtypes have not been established. To study the clinical relevance of the EPD and NEPD subtypes, we tested the association of these subtypes with prospective decline in forced expiratory volume in 1 second (FEV1) and mortality among 3,427 subjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric grade 2-4 COPD at baseline in the Genetic Epidemiology of COPD (COPDGene) Study, an ongoing national multicenter study that started in 2007. NEPD was defined as airflow obstruction with less than 5% computed tomography (CT) quantitative densitometric emphysema at -950 Hounsfield units, and EPD was defined as airflow obstruction with 10% or greater CT emphysema. Mixed-effects models for FEV1 demonstrated larger average annual FEV1 loss in EPD subjects than in NEPD subjects (-10.2 mL/year; P < 0.001), and subtype-specific associations with FEV1 decline were identified. Cox proportional hazards models showed higher risk of mortality among EPD patients versus NEPD patients (hazard ratio = 1.46, 95% confidence interval: 1.34, 1.60; P < 0.001). To determine whether the NEPD/EPD dichotomy is captured by previously described COPDGene subtypes, we used logistic regression and receiver operating characteristic (ROC) curve analysis to predict NEPD/EPD membership using these previous subtype definitions. The analysis generally showed excellent discrimination, with areas under the ROC curve greater than 0.9. The NEPD and EPD COPD subtypes capture important aspects of COPD heterogeneity and are associated with different rates of disease progression and mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Edwin K Silverman
- Correspondence to Dr. Edwin K. Silverman, Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115 (e-mail: )
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11
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Regan EA, Lowe ME, Make BJ, Curtis JL, Chen QG, Cho MH, Crooks JL, Lowe KE, Wilson C, O'Brien JK, Oates GR, Baldomero AK, Kinney GL, Young KA, Diaz AA, Bhatt SP, McCormack MC, Hansel NN, Kim V, Richmond NE, Westney GE, Foreman MG, Conrad DJ, DeMeo DL, Hoth KF, Amaza H, Balasubramanian A, Kallet J, Watts S, Hanania NA, Hokanson J, Beaty TH, Crapo JD, Silverman EK, Casaburi R, Wise R. Use of the Spirometric "Fixed-Ratio" Underdiagnoses COPD in African-Americans in a Longitudinal Cohort Study. J Gen Intern Med 2023; 38:2988-2997. [PMID: 37072532 PMCID: PMC10593702 DOI: 10.1007/s11606-023-08185-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND COPD diagnosis is tightly linked to the fixed-ratio spirometry criteria of FEV1/FVC < 0.7. African-Americans are less often diagnosed with COPD. OBJECTIVE Compare COPD diagnosis by fixed-ratio with findings and outcomes by race. DESIGN Genetic Epidemiology of COPD (COPDGene) (2007-present), cross-sectional comparing non-Hispanic white (NHW) and African-American (AA) participants for COPD diagnosis, manifestations, and outcomes. SETTING Multicenter, longitudinal US cohort study. PARTICIPANTS Current or former smokers with ≥ 10-pack-year smoking history enrolled at 21 clinical centers including over-sampling of participants with known COPD and AA. Exclusions were pre-existing non-COPD lung disease, except for a history of asthma. MEASUREMENTS Subject diagnosis by conventional criteria. Mortality, imaging, respiratory symptoms, function, and socioeconomic characteristics, including area deprivation index (ADI). Matched analysis (age, sex, and smoking status) of AA vs. NHW within participants without diagnosed COPD (GOLD 0; FEV1 ≥ 80% predicted and FEV1/FVC ≥ 0.7). RESULTS Using the fixed ratio, 70% of AA (n = 3366) were classified as non-COPD, versus 49% of NHW (n = 6766). AA smokers were younger (55 vs. 62 years), more often current smoking (80% vs. 39%), with fewer pack-years but similar 12-year mortality. Density distribution plots for FEV1 and FVC raw spirometry values showed disproportionate reductions in FVC relative to FEV1 in AA that systematically led to higher ratios. The matched analysis demonstrated GOLD 0 AA had greater symptoms, worse DLCO, spirometry, BODE scores (1.03 vs 0.54, p < 0.0001), and greater deprivation than NHW. LIMITATIONS Lack of an alternative diagnostic metric for comparison. CONCLUSIONS The fixed-ratio spirometric criteria for COPD underdiagnosed potential COPD in AA participants when compared to broader diagnostic criteria. Disproportionate reductions in FVC relative to FEV1 leading to higher FEV1/FVC were identified in these participants and associated with deprivation. Broader diagnostic criteria for COPD are needed to identify the disease across all populations.
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Affiliation(s)
| | - Melissa E Lowe
- Duke Cancer Center, Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Jeffrey L Curtis
- Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Pulmonary & Critical Care Medicine Section, Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | | | - Michael H Cho
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - James L Crooks
- Division of Biostatistics and Bioinformatics and Department of Immunology and Genomic Medicine, National Jewish Health, Denver, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Katherine E Lowe
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Carla Wilson
- Research Informatics Services, National Jewish Health, Denver, CO, USA
| | - James K O'Brien
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | | | - Arianne K Baldomero
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meredith C McCormack
- Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Nicole E Richmond
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Gloria E Westney
- Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Marilyn G Foreman
- Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Douglas J Conrad
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Dawn L DeMeo
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Hannatu Amaza
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Aparna Balasubramanian
- Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julia Kallet
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Shandi Watts
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Nicola A Hanania
- Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Terri H Beaty
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - James D Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Edwin K Silverman
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Robert Wise
- Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Labaki WW, Gu T, Murray S, Curtis JL, Wells JM, Bhatt SP, Bon J, Diaz AA, Hersh CP, Wan ES, Kim V, Beaty TH, Hokanson JE, Bowler RP, Arenberg DA, Kazerooni EA, Martinez FJ, Silverman EK, Crapo JD, Make BJ, Regan EA, Han MK. Causes of and Clinical Features Associated with Death in Tobacco Cigarette Users by Lung Function Impairment. Am J Respir Crit Care Med 2023; 208:451-460. [PMID: 37159910 PMCID: PMC10449063 DOI: 10.1164/rccm.202210-1887oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/08/2023] [Indexed: 05/11/2023] Open
Abstract
Rationale: Cigarette smoking contributes to the risk of death through different mechanisms. Objectives: To determine how causes of and clinical features associated with death vary in tobacco cigarette users by lung function impairment. Methods: We stratified current and former tobacco cigarette users enrolled in Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) into normal spirometry, PRISm (Preserved Ratio Impaired Spirometry), Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-2 COPD, and GOLD 3-4 COPD. Deaths were identified via longitudinal follow-up and Social Security Death Index search. Causes of death were adjudicated after a review of death certificates, medical records, and next-of-kin interviews. We tested associations between baseline clinical variables and all-cause mortality using multivariable Cox proportional hazards models. Measurements and Main Results: Over a 10.1-year median follow-up, 2,200 deaths occurred among 10,132 participants (age 59.5 ± 9.0 yr; 46.6% women). Death from cardiovascular disease was most frequent in PRISm (31% of deaths). Lung cancer deaths were most frequent in GOLD 1-2 (18% of deaths vs. 9-11% in other groups). Respiratory deaths outpaced competing causes of death in GOLD 3-4, particularly when BODE index ⩾7. St. George's Respiratory Questionnaire score ⩾25 was associated with higher mortality in all groups: Hazard ratio (HR), 1.48 (1.20-1.84) normal spirometry; HR, 1.40 (1.05-1.87) PRISm; HR, 1.80 (1.49-2.17) GOLD 1-2; HR, 1.65 (1.26-2.17) GOLD 3-4. History of respiratory exacerbations was associated with higher mortality in GOLD 1-2 and GOLD 3-4, quantitative emphysema in GOLD 1-2, and airway wall thickness in PRISm and GOLD 3-4. Conclusions: Leading causes of death vary by lung function impairment in tobacco cigarette users. Worse respiratory-related quality of life is associated with all-cause mortality regardless of lung function.
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Affiliation(s)
| | - Tian Gu
- Department of Biostatistics, T.H. Chan School of Public Health
| | | | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine
- Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - J. Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | - Craig P. Hersh
- Division of Pulmonary and Critical Care Medicine, and
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Emily S. Wan
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Terri H. Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John E. Hokanson
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Ella A. Kazerooni
- Division of Pulmonary and Critical Care Medicine
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
| | - Edwin K. Silverman
- Division of Pulmonary and Critical Care Medicine, and
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - James D. Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine and
| | - Barry J. Make
- Division of Pulmonary, Critical Care and Sleep Medicine and
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13
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Ngo D, Pratte KA, Flexeder C, Petersen H, Dang H, Ma Y, Keyes MJ, Gao Y, Deng S, Peterson BD, Farrell LA, Bhambhani VM, Palacios C, Quadir J, Gillenwater L, Xu H, Emson C, Gieger C, Suhre K, Graumann J, Jain D, Conomos MP, Tracy RP, Guo X, Liu Y, Johnson WC, Cornell E, Durda P, Taylor KD, Papanicolaou GJ, Rich SS, Rotter JI, Rennard SI, Curtis JL, Woodruff PG, Comellas AP, Silverman EK, Crapo JD, Larson MG, Vasan RS, Wang TJ, Correa A, Sims M, Wilson JG, Gerszten RE, O’Connor GT, Barr RG, Couper D, Dupuis J, Manichaikul A, O’Neal WK, Tesfaigzi Y, Schulz H, Bowler RP. Systemic Markers of Lung Function and Forced Expiratory Volume in 1 Second Decline across Diverse Cohorts. Ann Am Thorac Soc 2023; 20:1124-1135. [PMID: 37351609 PMCID: PMC10405603 DOI: 10.1513/annalsats.202210-857oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/13/2023] [Indexed: 06/24/2023] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) is a complex disease characterized by airway obstruction and accelerated lung function decline. Our understanding of systemic protein biomarkers associated with COPD remains incomplete. Objectives: To determine what proteins and pathways are associated with impaired pulmonary function in a diverse population. Methods: We studied 6,722 participants across six cohort studies with both aptamer-based proteomic and spirometry data (4,566 predominantly White participants in a discovery analysis and 2,156 African American cohort participants in a validation). In linear regression models, we examined protein associations with baseline forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC). In linear mixed effects models, we investigated the associations of baseline protein levels with rate of FEV1 decline (ml/yr) in 2,777 participants with up to 7 years of follow-up spirometry. Results: We identified 254 proteins associated with FEV1 in our discovery analyses, with 80 proteins validated in the Jackson Heart Study. Novel validated protein associations include kallistatin serine protease inhibitor, growth differentiation factor 2, and tumor necrosis factor-like weak inducer of apoptosis (discovery β = 0.0561, Q = 4.05 × 10-10; β = 0.0421, Q = 1.12 × 10-3; and β = 0.0358, Q = 1.67 × 10-3, respectively). In longitudinal analyses within cohorts with follow-up spirometry, we identified 15 proteins associated with FEV1 decline (Q < 0.05), including elafin leukocyte elastase inhibitor and mucin-associated TFF2 (trefoil factor 2; β = -4.3 ml/yr, Q = 0.049; β = -6.1 ml/yr, Q = 0.032, respectively). Pathways and processes highlighted by our study include aberrant extracellular matrix remodeling, enhanced innate immune response, dysregulation of angiogenesis, and coagulation. Conclusions: In this study, we identify and validate novel biomarkers and pathways associated with lung function traits in a racially diverse population. In addition, we identify novel protein markers associated with FEV1 decline. Several protein findings are supported by previously reported genetic signals, highlighting the plausibility of certain biologic pathways. These novel proteins might represent markers for risk stratification, as well as novel molecular targets for treatment of COPD.
