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Kim HJ, Park SJ, Park HK, Byun DW, Suh K, Yoo MH. Association of free thyroxine with obstructive lung pattern in euthyroid middle-aged subjects: A population-based study. PLoS One 2022; 17:e0270126. [PMID: 35867637 PMCID: PMC9307150 DOI: 10.1371/journal.pone.0270126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background The association between thyroid hormone levels and pulmonary function in euthyroid population is still unclear. We aimed to examine the relationship between thyroid function and lung function in a large cohort study of euthyroid subjects. Methods We analyzed biochemical and spirometry data from a nationwide, population-based, cross-sectional survey (KNHANES VI). A total of 1,261 middle-aged participants aged 45–65 years with spirometry tests and normal thyroid function were included in this study. The subjects were grouped according to free thyroxine (fT4) (ng/dL) quartiles (Q1, 0.89–1.09; Q2, 1.10–1.19; Q3, 1.20–1.30; Q4, 1.31–1.76). Obstructive lung pattern was defined as forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <0.7. The probability of obstructive lung patterns according to fT4 quartiles was assessed using logistic regression models, adjusted for potential confounders. Results Overall, 10.9% of the subjects had an obstructive lung pattern. The mean fT4 levels were significantly higher in those with obstructive lung pattern than in those with normal lung function (1.26 vs. 1.20 ng/dL, p<0.001). The proportion of participants with obstructive lung pattern increased across the fT4 quartile categories (p<0.001). With the Q1 group as reference, the multivariate-adjusted odds ratios (95% confidence intervals) for obstructive lung pattern in the Q3 and Q4 groups were 2.875 (1.265–6.535) and 2.970 (1.287–6.854), respectively, even after adjusting for confounding variables. Conclusion High fT4 levels are an independent predictor of obstructive lung pattern in euthyroid middle-aged subjects. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Hye Jeong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
- * E-mail:
| | - Sang Joon Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyeong Kyu Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Dong Won Byun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kyoil Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Myung Hi Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
- Elim Thyroid Clinic, Seoul, Korea
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Shao W, Luo X, Zhang Z, Han Z, Chandrasekaran V, Turzhitsky V, Bali V, Roberts AR, Metzger M, Baker J, La Rosa C, Weaver J, Dexter P, Huang K. Application of unsupervised deep learning algorithms for identification of specific clusters of chronic cough patients from EMR data. BMC Bioinformatics 2022; 23:140. [PMID: 35439945 PMCID: PMC9019947 DOI: 10.1186/s12859-022-04680-4] [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: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic cough affects approximately 10% of adults. The lack of ICD codes for chronic cough makes it challenging to apply supervised learning methods to predict the characteristics of chronic cough patients, thereby requiring the identification of chronic cough patients by other mechanisms. We developed a deep clustering algorithm with auto-encoder embedding (DCAE) to identify clusters of chronic cough patients based on data from a large cohort of 264,146 patients from the Electronic Medical Records (EMR) system. We constructed features using the diagnosis within the EMR, then built a clustering-oriented loss function directly on embedded features of the deep autoencoder to jointly perform feature refinement and cluster assignment. Lastly, we performed statistical analysis on the identified clusters to characterize the chronic cough patients compared to the non-chronic cough patients. RESULTS The experimental results show that the DCAE model generated three chronic cough clusters and one non-chronic cough patient cluster. We found various diagnoses, medications, and lab tests highly associated with chronic cough patients by comparing the chronic cough cluster with the non-chronic cough cluster. Comparison of chronic cough clusters demonstrated that certain combinations of medications and diagnoses characterize some chronic cough clusters. CONCLUSIONS To the best of our knowledge, this study is the first to test the potential of unsupervised deep learning methods for chronic cough investigation, which also shows a great advantage over existing algorithms for patient data clustering.
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Affiliation(s)
- Wei Shao
- Indiana University School of Medicine, 1101 W 10th Street, Indianapolis, IN, 46202, USA
| | - Xiao Luo
- Purdue School of Engineering and Technology, IUPUI, ET 301L, 799 W. Michigan Street, Indianapolis, IN, 46202, USA.
| | - Zuoyi Zhang
- Indiana University School of Medicine, 1101 W 10th Street, Indianapolis, IN, 46202, USA
| | - Zhi Han
- Indiana University School of Medicine, 1101 W 10th Street, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Vasu Chandrasekaran
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Vladimir Turzhitsky
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Vishal Bali
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | - Jarod Baker
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Carmen La Rosa
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Jessica Weaver
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Paul Dexter
- Indiana University School of Medicine, 1101 W 10th Street, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Eskenazi Health, Indianapolis, IN, USA
| | - Kun Huang
- Indiana University School of Medicine, 1101 W 10th Street, Indianapolis, IN, 46202, USA. .,Regenstrief Institute, Inc., Indianapolis, IN, USA.
