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Somigliana AB, Barbieri PG, Cavallo A, Colombo R, Consonni D, Mirabelli D. Lung asbestos fiber burden analysis: effects of the counting rules for legal medicine evaluations. Inhal Toxicol 2023; 35:300-307. [PMID: 37995092 DOI: 10.1080/08958378.2023.2285789] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES The work shows the effect of counting rules, such as analysis magnification and asbestos fiber dimension to be count (with length ≥5 µm or also asbestos fibers with length <5 µm) in the lung asbestos fiber burden analysis for legal medicine evaluations. METHODS On the same lung tissue samples, two different analyses were carried out to count any asbestos fibers with length ≥1 µm and with length ≥5 µm. Results of the amphibole burden of the two analyses were compared by linear regression analysis on log10-transformed values. RESULTS The analysis should be carried out at an appropriate magnification and on samples prepared in such a way as they allow the counting of very fine fibers. If the analysis is limited to the asbestos fibers with length ≥5 µm, there is a high risk of not detecting possible residual chrysotile fiber burden and thinner crocidolite asbestos fibers. CONCLUSIONS On average we estimated that 1 amphibole fiber with length ≥5 µm corresponds to ∼8 amphibole fibers with length ≥1 µm in the lung. The values of the Helsinki criteria should be updated taking this into account.
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Affiliation(s)
- Anna Benedetta Somigliana
- Regional Electron Microscopy Centre-Environmental Protection Agency of Lombardy Region, Milan, Italy
| | - Pietro Gino Barbieri
- Formerly Occupational Health Unit, Local Health Authority and Mesothelioma Registry of Brescia, Brescia, Italy
| | - Alessandro Cavallo
- Department of Earth and Environmental Sciences-DISAT, University of Milano-Bicocca, Milan, Italy
| | - Roberto Colombo
- Biology and Biotechnology Department "L. Spallanzani", University of Pavia, Pavia, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Mirabelli
- Formerly Unit of Cancer Epidemiology, Department of Medical Sciences, CPO Piemonte and University of Turin, Turin, Italy
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Schneider J, Arhelger R, Brückel B, Baur X. Diagnostic limitations of lung fiber counts in asbestos-related diseases. The Journal of Scientific Practice and Integrity 2023. [DOI: 10.35122/001c.70352] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background Lung dust fibre analyses have been used by some pathologists to estimate past asbestos exposure in the workplace and its related health risks. Asbestos, however, especially the predominately applied chrysotile asbestos type, undergoes translocation, clearance and degradation in the lungs. Objectives We quantified the asbestos fibre and ferruginous (asbestos) body (FB) content in human tissue with respect to the German asbestos ban in 1993 and the interim period of more than 20 years in order to evaluate the diagnostic evidence of these analyses for asbestos-related diseases (ARD). Methods Lung dust analyses have been used in empirical assessments of ARD since 1982. Tissue samples of about 2 cm3 were used and processed in standardized manner. FB was analysed by light microscopy and asbestos fibres by scanning transmission electron microscopy (STEM). Results Chrysotile and amphibole fibre concentrations in the lung tissue depend roughly on the cumulative asbestos exposure levels in the workplace. However, the concentration of lung asbestos fibre and FB depends on the year of examination and especially on the interim period. As the interim period increases, the asbestos fibre burden decreases. There is no relationship between FB and chrysotile asbestos fibre concentrations and only a weak correlation between FB and crocidolite fibre concentrations. There was no significant difference in chrysotile and amphibole fibre concentrations as well as in FB counts between the different ARD. Conclusions Due to the length of interim periods, a past exposure to chrysotile or amphibole asbestos can no longer be detected with FB or asbestos fibre measurement in lung tissue. This means that negative results of such measurements cannot disprove a qualified occupational case history of asbestos exposures and the related health risks due to the fibrogenic and carcinogenic potential of asbestos.