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Affiliation(s)
- Debby Ngo
- Cardiovascular Research Institute
- Division of Pulmonary, Critical Care, and Sleep Medicine, and
| | | | - Claudia Flexeder
- Institute of Epidemiology and
- Comprehensive Pneumology Center Munich (CPC-M) as member of the German Center for Lung Research (DZL), Munich, Germany
- Institute and Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Hans Petersen
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico
| | - Hong Dang
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yanlin Ma
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | | | - Yan Gao
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi; and
- Institute and Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | | | | | | | | | | | | | - Hanfei Xu
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Claire Emson
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | - Christian Gieger
- Institute of Epidemiology and
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
| | - Karsten Suhre
- Department of Physiology and Biophysics, Weill Cornell Medicine Qatar, Education City, Doha, Qatar
| | | | - Deepti Jain
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Matthew P. Conomos
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance, California
| | - Yongmei Liu
- Division of Cardiology, Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina
| | - W. Craig Johnson
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Elaine Cornell
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Peter Durda
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Kent D. Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance, California
| | - George J. Papanicolaou
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance, California
| | - Steven I. Rennard
- Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Prescott G. Woodruff
- Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | | | | | - Martin G. Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- The National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts
| | - Ramachandran S. Vasan
- The National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts
- Division of Preventive Medicine and
- Division of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Thomas J. Wang
- Department of Medicine, UT (University of Texas) Southwestern Medical Center, Dallas, Texas
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adolfo Correa
- Jackson Heart Study, Department of Medicine, and
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Mario Sims
- Jackson Heart Study, Department of Medicine, and
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - James G. Wilson
- Cardiovascular Research Institute
- Jackson Heart Study, Department of Medicine, and
| | - Robert E. Gerszten
- Cardiovascular Research Institute
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - George T. O’Connor
- The National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts
- Pulmonary Center, Department of Medicine, Boston University, Boston, Massachusetts
| | - R. Graham Barr
- Department of Medicine and
- Department of Epidemiology, Columbia University, New York, New York
| | - David Couper
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Ani Manichaikul
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | - Wanda K. O’Neal
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yohannes Tesfaigzi
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico
- Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Holger Schulz
- Institute of Epidemiology and
- Comprehensive Pneumology Center Munich (CPC-M) as member of the German Center for Lung Research (DZL), Munich, Germany
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14
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Huffman JE, Nicolas J, Hahn J, Heath AS, Raffield LM, Yanek LR, Brody JA, Thibord F, Almasy L, Bartz TM, Bielak LF, Bowler RP, Carrasquilla GD, Chasman DI, Chen MH, Emmert DB, Ghanbari M, Haessle J, Hottenga JJ, Kleber ME, Le NQ, Lee J, Lewis JP, Li-Gao R, Luan J, Malmberg A, Mangino M, Marioni RE, Martinez-Perez A, Pankratz N, Polasek O, Richmond A, Rodriguez BA, Rotter JI, Steri M, Suchon P, Trompet S, Weiss S, Zare M, Auer P, Cho MH, Christofidou P, Davies G, de Geus E, Deleuze JF, Delgado GE, Ekunwe L, Faraday N, Gögele M, Greinacher A, He G, Howard T, Joshi PK, Kilpeläinen TO, Lahti J, Linneberg A, Naitza S, Noordam R, Paüls-Vergés F, Rich SS, Rosendaal FR, Rudan I, Ryan KA, Souto JC, van Rooij FJ, Wang H, Zhao W, Becker LC, Beswick A, Brown MR, Cade BE, Campbell H, Cho K, Crapo JD, Curran JE, de Maat MP, Doyle M, Elliott P, Floyd JS, Fuchsberger C, Grarup N, Guo X, Harris SE, Hou L, Kolcic I, Kooperberg C, Menni C, Nauck M, O'Connell JR, Orrù V, Psaty BM, Räikkönen K, Smith JA, Soria JM, Stott DJ, van Hylckama Vlieg A, Watkins H, Willemsen G, Wilson P, Ben-Shlomo Y, Blangero J, Boomsma D, Cox SR, Dehghan A, Eriksson JG, Fiorillo E, Fornage M, Hansen T, Hayward C, Ikram MA, Jukema JW, Kardia SL, Lange LA, März W, Mathias RA, Mitchell BD, Mook-Kanamori DO, Morange PE, Pedersen O, Pramstaller PP, Redline S, Reiner A, Ridker PM, Silverman EK, Spector TD, Völker U, Wareham N, Wilson JF, Yao J, Trégouët DA, Johnson AD, Wolberg AS, de Vries PS, Sabater-Lleal M, Morrison AC, Smith NL. Whole genome analysis of plasma fibrinogen reveals population-differentiated genetic regulators with putative liver roles. medRxiv 2023:2023.06.07.23291095. [PMID: 37398003 PMCID: PMC10312878 DOI: 10.1101/2023.06.07.23291095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Genetic studies have identified numerous regions associated with plasma fibrinogen levels in Europeans, yet missing heritability and limited inclusion of non-Europeans necessitates further studies with improved power and sensitivity. Compared with array-based genotyping, whole genome sequencing (WGS) data provides better coverage of the genome and better representation of non-European variants. To better understand the genetic landscape regulating plasma fibrinogen levels, we meta-analyzed WGS data from the NHLBI's Trans-Omics for Precision Medicine (TOPMed) program (n=32,572), with array-based genotype data from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium (n=131,340) imputed to the TOPMed or Haplotype Reference Consortium panel. We identified 18 loci that have not been identified in prior genetic studies of fibrinogen. Of these, four are driven by common variants of small effect with reported MAF at least 10% higher in African populations. Three ( SERPINA1, ZFP36L2 , and TLR10) signals contain predicted deleterious missense variants. Two loci, SOCS3 and HPN , each harbor two conditionally distinct, non-coding variants. The gene region encoding the protein chain subunits ( FGG;FGB;FGA ), contains 7 distinct signals, including one novel signal driven by rs28577061, a variant common (MAF=0.180) in African reference panels but extremely rare (MAF=0.008) in Europeans. Through phenome-wide association studies in the VA Million Veteran Program, we found associations between fibrinogen polygenic risk scores and thrombotic and inflammatory disease phenotypes, including an association with gout. Our findings demonstrate the utility of WGS to augment genetic discovery in diverse populations and offer new insights for putative mechanisms of fibrinogen regulation. Key Points Largest and most diverse genetic study of plasma fibrinogen identifies 54 regions (18 novel), housing 69 conditionally distinct variants (20 novel).Sufficient power achieved to identify signal driven by African population variant.Links to (1) liver enzyme, blood cell and lipid genetic signals, (2) liver regulatory elements, and (3) thrombotic and inflammatory disease.
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15
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Baraghoshi D, Strand M, Humphries SM, San José Estépar R, Vegas Sanchez-Ferrero G, Charbonnier JP, Latisenko R, Silverman EK, Crapo JD, Lynch DA. Quantitative CT Evaluation of Emphysema Progression over 10 Years in the COPDGene Study. Radiology 2023; 307:e222786. [PMID: 37039685 PMCID: PMC10286952 DOI: 10.1148/radiol.222786] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 04/12/2023]
Abstract
Background Long-term studies of chronic obstructive pulmonary disease (COPD) can evaluate emphysema progression. Adjustment for differences in equipment and scanning protocols of individual CT examinations have not been studied extensively. Purpose To evaluate emphysema progression in current and former smokers in the COPDGene cohort over three imaging points obtained at 5-year intervals accounting for individual CT parameters. Materials and Methods Current and former cigarette smokers enrolled between 2008 and 2011 from the COPDGene study were prospectively followed for 10 years between 2008 and 2020. Extent of emphysema as adjusted lung density (ALD) from quantitative CT was measured at baseline and at 5- and 10-year follow-up. Linear mixed models adjusted for CT technical characteristics were constructed to evaluate emphysema progression. Mean annual changes in ALD over consecutive 5-year study periods were estimated by smoking status and baseline emphysema. Results Of 8431 participants at baseline (mean age, 60 years ± 9 [SD]; 3905 female participants), 4913 were at 5-year follow-up and 1544 participants were at 10-year follow-up. There were 4134 (49%) participants who were current smokers, and 4449 (53%) participants had more than trace emphysema at baseline. Current smokers with more than trace emphysema showed the largest decline in ALD, with mean annual decreases of 1.4 g/L (95% CI: 1.2, 1.5) in the first 5 years and 0.9 g/L (95% CI: 0.7, 1.2) in the second 5 years. Accounting for CT noise, field of view, and scanner model improved model fit for estimation of emphysema progression (P < .001 by likelihood ratio test). Conclusion Evaluation at CT of emphysema progression in the COPDGene study showed that, during the span of 10 years, participants with pre-existing emphysema who continued smoking had the largest decline in ALD. Adjusting for CT equipment and protocol factors improved these longitudinal estimates. Clinical trial registration no. NCT00608764 © RSNA, 2023 Supplemental material is available for this article. See the editorial by Parraga and Kirby in this issue.
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Affiliation(s)
- David Baraghoshi
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Matthew Strand
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Stephen M. Humphries
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Raúl San José Estépar
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Gonzalo Vegas Sanchez-Ferrero
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Jean-Paul Charbonnier
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Rudolfs Latisenko
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Edwin K. Silverman
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - James D. Crapo
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - David A. Lynch
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
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16
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Tran TV, Kinney GL, Comellas A, Hoth KF, Baldomero AK, Mamary AJ, Curtis JL, Hanania N, Casaburi R, Young KA, Kim V, Make B, Wan ES, Diaz AA, Hokanson J, Crapo JD, Silverman EK, Bhatt SP, Regan E, Fortis S. Prevalence of abnormal spirometry in individuals with a smoking history and no known obstructive lung disease. Respir Med 2023; 208:107126. [PMID: 36717002 PMCID: PMC9990311 DOI: 10.1016/j.rmed.2023.107126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Recent evidence suggests a high prevalence of undiagnosed chronic obstructive pulmonary disease (COPD). These individuals are at risk of exacerbations and delayed treatment. We analyzed an at-risk population for the prevalence of abnormal spirometry to provide clarity into who should undergo early spirometry. METHODS We analyzed data from the COPDGene study. Participants with ≥10 pack-years of smoking were included. Individuals with self-reported or physician-diagnosed COPD, asthma, chronic bronchitis, emphysema and/or were on inhalers were excluded. Parsimonious multivariable logistic regression models identified factors associated with abnormal spirometry, defined as either airflow obstruction (AFO) or preserved ratio impaired spirometry. Variables were selected for the final model using a stepwise backward variable elimination process which minimized Akaike information criterion (AIC). Similarly, during the 5-year follow-up period, we assessed factors associated with incident diagnosis of COPD. RESULTS Of 5055 individuals, 1064 (21%) had undiagnosed AFO. Age, pack-years, current smoking and a history of acute bronchitis were associated with AFO while body mass index, female sex, and Black race were inversely associated. Among 2800 participants with 5-year follow-up, 532 (19%) had an incident diagnosis of COPD. Associated risk factors included mMRC ≥2, chronic productive cough, respiratory exacerbations during the follow-up period, and abnormal spirometry. Age was inversely associated. CONCLUSIONS The prevalence of undiagnosed COPD is high in at-risk populations. We found multiple factors associated with undiagnosed COPD and incident diagnosis of COPD at follow up. These results can be used to identify those at risk for undiagnosed COPD to facilitate earlier diagnosis and treatment.
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Affiliation(s)
- Thuonghien V Tran
- Division of Pulmonary, Allergy and Critical Care, Harron Lung Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Alejandro Comellas
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, United States
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Arianne K Baldomero
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, United States
| | - A James Mamary
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, United States
| | - Jeffrey L Curtis
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicola Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, United States
| | - Barry Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, United States
| | - Emily S Wan
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, United States; VA Boston Healthcare System, Jamaica Plain, MA, United States
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - James D Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, United States
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Surya P Bhatt
- Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Elizabeth Regan
- Division of Rheumatology, National Jewish Health, Denver, CO, United States
| | - Spyridon Fortis
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, United States.
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Hayden LP, Hobbs BD, Busch R, Cho MH, Liu M, Lopes-Ramos CM, Lomas DA, Bakke P, Gulsvik A, Silverman EK, Crapo JD, Beaty TH, Laird NM, Lange C, DeMeo DL. X chromosome associations with chronic obstructive pulmonary disease and related phenotypes: an X chromosome-wide association study. Respir Res 2023; 24:38. [PMID: 36726148 PMCID: PMC9891756 DOI: 10.1186/s12931-023-02337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/18/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The association between genetic variants on the X chromosome to risk of COPD has not been fully explored. We hypothesize that the X chromosome harbors variants important in determining risk of COPD related phenotypes and may drive sex differences in COPD manifestations. METHODS Using X chromosome data from three COPD-enriched cohorts of adult smokers, we performed X chromosome specific quality control, imputation, and testing for association with COPD case-control status, lung function, and quantitative emphysema. Analyses were performed among all subjects, then stratified by sex, and subsequently combined in meta-analyses. RESULTS Among 10,193 subjects of non-Hispanic white or European ancestry, a variant near TMSB4X, rs5979771, reached genome-wide significance for association with lung function measured by FEV1/FVC ([Formula: see text] 0.020, SE 0.004, p 4.97 × 10-08), with suggestive evidence of association with FEV1 ([Formula: see text] 0.092, SE 0.018, p 3.40 × 10-07). Sex-stratified analyses revealed X chromosome variants that were differentially trending in one sex, with significantly different effect sizes or directions. CONCLUSIONS This investigation identified loci influencing lung function, COPD, and emphysema in a comprehensive genetic association meta-analysis of X chromosome genetic markers from multiple COPD-related datasets. Sex differences play an important role in the pathobiology of complex lung disease, including X chromosome variants that demonstrate differential effects by sex and variants that may be relevant through escape from X chromosome inactivation. Comprehensive interrogation of the X chromosome to better understand genetic control of COPD and lung function is important to further understanding of disease pathology. Trial registration Genetic Epidemiology of COPD Study (COPDGene) is registered at ClinicalTrials.gov, NCT00608764 (Active since January 28, 2008). Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints Study (ECLIPSE), GlaxoSmithKline study code SCO104960, is registered at ClinicalTrials.gov, NCT00292552 (Active since February 16, 2006). Genetics of COPD in Norway Study (GenKOLS) holds GlaxoSmithKline study code RES11080, Genetics of Chronic Obstructive Lung Disease.
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Affiliation(s)
- Lystra P. Hayden
- grid.38142.3c000000041936754XDivision of Pulmonary Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA ,grid.38142.3c000000041936754XChanning Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115 USA
| | - Brian D. Hobbs
- grid.38142.3c000000041936754XChanning Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Robert Busch
- grid.417587.80000 0001 2243 3366Division of Pulmonology, Allergy, and Critical Care, U.S. Food and Drug Administration, Silver Spring, MD USA
| | - Michael H. Cho
- grid.38142.3c000000041936754XChanning Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Ming Liu
- grid.268323.e0000 0001 1957 0327Bioinformatics and Computational Biology Program, Worcester Polytechnic Institute, Worcester, MA USA
| | - Camila M. Lopes-Ramos
- grid.38142.3c000000041936754XChanning Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - David A. Lomas
- grid.83440.3b0000000121901201UCL Respiratory, University College London, London, UK
| | - Per Bakke
- grid.7914.b0000 0004 1936 7443Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- grid.7914.b0000 0004 1936 7443Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Edwin K. Silverman
- grid.38142.3c000000041936754XChanning Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - James D. Crapo
- grid.240341.00000 0004 0396 0728Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, Denver, CO USA
| | - Terri H. Beaty
- grid.21107.350000 0001 2171 9311Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Nan M. Laird
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Christoph Lange
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Dawn L. DeMeo
- grid.38142.3c000000041936754XChanning Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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18
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Verstraete K, Das N, Gyselinck I, Topalovic M, Troosters T, Crapo JD, Silverman EK, Make BJ, Regan EA, Jensen R, De Vos M, Janssens W. Principal component analysis of flow-volume curves in COPDGene to link spirometry with phenotypes of COPD. Respir Res 2023; 24:20. [PMID: 36658542 PMCID: PMC9854102 DOI: 10.1186/s12931-023-02318-4] [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: 06/16/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Parameters from maximal expiratory flow-volume curves (MEFVC) have been linked to CT-based parameters of COPD. However, the association between MEFVC shape and phenotypes like emphysema, small airways disease (SAD) and bronchial wall thickening (BWT) has not been investigated. RESEARCH QUESTION We analyzed if the shape of MEFVC can be linked to CT-determined emphysema, SAD and BWT in a large cohort of COPDGene participants. STUDY DESIGN AND METHODS In the COPDGene cohort, we used principal component analysis (PCA) to extract patterns from MEFVC shape and performed multiple linear regression to assess the association of these patterns with CT parameters over the COPD spectrum, in mild and moderate-severe COPD. RESULTS Over the entire spectrum, in mild and moderate-severe COPD, principal components of MEFVC were important predictors for the continuous CT parameters. Their contribution to the prediction of emphysema diminished when classical pulmonary function test parameters were added. For SAD, the components remained very strong predictors. The adjusted R2 was higher in moderate-severe COPD, while in mild COPD, the adjusted R2 for all CT outcomes was low; 0.28 for emphysema, 0.21 for SAD and 0.19 for BWT. INTERPRETATION The shape of the maximal expiratory flow-volume curve as analyzed with PCA is not an appropriate screening tool for early disease phenotypes identified by CT scan. However, it contributes to assessing emphysema and SAD in moderate-severe COPD.
