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Milinic T, McElvaney OJ, Goss CH. Diagnosis and Management of Cystic Fibrosis Exacerbations. Semin Respir Crit Care Med 2023; 44:225-241. [PMID: 36746183 PMCID: PMC10131792 DOI: 10.1055/s-0042-1760250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
With the improving survival of cystic fibrosis (CF) patients and the advent of highly effective cystic fibrosis transmembrane conductance regulator (CFTR) therapy, the clinical spectrum of this complex multisystem disease continues to evolve. One of the most important clinical events for patients with CF in the course of this disease is acute pulmonary exacerbation (PEx). Clinical and microbial epidemiology studies of CF PEx continue to provide important insight into the disease course, prognosis, and complications. This work has now led to several large-scale clinical trials designed to clarify the treatment paradigm for CF PEx. The primary goal of this review is to provide a summary and update of the pathophysiology, clinical and microbial epidemiology, outcome and treatment of CF PEx, biomarkers for exacerbation, and the impact of highly effective modulator therapy on these events moving forward.
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Affiliation(s)
- Tijana Milinic
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Oliver J McElvaney
- Cysic Fibrosis Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, Washington
| | - Christopher H Goss
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- Cysic Fibrosis Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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2
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Culture-dependent evaluation of the respiratory microbiome in children with cystic fibrosis. EUREKA: HEALTH SCIENCES 2022. [DOI: 10.21303/2504-5679.2022.002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The study aimed to assess the regional peculiarities of the respiratory profile of children with cystic fibrosis (CF) in the Dnipro region (Ukraine).
Methods. Children living in the Dnipro region and aged younger than 18 years old with molecular-genetic confirmation of CF were enrolled in the study. Lung colonization was evaluated using a culture-dependent method. Sputum, mucus from the posterior pharyngeal wall and bronchoalveolar lavage fluid (BALF) were utilized.
Results. The Firmicutes phylum was the most common and occupied 54.00 % of the general proportion. On the other hand, the Proteobacteria phylum demonstrated overexpression in CF airways and kept the second rank with 28.87 %.
Sorensen's species similarity coefficient showed an allied affinity between the microbial burden of oropharyngeal samples with nasopharyngeal and sputum, QS = 0.61 and 0.91, respectively. However, the species composition within the nasal cavity was distinct from sputum and BALF (QS=0.47).
The primary pathogens in childhood were S. aureus, H. influenza, P. aeruginosa and A. fumigatus. In contrast to gram-negative non-fermenters (GNNF), the prevalence of S. aureus isolates by age had a non-linear character. The commensal microbiota changed negatively with age. Among children under 12 years, the Streptococcus genus was identified in 23.08 % of the samples, but among the age category older than 15 – only in 9.22 %.
11.06 % of S. aureus had small colony variants (SCVs) morphotypes. Isolates of P. aeruginosa with the properties of SCVs were also found in children who underwent prolonged antimicrobial treatment. However, the most prominent was the mucoid phenotype – 34.31 % of isolates.
Conclusions. Along with conventional microbiological properties, obligate pathobionts in children with CF exhibited changes, resulting in difficulties in identification. These included auxotrophic modification into SCVs and mucoid transformation.
The culture-dependent technique gives crucial data about the profile of pathogens usually associated with CF, although it is sufficiently limited
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Chen H, Bai X, Gao Y, Liu W, Yao X, Wang J. Profile of Bacteria with ARGs Among Real-World Samples from ICU Admission Patients with Pulmonary Infection Revealed by Metagenomic NGS. Infect Drug Resist 2021; 14:4993-5004. [PMID: 34866919 PMCID: PMC8636693 DOI: 10.2147/idr.s335864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/16/2021] [Indexed: 12/27/2022] Open
Abstract
Background Treatment of pulmonary infections in the intensive care unit (ICU) represents a great challenge, especially infections caused by antibiotic resistance pathogens. A thorough and up-to-date knowledge of the local spectrum of antibiotic resistant bacteria can improve the antibiotic treatment efficiency. In this study, we aimed to reveal the profile of bacteria with antibiotic resistance genes (ARGs) in real-world samples from ICU admission patients with pulmonary infection in Mainland, China, by metagenomic next-generation sequencing (mNGS). Methods A total of 504 different types of clinical samples from 452 ICU admission patients with pulmonary infection were detected by mNGS analysis. Results A total of 485 samples from 434 patients got successful mNGS results. Among 434 patients, one or more bacteria with ARGs were detected in 192 patients (44.24%, 192/434), and ≥2 bacteria with ARGs were detected in 85 (19.59%, 85/434) patients. The predominant detected bacteria were Corynebacterium striatum (C. striatum) (11.76%, 51/434), Acinetobacter baumannii (A. baumannii) (11.52%, 50/434) and Enterococcus faecium (E. faecium) (8.99%, 39/434). ermX conferred resistance to MSLB and cmx to phenicol were the only two ARGs detected in C. striatum; in A. baumannii, most of ARGs were resistance-nodulation-division (RND)-type efflux pumps genes, which conferred resistance to multi-drug; ermB conferred resistance to MSLB and efmA to multi-drug were the predominant ARGs in E. faecium. Bacteria with ARGs were detected in 50% (140/280) bronchoalveolar lavage fluid (BALF) and 50.5% (48/95) sputum samples, which were significantly higher than in blood and cerebrospinal fluid (CSF) samples. Conclusion High level of bacteria with ARGs was observed in clinical samples, especially BALF and sputum samples from ICU admission patients with pulmonary infection in Mainland, China. And C. striatum resistant to MSLB and/or phenicol, multi-drug resistance A. baumannii and E. faecium were the lead bacteria.
