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Nevel RJ, Brennan SK, Wambach JA. Genetic Disorders of Surfactant Metabolism. Neoreviews 2025; 26:e328-e338. [PMID: 40306683 DOI: 10.1542/neo.26-5-014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Accepted: 01/11/2025] [Indexed: 05/02/2025]
Abstract
Genetic disorders affecting surfactant protein production and function can result in respiratory distress and severe respiratory failure in late-preterm and term neonates. Pathogenic variants in surfactant pulmonary-associated protein B (SFTPB) are typically loss-of-function and disrupt surfactant protein B (SP-B) production and surfactant function. Dominant variants in surfactant pulmonary-associated protein C (SFTPC) generally result in a toxic gain-of-function with disruption of surfactant protein C (SP-C) processing and trafficking in the alveolar epithelial type 2 cells. Adenosine triphosphate binding cassette transporter A3 (ABCA3) variants include loss-of-function or "null" variants in which no ABCA3 protein is made or missense variants that disrupt intracellular trafficking of ABCA3 or impair phospholipid transport. Pathogenic variants and deletions of the NK2 homeobox 1 gene (NKX2-1) result in haploinsufficiency and alter transcription of surfactant-associated genes as well as genes for brain and thyroid development. Diagnosis of these disorders requires a high index of clinical suspicion because presentations may vary between and within diseases. Prognosis is highly variable, ranging from requiring supportive care with improvement in respiratory status over time to severe disease with early mortality without lung transplantation. Neonatologists and pulmonologists alike should recognize early presentations of these rare genetic disorders of surfactant metabolism to identify and care for affected infants and to counsel families regarding prognosis, treatment options, recurrence risk, and risk assessment for other family members.
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Affiliation(s)
- Rebekah J Nevel
- Division of Pediatric Pulmonary, Allergy/Immunology, and Sleep Medicine, Department of Pediatrics, University of Missouri School of Medicine and Children's Hospital, Columbia, Missouri
| | - Steven K Brennan
- Division of Pediatric Allergy and Pulmonary Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
| | - Jennifer A Wambach
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
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2
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Pham VD, Lee JH, Shin D, Vu HM, Jung J, Kashyap MK, Lee SH, Kim MS. On the Ocean of Biomarkers for the Precise Diagnosis and Prognosis of Lung Diseases. Proteomics Clin Appl 2025; 19:e70003. [PMID: 40098318 DOI: 10.1002/prca.70003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 02/25/2025] [Accepted: 02/26/2025] [Indexed: 03/19/2025]
Abstract
Bronchoalveolar lavage fluid (BALF) has long been used for diagnosing various lung diseases through its cellular components. However, the clinical utility of biomolecules in the BALF remains largely unexplored. Recently, mass spectrometry-based proteomics has been applied to profile the BALF proteomes to identify novel biomarkers for lung diseases. This review discusses the current progress in the field of BALF proteomics and highlights its potential as a valuable source of biomarkers for different lung diseases. Additionally, we explored the latest advancements and findings from BALF studies. Finally, we address the current limitations and propose future directions and research opportunities to advance the study of BALF.
