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Gu J, Gong D, Wang Y, Feng T, Zhang J, Hu S, Min L. Chronic exposure to IQOS results in impaired pulmonary function and lung tissue damage in mice. Toxicol Lett 2023; 374:1-10. [PMID: 36462770 DOI: 10.1016/j.toxlet.2022.11.022] [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: 03/15/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
The use of IQOS brand heated tobacco products (HTPs) is increasing worldwide; however, little is known about the long-term effects of HTPs aerosol exposure on the lungs. Herein, we exposed C57BL/6 J mice for 24 weeks to clean air, IQOS aerosol, or cigarette smoke, and determined pulmonary function, lung tissue pathology, inflammation, and oxidative stress. Compared with the control group mice, IQOS group mice showed substantially decreased weight and lung function. Levels of IL-6 and TNF-a, as well as oxidative stress markers, were comparable to those found in the cigarette group. In addition, hematoxylin and eosin staining showed that the alveolar space was enlarged and that emphysema had formed in the IQOS group. Masson staining showed that collagen deposition areas were substantially increased in the airway walls in the IQOS group than in the control group. Immunohistochemical staining showed epithelial-mesenchymal transition in the airways of mice in the IQOS group. In conclusion, chronic exposure to IQOS aerosol results in impaired pulmonary function and lung tissue damage; hence, concern should be raised regarding the long-term safety of this product.
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Affiliation(s)
- Jianjun Gu
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou University, Yangzhou 225001, Jiangsu, China
| | - Daohui Gong
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou University, Yangzhou 225001, Jiangsu, China
| | - Yuxiu Wang
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou University, Yangzhou 225001, Jiangsu, China
| | - Tingting Feng
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou University, Yangzhou 225001, Jiangsu, China
| | - Jun Zhang
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou University, Yangzhou 225001, Jiangsu, China
| | - Suwei Hu
- Medical Genetic Center, Yangzhou Maternal and Child Health Care Service Centre, The Affiliated Hospital of Yangzhou University Medical College, Yangzhou, Jiangsu, China
| | - Lingfeng Min
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou University, Yangzhou 225001, Jiangsu, China.
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2
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Herman KD, Wright CG, Marriott HM, McCaughran SC, Bowden KA, Collins MO, Renshaw SA, Prince LR. The EGFR/ErbB inhibitor neratinib modifies the neutrophil phosphoproteome and promotes apoptosis and clearance by airway macrophages. Front Immunol 2022; 13:956991. [PMID: 35967296 PMCID: PMC9371615 DOI: 10.3389/fimmu.2022.956991] [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] [Received: 05/31/2022] [Accepted: 07/04/2022] [Indexed: 12/05/2022] Open
Abstract
Dysregulated neutrophilic inflammation can be highly destructive in chronic inflammatory diseases due to prolonged neutrophil lifespan and continual release of histotoxic mediators in inflamed tissues. Therapeutic induction of neutrophil apoptosis, an immunologically silent form of cell death, may be beneficial in these diseases, provided that the apoptotic neutrophils are efficiently cleared from the tissue. Previous research in our group identified ErbB inhibitors as able to induce neutrophil apoptosis and reduce neutrophilic inflammation both in vitro and in vivo. Here, we extend that work using a clinical ErbB inhibitor, neratinib, which has the potential to be repurposed in inflammatory diseases. We show that neratinib reduces neutrophilic migration o an inflammatory site in zebrafish larvae. Neratinib upregulates efferocytosis and reduces the number of persisting neutrophil corpses in mouse models of acute, but not chronic, lung injury, suggesting that the drug may have therapeutic benefits in acute inflammatory settings. Phosphoproteomic analysis of human neutrophils shows that neratinib modifies the phosphorylation of proteins regulating apoptosis, migration, and efferocytosis. This work identifies a potential mechanism for neratinib in treating acute lung inflammation by upregulating the clearance of dead neutrophils and, through examination of the neutrophil phosphoproteome, provides important insights into the mechanisms by which this may be occurring.
