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Fiorino EK, Fishman MP. Approach to the patient with Childhood Interstitial and Diffuse Lung Disease. Pediatr Pulmonol 2024; 59:2267-2275. [PMID: 39056528 DOI: 10.1002/ppul.27162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 06/06/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
Childhood Interstitial and Diffuse Lung Disease (chILD) encompasses a group of rare, chronic lung disorders in infants and children with overlapping clinical features but diverse etiologies. The clinical presentation of chILD is of chronic or recurring respiratory signs and symptoms, often including increased work of breathing and hypoxia, with diffuse radiographic abnormalities on chest imaging. Recognition can be challenging since some clinical features overlap with those of more common pediatric respiratory diseases including asthma and recurrent viral infections, among others. chILD should be considered as an underlying diagnosis when a patient's respiratory symptoms seem disproportionate to the clinical scenario and/or persist. The diagnostic process involves multiple steps and is tailored to the individual patient. Nearly all children will undergo imaging and pulmonary function testing, many will undergo bronchoscopy with bronchoalveolar lavage, many will receive genetic testing, and some will require lung biopsy. Treatment includes preventive care, evaluation for comorbidities, pharmacotherapy according to diagnosis, and ongoing disease surveillance, including revisiting genetic and histopathologic results as new clinical information becomes available and as our understanding of these rare disorders improves. The purpose of this review is to provide a broad approach to the diagnosis and management of patients with chILD.
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Affiliation(s)
- Elizabeth K Fiorino
- Northwell, New Hyde Park, New York, USA
- Departments of Science Education and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Martha P Fishman
- Harvard Medical School, Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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2
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Fletcher C, Hadchouel A, Thumerelle C, Mazenq J, Fleury M, Corvol H, Jedidi N, Benhamida M, Bessaci K, Bilhouee T, Borie R, Brouard J, Cantais A, Clement A, Coutier L, Cisterne C, Cros P, Dalphin ML, Delacourt C, Deneuville E, Dubus JC, Egron C, Epaud R, Fayon M, Forgeron A, Gachelin E, Galode F, Gertini I, Giovannini-Chami L, Gourdan P, Guiddir T, Herzog A, Houdouin V, Hullo É, Jarreau PH, Labbé G, Labouret G, Ladaurade A, Le Clainche Viala L, Marguet C, Masson-Rouchaud A, Perisson C, Rames C, Reix P, Renoux MC, Roditis L, Schweitzer C, Tatopoulos A, Trioche-Eberschweiler P, Troussier F, Vigier C, Weiss L, Legendre M, Louvrier C, de Becdelievre A, Coulomb A, Sileo C, Ducou le Pointe H, Berteloot L, Delestrain C, Nathan N. Epidemiology of childhood interstitial lung disease in France: the RespiRare cohort. Thorax 2024; 79:842-852. [PMID: 38964860 DOI: 10.1136/thorax-2023-221325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/16/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Interstitial lung disease in children (chILD) are rare and mostly severe lung diseases. Very few epidemiological data are available in limited series of patients. The aim of this study was to assess the prevalence and incidence of chILD in France. METHODS We performed within the RespiRare network a multicentre retrospective observational study in patients with chILD from 2000 to 2022 and a prospective evaluation of chILD's incidence between February 2022 and 2023. RESULTS chILD was reported in 790 patients in 42 centres. The estimated 2022 prevalence in France was 44 /million children (95% CI 40.76 to 47.46) and the computed incidence was 4.4 /million children (95% CI 3.44 to 5.56). The median age at diagnosis was 3 months with 16.9% of familial forms. Lung biopsy and genetic analyses were performed in 23.4% and 76.9%, respectively. The most frequent chILD aetiologies in the <2 years group were surfactant metabolism disorders (16.3%) and neuroendocrine cell hyperplasia of infancy (11.8%), and in the 2-18 years group diffuse alveolar haemorrhage (12.2%), connective tissue diseases (11.4%), hypersensitivity pneumonitis (8.8%) and sarcoidosis (8.8%). The management included mainly oxygen therapy (52%), corticosteroid pulses (56%), oral corticosteroids (44%), azithromycin (27.2%), enteral nutrition (26.9%), immunosuppressants (20.3%) and hydroxychloroquine (15.9%). The 5-year survival rate was 57.3% for the patients diagnosed before 2 years and 86% between 2 and 18 years. CONCLUSION This large and systematic epidemiological study confirms a higher incidence and prevalence of chILD than previously described. In order to develop international studies, efforts are still needed to optimise the case collection and to harmonise diagnostic and management practices.
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Affiliation(s)
- Camille Fletcher
- Paediatric Pulmonology Department and Reference Center for Rare Lung Diseases, RespiRare, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
- Laboratory of Childhood Genetic Diseases, UMR_S933, Sorbonne University, INSERM, Armand Trousseau Hospital, Paris, France
| | - Alice Hadchouel
- AP-HP, Service de Pneumologie Pédiatrique and Reference center for rare lung diseases RespiRare, Necker-Enfants Malades Hospital, Paris, France
- INSERM U1151 INEM, Université Paris Cité, INSERM, Paris, France
| | | | - Julie Mazenq
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases RespiRare, Aix-Marseille University, AP-HM, Marseille, France
- INRAE, C2VN, INSERM, Marseille, France
| | - Manon Fleury
- APHP, Armand Trousseau Hospital, Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases RespiRare, Sorbonne University, Paris, France
| | - Harriet Corvol
- Paediatric Pulmonology Department and Reference Center for Rare Lung Diseases, RespiRare, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
- CDR Saint-Antoine, Paris, France
| | - Nouha Jedidi
- Paediatric Pulmonology Department and Reference Center for Rare Lung Diseases, RespiRare, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Myriam Benhamida
- Pediatric Department, University Hospital Centre Nantes, Nantes, France
| | - Katia Bessaci
- Pediatric Pulmonology Department, University Hospital Centre Reims, Reims, France
| | - Tiphaine Bilhouee
- Pediatric Department, University Hospital Centre Nantes, Nantes, France
| | - Raphael Borie
- APHP, Bichat Hospital, Pulmonology Department A, Université Paris Cité, Paris, France
- Inserm UMR-S 1152 PHERE, INSERM, Paris, France
| | - Jacques Brouard