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Groot Lipman KBW, de Gooijer CJ, Boellaard TN, van der Heijden F, Beets-Tan RGH, Bodalal Z, Trebeschi S, Burgers JA. Artificial intelligence-based diagnosis of asbestosis: analysis of a database with applicants for asbestosis state aid. Eur Radiol 2022. [PMID: 36567379 DOI: 10.1007/s00330-022-09304-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/27/2022] [Accepted: 11/18/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In many countries, workers who developed asbestosis due to their occupation are eligible for government support. Based on the results of clinical examination, a team of pulmonologists determine the eligibility of patients to these programs. In this Dutch cohort study, we aim to demonstrate the potential role of an artificial intelligence (AI)-based system for automated, standardized, and cost-effective evaluation of applications for asbestosis patients. METHODS A dataset of n = 523 suspected asbestosis cases/applications from across the Netherlands was retrospectively collected. Each case/application was reviewed, and based on the criteria, a panel of three pulmonologists would determine eligibility for government support. An AI system is proposed, which uses thoracic CT images as input, and predicts the assessment of the clinical panel. Alongside imaging, we evaluated the added value of lung function parameters. RESULTS The proposed AI algorithm reached an AUC of 0.87 (p < 0.001) in the prediction of accepted versus rejected applications. Diffusion capacity (DLCO) also showed comparable predictive value (AUC = 0.85, p < 0.001), with little correlation between the two parameters (r-squared = 0.22, p < 0.001). The combination of the imaging AI score and DLCO achieved superior performance (AUC = 0.95, p < 0.001). Interobserver variability between pulmonologists on the panel was estimated at alpha = 0.65 (Krippendorff's alpha). CONCLUSION We developed an AI system to support the clinical decision-making process for the application to the government support for asbestosis. A multicenter prospective validation study is currently ongoing to examine the added value and reliability of this system alongside the clinic panel. KEY POINTS • Artificial intelligence can detect imaging patterns of asbestosis in CT scans in a cohort of patients applying for state aid. • Combining the AI prediction with the diffusing lung function parameter reaches the highest diagnostic performance. • Specific cases with fibrosis but no asbestosis were correctly classified, suggesting robustness of the AI system, which is currently under prospective validation.
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Tran T, Egilman D, Rigler M, Emory T. A Critique of Helsinki Criteria for Using Lung Fiber Levels to Determine Causation in Mesothelioma Cases. Ann Glob Health 2021; 87:73. [PMID: 34395196 PMCID: PMC8323524 DOI: 10.5334/aogh.3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Asbestos is a known human carcinogen and the chief known cause of mesothelioma. In 1997, a group of experts developed the Helsinki Criteria, which established criteria for attribution of mesothelioma to asbestos. The criteria include two methods for causation attribution: 1) a history of significant occupational, domestic, or environmental exposure and/or 2) pathologic evidence of exposure to asbestos. In 2014, the Helsinki Criteria were updated, and these attribution criteria were not changed. However, since the Helsinki Criteria were first released in 1997, some pathologists, cell biologists, and others have claimed that a history of exposure cannot establish causation unless the lung asbestos fiber burden exceeds "the background range for the laboratory in question to attribute mesothelioma cases to exposure to asbestos." This practice ignores the impact on fiber burden of clearance/translocation over time, which in part is why the Helsinki Criteria concluded that a history of exposure to asbestos was independently sufficient to attribute causation to asbestos. After reviewing the Helsinki Criteria, we conclude that their methodology is fatally flawed because a quantitative assessment of a background lung tissue fiber level cannot be established. The flaws of the Helsinki Criteria are both technical and substantive. The 1995 paper that served as the scientific basis for establishing background levels used inconsistent methods to determine exposures in controls and cases. In addition, historic controls cannot be used to establish background fiber levels for current cases because ambient exposures to asbestos have decreased over time and control cases pre-date current cases by decades. The use of scanning electron microscope (SEM) compounded the non-compatibility problem; the applied SEM cannot distinguish talc from anthophyllite because it cannot perform selected area electron diffraction, which is a crucial identifier in ATEM for distinguishing the difference between serpentine asbestos, amphibole asbestos, and talc.
