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Ghonim MA, Boyd DF, Flerlage T, Thomas PG. Pulmonary inflammation and fibroblast immunoregulation: from bench to bedside. J Clin Invest 2023; 133:e170499. [PMID: 37655660 PMCID: PMC10471178 DOI: 10.1172/jci170499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
In recent years, there has been an explosion of interest in how fibroblasts initiate, sustain, and resolve inflammation across disease states. Fibroblasts contain heterogeneous subsets with diverse functionality. The phenotypes of these populations vary depending on their spatial distribution within the tissue and the immunopathologic cues contributing to disease progression. In addition to their roles in structurally supporting organs and remodeling tissue, fibroblasts mediate critical interactions with diverse immune cells. These interactions have important implications for defining mechanisms of disease and identifying potential therapeutic targets. Fibroblasts in the respiratory tract, in particular, determine the severity and outcome of numerous acute and chronic lung diseases, including asthma, chronic obstructive pulmonary disease, acute respiratory distress syndrome, and idiopathic pulmonary fibrosis. Here, we review recent studies defining the spatiotemporal identity of the lung-derived fibroblasts and the mechanisms by which these subsets regulate immune responses to insult exposures and highlight past, current, and future therapeutic targets with relevance to fibroblast biology in the context of acute and chronic human respiratory diseases. This perspective highlights the importance of tissue context in defining fibroblast-immune crosstalk and paves the way for identifying therapeutic approaches to benefit patients with acute and chronic pulmonary disorders.
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Affiliation(s)
- Mohamed A. Ghonim
- Department of Immunology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Department of Microbiology and Immunology, Faculty of Pharmacy, Al Azhar University, Cairo, Egypt
| | - David F. Boyd
- Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, California, USA
| | - Tim Flerlage
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Paul G. Thomas
- Department of Immunology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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2
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Gittus M, Chong J, Sutton A, Ong ACM, Fotheringham J. Barriers and facilitators to the implementation of guidelines in rare diseases: a systematic review. Orphanet J Rare Dis 2023; 18:140. [PMID: 37286999 DOI: 10.1186/s13023-023-02667-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/11/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Rare diseases present a challenge to guideline implementation due to a low prevalence in the general population and the unfamiliarity of healthcare professionals. Existing literature in more common diseases references barriers and facilitators to guideline implementation. This systematic review aims to identify these barriers and facilitators in rare diseases from existing literature. METHODS A multi-stage strategy included searching MEDLINE PubMed, EMBASE Ovid, Web of Science and Cochrane library from the earliest date available to April 2021, Orphanet journal hand-search, a pearl-growing strategy from a primary source and reference/citation search was performed. The Integrated Checklist of Determinants of Practice which comprises of twelve checklists and taxonomies, informed by 57 potential determinants was selected as a screening tool to identify determinants that warrant further in-depth investigation to inform design of future implementation strategies. RESULTS Forty-four studies were included, most of which were conducted in the United States (54.5%). There were 168 barriers across 36 determinants (37 studies) and 52 facilitators across 22 determinants (22 studies). Fifteen diseases were included across eight WHO ICD-11 disease categories. Together individual health professional factors and guideline factors formed the majority of the reported determinants (59.5% of barriers and 53.8% of facilitators). Overall, the three most reported individual barriers were the awareness/familiarity with the recommendation, domain knowledge and feasibility. The three most reported individual facilitators were awareness/familiarity with the recommendation, agreement with the recommendation and ability to readily access the guidelines. Resource barriers to implementation included technology costs, ancillary staff costs and more cost-effective alternatives. There was a paucity of studies reporting influential people, patient advocacy groups or opinion leaders, or organisational factors influencing implementation. CONCLUSIONS Key barriers and facilitators to the implementation of clinical practice guidelines in the setting of rare diseases were at the individual health professional and guideline level. Influential people and organisational factors were relatively under-reported and warrant exploration, as does increasing the ability to access the guidelines as a potential intervention.
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Affiliation(s)
- Matthew Gittus
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK.
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK.
| | - Jiehan Chong
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Albert C M Ong
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - James Fotheringham
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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3
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Kam M, Caliez J, Nunes H, Gille T. The road to hell is paved with good intentions: a look back at the PANTHER-IPF trial. Breathe (Sheff) 2022; 18:220074. [PMID: 36340823 PMCID: PMC9584592 DOI: 10.1183/20734735.0074-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022] Open
Abstract
The PANTHER-IPF trial was a turning point in treatment of idiopathic pulmonary fibrosis (#IPF) highlighting the importance of randomised controlled trials in determining treatment strategies, even for rare diseases and/or potentially fatal acute events https://bit.ly/3Oi0KwD.
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Affiliation(s)
- Michelle Kam
- Dept of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore,Both authors contributed equally to this manuscript,Corresponding author: Michelle Kam ()
| | - Julien Caliez
- Dept of Pulmonology, Reference Center for Rare Pulmonary Diseases, Avicenne University Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), Assistance Publique - Hôpitaux de Paris (AP-HP), Bobigny, France,Both authors contributed equally to this manuscript
| | - Hilario Nunes
- Dept of Pulmonology, Reference Center for Rare Pulmonary Diseases, Avicenne University Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), Assistance Publique - Hôpitaux de Paris (AP-HP), Bobigny, France,Inserm UMR 1272 “Hypoxia & the Lung”, UFR Santé, Médecine, Biologie Humaine (SMBH), Université Sorbonne Paris Nord (USPN), Bobigny, France
| | - Thomas Gille
- Inserm UMR 1272 “Hypoxia & the Lung”, UFR Santé, Médecine, Biologie Humaine (SMBH), Université Sorbonne Paris Nord (USPN), Bobigny, France,Dept of Physiology and Functional Explorations, Avicenne University Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), Assistance Publique - Hôpitaux de Paris (AP-HP), Bobigny, France,Dept of Physiology and Functional Explorations, Jean Verdier University Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), Assistance Publique - Hôpitaux de Paris (AP-HP), Bondy, France
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4
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Gorini F, Santoro M, Pierini A, Mezzasalma L, Baldacci S, Bargagli E, Boncristiano A, Brunetto MR, Cameli P, Cappelli F, Castaman G, Coco B, Donati MA, Guerrini R, Linari S, Murro V, Olivotto I, Parronchi P, Pochiero F, Rossi O, Scappini B, Sodi A, Vannucchi AM, Coi A. Orphan Drug Use in Patients With Rare Diseases: A Population-Based Cohort Study. Front Pharmacol 2022; 13:869842. [PMID: 35652051 PMCID: PMC9148958 DOI: 10.3389/fphar.2022.869842] [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: 02/05/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Orphan drugs are used for the diagnosis, prevention and treatment of rare diseases that, in the European Union, are defined as disorders affecting no more than 5 persons in 10,000. So far, a total of around 800 orphan medicinal products have been approved by the European Medicines Agency, however the utilization profile of orphan drugs has yet to be explored. This study aimed at assessing the utilization profile of orphan drugs authorized for marketing by the Italian Medicines Agency using population-based data. Methods: A total of 21 orphan drugs used in outpatient settings, approved in the European Union before or during the 2008–2018 period and involving 15 rare diseases, were included in the study. The monitored population included patients with one of the conditions surveilled by the population-based Tuscany Registry of Rare Diseases and diagnosed between 2000–2018. A multi-database approach was applied, by linking data from the registry with information collected in drug prescriptions databases. The prevalence and intensity of use were estimated for the selected orphan drugs and other non-orphan medications, used to treat the same rare disease and for which a change in the prevalence of use was hypothesized after authorization of the orphan drug. Results: For some diseases (acquired aplastic anemia, tuberous sclerosis complex, most metabolic diseases) a low prevalence of orphan drugs use was observed (range between 1.1–12.5%). Conversely, orphan drugs were frequently used in hemophilia B, Wilson disease and idiopathic pulmonary fibrosis (maximum of 78.3, 47.6 and 41.8%, respectively). For hemophilia B and Leber’s hereditary optic neuropathy, there are currently no other medications used in clinical practice in addition to orphan drugs. Six orphan drugs were used for the treatment of pulmonary arterial hypertension, appearing the elective therapy for this disease, albeit with different utilization profiles (range of prevalence 1.7–55.6%). Conclusion: To the best of our knowledge, this is the first study investigating the utilization profile of orphan drugs prescribed in a defined geographical area, and providing relevant information to monitor over time potential changes in the prevalence of these medications as well as in the health care decision making.