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Mineral Micronutrients in Asthma. Nutrients 2021; 13:nu13114001. [PMID: 34836256 PMCID: PMC8625329 DOI: 10.3390/nu13114001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 01/01/2023] Open
Abstract
Asthma represents one of the most common medical issues in the modern world. It is a chronic inflammatory disease characterized by persistent inflammation of the airways and disturbances in redox status, leading to hyperresponsiveness of bronchi and airway obstruction. Apart from classical risk factors such as air pollution, family history, allergies, or obesity, disturbances of the levels of micronutrients lead to impairments in the defense mechanisms of the affected organism against oxidative stress and proinflammatory stimuli. In the present review, the impact of micronutrients on the prevalence, severity, and possible risk factors of asthma is discussed. Although the influence of classical micronutrients such as selenium, copper, or zinc are well known, the effects of those such as iodine or manganese are only rarely mentioned. As a consequence, the aim of this paper is to demonstrate how disturbances in the levels of micronutrients and their supplementation might affect the course of asthma.
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4
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Mohammed RN, Kadhum HJ, Hashim AR. Spirometry in adult hypothyroid patients: a comparative study. J Basic Clin Physiol Pharmacol 2020; 32:189-195. [PMID: 33180033 DOI: 10.1515/jbcpp-2019-0359] [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: 12/19/2019] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Hypothyroidism adversely affects pulmonary function, which may improve by thyroxine therapy. Limited studies about the effect of hypothyroidism on spirometric parameters in adult patients were conducted in Basra, south of Iraq. Moreover, the effect of thyroxine therapy on spirometric parameters was not covered by these studies. In this study, pulmonary function in adult's hypothyroid patients was evaluated by spirometry to detect any impairment, type of impairment, and to evaluate the effect of thyroxine therapy. METHODS A comparative study was conducted in Al-Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) in Al-Faiha teaching hospital, Basrah, Iraq. Subjects are divided into four groups: uncontrolled hypothyroid group (n=72), controlled hypothyroid group (n=60), newly diagnosed hypothyroid group (n=52), and control group (n=110). Spirometry was done to all subjects in sitting position, it's repeated at least three times and the best result was recorded. RESULTS A significantly (p<0.05) less spirometric parameters and more abnormal pulmonary function test (PFT) were noticed in hypothyroid groups, the reduction were more pronounced in the uncontrolled hypothyroid group. The abnormality in PFT was mostly of restrictive type. A significantly (p<0.05) negative correlation has been found between thyroid-stimulating hormone (TSH) and spirometric parameters, while the correlation of fT4 is significantly (p<0.05) positive with FVC% and FEV%. CONCLUSION In hypothyroidism, high TSH and low fT4 are recognized causes of a reduction in spirometric parameters. Therefore, spirometry can be used to detect pulmonary function changes in hypothyroidism.
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Affiliation(s)
- Rasha N Mohammed
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Basrah, Basrah, Iraq
| | - Haithem J Kadhum
- Department of Physiology, College of Medicine, University of Basrah, Basrah, Iraq
| | - Ali R Hashim
- Department of Medicine, College of Medicine, University of Basrah, Basrah, Iraq
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Bavarsad K, Saadat S, Mohammadian Roshan N, Hadjzadeh MAR, Boskabady MH. Effects of levothyroxine on lung inflammation, oxidative stress and pathology in a rat model of Alzheimer's disease. Respir Physiol Neurobiol 2020; 277:103437. [PMID: 32259689 DOI: 10.1016/j.resp.2020.103437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/13/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In this study, the effect of levothyroxine (L-T4) on tracheal responsiveness, lung inflammation, oxidative stress and pathological features in a rat model of Alzheimer's disease (AD), was evaluated. METHODS An animal model of AD was established by intracerebroventricular injection of streptozotocin (STZ) (3 mg/kg) in rats. The rats were then treated for 3 weeks with L-T4 (10 and 100 μg/kg). RESULTS In AD animals, tracheal responsiveness to methacholine and ovalbumin (p < 0.05), white blood cell (WBC) count (p < 0.05 to p < 0.01), malondialdehyde (MDA) concentration (p < 0.05) and inflammation score (p < 0.01) were increased, but superoxide dismutase (SOD) activity and total thiol content (for both cases p < 0.05) were decreased compared to the controls. Tracheal responsiveness to methacholine and MDA concentration (p < 0.05) were decreased in AD animals treated with T4 compared to the AD group. Bronchial inflammation in terms of total and some differential WBC in the BALF and inflammatory score, was significantly worsened in AD animals treated with high dose of T4 (p < 0.05 to p < 0.001) compared to the controls. CONCLUSION Alzheimer's disease may cause lung inflammation and treatment with low dose of T4 improved MDA level and lung inflammation.