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Affiliation(s)
- Van Duc Pham
- Department of New Biology, DGIST, Daegu, Republic of Korea
| | - Jung-Hyung Lee
- Department of New Biology, DGIST, Daegu, Republic of Korea
| | - Doyun Shin
- Department of New Biology, DGIST, Daegu, Republic of Korea
| | - Hung M Vu
- Bertis R&D Division, Bertis Inc., Gwacheon-si, Gyeonggi-do, Republic of Korea
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
| | - Junyang Jung
- Department of Precision Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Department of Anatomy and Neurobiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Manoj K Kashyap
- Molecular Oncology Laboratory, Amity Stem Cell Institute, Amity Medical School, Amity University Haryana, Panchgaon (Manesar), Gurugram, Haryana, India
| | - Seung Hyeun Lee
- Department of Precision Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Min-Sik Kim
- Department of New Biology, DGIST, Daegu, Republic of Korea
- New Biology Research Center, DGIST, Daegu, Republic of Korea
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3
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Schneider H, Ius F, Müller C, Salman J, Schütz K, Köditz H, Nickel K, Hansen G, Bobylev D, Schwerk N, Carlens J. Paediatric Lung Transplantation for Childhood Interstitial Lung Disease: Indications and Outcome. J Heart Lung Transplant 2025:S1053-2498(25)01899-6. [PMID: 40209866 DOI: 10.1016/j.healun.2025.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 03/17/2025] [Accepted: 04/01/2025] [Indexed: 04/12/2025] Open
Abstract
BACKGROUND Childhood interstitial lung disease (chILD) is heterogeneous, associated with significant morbidity and can cause organ failure. In these cases, lung transplantation (LuTx) is a treatment option. Data on indications and outcome after LuTx for chILD is limited. We compared characteristics of LuTx for chILD to the indications cystic fibrosis (CF) and pulmonary hypertension (PH). METHODS chILD-patients <18 years who underwent LuTx at our center between Jan 1st, 2011 and Sep 30th, 2023, were retrospectively analysed and divided into two groups depending on their age at disease manifestation: Children in the chILD A group predominantly became ill during the first two years of life, chILD B patients thereafter. Outcomes were compared to patients with CF and PH. RESULTS 101 children were included (chILD A 12; chILD B 19; CF 49; PH 21). Patients in the chILD A group were younger (mean age 1.5 vs., 12.9, 15.2, 10.9 years) and frequently required mechanical ventilation before LuTx (41.7%, vs. 10.5%, 2%, 9.5%, respectively). Their median ICU stay (23 vs. 4, 2, 13 days) and median hospital stay (48 vs. 27, 30, 42 days) after LuTx was longer. Patients with chILD B had the lowest pre-transplant ICU requirement (21.1% vs. 66.7% for chILD A, 30.6% for CF and 47.6% for PH) and short median hospital stay. Five year survival was comparable in all groups (80.2%, 86.5%, 80.4%, and 81.2%). CONCLUSION LuTx for patients with chILD shows favourable outcome, although younger chILD A patients had a higher pre-transplant morbidity and longer ICU and hospital stay surrounding the transplantation.
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Affiliation(s)
- Hendrik Schneider
- Clinic for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Carsten Müller
- Clinic for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Katharina Schütz
- Clinic for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Harald Köditz
- Clinic for Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Katja Nickel
- Clinic of Anesthesiology and Pain medicine, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Clinic for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Clinic for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Clinic for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.
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4
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Tsujioka Y, Nishimura G, Nishi E, Kono T, Nozaki T, Hashimoto M, Yamada Y, Jinzaki M. Childhood interstitial lung diseases: current understanding of the classification and imaging findings. Jpn J Radiol 2024; 42:937-952. [PMID: 39012450 PMCID: PMC11364587 DOI: 10.1007/s11604-024-01603-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/23/2024] [Indexed: 07/17/2024]
Abstract
Childhood interstitial lung diseases (chILDs) encompass a diverse group of disorders with a high mortality rate and severe respiratory morbidities. Recent investigations have revealed that the classification of adult ILDs is not valid for chILDs, particularly for ILDs of early onset. Therefore, Children's Interstitial Lung Disease Research Cooperative of North America proposed a new classification of chILDs for affected children under 2 years of age, and later another classification for affected individuals between 2 and 18 years of age. In this review, we provide an overview of the imaging findings of chILDs by classification. Most infantile ILDs have unique clinical, radiological, and molecular findings, while the manifestation of pediatric ILDs overlaps with that of adult ILDs.