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Affiliation(s)
- Francesca Gorini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
- *Correspondence: Francesca Gorini,
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Lorena Mezzasalma
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Silvia Baldacci
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | | | | | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Barbara Coco
- Hepatology Unit, University Hospital of Pisa, Pisa, Italy
| | - Maria Alice Donati
- Metabolic and Muscular Unit, A. Meyer Children Hospital, Florence, Italy
| | - Renzo Guerrini
- Neuroscience Department, A. Meyer Children Hospital-University of Florence, Florence, Italy
| | - Silvia Linari
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Vittoria Murro
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, SOD Immunologia e Terapie Cellulari, Careggi University Hospital, University of Florence, Florence, Italy
| | - Francesca Pochiero
- Metabolic and Muscular Unit, A. Meyer Children Hospital, Florence, Italy
| | - Oliviero Rossi
- Immunuallergology Unit, SOD Immunoallergologia, Careggi University Hospital, Florence, Italy
| | | | - Andrea Sodi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Careggi University Hospital, Florence, Italy
| | - Alessandro Maria Vannucchi
- Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
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Lu Y, Chen J, Wang S, Tian Z, Fan Y, Wang M, Zhao J, Tang K, Xie J. Identification of Genetic Signature Associated With Aging in Pulmonary Fibrosis. Front Med (Lausanne) 2021; 8:744239. [PMID: 34746180 PMCID: PMC8564051 DOI: 10.3389/fmed.2021.744239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Aging is a strong risk factor and an independent prognostic factor in idiopathic pulmonary fibrosis (IPF). In this study, we aimed to conduct a comprehensive analysis based on gene expression profiles for the role of aging in pulmonary fibrosis. Method: Four datasets (GSE21411, GSE24206, GSE47460, and GSE101286) for patients with clinical IPF and one dataset for bleomycin (BLM)-induced pulmonary fibrosis (BIPF) mouse model (GSE123293) were obtained from Gene Expression Omnibus (GEO). According to different age ranges, both patients with IPF and BIPF mice were divided into young and aged groups. The differently expressed genes (DEGs) were systemically analyzed using Gene Ontology (GO) functional, Kyoto Encyclopedia of Genes and Genomes (KEGG), and hub genes analysis. Finally, we verified the role of age and core genes associated with age in vivo. Results:Via the expression profile comparisons of aged and young patients with IPF, we identified 108 aging-associated DEGs, with 21 upregulated and 87 downregulated. The DEGs were associated with “response to glucocorticoid,” “response to corticosteroid,” and “rhythmic process” in GO biological process (BP). For KEGG analysis, the top three significantly enriched KEGG pathways of the DEGs included “IL-17 signaling pathway,” “Mineral absorption,” and “HIF-1-signaling pathway.” Through the comparisons of aged and young BIPF mice, a total number of 778 aging-associated DEGs were identified, with 453 genes increased and 325 genes decreased. For GO and KEGG analysis, the DEGs were enriched in extracellular matrix (ECM) and collagen metabolism. The common DEGs of patients with IPF and BIPF mice were enriched in the BP category, including “induction of bacterial agglutination,” “hyaluronan biosynthetic process,” and “positive regulation of heterotypic cell-cell adhesion.” We confirmed that aged BIPF mice developed more serious pulmonary fibrosis. Finally, the four aging-associated core genes (Slc2a3, Fga, Hp, and Thbs1) were verified in vivo. Conclusion: This study provides new insights into the impact of aging on pulmonary fibrosis. We also identified four aging-associated core genes (Slc2a3, Fga, Hp, and Thbs1) related to the development of pulmonary fibrosis.
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Affiliation(s)
- Yanjiao Lu
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinkun Chen
- Department of Science, Western University, London, ON, Canada
| | - Shanshan Wang
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Tian
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Fan
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meijia Wang
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianping Zhao
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Tang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Institute of Respiratory Diseases of Sun Yat-sen University, Guangzhou, China
| | - Jungang Xie
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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6
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Jacobs I, Ceulemans M, Wauters L, Breynaert C, Vermeire S, Verstockt B, Vanuytsel T. Role of Eosinophils in Intestinal Inflammation and Fibrosis in Inflammatory Bowel Disease: An Overlooked Villain? Front Immunol 2021; 12:754413. [PMID: 34737752 PMCID: PMC8560962 DOI: 10.3389/fimmu.2021.754413] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022] Open
Abstract
Eosinophils are leukocytes which reside in the gastrointestinal tract under homeostatic conditions, except for the esophagus which is normally devoid of eosinophils. Research on eosinophils has primarily focused on anti-helminth responses and type 2 immune disorders. In contrast, the search for a role of eosinophils in chronic intestinal inflammation and fibrosis has been limited. With a shift in research focus from adaptive to innate immunity and the fact that the eosinophilic granules are filled with inflammatory mediators, eosinophils are becoming a point of interest in inflammatory bowel diseases. In the current review we summarize eosinophil characteristics and recruitment as well as the current knowledge on presence, inflammatory and pro-fibrotic functions of eosinophils in inflammatory bowel disease and other chronic inflammatory conditions, and we identify research gaps which should be covered in the future.
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Affiliation(s)
- Inge Jacobs
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Matthias Ceulemans
- Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lucas Wauters
- Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Christine Breynaert
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of General Internal Medicine, Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Bram Verstockt
- Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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7
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Rea G, De Martino M, Capaccio A, Dolce P, Valente T, Castaldo S, Canora A, Lassandro F, Bocchino M. Comparative analysis of density histograms and visual scores in incremental and volumetric high-resolution computed tomography of the chest in idiopathic pulmonary fibrosis patients. Radiol Med 2020; 126:599-607. [PMID: 33252712 PMCID: PMC7700912 DOI: 10.1007/s11547-020-01307-7] [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: 05/31/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022]
Abstract
Background Volumetric high-resolution computed tomography (HRCT) of the chest has recently replaced incremental CT in the diagnostic workup of idiopathic pulmonary fibrosis (IPF). Concomitantly, visual and quantitative scores have been proposed for disease extent assessment to ameliorate disease management. Purpose To compare the performance of density histograms (mean lung attenuation, skewness, and kurtosis) and visual scores, along with lung function correlations, in IPF patients submitted to incremental or volumetric thorax HRCT. Material and methods Clinical data and CT scans of 89 newly diagnosed and therapy-naive IPF patients were retrospectively evaluated. Results Forty-six incremental and 43 volumetric CT scans were reviewed. No differences of density histograms and visual scores estimates were found by comparing two HRCT techniques, with an optimal inter-operator agreement (concordance correlation coefficient >0.90 in all instances). Single-breath diffusing lung capacity for carbon monoxide (DLCOsb) was inversely related with the Best score (r = −00.416; p = 0.014), the Kazerooni fibrosis extent (r = −0.481; p = 0.004) and the mean lung attenuation (r = −0.382; p = 0.026), while a positive correlation was observed with skewness (r = 0.583; p = 0.001) and kurtosis (r = 0.543; p = 0.001) in the incremental HRCT sub-group. Similarly, in the volumetric CT sub-cohort, DLCOsb was significantly associated with skewness (r = 0.581; p = 0.007) and kurtosis (r = 0.549; p = 0.018). Correlations with visual scores were not confirmed. Forced vital capacity significantly related to all density indices independently on HRCT technique.
Conclusions Density histograms and visual scores similarly perform in incremental and volumetric HRCT. Density quantification displays an optimal reproducibility and proves to be superior to visual scoring as more strongly correlated with lung function.