- Medical Pediatric Department, Inserm UMRS 1311, DYNAMICURE, UNICAEN, University Hospital Centre Caen, Caen, France
| | - Aurélie Cantais
- Pediatric Department, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Annick Clement
- Plateforme d'expertise maladies rares, AP-HP.Sorbonne University, Paris, France
| | - Laurianne Coutier
- Pediatric Pulmonology Department, University Hospital Lyon, Lyon, France
| | - Camille Cisterne
- Pediatric Pulmonology Department, Lille University Hospital, Lille, France
| | - Pierrick Cros
- Pediatric Department, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Marie-Laure Dalphin
- Pediatric Pulmonology Department, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | - Christophe Delacourt
- AP-HP, Service de Pneumologie Pédiatrique and Reference center for rare lung diseases RespiRare, Necker-Enfants Malades Hospital, Paris, France
- INSERM U1151 INEM, Université Paris Cité, INSERM, Paris, France
| | - Eric Deneuville
- Pediatric Pulmonology Department, University Hospital Centre Rennes, Rennes, France
| | - Jean-Christophe Dubus
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases RespiRare, Aix-Marseille University, AP-HM, Marseille, France
- IRD, MEPHI, IHU Méditerranée-Infection, Aix-Marseille Université, Marseille, France
| | - Carole Egron
- University Hospital Centre Clermont-Ferrand, Clermont-Ferrand, France
| | - Ralph Epaud
- Pédiatrie, Centre Hospitalier Intercommunal de Créteil, Creteil, France
- FHU SENEC; University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Michael Fayon
- Pediatric Pulmonology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Clinical Investigation Center (CIC 1401); Bordeaux University, Cardio-Thoracic Research Center of Bordeaux, Inserm, U1045, INSERM, Bordeaux, France
| | - Aude Forgeron
- Pediatric Pulmonology Department, Hospital Centre Le Mans, Le Mans, France
| | - Elsa Gachelin
- Pediatric Pulmonology Department, CHU Nord Réunion, Saint-Denis, France
| | - François Galode
- Pediatric Pulmonology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Isabelle Gertini
- Pediatric Pulmonology Department, Tours University hospital, Tours, France
| | - Lisa Giovannini-Chami
- Pediatric Pulmonology Department, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, France
| | - Pierre Gourdan
- Pediatric Pulmonology Department, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, France
| | - Tamazoust Guiddir
- Pediatric Pulmonology Department, AP-HP - Université Paris Saclay, Hospital Bicetre, Le Kremlin-Bicetre, France
| | - Audrey Herzog
- Pediatric Pulmonology Department, CHU de Strasbourg, Strasbourg, France
| | - Véronique Houdouin
- Pediatric Pulmonology Department, AP-HP - Paris University, Robert Debré Hospital, Paris, France
| | - Églantine Hullo
- Pediatric Pulmonology Department, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Pierre-Henri Jarreau
- Néonatal intensive care unit, Cochin Hospital, Université Paris Cité, Paris, France
| | - Guillame Labbé
- University Hospital Centre Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Alice Ladaurade
- Pediatric Pulmonology Department, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | | | | | | | - Caroline Perisson
- Pediatric Pulmonology Department, CHU de La Réunion Sites Sud, Saint-Pierre, Réunion
| | - Cinthia Rames
- Pediatric Department, CHU Amiens-Picardie, Amiens, France
| | - Philippe Reix
- Pediatric Pulmonology Department, University Hospital Lyon, Lyon, France
| | | | - Léa Roditis
- Pediatric Pulmonology Department, CHU Toulouse, Toulouse, France
| | | | | | | | | | - Clémentine Vigier
- Pediatric Pulmonology Department, University Hospital Centre Rennes, Rennes, France
| | - Laurence Weiss
- Pediatric Pulmonology Department, CHU de Strasbourg, Strasbourg, France
| | - Marie Legendre
- Laboratory of Childhood Genetic Diseases, UMR_S933, Sorbonne University, INSERM, Armand Trousseau Hospital, Paris, France
- APHP, Armand Trousseau Hospital, Molecular Genetics Department, Sorbonne University, Paris, France
| | - Camille Louvrier
- Laboratory of Childhood Genetic Diseases, UMR_S933, Sorbonne University, INSERM, Armand Trousseau Hospital, Paris, France
- APHP, Armand Trousseau Hospital, Molecular Genetics Department, Sorbonne University, Paris, France
| | - Alix de Becdelievre
- Molecular Genetics Department, Centre Hospitalier Universitaire Henri Mondor, Creteil, France
- INSERM U-955, Université Paris Est Creteil, INSERM, Créteil, France
| | - Aurore Coulomb
- Pathology Department, Sorbonne University, AP-HP, Armand-Trousseau Hospital, Paris, France
| | - Chiara Sileo
- APHP, Sorbonne University, Radiology Department, Armand-Trousseau Hospital, Paris, France
| | - Hubert Ducou le Pointe
- APHP, Sorbonne University, Radiology Department, Armand-Trousseau Hospital, Paris, France
| | - Laureline Berteloot
- Pediatric Radiology Department, APHP, Université Paris Cité, Necker-Enfants Malades Hospitals, Paris, France
| | - Céline Delestrain
- Pédiatrie, Centre Hospitalier Intercommunal de Créteil, Creteil, France
- FHU SENEC; University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Nadia Nathan
- Paediatric Pulmonology Department and Reference Center for Rare Lung Diseases, RespiRare, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
- Laboratory of Childhood Genetic Diseases, UMR_S933, Sorbonne University, INSERM, Armand Trousseau Hospital, Paris, France
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3
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Giunta-Stibb H, Hackett B. Interstitial lung disease in the newborn. J Perinatol 2024:10.1038/s41372-024-02036-9. [PMID: 38956315 DOI: 10.1038/s41372-024-02036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/30/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Abstract
Although relatively rare, interstitial lung diseases may present with respiratory distress in the newborn period. Most commonly these include developmental and growth disorders, disorders of surfactant synthesis and homeostasis, pulmonary interstitial glycogenosis, and neuroendocrine cell hyperplasia of infancy. Although the diagnosis of these disorders is sometimes made based on clinical presentation and imaging, due to the significant overlap between disorders and phenotypic variability, lung biopsy or, increasingly genetic testing is needed for diagnosis. These diseases may result in significant morbidity and mortality. Effective medical treatment options are in some cases limited and/or invasive. The genetic basis for some of these disorders has been identified, and with increased utilization of exome and whole genome sequencing even before lung biopsy, further insights into their genetic etiologies should become available.
