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Guo B, Liu W, Ji X, Xi B, Meng X, Xie W, Sun Y, Zhang M, Liu P, Zhang W, Yan X, Chen B. CSF3 aggravates acute exacerbation of pulmonary fibrosis by disrupting alveolar epithelial barrier integrity. Int Immunopharmacol 2024; 135:112322. [PMID: 38788452 DOI: 10.1016/j.intimp.2024.112322] [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: 03/14/2024] [Revised: 05/03/2024] [Accepted: 05/19/2024] [Indexed: 05/26/2024]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive respiratory disorder characterized by poor prognosis, often presenting with acute exacerbation. The primary cause of death associated with IPF is acute exacerbation of IPF (AE-IPF). However, the pathophysiology of acute exacerbation has not been clearly elucidated yet. This study aims to investigate the underlying pathophysiological molecular mechanism in a mouse AE-PF model. C57BL/6J mice were intratracheally administered bleomycin (BLM, 5 mg/kg) to induce pulmonary fibrosis. After 14 days, lipopolysaccharide (LPS, 2 mg/kg) was injected via the trachea route. Histological assessments, including H&E and Masson staining, as well as inflammatory indicators, were included to evaluate the induction of AE-PF by BLM and LPS in mice. Transcriptomic profiling of pulmonary tissues identified CSF3 as one of the top 10 upregulated DEGs in AE-PF mice. Indeed, administration of exogenous CSF3 protein exacerbated AE-PF in mice. Mechanistically, CSF3 disrupted alveolar epithelial barrier integrity and permeability by regulating specialized cell adhesion complexes such as tight junctions (TJs) and adherens junctions (AJs) via PI3K/p-Akt/Snail pathway, contributing to the aggravation of AE-PF in mice. Moreover, the discovery of elevated sera CSF3 indicated a notable increase in IPF patients during the exacerbation of the disease. Pearson correlation analysis in IPF patients revealed significant positive associations between CSF3 levels and KL-6 levels, LDH levels, CRP levels, respectively. These results provide mechanistic insights into the role of CSF3 in exacerbating of lung fibrotic disease and indicate monitoring CSF3 levels may aid in early clinical decisions for alternative therapy in the management of rapidly progressing IPF.
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Affiliation(s)
- Bingnan Guo
- The Laboratory of Emergency Medicine, School of Second Clinical Medicine, Xuzhou Medical University, Department of Emergency Medicine, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Wenwen Liu
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Department of Respiratory Medicine, School of First Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Xuan Ji
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Department of Respiratory Medicine, School of First Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China; Department of Respiratory Medicine, Yancheng Third People's Hospital, Yancheng, Jiangsu 224000, China
| | - Bin Xi
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Department of Respiratory Medicine, School of First Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Xiao Meng
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Department of Respiratory Medicine, School of First Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Wanwan Xie
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Department of Respiratory Medicine, School of First Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Yitian Sun
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Department of Respiratory Medicine, School of First Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Maowei Zhang
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Department of Respiratory Medicine, School of First Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Pingli Liu
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Department of Respiratory Medicine, School of First Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Wenhui Zhang
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Department of Respiratory Medicine, School of First Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Xianliang Yan
- The Laboratory of Emergency Medicine, School of Second Clinical Medicine, Xuzhou Medical University, Department of Emergency Medicine, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China; Department of Emergency Medicine, Suining People's Hospital, Xuzhou 221225, Jiangsu, China.
| | - Bi Chen
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University, Department of Respiratory Medicine, School of First Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China.