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Affiliation(s)
- Gaetano Rea
- Dipartimento Dei Servizi Diagnostici E Generali, Ospedali dei Colli, Monaldi-Cotugno, Napoli, Italy
| | - Marina De Martino
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Malattie Dell'Apparato Respiratorio, Università Federico II, Napoli, Italy
| | - Annalisa Capaccio
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Malattie Dell'Apparato Respiratorio, Università Federico II, Napoli, Italy
| | - Pasquale Dolce
- Dipartimento Di Sanità Pubblica, Università Federico II, Napoli, Italy
| | - Tullio Valente
- Dipartimento Dei Servizi Diagnostici E Generali, Ospedali dei Colli, Monaldi-Cotugno, Napoli, Italy
| | - Sabrina Castaldo
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Malattie Dell'Apparato Respiratorio, Università Federico II, Napoli, Italy
| | - Angelo Canora
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Malattie Dell'Apparato Respiratorio, Università Federico II, Napoli, Italy
| | - Francesco Lassandro
- Dipartimento Dei Servizi Diagnostici E Generali, Ospedali dei Colli, Monaldi-Cotugno, Napoli, Italy
| | - Marialuisa Bocchino
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Malattie Dell'Apparato Respiratorio, Università Federico II, Napoli, Italy.
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8
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Chen WC, Chen NJ, Chen HP, Yu WK, Su VYF, Chen H, Wu HH, Yang KY. Nintedanib Reduces Neutrophil Chemotaxis via Activating GRK2 in Bleomycin-Induced Pulmonary Fibrosis. Int J Mol Sci 2020; 21:ijms21134735. [PMID: 32630825 PMCID: PMC7370174 DOI: 10.3390/ijms21134735] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/28/2022] Open
Abstract
Neutrophils are involved in the alveolitis of idiopathic pulmonary fibrosis (IPF). However, their pathogenic mechanisms are still poorly understood. Nintedanib has antifibrotic and anti-inflammatory activity in IPF. This study aimed to investigate the regulatory mechanism of nintedanib on neutrophil chemotaxis in bleomycin (BLM)-induced pulmonary fibrosis. Nintedanib was administered via oral gavage to male C57BL/6 mice 24 h after a bleomycin intratracheal injection (1.5 U/kg). Lung histopathological findings, the expression of cytokines, and the regulatory signaling pathways of neutrophil chemotaxis were analyzed. The effect of nintedanib was also investigated in a mouse model with adoptive neutrophil transfer in vivo. Nintedanib significantly decreased the histopathological changes and neutrophil recruitment in BLM-induced pulmonary fibrosis. Nintedanib mediated a downregulation of chemokine (C-X-C motif) receptor 2 (CXCR2) and very late antigen 4 (VLA-4) expression, as well as an upregulation of G protein-coupled receptor kinase 2 (GRK2) activity in peripheral blood neutrophils in BLM-induced pulmonary fibrosis. Nintedanib also decreased the activation of endothelial cells by the decreased expression of vascular cell adhesion molecule 1 (VCAM-1). The effect of nintedanib on regulating neutrophil chemotaxis was also confirmed by a mouse model with adoptive neutrophil transfer in vivo. In conclusion, nintedanib reduces neutrophil chemotaxis and endothelial cell activation to regulate the severity of BLM-induced pulmonary fibrosis. These effects are associated with an enhancement of GRK2 activity and a reduction in CXCR2 and VLA-4 expression on neutrophils and a decrease in VCAM-1 expression on endothelial cells.
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Affiliation(s)
- Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (W.-C.C.); (W.-K.Y.); (H.C.); (H.-H.W.)
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (H.-P.C.); (V.Y.-F.S.)
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Nien-Jung Chen
- Institute of Microbiology and Immunology, School of Life Sciences, National Yang-Ming University, Taipei 112, Taiwan;
- Cancer Progression Research Center, National Yang-Ming University, Taipei 112, Taiwan
| | - Hsin-Pai Chen
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (H.-P.C.); (V.Y.-F.S.)
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Wen-Kuang Yu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (W.-C.C.); (W.-K.Y.); (H.C.); (H.-H.W.)
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (H.-P.C.); (V.Y.-F.S.)
- Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Vincent Yi-Fong Su
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (H.-P.C.); (V.Y.-F.S.)
- Department of Internal Medicine, Taipei City Hospital, Taipei 112, Taiwan
| | - Hao Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (W.-C.C.); (W.-K.Y.); (H.C.); (H.-H.W.)
| | - Huai-Hsuan Wu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (W.-C.C.); (W.-K.Y.); (H.C.); (H.-H.W.)
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (W.-C.C.); (W.-K.Y.); (H.C.); (H.-H.W.)
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (H.-P.C.); (V.Y.-F.S.)
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Cancer Progression Research Center, National Yang-Ming University, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-2-2875-7455; Fax: +886-2-2875-7610
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Sarkar P, Avram C, Chaudhuri N. The extended utility of antifibrotic therapy in progressive fibrosing interstitial lung disease. Expert Rev Respir Med 2020; 14:1001-1008. [PMID: 32567402 DOI: 10.1080/17476348.2020.1784730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The approval of two antifibrotic treatment agents for delaying disease progression in idiopathic pulmonary fibrosis (IPF), has prompted researchers to look at expanding the role of antifibrotic therapy to other fibrosing interstitial lung disease (ILD). Similarities in the pathological mechanisms that lead to the development of IPF have been implicated in other progressive fibrosing ILD (PF-ILD) such as chronic hypersensitivity pneumonitis, connective tissues disease associated ILD, sarcoidosis, occupational ILD and idiopathic non-specific interstitial pneumonia (iNSIP). This has prompted the rationale to use antifibrotic therapy to target similar molecular pathways in these diseases. AREAS COVERED This review will summarise the available evidence from randomised controlled trials that have evaluated the use of antifibrotic therapy in PF-ILD outside the realm of IPF. EXPERT OPINION There is promising data for antifibrotic therapy as a therapeutic option for non IPF PF-ILD. The new therapy option does provide some challenges that need to be addressed such as timing of initiation of therapy, clarifying the strategy for overlap or combination with existing immunosuppressive therapies and potential drug interactions. There is an unmet need to determine accurate predictors of disease progression to allow early intervention for the preservation of lung function and mortality reduction.
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Affiliation(s)
- Paroma Sarkar
- Department of Thoracic Medicine, The Royal Adelaide Hospital , Adelaide, Australia
| | - Cristina Avram
- Department of Respiratory Medicine, Manchester University NHS Foundation Trust , Manchester, UK
| | - Nazia Chaudhuri
- Department of Respiratory Medicine, Manchester University NHS Foundation Trust , Manchester, UK
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Argollo M, Gilardi D, Roda G, Fiorino G, Peyrin-Biroulet L, Danese S. Anti-fibrotic Drugs for Crohn’s Disease: Ready for Prime Time? Curr Pharm Des 2019; 25:47-56. [DOI: 10.2174/1381612825666190308100844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/01/2019] [Indexed: 12/17/2022]
Abstract
Intestinal fibrosis, driven by chronic inflammation in Crohn’s disease, can be defined as an excessive
accumulation of extracellular matrix in the affected gut segment ultimately leading to an impaired wound healing
and cumulative tissue damage, possibly resulting in organ dysfunction, formation of stenotic lesions and necessity
of surgical intervention. Despite continuous advances in developing novel treatment modalities targeting different
pathways to control chronic gut inflammation in CD, no effective anti-fibrotic agents have been released, to date.
Thus, a better understanding of the molecular and cellular mechanisms underlying intestinal fibrosis is key to
move this area of investigation forward.