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Affiliation(s)
- Kenneth Verstraete
- grid.5596.f0000 0001 0668 7884Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, O&N 1Bis, Box 706, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
| | - Nilakash Das
- grid.5596.f0000 0001 0668 7884Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, O&N 1Bis, Box 706, 3000 Leuven, Belgium
| | - Iwein Gyselinck
- grid.5596.f0000 0001 0668 7884Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, O&N 1Bis, Box 706, 3000 Leuven, Belgium
| | | | - Thierry Troosters
- grid.5596.f0000 0001 0668 7884Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - James D. Crapo
- grid.240341.00000 0004 0396 0728National Jewish Medical and Research Center, Denver, CO USA
| | - Edwin K. Silverman
- grid.38142.3c000000041936754XChanning Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Barry J. Make
- grid.240341.00000 0004 0396 0728National Jewish Medical and Research Center, Denver, CO USA
| | - Elizabeth A. Regan
- grid.240341.00000 0004 0396 0728National Jewish Medical and Research Center, Denver, CO USA
| | - Robert Jensen
- grid.223827.e0000 0001 2193 0096University of Utah, Salt Lake City, Utah USA
| | - Maarten De Vos
- grid.5596.f0000 0001 0668 7884STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- grid.5596.f0000 0001 0668 7884Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, O&N 1Bis, Box 706, 3000 Leuven, Belgium
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19
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Morris AH, Horvat C, Stagg B, Grainger DW, Lanspa M, Orme J, Clemmer TP, Weaver LK, Thomas FO, Grissom CK, Hirshberg E, East TD, Wallace CJ, Young MP, Sittig DF, Suchyta M, Pearl JE, Pesenti A, Bombino M, Beck E, Sward KA, Weir C, Phansalkar S, Bernard GR, Thompson BT, Brower R, Truwit J, Steingrub J, Hiten RD, Willson DF, Zimmerman JJ, Nadkarni V, Randolph AG, Curley MAQ, Newth CJL, Lacroix J, Agus MSD, Lee KH, deBoisblanc BP, Moore FA, Evans RS, Sorenson DK, Wong A, Boland MV, Dere WH, Crandall A, Facelli J, Huff SM, Haug PJ, Pielmeier U, Rees SE, Karbing DS, Andreassen S, Fan E, Goldring RM, Berger KI, Oppenheimer BW, Ely EW, Pickering BW, Schoenfeld DA, Tocino I, Gonnering RS, Pronovost PJ, Savitz LA, Dreyfuss D, Slutsky AS, Crapo JD, Pinsky MR, James B, Berwick DM. Computer clinical decision support that automates personalized clinical care: a challenging but needed healthcare delivery strategy. J Am Med Inform Assoc 2022; 30:178-194. [PMID: 36125018 PMCID: PMC9748596 DOI: 10.1093/jamia/ocac143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 12/15/2022] Open
Abstract
How to deliver best care in various clinical settings remains a vexing problem. All pertinent healthcare-related questions have not, cannot, and will not be addressable with costly time- and resource-consuming controlled clinical trials. At present, evidence-based guidelines can address only a small fraction of the types of care that clinicians deliver. Furthermore, underserved areas rarely can access state-of-the-art evidence-based guidelines in real-time, and often lack the wherewithal to implement advanced guidelines. Care providers in such settings frequently do not have sufficient training to undertake advanced guideline implementation. Nevertheless, in advanced modern healthcare delivery environments, use of eActions (validated clinical decision support systems) could help overcome the cognitive limitations of overburdened clinicians. Widespread use of eActions will require surmounting current healthcare technical and cultural barriers and installing clinical evidence/data curation systems. The authors expect that increased numbers of evidence-based guidelines will result from future comparative effectiveness clinical research carried out during routine healthcare delivery within learning healthcare systems.
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Affiliation(s)
- Alan H Morris
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Christopher Horvat
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian Stagg
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - David W Grainger
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Michael Lanspa
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - James Orme
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Terry P Clemmer
- Department of Internal Medicine (Critical Care), Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Lindell K Weaver
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Frank O Thomas
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Colin K Grissom
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Ellie Hirshberg
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Thomas D East
- SYNCRONYS - Chief Executive Officer, Albuquerque, New Mexico, USA
| | - Carrie Jane Wallace
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Michael P Young
- Department of Critical Care, Renown Regional Medical Center, Reno, Nevada, USA
| | - Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Mary Suchyta
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - James E Pearl
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Antinio Pesenti
- Faculty of Medicine and Surgery—Anesthesiology, University of Milan, Milano, Lombardia, Italy
| | - Michela Bombino
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza (MB), Italy
| | - Eduardo Beck
- Faculty of Medicine and Surgery - Anesthesiology, University of Milan, Ospedale di Desio, Desio, Lombardia, Italy
| | - Katherine A Sward
- Department of Biomedical Informatics, College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Shobha Phansalkar
- Wolters Kluwer Health—Clinical Solutions—Medical Informatics, Wolters Kluwer Health, Newton, Massachusetts, USA
| | - Gordon R Bernard
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - B Taylor Thompson
- Pulmonary and Critical Care Division, Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Roy Brower
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jonathon Truwit
- Department of Internal Medicine, Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jay Steingrub
- Department of Internal Medicine, Pulmonary and Critical Care, University of Massachusetts Medical School, Baystate Campus, Springfield, Massachusetts, USA
| | - R Duncan Hiten
- Department of Internal Medicine, Pulmonary and Critical Care, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Douglas F Willson
- Pediatric Critical Care, Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jerry J Zimmerman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Martha A Q Curley
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Christopher J L Newth
- Childrens Hospital Los Angeles, Department of Anesthesiology and Critical Care, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Université de Montréal Faculté de Médecine, Montreal, Quebec, Canada
| | - Michael S D Agus
- Division of Medical Pediatric Critical Care, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kang Hoe Lee
- Department of Intensive Care Medicine, Ng Teng Fong Hospital and National University Centre of Transplantation, National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Bennett P deBoisblanc
- Department of Internal Medicine, Pulmonary and Critical Care, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Frederick Alan Moore
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - R Scott Evans
- Department of Medical Informatics, Intermountain Healthcare, and Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Dean K Sorenson
- Department of Medical Informatics, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Anthony Wong
- Department of Data Science Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael V Boland
- Department of Ophthalmology, Massachusetts Ear and Eye Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Willard H Dere
- Endocrinology and Metabolism Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alan Crandall
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
- Posthumous
| | - Julio Facelli
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Stanley M Huff
- Department of Medical Informatics, Intermountain Healthcare, Department of Biomedical Informatics, University of Utah, and Graphite Health, Salt Lake City, Utah, USA
| | - Peter J Haug
- Department of Medical Informatics, Intermountain Healthcare, and Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ulrike Pielmeier
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Stephen E Rees
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Dan S Karbing
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Steen Andreassen
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Eddy Fan
- Internal Medicine, Pulmonary and Critical Care Division, Institute of Health Policy, Management and Evaluation, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Roberta M Goldring
- Department of Internal Medicine, Pulmonary and Critical Care, New York University School of Medicine, New York, New York, USA
| | - Kenneth I Berger
- Department of Internal Medicine, Pulmonary and Critical Care, New York University School of Medicine, New York, New York, USA
| | - Beno W Oppenheimer
- Department of Internal Medicine, Pulmonary and Critical Care, New York University School of Medicine, New York, New York, USA
| | - E Wesley Ely
- Internal Medicine, Pulmonary and Critical Care, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Brian W Pickering
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David A Schoenfeld
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Irena Tocino
- Department of Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Russell S Gonnering
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peter J Pronovost
- Department of Anesthesiology and Critical Care Medicine, University Hospitals, Highland Hills, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lucy A Savitz
- Northwest Center for Health Research, Kaiser Permanente, Oakland, California, USA
| | - Didier Dreyfuss
- Assistance Publique—Hôpitaux de Paris, Université de Paris, Sorbonne Université - INSERM unit UMR S_1155 (Common and Rare Kidney Diseases), Paris, France
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - James D Crapo
- Department of Internal Medicine, National Jewish Health, Denver, Colorado, USA
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brent James
- Department of Internal Medicine, Clinical Excellence Research Center (CERC), Stanford University School of Medicine, Stanford, California, USA
| | - Donald M Berwick
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
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20
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Bhatt SP, Bodduluri S, Dransfield MT, Reinhardt JM, Crapo JD, Silverman EK, Humphries S, Lynch DA, Strand MJ. Acute Exacerbations Are Associated with Progression of Emphysema. Ann Am Thorac Soc 2022; 19:2108-2111. [PMID: 35914221 PMCID: PMC9743469 DOI: 10.1513/annalsats.202112-1385rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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21
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Oh AS, Baraghoshi D, Lynch DA, Ash SY, Crapo JD, Humphries SM. Emphysema Progression at CT by Deep Learning Predicts Functional Impairment and Mortality: Results from the COPDGene Study. Radiology 2022; 304:672-679. [PMID: 35579519 PMCID: PMC9434819 DOI: 10.1148/radiol.213054] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022]
Abstract
Background Visual assessment remains the standard for evaluating emphysema at CT; however, it is time consuming, is subjective, requires training, and is affected by variability that may limit sensitivity to longitudinal change. Purpose To evaluate the clinical and imaging significance of increasing emphysema severity as graded by a deep learning algorithm on sequential CT scans in cigarette smokers. Materials and Methods A secondary analysis of the prospective Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study participants was performed and included baseline and 5-year follow-up CT scans from 2007 to 2017. Emphysema was classified automatically according to the Fleischner emphysema grading system at baseline and 5-year follow-up using a deep learning model. Baseline and change in clinical and imaging parameters at 5-year follow-up were compared in participants whose emphysema progressed versus those who did not. Kaplan-Meier analysis and multivariable Cox regression were used to assess the relationship between emphysema score progression and mortality. Results A total of 5056 participants (mean age, 60 years ± 9 [SD]; 2566 men) were evaluated. At 5-year follow-up, 1293 of the 5056 participants (26%) had emphysema progression according to the Fleischner grading system. This group demonstrated progressive airflow obstruction (forced expiratory volume in 1 second [percent predicted]: -3.4 vs -1.8), a greater decline in 6-minute walk distance (-177 m vs -124 m), and greater progression in quantitative emphysema extent (adjusted lung density: -1.4 g/L vs 0.5 g/L; percentage of lung voxels with CT attenuation less than -950 HU: 0.6 vs 0.2) than those with nonprogressive emphysema (P < .001 for each). Multivariable Cox regression analysis showed a higher mortality rate in the group with emphysema progression, with an estimated hazard ratio of 1.5 (95% CI: 1.2, 1.8; P < .001). Conclusion An increase in Fleischner emphysema grade on sequential CT scans using an automated deep learning algorithm was associated with increased functional impairment and increased risk of mortality. ClinicalTrials.gov registration no. NCT00608764 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Grenier in this issue.
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Affiliation(s)
- Andrea S. Oh
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - David Baraghoshi
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - David A. Lynch
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - Samuel Y. Ash
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - James D. Crapo
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - Stephen M. Humphries
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - for the COPDGene Investigators
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
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22
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Boueiz A, Xu Z, Chang Y, Masoomi A, Gregory A, Lutz S, Qiao D, Crapo JD, Dy JG, Silverman EK, Castaldi PJ. Machine Learning Prediction of Progression in Forced Expiratory Volume in 1 Second in the COPDGene® Study. Chronic Obstr Pulm Dis 2022; 9:349-365. [PMID: 35649102 PMCID: PMC9448009 DOI: 10.15326/jcopdf.2021.0275] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 05/24/2023]
Abstract
BACKGROUND The heterogeneous nature of chronic obstructive pulmonary disease (COPD) complicates the identification of the predictors of disease progression. We aimed to improve the prediction of disease progression in COPD by using machine learning and incorporating a rich dataset of phenotypic features. METHODS We included 4496 smokers with available data from their enrollment and 5-year follow-up visits in the COPD Genetic Epidemiology (COPDGene®) study. We constructed linear regression (LR) and supervised random forest models to predict 5-year progression in forced expiratory in 1 second (FEV1) from 46 baseline features. Using cross-validation, we randomly partitioned participants into training and testing samples. We also validated the results in the COPDGene 10-year follow-up visit. RESULTS Predicting the change in FEV1 over time is more challenging than simply predicting the future absolute FEV1 level. For random forest, R-squared was 0.15 and the area under the receiver operator characteristic (ROC) curves for the prediction of participants in the top quartile of observed progression was 0.71 (testing) and respectively, 0.10 and 0.70 (validation). Random forest provided slightly better performance than LR. The accuracy was best for Global initiative for chronic Obstructive Lung Disease (GOLD) grades 1-2 participants, and it was harder to achieve accurate prediction in advanced stages of the disease. Predictive variables differed in their relative importance as well as for the predictions by GOLD. CONCLUSION Random forest, along with deep phenotyping, predicts FEV1 progression with reasonable accuracy. There is significant room for improvement in future models. This prediction model facilitates the identification of smokers at increased risk for rapid disease progression. Such findings may be useful in the selection of patient populations for targeted clinical trials.
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Affiliation(s)
- Adel Boueiz
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
- *These authors contributed equally
| | - Zhonghui Xu
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
- *These authors contributed equally
| | - Yale Chang
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts, United States
| | - Aria Masoomi
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts, United States
| | - Andrew Gregory
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Sharon Lutz
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - Dandi Qiao
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - James D. Crapo
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Jennifer G. Dy
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts, United States
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Peter J. Castaldi
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
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23
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Strand M, Khatiwada A, Baraghoshi D, Lynch D, Silverman EK, Bhatt SP, Austin E, Regan EA, Boriek AM, Crapo JD. Predicting COPD Progression in Current and Former Smokers Using a Joint Model for Forced Expiratory Volume in 1 Second and Forced Expiratory Volume in 1 Second to Forced Vital Capacity Ratio. Chronic Obstr Pulm Dis 2022; 9:439-453. [PMID: 35905755 PMCID: PMC9448007 DOI: 10.15326/jcopdf.2022.0281] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
Understanding baseline characteristics that can predict the progression of lung disease such as chronic obstructive pulmonary disease (COPD) for current or former smokers may allow for therapeutic intervention, particularly for individuals at high risk of rapid disease progression or transition from non-COPD to COPD. Classic diagnostic criteria for COPD and disease severity such as the Global Initiative for Chronic Obstructive Lung Disease document are based on forced expiratory volume in 1 second (FEV1) and FEV1 to forced vital capacity (FVC) ratio. Modeling changes in these outcomes jointly is beneficial given that they are correlated, and they are both required for specific disease classifications. Here, linear mixed models were used to model changes in FEV1 and FEV1/FVC jointly for 5- and 10-year intervals, using important baseline predictors to better understand the factors that affect disease progression. Participants with predicted loss of FEV1 and/or FEV1/FVC of at least 5% tended to have more emphysema, higher functional residual capacity, higher airway wall thickness as measured by Pi10, lower FVC to total lung capacity ratio and a lower body mass index at baseline, all relative to overall cohort averages. The model developed can be used to predict progression for any potential COPD individual, based on demographic, symptom, computed tomography, and comorbidity variables.