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Affiliation(s)
- Kowsar Bavarsad
- Department of Physiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeideh Saadat
- Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Nema Mohammadian Roshan
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mousa-Al-Reza Hadjzadeh
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hossein Boskabady
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Polverino F, de Torres JP, Santoriello C, Capuozzo A, Mauro I, Rojas-Quintero J, D'Agostino B, Pistolesi M, Celli B, Polverino M, Owen CA. Gas exchange and breathing pattern in women with postmenopausal bone fragility. Respir Med 2018; 137:141-146. [PMID: 29605198 DOI: 10.1016/j.rmed.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/25/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Little is known about the relationship between bone fragility and respiratory function. We hypothesized that women with osteoporosis or osteopenia, without cardio-pulmonary disease, have perturbations in the pattern of breathing and gas exchange. METHODS In 44 women with bone fragility (BF, T score: < -1), and 20 anthropomorphically-matched control women (T score > -1) we compared pulmonary function tests, central respiratory drive (mouth occlusion pressure or P 0.1), pattern of breathing using optoelectronic plethysmograph and arterial blood gases at rest. RESULTS Static pulmonary function was similar in BF subjects and controls. However, the arterial blood gas measurements differed significantly. The arterial pH was significantly higher in BF subjects than in controls (P < 0.001). The partial pressure of carbon dioxide (PaCO2) and oxygen (PaO2) in arterial blood were significantly lower in BF subjects than controls (P < 0.001 and P = 0.009, respectively). The BF subjects had a shorter inspiratory fraction compared with controls (P = 0.036). Moreover, T-scores were significantly inversely correlated with the alveolar-arterial gradient of oxygen (r = -0.5; P = 0.0003) and the arterial pH (r = -0.4; P = 0.002), and positively correlated with arterial PaO2 (r = 0.3; P = 0.01) and PaCO2 (r = 0.4; P = 0.002) among all subjects. CONCLUSION In the absence of known cardio-pulmonary disease, BF is associated with statistically significant perturbations in gas exchange and alterations in the pattern of breathing including shortening of the inspiratory time.
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Affiliation(s)
- F Polverino
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Lovelace Respiratory Research Institute, Albuquerque, NM, USA.
| | | | - C Santoriello
- Department of Respiratory Medicine, Scafati Hospital, Scafati, Italy
| | - A Capuozzo
- Department of Respiratory Medicine, Scafati Hospital, Scafati, Italy
| | - I Mauro
- Department of Respiratory Medicine, Scafati Hospital, Scafati, Italy
| | - Joselyn Rojas-Quintero
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - B D'Agostino
- Pharmacology Division, Department of Experimental Medicine, University of Campania "L.Vanvitelli, Naples, Italy
| | - M Pistolesi
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - B Celli
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | | | - C A Owen
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Chang HS, Lee TH, Jun JA, Baek AR, Park JS, Koo SM, Kim YK, Lee HS, Park CS. Neutrophilic inflammation in asthma: mechanisms and therapeutic considerations. Expert Rev Respir Med 2016; 11:29-40. [PMID: 27918221 DOI: 10.1080/17476348.2017.1268919] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Neutrophilic airway inflammation represents a pathologically distinct form of asthma and frequently appears in symptomatic adulthood asthmatics. However, clinical impacts and mechanisms of the neutrophilic inflammation have not been thoroughly evaluated up to date. Areas covered: Currently, distinct clinical manifestations, triggers, and molecular mechanisms of the neutrophilic inflammation (namely Toll-like receptor, Th1, Th17, inflammasome) are under investigation in asthma. Furthermore, possible role of the neutrophilic inflammation is being investigated in respect to the airway remodeling. We searched the related literatures published during the past 10 years on the website of Pub Med under the title of asthma and neutrophilic inflammation in human. Expert commentary: Epidemiologic and experimental studies have revealed that the neutrophilic airway inflammation is induced by a wide variety of stimuli including ozone, particulate matters, cigarette smoke, occupational irritants, endotoxins, microbial infection and colonization, and aeroallergens. These triggers provoke diverse immune and inflammatory responses leading to progressive and sometimes irreversible airway obstruction. Clinically, neutrophilic airway inflammation is frequently associated with severe asthma and poor response to glucocorticoid therapy, indicating the need for other treatment strategies. Accordingly, therapeutics will be targeted against the main mediators behind the underlying molecular mechanisms of the neutrophilic inflammation.