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Affiliation(s)
- Marjorie Argollo
- IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Daniela Gilardi
- IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Giulia Roda
- IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Gionata Fiorino
- IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre, France
| | - Silvio Danese
- IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
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11
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Chen MJ, Yang GL, Ding YX, Tong ZQ. Efficacy of TCM therapy of tonifying lung-kidney's Qi-deficiency in a case of idiopathic pulmonary fibrosis: A case report. Medicine (Baltimore) 2019; 98:e15140. [PMID: 31045757 PMCID: PMC6504330 DOI: 10.1097/md.0000000000015140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RATIONALE Idiopathic pulmonary fibrosis (IPF) is a special form of spontaneous, chronic, progressive interstitial fibrotic pneumonia of unknown cause, and treatments for IPF have shown a poor prognosis. This study reports a new treatment, traditional Chinese medicine (TCM) therapy, for tonifying Qi-deficiency of lung-kidney in a 64-year-old patient with IPF. PATIENT CONCERNS A 64-year-old man, who complained of cough and asthma, was diagnosed as IPF with mild impairment in lung function by thoracic high-resolution computed tomography and pulmonary function test. He received an 18-month N-acetylcysteine monotherapy but had no improvement in lung function. DIAGNOSES IPF with mild impairment in lung function was diagnosed. INTERVENTIONS The Chinese herbal medicine composition was decocted in 300 ml water for oral administration with 150 ml decoction twice daily in June 2017. OUTCOMES The pulmonary function test showed that diffusing capacity for carbon monoxide had increased to 81% of predicted back to normal after 2-month TCM monotherapy. And diffusing capacity for carbon monoxide had increased to 89% of predicted, and forced expiratory volume in 1 s/forced vital capacity ratio increased to 92% at 14-month follow-up. No adverse events occurred during the 14 months of therapy and observation. LESSONS The treatment by TCM therapy of tonifying lung-kidney's Qi-deficiency for IPF can improve the pulmonary function and reverse disease progression; it may be considered as a complementary treatment for IPF with mild-to-moderate impairment. However, the insights provided in this case report require further exploration and verification.
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Affiliation(s)
- Ming-Jun Chen
- Department of Traditional Chinese Medicine and Acupuncture, Chinese PLA General Hospital
| | - Ge-Lliang Yang
- Department of Traditional Chinese Medicine and Acupuncture, Chinese PLA General Hospital
| | | | - Zhan-Qi Tong
- Department of Traditional Chinese Medicine and Acupuncture, Chinese PLA General Hospital
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12
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Jo HE, Troy LK, Keir G, Chambers DC, Holland A, Goh N, Wilsher M, de Boer S, Moodley Y, Grainge C, Whitford H, Chapman S, Reynolds PN, Glaspole I, Beatson D, Jones L, Hopkins P, Corte TJ. Treatment of idiopathic pulmonary fibrosis in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand and the Lung Foundation Australia. Respirology 2017; 22:1436-1458. [DOI: 10.1111/resp.13146] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Helen E. Jo
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney NSW Australia
- Faculty of Medicine, University of Sydney; Sydney NSW Australia
| | - Lauren K. Troy
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney NSW Australia
- Faculty of Medicine, University of Sydney; Sydney NSW Australia
| | - Gregory Keir
- Department of Respiratory Medicine, Princess Alexandra Hospital; Brisbane QLD Australia
| | - Daniel C. Chambers
- Department of Respiratory Medicine, The Prince Charles Hospital; Brisbane QLD Australia
| | - Anne Holland
- Department of Physiotherapy, The Alfred Hospital; Melbourne VIC Australia
| | - Nicole Goh
- Department of Respiratory Medicine, The Prince Charles Hospital; Brisbane QLD Australia
- Department of Respiratory Medicine; Austin Hospital; Melbourne VIC Australia
| | - Margaret Wilsher
- Department of Respiratory Medicine; Auckland District Health Board; Auckland New Zealand
| | - Sally de Boer
- Department of Respiratory Medicine; Auckland District Health Board; Auckland New Zealand
| | - Yuben Moodley
- Department of Respiratory Medicine; Fiona Stanley Hospital; Perth WA Australia
| | - Christopher Grainge
- Department of Respiratory Medicine; John Hunter Hospital; Newcastle NSW Australia
| | - Helen Whitford
- Department of Respiratory Medicine, The Alfred Hospital; Melbourne VIC Australia
| | - Sally Chapman
- Department of Respiratory Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Paul N. Reynolds
- Department of Respiratory Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Ian Glaspole
- Department of Respiratory Medicine, The Alfred Hospital; Melbourne VIC Australia
| | | | - Leonie Jones
- Department of Respiratory Medicine; John Hunter Hospital; Newcastle NSW Australia
| | - Peter Hopkins
- Department of Respiratory Medicine, The Prince Charles Hospital; Brisbane QLD Australia
| | - Tamera J. Corte
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney NSW Australia
- Faculty of Medicine, University of Sydney; Sydney NSW Australia
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13
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Hayton C, Chaudhuri N. Current Treatments in the Management of Idiopathic Pulmonary Fibrosis: Pirfenidone and Nintedanib. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1179559x17719126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Conal Hayton
- Specialist Registrar in Respiratory Medicine, Department of Respiratory Medicine, North Manchester General Hospital, Manchester, UK
| | - Nazia Chaudhuri
- Consultant in Respiratory Medine and Clinical Lead in Interstitial Lung Disease, North West Interstitial Lung Disease Unit, University Hospital of South Manchester, Manchester, UK
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14
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Ekström M, Bornefalk-Hermansson A. Cardiovascular and antacid treatment and mortality in oxygen-dependent pulmonary fibrosis: A population-based longitudinal study. Respirology 2016; 21:705-11. [PMID: 27009834 DOI: 10.1111/resp.12781] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/19/2015] [Accepted: 02/23/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Severe idiopathic pulmonary fibrosis is associated with an increased risk of cardiovascular disease and gastro-oesophageal reflux, which may influence prognosis. We evaluated associations between cardiovascular and antacid medications, and mortality, in oxygen-dependent pulmonary fibrosis (PF) of unknown cause. METHODS Prospective population-based study of adults starting long-term oxygen therapy (LTOT) for PF in Sweden 2005-2009. PF of unknown cause was defined by excluding patients with known or probable secondary PF. Time-dependent associations between medications and all-cause mortality were analysed using extended Cox regression, adjusting for potential confounders including age, sex, vital capacity, blood gases, body mass index, performance status, comorbidity and concurrent medications. RESULTS Of 462 included patients, 329 (71%) died under observation. No patient was lost to follow-up. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) were associated with reduced adjusted mortality (HR 0.63; 0.47-0.85) and antiplatelet drugs with increased mortality (HR 1.49; 1.11-2.00), largely driven by higher mortality in women. There were no associations with mortality for antacid treatments, β-blockers, diuretics or statins. CONCLUSION In oxygen-dependent PF, treatment with ACEI/ARB was associated with improved survival, antiplatelet drugs with decreased survival, whereas there was no association between antacid, β-blocker, diuretic or statin treatment and survival.
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Affiliation(s)
- Magnus Ekström
- Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden
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15
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Meyer KC, Danoff SK, Lancaster LH, Nathan SD. Management of Idiopathic Pulmonary Fibrosis in the Elderly Patient: Addressing Key Questions. Chest 2015; 148:242-252. [PMID: 26149553 DOI: 10.1378/chest.14-2475] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is strongly associated with advanced age. Making an accurate diagnosis of IPF is critical, as it remains only one of many potential diagnoses for an elderly patient with newly recognized interstitial lung disease. Optimal management of IPF, especially in older-aged patients, hinges on such factors as balancing the application of standard-of-care measures with the patient's overall health status (robustness vs frailty) and considering the patient's wishes, desires, and expectations. IPF is known to be associated with certain comorbidities that tend to be more prevalent in the elderly population. Until recently, options for the pharmacologic management of IPF were limited and included therapies such as immunosuppressive agents, which may pose substantial risk to the elderly patient. However, the antifibrotic agents pirfenidone and nintedanib have now become commercially available in the United States for the treatment of IPF. The monitoring and treatment of patients with IPF, especially elderly patients with comorbid medical conditions, require consideration of adverse side effects, the avoidance of potential drug-drug interactions, treatment of comorbidities, and the timely implementation of supportive and palliative measures. Individualized counseling to guide decision-making and enhance quality of life is also integral to optimal management of the elderly patient with IPF.
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Affiliation(s)
- Keith C Meyer
- Department of Medicine (Dr Meyer), Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Sonye K Danoff
- Division of Allergy, Pulmonary, and Critical Care Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa H Lancaster
- Division of Allergy, Pulmonary, and Critical Care Medicine, the Vanderbilt University Medical Center, Nashville, TN
| | - Steven D Nathan
- Advanced Lung Disease and Transplant Program, Department of Medicine, Inova Health Systems, Falls Church, VA
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16
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Abstract
Introduction The present review serves to provide a concise overview of the current knowledge on therapeutic strategies with regard to fibrostenotic lesions in Crohn's disease. Methods A literature search was performed focusing on the last 5 years, and current concepts of pathophysiology, epidemiology, and treatment have been summarized. Results Fibrostenotic lesions in Crohn's disease are currently considered to be a consequence of the chronic inflammatory nature of the disease. Hence, therapeutic strategies are limited to the concept that early treatment of the inflammatory lesions can prevent structural changes, and to various endoscopic and surgical approaches. Direct targeting of the fibrostenotic lesion itself has not been the focus until now. This review will provide an overview of the pathophysiology and epidemiology of fibrostenotic lesions including current therapeutic approaches. Since research with regard to other organ systems and fibrosis is far more advanced, current strategies from available studies in these areas will be discussed. The results and the potential impact for Crohn's disease will be considered. Conclusion The vision of these approaches is to reverse structural changes and restore normal function.