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Affiliation(s)
- Triet Tran
- Never Again Consulting, Attleboro, MA, US
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Baur X, Frank AL. Ongoing downplaying of the carcinogenicity of chrysotile asbestos by vested interests. J Occup Med Toxicol 2021; 16:6. [PMID: 33622366 PMCID: PMC7901213 DOI: 10.1186/s12995-021-00295-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
Industries that mine, manufacture and sell asbestos or asbestos-containing products have a long tradition of promoting the use of asbestos, while placing the burden of economic and health costs on workers and society. This has been successfully done in recent years and decades in spite of the overwhelming evidence that all asbestos types are carcinogenic and cause asbestosis. In doing so, the asbestos industry has undermined the WHO campaign to reach a worldwide ban of asbestos and to eliminate asbestos-related diseases. Even worse, in recent years they succeeded in continuing asbestos mining and consuming in the range of about 1.3 million tons annually. Nowadays, production takes place predominantly in Russia, Kazakhstan and China. Chrysotile is the only asbestos type still sold and represents 95% of asbestos traded over the last century.The asbestos industry, especially its PR agency, the International Chrysotile Association, ICA, financed by asbestos mining companies in Russia, Kazakhstan and Zimbabwe and asbestos industrialists in India and Mexico, continues to be extremely active by using slogans such as chrysotile can be used safely.Another approach of the asbestos industry and of some of its insurance agencies is to broadly defeat liability claims of asbestos victims.In doing so they systematically use inappropriate science produced by their own and/or by industry-affiliated researchers. Some of the latter were also engaged in producing defense material for other industries including the tobacco industry. Frequent examples of distributing such disinformation include questioning or denying established scientific knowledge about adverse health effects of asbestos. False evidence continues to be published in scientific journals and books.The persisting strong influence of vested asbestos-related interests in workers and public health issues including regulations and compensation necessitate ongoing alertness, corrections and appropriate reactions in scientific as well as public media and policy advisory bodies.
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Affiliation(s)
- Xaver Baur
- Chair Em. of Occupational Medicine, University of Hamburg, Hamburg, Germany.
- European Society for Environmental and Occupational Medicine, P.O. Box 370514, D-14135, Berlin, Germany.
| | - Arthur L Frank
- Chair Em. of Environmental & Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
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Schneider J, Baur X, Becker P. [Assessment of Asbestos-related Occupational Diseases: Socio-medical and Legal Aspects]. Pneumologie 2020; 74:603-610. [PMID: 32643765 DOI: 10.1055/a-1201-3840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Occupational diseases are certain diseases designated as such by law. Whereas the medical conditions are described in guidelines, their recognition is based on judicial administrative procedures. Establishing causality is based on requirements of social law. The basic socio-legal concepts are mentioned and the principles of causality in asbestos-related occupational diseases are listed. Exemplary social court judgments are cited. Judgements may not infrequently differ from the medical point of view. The aim of this article is to describe the correct use of social medical understanding in order to carry out adequate assessment of occupational diseases, which implements the legal requirements.
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Affiliation(s)
- J Schneider
- Institut und Poliklinik für Arbeits- und Sozialmedizin (Komm. Leiter: Prof. Dr. Joachim Schneider), Gießen
| | - X Baur
- European Society for Environmental and Occupational Medicine, Berlin, Deutschland, Universität von Hamburg, ZFA Hamburg (em. Professor Dr. Xaver Baur)
| | - P Becker
- Vorsitzender Richter am Bundessozialgericht, Honorarprofessor der Universität Kassel, Bundessozialgericht, Kassel
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Klebe S, Leigh J, Henderson DW, Nurminen M. Asbestos, Smoking and Lung Cancer: An Update. Int J Environ Res Public Health 2019; 17:ijerph17010258. [PMID: 31905913 PMCID: PMC6982078 DOI: 10.3390/ijerph17010258] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/17/2019] [Accepted: 12/24/2019] [Indexed: 01/19/2023]
Abstract
This review updates the scientific literature concerning asbestos and lung cancer, emphasizing cumulative exposure and synergism between asbestos exposure and tobacco smoke, and proposes an evidence-based and equitable approach to compensation for asbestos-related lung cancer cases. This update is based on several earlier reviews written by the second and third authors on asbestos and lung cancer since 1995. We reevaluated the peer-reviewed epidemiologic studies. In addition, selected in vivo and in vitro animal studies and molecular and cellular studies in humans were included. We conclude that the mechanism of lung cancer causation induced by the interdependent coaction of asbestos fibers and tobacco smoke at a biological level is a multistage stochastic process with both agents acting conjointly at all times. The new knowledge gained through this review provides the evidence for synergism between asbestos exposure and tobacco smoke in lung cancer causation at a biological level. The evaluated statistical data conform best to a multiplicative model for the interaction effects of asbestos and smoking on the lung cancer risk, with no requirement for asbestosis. Any asbestos exposure, even in a heavy smoker, contributes to causation. Based on this information, we propose criteria for the attribution of lung cancer to asbestos in smokers and non-smokers.