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Affiliation(s)
- Hannah Giunta-Stibb
- Divisions of Neonatology and Pulmonology, Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | - Brian Hackett
- Mildred Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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4
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Bernardinello N, Griese M, Borie R, Spagnolo P. Emerging Treatments for Childhood Interstitial Lung Disease. Paediatr Drugs 2024; 26:19-30. [PMID: 37948041 PMCID: PMC10770003 DOI: 10.1007/s40272-023-00603-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
Childhood interstitial lung disease (chILD) is a large and heterogeneous group of disorders characterized by diffuse lung parenchymal markings on chest imaging and clinical signs such as dyspnea and hypoxemia from functional impairment. While some children already present in the neonatal period with interstitial lung disease (ILD), others develop ILD during their childhood and adolescence. A timely and accurate diagnosis is essential to gauge treatment and improve prognosis. Supportive care can reduce symptoms and positively influence patients' quality of life; however, there is no cure for many of the chILDs. Current therapeutic options include anti-inflammatory or immunosuppressive drugs. Due to the rarity of the conditions and paucity of research in this field, most treatments are empirical and based on case series, and less than a handful of small, randomized trials have been conducted thus far. A trial on hydroxychloroquine yielded good safety but a much smaller effect size than anticipated. A trial in fibrotic disease with the multitargeted tyrosine kinase inhibitor nintedanib showed similar pharmacokinetics and safety as in adults. The unmet need for the treatment of chILDs remains high. This article summarizes current treatments and explores potential therapeutic options for patients suffering from chILD.
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Affiliation(s)
- Nicol Bernardinello
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani n°2, 35128, Padua, Italy
| | - Matthias Griese
- Department of Pediatric Pneumology, Dr. von Hauner Children's Hospital, German Center for Lung Research (DZL), Ludwig-Maximilians University, Munich, Germany
| | - Raphaël Borie
- Université de Paris, INSERM UMR 1152, Service de Pneumologie A, Centre de compétences maladies pulmonaires rares, Hôpital Bichat-Claude Bernard, AP-HP, 75018, Paris, France
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani n°2, 35128, Padua, Italy.
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5
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Nathan N, Griese M, Michel K, Carlens J, Gilbert C, Emiralioglu N, Torrent-Vernetta A, Marczak H, Willemse B, Delestrain C, Epaud R. Diagnostic workup of childhood interstitial lung disease. Eur Respir Rev 2023; 32:32/167/220188. [PMID: 36813289 PMCID: PMC9945877 DOI: 10.1183/16000617.0188-2022] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/18/2022] [Indexed: 02/24/2023] Open
Abstract
Childhood interstitial lung diseases (chILDs) are rare and heterogeneous diseases with significant morbidity and mortality. An accurate and quick aetiological diagnosis may contribute to better management and personalised treatment. On behalf of the European Respiratory Society Clinical Research Collaboration for chILD (ERS CRC chILD-EU), this review summarises the roles of the general paediatrician, paediatric pulmonologists and expert centres in the complex diagnostic workup. Each patient's aetiological chILD diagnosis must be reached without prolonged delays in a stepwise approach from medical history, signs, symptoms, clinical tests and imaging, to advanced genetic analysis and specialised procedures including bronchoalveolar lavage and biopsy, if necessary. Finally, as medical progress is fast, the need to revisit a diagnosis of "undefined chILD" is stressed.
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Affiliation(s)
- Nadia Nathan
- AP-HP, Sorbonne Université, Pediatric Pulmonology Department and Reference Center for Rare Lung Disease RespiRare, Armand Trousseau Hospital, Paris, France .,Sorbonne Université, Inserm UMR_S933 Laboratory of Childhood Genetic Diseases, Armand Trousseau Hospital, Paris, France
| | - Matthias Griese
- Department of Paediatric Pneumology, Dr von Hauner Children's Hospital, German Centre for Lung Research, University of Munich, Munich, Germany
| | - Katarzyna Michel
- Department of Paediatric Pneumology, Dr von Hauner Children's Hospital, German Centre for Lung Research, University of Munich, Munich, Germany
| | - Julia Carlens
- Clinic for Pediatric Pneumology, Hannover Medical School, Hannover, Germany
| | - Carlee Gilbert
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alba Torrent-Vernetta
- Pediatric Allergy and Pulmonology Section, Department of Pediatrics, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Honorata Marczak
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Brigitte Willemse
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Céline Delestrain
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE®), CRCM, Créteil, France
| | - Ralph Epaud
- Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE®), CRCM, Créteil, France,University Paris Est Créteil, INSERM, IMRB, Créteil, France
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6
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Li Y, Seidl E, Knoflach K, Gothe F, Forstner ME, Michel K, Pawlita I, Gesenhues F, Sattler F, Yang X, Kroener C, Reu-Hofer S, Ley-Zaporozhan J, Kammer B, Krüger-Stollfuß I, Dinkel J, Carlens J, Wetzke M, Moreno-Galdó A, Torrent-Vernetta A, Lange J, Krenke K, Rumman N, Mayell S, Sismanlar T, Aslan A, Regamey N, Proesmans M, Stehling F, Naehrlich L, Ayse K, Becker S, Koerner-Rettberg C, Plattner E, Manali ED, Papiris SA, Campo I, Kappler M, Schwerk N, Griese M. ABCA3 -related interstitial lung disease beyond infancy. Thorax 2023; 78:587-595. [PMID: 36808083 DOI: 10.1136/thorax-2022-219434] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/30/2022] [Indexed: 02/22/2023]
Abstract
BACKGROUND The majority of patients with childhood interstitial lung disease (chILD) caused by pathogenic variants in ATP binding cassette subfamily A member 3 (ABCA3) develop severe respiratory insufficiency within their first year of life and succumb to disease if not lung transplanted. This register-based cohort study reviews patients with ABCA3 lung disease who survived beyond the age of 1 year. METHOD Over a 21-year period, patients diagnosed as chILD due to ABCA3 deficiency were identified from the Kids Lung Register database. 44 patients survived beyond the first year of life and their long-term clinical course, oxygen supplementation and pulmonary function were reviewed. Chest CT and histopathology were scored blindly. RESULTS At the end of the observation period, median age was 6.3 years (IQR: 2.8-11.7) and 36/44 (82%) were still alive without transplantation. Patients who had never received supplemental oxygen therapy survived longer than those persistently required oxygen supplementation (9.7 (95% CI 6.7 to 27.7) vs 3.0 years (95% CI 1.5 to 5.0), p=0.0126). Interstitial lung disease was clearly progressive over time based on lung function (forced vital capacity % predicted absolute loss -1.1% /year) and on chest CT (increasing cystic lesions in those with repetitive imaging). Lung histology pattern were variable (chronic pneumonitis of infancy, non-specific interstitial pneumonia, and desquamative interstitial pneumonia). In 37/44 subjects, the ABCA3 sequence variants were missense variants, small insertions or deletions with in-silico tools predicting some residual ABCA3 transporter function. CONCLUSION The natural history of ABCA3-related interstitial lung disease progresses during childhood and adolescence. Disease-modifying treatments are desirable to delay such disease course.