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Affiliation(s)
- Britta Siegmund
- Medical Department (Gastroenterology, Infectious Diseases, Rheumatology), Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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17
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Behr J, Kreuter M, Hoeper MM, Wirtz H, Klotsche J, Koschel D, Andreas S, Claussen M, Grohé C, Wilkens H, Randerath W, Skowasch D, Meyer FJ, Kirschner J, Gläser S, Herth FJF, Welte T, Huber RM, Neurohr C, Schwaiblmair M, Kohlhäufl M, Höffken G, Held M, Koch A, Bahmer T, Pittrow D. Management of patients with idiopathic pulmonary fibrosis in clinical practice: the INSIGHTS-IPF registry. Eur Respir J 2015; 46:186-96. [PMID: 25837040 PMCID: PMC4486374 DOI: 10.1183/09031936.00217614] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 02/03/2015] [Indexed: 11/26/2022]
Abstract
After introduction of the new international guidelines on idiopathic pulmonary fibrosis (IPF) in 2011, we investigated clinical management practices for patients with IPF according to physicians' diagnoses. A prospective, multicenter, noninterventional study with comprehensive quality measures including on-site source data verification was performed in Germany. 502 consecutive patients (171 newly diagnosed, 331 prevalent; mean±SD age 68.7±9.4 years, 77.9% males) with a mean disease duration of 2.3±3.5 years were enrolled. IPF diagnosis was based on clinical assessments and high-resolution computed tomography (HRCT) in 90.2%, and on surgical lung biopsy combined with histology in 34.1% (lavage in 61.8%). The median 6-min walk distance was 320 m (mean 268±200 m). The mean forced vital capacity was 72±20% pred and diffusing capacity of the lung for carbon monoxide was 35±15% pred. No drugs were administered in 17.9%, oral steroids in 23.7%, N-acetylcysteine in 33.7%, pirfenidone in 44.2% and other drugs in 4.6% of patients. Only 2.8% of the cohort was listed for lung transplantation. IPF patients were diagnosed in line with the new guidelines. They had more severe disease than those enrolled in recent randomised controlled trials. In addition to HRCT, the frequency of lung biopsies was surprisingly high. Treatment patterns varied substantially.
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Affiliation(s)
| | | | | | | | | | - Dirk Koschel
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Stefan Andreas
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Martin Claussen
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Christian Grohé
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Henrike Wilkens
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Winfried Randerath
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Dirk Skowasch
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - F Joachim Meyer
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Joachim Kirschner
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Sven Gläser
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Felix J F Herth
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Tobias Welte
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Rudolf Maria Huber
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Claus Neurohr
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Martin Schwaiblmair
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Martin Kohlhäufl
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Gert Höffken
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Matthias Held
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Andrea Koch
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Thomas Bahmer
- For the authors' affiliations, see the Acknowledgements Study steering committee members
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18
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Update on New Treatments for Idiopathic Pulmonary Fibrosis. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2015. [DOI: 10.1007/s40138-015-0076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Koelsch TL, Chung JH, Lynch DA. Radiologic Evaluation of Idiopathic Interstitial Pneumonias. Clin Chest Med 2015; 36:269-82, ix. [DOI: 10.1016/j.ccm.2015.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Troy LK, Chapman SA, Lake F, Wilsher ML, Honeysett LB, Macansh S, Corte TJ. Current Australasian practice for diagnosis and management of idiopathic pulmonary fibrosis: Where are we now? Respirology 2015; 20:647-53. [DOI: 10.1111/resp.12512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 12/24/2014] [Accepted: 01/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Lauren K. Troy
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Sally A. Chapman
- Department of Thoracic Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
- Australian IPF Registry Steering Committee; Lung Foundation Australia; Brisbane Queensland Australia
| | - Fiona Lake
- School of Medicine and Pharmacology, SCGH Unit; University of Western Australia; Perth Western Australia Australia
| | - Margaret L. Wilsher
- Green Lane Respiratory Services; Auckland City Hospital; Auckland New Zealand
- Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - Liarna B. Honeysett
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Australian IPF Registry Steering Committee; Lung Foundation Australia; Brisbane Queensland Australia
| | - Sacha Macansh
- Australian IPF Registry Steering Committee; Lung Foundation Australia; Brisbane Queensland Australia
| | - Tamera J. Corte
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Australian IPF Registry Steering Committee; Lung Foundation Australia; Brisbane Queensland Australia
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21
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Romei C, Tavanti L, Sbragia P, De Liperi A, Carrozzi L, Aquilini F, Palla A, Falaschi F. Idiopathic interstitial pneumonias: do HRCT criteria established by ATS/ERS/JRS/ALAT in 2011 predict disease progression and prognosis? Radiol Med 2015; 120:930-40. [DOI: 10.1007/s11547-015-0526-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
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22
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Choi EJ, Jin GY, Bok SM, Han YM, Lee YS, Jung MJ, Kwon KS. Serial micro-CT assessment of the therapeutic effects of rosiglitazone in a bleomycin-induced lung fibrosis mouse model. Korean J Radiol 2014; 15:448-55. [PMID: 25053904 PMCID: PMC4105807 DOI: 10.3348/kjr.2014.15.4.448] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 03/24/2014] [Indexed: 12/17/2022] Open
Abstract
Objective The aim of this study was to assess the therapeutic effects of rosiglitazone with serial micro-CT findings before and after rosiglitazone administration in a lung fibrosis mouse model induced with bleomycin. Materials and Methods We instilled the bleomycin solution directly into the trachea in twenty mice (female, C57BL/6 mice). After the instillation with bleomycin, mice were closely observed for 3 weeks and then all mice were scanned using micro-CT without sacrifice. At 3 weeks, the mice were treated with rosiglitazone on days 21 to 27 if they had abnormal CT findings (n = 9, 45%). For the mice treated with rosiglitazone, we performed micro-CT with mouse sacrifice 2 weeks after the rosiglitazone treatment completion. We assessed the abnormal CT findings (ground glass attenuation, consolidation, bronchiectasis, reticular opacity, and honeycombing) using a five-point scale at 3 and 6 weeks using Wilcoxon-signed ranked test. The micro-CT findings were correlated with the histopathologic results. Results One out of nine (11.1%) mice improved completely. In terms of consolidation, all mice (100%) showed marked decrease from 3.1 ± 1.4 at 3 weeks to 0.9 ± 0.9 at 6 weeks (p = 0.006). At 6 weeks, mild bronchiectasis (n = 6, 66.7%), mild reticular opacity (n = 7, 77.8%) and mild honeycomb patterns (n = 3, 33.3%) appeared. Conclusion A serial micro-CT enables the evaluation of drug effects in a lung fibrosis mouse model.