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Affiliation(s)
- Yuko Tsujioka
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan.
| | - Gen Nishimura
- Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan
| | - Eugene Nishi
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
- Department of Radiology, Keiyu Hospital, Yokohama, Japan
| | - Tatsuo Kono
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Masahiro Hashimoto
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-0016, Japan
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5
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Bernardinello N, Griese M, Borie R, Spagnolo P. Emerging Treatments for Childhood Interstitial Lung Disease. Paediatr Drugs 2024; 26:19-30. [PMID: 37948041 PMCID: PMC10770003 DOI: 10.1007/s40272-023-00603-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
Childhood interstitial lung disease (chILD) is a large and heterogeneous group of disorders characterized by diffuse lung parenchymal markings on chest imaging and clinical signs such as dyspnea and hypoxemia from functional impairment. While some children already present in the neonatal period with interstitial lung disease (ILD), others develop ILD during their childhood and adolescence. A timely and accurate diagnosis is essential to gauge treatment and improve prognosis. Supportive care can reduce symptoms and positively influence patients' quality of life; however, there is no cure for many of the chILDs. Current therapeutic options include anti-inflammatory or immunosuppressive drugs. Due to the rarity of the conditions and paucity of research in this field, most treatments are empirical and based on case series, and less than a handful of small, randomized trials have been conducted thus far. A trial on hydroxychloroquine yielded good safety but a much smaller effect size than anticipated. A trial in fibrotic disease with the multitargeted tyrosine kinase inhibitor nintedanib showed similar pharmacokinetics and safety as in adults. The unmet need for the treatment of chILDs remains high. This article summarizes current treatments and explores potential therapeutic options for patients suffering from chILD.
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Affiliation(s)
- Nicol Bernardinello
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani n°2, 35128, Padua, Italy
| | - Matthias Griese
- Department of Pediatric Pneumology, Dr. von Hauner Children's Hospital, German Center for Lung Research (DZL), Ludwig-Maximilians University, Munich, Germany
| | - Raphaël Borie
- Université de Paris, INSERM UMR 1152, Service de Pneumologie A, Centre de compétences maladies pulmonaires rares, Hôpital Bichat-Claude Bernard, AP-HP, 75018, Paris, France
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani n°2, 35128, Padua, Italy.
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Yoon SY, Concepcion NDP, DiPrete O, Vargas SO, Winant AJ, Garcia-Peña P, Chu WC, Kasznia-Brown J, Daltro P, Lee EY, Laya BF. Neonatal and Infant Lung Disorders: Glossary, Practical Approach, and Diagnoses. J Thorac Imaging 2024; 39:3-17. [PMID: 37982525 DOI: 10.1097/rti.0000000000000758] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
A multitude of lung disorders ranging from congenital and genetic anomalies to iatrogenic complications can affect the neonate or the infant within the first year of life. Neonatal and infant chest imaging, predominantly by plain radiography and computed tomography, is frequently employed to aid in diagnosis and management; however, these disorders can be challenging to differentiate due to their broad-ranging, and frequently overlapping radiographic features. A systematic and practical approach to imaging interpretation which includes recognition of radiologic patterns, utilization of commonly accepted nomenclature and classification, as well as interpretation of imaging findings in conjunction with clinical history can not only assist radiologists to suggest the diagnosis, but also aid clinicians in management planning. The contents of this article were endorsed by the leadership of both the World Federation of Pediatric Imaging (WFPI), and the International Society of Pediatric Thoracic Imaging (ISPTI).