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Affiliation(s)
- Yang Li
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany.,Medical college, Chongqing University, Chongqing, China
| | - Elias Seidl
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Knoflach
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Florian Gothe
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Maria Elisabeth Forstner
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Katarzyna Michel
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Ingo Pawlita
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Florian Gesenhues
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Franziska Sattler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Xiaohua Yang
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Carolin Kroener
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | | | - Julia Ley-Zaporozhan
- Department of Radiology, Pediatric Radiology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Birgit Kammer
- Department of Radiology, Pediatric Radiology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Ingrid Krüger-Stollfuß
- Department of Radiology, Pediatric Radiology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Julien Dinkel
- German Center for Lung Research (DZL), Munich, Germany.,Department of Radiology, Pediatric Radiology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Julia Carlens
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hanover, Germany.,German Center for Lung Research (DZL), BREATH Hannover, Hanover, Germany
| | - Martin Wetzke
- German Center for Lung Research (DZL), BREATH Hannover, Hanover, Germany.,Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Antonio Moreno-Galdó
- Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain and CIBER of Rare Diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Alba Torrent-Vernetta
- Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain and CIBER of Rare Diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Joanna Lange
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Nisreen Rumman
- Department of Pediatrics, Makassed Charitable Society Hospital, East Jerusalem, Palestine
| | - Sarah Mayell
- Regional Paediatric CF Centre, Alder Hey Children's Hospital, Liverpool, UK
| | - Tugba Sismanlar
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayse Aslan
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nicolas Regamey
- Pediatric Respiratory Medicine, Children's Hospital, Luzern, Switzerland
| | - Marijke Proesmans
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Florian Stehling
- Children's Hospital, Department of Pneumology, University Hospital Essen, Essen, Germany
| | - Lutz Naehrlich
- Department of Pediatrics, Justus-Liebig-University Giessen, German Center for Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Sebastian Becker
- Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | | | - Erika Plattner
- Universitätsklinikum Erlangen, Children's Hospital, Erlangen, Germany
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, Medical School, "ATTIKON" University Hospital, Haidari, Greece
| | - Spyridon A Papiris
- 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, Medical School, "ATTIKON" University Hospital, Haidari, Greece
| | - Ilaria Campo
- SC Pneumologia - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matthias Kappler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Nicolaus Schwerk
- German Center for Lung Research (DZL), BREATH Hannover, Hanover, Germany.,Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany .,German Center for Lung Research (DZL), Munich, Germany
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7
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Chen F, Xie Z, Zhang VW, Chen C, Fan H, Zhang D, Jiang W, Wang C, Wu P. Case Report: Report of Two Cases of Interstitial Lung Disease Caused by Novel Compound Heterozygous Variants in the ABCA3 Gene. Front Genet 2022; 13:875015. [PMID: 35464853 PMCID: PMC9019779 DOI: 10.3389/fgene.2022.875015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Interstitial lung disease (ILD) is a heterogeneous group of pulmonary disorders involving the lung interstitium and distal airways, also known as diffuse lung disease. The genetic defects resulting in alveolar surfactant protein dysfunction are a rare cause of ILD in pediatric patients. We report two unrelated pediatric patients with shortness of breath, dyspnea and hypoxemia, and the chest CT findings including patchy ground-glass opacity in both lung fields, suggestive of diffuse ILD. One patient was a full-term male infant who had shortness of breath a few hours after the birth, and then developed into severe respiratory distress syndrome (RDS). Whole exome sequencing revealed novel compound heterozygous variants in the ABCA3 gene (NM_001,089.3): paternally inherited c.4035+5G > A and c.668T > C (p.M223T), and maternally inherited c.1285+4A > C. The second patient was a 34-month-old boy with onset of chronic repeated cough and hypoxemia at 9 months of age. We unveiled novel compound heterozygous ABCA3 variants (c.704T > C, p.F235S; c.4037_4040del, p.T1346Nfs*15) in this patient. Surfactant protein dysfunction due to bi-allelic mutations in the ABCA3 gene was the cause of ILD in two patients. The novel mutations found in this study expanded the spectrum of known mutations in the ABCA3 gene.
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Affiliation(s)
- Fang Chen
- Respiratory Department of Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zhiwei Xie
- Respiratory Department of Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Victor Wei Zhang
- Department of Human and Molecular Genetics, Baylor College of Medicine, Houston, TX, United States.,AmCare Genomics Lab, Guangzhou, China
| | - Chen Chen
- Respiratory Department of Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Huifeng Fan
- Respiratory Department of Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Dongwei Zhang
- Respiratory Department of Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wenhui Jiang
- Respiratory Department of Guangzhou Women and Children's Medical Center, Guangzhou, China
| | | | - Peiqiong Wu
- Respiratory Department of Guangzhou Women and Children's Medical Center, Guangzhou, China
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8
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DeBoer EM, Liptzin DR, Humphries SM, Lynch DA, Robison K, Galambos C, Dishop MK, Deterding RR, Weinman JP. Ground glass and fibrotic change in children with surfactant protein C dysfunction mutations. Pediatr Pulmonol 2021; 56:2223-2231. [PMID: 33666361 DOI: 10.1002/ppul.25356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Therapeutics exist to treat fibrotic lung disease in adults, but these have not been investigated in children. Defining biomarkers for pediatric fibrotic lung disease in children is crucial for clinical trials. Children with surfactant protein C (SFTPC) dysfunction mutations develop fibrotic lung disease over time. We evaluated chest computed tomography (CT) changes over time in children with SFTPC dysfunction mutations. METHODS We performed an institutional review board-approved retrospective review of children with SFTPC dysfunction mutations. We collected demographic and clinical information. Chest CT scans were evaluated using visual and computerized scores. Chest CT scores and pulmonary function tests were reviewed. RESULTS Eleven children were included. All children presented in infancy and four children suffered from respiratory failure requiring mechanical ventilation. Those who performed pulmonary function tests had stable forced vital capacities over time by percent predicted, but increased forced vital capacity in liters. CT findings evolved over time in most patients with earlier CT scans demonstrating ground glass opacities and later CT scans with more fibrotic features. In a pilot analysis, data-driven textural analysis software identified fibrotic features in children with SFTPC dysfunction that increased over time and correlated with visual CT scores. DISCUSSION We describe 11 children with SFTPC dysfunction mutations. Increases in forced vital capacity over time suggest that these children experience lung growth and that therapeutic intervention may maximize lung growth. Ground glass opacities are the primary early imaging findings while fibrotic features dominate later. CT findings suggest the development of and increases in fibrotic features that may serve as potential biomarkers for antifibrotic therapeutic trials.