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Affiliation(s)
- Eun Jung Choi
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Se Mi Bok
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Young Min Han
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Young Sun Lee
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Myung Ja Jung
- Department of Pathology, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Keun Sang Kwon
- Department of Preventive Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
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23
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Martinez FJ, de Andrade JA, Anstrom KJ, King TE, Raghu G. Randomized trial of acetylcysteine in idiopathic pulmonary fibrosis. N Engl J Med 2014; 370:2093-101. [PMID: 24836309 PMCID: PMC4116664 DOI: 10.1056/nejmoa1401739] [Citation(s) in RCA: 340] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acetylcysteine has been suggested as a beneficial treatment for idiopathic pulmonary fibrosis, although data from placebo-controlled studies are lacking. METHODS In our initial double-blind, placebo-controlled trial, we randomly assigned patients who had idiopathic pulmonary fibrosis with mild-to-moderate impairment in pulmonary function to receive a three-drug regimen of prednisone, azathioprine, and acetylcysteine; acetylcysteine alone; or placebo. The study was interrupted owing to safety concerns associated with the three-drug regimen. The trial continued as a two-group study (acetylcysteine vs. placebo) without other changes; 133 and 131 patients were enrolled in the acetylcysteine and placebo groups, respectively. The primary outcome was the change in forced vital capacity (FVC) over a 60-week period. RESULTS At 60 weeks, there was no significant difference in the change in FVC between the acetylcysteine group and the placebo group (-0.18 liters and -0.19 liters, respectively; P=0.77). In addition, there were no significant differences between the acetylcysteine group and the placebo group in the rates of death (4.9% vs. 2.5%, P=0.30 by the log-rank test) or acute exacerbation (2.3% in each group, P>0.99). CONCLUSIONS As compared with placebo, acetylcysteine offered no significant benefit with respect to the preservation of FVC in patients with idiopathic pulmonary fibrosis with mild-to-moderate impairment in lung function. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT00650091.).
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Affiliation(s)
- Fernando J. Martinez
- Weill Cornell Medical College, New York, NY
- University of Michigan, Ann Arbor, MI
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24
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Bettenworth D, Rieder F. Medical therapy of stricturing Crohn's disease: what the gut can learn from other organs - a systematic review. FIBROGENESIS & TISSUE REPAIR 2014; 7:5. [PMID: 24678903 PMCID: PMC4230721 DOI: 10.1186/1755-1536-7-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/06/2014] [Indexed: 12/11/2022]
Abstract
Crohn’s disease (CD) is a chronic remitting and relapsing disease. Fibrostenosing complications such as intestinal strictures, stenosis and ultimately obstruction are some of its most common long-term complications. Despite recent advances in the pathophysiological understanding of CD and a significant improvement of anti-inflammatory therapeutics, medical therapy for stricturing CD is still inadequate. No specific anti-fibrotic therapy exists and the incidence rate of strictures has essentially remained unchanged. Therefore, the current therapy of established fibrotic strictures comprises mainly endoscopic dilation as well as surgical approaches. However, these treatment options are associated with major complications as well as high recurrence rates. Thus, a specific anti-fibrotic therapy for CD is urgently needed. Importantly, there is now a growing body of evidence for prevention as well as effective medical treatment of fibrotic diseases of other organs such as the skin, lung, kidney and liver. In face of the similarity of molecular mechanisms of fibrogenesis across these organs, translation of therapeutic approaches from other fibrotic diseases to the intestine appears to be a promising treatment strategy. In particular transforming growth factor beta (TGF-β) neutralization, selective tyrosine kinase inhibitors, blockade of components of the renin-angiotensin system, IL-13 inhibitors and mammalian target of rapamycin (mTOR) inhibitors have emerged as potential drug candidates for anti-fibrotic therapy and may retard progression or even reverse established intestinal fibrosis. However, major challenges have to be overcome in the translation of novel anti-fibrotics into intestinal fibrosis therapy, such as the development of appropriate biomarkers that predict the development and accurately monitor therapeutic responses. Future clinical studies are a prerequisite to evaluate the optimal timing for anti-fibrotic treatment approaches, to elucidate the best routes of application, and to evaluate the potential of drug candidates to reach the ultimate goal: the prevention or reversal of established fibrosis and strictures in CD patients.
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Affiliation(s)
| | - Florian Rieder
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Department of Pathobiology, Lerner Research Institute, NC22, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Gomer RH. New approaches to modulating idiopathic pulmonary fibrosis. Curr Allergy Asthma Rep 2014; 13:607-12. [PMID: 23959780 DOI: 10.1007/s11882-013-0377-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Until recently, idiopathic pulmonary fibrosis (IPF) has been a devastating and generally fatal disease with no effective therapeutic. New developments in understanding the biology of the disease include a growing consensus that the lesions are mainly composed of cells that originated from resident fibroblasts. New developments in therapeutics include recommendations against several treatment regimes that have been previously used. On a positive note, the orally available drug pirfenidone has been approved for use in IPF in China, Japan, India, and the European Union, but not yet in the United States. Other possibilities for managing IPF include managing gastrointestinal reflux, and limiting excessive salt intake. A variety of potential therapeutics for IPF are in clinical trials; for instance, in a Phase 1b trial, intravenous injections of a recombinant version of the normal human serum protein Serum Amyloid P (SAP, also known as PTX2) improved lung function in IPF patients.
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Management of idiopathic pulmonary fibrosis in France: a survey of 1244 pulmonologists. Respir Med 2013; 108:195-202. [PMID: 24361163 DOI: 10.1016/j.rmed.2013.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/11/2013] [Accepted: 11/25/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The present survey coordinated by the French expert centres for rare pulmonary diseases investigated French pulmonologists' current diagnostic and therapeutic practice for idiopathic pulmonary fibrosis (IPF). METHODS From December 7, 2011 to February 18, 2012, all French pulmonologists (n = 2608) were contacted. Those who reported following up at least one IPF patient (n = 509) were administered a 26-item questionnaire by phone or e-mail. RESULTS 509 pulmonologists (41% of responders, 20% of French pulmonologists) were involved in the management of IPF patients. Of those, 36% discussed the cases with radiologists and pathologists. Out of 406 community pulmonologists practicing outside of reference or competence (e.g. expert) centres, 141 (35%) indicated referring patients to those centres. The 2011 international guidelines for IPF were known by 67% of pulmonologists involved in IPF, 84% of whom considered them appropriate for practice. About 58% of patients were diagnosed with mild to moderate IPF as defined by percentage predicted forced vital capacity ≥50% and percentage predicted diffusing capacity of the lung for carbon monoxide ≥35%. Management resulted from multidisciplinary discussion in 36% of the cases. By the end of December 2011, 49% of patients with mild to moderately severe IPF were treated with oral corticosteroids, and 27% received no treatment. CONCLUSIONS Despite correct awareness of international IPF guidelines, modalities of multidisciplinary discussion and of early diagnosis and management need to be improved through the network of expert centres.
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Bartholmai BJ, Raghunath S, Karwoski RA, Moua T, Rajagopalan S, Maldonado F, Decker PA, Robb RA. Quantitative computed tomography imaging of interstitial lung diseases. J Thorac Imaging 2013; 28:298-307. [PMID: 23966094 PMCID: PMC3850512 DOI: 10.1097/rti.0b013e3182a21969] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE High-resolution chest computed tomography (HRCT) is essential in the characterization of interstitial lung disease. The HRCT features of some diseases can be diagnostic. Longitudinal monitoring with HRCT can assess progression of interstitial lung disease; however, subtle changes in the volume and character of abnormalities can be difficult to assess. Accuracy of diagnosis can be dependent on expertise and experience of the radiologist, pathologist, or clinician. Quantitative analysis of thoracic HRCT has the potential to determine the extent of disease reproducibly, classify the types of abnormalities, and automate the diagnostic process. MATERIALS AND METHODS Novel software that utilizes histogram signatures to characterize pulmonary parenchyma was used to analyze chest HRCT data, including retrospective processing of clinical CT scans and research data from the Lung Tissue Research Consortium. Additional information including physiological, pathologic, and semiquantitative radiologist assessment was available to allow comparison of quantitative results, with visual estimates of the disease, physiological parameters, and measures of disease outcome. RESULTS Quantitative analysis results were provided in regional volumetric quantities for statistical analysis and a graphical representation. These results suggest that quantitative HRCT analysis can serve as a biomarker with physiological, pathologic, and prognostic significance. CONCLUSIONS It is likely that quantitative analysis of HRCT can be used in clinical practice as a means to aid in identifying a probable diagnosis, stratifying prognosis in early disease, and consistently determining progression of the disease or response to therapy. Further optimization of quantitative techniques and longitudinal analysis of well-characterized subjects would be helpful in validating these methods.