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Affiliation(s)
- Kimberly D Herman
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease and The Bateson Centre, The Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Carl G Wright
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Helen M Marriott
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Sam C McCaughran
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Kieran A Bowden
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Mark O Collins
- Department of Biomedical Science, University of Sheffield, Sheffield, United Kingdom
| | - Stephen A Renshaw
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease and The Bateson Centre, The Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Lynne R Prince
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, United Kingdom
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3
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Feng Q, Yu YZ, Meng QH. Blocking tumor necrosis factor-α delays progression of chronic obstructive pulmonary disease in rats through inhibiting MAPK signaling pathway and activating SOCS3/TRAF1. Exp Ther Med 2021; 22:1311. [PMID: 34630665 PMCID: PMC8461615 DOI: 10.3892/etm.2021.10746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/25/2021] [Indexed: 01/04/2023] Open
Abstract
The present study was conducted in order to study the detailed molecular mechanism of tumor necrosis factor (TNF)-α in chronic obstructive pulmonary disease (COPD). The rats were treated with cigarette smoke (CS) and lipopolysaccharide (LPS) to establish the COPD model. Next, the changes in lung injury in COPD rats with TNF-α knockdown was tested. Meanwhile, the regulation of TNF-α on MAPK pathway and its downstream molecules (SOCS3/TRAF1) was determined by western blotting. On this basis, the activation of MAPK and inhibition of SOCS3/TRAF1 was also examined. Subsequently, the lung function was tested with the plethysmograph, the cells of bronchoalveolar lavage fluid was counted and classified. Furthermore, lung tissue sections were stained with hematoxylin and eosin to verify whether the treatment of MAPK pathway and downstream molecules affected the effect of TNF-α knockdown on COPD. The present study showed that TNF-α knockdown could alleviate the decrease in the function and inflammatory injury of the lungs of rats with COPD. Western blot analysis verified that TNF-α knockdown could inhibit the activation of MAPK pathway and increase the expression of SOCS3/TRAF1. The following experimental results showed that the relief of lung injury caused by TNF-α knockdown could be deteriorated by activating MAPK pathway. It was also found that the symptom of COPD was decreased following transfection with sh-TNF-α but worsened by SOCS3/TRAF1 knockdown. Overall, TNF-α knockdown inhibited the activation of MAPK pathway and increased the expression of SOCS3/TRAF1, thus delaying the process of COPD.
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Affiliation(s)
- Qiong Feng
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Jianghan University, Wuhan, Hubei 430015, P.R. China
| | - Yan-Zi Yu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Jianghan University, Wuhan, Hubei 430015, P.R. China
| | - Qing-Hua Meng
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Jianghan University, Wuhan, Hubei 430015, P.R. China
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4
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Shafiek H, Verdú J, Iglesias A, Ramon-Clar L, Toledo-Pons N, Lopez-Causape C, Juan C, Fraile-Ribot P, Oliver A, Cosio BG. Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD. BMJ Open Respir Res 2021; 8:8/1/e001067. [PMID: 34615691 PMCID: PMC8496398 DOI: 10.1136/bmjresp-2021-001067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease (COPD) with frequent exacerbations (ExCOPD) are commonly treated with inhaled corticosteroids (ICS) and are at risk of infections caused by potential pathogenic bacteria (PPB) including Pseudomonas aeruginosa (PsA). OBJECTIVES To investigate the association between the use of ICS and PsA infection among ExCOPD. METHODS Case-control study with longitudinal follow-up that recruited ExCOPD after a hospitalisation due to exacerbation between 2012 and 2020. Patients with isolation of PsA (COPD-PsA) in sputum either during admission or follow-up were compared with those with other or no PPB. Clinical, functional characteristics, DDD, use of ICS and survival were evaluated. Cox regression analysis was performed to evaluate the risk factors associated to PsA infection and mortality. RESULTS 358 patients (78% male, mean age 73±9 years) were enrolled and followed up for a median of 4 years (IQR=3-8). 173 patients (48.3%) had at least a positive culture for PsA. COPD-PsA had more frequent exacerbations, more severe airflow limitation and higher mortality (69.4% vs 46.5%, p<0.001). There were no differences in the use of ICS between groups but the dose of ICS was significantly higher among COPD-PsA (median of 500 µg fluticasone propionate equivalents (IQR=250-1000) vs 400 µg (IQR=200-1000), p=0.007). Blood eosinophil count (BEC) was not different between ICS users and non-users. In multivariate analysis, the dose of ICS was an independent risk factor for PsA infection and mortality but not ICS use. CONCLUSIONS ICS dose, but not its use, could be a risk factor for PsA infection in patients with severe COPD regardless of BEC.