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Yamazaki R, Nishiyama O, Yoshikawa K, Tohda Y, Matsumoto H. Prognostic value of the qSOFA in patients with acute exacerbation of idiopathic pulmonary fibrosis. Respir Investig 2023; 61:339-346. [PMID: 36933282 DOI: 10.1016/j.resinv.2023.02.006] [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: 09/16/2022] [Revised: 01/09/2023] [Accepted: 02/05/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Patients with idiopathic pulmonary fibrosis (IPF) have a slowly progressive clinical course, although some develop acute exacerbations (AEs). An easily obtained composite score is desirable for predicting the survival rate in patients with AE of IPF (AE-IPF). We investigated the quick sequential organ failure assessment (qSOFA), originally developed to identify sepsis, as a predictor of mortality in patients with AE-IPF and compared it to other composite assessments. METHODS Consecutive patients with IPF admitted for their first AE between 2008 and 2019 were recruited retrospectively. The association between the qSOFA score obtained at admission and mortality was investigated. RESULTS During the study period, 97 patients with AE-IPF were hospitalized. The hospital mortality was 30.9%. Multivariate logistic regression analysis revealed that both the qSOFA and the Japanese Association for Acute Medicine (JAAM)-disseminated intravascular coagulation (DIC) scores were significant predictors of hospital mortality (odds ratio [OR] 3.86, 95% confidence interval [CI] 1.43-10.3; p = 0.007 and OR 2.71, 95% CI 1.56-4.67; p = 0.0004; respectively). Kaplan-Meier survival curves showed that both scores were consistently associated with survival. Furthermore, the sum of the two scores was a more effective predictor than the individual scores. CONCLUSIONS The qSOFA score of patients admitted with AE-IPF was associated with both in-hospital and long-term mortality, which was also true for the JAAM-DIC score. The qSOFA score plus the JAAM-DIC score should be determined during the diagnostic evaluation of a patient with AE-IPF. Both scores combined may be more effective at predicting outcomes than individual scores.
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Affiliation(s)
- Ryo Yamazaki
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan.
| | - Kazuya Yoshikawa
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Yuji Tohda
- Kindai University Hospital, Osakasayama, Osaka 589-8511, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
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Homma S, Suda T, Hongo Y, Yoshida M, Hiroi S, Iwasaki K, Takeshima T, Kondoh Y. Incidence and changes in treatment of acute exacerbation of idiopathic pulmonary fibrosis in Japan: A claims-based retrospective study. Respir Investig 2022; 60:798-805. [PMID: 36068159 DOI: 10.1016/j.resinv.2022.07.004] [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: 04/26/2022] [Revised: 07/13/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute exacerbation is an essential prognostic factor in idiopathic pulmonary fibrosis (IPF) and is the leading cause of death in Japanese patients with IPF. Its epidemiology, treatment status, and effect on IPF progression have been insufficiently investigated. We examined the incidence of acute exacerbation and treatment status before and after the onset of acute exacerbation in Japanese patients with IPF to provide basic information for treatment strategies. METHODS A Japanese claims database (April 2008-March 2019) from acute-care hospitals was analyzed. Incidence of acute exacerbation, time to the next event, and percentages of patients who received each treatment by the year before and after the onset of acute exacerbation were examined in patients diagnosed with IPF at least once. Acute exacerbation was defined according to the use of steroid pulse therapy. RESULTS We identified 9961 patients with IPF and 2629 acute exacerbations (average age at the time of acute exacerbation: 74.8 years, percentage of men: 79%). The annual incidence of acute exacerbation was approximately 10% between 2010 and 2018. The time to the next acute exacerbation shortened with increasing number of these events. The percentage of patients receiving antifibrotic drugs remained constant (30%-40%) throughout the period. The percentages of patients receiving steroid therapy, immunosuppressive drugs, and oxygen therapy increased after the onset of acute exacerbation compared with before the onset. CONCLUSIONS The annual incidence of acute exacerbation was approximately 10% in recent years. It is suggested that acute exacerbation worsens respiratory function in patients with IPF.
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Affiliation(s)
- Sakae Homma
- Department of Respiratory Medicine, School of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-8541, Japan
| | - Takafumi Suda
- The Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu-shi, Shizuoka 431-3192, Japan
| | - Yoshie Hongo
- Medical Affairs, Shionogi & Co., Ltd., 7F, Tekko Building, 1-8-2, Marunouchi, Chiyoda-ku, Tokyo 100-0005, Japan.
| | - Manami Yoshida
- Medical Affairs, Shionogi & Co., Ltd., 7F, Tekko Building, 1-8-2, Marunouchi, Chiyoda-ku, Tokyo 100-0005, Japan
| | - Shinzo Hiroi
- Medical Affairs, Shionogi & Co., Ltd., 7F, Tekko Building, 1-8-2, Marunouchi, Chiyoda-ku, Tokyo 100-0005, Japan
| | - Kosuke Iwasaki
- Milliman, Inc., 8F, Kojimachi 1-chome Building, 1-6-2 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan
| | - Tomomi Takeshima
- Milliman, Inc., 8F, Kojimachi 1-chome Building, 1-6-2 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwakechō, Seto-shi, Aichi 489-8642, Japan
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