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Affiliation(s)
- Matthew Strand
- Division of Biostatistics, National Jewish Health, Denver, Colorado, United States
| | - Aastha Khatiwada
- Division of Biostatistics, National Jewish Health, Denver, Colorado, United States
| | - David Baraghoshi
- Division of Biostatistics, National Jewish Health, Denver, Colorado, United States
| | - David Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, United States
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical Center, Boston, Massachusetts, United States
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Erin Austin
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, Colorado, United States
| | - Elizabeth A. Regan
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Aladin M. Boriek
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - James D. Crapo
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
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24
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Wan ES, Hokanson JE, Regan EA, Young KA, Make BJ, DeMeo DL, Mason SE, San Jose Estepar R, Crapo JD, Silverman EK. Significant Spirometric Transitions and Preserved Ratio Impaired Spirometry Among Ever Smokers. Chest 2022; 161:651-661. [PMID: 34592319 PMCID: PMC8941606 DOI: 10.1016/j.chest.2021.09.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 05/14/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Emerging data from longitudinal studies suggest that preserved ratio impaired spirometry (PRISm), defined by proportionate reductions in FEV1 and FVC, is a heterogeneous population with frequent transitions to other lung function categories relative to individuals with normal and obstructive spirometry. Controversy regarding the clinical significance of these transitions exists (eg, whether transitions merely reflect measurement variability or noise). RESEARCH QUESTION Are individuals with PRISm enriched for transitions associated with substantial changes in lung function? STUDY DESIGN AND METHODS Current and former smokers enrolled in the Genetic Epidemiology of COPD (COPDGene) study with spirometry available in phases 1 through 3 (enrollment, 5-year follow-up, and 10-year follow-up) were analyzed. Postbronchodilator lung function categories were as follows: PRISm (FEV1 < 80% predicted with FEV1/FVC ratio ≥ 0.7), Global Initiative for Chronic Obstructive Lung Disease grade 0 (FEV1 ≥ 80% predicted and FEV1/FVC ≥ 0.7), and obstruction (FEV1/FVC < 0.7). Significant transition status was affirmative if a subject belonged to two or more spirometric categories and had > 10% change in FEV1 % predicted and/or FVC % predicted between consecutive visits. Ever-PRISm was present if a subject had PRISm at any visit. Logistic regression examined the association between significant transitions and ever-PRISm status, adjusted for age, sex, race, FEV1 % predicted, current smoking, pack-years, BMI, and ever-positive bronchodilator response. RESULTS Among subjects with complete data (N = 1,775) over 10.1 ± 0.4 years of follow-up, the prevalence of PRISm remained consistent (10.4%-11.3%) between phases 1 through 3, but nearly one-half of subjects with PRISm transitioned into or out of PRISm at each visit. Among all subjects, 19.7% had a significant transition; ever-PRISm was a significant predictor of significant transitions (unadjusted OR, 10.3; 95% CI, 7.9-13.5; adjusted OR, 14.9; 95% CI, 10.9-20.7). Results were similar with additional adjustment for radiographic emphysema and gas trapping, when lower limit of normal criteria were used to define lung function categories, and when FEV1 alone (regardless of change in FVC % predicted) was used to define significant transitions. INTERPRETATION PRISm is an unstable group, with frequent significant transitions to both obstruction and normal spirometry over time. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT000608764; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Emily S. Wan
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA,Pulmonary & Critical Care Section, VA Boston Healthcare System, Boston, MA,CORRESPONDENCE TO: Emily S. Wan, MD, MPH
| | - John E. Hokanson
- University of Colorado, Denver, CO,Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | - Elizabeth A. Regan
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO,National Jewish Health, Denver, CO
| | - Kendra A. Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | | | - Dawn L. DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Stefanie E. Mason
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA
| | | | | | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
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Koo HK, Hoth KF, Make BJ, Regan EA, Crapo JD, Silverman EK, DeMeo DL. Optimism is associated with respiratory symptoms and functional status in chronic obstructive pulmonary disease. Respir Res 2022; 23:19. [PMID: 35093071 PMCID: PMC8800351 DOI: 10.1186/s12931-021-01922-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022] Open
Abstract
Background Optimism is the general belief that good things will occur in the future; optimism is modifiable by cognitive behavioral therapy (CBT). Previous studies have associated higher optimism with improved health outcomes and lower all-cause mortality. Research question Investigate association between optimism and disease-related characteristics in chronic obstructive pulmonary disease (COPD). Study design and methods Current and former smokers with/without COPD and Preserved Ratio Impaired Spirometry (PRISm) from the 10-year follow-up visit for the Genetic Epidemiology of COPD (COPDGene) study were included. Optimism was assessed at the 10-year visit using the Life Orientation Test-Revised. Models of optimism as a predictor of lung function, COPD-associated phenotypes including exacerbations, and functional assessments, were adjusted for demographic confounders, smoking status, and comorbidities. Results Among 1967 subjects, higher optimism was significantly associated with older age, non-Hispanic white race, marital status, quitting smoking status, absence of COPD, and absence of depression. In multivariable analysis, higher optimism was independently associated with fewer prior exacerbations of COPD (coef = − 0.037, P < 0.001). Higher optimism was also related to better MMRC scores (coef = − 0.041, P < 0.001), CAT scores (coef = − 0.391, P < 0.001), SGRQ scores (coef = − 0.958, P < 0.001), BODE index (coef = − 0.059, P < 0.001), and longer 6-min walk distance (coef = 10.227, P < 0.001). After stratification by severity of COPD, these associations with optimism were still significant in all groups. No significant association was observed for cross-sectional FEV1 (%) or FVC (%) with optimism score. Interpretation Fewer exacerbations and less severe respiratory symptoms and higher functional capacity were associated with higher optimism, which may impact health outcomes in current and former smokers with and without COPD. Optimism is a modifiable trait and these results may further support a role for CBT to improve outcomes in COPD. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01922-6.
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26
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Fortis S, Wan ES, Kunisaki K, Eyck PT, Ballas ZK, Bowler RP, Crapo JD, Hokanson JE, Wendt C, Silverman EK, Comellas AP. Increased mortality associated with frequent exacerbations in COPD patients with mild-to-moderate lung function impairment, and smokers with normal spirometry. Respiratory Medicine: X 2021; 3. [PMID: 35911870 PMCID: PMC9333066 DOI: 10.1016/j.yrmex.2020.100025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Methods: Results: Conclusions:
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Affiliation(s)
- Spyridon Fortis
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
- Corresponding author. UIHC – Internal Medicine, 200 Hawkins Drive – C33 GH, Iowa City, IA, 52242, USA. (S. Fortis)
| | - Emily S. Wan
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- VA Boston Healthcare System, Jamaica Plain, MA, USA
| | - Ken Kunisaki
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - Patrick Tel Eyck
- Biostatistics and Research Design, Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Zuhair K. Ballas
- Division of Immunology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - James D. Crapo
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - John E. Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Chris Wendt
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alejandro P. Comellas
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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27
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Thomashow BM, Mannino DM, Tal-Singer R, Crapo JD. A rapidly changing understanding of COPD: World COPD Day from the COPD Foundation. Am J Physiol Lung Cell Mol Physiol 2021; 321:L983-L987. [PMID: 34612086 DOI: 10.1152/ajplung.00400.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
World COPD Day raises awareness about chronic obstructive pulmonary disease (COPD). COPD accounts for over 150,000 US deaths per year. A major challenge is that COPD receives only a fraction of the research funding provided to other major diseases. Control of COPD is dependent on developing new approaches to diagnose the disease earlier with a recognition of either pre-COPD or established COPD based on symptoms, lung structural change and/or loss of lung function that occurs before meeting long established criteria for a population-based definition of obstruction. Optimization of current therapies improves lung function, exercise capacity, quality of life, and survival. New pathways of disease progression are being identified creating new opportunities for development of therapies that could stop or cure this disease.
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Affiliation(s)
- Byron M Thomashow
- COPD Foundation, Miami, Florida.,Department of Medicine, Columbia University, New York, New York
| | - David M Mannino
- COPD Foundation, Miami, Florida.,Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | | | - James D Crapo
- COPD Foundation, Miami, Florida.,Department of Medicine, National Jewish Health, Denver, Colorado
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28
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Lindsay SE, Lindsay HG, Kallet J, Weaver MR, Curran-Everett D, Crapo JD, Regan EA. MnTE-2-PyP disrupts Staphylococcus aureus biofilms in a novel fracture model. J Orthop Res 2021; 39:2439-2445. [PMID: 33347639 DOI: 10.1002/jor.24967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/05/2020] [Accepted: 12/16/2020] [Indexed: 02/04/2023]
Abstract
Biofilm-associated infections in orthopedic surgery lead to worse clinical outcomes and greater morbidity and mortality. The scope of the problem encompasses infected total joints, internally fixed fractures, and implanted devices. Diagnosis is difficult. Cultures are often negative, and antibiotic treatments are ineffective. The infections resist killing by the immune system and antibiotics. The organized matrix structure of extracellular polymeric substances within the biofilm shields and protects the bacteria from identification and immune cell action. Bacteria in biofilms actively modulate their redox environment and can enhance the matrix structure by creating an oxidizing environment. We postulated that a potent redox-active metalloporphyrin MnTE-2-PyP (chemical name: manganese (II) meso-tetrakis-(N-methylpyridinium-2-yl) porphyrin) that scavenges reactive species and modulates the redox state to a reduced state, would improve the effect of antibiotic treatment for a biofilm-associated infection. An infected fracture model with a midshaft femoral osteotomy was created in C57B6 mice, internally fixed with an intramedullary 23-gauge needle and seeded with a biofilm-forming variant of Staphylococcus aureus. Animals were divided into three treatment groups: control, antibiotic alone, and combined antibioticplus MnTE-2-PyP. The combined treatment group had significantly decreased bacterial counts in harvested bone, compared with antibiotic alone. In vitro crystal violet assay of biofilm structure and corresponding nitroblue tetrazolium assay for reactive oxygen species (ROS) demonstrated that MnTE-2-PyP decreased the biofilm structure and reduced ROS in a correlated and dose-dependent manner. The biofilm structure is redox-sensitive in S. aureus and an ROS scavenger improved the effect of antibiotic therapy in model of biofilm-associated infections.
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29
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Brunette AM, Warner K, Holm KE, Meschede K, Wamboldt FS, Kozora E, Moser DJ, Make BJ, Crapo JD, Moreau KL, Weinberger HD, Bowler R, Hoth KF. Daily Activities: The Impact of COPD and Cognitive Dysfunction. Arch Clin Neuropsychol 2021; 36:acaa090 767 779-767. [PMID: 33103191 PMCID: PMC8500183 DOI: 10.1093/arclin/acaa090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation; however, pulmonary function does not fully account for patients' functional difficulties. The primary aim of the study was to determine the association between several domains of cognition and daily activity among those with COPD. METHOD Eighty-nine former smokers completed a neuropsychological battery including measures across multiple domains of cognition, pulmonary function measures, and daily activity questionnaires. Using a cross-sectional design, we compared daily activity between former smokers with and without COPD using two measures (St. George's Respiratory Questionnaire [SGRQ] Activity Subscale and Lawton Instrumental Activities of Daily Living [IADL] Scale) and examined the association between cognition and daily activity among those with COPD. RESULTS As expected, former smokers with COPD reported more difficulty than those without COPD on both activity measures (SGRQ Activity Subscale p < .001; Lawton IADL Scale p = .040). Among former smokers with COPD, poorer delayed recall was associated with more difficulty with daily activities (SGRQ Activity Subscale) (p = .038) while adjusting for severity of airflow limitation, exercise tolerance, oxygen use, dyspnea, and symptoms of anxiety and depression. CONCLUSION The findings suggest that cognition is associated with daily activity in patients with COPD. Future research should examine whether cognitive interventions may help to maximize patients' engagement in daily activities.
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Affiliation(s)
- Amanda M Brunette
- University of Iowa, Department of Psychological and Brain Sciences, Iowa City, IA 52242, USA
| | - Kelsey Warner
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
- Hennepin Healthcare, Department of Speech-Language Pathology, Minneapolis, MN 55404, USA
| | - Kristen E Holm
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO 80045, USA
| | - Kimberly Meschede
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
| | - Frederick S Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO 80045, USA
| | - Elizabeth Kozora
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO 80045, USA
| | - David J Moser
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Barry J Make
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - James D Crapo
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
- Denver Veterans Administration Medical Center, Geriatric Research Education and Clinical Center, Denver, CO 80220 USA
| | - Howard D Weinberger
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Russell Bowler
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Karin F Hoth
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Iowa, Iowa Neuroscience Institute, Iowa City, IA 52242, USA
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30
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Luehrs RE, Moreau KL, Pierce GL, Wamboldt F, Aloia M, Weinberger HD, Make B, Bowler R, Crapo JD, Meschede K, Kozora E, Moser DJ, Hoth KF. Cognitive performance is lower among individuals with overlap syndrome than in individuals with COPD or obstructive sleep apnea alone: association with carotid artery stiffness. J Appl Physiol (1985) 2021; 131:131-141. [PMID: 33982592 PMCID: PMC8325616 DOI: 10.1152/japplphysiol.00477.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are both independently associated with increased cardiovascular disease (CVD) risk and impaired cognitive function. It is unknown if individuals with both COPD and OSA (i.e., overlap syndrome) have greater common carotid artery (CCA) stiffness, an independent predictor of CVD risk, and lower cognitive performance than either COPD or OSA alone. Elevated CCA stiffness is associated with cognitive impairment in former smokers with and without COPD in past studies. We compared CCA stiffness and cognitive performance between former smokers with overlap syndrome, COPD only, OSA only and former smoker controls using analysis of covariance (ANCOVA) tests to adjust for age, sex, body mass index (BMI), pack years, and postbronchodilator FEV1/FVC. We also examined the association between CCA stiffness and cognitive performance among each group separately. Individuals with overlap syndrome (n = 12) had greater CCA β-stiffness index (P = 0.015) and lower executive function-processing speed (P = 0.019) than individuals with COPD alone (n = 47), OSA alone (n = 9), and former smoker controls (n = 21), differences that remained significant after adjusting for age, BMI, sex, pack years, and FEV1/FVC. Higher CCA β-stiffness index was associated with lower executive function-processing speed in individuals with overlap syndrome (r = -0.58, P = 0.047). These data suggest that CCA stiffness is greater and cognitive performance is lower among individuals with overlap syndrome compared with individuals with COPD or OSA alone and that CCA stiffening may be an underlying mechanism contributing to the lower cognitive performance observed in patients with overlap syndrome.NEW & NOTEWORTHY Previous studies have demonstrated greater carotid artery stiffness and lower cognitive function among individuals with COPD alone and OSA alone. However, the present study is the first to demonstrate that individuals that have both COPD and OSA (i.e., overlap syndrome) have greater carotid artery stiffness and lower executive function-processing speed than individuals with either disorder alone. Furthermore, among individuals with overlap syndrome greater carotid artery stiffness is associated with lower executive function-processing speed.