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Affiliation(s)
- Hanaa Shafiek
- Department of Chest Diseases, Alexandria University Faculty of Medicine, Alexandria, Egypt.,Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Javier Verdú
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Amanda Iglesias
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Lluisa Ramon-Clar
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Nuria Toledo-Pons
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Carla Lopez-Causape
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain.,Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Carlos Juan
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain.,Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Pablo Fraile-Ribot
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain.,Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Antonio Oliver
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain.,Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Borja G Cosio
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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5
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Naz İ, Şahin H, Aktaş B. Predictors of improvement in resting heart rate after exercise training in patients with chronic obstructive pulmonary disease. Ir J Med Sci 2021; 191:1613-1619. [PMID: 34510377 DOI: 10.1007/s11845-021-02771-4] [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: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND High resting heart rate (RHR) is associated with multiple morbidity in chronic obstructive pulmonary disease (COPD) patients. Factors regarding the effectiveness of exercise training (ET) on RHR in COPD patients are unclear. AIMS The main objective of the current study is to determine the predictors of the eventual change in RHR after ET. METHODS One hundred and ten COPD patients (mean age: 63.1 ± 8.1 years, FEV1%: 43.6 ± 16.6) who participated in the ET program that consisted of supervised breathing, aerobic, strengthening, and stretching exercises for 8 weeks, 2 days a week, were included in the study. RHR, pulmonary functions, 6-min walk distance (6-MWD), Modified Medical Research Council Dyspnea Scale, St. George Respiratory Questionnaire, and Hospital Anxiety and Depression scores were compared before and after ET. Multivariate regression analysis was performed to correlate factors related to changes in RHR before and after exercise. RESULTS There was a significant improvement in RHR after the ET program (p < 0.001). Improvement in RHR was correlated with baseline RHR, 6-MWD, partial arterial oxygen pressure, dyspnea sensation, forced expiratory volume in the first second (r = 0.516, -0.388, -0.489, 0.369, -0.360, p < 0.05, respectively), and change in 6-MWD, partial arterial oxygen pressure, and symptom score (r = 0.523, 0.451, -0.325, p < 0.05, respectively) after ET. Baseline RHR, 6-MWD, and the change in 6-MWD were the independent factors that predicted the change in RHR after ET. CONCLUSIONS Patients with a high RHR and low functional capacity and whose functional capacity improves more have a greater decrease in RHR after the ET program. By considering these related factors, clinicians can focus on improving the cardiovascular system in COPD patients. CLINICAL TRIAL NUMBER NCT04890080 (retrospectively registered-date of registration: 05.17.2021).
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Affiliation(s)
- İlknur Naz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Kâtip Celebi University, 35620, Çiğli, İzmir, Turkey.
| | - Hülya Şahin
- Chest Diseases Clinic, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Büşra Aktaş
- Institute of Health Sciences, Izmir Kâtip Celebi University, Izmir, Turkey
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6
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Chakrabarti A, Mar JS, Choy DF, Cao Y, Rathore N, Yang X, Tew GW, Li O, Woodruff PG, Brightling CE, Grimbaldeston M, Christenson SA, Bafadhel M, Rosenberger CM. High serum granulocyte-colony stimulating factor characterises neutrophilic COPD exacerbations associated with dysbiosis. ERJ Open Res 2021; 7:00836-2020. [PMID: 34350278 PMCID: PMC8326681 DOI: 10.1183/23120541.00836-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/09/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction COPD exacerbations are heterogeneous and can be triggered by bacterial, viral, or noninfectious insults. Exacerbations are also heterogeneous in neutrophilic or eosinophilic inflammatory responses. A noninvasive peripheral biomarker of COPD exacerbations characterised by bacterial/neutrophilic inflammation is lacking. Granulocyte-colony stimulating factor (G-CSF) is a key cytokine elevated during bacterial infection