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Affiliation(s)
- Emily M DeBoer
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Deborah R Liptzin
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, USA
| | - Kyle Robison
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Csaba Galambos
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pathology and Laboratory Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan K Dishop
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pathology, University of Arizona, Phoenix, Arizona, USA
| | - Robin R Deterding
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jason P Weinman
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Radiology, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA
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9
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Delestrain C, Aissat A, Simon S, Tarze A, Duprat E, Nattes E, Costes B, Delattre V, Finet S, Fanen P, Epaud R. Methylprednisolone pulse treatment improves ProSP-C trafficking in twins with SFTPC mutation: An isoform story? Br J Clin Pharmacol 2021; 87:2361-2373. [PMID: 33179299 DOI: 10.1111/bcp.14645] [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] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022] Open
Abstract
Mutations in the gene encoding surfactant protein C (SP-C) cause interstitial lung disease (ILD), and glucocorticosteroid (GC) treatment is the most recognized therapy in children. We aimed to decipher the mechanisms behind successful GC treatment in twins carrying a BRICHOS c.566G > A (p.Cys189Tyr) mutation in the SP-C gene (SFTPC). METHODS: The twins underwent bronchoscopy before and after GC treatment and immunoblotting analysis of SP-C proprotein (proSP-C) and SP-C mature in bronchoalveolar fluid (BALF). Total RNA was extracted and analysed using quantitative real-time PCR assays. In A549 cells, the processing of mutated protein C189Y was studied by immunofluorescence and immunoblotting after heterologous expression of eukaryotic vectors containing wild type or C189Y mutant cDNA. RESULTS: Before treatment, BALF analysis identified an alteration of the proSP-C maturation process. Functional study of C189Y mutation in alveolar A549 cells showed that pro-SP-CC189Y was retained within the endoplasmic reticulum together with ABCA3. After 5 months of GC treatment with clinical benefit, the BALF analysis showed an improvement of proSP-C processing. SFTPC mRNA analysis in twins revealed a decrease in the expression of total SFTPC mRNA and a change in its splicing, leading to the expression of a second shorter proSP-C isoform. In A549 cells, the processing and the stability of this shorter wild-type proSP-C isoform was similar to that of the longer isoform, but the half-life of the mutated shorter isoform was decreased. These results suggest a direct effect of GC on proSP-C metabolism through reducing the SFTPC mRNA level and favouring the expression of a less stable protein isoform.
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Affiliation(s)
- Céline Delestrain
- Université Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, 94000, France.,FHU SENEC, Créteil, France
| | - Abdel Aissat
- Université Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,FHU SENEC, Créteil, France.,AP-HP, Hôpital Henri Mondor, Pôle de Biologie-Pathologie, Département de Génétique, Créteil, 94000, France
| | - Stéphanie Simon
- Université Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Agathe Tarze
- Université Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Elodie Duprat
- Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie, CNRS, Sorbonne Université, Muséum National d'Histoire Naturelle, Paris, France
| | - Elodie Nattes
- Université Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, 94000, France.,FHU SENEC, Créteil, France
| | - Bruno Costes
- Université Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,FHU SENEC, Créteil, France.,AP-HP, Hôpital Henri Mondor, Pôle de Biologie-Pathologie, Département de Génétique, Créteil, 94000, France
| | - Valérie Delattre
- AP-HP, Hôpital Henri Mondor, Pôle de Biologie-Pathologie, Département de Génétique, Créteil, 94000, France
| | - Stéphanie Finet
- Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie, CNRS, Sorbonne Université, Muséum National d'Histoire Naturelle, Paris, France
| | - Pascale Fanen
- Université Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,FHU SENEC, Créteil, France.,AP-HP, Hôpital Henri Mondor, Pôle de Biologie-Pathologie, Département de Génétique, Créteil, 94000, France
| | - Ralph Epaud
- Université Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.,Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, 94000, France.,FHU SENEC, Créteil, France
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10
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Nathan N, Berdah L, Delestrain C, Sileo C, Clement A. Interstitial lung diseases in children. Presse Med 2020; 49:103909. [PMID: 32563946 DOI: 10.1016/j.lpm.2019.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/11/2019] [Indexed: 01/16/2023] Open
Abstract
Interstitial lung disease (ILD) in children (chILD) is a heterogeneous group of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality. The pathogenesis of the various chILD is complex and the diseases share common features of inflammatory and fibrotic changes of the lung parenchyma that impair gas exchanges. The etiologies of chILD are numerous. In this review, we chose to classify them as ILD related to exposure/environment insults, ILD related to systemic and immunological diseases, ILD related to primary lung parenchyma dysfunctions and ILD specific to infancy. A growing part of the etiologic spectrum of chILD is being attributed to molecular defects. Currently, the main genetic mutations associated with chILD are identified in the surfactant genes SFTPA1, SFTPA2, SFTPB, SFTPC, ABCA3 and NKX2-1. Other genetic contributors include mutations in MARS, CSF2RA and CSF2RB in pulmonary alveolar proteinosis, and mutations in TMEM173 and COPA in specific auto-inflammatory forms of chILD. However, only few genotype-phenotype correlations could be identified so far. Herein, information is provided about the clinical presentation and the diagnosis approach of chILD. Despite improvements in patient management, the therapeutic strategies are still relying mostly on corticosteroids although specific therapies are emerging. Larger longitudinal cohorts of patients are being gathered through ongoing international collaborations to improve disease knowledge and targeted therapies. Thus, it is expected that children with ILD will be able to reach the adulthood transition in a better condition.
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Affiliation(s)
- Nadia Nathan
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France; Sorbonne université and Inserm UMRS933, 75012 Paris, France
| | - Laura Berdah
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France; Sorbonne université and Inserm UMRS933, 75012 Paris, France
| | - Céline Delestrain
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France
| | - Chiara Sileo
- Radiology department, AP-HP, Trousseau hospital, 75012 Paris, France
| | - Annick Clement
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France; Sorbonne université and Inserm UMRS933, 75012 Paris, France.