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Affiliation(s)
- Rachel E Luehrs
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
- Department of Kinesiology, North Central College, Naperville, Illinois
| | - Kerrie L Moreau
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Eastern Colorado VA Geriatric, Research, Education, and Clinical Center (GRECC), Aurora, Colorado
| | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa
| | - Frederick Wamboldt
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mark Aloia
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - Howard D Weinberger
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Barry Make
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Elizabeth Kozora
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David J Moser
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa
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31
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Morris AH, Stagg B, Lanspa M, Orme J, Clemmer TP, Weaver LK, Thomas F, Grissom CK, Hirshberg E, East TD, Wallace CJ, Young MP, Sittig DF, Pesenti A, Bombino M, Beck E, Sward KA, Weir C, Phansalkar SS, Bernard GR, Taylor Thompson B, Brower R, Truwit JD, Steingrub J, Duncan Hite R, Willson DF, Zimmerman JJ, Nadkarni VM, Randolph A, Curley MAQ, Newth CJL, Lacroix J, Agus MSD, Lee KH, deBoisblanc BP, Scott Evans R, Sorenson DK, Wong A, Boland MV, Grainger DW, Dere WH, Crandall AS, Facelli JC, Huff SM, Haug PJ, Pielmeier U, Rees SE, Karbing DS, Andreassen S, Fan E, Goldring RM, Berger KI, Oppenheimer BW, Wesley Ely E, Gajic O, Pickering B, Schoenfeld DA, Tocino I, Gonnering RS, Pronovost PJ, Savitz LA, Dreyfuss D, Slutsky AS, Crapo JD, Angus D, Pinsky MR, James B, Berwick D. Enabling a learning healthcare system with automated computer protocols that produce replicable and personalized clinician actions. J Am Med Inform Assoc 2021; 28:1330-1344. [PMID: 33594410 PMCID: PMC8661391 DOI: 10.1093/jamia/ocaa294] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 02/05/2023] Open
Abstract
Clinical decision-making is based on knowledge, expertise, and authority, with clinicians approving almost every intervention-the starting point for delivery of "All the right care, but only the right care," an unachieved healthcare quality improvement goal. Unaided clinicians suffer from human cognitive limitations and biases when decisions are based only on their training, expertise, and experience. Electronic health records (EHRs) could improve healthcare with robust decision-support tools that reduce unwarranted variation of clinician decisions and actions. Current EHRs, focused on results review, documentation, and accounting, are awkward, time-consuming, and contribute to clinician stress and burnout. Decision-support tools could reduce clinician burden and enable replicable clinician decisions and actions that personalize patient care. Most current clinical decision-support tools or aids lack detail and neither reduce burden nor enable replicable actions. Clinicians must provide subjective interpretation and missing logic, thus introducing personal biases and mindless, unwarranted, variation from evidence-based practice. Replicability occurs when different clinicians, with the same patient information and context, come to the same decision and action. We propose a feasible subset of therapeutic decision-support tools based on credible clinical outcome evidence: computer protocols leading to replicable clinician actions (eActions). eActions enable different clinicians to make consistent decisions and actions when faced with the same patient input data. eActions embrace good everyday decision-making informed by evidence, experience, EHR data, and individual patient status. eActions can reduce unwarranted variation, increase quality of clinical care and research, reduce EHR noise, and could enable a learning healthcare system.
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Affiliation(s)
- Alan H Morris
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine
- Department of Biomedical Informatics
| | - Brian Stagg
- Department of Ophthalmology and Visual Sciences and John Moran Eye Center
| | - Michael Lanspa
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - James Orme
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine
- Department of Biomedical Informatics
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Terry P Clemmer
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine
- Department of Biomedical Informatics
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
- Emeritus
| | - Lindell K Weaver
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine
- Department of Biomedical Informatics
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Frank Thomas
- Department of Value Engineering, University of Utah Hospitals and Clinics, Salt Lake City, Utah, USA
- Emeritus
| | - Colin K Grissom
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine
- Department of Biomedical Informatics
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Ellie Hirshberg
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Thomas D East
- SYNCRONYS, and University of New Mexico Health Sciences Library & Informatics, Albuquerque, New Mexico, USA
| | - Carrie Jane Wallace
- Department of Ophthalmology and Visual Sciences and John Moran Eye Center
- Emeritus
| | - Michael P Young
- Critical Care Division, Renown Medical Center, School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Antonio Pesenti
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Michela Bombino
- Department of Emergency and Intensive Care Medicine, ASST-Monza San Gerardo Hospital, Milan, Italy
| | - Eduardo Beck
- Ospedale di Desio—ASST Monza, UOC Anestesia e Rianimazione, Milan, Italy
| | | | - Charlene Weir
- Department of Biomedical Informatics
- School of Nursing
| | | | - Gordon R Bernard
- Pulmonary, Critical Care, and Allergy Division, Department of Internal Medicine
| | - B Taylor Thompson
- Pulmonary, Critical Care, and Sleep Division , Department of Internal Medicine
| | - Roy Brower
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonathon D Truwit
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jay Steingrub
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - R Duncan Hite
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Douglas F Willson
- Division of Pediatric Critical Care, Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jerry J Zimmerman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Vinay M Nadkarni
- Department of Anesthesia and Critical Care Medicine
- Department of Pediatrics, Perelman School of Medicine
| | | | - Martha A. Q Curley
- Department of Pediatrics, Perelman School of Medicine
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher J. L Newth
- Department of Pediatrics, University of Southern California, Los Angeles, California, USA
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montréal, Canada
| | | | - Kang H Lee
- Asian American Liver Centre, Gleneagles Hospital, Singapore, Singapore
| | - Bennett P deBoisblanc
- Section of Pulmonary/Critical Care & Allergy/Immunology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | | | | | - Anthony Wong
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | - David W Grainger
- Department of Biomedical Engineering and Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah
| | - Willard H Dere
- Department of Biomedical Engineering and Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah
| | - Alan S Crandall
- Department of Ophthalmology and Visual Sciences and John Moran Eye Center
| | - Julio C Facelli
- Department of Biomedical Informatics
- Center for Clinical and Translational Science, School of Medicine
| | | | | | - Ulrike Pielmeier
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stephen E Rees
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Dan S Karbing
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Steen Andreassen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Eddy Fan
- Institute of Health Policy, Management and Evaluation
| | - Roberta M Goldring
- Pulmonary, Critical Care, and Sleep Division, NYU School of Medicine, New York, New York, USA
| | - Kenneth I Berger
- Pulmonary, Critical Care, and Sleep Division, NYU School of Medicine, New York, New York, USA
| | - Beno W Oppenheimer
- Pulmonary, Critical Care, and Sleep Division, NYU School of Medicine, New York, New York, USA
| | - E Wesley Ely
- Pulmonary, Critical Care, and Allergy Division, Department of Internal Medicine
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center
- Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Ognjen Gajic
- Pulmonary , Critical Care, and Sleep Division, Department of Internal Medicine
| | - Brian Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - David A Schoenfeld
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Irena Tocino
- Department of Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Russell S Gonnering
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peter J Pronovost
- Critical Care, Department of Anesthesia, Chief Clinical Transformation Officer, University Hospitals, Highland Hills, Case Western Reserve University, Cleveland, OH, USA
| | - Lucy A Savitz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Didier Dreyfuss
- Assistance Publique – Hôpitaux de Paris, Université de Paris, INSERM unit UMR S_1155 (Common and Rare Kidney Diseases), Sorbonne Université, Paris, France
| | - Arthur S Slutsky
- Keenan Research Center, Li Ka Shing Knowledge Institute / ST. Michaels' Hospital and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - James D Crapo
- Department of Internal Medicine, National Jewish Health, Denver, Colorado, USA
| | - Derek Angus
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brent James
- Clinical Excellence Research Center (CERC), Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Donald Berwick
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
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Wade RC, Simmons JP, Boueiz A, Gregory A, Wan ES, Regan EA, Bhatt SP, Han MK, Bowler RP, Crapo JD, Silverman EK, Washko GR, Dransfield MT, Wells JM. Pulmonary Artery Enlargement is Associated with Exacerbations and Mortality in Ever-Smokers with Preserved Ratio Impaired Spirometry (PRISm). Am J Respir Crit Care Med 2021; 204:481-485. [PMID: 34014810 DOI: 10.1164/rccm.202103-0619le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- R Chad Wade
- The University of Alabama at Birmingham School of Medicine, 9967, Division of Pulmonary, Allergy, and Critical Medicine, Birmingham, Alabama, United States.,UAB Lung Health Center, Birmingham, Alabama, United States.,The University of Alabama at Birmingham School of Medicine, 9967, Department of Medicine, Birmingham, Alabama, United States
| | - J Patrick Simmons
- The University of Alabama at Birmingham School of Medicine, 9967, Division of Pulmonary, Allergy, and Critical Medicine, Birmingham, Alabama, United States.,UAB Lung Health Center, Birmingham, Alabama, United States.,The University of Alabama at Birmingham School of Medicine, 9967, Department of Medicine, Birmingham, Alabama, United States
| | - Adel Boueiz
- Brigham and Women's Hospital Channing Division of Network Medicine, 1869, Boston, Massachusetts, United States.,Brigham and Women's Hospital Department of Medicine, 370908, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Andrew Gregory
- Brigham and Women's Hospital, 1861, Channing Division of Network Medicine, Boston, Massachusetts, United States
| | - Emily S Wan
- Brigham and Women's Hospital, 1861, Channing Division of Network Medicine, Boston, Massachusetts, United States.,VA Boston Health Care System Jamaica Plain Campus, 20025, Boston, Massachusetts, United States
| | - Elizabeth A Regan
- National Jewish Health Department of Medicine, 551774, Division of Rheumatology, Denver, Colorado, United States
| | - Surya P Bhatt
- The University of Alabama at Birmingham School of Medicine, 9967, Pulmonary, Allergy and Critical Care Medicine, Birmingham, Alabama, United States.,UAB Lung Health Center, Birmingham, Alabama, United States.,The University of Alabama at Birmingham School of Medicine, 9967, Department of Medicine, Birmingham, Alabama, United States
| | - MeiLan K Han
- University of Michigan Michigan Medicine, 21614, Division of Pulmonary and Critical Care Medicine, Ann Arbor, Michigan, United States
| | - Russell P Bowler
- National Jewish Health Department of Medicine, 551774, Division of Pulmonary, Critical Care, and Sleep Medicine, Denver, Colorado, United States
| | - James D Crapo
- National Jewish Health Department of Medicine, 551774, Division of Pulmonary, Critical Care, and Sleep Medicine, Denver, Colorado, United States
| | - Edwin K Silverman
- Brigham and Women's Hospital Channing Division of Network Medicine, 1869, Boston, Massachusetts, United States.,Brigham and Women's Hospital Department of Medicine, 370908, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - George R Washko
- Brigham and Women's Hospital Department of Medicine, 370908, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Mark T Dransfield
- The University of Alabama at Birmingham School of Medicine, 9967, Division of Pulmonary, Allergy, and Critical Care Medicine, Birmingham, Alabama, United States.,UAB Lung Health Center, Birmingham, Alabama, United States.,The University of Alabama at Birmingham School of Medicine, 9967, Birmingham, Alabama, United States.,Birmingham VA Medical Center, 19957, Acute Care Service, Birmingham, Alabama, United States
| | - J Michael Wells
- The University of Alabama at Birmingham School of Medicine, 9967, Pulmonary, Allergy, and Critical Care Medicine, Birmingham, Alabama, United States.,UAB Lung Health Center, Birmingham, Alabama, United States.,The University of Alabama at Birmingham School of Medicine, 9967, Department of Medicine, Birmingham, Alabama, United States.,Birmingham VA Medical Center, 19957, Acute Care Service, Birmingham, Alabama, United States;
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33
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Pompe E, Moore CM, Mohamed Hoesein FA, de Jong PA, Charbonnier JP, Han MK, Humphries SM, Hatt CR, Galbán CJ, Silverman EK, Crapo JD, Washko GR, Regan EA, Make B, Strand M, Lammers JWJ, van Rikxoort EM, Lynch DA. Progression of Emphysema and Small Airways Disease in Cigarette Smokers. Chronic Obstr Pulm Dis 2021; 8:198-212. [PMID: 33290645 PMCID: PMC8237975 DOI: 10.15326/jcopdf.2020.0140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about factors associated with emphysema progression in cigarette smokers. We evaluated factors associated with change in emphysema and forced expiratory volume in 1 second (FEV1) in participants with and without chronic obstructive pulmonary disease (COPD). METHODS This retrospective study included individuals participating in the COPD Genetic Epidemiology study who completed the 5-year follow-up, including inspiratory and expiratory computed tomography (CT) and spirometry. All paired CT scans were analyzed using micro-mapping, which classifies individual voxels as emphysema or functional small airway disease (fSAD). Presence and progression of emphysema and FEV1 were determined based on comparison to nonsmoker values. Logistic regression analyses were used to identify clinical parameters associated with disease progression. RESULTS A total of 3088 participants were included with a mean ± SD age of 60.7±8.9 years, including 72 nonsmokers. In all Global initiative for chronic Obstructive Lung Disease (GOLD) stages, the presence of emphysema at baseline was associated with emphysema progression (odds ratio [OR]: GOLD 0: 4.32; preserved ratio-impaired spirometry [PRISm]; 5.73; GOLD 1: 5.16; GOLD 2: 5.69; GOLD 3/4: 5.55; all p ≤0.01). If there was no emphysema at baseline, the amount of fSAD at baseline was associated with emphysema progression (OR for 1% increase: GOLD 0: 1.06; PRISm: 1.20; GOLD 1: 1.7; GOLD 3/4: 1.08; all p ≤ 0.03).In 1735 participants without spirometric COPD, progression in emphysema occurred in 105 (6.1%) participants and only 21 (1.2%) had progression in both emphysema and FEV1. CONCLUSIONS The presence of emphysema is an important predictor of emphysema progression. In patients without emphysema, fSAD is associated with the development of emphysema. In participants without spirometric COPD, emphysema progression occurred independently of FEV1 decline.