and mediates survival, proliferation, differentiation and function of neutrophils. Objective We hypothesised that high peripheral G-CSF would be indicative of COPD exacerbations with a neutrophilic and bacterial phenotype associated with microbial dysbiosis. Methods Serum G-CSF was measured during hospitalised exacerbation (day 0 or D0) and after 30 days of recovery (Day30 or D30) in 37 subjects. In a second cohort, serum and sputum cytokines were measured in 59 COPD patients during stable disease, at exacerbation, and at 2-weeks and 6-weeks following exacerbation. Results Serum G-CSF was increased during exacerbation in a subset of patients. These exacerbations were enriched for bacterial but not viral or type-2 biologies. The median serum G-CSF level was 1.6-fold higher in bacterial exacerbation compared to nonbacterial exacerbation (22 pg·mL−1versus 13 pg·mL−1, p=0.0007). Serum G-CSF classified bacterial exacerbations with an area under the curve (AUC) for the receiver operating characteristic (ROC) curve equal to 0.76. Exacerbations with a two-fold or greater increase in serum G-CSF were characterised by neutrophilic inflammation, with increased sputum and blood neutrophils, and high sputum interleukin (IL)-1β, IL-6 and serum amyloid A1 (SAA1) levels. These exacerbations were preceded by dysbiosis, with decreased microbiome diversity and enrichment of respiratory pathogens such as Haemophilus and Moraxella. Furthermore, serum G-CSF at exacerbation classified neutrophilic-dysbiotic exacerbations (AUC for the ROC curve equal to 0.75). Conclusions High serum G-CSF enriches for COPD exacerbations characterised by neutrophilic inflammation with underlying bacterial dysbiosis. Noninvasive biomarkers to characterise #AECOPD subtypes are limited. High serum G-CSF enriches for COPD exacerbations associated with bacterial infection and neutrophilic inflammation preceded by lung microbial dysbiosis.https://bit.ly/3rck3M6
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Affiliation(s)
| | - Jordan S Mar
- Biomarker Discovery OMNI, Genentech Inc., South San Francisco, CA, USA
| | - David F Choy
- Biomarker Discovery OMNI, Genentech Inc., South San Francisco, CA, USA
| | - Yi Cao
- Bioinformatics, Genentech Inc., South San Francisco, CA, USA
| | - Nisha Rathore
- Biomarker Discovery OMNI, Genentech Inc., South San Francisco, CA, USA
| | - Xiaoying Yang
- Biostatistics, Genentech Inc., South San Francisco, CA, USA
| | - Gaik W Tew
- OMNI Biomarker Development, Genentech Inc., South San Francisco, CA, USA
| | - Olga Li
- OMNI Biomarker Development, Genentech Inc., South San Francisco, CA, USA
| | | | | | | | | | - Mona Bafadhel
- Nuffield Dept of Medicine, University of Oxford, Oxford, UK
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7
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Impact of COPD exacerbations leading to hospitalization on general and disease-specific quality of life. Respir Med 2021; 186:106526. [PMID: 34229290 DOI: 10.1016/j.rmed.2021.106526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 01/01/2023]
Abstract
RATIONALE Acute exacerbations negatively impact quality of life in patients with chronic obstructive pulmonary disease (COPD), but the impact of hospitalized exacerbations on quality of life is not clear. We hypothesized that patients with hospitalized exacerbations would benefit from hospitalization and experience improvement in general and disease-specific quality of life (as measured by the St. George's respiratory questionnaire (SGRQ) and the medical outcomes study 36-item short form health survey (SF-36)) compared to those without exacerbations, or with non-hospitalized acute exacerbations. METHODS 1219 COPD patients enrolled in either the simvastatin for the prevention of exacerbations in moderate-to severe COPD Trial (STATCOPE) or azithromycin for prevention of exacerbations of COPD trial (MACRO) were analyzed. Demographic information, spirometry, and symptom scores were noted at baseline. Exacerbation events and changes in quality of life scores were assessed over a mean of 538 days of follow-up. RESULTS Of patients studied, 25.6% were hospitalized, 44.0% had at least one outpatient exacerbation, and 30.4% had no exacerbation. Baseline SGRQ and SF-36 scores were severely impaired in all groups studied. Over time, SF-36 scores did not change significantly between groups. SGRQ symptom domain scores improved in other groups but did not improve in those hospitalized for a COPD exacerbation. CONCLUSIONS At baseline, patients hospitalized for acute exacerbations of COPD had more impaired quality of life scores. Over time, SGRQ symptom domain scores improved in other groups but did not in those who were hospitalized. Other measurements of quality of life were not improved by hospitalization for COPD.