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Affiliation(s)
- Hun Soo Chang
- a Department of Interdisciplinary Program in Biomedical Science Major , Soonchunhyang Graduate School , Bucheon , Gyeonggi-do , Republic of Korea
| | - Tae-Hyeong Lee
- a Department of Interdisciplinary Program in Biomedical Science Major , Soonchunhyang Graduate School , Bucheon , Gyeonggi-do , Republic of Korea
| | - Ji Ae Jun
- a Department of Interdisciplinary Program in Biomedical Science Major , Soonchunhyang Graduate School , Bucheon , Gyeonggi-do , Republic of Korea
| | - Ae Rin Baek
- b Division of Allergy and Respiratory Disease , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do , Republic of Korea
| | - Jong-Sook Park
- b Division of Allergy and Respiratory Disease , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do , Republic of Korea
| | - So-My Koo
- c Division of Allergy and Respiratory Medicine , Soonchunhyang University Seoul Hospital , Seoul , Republic of Korea
| | - Yang-Ki Kim
- c Division of Allergy and Respiratory Medicine , Soonchunhyang University Seoul Hospital , Seoul , Republic of Korea
| | - Ho Sung Lee
- d Division of Respiratory Medicine , Soonchunhyang University CheonAn Hospital , Cheonan , Chungcheongnam-do , Republic of Korea
| | - Choon-Sik Park
- b Division of Allergy and Respiratory Disease , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do , Republic of Korea
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Ali ER. Assessment of functional lung impairment in patients with thyroid disorders. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.193641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Sorensen JR, Winther KH, Bonnema SJ, Godballe C, Hegedüs L. Respiratory Manifestations of Hypothyroidism: A Systematic Review. Thyroid 2016; 26:1519-1527. [PMID: 27673426 DOI: 10.1089/thy.2015.0642] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Hypothyroidism has been associated with increased pulmonary morbidity and overall mortality. A systematic review was conducted to identify the prevalence and underlying mechanisms of respiratory problems among patients with thyroid insufficiency. METHODS PubMed and EMBASE databases were searched for relevant literature from January 1950 through January 2015 with the following study eligibility criteria: English-language publications; adult subclinical or overt hypothyroid patients; intervention, observational, or retrospective studies; and respiratory manifestations. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was followed, and Cochrane's risk of bias tool was used. RESULTS A total of 1699 papers were screened by two independent authors for relevant titles. Of 109 relevant abstracts, 28 papers underwent full-text analyses, of which 22 were included in the review. Possible mechanisms explaining respiratory problems at multiple physiological levels were identified, such as the ventilator control system, diaphragmatic muscle function, pulmonary gas exchange, goiter caused upper airway obstruction, decreased capacity for energy transduction, and reduced glycolytic activity. Obstructive sleep apnea syndrome was found among 30% of newly diagnosed patients with overt hypothyroidism, and demonstrated reversibility following treatment. The evidence for or against a direct effect on pulmonary function was ambiguous. However, each of the above-mentioned areas was only dealt with in a limited number of studies. Therefore, it is not possible to draw any strong conclusions on any of these themes. Moreover, most studies were hampered by considerable risk of bias due for example to small numbers of patients, lack of control groups, randomization and blinding, and differences in body mass index, sex, and age between subjects and controls. CONCLUSION Mechanistic data linking hypothyroidism and respiratory function are at best limited. This area of research is therefore open for retesting hypotheses, using appropriate study designs and methods.