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11
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Nathan N, Sileo C, Thouvenin G, Berdah L, Delestrain C, Manali E, Papiris S, Léger PL, Pointe HDL, l'Hermine AC, Clement A. Pulmonary Fibrosis in Children. J Clin Med 2019; 8:E1312. [PMID: 31455000 PMCID: PMC6780823 DOI: 10.3390/jcm8091312] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 12/20/2022] Open
Abstract
: Pulmonary fibrosis (PF) is a very rare condition in children, which may be observed in specific forms of interstitial lung disease. None of the clinical, radiological, or histological descriptions used for PF diagnosis in adult patients, especially in situations of idiopathic PF, can apply to pediatric situations. This observation supports the view that PF expression may differ with age and, most likely, may cover distinct entities. The present review aims at summarizing the current understanding of PF pathophysiology in children and identifying suitable diagnostic criteria.
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Affiliation(s)
- Nadia Nathan
- Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases (RespiRare), Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 75012 Paris, France.
- Inserm UMR_S933, Sorbonne Université, 75012 Paris, France.
| | - Chiara Sileo
- Pediatric Radiology Department, Armand Trousseau Hospital, AP-HP, 75012 Paris, France
| | - Guillaume Thouvenin
- Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases (RespiRare), Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 75012 Paris, France
| | - Laura Berdah
- Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases (RespiRare), Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 75012 Paris, France
| | - Céline Delestrain
- Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases (RespiRare), Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 75012 Paris, France
| | - Effrosyne Manali
- nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Spyros Papiris
- nd Pulmonary Medicine Department, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Pierre-Louis Léger
- Intensive Care Unit, Armand Trousseau Hospital, AP-HP, 75012 Paris, France
| | | | | | - Annick Clement
- Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases (RespiRare), Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 75012 Paris, France
- Inserm UMR_S933, Sorbonne Université, 75012 Paris, France
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12
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Cunningham S, Jaffe A, Young LR. Children's interstitial and diffuse lung disease. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:568-577. [DOI: 10.1016/s2352-4642(19)30117-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/19/2019] [Accepted: 03/27/2019] [Indexed: 12/21/2022]
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13
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Manali ED, Legendre M, Nathan N, Kannengiesser C, Coulomb-L'Hermine A, Tsiligiannis T, Tomos P, Griese M, Borie R, Clement A, Amselem S, Crestani B, Papiris SA. Bi-allelic missense ABCA3 mutations in a patient with childhood ILD who reached adulthood. ERJ Open Res 2019; 5:00066-2019. [PMID: 31360696 PMCID: PMC6646961 DOI: 10.1183/23120541.00066-2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022] Open
Abstract
The adenosine triphosphate (ATP)-binding cassette subfamily A member 3 (ABCA3) is a transmembrane glycoprotein that uses energy of ATP hydrolysis to transport phospholipids into the lamellar bodies of type 2 alveolar epithelial cells (AEC) and regulates lung surfactant homeostasis. More than 200 mutations have already been described in ABCA3, located on chromosome 16 [1, 2]. Patients present with a great heterogeneity of phenotypes, from lethal neonatal respiratory distress syndrome (RDS) to childhood and rarely adult interstitial lung disease (ILD) [3, 4]. ABCA3 mutations-related lung disease inheritance is autosomal recessive, as it requires two disease-causing (bi-allelic) mutations, one from each parent. Children with ABCA3 mutations may survive beyond infancy and reach adulthood. Genetic mechanisms should always be examined in adult patients with childhood onset ILD and molecular analysis should be performed accordingly in specialised referral centres.http://bit.ly/2LzMNOE
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Affiliation(s)
- Effrosyni D Manali
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,These authors contributed equally
| | - Marie Legendre
- Sorbonne Université, INSERM UMR_S933, and Assistance Publique Hôpitaux de Paris, Service de Génétique et d'Embryologie Médicales, Hôpital Armand Trousseau, Paris, France.,These authors contributed equally
| | - Nadia Nathan
- Sorbonne Université, INSERM UMR_S933, France, Assistance Publique Hôpitaux de Paris, Service de Pneumologie Pédiatrique, Hôpital Armand Trousseau, Centre National de Référence des Maladies Respiratoires Rares RespiRare, Paris, France
| | - Caroline Kannengiesser
- Service de Génétique, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Aurore Coulomb-L'Hermine
- Service d'Anatomie et de Cytologie Pathologiques, Sorbonne Université, Hôpital d'Enfants Armand Trousseau, Paris, France
| | | | - Pericles Tomos
- Dept of Thoracic Surgery, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Matthias Griese
- Dept of Pediatric Pneumology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, German Center for Lung Research, Munich, Germany
| | - Raphael Borie
- Service de Pneumologie A, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Centre de Référence des Maladies Pulmonaires Rares, Université Paris Diderot, Sorbonne Paris Cité, DHU FIRE, Paris, France
| | - Annick Clement
- Sorbonne Université, INSERM UMR_S933, France, Assistance Publique Hôpitaux de Paris, Service de Pneumologie Pédiatrique, Hôpital Armand Trousseau, Centre National de Référence des Maladies Respiratoires Rares RespiRare, Paris, France
| | - Serge Amselem
- Sorbonne Université, INSERM UMR_S933, and Assistance Publique Hôpitaux de Paris, Service de Génétique et d'Embryologie Médicales, Hôpital Armand Trousseau, Paris, France
| | - Bruno Crestani
- Service de Génétique, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de Pneumologie A, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Centre de Référence des Maladies Pulmonaires Rares, Université Paris Diderot, Sorbonne Paris Cité, DHU FIRE, Paris, France.,These authors contributed equally
| | - Spyros A Papiris
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,These authors contributed equally
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14
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Klay D, Hoffman TW, Harmsze AM, Grutters JC, van Moorsel CHM. Systematic review of drug effects in humans and models with surfactant-processing disease. Eur Respir Rev 2018; 27:27/149/170135. [PMID: 29997245 DOI: 10.1183/16000617.0135-2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/12/2018] [Indexed: 12/14/2022] Open
Abstract
Fibrotic interstitial pneumonias are a group of rare diseases characterised by distortion of lung interstitium. Patients with mutations in surfactant-processing genes, such as surfactant protein C (SFTPC), surfactant protein A1 and A2 (SFTPA1 and A2), ATP binding cassette A3 (ABCA3) and Hermansky-Pudlak syndrome (HPS1, 2 and 4), develop progressive pulmonary fibrosis, often culminating in fatal respiratory insufficiency. Although many mutations have been described, little is known about the optimal treatment strategy for fibrotic interstitial pneumonia patients with surfactant-processing mutations.We performed a systematic literature review of studies that described a drug effect in patients, cell or mouse models with a surfactant-processing mutation. In total, 73 articles were selected, consisting of 55 interstitial lung disease case reports/series, two clinical trials and 16 cell or mouse studies. Clinical effect parameters included lung function, radiological characteristics and clinical symptoms, while experimental outcome parameters included chemokine/cytokine expression, surfactant trafficking, necrosis and apoptosis. SP600125, a c-jun N-terminal kinase (JNK) inhibitor, hydroxychloroquine and 4-phenylbutyric acid were most frequently studied in disease models and lead to variable outcomes, suggesting that outcome is mutation dependent.This systematic review summarises effect parameters for future studies on surfactant-processing disorders in disease models and provides directions for future trials in affected patients.