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8
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Groves D, Karsanji U, Evans RA, Greening N, Singh SJ, Quint JK, Whittaker H, Richardson M, Barrett J, Sutch SP, Steiner MC. Predicting Future Health Risk in COPD: Differential Impact of Disease-Specific and Multi-Morbidity-Based Risk Stratification. Int J Chron Obstruct Pulmon Dis 2021; 16:1741-1754. [PMID: 34163156 PMCID: PMC8215908 DOI: 10.2147/copd.s303202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Multi-morbidity contributes to mortality and hospitalisation in COPD, but it is uncertain how this interacts with disease severity in risk prediction. We compared contributions of multi-morbidity and disease severity factors in modelling future health risk using UK primary care healthcare data. Methods Health records from 103,955 patients with COPD identified from the Clinical Practice Research Datalink were analysed. We compared area under the curve (AUC) statistics for logistic regression (LR) models incorporating disease indices with models incorporating categorised comorbidities. We also compared these models with performance of The John Hopkins Adjusted Clinical Groups® System (ACG) risk prediction algorithm. Results LR models predicting all-cause mortality outperformed models predicting hospitalisation. Mortality was best predicted by disease severity (AUC & 95% CI: 0.816 (0.805–0.827)) and prediction was enhanced only marginally by the addition of multi-morbidity indices (AUC & 95% CI: 0.829 (0.818–0.839)). The model combining disease severity and multi-morbidity indices was a better predictor of hospitalisation (AUC & 95% CI: 0.679 (0.672–0.686)). ACG-derived LR models outperformed conventional regression models for hospitalisation (AUC & 95% CI: 0.697 (0.690–0.704)) but not for mortality (AUC & 95% CI: 0.816 (0.805–0.827)). Conclusion Stratification of future health risk in COPD can be undertaken using clinical and demographic data recorded in primary care, but the impact of disease severity and multi-morbidity varies depending on the choice of health outcome. A more comprehensive risk modelling algorithm such as ACG offers enhanced prediction for hospitalisation by incorporating a wider range of coded diagnoses.
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Affiliation(s)
- David Groves
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Urvee Karsanji
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Rachael A Evans
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Neil Greening
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Sally J Singh
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Richardson
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - James Barrett
- Johns Hopkins HealthCare Solutions, Baltimore, MD, USA
| | - Stephen P Sutch
- Bloomberg School of Public Health, John Hopkins University, Department of Health Policy and Management, Baltimore, MD, USA
| | - Michael C Steiner
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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9
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Pascual-Guardia S, Ataya M, Ramírez-Martínez I, Yélamos J, Chalela R, Bellido S, López-Botet M, Gea J. Adaptive NKG2C+ natural killer cells are related to exacerbations and nutritional abnormalities in COPD patients. Respir Res 2020; 21:63. [PMID: 32131843 PMCID: PMC7057582 DOI: 10.1186/s12931-020-1323-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
Abstract
Abstract Chronic obstructive pulmonary disease (COPD) is a chronic and often progressive disorder with a heterogeneous presentation and frequent systemic manifestations. Several aspects like persistence in smoking habit, continuous exacerbations, alpha-1-antitrypsin deficiency and inflammatory-immune response, are involved in the pathophysiology and progression of the disease. However, the role of natural killer (NK) cells remains controversial. Otherwise, human cytomegalovirus (HCMV) infection has been reported to induce an adaptive differentiation and expansion of an NK cell subset which carries the CD94/NKG2C receptor, which may contribute to an upset immune defense. For these reasons, our objective is to assess the distribution of NK cells and their subset in COPD patients and some of its phenotypes. Methods Peripheral blood samples were obtained from 66 COPD patients. HCMV serology and the proportions of total NK cells and the NKG2C+ and NKG2A+ subsets were evaluated by flow cytometry. The NKG2C genotype was also assessed. Results Eighty-eight per cent of COPD patients were HCMV(+), and the proportions of total NK cells were higher in patients with severe-very severe airway obstruction than in those with only mild-moderate involvement. There were no differences in the proportions of NKG2C+ cells between controls and COPD, either among COPD patients classified by severity of the disease. However, the percentage of NKG2C+ cells were higher in COPD patients with frequent exacerbations than in occasional exacerbators, and higher in cases with reduced lean mass (Fat free mass index) than in those with normal nutritional status. Conclusion These results suggest a relationship between levels of NKG2C+ cells in COPD patients and clinical variables closely linked to a poor/worse prognosis.