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Affiliation(s)
- Se-Young Yoon
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University
| | - Nathan David P Concepcion
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center, Global City, Taguig, Philippines
| | - Olivia DiPrete
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University
| | | | - Abbey J Winant
- Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Pilar Garcia-Peña
- University Hospital Materno-Infantil Vall d'Hebron, Barcelona, Spain
| | - Winnie C Chu
- Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong Prince of Wales Hospital, Shatin, N.T. Hong Kong SAR, China
| | | | - Pedro Daltro
- Department of Pediatric Radiology, Instituto Fernandes Figueira-FIOCRUZ, ALTA Excelência Diagnóstica-DASA, Rio de Janeiro, Brazil
| | - Edward Y Lee
- Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Bernard F Laya
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center, Quezon City, Philippines
- Department of Radiology, St. Luke's Medical Center College of Medicine, William H Quasha Memorial, Quezon City, Philippines
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7
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Zuo B, Wang L, Li X, Li X, Wang J, Xiong Y, Lei J, Zhang X, Chen Y, Liu Q, Jiao J, Sui M, Fan J, Wu N, Song Z, Li G. Abnormal low expression of SFTPC promotes the proliferation of lung adenocarcinoma by enhancing PI3K/AKT/mTOR signaling transduction. Aging (Albany NY) 2023; 15:12451-12475. [PMID: 37955668 PMCID: PMC10683597 DOI: 10.18632/aging.205191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
The abnormality of surfactant protein C (SFTPC) has been linked to the development of a number of interstitial lung diseases, according to mounting evidence. Nonetheless, the function and mechanism of SFTPC in the biological progression of lung adenocarcinoma (LUAD) remain unclear. Analysis of public datasets and testing of clinical samples suggested that SFTPC expression was abnormally low in LUAD, which was associated with the onset and poor prognosis of LUAD. The SFTPC-related risk score was derived using least absolute shrinkage and selection operator Cox regression as well as multivariate Cox regression. The risk score was highly correlated with tumor purity and tumor mutation burden, and it could serve as an independent prognostic indicator for LUAD. Low-risk LUAD patients may benefit more from CTLA-4 or/and PD-1 inhibitors. Overall, the risk score is useful for LUAD patient prognostication and treatment guidance. Moreover, in vitro and in vivo experiments demonstrated that SFTPC inhibits the proliferation of LUAD by inhibiting PI3K/AKT/mTOR signaling transduction. These results reveal the molecular mechanism by which SFTPC inhibits the proliferation of LUAD and suggest that SFTPC could be a new therapeutic target for LUAD.
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Affiliation(s)
- Baile Zuo
- Henan Key Laboratory of Immunology and Targeted Drugs, School of Medical Technology, Xinxiang Medical University, Xinxiang, Henan, China
| | - Lin Wang
- Department of Geriatrics, Xijing Hospital, The Air Force Military Medical University, Xi’an, Shaanxi, China
| | - Xiaoyan Li
- Department of Blood Transfusion, Shanxi Provincial People’s Hospital, Affiliate of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xin Li
- Department of Geriatric Medicine, Shanxi Provincial People’s Hospital, Affiliate of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jinping Wang
- Department of Ultrasound, Shanxi Provincial People’s Hospital, Affiliate of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yanlu Xiong
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Jie Lei
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Xi Zhang
- Department of Oncology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yifan Chen
- College of Management, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Qiongwen Liu
- College of Life Science and Agronomy, Zhoukou Normal University, Zhoukou, Henan, China
| | - Jinke Jiao
- College of Life Science and Agronomy, Zhoukou Normal University, Zhoukou, Henan, China
| | - Mengru Sui
- College of Life Science and Agronomy, Zhoukou Normal University, Zhoukou, Henan, China
| | - Jinhan Fan
- College of Life Science and Agronomy, Zhoukou Normal University, Zhoukou, Henan, China
| | - Ningxue Wu
- College of Life Science and Agronomy, Zhoukou Normal University, Zhoukou, Henan, China
| | - Zewen Song
- Department of Oncology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Guoyin Li
- College of Life Science and Agronomy, Zhoukou Normal University, Zhoukou, Henan, China
- MOE Key Laboratory of Modern Teaching Technology, Center for Teacher Professional Ability Development, Shaanxi Normal University, Xi’an, Shaanxi, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, China
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8