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Affiliation(s)
- Sonja Klebe
- Department of Anatomical Pathology, SA Pathology and Flinders University, Adelaide, SA 5042, Australia
- Correspondence: ; Tel.: +61-08-820-439-36
| | - James Leigh
- Asbestos Diseases Research Institute, University of Sydney, Concord, NSW 2139, Australia;
| | - Douglas W. Henderson
- Department of Anatomical Pathology, SA Pathology and Flinders University, Adelaide, SA 5042, Australia
| | - Markku Nurminen
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
- MarkStat Consultancy, 00250 Helsinki, Finland
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Apostoli P, Boffetta P, Bovenzi M, Cocco PL, Consonni D, Cristaudo A, Discalzi G, Farioli A, Manno M, Mattioli S, Pira E, Soleo L, Taino G, Violante FS, Zocchetti C. Position Paper on Asbestos of the Italian Society of Occupational Medicine. Med Lav 2019; 110:459-485. [PMID: 31846450 PMCID: PMC7809933 DOI: 10.23749/mdl.v110i6.9022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Indexed: 12/24/2022]
Abstract
The Position Paper (PP) on asbestos of the Italian Society of Occupational Medicine (SIML) aims at providing a tool to the occupational physician to address current diagnostic criteria and results of epidemiological studies, and their consequences in terms of preventive and evaluation actions for insurance, compensation and litigation. The PP was based on an extensive review of the scientific literature and was compiled by a Working Group comprising researchers who have contributed to the international literature on asbestos-related diseases, as well as occupational physicians with extensive experience in the evaluation of risks and the medical surveillance of workers currently and formerly exposed to asbestos. The PP was drafted and reviewed between 2017 and 2018; its final version was prepared according to the guidelines of AGREE Reporting Checklist. All the members of the Working Group subscribed to the document, which was eventually approved by SIML's Executive Committee. The first section addresses industrial hygiene issues, such as methods for environmental monitoring, advantages and limitations of different microscopy techniques, the potential role of microfibers and approaches for retrospective assessment of exposure, in particular in epidemiological studies. The second section reviews the biological effects of asbestos with particular attention to the diagnostic aspects of asbestosis, pleural changes, mesothelioma and lung cancer. In the following section the criteria of causal attribution are discussed, together with different hypotheses on the form of the risk functions, with a comparison of the opinions prevalent in the literature. In particular, the models of the risk function for mesothelioma were examined, in the light of the hypothesis of an acceleration or anticipation of the events in relation to the dose. The last section discusses topics of immediate relevance for the occupational physician, such as health surveillance of former exposed and of workers currently exposed in remediation activities.
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Affiliation(s)
- Pietro Apostoli
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Brescia, Italia..