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Affiliation(s)
- Sergi Pascual-Guardia
- Respiratory Department, Hospital del Mar, Pg. Marítim 27, 08003, Barcelona, Spain. .,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain. .,CIBERES, ISCIII, Barcelona, Spain. .,Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra, Barcelona, Spain.
| | - Michelle Ataya
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Isabel Ramírez-Martínez
- Immunology Department, Hospital del Mar, Barcelona, Spain.,Psychiatry department, Hospital Torrecardenas, Almería, Spain
| | - José Yélamos
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Immunology Department, Hospital del Mar, Barcelona, Spain
| | - Roberto Chalela
- Respiratory Department, Hospital del Mar, Pg. Marítim 27, 08003, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBERES, ISCIII, Barcelona, Spain.,Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Salomé Bellido
- Respiratory Department, Hospital del Mar, Pg. Marítim 27, 08003, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Miguel López-Botet
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBERES, ISCIII, Barcelona, Spain.,Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra, Barcelona, Spain.,Immunology Department, Hospital del Mar, Barcelona, Spain
| | - Joaquim Gea
- Respiratory Department, Hospital del Mar, Pg. Marítim 27, 08003, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBERES, ISCIII, Barcelona, Spain.,Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra, Barcelona, Spain.,Barcelona Respiratory Network, Barcelona, Spain
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10
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Barreiro E, Wang X, Tang J. COPD: preclinical models and emerging therapeutic targets. Expert Opin Ther Targets 2019; 23:829-838. [DOI: 10.1080/14728222.2019.1667976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Esther Barreiro
- Respiratory Medicine Department, Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Institute of Medical Research of Hospital del Mar (IMIM)-Hospital del Mar, Parc de Salut Mar, Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Health Sciences (CEXS), Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Xuejie Wang
- Respiratory Medicine Department, Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Institute of Medical Research of Hospital del Mar (IMIM)-Hospital del Mar, Parc de Salut Mar, Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Jun Tang
- Respiratory Medicine Department, Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Institute of Medical Research of Hospital del Mar (IMIM)-Hospital del Mar, Parc de Salut Mar, Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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11
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Ergosterol attenuates cigarette smoke extract-induced COPD by modulating inflammation, oxidative stress and apoptosis in vitro and in vivo. Clin Sci (Lond) 2019; 133:1523-1536. [PMID: 31270147 DOI: 10.1042/cs20190331] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023]
Abstract
Cigarette smoke (CS) is the major cause of chronic obstructive pulmonary disease (COPD). CS heightens inflammation, oxidative stress and apoptosis. Ergosterol is the main bioactive ingredient in Cordyceps sinensis (C. sinensis), a traditional medicinal herb for various diseases. The objective of this work was to investigate the effects of ergosterol on anti-inflammatory and antioxidative stress as well as anti-apoptosis in a cigarette smoke extract (CSE)-induced COPD model both in vitro and in vivo Our results demonstrate that CSE induced inflammatory and oxidative stress and apoptosis with the involvement of the Bcl-2 family proteins via the nuclear factor kappa B (NF-κB)/p65 pathway in both 16HBE cells and Balb/c mice. CSE induced epithelial cell death and increased the expression of nitric oxide (NO), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), malondialdehyde (MAD) and the apoptosis-related proteins cleaved caspase 3/7/9 and cleaved-poly-(ADP)-ribose polymerase (PARP) both in vitro and in vivo, whereas decreased the levels of superoxide dismutase (SOD) and catalase (CAT). Treatment of 16HBE cells and Balb/c mice with ergosterol inhibited CSE-induced inflammatory and oxidative stress and apoptosis by inhibiting the activation of NF-κB/p65. Ergosterol suppressed apoptosis by inhibiting the expression of the apoptosis-related proteins both in vitro and in vivo Moreover, the usage of QNZ (an inhibitor of NF-κB) also partly demonstrated that NF-κB/p65 pathway was involved in the ergosterol protective progress. These results show that ergosterol suppressed COPD inflammatory and oxidative stress and apoptosis through the NF-κB/p65 pathway, suggesting that ergosterol may be partially responsible for the therapeutic effects of cultured C. sinensis on COPD patients.