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Affiliation(s)
- Jesper Roed Sorensen
- 1 Department of ORL Head & Neck Surgery, Odense University Hospital , Odense, Denmark
| | | | - Steen Joop Bonnema
- 2 Department of Endocrinology, Odense University Hospital , Odense, Denmark
| | - Christian Godballe
- 1 Department of ORL Head & Neck Surgery, Odense University Hospital , Odense, Denmark
| | - Laszlo Hegedüs
- 2 Department of Endocrinology, Odense University Hospital , Odense, Denmark
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Peng YH, Chen CK, Su CH, Liao WC, Muo CH, Hsia TC, Sung FC, Lai CH, Kao CH. Increased risk of chronic obstructive pulmonary disease among patients with Helicobacter pylori infection: a population-based cohort study. CLINICAL RESPIRATORY JOURNAL 2015; 11:558-565. [PMID: 26364850 DOI: 10.1111/crj.12382] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/10/2015] [Accepted: 09/06/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Increasing evidence suggests that Helicobacter pylori infection (HPI) may have extragastric manifestations, including the respiratory system. This study investigated the role of HPI in increasing the subsequent risk of chronic obstructive pulmonary disease (COPD) in a nationwide population. METHODS We conducted this retrospective cohort study using data from the Longitudinal Health Insurance Database, which is derived from the Taiwanese National Health Insurance Research Database. A total of 5941 adults who were newly diagnosed with HPI between 2005 and 2006 were selected. Healthy patients without HPI were selected from the general population and frequency matched as a ratio of 4:1, according to age, sex, and index years. Both cohorts were followed up from the index date to the end of 2011 to measure the incidence of COPD. Cox proportional hazard regression analysis was used to assess the hazard ratio (HR) of COPD between the HPI cohort and non-HPI cohorts. RESULTS The overall HR of COPD was 1.84 (95% confidence intervals = 1.57-2.17) for the HPI cohort, compared with the non-HPI cohort, after adjusting for age, sex, and comorbidities. Although the incidence of COPD was substantially higher in the elderly participants (age, ≥ 65 years) than that in younger participants, the highest HR (4.05, 95% confidence intervals = 1.39-11.8) of COPD was observed in the youngest (age, 20-49 years) participants. CONCLUSION In this study, the patients with HPI exhibited a significantly higher risk of COPD than those without HPI did.
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Affiliation(s)
- Yi-Hao Peng
- Department of Respiratory Therapy, China Medical University Hospital, Taichung, Taiwan.,Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
| | - Cheng-Kuo Chen
- Department of Gastroenterology, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Hua Su
- Section of Respiratory Therapy, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Te-Chun Hsia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Ho Lai
- Department of Microbiology and Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan.,Department of Microbiology and Immunology, Graduate Institute of Biomedical Science, Chang Gung University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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11
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Dekkers BGJ, Naeimi S, Bos IST, Menzen MH, Halayko AJ, Hashjin GS, Meurs H. L-thyroxine promotes a proliferative airway smooth muscle phenotype in the presence of TGF-β1. Am J Physiol Lung Cell Mol Physiol 2014; 308:L301-6. [PMID: 25480330 DOI: 10.1152/ajplung.00071.2014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hypothyroidism may reduce, whereas hyperthyroidism may aggravate, asthma symptoms. The mechanisms underlying this relationship are largely unknown. Since thyroid hormones have central roles in cell growth and differentiation, we hypothesized that airway remodeling, in particular increased airway smooth muscle (ASM) mass, may be involved. To address this hypothesis, we investigated the effects of triiodothyronine (T3) and l-thyroxine (T4) in the absence and presence of the profibrotic transforming growth factor (TGF)-β1 on human ASM cell phenotype switching. T3 (1-100 nM) and T4 (1-100 nM) did not affect basal ASM proliferation. However, when combined with TGF-β1 (2 ng/ml), T4 synergistically increased the proliferative response, whereas only a minor effect was observed for T3. In line with a switch from a contractile to a proliferative ASM phenotype, T4 reduced the TGF-β1-induced contractile protein expression by ∼50%. Cotreatment with T3 reduced TGF-β1-induced contractile protein expression by ∼25%. The synergistic increase in proliferation was almost fully inhibited by the integrin αvβ3 antagonist tetrac (100 nM), whereas no significant effects of the thyroid receptor antagonist 1-850 (3 μM) were observed. Inhibition of MEK1/2, downstream of the integrin αvβ3, also inhibited the T4- and TGF-β1-induced proliferative responses. Collectively, the results indicate that T4, and to a lesser extent T3, promotes a proliferative ASM phenotype in the presence of TGF-β1, which is predominantly mediated by the membrane-bound T4 receptor αvβ3. These results indicate that thyroid hormones may enhance ASM remodeling in asthma, which could be of relevance for hyperthyroid patients with this disease.