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Scimeca M, Bischetti S, Lamsira HK, Bonfiglio R, Bonanno E. Energy Dispersive X-ray (EDX) microanalysis: A powerful tool in biomedical research and diagnosis. Eur J Histochem 2018; 62:2841. [PMID: 29569878 PMCID: PMC5907194 DOI: 10.4081/ejh.2018.2841] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 02/06/2023] Open
Abstract
The Energy Dispersive X-ray (EDX) microanalysis is a technique of elemental analysis associated to electron microscopy based on the generation of characteristic Xrays that reveals the presence of elements present in the specimens. The EDX microanalysis is used in different biomedical fields by many researchers and clinicians. Nevertheless, most of the scientific community is not fully aware of its possible applications. The spectrum of EDX microanalysis contains both semi-qualitative and semi-quantitative information. EDX technique is made useful in the study of drugs, such as in the study of drugs delivery in which the EDX is an important tool to detect nanoparticles (generally, used to improve the therapeutic performance of some chemotherapeutic agents). EDX is also used in the study of environmental pollution and in the characterization of mineral bioaccumulated in the tissues. In conclusion, the EDX can be considered as a useful tool in all works that require element determination, endogenous or exogenous, in the tissue, cell or any other sample.
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Affiliation(s)
- Manuel Scimeca
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention.
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Baur X. Asbestos-Related Disorders in Germany: Background, Politics, Incidence, Diagnostics and Compensation. Int J Environ Res Public Health 2018; 15:E143. [PMID: 29337930 PMCID: PMC5800242 DOI: 10.3390/ijerph15010143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/19/2017] [Accepted: 01/11/2018] [Indexed: 11/16/2022]
Abstract
There was some limited use of asbestos at end of the 19th century in industrialized countries including Germany, but its consumption dramatically increased after World War II. The increase in use and exposure was followed by the discovery of high numbers of asbestos-related diseases with a mean latency period of about 38 years in Germany. The strong socio-political pressure from the asbestos industry, its affiliated scientists and physicians has successfully hindered regulatory measures and an asbestos ban for many years; a restrictive stance that is still being unravelled in compensation litigation. This national experience is compared with the situation in other industrialized countries and against the backdrop of the constant efforts of the WHO to eliminate asbestos-related diseases worldwide.
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Affiliation(s)
- Xaver Baur
- European Society for Occupational and Environmental Medicine, EOM, Berlin, Germany.
- Emeritus, Institute for Occupational and Maritime Medicine, University of Hamburg, D-20246 Hamburg, Germany.
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Tashiro J, Rubio GA, Limper AH, Williams K, Elliot SJ, Ninou I, Aidinis V, Tzouvelekis A, Glassberg MK. Exploring Animal Models That Resemble Idiopathic Pulmonary Fibrosis. Front Med (Lausanne) 2017; 4:118. [PMID: 28804709 PMCID: PMC5532376 DOI: 10.3389/fmed.2017.00118] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [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: 05/10/2017] [Accepted: 07/11/2017] [Indexed: 02/03/2023] Open
Abstract
Large multicenter clinical trials have led to two recently approved drugs for patients with idiopathic pulmonary fibrosis (IPF); yet, both of these therapies only slow disease progression and do not provide a definitive cure. Traditionally, preclinical trials have utilized mouse models of bleomycin (BLM)-induced pulmonary fibrosis—though several limitations prevent direct translation to human IPF. Spontaneous pulmonary fibrosis occurs in other animal species, including dogs, horses, donkeys, and cats. While the fibrotic lungs of these animals share many characteristics with lungs of patients with IPF, current veterinary classifications of fibrotic lung disease are not entirely equivalent. Additional studies that profile these examples of spontaneous fibroses in animals for similarities to human IPF should prove useful for both human and animal investigators. In the meantime, studies of BLM-induced fibrosis in aged male mice remain the most clinically relevant model for preclinical study for human IPF. Addressing issues such as time course of treatment, animal size and characteristics, clinically irrelevant treatment endpoints, and reproducibility of therapeutic outcomes will improve the current status of preclinical studies. Elucidating the mechanisms responsible for the development of fibrosis and disrepair associated with aging through a collaborative approach between researchers will promote the development of models that more accurately represent the realm of interstitial lung diseases in humans.
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Affiliation(s)
- Jun Tashiro
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gustavo A Rubio
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Andrew H Limper
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Kurt Williams
- Department Pathobiology and Diagnostic Investigations, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Sharon J Elliot
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ioanna Ninou
- Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | - Vassilis Aidinis
- Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | - Argyrios Tzouvelekis
- Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | - Marilyn K Glassberg
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
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