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Affiliation(s)
- Brian J Bartholmai
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Sushravya Raghunath
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ronald A Karwoski
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Srinivasan Rajagopalan
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Fabien Maldonado
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Paul A Decker
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Richard A Robb
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Kolb M, Shargall Y. Lung surgery in interstitial lung disease-a safe and useful procedure? J Thorac Dis 2013; 5:375-7. [PMID: 23991288 DOI: 10.3978/j.issn.2072-1439.2013.07.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 07/05/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Martin Kolb
- Firestone Institute for Respiratory Health, Department of Medicine, Division of Respirology, McMaster University, Hamilton, ON, Canada
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Abstract
PURPOSE OF REVIEW Since the late 1990 s, when a more uniform definition of idiopathic pulmonary fibrosis (IPF) was proposed, more than 3000 patients have been enrolled in clinical studies exploring novel therapies. Some of the most relevant trials have been published only recently. RECENT FINDINGS This review describes and comments on the randomized clinical trials in IPF published within the past 18 months, with emphasis on the studies evaluating pirfenidone, which at present is the only drug approved for IPF (at least in Europe and Japan), and bosentan. This latter represents the largest single trial performed in IPF so far. SUMMARY Despite multiple clinical trials, there is no strong, definitive evidence in favor of any agent to treat IPF. On the other hand, the placebo arms of these large trials have provided us with important critical information on the natural history of this disease. Clinical heterogeneity represents a critical issue to be taken into account in designing future clinical trials. The limited effectiveness of current treatment regimes has fuelled the search for a variety of new therapeutic approaches.
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Surgical biopsy for diffuse parenchymal lung diseases: are we causing more harm than good? J Bronchology Interv Pulmonol 2012; 16:227-8. [PMID: 23168583 DOI: 10.1097/lbr.0b013e3181bb7371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang J, Xu DJ, Xu KF, Wu B, Zheng MF, Chen JY, Huang JA. HLA-A and HLA-B gene polymorphism and idiopathic pulmonary fibrosis in a Han Chinese population. Respir Med 2012; 106:1456-62. [PMID: 22784404 DOI: 10.1016/j.rmed.2012.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 06/12/2012] [Accepted: 06/20/2012] [Indexed: 02/06/2023]
Abstract
UNLABELLED Idiopathic pulmonary fibrosis (IPF) is a progressive diffuse interstitial lung disease with poor prognosis of unknown etiology that leading ultimately to death. Predisposing factors are thought to have environmental and genetic inputs. OBJECTIVE We investigated the relationship between HLA-A, B gene polymorphism and idiopathic pulmonary fibrosis (IPF) in a Han Chinese population. PATIENTS AND METHODS The gene frequency of 36 patients with IPF was detected using a PCR-SSP grouping method. These values were compared with those a Bone Marrow Bank (Shanghai, China) of healthy subjects of identical racial origin as the patient group. RESULTS The gene frequency of HLA-A*3 (3.5%), HLA-B*14 (1.4%), -B*15 (10.2%), and -B*40 (5.0%)of the IPF group increased significantly (Pc < 0.05) compared with that in the control group HLA-A*3 (1.0%), HLA-B*14 (0.1%) and -B*15 (1.1%) and -B*40 (0.8%). Investigation of the link between the HLA-A and -B gene showed the gene frequency of HLA-A2B15 to be 5.0% as well as -A2B40 (4.3%), -A11B15 (5.0%), -A24B48 (2.8%) and -A30B40 (2.8%), which were significantly higher than those of the control group (Pc < 0.05). CONCLUSION These data suggest that the gene frequency of HLA-A*3, HLA-B*14, -B*15, -B*40, and the linked gene frequency of HLA-A2B15, -A2B40, -A11B15, -A24B58, -A30B40 is associated with IPF pathogenesis.
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Affiliation(s)
- Ji Zhang
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Shizi Road 1#, Soochow City, Jiangsu Province, China
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Raghu G, Anstrom KJ, King TE, Lasky JA, Martinez FJ. Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis. N Engl J Med 2012; 366:1968-77. [PMID: 22607134 PMCID: PMC3422642 DOI: 10.1056/nejmoa1113354] [Citation(s) in RCA: 1084] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND A combination of prednisone, azathioprine, and N-acetylcysteine (NAC) has been widely used as a treatment for idiopathic pulmonary fibrosis. The safety and efficacy of this three-drug regimen is unknown. METHODS In this randomized, double-blind, placebo-controlled trial, we assigned patients with idiopathic pulmonary fibrosis who had mild-to-moderate lung-function impairment to one of three groups -- receiving a combination of prednisone, azathioprine, and NAC (combination therapy), NAC alone, or placebo -- in a 1:1:1 ratio. The primary outcome was the change in longitudinal measurements of forced vital capacity during a 60-week treatment period. RESULTS When approximately 50% of data had been collected (with 77 patients in the combination-therapy group and 78 in the placebo group), a planned interim analysis revealed that patients in the combination-therapy group, as compared with the placebo group, had an increased rate of death (8 vs. 1, P=0.01) and hospitalization (23 vs. 7, P<0.001). These observations, coupled with no evidence of physiological or clinical benefit for combination therapy, prompted the independent data and safety monitoring board to recommend termination of the combination-therapy group at a mean follow-up of 32 weeks. Data from the ongoing comparison of the NAC-only group and the placebo group are not reported here. CONCLUSIONS Increased risks of death and hospitalization were observed in patients with idiopathic pulmonary fibrosis who were treated with a combination of prednisone, azathioprine, and NAC, as compared with placebo. These findings provide evidence against the use of this combination in such patients. (Funded by the National Heart, Lung, and Blood Institute and the Cowlin Family Fund; ClinicalTrials.gov number, NCT00650091.).
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Inoue K, Naito Y, Takagi T, Hayashi N, Hirai Y, Mizushima K, Horie R, Fukumoto K, Yamada S, Harusato A, Hirata I, Omatsu T, Yoshida N, Uchiyama K, Ishikawa T, Handa O, Konishi H, Wakabayashi N, Yagi N, Ichikawa H, Kokura S, Yoshikawa T. Daikenchuto, a Kampo medicine, regulates intestinal fibrosis associated with decreasing expression of heat shock protein 47 and collagen content in a rat colitis model. Biol Pharm Bull 2012; 34:1659-65. [PMID: 22040876 DOI: 10.1248/bpb.34.1659] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Heat shock protein (HSP) 47 may play an important role in the pathogenesis of intestinal fibrosis. Daikenchuto (DKT), a traditional Japanese herbal (Kampo) medicine, has been reported to ameliorate intestinal inflammation. The aims of this study were to determine time-course profiles of several parameters of fibrosis in a rat model, to confirm the HSP47-expressing cells in the colon, and finally to evaluate DKT's effects on intestinal fibrosis. Colitis was induced in male Wistar rats weighing 200 g using an enema of trinitrobenzene sulfonic acid (TNBS). HSP47 localization was determined by immunohistochemistry. Colonic inflammation and fibrosis were assessed by macroscopic, histological, morphometric, and immunohistochemical analyses. Colonic mRNA expression of transforming growth factor β1 (TGF-β1), HSP47, and collagen type I were assessed by real time-polymerase chain reaction (PCR). DKT was administered orally once a day from 8 to 14 d after TNBS administration. The colon was removed on the 15th day. HSP47 immunoreactivity was coexpressed with α-smooth muscle actin-positive cells located in the subepithelial space. Intracolonic administration of TNBS resulted in grossly visible ulcers. Colonic inflammation persisted for 6 weeks, and fibrosis persisted for 4 weeks after cessation of TNBS treatment. The expression levels of mRNA and proteins for TGF-β1, HSP47, and collagen I were elevated in colonic mucosa treated with TNBS. These fibrosis markers indicated that DKT treatment significantly inhibited TNBS-induced fibrosis. These findings suggest that DKT reduces intestinal fibrosis associated with decreasing expression of HSP47 and collagen content in the intestine.