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Affiliation(s)
- Bart G J Dekkers
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands;
| | - Saeideh Naeimi
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands; Department of Pharmacology, Faculty of Veterinary Medicine, Semnan University, Semnan, Iran
| | - I Sophie T Bos
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - Mark H Menzen
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - Andrew J Halayko
- Department of Physiology, University of Manitoba, Winnipeg, Canada; and
| | - Goudarz Sadeghi Hashjin
- Department of Pharmacology, Faculty of Veterinary Medicine, University of Tehran, Teheran, Iran
| | - Herman Meurs
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
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Ittermann T, Gläser S, Ewert R, Felix S, Völzke H, Dörr M. Serum thyroid-stimulating hormone levels are not associated with exercise capacity and lung function parameters in two population-based studies. BMC Pulm Med 2014; 14:145. [PMID: 25182209 PMCID: PMC4236747 DOI: 10.1186/1471-2466-14-145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 08/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thyroid dysfunction has been described to be linked to a variety of cardiovascular morbidities. Through this pathway thyroid function might also be associated with cardiorespiratory function and exercise capacity. So far only few patient-studies with small study populations investigated the association between thyroid dysfunction and exercise capacity. Thus, the aim of our study was to investigate the association of serum thyroid-stimulating hormone (TSH) levels with lung function and cardiopulmonary exercise testing (CPET) in the general population. METHODS Data from the two independent cross-sectional population-based studies (Study of Health in Pomerania [SHIP] and SHIP-Trend-0) were pooled. SHIP was conducted between 2002 and 2006 and SHIP-Trend-0 between 2008 and 2012. Participants were randomly selected from population registries. In total, 4206 individuals with complete data were available for the present analysis. Thyroid function was defined based on serum TSH levels. Lung function was evaluated by forced expiratory volume in 1 s and forced vital capacity. CPET was based on symptom limited exercise tests on a bicycle in a sitting position according to a modified Jones protocol. Associations of serum TSH levels with lung function and CPET parameters were analysed by multivariable quantile regression adjusted for age, sex, height, weight, use of beta blockers, smoking status, and physical activity. RESULTS Serum TSH levels, used as continuously distributed variable and categorized according to the clinical cut-offs 0.3 and 3.0 mIU/L or according to quintiles, were not consistently associated with parameters of lung function or CPET. CONCLUSIONS Our results suggest that thyroid dysfunction is not associated with lung function and cardiopulmonary exercise capacity in the general population.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine, Ernst Moritz Arndt University, Walther Rathenau Str, 48, D-17475 Greifswald, Germany.
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Stone H, Pye A, Stockley RA. Disease associations in alpha-1-antitrypsin deficiency. Respir Med 2013; 108:338-43. [PMID: 24176989 DOI: 10.1016/j.rmed.2013.10.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/04/2013] [Accepted: 10/06/2013] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In addition to emphysema alpha-1-antitrypsin deficiency (AATD) has been shown to be associated with several inflammatory conditions, including bronchiectasis, vasculitis, (in particular Wegener's granulomatosis), and panniculitis, suggesting neutrophil proteinases also play a role in their pathophysiology. However, it remains unknown whether other inflammatory diseases are also more prevalent in AATD than the general population. The current study describes the prevalence of other co-morbidities in AATD with particular emphasis on inflammatory bowel disease. METHODS AND RESULTS The case notes of 651 PiZZ or PiZnull patients attending the UK national centre for AATD between 1996 and 2011 were reviewed. The prevalence of inflammatory bowel disease (1.5%) was higher than that predicted in the UK (0.4%). Ten patients had a confirmed diagnosis of ulcerative colitis, and 1 had Crohn's disease. In 2 cases there was a family history of inflammatory bowel disease and all but 1 patient were ex or never smokers. There was also a higher prevalence of hypothyroidism in this patient group than expected for the UK population - 26 cases (7.2% of females and 1.3% of males). CONCLUSIONS The current study of the UK cohort of patients with AATD confirmed a higher prevalence of ulcerative colitis than would be expected in the general population, providing further evidence of a potential link between these 2 conditions. In addition, the data suggested a potential link between hypothyroidism and AATD.