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12
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Yan F, Gao H, Zhao H, Bhatia M, Zeng Y. Roles of airway smooth muscle dysfunction in chronic obstructive pulmonary disease. J Transl Med 2018; 16:262. [PMID: 30257694 PMCID: PMC6158847 DOI: 10.1186/s12967-018-1635-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/16/2018] [Indexed: 12/24/2022] Open
Abstract
The airway smooth muscle (ASM) plays an indispensable role in airway structure and function. Dysfunction in ASM plays a central role in the pathogenesis of chronic obstructive pulmonary disease (COPD) and contributes to alterations of contractility, inflammatory response, immunoreaction, phenotype, quantity, and size of airways. ASM makes a key contribution in COPD by various mechanisms including altered contractility and relaxation induce by [Ca2+]i, cell proliferation and hypertrophy, production and modulation of extracellular cytokines, and release of pro-and-anti-inflammatory mediators. Multiple dysfunctions of ASM contribute to modulating airway responses to stimuli, remodeling, and fibrosis, as well as influence the compliance of lungs. The present review highlights regulatory roles of multiple factors in the development of ASM dysfunction in COPD, aims to understand the regulatory mechanism by which ASM dysfunctions are initiated, and explores the clinical significance of ASM on alterations of airway structure and function in COPD and development of novel therapeutic strategies for COPD.
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Affiliation(s)
- Furong Yan
- Center for Molecular Diagnosis and Therapy, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Hongzhi Gao
- Center for Molecular Diagnosis and Therapy, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Hong Zhao
- Center for Molecular Diagnosis and Therapy, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Madhav Bhatia
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Yiming Zeng
- Department of Pulmonary and Critical Care Medicine, Respiratory Medicine Center of Fujian Province, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China.
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13
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Qin J, Qin Y, Wu Y, Wei A, Luo M, Liao L, Lin F. Application of albumin/globulin ratio in elderly patients with acute exacerbation of chronic obstructive pulmonary disease. J Thorac Dis 2018; 10:4923-4930. [PMID: 30233866 DOI: 10.21037/jtd.2018.07.47] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has become an important disease of hospitalized elderly patients, which lack simple and inexpensive indicators for evaluating the condition and prognosis. This study was performed to investigate the clinical significance of the serum albumin/globulin ratio (AGR) in elderly patients with AECOPD. Methods The data of 252 hospitalized elderly patients with AECOPD, 89 stable COPD patients and 115 elderly healthy individuals were analyzed and compared. The differences in the AGR, logarithm of the serum C-reactive protein (LogCRP) level, prealbumin (PA) level, and immunoglobulin G (IgG) level were compared. AECOPD patients were grouped using the optimal cutoff values of each index to compare the difference in the combined infection rate. The correlation between hospital stays and AGR was analyzed. Results The AGR, LogCRP, PA level, and IgG level were different among the AECOPD group, stable COPD group and healthy control groups (P<0.05). The AGR, LogCRP, and PA level were different (P<0.05) among the Global Initiative for Chronic Obstructive Lung Disease (GOLD) I, II, II, and IV groups. Age, AGR, LogCRP, and PA level were different (P<0.05) between the infection and non-infection groups. After grouping according to the optimal cutoff values, the combined infection rate was different (P<0.05). The AGR was negatively correlated with the hospital stay (r=-0.583, P<0.001). The hospital stay was longer in patients with an AGR of <1.37 than ≥1.37 (P<0.001). Conclusions The AGR can be regarded as a reference index for evaluating the condition of elderly patients with AECOPD, determining the presence of combined infection, and predicting the prognosis.