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Cao TBT, Moon JY, Yoo HJ, Ban GY, Kim SH, Park HS. Down-regulated surfactant protein B in obese asthmatics. Clin Exp Allergy 2022; 52:1321-1329. [PMID: 35294785 DOI: 10.1111/cea.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Obesity is a common comorbid condition in adult asthmatics and known as a feature of asthma severity. However, the molecular mechanism under obesity-induced inflammation has not yet been fully understood. OBJECTIVE Considering the essential role of hydrophobic surfactant protein B (SP-B) in lung function, SP-B was targeted to examine its involvement in the development of obesity-induced airway inflammation in asthmatics. METHODS The aim was to examine an alteration in circulating SP-B according to obesity in adult asthmatics, 129 asthmatics were enrolled and classified into 3 groups (obese, overweight and normal-weight groups) according to body mass index (BMI). Circulating SP-B levels were determined by enzyme-linked immunosorbent assay. Four single nucleotide polymorphisms of SFTPB gene were genotyped. Serum ceramide levels were measured by liquid chromatography-tandem mass spectrometry. RESULTS Significantly lower serum SP-B levels were noted in the obese group than in the overweight or normal-weight group (p = .002). The serum SP-B level was significantly correlated with serum levels of C18:0 ceramide and transforming growth factor beta 1 as well as BMI (r = -0.200; r = -0.215; r = -0.332, p < .050 for all). An inverse correlation was noted between serum SP-B and fractional exhaled nitric oxide levels in female asthmatics (r = -0.287, p = .009). Genetic predisposition of the SFTPB gene at 9306 A>G to the obese and overweight groups was noted. CONCLUSION Obesity altered ceramide metabolism leading to pulmonary surfactant dysfunction and impaired resolution of airway inflammation, finally contributing to the phenotypes of obese asthmatics.
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Affiliation(s)
- Thi Bich Tra Cao
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Ji-Young Moon
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun-Ju Yoo
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ga-Young Ban
- Department of Pulmonary, Allergy, and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine Institute for Life Sciences, Seoul, Korea
| | - Seung-Hyun Kim
- Translational Research Laboratory for Inflammatory Disease, Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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9
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Chua WC, Chen IC, Liu YC, Wu YH, Lo SH, Hsu JH, Liang PI, Chen HL, Dai ZK. Congenital Surfactant C Deficiency with Pulmonary Hypertension-A Case Report. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1435. [PMID: 36291368 PMCID: PMC9601149 DOI: 10.3390/children9101435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Interstitial lung diseases in children are a diverse group in terms of etiology and pathogenesis. With advances in genetic testing, mutations in surfactant protein have now been identified as the etiology for childhood interstitial lung disease of variable onset and severity, ranging from fatal acute respiratory distress syndrome (RDS) in neonates to chronic lung disease in adults. We presented an 11-month-old girl with surfactant protein C deficiency and secondary pulmonary hypertension, successfully treated with hydroxychloroquine, and provided a detailed discussion of the clinical and diagnostic approach and management.
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Affiliation(s)
- Wei Chard Chua
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Yen-Hsien Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Shih-Hsing Lo
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Peir-In Liang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Hsiu-Lin Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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10
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Temple SEL, Ho G, Bennetts B, Boggs K, Vidic N, Mowat D, Christodoulou J, Schultz A, Gayagay T, Roscioli T, Zhu Y, Lunke S, Armstrong D, Harrison J, Kapur N, McDonald T, Selvadurai H, Tai A, Stark Z, Jaffe A. The role of exome sequencing in childhood interstitial or diffuse lung disease. Orphanet J Rare Dis 2022; 17:350. [PMID: 36085161 PMCID: PMC9463757 DOI: 10.1186/s13023-022-02508-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children's interstitial and diffuse lung disease (chILD) is a complex heterogeneous group of lung disorders. Gene panel approaches have a reported diagnostic yield of ~ 12%. No data currently exist using trio exome sequencing as the standard diagnostic modality. We assessed the diagnostic utility of using trio exome sequencing in chILD. We prospectively enrolled children meeting specified clinical criteria between 2016 and 2020 from 16 Australian hospitals. Exome sequencing was performed with analysis of an initial gene panel followed by trio exome analysis. A subset of critically ill infants underwent ultra-rapid trio exome sequencing as first-line test. RESULTS 36 patients [median (range) age 0.34 years (0.02-11.46); 11F] were recruited from multiple States and Territories. Five patients had clinically significant likely pathogenic/pathogenic variants (RARB, RPL15, CTCF, RFXANK, TBX4) and one patient had a variant of uncertain significance (VIP) suspected to contribute to their clinical phenotype, with VIP being a novel gene candidate. CONCLUSIONS Trio exomes (6/36; 16.7%) had a better diagnostic rate than gene panel (1/36; 2.8%), due to the ability to consider a broader range of underlying conditions. However, the aetiology of chILD in most cases remained undetermined, likely reflecting the interplay between low penetrant genetic and environmental factors.