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Affiliation(s)
- H Stone
- ADAPT Project, Lung Function and Sleep Department, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
| | - A Pye
- ADAPT Project, Lung Function and Sleep Department, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - R A Stockley
- ADAPT Project, Lung Function and Sleep Department, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
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Gonem S, Raj V, Wardlaw AJ, Pavord ID, Green R, Siddiqui S. Phenotyping airways disease: an A to E approach. Clin Exp Allergy 2013. [PMID: 23181785 DOI: 10.1111/j.1365-2222.2012.04008.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The airway diseases asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous conditions with overlapping pathophysiological and clinical features. It has previously been proposed that this heterogeneity may be characterized in terms of five relatively independent domains labelled from A to E, namely airway hyperresponsiveness (AHR), bronchitis, cough reflex hypersensitivity, damage to the airways and surrounding lung parenchyma, and extrapulmonary factors. Airway hyperresponsiveness occurs in both asthma and COPD, accounting for variable day to day symptoms, although the mechanisms most likely differ between the two conditions. Bronchitis, or airway inflammation, may be predominantly eosinophilic or neutrophilic, with different treatments required for each. Cough reflex hypersensitivity is thought to underlie the chronic dry cough out of proportion to other symptoms that can occur in association with airways disease. Structural changes associated with airway disease (damage) include bronchial wall thickening, airway smooth muscle hypertrophy, bronchiectasis and emphysema. Finally, a variety of extrapulmonary factors may impact upon airway disease, including rhinosinusitis, gastroesophageal reflux disease, obesity and dysfunctional breathing. This article discusses the A to E concept in detail and describes how this framework may be used to assess and treat patients with airway diseases in the clinic.
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Affiliation(s)
- S Gonem
- Department of Infection, Immunity & Inflammation, Institute for Lung Health, University of Leicester, Leicester, UK
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Pavord ID. Complex airway disease: an approach to assessment and management. THE LANCET RESPIRATORY MEDICINE 2012; 1:84-90. [PMID: 24321807 DOI: 10.1016/s2213-2600(12)70049-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Research into new treatments for airway disease focuses on severe disease because morbidity, mortality, and health-care costs are substantial and the unmet need is greatest. One reason why outcomes are poor in these patients could be that the clinical expression of disease is heterogeneous and difficult to classify. As a result, guideline-based management algorithms fail. Additionally, difficulties with disease classification and misconceptions about the relation between different aspects of severe airway disease have hindered new drug development. A potential solution is to use a new approach to assess severe airway disease, which moves the diagnostic focus from categorisation of patients to identification and characterisation of the main drivers of disease. This approach will help rather than hinder identification of clinically important phenotypes of disease and will facilitate the development of new phenotype-specific treatment options.
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Affiliation(s)
- Ian D Pavord
- University Hospitals of Leicester NHS Trust, Institute for Lung Health, Glenfield Hospital, Leicester, UK.
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Abstract
This review presents current knowledge about the thyroid emergencies known as myxedema coma and thyrotoxic storm. Understanding the pathogenesis of these conditions, appropriate recognition of the clinical signs and symptoms, and their prompt and accurate diagnosis and treatment are crucial in optimizing survival.
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Affiliation(s)
- Joanna Klubo-Gwiezdzinska
- Division of Endocrinology, Department of Medicine, Washington Hospital Center, Washington, DC 20010-2910, USA
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17
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New concepts in the management of chronic cough. Pulm Pharmacol Ther 2011; 24:334-8. [PMID: 21255671 DOI: 10.1016/j.pupt.2011.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 12/31/2010] [Accepted: 01/12/2011] [Indexed: 02/04/2023]
Abstract
There has been significant progress in the field of cough in the past 10 years. Obstructive sleep apnoea, tonsillar enlargement and environmental fungi have recently been described as causes of chronic cough. The advances in the assessment of gastro-oesophageal reflux (GOR) have led to a greater understanding of the relationship between cough and GOR and are likely to change the approach to managing patients with GOR-cough. The investigation of the phenotype of patients with idiopathic chronic cough has provided novel insights. Patients with an idiopathic chronic are predominantly female, have an onset of cough around the menopause and have a high prevalence of organ specific autoimmune disease, particularly hypothyroidism. The presence of bronchoalveolar lymphocytosis suggests there is homing of inflammatory cells from primary sites of autoimmune inflammation to the lungs. A heightened cough reflex is a key feature of most patients with chronic cough and has led some investigators to suggest that chronic cough be recognised as a unique entity called Cough Hypersensitivity Syndrome (CHS). A number of subjective and objective tools have been developed recently to assess cough severity. Antitussive drug development is an emerging and exciting area of cough research.