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Affiliation(s)
- Esther Pompe
- Imaging Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Camille M. Moore
- Division of Biostatistics, Environment and Health, National Jewish Health, Denver, Colorado, United States
| | | | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jean-Paul Charbonnier
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Steven M. Humphries
- Department of Radiology, National Jewish Health, Denver, Colorado, United States
| | | | - Craig J. Galbán
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States
- Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan, United States
| | - Ed K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - James D. Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - George R. Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Elisabeth A. Regan
- Division of Rheumatology, Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Barry Make
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Matthew Strand
- Division of Biostatistics, Environment and Health, National Jewish Health, Denver, Colorado, United States
| | | | - Eva M. van Rikxoort
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, United States
| | - on behalf of the COPDGene® investigators
- Imaging Department, University Medical Center Utrecht, Utrecht, the Netherlands
- Division of Biostatistics, Environment and Health, National Jewish Health, Denver, Colorado, United States
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Michigan, United States
- Department of Radiology, National Jewish Health, Denver, Colorado, United States
- Imbio LLC, Minneapolis, Minnesota, United States
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States
- Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan, United States
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
- Division of Rheumatology, Department of Medicine, National Jewish Health, Denver, Colorado, United States
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Lindsay HG, Wamboldt FS, Holm KE, Make BJ, Hokanson J, Crapo JD, Regan EA. Impact of a Medical Diagnosis on Decision to Stop Smoking and Successful Smoking Cessation. Chronic Obstr Pulm Dis 2021; 8:360-370. [PMID: 34010545 DOI: 10.15326/jcopdf.2020.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Smoking cessation counseling is a central part of the Medicare guidelines for lung cancer screening. With increasing age, many heavy smokers eventually stop smoking, however, factors influencing the decision to stop smoking are poorly understood. We postulated that declining health or physician-diagnosis of a medical condition may be associated with successful smoking cessation. Methods A total of 4448 current and former smokers in Phase 2 of the COPD Genetic Epidemiology (COPDGene®) study answered a question about reasons for stopping smoking. Participants were classified as successful quitters (n=3345), and unsuccessful quitters (n=1003). Reasons cited for quitting were grouped as: medical diagnoses, social factors, symptoms. Logistic modeling of factors associated with successful quitting were adjusted for age, gender, race, and education. Results The most common factors cited for a quit attempt by all respondents were medical diagnoses (48%), followed by social factors (47%), and respiratory symptoms (36%). Successful quitters were more likely to be older, male, and non-Hispanic White. An adjusted model found increased age, White race, education beyond high school, and male sex favored successful quitting while the cited medical diagnoses, social factors, and "other" reasons were associated with unsuccessful quitting. Fagerstrom Nicotine Dependence scores were ³ 5 in 54% of the unsuccessful group compared to 45% for successful quitters(p<0.0001) suggesting some increased nicotine dependence in the unsuccessful quitters. Conclusions Medical diagnosis was the most common factor cited for considering a quit attempt by both successful and unsuccessful quitters; however, successful quitting was influenced by demographic factors and potentially the severity of nicotine dependence.
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Affiliation(s)
| | - Frederick S Wamboldt
- National Jewish Health, Denver Colorado, United States.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
| | - Kristen E Holm
- National Jewish Health, Denver Colorado, United States.,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora Colorado, United States
| | - Barry J Make
- National Jewish Health, Denver Colorado, United States
| | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
| | - James D Crapo
- National Jewish Health, Denver Colorado, United States
| | - Elizabeth A Regan
- National Jewish Health, Denver Colorado, United States.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
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Strand M, Austin E, Moll M, Pratte KA, Regan EA, Hayden LP, Bhatt SP, Boriek AM, Casaburi R, Silverman EK, Fortis S, Ruczinski I, Koegler H, Rossiter HB, Occhipinti M, Hanania NA, Gebrekristos HT, Lynch DA, Kunisaki KM, Young KA, Sieren JC, Ragland M, Hokanson JE, Lutz SM, Make BJ, Kinney GL, Cho MH, Pistolesi M, DeMeo DL, Sciurba FC, Comellas AP, Diaz AA, Barjaktarevic I, Bowler RP, Kanner RE, Peters SP, Ortega VE, Dransfield MT, Crapo JD. A Risk Prediction Model for Mortality Among Smokers in the COPDGene® Study. Chronic Obstr Pulm Dis 2020; 7:346-361. [PMID: 32877963 PMCID: PMC7883903 DOI: 10.15326/jcopdf.7.4.2020.0146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Risk factor identification is a proven strategy in advancing treatments and preventive therapy for many chronic conditions. Quantifying the impact of those risk factors on health outcomes can consolidate and focus efforts on individuals with specific high-risk profiles. Using multiple risk factors and longitudinal outcomes in 2 independent cohorts, we developed and validated a risk score model to predict mortality in current and former cigarette smokers. METHODS We obtained extensive data on current and former smokers from the COPD Genetic Epidemiology (COPDGene®) study at enrollment. Based on physician input and model goodness-of-fit measures, a subset of variables was selected to fit final Weibull survival models separately for men and women. Coefficients and predictors were translated into a point system, allowing for easy computation of mortality risk scores and probabilities. We then used the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) cohort for external validation of our model. RESULTS Of 9867 COPDGene participants with standard baseline data, 17.6% died over 10 years of follow-up, and 9074 of these participants had the full set of baseline predictors (standard plus 6-minute walk distance and computed tomography variables) available for full model fits. The average age of participants in the cohort was 60 for both men and women, and the average predicted 10-year mortality risk was 18% for women and 25% for men. Model time-integrated area under the receiver operating characteristic curve statistics demonstrated good predictive model accuracy (0.797 average), validated in the external cohort (0.756 average). Risk of mortality was impacted most by 6-minute walk distance, forced expiratory volume in 1 second and age, for both men and women. CONCLUSIONS Current and former smokers exhibited a wide range of mortality risk over a 10- year period. Our models can identify higher risk individuals who can be targeted for interventions to reduce risk of mortality, for participants with or without chronic obstructive pulmonary disease (COPD) using current Global initiative for obstructive Lung Disease (GOLD) criteria.
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Affiliation(s)
| | | | - Matthew Moll
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | | | | | | | - Richard Casaburi
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | | | | | - Ingo Ruczinski
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Harry B. Rossiter
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- University of Leeds, Leeds, United Kingdom
| | - Mariaelena Occhipinti
- University of Florence, Florence, Italy
- *Dr. Occhipinti is now at the Imaging Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | | | | | - Ken M. Kunisaki
- Minneapolis Veterans Administration Health Care System, Minnesota
| | | | | | | | | | - Sharon M. Lutz
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | | | | | - Dawn L. DeMeo
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | | | - Igor Barjaktarevic
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles
| | | | | | - Stephen P. Peters
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Victor E. Ortega
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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36
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Oh AS, Strand M, Pratte K, Regan EA, Humphries S, Crapo JD, Lynch DA. Visual Emphysema at Chest CT in GOLD Stage 0 Cigarette Smokers Predicts Disease Progression: Results from the COPDGene Study. Radiology 2020; 296:641-649. [PMID: 32633676 DOI: 10.1148/radiol.2020192429] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The clinical significance of visually evident emphysema on CT images in individuals without spirometric evidence of chronic obstructive pulmonary disease (COPD) by current diagnostic criteria is, to the knowledge of the authors, unknown. Purpose To evaluate whether participants with visually evident emphysema at CT were more likely to have progressive disease and increased mortality at 5 years compared with those without visual emphysema. Materials and Methods This secondary analysis of the prospective Genetic Epidemiology of COPD study evaluated current or former smokers enrolled between 2008 and 2011 who did not meet current criteria for COPD (defined as Global Initiative for Obstructive Lung Disease stage 0). Statistical analysis was performed by using linear mixed models to estimate mean physiologic, imaging, and clinical outcomes for those with and without visual emphysema. Hazard ratios for mortality were calculated by using Cox regression models with emphysema as the main predictor. Results Of the 4095 participants, 48.3% (1979 participants; 1096 men and 883 women; mean age, 57 years ± 8 [standard deviation]) had trace or greater visual emphysema at CT and 51.7% (2116 participants; 1068 men and 1048 women; mean age, 56 years ± 8) had no emphysema at CT. At 5 years, participants with visual emphysema at CT demonstrated progressive airflow obstruction with lower values of ratio of forced expiratory volume in 1 second (FEV1)-to-functional vital capacity (FVC) ratio (-1.7 vs -0.7) and greater progression in quantitative emphysema measured by 15th percentile lung density (-3.3 vs -0.3 HU), adjusted lung density (-3.1 vs -0.2 g/L), and percentage of lung voxels with CT attenuation less than -950 HU (0.17 vs -0.20) than participants without emphysema (P < .001 for each). The rate of quantitative emphysema progression increased with greater grades of emphysema severity within the emphysema group. Conclusion The presence of visual emphysema at CT in current and former Global Initiative for Obstructive Lung Disease stage 0 smokers predicted structural and physiologic disease progression. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Grenier in this issue.
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Affiliation(s)
- Andrea S Oh
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Matthew Strand
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Katherine Pratte
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Elizabeth A Regan
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - Stephen Humphries
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - James D Crapo
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | - David A Lynch
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
| | -
- From the Department of Radiology (A.S.O., S.H., D.A.L.), Department of Biostatistics (M.S., K.P.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Room A367, Denver, CO 80206
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Moll M, Sakornsakolpat P, Shrine N, Hobbs BD, DeMeo DL, John C, Guyatt AL, McGeachie MJ, Gharib SA, Obeidat M, Lahousse L, Wijnant SRA, Brusselle G, Meyers DA, Bleecker ER, Li X, Tal-Singer R, Manichaikul A, Rich SS, Won S, Kim WJ, Do AR, Washko GR, Barr RG, Psaty BM, Bartz TM, Hansel NN, Barnes K, Hokanson JE, Crapo JD, Lynch D, Bakke P, Gulsvik A, Hall IP, Wain L, Weiss ST, Silverman EK, Dudbridge F, Tobin MD, Cho MH. Chronic obstructive pulmonary disease and related phenotypes: polygenic risk scores in population-based and case-control cohorts. Lancet Respir Med 2020; 8:696-708. [PMID: 32649918 PMCID: PMC7429152 DOI: 10.1016/s2213-2600(20)30101-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/24/2020] [Accepted: 02/17/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Genetic factors influence chronic obstructive pulmonary disease (COPD) risk, but the individual variants that have been identified have small effects. We hypothesised that a polygenic risk score using additional variants would predict COPD and associated phenotypes. METHODS We constructed a polygenic risk score using a genome-wide association study of lung function (FEV1 and FEV1/forced vital capacity [FVC]) from the UK Biobank and SpiroMeta. We tested this polygenic risk score in nine cohorts of multiple ethnicities for an association with moderate-to-severe COPD (defined as FEV1/FVC <0·7 and FEV1 <80% of predicted). Associations were tested using logistic regression models, adjusting for age, sex, height, smoking pack-years, and principal components of genetic ancestry. We assessed predictive performance of models by area under the curve. In a subset of studies, we also studied quantitative and qualitative CT imaging phenotypes that reflect parenchymal and airway pathology, and patterns of reduced lung growth. FINDINGS The polygenic risk score was associated with COPD in European (odds ratio [OR] per SD 1·81 [95% CI 1·74-1·88] and non-European (1·42 [1·34-1·51]) populations. Compared with the first decile, the tenth decile of the polygenic risk score was associated with COPD, with an OR of 7·99 (6·56-9·72) in European ancestry and 4·83 (3·45-6·77) in non-European ancestry cohorts. The polygenic risk score was superior to previously described genetic risk scores and, when combined with clinical risk factors (ie, age, sex, and smoking pack-years), showed improved prediction for COPD compared with a model comprising clinical risk factors alone (AUC 0·80 [0·79-0·81] vs 0·76 [0·75-0·76]). The polygenic risk score was associated with CT imaging phenotypes, including wall area percent, quantitative and qualitative measures of emphysema, local histogram emphysema patterns, and destructive emphysema subtypes. The polygenic risk score was associated with a reduced lung growth pattern. INTERPRETATION A risk score comprised of genetic variants can identify a small subset of individuals at markedly increased risk for moderate-to-severe COPD, emphysema subtypes associated with cigarette smoking, and patterns of reduced lung growth. FUNDING US National Institutes of Health, Wellcome Trust.