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Affiliation(s)
- Suzanna E L Temple
- Department of Clinical Genetics, Liverpool Hospital, Sydney, NSW, Australia. .,School of Women's and Children's Health, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia.
| | - Gladys Ho
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Disciplines of Child and Adolescent Health and Genomic Medicine, University of Sydney, Sydney, NSW, Australia
| | - Bruce Bennetts
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Disciplines of Child and Adolescent Health and Genomic Medicine, University of Sydney, Sydney, NSW, Australia
| | - Kirsten Boggs
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Department of Clinical Genetics, Children's Hospital Westmead, Sydney, NSW, Australia.,Centre for Clinical Genetics, Sydney Children's Hospital Randwick, Sydney, NSW, Australia
| | - Nada Vidic
- School of Women's and Children's Health, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia.,Australian Genomics Health Alliance, Melbourne, VIC, Australia
| | - David Mowat
- School of Women's and Children's Health, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia.,Centre for Clinical Genetics, Sydney Children's Hospital Randwick, Sydney, NSW, Australia
| | - John Christodoulou
- Disciplines of Child and Adolescent Health and Genomic Medicine, University of Sydney, Sydney, NSW, Australia.,Australian Genomics Health Alliance, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - André Schultz
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Australia
| | - Thet Gayagay
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Tony Roscioli
- Centre for Clinical Genetics, Sydney Children's Hospital Randwick, Sydney, NSW, Australia.,Randwick Genomics Laboratory, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia.,Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Ying Zhu
- Randwick Genomics Laboratory, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Sebastian Lunke
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - David Armstrong
- Department of Paediatrics, Monash University, Clayton Rd, Clayton, VIC, Australia.,Department of Respiratory and Sleep Medicine, Monash Children's Hospital, Clayton Rd, Clayton, VIC, Australia
| | - Joanne Harrison
- University of Melbourne, Melbourne, VIC, Australia.,Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nitin Kapur
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Hiran Selvadurai
- Disciplines of Child and Adolescent Health and Genomic Medicine, University of Sydney, Sydney, NSW, Australia.,Children's Hospital Westmead, Sydney, NSW, Australia
| | - Andrew Tai
- Paediatric Respiratory and Sleep Department, Women's and Children's Hospital, Adelaide, SA, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Zornitza Stark
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia.,Department Respiratory and Sleep Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
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11
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McLachlan G, Alton EWFW, Boyd AC, Clarke NK, Davies JC, Gill DR, Griesenbach U, Hickmott JW, Hyde SC, Miah KM, Molina CJ. Progress in Respiratory Gene Therapy. Hum Gene Ther 2022; 33:893-912. [PMID: 36074947 PMCID: PMC7615302 DOI: 10.1089/hum.2022.172] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The prospect of gene therapy for inherited and acquired respiratory disease has energized the research community since the 1980s, with cystic fibrosis, as a monogenic disorder, driving early efforts to develop effective strategies. The fact that there are still no approved gene therapy products for the lung, despite many early phase clinical trials, illustrates the scale of the challenge: In the 1990s, first-generation non-viral and viral vector systems demonstrated proof-of-concept but low efficacy. Since then, there has been steady progress toward improved vectors with the capacity to overcome at least some of the formidable barriers presented by the lung. In addition, the inclusion of features such as codon optimization and promoters providing long-term expression have improved the expression characteristics of therapeutic transgenes. Early approaches were based on gene addition, where a new DNA copy of a gene is introduced to complement a genetic mutation: however, the advent of RNA-based products that can directly express a therapeutic protein or manipulate gene expression, together with the expanding range of tools for gene editing, has stimulated the development of alternative approaches. This review discusses the range of vector systems being evaluated for lung delivery; the variety of cargoes they deliver, including DNA, antisense oligonucleotides, messenger RNA (mRNA), small interfering RNA (siRNA), and peptide nucleic acids; and exemplifies progress in selected respiratory disease indications.