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Birring SS. Controversies in the evaluation and management of chronic cough. Am J Respir Crit Care Med 2010; 183:708-15. [PMID: 21148722 DOI: 10.1164/rccm.201007-1017ci] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic cough that cannot be explained after basic evaluation is a common reason for patients to be referred to respiratory outpatient clinics. Asthma, gastroesophageal reflux, and upper airway disorders frequently coexist with chronic cough. There is some controversy as to whether these conditions are causes or aggravants of cough. Heightened cough reflex sensitivity is an important feature in most patients. There is good evidence that it is reversible when associated with upper respiratory tract infection, angiotensin-converting enzyme inhibitor medications, and chronic cough associated with eosinophilic airway inflammation. In many patients, heightened cough reflex sensitivity is persistent and their cough is unexplained. There are few therapeutic options for patients with unexplained chronic cough. There is a pressing need to understand the genetic, molecular, and physiological basis of unexplained chronic cough and to develop novel antitussive drugs that down-regulate cough reflex sensitivity.
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Affiliation(s)
- Surinder S Birring
- King's College London, Division of Asthma, Allergy and Lung Biology, Denmark Hill, London SE5 9RS, UK.
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Haldar P, Pavord ID. Noneosinophilic asthma: A distinct clinical and pathologic phenotype. J Allergy Clin Immunol 2007; 119:1043-52; quiz 1053-4. [PMID: 17472810 DOI: 10.1016/j.jaci.2007.02.042] [Citation(s) in RCA: 195] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 02/26/2007] [Accepted: 02/26/2007] [Indexed: 11/18/2022]
Abstract
The use of induced sputum to assess airway inflammation in large and diverse populations with asthma has led to the recognition that significant numbers of patients do not have evidence of eosinophilic airway inflammation. The absence of a sputum eosinophilia has been noted in patients across the range of asthma severity; it has also been reported in patients presenting with an asthma exacerbation. However, whether noneosinophilic asthma represents a pathologically distinct and clinically important asthma phenotype remains unclear. In this review, we present recent evidence suggesting that noneosinophilic asthma represents a stable phenotype associated with a distinct lower airway pathology and structure. We suggest that this lower airway inflammation develops in response to etiologic factors acting through the innate immune pathway and that elements of this immune response contribute to airway dysfunction. Finally, we argue that noneosinophilic asthma is associated with clinically important differences in natural history and treatment response. We particularly highlight evidence that noneosinophilic asthma is associated with a reduced short-term and long-term response to corticosteroid therapy.
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Affiliation(s)
- Pranab Haldar
- Institute for Lung Health, Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK
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21
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Affiliation(s)
- A H Morice
- University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ, UK.
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McGrath-Morrow S, Laube B, Tzou SC, Cho C, Cleary J, Kimura H, Rose NR, Caturegli P. IL-12 overexpression in mice as a model for Sjögren lung disease. Am J Physiol Lung Cell Mol Physiol 2006; 291:L837-46. [PMID: 16751222 DOI: 10.1152/ajplung.00134.2006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Interleukin-12 (IL-12), a Th1 proinflammatory cytokine, is reported to be increased in Sjögren syndrome. To evaluate the effects of local Th1/Th2 deregulation, we generated a transgenic mouse model that overexpresses IL-12 in the lungs. IL-12 transgenic mice developed bronchial and alveolar abnormalities strikingly similar to those found in the lungs of Sjögren patients. Pathologically, lung abnormalities began at approximately 4 mo of age and were characterized by lymphocytic infiltrates around the bronchi, intraluminal periodic acid Schiff-positive debris, increased cell proliferation in the alveolar region, and increased interstitial and alveolar macrophages. Functionally, these abnormalities translated into decreased mucociliary clearance (P<0.05 vs. wild-type littermates) and increased oxidative stress (P<0.01). The pathological and functional abnormalities were accompanied by significant changes in lung natural killer (NK) cells. The number of NK cells was fourfold higher in IL-12 transgenic than wild-type lungs (20% of all lymphoid cells vs. 5%) during the first month of life. NK cells then decreased within a narrow window of time (from 30 to 50 days of age), reaching a nadir of approximately 2% on day 50, and remained at these low levels thereafter. This new mouse model highlights the role of IL-12 in the initiation of Sjögren syndrome.
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Affiliation(s)
- Sharon McGrath-Morrow
- Department of Pediatrics, The Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Birring SS, Pavord ID. Idiopathic chronic cough and organ-specific autoimmune disease. Chest 2006; 129:213; author reply 213-4. [PMID: 16424439 DOI: 10.1378/chest.129.1.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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