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Affiliation(s)
- Jinqiu Qin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yuanyuan Qin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yangyang Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Aiqiu Wei
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Meiling Luo
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Lin Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Faquan Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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Hwang J, Oh YM, Lee M, Choi S, Seo JB, Lee SM, Kim N. Low morphometric complexity of emphysematous lesions predicts survival in chronic obstructive pulmonary disease patients. Eur Radiol 2018; 29:176-185. [PMID: 29959456 DOI: 10.1007/s00330-018-5551-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/20/2018] [Accepted: 05/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate whether morphometric complexity in the lung can predict survival and act as a new prognostic marker in patients with chronic obstructive pulmonary disease (COPD). METHODS COPD (n = 302) patients were retrospectively reviewed. All patients underwent volumetric computed tomography and pulmonary function tests at enrollment (2005-2015). For complexity analysis, we applied power law exponent of the emphysema size distribution (Dsize) as well as box-counting fractal dimension (Dbox3D) analysis. Patients' survival at February 2017 was ascertained. Univariate and multivariate Cox proportional hazards analyses were performed, and prediction performances of various combinatorial models were compared. RESULTS Patients were 66 ± 6 years old, had 41 ± 28 pack-years' smoking history and variable GOLD stages (n = 20, 153, 108 and 21 in stages I-IV). The median follow-up time was 6.1 years (range: 0.2-11.6 years). Sixty-three patients (20.9%) died, of whom 35 died of lung-related causes. In univariate Cox analysis, lower Dsize and Dbox3D were significantly associated with both all-cause and lung-related mortality (both p < 0.001). In multivariate analysis, the backward elimination method demonstrated that Dbox3D, along with age and the BODE index, was an independent predictor of survival (p = 0.014; HR, 2.08; 95% CI, 1.16-3.71). The contributions of Dsize and Dbox3D to the combinatorial survival model were comparable with those of the emphysema index and lung-diffusing capacity. CONCLUSIONS Low morphometric complexity in the lung is a predictor of survival in patients with COPD. KEY POINTS • A newly suggested method for quantifying lung morphometric complexity is feasible. • Morphometric complexity measured on chest CT images predicts COPD patients' survival. • Complexity, diffusing capacity and emphysema index contribute similarly to the survival model.
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Affiliation(s)
- Jeongeun Hwang
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Seoul, 05505, Republic of Korea
| | - Minho Lee
- Biomedical Engineering Research Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Seunghyun Choi
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Seoul, 05505, Republic of Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Seoul, 05505, Republic of Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Seoul, 05505, Republic of Korea.
| | - Namkug Kim
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Seoul, 05505, Republic of Korea.
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Seoul, 05505, Republic of Korea.
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Nyberg A, Wadell K, Lindgren H, Tistad M. Internet-based support for self-management strategies for people with COPD-protocol for a controlled pragmatic pilot trial of effectiveness and a process evaluation in primary healthcare. BMJ Open 2017; 7:e016851. [PMID: 28765136 PMCID: PMC5642786 DOI: 10.1136/bmjopen-2017-016851] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/26/2017] [Accepted: 06/30/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The use of adequate self-management strategies for people with chronic obstructive pulmonary disease (COPD) reduces healthcare use, improves health-related quality of life (HRQoL) and recovery after acute exacerbations. However, not many people with COPD receive support that promotes the use of such strategies and therefore new methods to facilitate and promote the use of self-management strategies are highly warranted. This pilot trial aims to evaluate the feasibility of the study design and study procedures considering effectiveness of the novel intervention, the COPD-web. METHODS AND ANALYSIS: The overall design is a pragmatic controlled pilot trial with preassessments and postassessments and a parallel process evaluation. Patients with the diagnosis of COPD will be eligible for the study. The intervention group will be recruited when visiting one of the six participating primary care units in Sweden. The control group will be identified from the unit's computerised registers. The intervention, the COPD-web, is an interactive web page with two sections; one directed at people with COPD and one at healthcare professionals. The sections aim to support patients' self-management skills-and to facilitate the provision of support for self-management strategies, respectively. Effectiveness with regard to patients' symptoms, HRQoL, knowledge of and readiness for COPD-related self-management, health literacy, self-efficacy for physical activity and time spent in physical activity and time being sedentary, and further, healthcare professionals' knowledge of and readiness to support COPD-related self-management strategies will be assessed using questionnaires at 3 and 12 months. The process evaluation will include observations and interviews. ETHICS AND DISSEMINATION Ethical approval has been obtained. Findings will be presented at conferences, submitted for publication in peer-reviewed publications and presented to the involved healthcare professionals, patients and to patient organisations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT02696187.
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Affiliation(s)
- André Nyberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Helena Lindgren
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - Malin Tistad
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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