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Affiliation(s)
- Matthew Moll
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Phuwanat Sakornsakolpat
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nick Shrine
- Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Brian D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Catherine John
- Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anna L Guyatt
- Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Michael J McGeachie
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sina A Gharib
- Computational Medicine Core, Center for Lung Biology, Department of Medicine, University of Washington, Seattle, WA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ma'en Obeidat
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA; University of British Columbia Center for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Lies Lahousse
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, Netherlands; Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Sara R A Wijnant
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, Netherlands; Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Guy Brusselle
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, Netherlands; Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, Netherlands; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | | | | | - Xingnan Li
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Ruth Tal-Singer
- GlaxoSmithKline Research and Development, Collegeville, PA, USA
| | - Ani Manichaikul
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Sungho Won
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea; Interdisciplinary Program of Bioinformatics, College of National Sciences, Seoul National University, Seoul, South Korea; Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Woo Jin Kim
- Department of Internal Medicine, Kangwon National University, Chuncheon, South Korea
| | - Ah Ra Do
- Interdisciplinary Program of Bioinformatics, College of National Sciences, Seoul National University, Seoul, South Korea
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - R Graham Barr
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Traci M Bartz
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Nadia N Hansel
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kathleen Barnes
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - James D Crapo
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - David Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Per Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Division of Respiratory Medicine, Queen's Medical Centre, Nottingham, UK
| | - Ian P Hall
- National Institute for Health Research Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Louise Wain
- Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, UK; National Institute for Health Research Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Frank Dudbridge
- Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Martin D Tobin
- Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, UK; National Institute for Health Research Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Occhipinti M, Paoletti M, Crapo JD, Make BJ, Lynch DA, Brusasco V, Lavorini F, Silverman EK, Regan EA, Pistolesi M. Validation of a method to assess emphysema severity by spirometry in the COPDGene study. Respir Res 2020; 21:103. [PMID: 32357885 PMCID: PMC7195744 DOI: 10.1186/s12931-020-01366-4] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Standard spirometry cannot identify the predominant mechanism underlying airflow obstruction in COPD, namely emphysema or airway disease. We aimed at validating a previously developed methodology to detect emphysema by mathematical analysis of the maximal expiratory flow-volume (MEFV) curve in standard spirometry. Methods From the COPDGene population we selected those 5930 subjects with MEFV curve and inspiratory-expiratory CT obtained on the same day. The MEFV curve descending limb was fit real-time using forced vital capacity (FVC), peak expiratory flow, and forced expiratory flows at 25, 50 and 75% of FVC to derive an emphysema severity index (ESI), expressed as a continuous positive numeric parameter ranging from 0 to 10. According to inspiratory CT percent lung attenuation area below − 950 HU we defined three emphysema severity subgroups (%LAA-950insp < 6, 6–14, ≥14). By co-registration of inspiratory-expiratory CT we quantified persistent (%pLDA) and functional (%fLDA) low-density areas as CT metrics of emphysema and airway disease, respectively. Results ESI differentiated CT emphysema severity subgroups increasing in parallel with GOLD stages (p < .001), but with high variability within each stage. ESI had significantly higher correlations (p < .001) with emphysema than with airway disease CT metrics, explaining 67% of %pLDA variability. Conversely, standard spirometric variables (FEV1, FEV1/FVC) had significantly lower correlations than ESI with emphysema CT metrics and did not differentiate between emphysema and airways CT metrics. Conclusions ESI adds to standard spirometry the power to discriminate whether emphysema is the predominant mechanism of airway obstruction. ESI methodology has been validated in the large multiethnic population of smokers of the COPDGene study and therefore it could be applied for clinical and research purposes in the general population of smokers, using a readily available online website.
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Affiliation(s)
- Mariaelena Occhipinti
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Largo A. Brambilla 3, 50134, Florence, Italy. .,Section of Radiology, Department of Biomedical, Experimental, and Clinical Sciences, University of Florence, Largo A. Brambilla 3, 50134, Florence, Italy.
| | - Matteo Paoletti
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Largo A. Brambilla 3, 50134, Florence, Italy
| | - James D Crapo
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Barry J Make
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Vito Brusasco
- Department of Experimental Medicine, University of Genoa, Via Leon Battista Alberti 2, 16132, Genoa, Italy
| | - Federico Lavorini
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Largo A. Brambilla 3, 50134, Florence, Italy
| | - Edwin K Silverman
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Channing Division of Network Medicine, 75 Francis St, Boston, MA 02115, USA
| | - Elizabeth A Regan
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Massimo Pistolesi
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Largo A. Brambilla 3, 50134, Florence, Italy
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Hoth KF, Moreau KL, Weinberger HD, Holm KE, Meschede K, Crapo JD, Make BJ, Moser DJ, Kozora E, Bowler RP, Pierce GL, Ten Eyck P, Wamboldt FS. Carotid Artery Stiffness is Associated With Cognitive Performance in Former Smokers With and Without Chronic Obstructive Pulmonary Disease. J Am Heart Assoc 2020; 9:e014862. [PMID: 32338117 PMCID: PMC7428572 DOI: 10.1161/jaha.119.014862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Heavy smokers perform worse on neuropsychological assessment than age‐matched peers. However, traditional pulmonary measures of airflow limitation and hypoxemia explain only a modest amount of variance in cognition. The current objective was to determine whether carotid artery stiffness is associated with cognition in former smokers beyond the effects of amount of smoking and pulmonary function. Methods and Results Eighty‐four former smokers including individuals across a spectrum of airflow limitation severity were included: 30 without chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease [GOLD] 0 with normal spirometry and lung computed tomography), 31 with mild‐moderate chronic obstructive pulmonary disease (GOLD 1–2), and 23 with severe‐very severe chronic obstructive pulmonary disease (GOLD 3–4). Participants completed questionnaires, spirometry, carotid ultrasonography, and neuropsychological testing. Multiple linear regression was used to determine whether carotid artery stiffness is associated with neuropsychological performance in 4 cognitive domains after adjusting for age, sex, pack‐years of smoking, estimated premorbid intellectual functioning, and airflow limitation. Higher carotid artery β‐stiffness index was associated with reduced executive functioning‐processing speed in the fully adjusted model (β=−0.49, SE=0.14; P=0.001). Lower premorbid intellectual function, male sex, and presence of airflow limitation (GOLD 1 or 2 and GOLD 3 or 4) were also associated with worse executive functioning‐processing speed. β‐Stiffness index was not significantly associated with performance in other cognitive domains. Conclusions Carotid artery stiffness is associated with worse performance on executive functioning‐processing speed in former smokers beyond the effects of aging, amount of past smoking, severity of airflow limitation, and hypoxemia. Future research should examine whether carotid stiffness can be used to identify former smokers at risk for subsequent cognitive impairment.
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Affiliation(s)
- Karin F Hoth
- Psychiatry University of Iowa Iowa City IA.,Iowa Neuroscience Institute University of Iowa Iowa City IA.,Medicine National Jewish Health Denver CO
| | - Kerrie L Moreau
- Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Howard D Weinberger
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Kristen E Holm
- Medicine National Jewish Health Denver CO.,Community and Behavioral Health University of Colorado School of Public Health Aurora CO
| | | | - James D Crapo
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Barry J Make
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | | | - Elizabeth Kozora
- Medicine National Jewish Health Denver CO.,Psychiatry University of Colorado Anschutz Medical Campus Aurora CO
| | - Russell P Bowler
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Gary L Pierce
- Health and Human Physiology University of Iowa Iowa City IA.,Abboud Cardiovascular Research Center University of Iowa Iowa City IA.,Environmental Health Sciences Research Center University of Iowa Iowa City IA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science University of Iowa Iowa City IA
| | - Frederick S Wamboldt
- Medicine National Jewish Health Denver CO.,Psychiatry University of Colorado Anschutz Medical Campus Aurora CO
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Regan EA, Vaidya A, Margulies PL, Make BJ, Lowe KE, Crapo JD. Primary adrenal insufficiency in the United States: diagnostic error and patient satisfaction with treatment. ACTA ACUST UNITED AC 2020; 6:343-350. [PMID: 31256064 DOI: 10.1515/dx-2019-0013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/07/2019] [Indexed: 01/31/2023]
Abstract
Background The objective of the study was to assess the diagnostic process, access to care and treatment adequacy for primary adrenal insufficiency (PAI) patients from a US-based online registry. Methods The National Adrenal Diseases Foundation (NADF) patient registry from 2015 to 2016 was used for a cross-sectional assessment of PAI patients. Five hundred and forty-one adults met the study inclusion criteria (US residents, age >20, self-reported physician diagnosis of PAI and replacement dosing for cortisol). Issues in diagnosis, comorbid conditions, symptoms, with demographic and socioeconomic characteristics were determined. Disease management assessment included medication dose, patient satisfaction with function, and education. Factors associated with adrenal crisis were noted. Results The cohort was predominantly female (83%), non-Hispanic White (97%), and well-educated (94% > high school education). A majority (57%) of patients reported difficulty with initial diagnosis, while 27% felt that their current steroid replacement was not adequate. Comorbid thyroid disease and other autoimmune conditions were common among PAI patients in the registry. More than three-quarters (78%) of patients used hydrocortisone for glucocorticoid replacement with a mean dose of 24.4 (standard deviation [SD]: 8.7) mg. Mean dose of hydrocortisone has declined over time following current treatment recommendations. Conclusions Timely, accurate diagnosis remains a problem for patients with primary adrenal insufficiency in an affluent, well-educated US cohort. Episodes of adrenal crisis are common and replacement steroid treatment is not always effective for patient function. Comprehensive information about outcomes of care for PAI in the US remains limited and the establishment of a research-specific registry to foster future research may be desirable. Patient registry data is a valuable source of information on diagnostic error and outcomes of care in rare diseases.
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Affiliation(s)
- Elizabeth A Regan
- Department of Medicine, National Jewish Health, Denver, CO, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Anand Vaidya
- Center for Adrenal Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul L Margulies
- Department of Medicine, Endocrinology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Katherine E Lowe
- Department of Medicine, National Jewish Health, Denver, CO, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, CO, USA
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Regan EA, Hersh CP, Castaldi PJ, DeMeo DL, Silverman EK, Crapo JD, Bowler RP. Omics and the Search for Blood Biomarkers in Chronic Obstructive Pulmonary Disease. Insights from COPDGene. Am J Respir Cell Mol Biol 2020; 61:143-149. [PMID: 30874442 DOI: 10.1165/rcmb.2018-0245ps] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
There is an unmet need for blood biomarkers in diagnosis and prognosis of chronic obstructive pulmonary disease (COPD). The search for these biomarkers has been revolutionized by high-throughput sequencing techniques and multiplex platforms that can measure thousands of gene transcripts, proteins, or metabolites. We review COPDGene (Genetic Epidemiology of COPD) project publications that include DNA methylation, transcriptomic, proteomic, and metabolomic blood biomarkers and discuss their impact on COPD. Key contributions from COPDGene include identification of DNA methylation effects from smoking and genetic variation, new transcriptomic signatures in the blood, identification of protein biomarkers associated with severity and progression (e.g., sRAGE [soluble receptor for advanced glycosylation end products], inflammatory cytokines IL-6 and IL-8), and identification of small molecules (ceramides and sphingomyelin) that may be pathogenic. COPDGene studies have revealed that some of the COPD genome-wide association study polymorphisms are strongly associated with blood biomarkers (e.g., rs2070600 in AGER is a pQTL [protein quantitative trait locus] for sRAGE), underscoring the importance of combining omics results. Investigators have developed molecular networks identifying lower CD4+ resting memory cells associated with COPD. Genes, proteins, and metabolite networks are particularly important because the explanatory value of any single molecule is small (1-10%) compared with panels of multiple markers. COPDGene has been a useful resource in the identification and validation of multiple biomarkers for COPD. These biomarkers, either combined in multiple biomarker panels or integrated with other omics data types, may lead to novel diagnostic and prognostic tests for COPD phenotypes and may be relevant for assessing novel therapies.
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Affiliation(s)
- Elizabeth A Regan
- 1Department of Medicine, National Jewish Health, Denver, Colorado; and
| | - Craig P Hersh
- 2Channing Division of Network Medicine and.,3Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter J Castaldi
- 2Channing Division of Network Medicine and.,3Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dawn L DeMeo
- 2Channing Division of Network Medicine and.,3Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edwin K Silverman
- 2Channing Division of Network Medicine and.,3Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - James D Crapo
- 1Department of Medicine, National Jewish Health, Denver, Colorado; and
| | - Russell P Bowler
- 1Department of Medicine, National Jewish Health, Denver, Colorado; and
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Lutz SM, Frederiksen B, Begum F, McDonald MLN, Cho MH, Hobbs BD, Parker MM, DeMeo DL, Hersh CP, Ehringer MA, Young K, Jiang L, Foreman MG, Kinney GL, Make BJ, Lomas DA, Bakke P, Gulsvik A, Crapo JD, Silverman EK, Beaty TH, Hokanson JE. Common and Rare Variants Genetic Association Analysis of Cigarettes per Day Among Ever-Smokers in Chronic Obstructive Pulmonary Disease Cases and Controls. Nicotine Tob Res 2020; 21:714-722. [PMID: 29767774 DOI: 10.1093/ntr/nty095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 05/09/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cigarette smoking is a major environmental risk factor for many diseases, including chronic obstructive pulmonary disease (COPD). There are shared genetic influences on cigarette smoking and COPD. Genetic risk factors for cigarette smoking in cohorts enriched for COPD are largely unknown. METHODS We performed genome-wide association analyses for average cigarettes per day (CPD) across the Genetic Epidemiology of COPD (COPDGene) non-Hispanic white (NHW) (n = 6659) and African American (AA) (n = 3260), GenKOLS (the Genetics of Chronic Obstructive Lung Disease) (n = 1671), and ECLIPSE (the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) (n = 1942) cohorts. In addition, we performed exome array association analyses across the COPDGene NHW and AA cohorts. We considered analyses across the entire cohort and stratified by COPD case-control status. RESULTS We identified genome-wide significant associations for CPD on chromosome 15q25 across all cohorts (lowest p = 1.78 × 10-15), except in the COPDGene AA cohort alone. Previously reported associations on chromosome 19 had suggestive and directionally consistent associations (RAB4, p = 1.95 × 10-6; CYP2A7, p = 7.50 × 10-5; CYP2B6, p = 4.04 × 10-4). When we stratified by COPD case-control status, single nucleotide polymorphisms on chromosome 15q25 were nominally associated with both NHW COPD cases (β = 0.11, p = 5.58 × 10-4) and controls (β = 0.12, p = 3.86 × 10-5) For the gene-based exome array association analysis of rare variants, there were no exome-wide significant associations. For these previously replicated associations, the most significant results were among COPDGene NHW subjects for CYP2A7 (p = 5.2 × 10-4). CONCLUSIONS In a large genome-wide association study of both common variants and a gene-based association of rare coding variants in ever-smokers, we found genome-wide significant associations on chromosome 15q25 with CPD for common variants, but not for rare coding variants. These results were directionally consistent among COPD cases and controls. IMPLICATIONS We examined both common and rare coding variants associated with CPD in a large population of heavy smokers with and without COPD of NHW and AA descent. We replicated genome-wide significant associations on chromosome 15q25 with CPD for common variants among NHW subjects, but not for rare variants. We demonstrated for the first time that common variants on chromosome 15q25 associated with CPD are similar among COPD cases and controls. Previously reported associations on chromosome 19 showed suggestive and directionally consistent associations among common variants (RAB4, CYP2A7, and CYP2B6) and for rare variants (CYP2A7) among COPDGene NHW subjects. Although the genetic effect sizes for these single nucleotide polymorphisms on chromosome 15q25 are modest, we show that this creates a substantial smoking burden over the lifetime of a smoker.