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Affiliation(s)
- Gerry McLachlan
- The Roslin Institute & R(D)SVS, University of Edinburgh, Edinburgh, United Kingdom
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
| | - Eric W F W Alton
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - A Christopher Boyd
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
- Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Edinburgh, United Kingdom
| | - Nora K Clarke
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jane C Davies
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Deborah R Gill
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
- Gene Medicine Group, Radcliffe Department of Medicine (NDCLS), University of Oxford, Oxford, United Kingdom
| | - Uta Griesenbach
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jack W Hickmott
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Stephen C Hyde
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
- Gene Medicine Group, Radcliffe Department of Medicine (NDCLS), University of Oxford, Oxford, United Kingdom
| | - Kamran M Miah
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
- Gene Medicine Group, Radcliffe Department of Medicine (NDCLS), University of Oxford, Oxford, United Kingdom
| | - Claudia Juarez Molina
- UK Respiratory Gene Therapy Consortium, London, United Kingdom
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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12
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Advances in Imaging of the ChILD – Childhood Interstitial Lung Disease. Radiol Clin North Am 2022; 60:1003-1020. [DOI: 10.1016/j.rcl.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Laenger FP, Schwerk N, Dingemann J, Welte T, Auber B, Verleden S, Ackermann M, Mentzer SJ, Griese M, Jonigk D. Interstitial lung disease in infancy and early childhood: a clinicopathological primer. Eur Respir Rev 2022; 31:31/163/210251. [PMID: 35264412 PMCID: PMC9488843 DOI: 10.1183/16000617.0251-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023] Open
Abstract
Children's interstitial lung disease (chILD) encompasses a wide and heterogeneous spectrum of diseases substantially different from that of adults. Established classification systems divide chILD into conditions more prevalent in infancy and other conditions occurring at any age. This categorisation is based on a multidisciplinary approach including clinical, radiological, genetic and histological findings. The diagnostic evaluation may include lung biopsies if other diagnostic approaches failed to identify a precise chILD entity, or if severe or refractory respiratory distress of unknown cause is present. As the majority of children will be evaluated and diagnosed outside of specialist centres, this review summarises relevant clinical, genetic and histological findings of chILD to provide assistance in clinical assessment and rational diagnostics. ILD of childhood is comparable by name only to lung disease in adults. A dedicated interdisciplinary team is required to achieve the best possible outcome. This review summarises the current clinicopathological criteria and associated genetic alterations.https://bit.ly/3mpxI3b
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Affiliation(s)
- Florian Peter Laenger
- Institute of Pathology, Medical School Hannover, Hannover, Germany .,German Center for Lung Research (DZL), Hannover, Germany
| | - Nicolaus Schwerk
- German Center for Lung Research (DZL), Hannover, Germany.,Clinic for Pediatric Pneumology, Allergology and Neonatology, Medical School Hannover, Hannover, Germany
| | - Jens Dingemann
- German Center for Lung Research (DZL), Hannover, Germany.,Dept of Pediatric Surgery, Medical School Hannover, Hannover, Germany
| | - Tobias Welte
- German Center for Lung Research (DZL), Hannover, Germany.,Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Bernd Auber
- Dept of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Stijn Verleden
- Antwerp Surgical Training, Anatomy and Research Center, University of Antwerp, Antwerp, Belgium
| | - Maximilian Ackermann
- Division of Thoracic Surgery, Dept of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven J Mentzer
- Division of Thoracic Surgery, Dept of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthias Griese