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Affiliation(s)
- Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
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Huang Y, Dai Y, Zhang J, Wang C, Li D, Cheng J, Lu Y, Ma K, Tan L, Xue F, Qin B. Circulating microRNAs as potential biomarkers for smoking-related interstitial fibrosis. Biomarkers 2012; 17:435-40. [DOI: 10.3109/1354750x.2012.680611] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Königshoff M, Rojas M. Galectin-3: The Bridge over Troubled Waters. Am J Respir Crit Care Med 2012; 185:473-5. [DOI: 10.1164/rccm.201112-2190ed] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a specific clinicopathologic syndrome presenting in older adults with the predominant features: dyspnea, dry cough, restrictive defect on pulmonary function tests (PFTs), hypoxemia, characteristic abnormalities on high-resolution thin section computed tomographic (HRCT) scans, usual interstitial pneumonitis (UIP) pattern on lung biopsy. Surgical lung biopsy is the gold standard of diagnosis, but the diagnosis can be established in some cases by HRCT, provided the clinical features are consistent. The cause of IPF is unknown. However, IPF is more common in adults >60 years old, smokers (current or ex), and patients with specific occupational or noxious exposures. Familial IPF, associated with several distinct genetic mutations, accounts for 1.5–3% of cases. Unfortunately, the prognosis is poor, and most patients die of respiratory failure within 3–6 years of diagnosis. However, the course is highly variable. In some patients, the disease is fulminant, progressing to lethal respiratory failure within months, whereas the course may be indolent, spanning >5 years in some patients. Therapy has not been proven to alter the course of the disease or influence mortality, but recent studies with pirfenidone and tyrosine kinase inhibitors are promising. Lung transplantation is the best therapeutic option, but is limited to selected patients with severe, life-threatening disease and no contraindications to transplant.
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Affiliation(s)
- Robert P. Baughman
- University of Cincinnati, College of Medicine, Department of Internal Medicine, Eden Ave, Cincinnati, 45267-0565 Ohio USA
| | - Roland M. du Bois
- of Respiratory Medicine, Imperial College, Emeritus Professor, Grand Ave 14, London, N10 3BB United Kingdom
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The IPFnet Strategy: Creating a comprehensive approach in the treatment of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2010; 181:527-8. [PMID: 20208036 DOI: 10.1164/rccm.200903-0483ed] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
The Idiopathic Pulmonary Fibrosis (IPF) is a progressive fibrotic lung disease with poor prognosis. It is distinct from other idiopathic interstitial pneumonias by its histopathological pattern of usual interstitial pneumonia which is characterized by accumulation of fibroblasts, extracellular matrix and honeycombing. Inflammation is only scarce in true IPF. The use of anti-inflammatory therapy is still part of guidelines for IPF management, although not specifically recommended, because convincing evidence showing beneficial effects of this approach is lacking. This review provides a summary of important arguments PRO and CON using anti-inflammatory and anti-oxidant therapy for patients with IPF in form of a debate with a concluding statement of both positions at the end.
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Affiliation(s)
- Jürgen Behr
- Division of Pulmonary Diseases, Department of Internal Medicine I, Ludwig-Maximilians University of Munich, 81377 Munich, Germany.
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Pulmonary hypertension in lung diseases: survey of beliefs and practice patterns. Respir Med 2010; 104:741-8. [PMID: 20092992 DOI: 10.1016/j.rmed.2009.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/16/2009] [Accepted: 12/30/2009] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Pulmonary hypertension can be associated with decreased functional capacity and poor prognosis in patients with parenchymal lung diseases (PLD). Yet, little attention has been given to current beliefs and practice patterns. METHODS An 18-question survey was submitted electronically to members of four Networks of the American College of Chest Physicians. RESULTS Analyzable responses were received from 453 physicians. Most (95%) respondents reported testing for PH in patients with PLD using transthoracic echocardiography (TTE) or right-heart catheterization (RHC) and believed that PH could occur in the absence of severe compromise in pulmonary function (70%) and hypoxemia (50%). Approximately 30% of physicians reported not performing RHC to confirm a diagnosis of PH before initiating therapy. Most respondents (92%) felt that medical therapy was effective and the medication of first choice was either bosentan or sildenafil. Most respondents believed that treating PH in these patients improves quality of life (63%) and dyspnea (67%), but were less sure about the impact on functional capacity and survival. CONCLUSIONS Approximately 30% of physicians do not perform RHC to confirm this diagnosis prior to initiating therapy. Despite relatively little supportive evidence, most physicians treat with vasoactive medications and believe that medical therapy confers benefit.
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Abstract
PURPOSE OF REVIEW This review aims to highlight and place in context recent advances in and insights into the natural history, diagnosis, and management of idiopathic pulmonary fibrosis (IPF). RECENT FINDINGS Although the diagnosis of IPF remains challenging, an evolution in systems of practice and advancing technologies are steadily improving diagnostic accuracy. The identification of concomitant pulmonary hypertension as well as acute exacerbations of the underlying disease have taken on increasing importance in the natural history of IPF. Similarly, the management of IPF remains challenging, and although a number of recent trials of novel investigational agents for the treatment of IPF yielded negative results, at least one of these trials showed significant benefit suggesting progress in the treatment of this disease. SUMMARY Although IPF remains a diagnostic and therapeutic challenge to even the most experienced of clinicians, our knowledge of the natural history of the disease, diagnostic accuracy, and therapeutic approach continue to advance.
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Ohshimo S, Bonella F, Cui A, Beume M, Kohno N, Guzman J, Costabel U. Significance of bronchoalveolar lavage for the diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2009; 179:1043-7. [PMID: 19246718 DOI: 10.1164/rccm.200808-1313oc] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE According to the 2002 ATS/ERS Consensus Classification, a confident diagnosis of idiopathic pulmonary fibrosis (IPF) without surgical lung biopsy is made with consistent clinical/physiological findings and the typical features on high-resolution computed tomography (HRCT). Bronchoalveolar lavage (BAL) and/or transbronchial biopsy, one of four major criteria in the 2000 ATS/ERS IPF Statement, was no more essential in the diagnostic algorithm of 2002 ATS/ERS Consensus Classification. OBJECTIVES To evaluate the additional utility of BAL for the diagnosis of IPF. METHODS A total of 101 patients with suspected IPF on HRCT were studied. Twenty-seven patients were excluded because of lack of functional impairment (n = 20), an underlying condition causing fibrosis (n = 5), or a clinical history inconsistent with IPF (n = 2). The remaining 74 patients met all the criteria recommended in the 2002 ATS/ERS Consensus Classification for making a diagnosis in the absence of surgical biopsy. The final diagnosis was made with further examinations, including pathological analysis, in patients who showed inconsistent findings for IPF on BAL. MEASUREMENTS AND MAIN RESULTS A cut-off level of 30% for lymphocytes in BAL demonstrated a favorable discriminative power for the diagnosis of IPF. Six of the 74 patients (8%) showed a lymphocytosis of 30% or greater in BAL. Their final diagnoses were idiopathic nonspecific interstitial pneumonia (n = 3) and extrinsic allergic alveolitis (n = 3). The change in perception of the diagnosis was validated by a surgical biopsy in two cases and by subsequent outcome in four cases. CONCLUSIONS BAL lymphocytosis changed the diagnostic perception in six of 74 patients who would have been misdiagnosed as having IPF without BAL.
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Affiliation(s)
- Shinichiro Ohshimo
- University of Duisburg-Essen, Department of Pneumology/Allergy, Ruhrlandklinik Tueschener Weg 40, 45239 Essen, Germany
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Kim R, Meyer KC. Therapies for interstitial lung disease: past, present and future. Ther Adv Respir Dis 2009; 2:319-38. [PMID: 19124380 DOI: 10.1177/1753465808096948] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
As our understanding of the pathobiology and natural history of the various forms of interstitial lung disease (ILD) has evolved, so have our approaches to treating this heterogeneous group of lung disorders. The earliest pharmacologic agents used to treat various forms of ILD were corticosteroids, and corticosteroids are currently the mainstay of therapy for many forms of ILD. However, it has become clear that corticosteroids and other anti-inflammatory agents lack efficacy for many forms of ILD, such as idiopathic pulmonary fibrosis (IPF), and newer therapies that are in clinical trials target the fibrogenic process and/or secondary pulmonary hypertension (PH) that is present in various forms of fibrotic lung disease. Novel therapies, such as the use of biologic agents (antibodies and cell cycle inhibitors) or stem cell therapies will undoubtedly evolve as new research is performed and clinical trials are undertaken. Lung transplantation remains an option for advanced lung disease that is progressive and unresponsive to non-surgical therapies.
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Affiliation(s)
- Robert Kim
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI, USA
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