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Affiliation(s)
- Sharon M Lutz
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Brittni Frederiksen
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ferdouse Begum
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Merry-Lynn N McDonald
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brian D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Margaret M Parker
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marissa A Ehringer
- Institute for Behavioral Genetics, University of Colorado at Boulder, Boulder, CO
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lai Jiang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Greg L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - David A Lomas
- UCL Respiratory, University College London, London, UK
| | - Per Bakke
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - James D Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
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Lowe KE, Hokanson JE, Make BJ, Pratte KA, Regan EA, Silverman EK, Young KA, Kinney GL, Crapo JD. Letter to the Editor: Response by Authors. Chronic Obstr Pulm Dis 2020; 7:82-85. [PMID: 32324979 PMCID: PMC7454025 DOI: 10.15326/jcopdf.7.2.2020.0152] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Katherine E. Lowe
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve School of Medicine, Cleveland, Ohio
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Affiliation(s)
| | - James D. Crapo
- Editor in Chief, Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, COPD Foundation, Washington, DC
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
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45
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Ragland MF, Benway CJ, Lutz SM, Bowler RP, Hecker J, Hokanson JE, Crapo JD, Castaldi PJ, DeMeo DL, Hersh CP, Hobbs BD, Lange C, Beaty TH, Cho MH, Silverman EK. Genetic Advances in Chronic Obstructive Pulmonary Disease. Insights from COPDGene. Am J Respir Crit Care Med 2020; 200:677-690. [PMID: 30908940 DOI: 10.1164/rccm.201808-1455so] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common and progressive disease that is influenced by both genetic and environmental factors. For many years, knowledge of the genetic basis of COPD was limited to Mendelian syndromes, such as alpha-1 antitrypsin deficiency and cutis laxa, caused by rare genetic variants. Over the past decade, the proliferation of genome-wide association studies, the accessibility of whole-genome sequencing, and the development of novel methods for analyzing genetic variation data have led to a substantial increase in the understanding of genetic variants that play a role in COPD susceptibility and COPD-related phenotypes. COPDGene (Genetic Epidemiology of COPD), a multicenter, longitudinal study of over 10,000 current and former cigarette smokers, has been pivotal to these breakthroughs in understanding the genetic basis of COPD. To date, over 20 genetic loci have been convincingly associated with COPD affection status, with additional loci demonstrating association with COPD-related phenotypes such as emphysema, chronic bronchitis, and hypoxemia. In this review, we discuss the contributions of the COPDGene study to the discovery of these genetic associations as well as the ongoing genetic investigations of COPD subtypes, protein biomarkers, and post-genome-wide association study analysis.
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Affiliation(s)
- Margaret F Ragland
- Division of Pulmonary Sciences and Critical Care Medicine, School of Medicine, and
| | | | | | | | - Julian Hecker
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
| | | | | | - Dawn L DeMeo
- Channing Division of Network Medicine and.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Craig P Hersh
- Channing Division of Network Medicine and.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian D Hobbs
- Channing Division of Network Medicine and.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christoph Lange
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and
| | - Terri H Beaty
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael H Cho
- Channing Division of Network Medicine and.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edwin K Silverman
- Channing Division of Network Medicine and.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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LaFon DC, Bhatt SP, Labaki WW, Rahaghi FN, Moll M, Bowler RP, Regan EA, Make BJ, Crapo JD, San Jose Estepar R, Diaz AA, Silverman EK, Han MK, Hobbs B, Cho MH, Washko GR, Dransfield MT, Wells JM. Pulmonary artery enlargement and mortality risk in moderate to severe COPD: results from COPDGene. Eur Respir J 2020; 55:13993003.01812-2019. [PMID: 31772001 DOI: 10.1183/13993003.01812-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/23/2019] [Indexed: 11/05/2022]
Affiliation(s)
- David C LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA .,UAB Lung Health Center, Birmingham, AL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,UAB Lung Imaging Core, Birmingham, AL, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Moll
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russ P Bowler
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Elizabeth A Regan
- Division of Rheumatology, Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Barry J Make
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - James D Crapo
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Raul San Jose Estepar
- Applied Chest Imaging Laboratory, Dept of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edwin K Silverman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian Hobbs
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
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Pompe E, Strand M, van Rikxoort EM, Hoffman EA, Barr RG, Charbonnier JP, Humphries S, Han MK, Hokanson JE, Make BJ, Regan EA, Silverman EK, Crapo JD, Lynch DA. Five-year Progression of Emphysema and Air Trapping at CT in Smokers with and Those without Chronic Obstructive Pulmonary Disease: Results from the COPDGene Study. Radiology 2020; 295:218-226. [PMID: 32013794 DOI: 10.1148/radiol.2020191429] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background CT is used to quantify abnormal changes in the lung parenchyma of smokers that might overlap chronic obstructive pulmonary disease (COPD), but studies on the progression of expiratory air trapping in smokers are scarce. Purpose To evaluate the relationship between longitudinal changes in forced expiratory volume in 1 second (FEV1) and CT-quantified emphysema and air trapping in smokers. Materials and Methods Cigarette smokers with and those without COPD participating in the multicenter observational COPDGene study were evaluated. Subjects underwent inspiratory and expiratory chest CT and spirometry at baseline and 5-year follow-up. Emphysema was quantified by using adjusted lung density (ALD). Air trapping was quantified by using mean lung density at expiratory CT and CT-measured functional residual capacity-to-total lung volume ratio. Linear models were used to regress quantitative CT measurements taken 5 years apart, and models were fit with and without adding FEV1 as a predictor. Analyses were stratified by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage (GOLD 0, no COPD; GOLD 1, mild COPD; GOLD 2, moderate COPD; GOLD 3, severe COPD; GOLD 4, very severe COPD). Subjects with preserved FEV1-to-forced vital capacity ratio and reduced FEV1 percentage predicted were categorized as having preserved ratio impaired spirometry (PRISm). Results A total of 4211 subjects (503 with PRISm; 2034 with GOLD 0, 388 with GOLD 1, 816 with GOLD 2, 381 with GOLD 3, 89 with GOLD 4) were evaluated. ALD decreased by 1.7 g/L (95% confidence interval [CI]: -2.5, -0.9) in subjects with GOLD 0 at baseline and by 5.3 g/L (95% CI: -6.2, -4.4) in those with GOLD 1-4 (P < .001 for both). When adjusted for changes in FEV1, corresponding numbers were -2.2 (95% CI: -3.0, -1.3) and -4.6 g/L (95% CI: -5.6, -3.4) (P < .001 for both). Progression in air trapping was identified only in GOLD stage 2-4. Approximately 33%-50% of changes in air trapping in GOLD stages 2-4 were accounted for by changes in FEV1. Conclusion CT measures of emphysema and air trapping increased over 5 years in smokers. Forced expiratory volume in one second accounted for less than 10% of emphysema progression and less than 50% of air trapping progression detected at CT. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Esther Pompe
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Matthew Strand
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Eva M van Rikxoort
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Eric A Hoffman
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - R Graham Barr
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Jean Paul Charbonnier
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Stephen Humphries
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - MeiLan K Han
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - John E Hokanson
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Barry J Make
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Elizabeth A Regan
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - Edwin K Silverman
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - James D Crapo
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
| | - David A Lynch
- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
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- From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass
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Humphries SM, Notary AM, Centeno JP, Strand MJ, Crapo JD, Silverman EK, Lynch DA. Deep Learning Enables Automatic Classification of Emphysema Pattern at CT. Radiology 2020; 294:434-444. [PMID: 31793851 PMCID: PMC6996603 DOI: 10.1148/radiol.2019191022] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022]
Abstract
BackgroundPattern of emphysema at chest CT, scored visually by using the Fleischner Society system, is associated with physiologic impairment and mortality risk.PurposeTo determine whether participant-level emphysema pattern could predict impairment and mortality when classified by using a deep learning method.Materials and MethodsThis retrospective analysis of Genetic Epidemiology of COPD (COPDGene) study participants enrolled between 2007 and 2011 included those with baseline CT, visual emphysema scores, and survival data through 2018. Participants were partitioned into nonoverlapping sets of 2407 for algorithm training, 100 for validation and parameter tuning, and 7143 for testing. A deep learning algorithm using convolutional neural network and long short-term memory architectures was trained to classify pattern of emphysema according to Fleischner criteria. Deep learning scores were compared with visual scores and clinical parameters including pulmonary function tests. Cox proportional hazard models were used to evaluate relationships between emphysema scores and survival. The algorithm was also tested by using CT and clinical data in 1962 participants enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) study.ResultsA total of 7143 COPDGene participants (mean age ± standard deviation, 59.8 years ± 8.9; 3734 men and 3409 women) were evaluated. Deep learning emphysema classifications were associated with impaired pulmonary function tests, 6-minute walk distance, and St George's Respiratory Questionnaire at univariate analysis (P < .001 for each). Testing in the ECLIPSE cohort showed similar associations (P < .001). In the COPDGene test cohort, deep learning emphysema classification improved the fit of linear mixed models in the prediction of these clinical parameters compared with visual scoring (P < .001). Compared with participants without emphysema, mortality was greater in participants classified by the deep learning algorithm as having any grade of emphysema (adjusted hazard ratios were 1.5, 1.7, 2.9, 5.3, and 9.7, respectively, for trace, mild, moderate, confluent, and advanced destructive emphysema; P < .05).ConclusionDeep learning automation of the Fleischner grade of emphysema at chest CT is associated with clinical measures of pulmonary insufficiency and the risk of mortality.© RSNA, 2019Online supplemental material is available for this article.
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Affiliation(s)
- Stephen M. Humphries
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - Aleena M. Notary
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - Juan Pablo Centeno
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - Matthew J. Strand
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - James D. Crapo
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - Edwin K. Silverman
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - David A. Lynch
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - For the Genetic Epidemiology of COPD (COPDGene) Investigators
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
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Gad SC, Sullivan DW, Mujer CV, Spainhour CB, Crapo JD. Nonclinical Safety and Toxicokinetics of MnTE-2-PyP (BMX-010), a Topical Agent in Phase 2 Trials for Psoriasis and Atopic Dermatitis. Int J Toxicol 2020; 38:291-302. [PMID: 31333066 DOI: 10.1177/1091581819852325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since our earlier publication (Gad et al, 2013), BioMimetix has advanced BMX-010 (Manganese (III) meso-tetrakis(N-ethylpyridinium-2-yl)porphyrin or MnTE020PyP; CASRN 219818-60-7) into clinical development as a topical agent for the treatment of psoriasis, atopic dermatitis, and pruritus (idiopathic nonspecific itch). A multiple dose phase I study has been completed in 64 patients without any serious adverse effects. During the course of development, the formulation was initially a gel but has been modified to a cream formulation. The nonclinical safety program has been carried onward to assess preclinical risk to patients. Additional studies completed and reported here include dermal sensitization in a Guinea Pig maximization test study, 2 rabbit phototoxicity studies, a 28-day oral toxicity study in juvenile mice, a 28-day topical systemic toxicity study in Gottingen minipigs, range-finding studies, and complete embryo-fetal developmental toxicity (Segment II) studies in mice and rabbits, an ICH M7 compliant qualification of impurities using 2 (Q)SAR in silico methods, and a 14-day subcutaneous toxicity study of mice to qualify an impurity. All studies (except the (Q)SAR evaluations) were performed in accordance with Good Laboratory Practices (GLP) using Good Manufacturing Practices (GMP) drug substance. The systemic toxicity studies, with the exception of the juvenile toxicity study, included toxicokinetic evaluations, which are reported here. The phase I clinical study had 67 patient participants who received topically applied BMX-010, and there were no notable safety findings and included pharmacokinetic determinations on these patients which are also reported here. Chronic GLP toxicity studies have been initiated in the mouse (6-month oral) and minipig (9-month dermal). To date, the only observed nonclinical toxicity remains a reversible hypertension seen in mice in response to Cmax levels with a no effect threshold, and there have been no drug-related adverse effects.
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Moll M, Regan EA, Hokanson JE, Lutz SM, Silverman EK, Crapo JD, Make BJ, DeMeo DL. The Association of Multiparity with Lung Function and Chronic Obstructive Pulmonary Disease-Related Phenotypes. Chronic Obstr Pulm Dis 2020; 7:86-98. [PMID: 32324980 PMCID: PMC7454017 DOI: 10.15326/jcopdf.7.2.2019.0166] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Apparent increased female susceptibility to chronic obstructive pulmonary disease (COPD) suggests sex hormones modulate disease pathogenesis. Little is known about associations between multiparity and lung function in smokers. RESEARCH QUESTION We hypothesized that multiparity is associated with lung function and measures of emphysema and airway disease. STUDY DESIGN AND METHODS Utilizing female participants from the 5-year follow up of the COPD Genetic Epidemiology (COPDGene®) study we performed multivariable linear regressions to assess the effect of multiparity and number of pregnancies on forced expiratory volume in 1 second (FEV1) percentage of predicted (% predicted), FEV1/forced vital capacity (FVC), percent emphysema on computed tomography (CT) scans, and Pi10, a measure of airway thickening. We sampled never smokers and those with lower smoking exposure from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 dataset. RESULTS We included 1820 participants from COPDGene® and 418 participants from NHANES (321 never smokers, 97 ever smokers). In COPDGene®, multiparity (beta coefficient [β] = -3.8, 95% confidence interval [CI]: [-6.5, -1.1], p = 0.005) and higher number of pregnancies were associated with lower FEV1 % predicted. Multiparity was not associated with percent emphysema or Pi10. In individuals with no or mild obstruction, multiparity was associated with lower FEV1 % predicted. There was an interaction with multiparity and age on FEV1 % predicted (p = 0.025). In NHANES, there was no association between multiparity and FEV1 % predicted in never smokers or the lower smoking exposure group. INTERPRETATION Multiparity was associated with lower FEV1 % predicted in current and former smokers in COPDGene® study participants. These preliminary results emphasize the importance of smoking abstinence in women of child-bearing age.
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Affiliation(s)
- Matthew Moll
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - John E. Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Sharon M. Lutz
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - James D. Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Barry J. Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Dawn L. DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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