- German Center for Lung Research (DZL), Hannover, Germany.,Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Danny Jonigk
- Institute of Pathology, Medical School Hannover, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
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14
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Gooptu B. Surfactant protein C mutations and familial pulmonary fibrosis: stuck in a loop on the scenic route. Eur Respir J 2022; 59:59/1/2102147. [PMID: 35086844 DOI: 10.1183/13993003.02147-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/27/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Bibek Gooptu
- Dept of Respiratory Medicine, University Hospitals of Leicester, Institute for Lung Health, NIHR Biomedical Research Centre, Leicester, UK .,Dept of Respiratory Sciences, University of Leicester, Glenfield Hospital, Leicester, UK.,Leicester Institute of Structural and Chemical Biology, University of Leicester, Leicester, UK
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15
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Acosta-Rivera V, Melendez-Montañez JM, Diaz-Sotomayor F, De Jesús-Rojas W. Surfactant Protein C Deficiency in a Puerto Rican Adolescent With a Rare SFTPC Genetic Variant. Cureus 2021; 13:e17422. [PMID: 34589332 PMCID: PMC8460488 DOI: 10.7759/cureus.17422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
Surfactant protein C (SP-C) is a hydrophobic lipoprotein necessary for lowering alveolar surface tension and lung defense mechanisms. Defects in its function due to genetic mutations in the SFTPC gene have been increasingly identified in patients presenting with childhood interstitial lung disease. SFTPC mutations are inherited in an autosomal dominant pattern with reduced penetration and variable expressivity, although de novo mutations have also been documented. In this article, we present the case of an oxygen-dependent 13-year-old male with interstitial lung disease and severe pulmonary hypertension. Genetic analysis and lung biopsy confirmed the diagnosis of SP-C deficiency with the rare heterozygous mutation IVS4+2. To our knowledge, this is the first documented case of SP-C deficiency in the Puerto Rican population and the second worldwide with the IVS4+2 genetic mutation.
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Affiliation(s)
- Victor Acosta-Rivera
- Department of Internal Medicine, University of Massachusetts Medical School, Massachusetts, USA.,Department of Internal Medicine, Ponce Health Sciences University, Ponce, PRI
| | | | | | - Wilfredo De Jesús-Rojas
- Department of Pediatrics, Ponce Health Sciences University, Ponce, PRI.,Department of Pediatrics, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
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16
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Darawshy F, Rmeileh AA, Kuint R, Berkman N. Possible association between SP-C mutations and lung cancer: Two case reports and review of literature. Cancer Treat Res Commun 2021; 29:100461. [PMID: 34600418 DOI: 10.1016/j.ctarc.2021.100461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Surfactant protein C (SP-C) is one of four surfactant proteins produced by type II pneumocytes. Mutations in surfactant protein A are strongly associated with development of lung cancer. Mutations in the SP-C gene are rare and are associated with interstitial lung disease in the pediatric age group. We describe two patients with SP-C mutations who developed lung cancer. Both patients had concurrent interstitial lung disease, although the clinical phenotype was variable. In both cases, mutations were in translated region of the SP-C gene; one in the BRICHOS domain and the other in the transmembrane domain. Our paper suggests that patients with SP-C mutations can be at increased risk for the development of lung cancer, and it's reasonable to follow them routinely.
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Affiliation(s)
- Fares Darawshy
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Ayman Abu Rmeileh
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Rottem Kuint
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Neville Berkman
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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