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Affiliation(s)
- Dymph Klay
- Interstitial Lung Disease Center of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Thijs W Hoffman
- Interstitial Lung Disease Center of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Ankie M Harmsze
- Dept of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan C Grutters
- Interstitial Lung Disease Center of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands.,Division of Heart and Lung, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Coline H M van Moorsel
- Interstitial Lung Disease Center of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands .,Division of Heart and Lung, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Faverio P, Bini F, Vaghi A, Pesci A. Long-term macrolides in diffuse interstitial lung diseases. Eur Respir Rev 2017; 26:26/146/170082. [DOI: 10.1183/16000617.0082-2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/07/2017] [Indexed: 12/18/2022] Open
Abstract
In the present review we provide currently available evidence for the use of macrolides in the treatment of diffuse interstitial lung diseases (ILDs). Up to now, research on macrolides has mainly focused on three areas. First, macrolides have shown some promising results in cellular models and case reports as antifibrotic agents, by promoting autophagy and clearance of intracellular protein aggregates and acting as regulators of surfactant homeostasis. Secondly, macrolides have an immunomodulatory effect, which has been applied in some organising pneumonia cases. In particular, macrolides have been tested in association with systemic corticosteroids as steroid-sparing agents and alone as either first-line agents in mild cases or second-line agents where steroids were poorly tolerated or had failed. Thirdly, a recent area of research concerns the possible role of macrolides as modulators of lung microbiota and the host–microbiota interaction. This function has been particularly studied in idiopathic pulmonary fibrosis patients, in whom changes in microbiota have been proved to be associated with disease progression. However, the lack of high-quality studies makes the application of macrolide therapy in ILDs a field in which research should be conducted on a large scale.
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16
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Nattes E, Lejeune S, Carsin A, Borie R, Gibertini I, Balinotti J, Nathan N, Marchand-Adam S, Thumerelle C, Fauroux B, Bosdure E, Houdouin V, Delestrain C, Louha M, Couderc R, De Becdelievre A, Fanen P, Funalot B, Crestani B, Deschildre A, Dubus JC, Epaud R. Heterogeneity of lung disease associated with NK2 homeobox 1 mutations. Respir Med 2017; 129:16-23. [DOI: 10.1016/j.rmed.2017.05.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 04/13/2017] [Accepted: 05/25/2017] [Indexed: 12/18/2022]
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17
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Eldridge WB, Zhang Q, Faro A, Sweet SC, Eghtesady P, Hamvas A, Cole FS, Wambach JA. Outcomes of Lung Transplantation for Infants and Children with Genetic Disorders of Surfactant Metabolism. J Pediatr 2017; 184:157-164.e2. [PMID: 28215425 PMCID: PMC5443678 DOI: 10.1016/j.jpeds.2017.01.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 11/22/2016] [Accepted: 01/05/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare outcomes of infants and children who underwent lung transplantation for genetic disorders of surfactant metabolism (SFTPB, SFTPC, ABCA3, and NKX2-1) over 2 epochs (1993-2003 and 2004-2015) at St Louis Children's Hospital. STUDY DESIGN We retrospectively reviewed clinical characteristics, mortality, and short- and long-term morbidities of infants (transplanted at <1 year; n = 28) and children (transplanted >1 year; n = 16) and compared outcomes by age at transplantation (infants vs children) and by epoch of transplantation. RESULTS Infants underwent transplantation more frequently for surfactant protein-B deficiency, whereas children underwent transplantation more frequently for SFTPC mutations. Both infants and children underwent transplantation for ABCA3 deficiency. Compared with children, infants experienced shorter times from listing to transplantation (P = .014), were more likely to be mechanically ventilated at the time of transplantation (P < .0001), were less likely to develop bronchiolitis obliterans post-transplantation (P = .021), and were more likely to have speech and motor delays (P ≤ .0001). Despite advances in genetic diagnosis, immunosuppressive therapies, and supportive respiratory and nutritional therapies, mortality did not differ between infants and children (P = .076) or between epochs. Kaplan-Meier analyses demonstrated that children transplanted in epoch 1 (1993-2003) were more likely to develop systemic hypertension (P = .049) and less likely to develop post-transplantation lymphoproliferative disorder compared with children transplanted in epoch 2 (2004-2015) (P = .051). CONCLUSION Post-lung transplantation morbidities and mortality remain substantial for infants and children with genetic disorders of surfactant metabolism.
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Affiliation(s)
- Whitney B Eldridge
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St Louis, MO
| | - Qunyuan Zhang
- Division of Statistical Genomics, Washington University School of Medicine and St. Louis Children's Hospital, St Louis, MO
| | - Albert Faro
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St Louis, MO
| | - Stuart C Sweet
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St Louis, MO
| | - Pirooz Eghtesady
- Department of Surgery, Washington University School of Medicine and St. Louis Children's Hospital, St Louis, MO
| | - Aaron Hamvas
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - F Sessions Cole
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St Louis, MO
| | - Jennifer A Wambach
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St Louis, MO.
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Borie R, Kannengiesser C, Sicre de Fontbrune F, Gouya L, Nathan N, Crestani B. Management of suspected monogenic lung fibrosis in a specialised centre. Eur Respir Rev 2017; 26:26/144/160122. [DOI: 10.1183/16000617.0122-2016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/21/2017] [Indexed: 12/20/2022] Open
Abstract
At least 10% of patients with interstitial lung disease present monogenic lung fibrosis suspected on familial aggregation of pulmonary fibrosis, specific syndromes or early age of diagnosis. Approximately 25% of families have an identified mutation in genes mostly involved in telomere homeostasis, and more rarely in surfactant homeostasis.Beyond pathophysiological knowledge, detection of these mutations has practical consequence for patients. For instance, mutations involved in telomere homeostasis are associated with haematological complications after lung transplantation and may require adapted immunosuppression. Moreover, relatives may benefit from a clinical and genetic evaluation that should be specifically managed.The field of genetics of pulmonary fibrosis has made great progress in the last 10 years, raising specific problems that should be addressed by a specialised team.
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The Effectiveness of Low-dose Azithromycin in Relapsing Cryptogenic Organizing Pneumonia: A Case Report and A Review of the Literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1097/cpm.0000000000000160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Kitazawa H, Kure S. Interstitial Lung Disease in Childhood: Clinical and Genetic Aspects. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:57-68. [PMID: 26512209 PMCID: PMC4603523 DOI: 10.4137/ccrpm.s23282] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/12/2015] [Accepted: 08/19/2015] [Indexed: 12/16/2022]
Abstract
Interstitial lung disease (ILD) in childhood is a heterogeneous group of rare pulmonary conditions presenting chronic respiratory disorders. Many clinical features of ILD still remain unclear, making the treatment strategies mainly investigative. Guidelines may provide physicians with an overview on the diagnosis and therapeutic directions. However, the criteria used in different clinical studies for the classification and diagnosis of ILDs are not always the same, making the development of guidelines difficult. Advances in genetic testing have thrown light on some etiologies of ILD, which were formerly classified as ILDs of unknown origins. The need of genetic testing for unexplained ILD is growing, and new classification criteria based on the etiology should be adopted to better understand the disease. The purpose of this review is to give an overview of the clinical and genetic aspects of ILD in children.
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Affiliation(s)
- Hiroshi Kitazawa
- Department of General Pediatrics, Division of Allergy, Miyagi Children's Hospital, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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21
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Malý J, Navrátilová M, Hornychová H, Looman AC. Respiratory failure in a term newborn due to compound heterozygous ABCA3 mutation: the case report of another lethal variant. J Perinatol 2014; 34:951-3. [PMID: 25421131 DOI: 10.1038/jp.2014.132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 11/09/2022]
Abstract
Inherited disorders of surfactant metabolism are manifested in neonatal period as a severe respiratory failure not responding to exogenous surfactant administration. We illustrate the case of a term newborn with respiratory failure because of compound heterozygous mutation in adenosine triphosphate-binding cassette transporter A3 (ABCA3)-in exon 24 M1227R and in exon 29 Ins1510fs/ter1519. These mutations of ABCA3 have not been described yet and expand the group of lethal ABCA3 variants.
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Affiliation(s)
- J Malý
- Faculty of Medicine, Division of Neonatology, Department of Pediatrics, Charles University in Prague, University Hospital at Hradec Králové, Hradec Králové, Czech Republic
| | - M Navrátilová
- Faculty of Medicine, Division of Neonatology, Department of Pediatrics, Charles University in Prague, University Hospital at Hradec Králové, Hradec Králové, Czech Republic
| | - H Hornychová
- Faculty of Medicine, Fingerland's Department of Pathology, Charles University in Prague, University Hospital at Hradec Králové, Hradec Králové, Czech Republic
| | - A C Looman
- Gene Analysis Service GmbH, Berlin, Germany
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22
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Balloy V, Deveaux A, Lebeaux D, Tabary O, le Rouzic P, Ghigo JM, Busson PF, Boëlle PY, Guez JG, Hahn U, Clement A, Chignard M, Corvol H, Burnet M, Guillot L. Azithromycin analogue CSY0073 attenuates lung inflammation induced by LPS challenge. Br J Pharmacol 2014; 171:1783-94. [PMID: 24417187 DOI: 10.1111/bph.12574] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/16/2013] [Accepted: 01/07/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Azithromycin is a macrolide antibiotic with anti-inflammatory and immunomodulating effects. Long-term azithromycin therapy in patients with chronic lung diseases such as cystic fibrosis has been associated with increased antimicrobial resistance, emergence of hypermutable strains, ototoxicity and cardiac toxicity. The aim of this study was to assess the anti-inflammatory effects of the non-antibiotic azithromycin derivative CSY0073. EXPERIMENTAL APPROACH We compared the effects of CSY0073 with those of azithromycin in experiments on bacterial cultures, Pseudomonas aeruginosa biofilm, lung cells and mice challenged intranasally with P. aeruginosa LPS. KEY RESULTS In contrast to azithromycin, CSY0073 did not inhibit the growth of P. aeruginosa, Staphylococcus aureus or Haemophilus influenzae and had no effect on an established P. aeruginosa biofilm. Bronchoalveolar lavage (BAL) fluids and lung homogenates collected after the LPS challenge in mice showed that CSY0073 and azithromycin (200 mg·kg(-1), i.p.) decreased neutrophil counts at 24 h and TNF-α, CXCL1 and CXCL2 levels in the BAL fluid after 3 h and IL-6, CXCL2 and IL-1β levels in the lung after 3 h compared with the vehicle. However, only azithromycin reduced IL-1β levels in the lung 24 h post LPS challenge. CSY0073 and azithromycin similarly diminished the production of pro-inflammatory cytokines by macrophages, but not lung epithelial cells, exposed to P. aeruginosa LPS. CONCLUSIONS AND IMPLICATIONS Unlike azithromycin, CSY0073 had no antibacterial effects but it did have a similar anti-inflammatory profile to that of azithromycin. Hence, CSY0073 may have potential as a long-term treatment for patients with chronic lung diseases.
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Affiliation(s)
- V Balloy
- INSERM, UMR_S 938, CDR Saint-Antoine, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 938, CDR Saint-Antoine, Paris, France; Inserm U874, Paris, France; Unité de défense Innée et Inflammation, Institut Pasteur, Paris, France
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Corvol H, Taytard J, Thouvenin G, Périsson C, Nathan N, Clement A. [Why use long-term macrolide therapy in pediatric pulmonology?]. Arch Pediatr 2014; 21:314-21. [PMID: 24503457 DOI: 10.1016/j.arcped.2013.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/31/2013] [Accepted: 12/11/2013] [Indexed: 12/16/2022]
Abstract
Macrolides are well-known antibiotics exerting antimicrobial as well as anti-inflammatory and immunomodulatory effects. Since the observation of a dramatic improvement in lung disease and survival in patients with diffuse panbronchiolitis, macrolides have been used over the long term in several chronic respiratory diseases. This review describes the results of trials that have evaluated long-term macrolides in the treatment of cystic fibrosis, non-cystic fibrosis bronchiectasis, and asthma, particularly focusing on the impact on children. It also provides new insights on the potential effects of macrolides on diffuse parenchymal lung diseases.
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Affiliation(s)
- H Corvol
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France.
| | - J Taytard
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France
| | - G Thouvenin
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France
| | - C Périsson
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France
| | - N Nathan
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France
| | - A Clement
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, centre de ressources et de compétences pour la mucoviscidose, centre de référence des maladies respiratoires rares, université Pierre-et-Marie-Curie-Paris 6, unité Inserm U938, 26, avenue du Dr-Netter, 75012 Paris, France
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