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Affiliation(s)
- Huijuan Chen
- Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology, Beijing, People's Republic of China
| | - Xinhua Bai
- Department of Clinical Laboratory, Beijing Capitalbio Medlab, Beijing, People's Republic of China
| | - Yang Gao
- Department of Clinical Laboratory, Beijing Capitalbio Medlab, Beijing, People's Republic of China
| | - Wenxuan Liu
- Department of Clinical Laboratory, Beijing Capitalbio Medlab, Beijing, People's Republic of China
| | - Xuena Yao
- Department of Clinical Laboratory, Beijing Capitalbio Medlab, Beijing, People's Republic of China
| | - Jing Wang
- Department of Clinical Laboratory, Beijing Capitalbio Medlab, Beijing, People's Republic of China
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4
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Tron C, Belleguic C, Piau C, Brinchault G, Deneuville E, Ricordel C, Kayal S, Bellissant E, Verdier MC, Lemaitre F. Determination of amoxicillin and cotrimoxazole concentrations in sputum of patients with cystic fibrosis. Biomed Chromatogr 2021; 35:e5208. [PMID: 34212399 DOI: 10.1002/bmc.5208] [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: 01/22/2021] [Revised: 06/19/2021] [Accepted: 06/28/2021] [Indexed: 11/09/2022]
Abstract
In the management of cystic fibrosis, treatments against Staphylococcus aureus and Haemophilus influenzae such as amoxicillin or cotrimoxazole have to be prescribed and the antibiotherapy's efficacy may be linked to the concentration that reaches the infected site. As cystic fibrosis patients present disturbed pharmacokinetics parameters, drug monitoring would be relevant to assess the lung distribution of antibiotics and to optimize dosing regimens. In this context, the aim of the study was to develop and validate HPLC-based methods for the determination of both antibiotics in bronchial sputum from cystic fibrosis patients, in order to assess the distribution of the drugs into the lungs. Plasma proteins were precipitated by acetonitrile and amoxicillin concentrations in sputum were determined by HPLC coupled with tandem-mass spectrometry. Following liquid extraction with ethyl acetate, cotrimoxazole was quantified by HPLC using ultraviolet detection. Both methods were rapid, specific, accurate and reproducible. The method was applied to patient samples. In three treated patients, concentrations of amoxicillin in sputum were similar and below the lower limit of quantification (0.1 μg/g) and in six patients, sputum concentrations up to 11.1 and 6.4 μg/g were measured for sulfamethoxazole and trimethoprim, respectively.
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Affiliation(s)
- Camille Tron
- Université Rennes, CHU Rennes, Inserm, EHESP, Institut de recherche en santé, environnement et travail - UM_SR, Rennes, France
| | - Chantal Belleguic
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, Rennes, France
| | - Caroline Piau
- Bacteriology-Hygiene Unit, Rennes university hospital, Rennes, France
| | - Graziella Brinchault
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, Rennes, France
| | - Eric Deneuville
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, Rennes, France
| | - Charles Ricordel
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, Rennes, France
| | - Samer Kayal
- Bacteriology-Hygiene Unit, Rennes university hospital, Rennes, France
| | - Eric Bellissant
- Université Rennes, CHU Rennes, Inserm, EHESP, Institut de recherche en santé, environnement et travail - UM_SR, Rennes, France
| | - Marie-Clémence Verdier
- Université Rennes, CHU Rennes, Inserm, EHESP, Institut de recherche en santé, environnement et travail - UM_SR, Rennes, France
| | - Florian Lemaitre
- Université Rennes, CHU Rennes, Inserm, EHESP, Institut de recherche en santé, environnement et travail - UM_SR, Rennes, France
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5
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Schupp JC, Khanal S, Gomez JL, Sauler M, Adams TS, Chupp GL, Yan X, Poli S, Zhao Y, Montgomery RR, Rosas IO, Dela Cruz CS, Bruscia EM, Egan ME, Kaminski N, Britto CJ. Single-Cell Transcriptional Archetypes of Airway Inflammation in Cystic Fibrosis. Am J Respir Crit Care Med 2020; 202:1419-1429. [PMID: 32603604 DOI: 10.1164/rccm.202004-0991oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rationale: Cystic fibrosis (CF) is a life-shortening, multisystem hereditary disease caused by abnormal chloride transport. CF lung disease is driven by innate immune dysfunction and exaggerated inflammatory responses that contribute to tissue injury. To define the transcriptional profile of this airway immune dysfunction, we performed the first single-cell transcriptome characterization of CF sputum.Objectives: To define the transcriptional profile of sputum cells and its implication in the pathogenesis of immune function and the development of CF lung disease.Methods: We performed single-cell RNA sequencing of sputum cells from nine subjects with CF and five healthy control subjects. We applied novel computational approaches to define expression-based cell function and maturity profiles, herein called transcriptional archetypes.Measurements and Main Results: The airway immune cell repertoire shifted from alveolar macrophages in healthy control subjects to a predominance of recruited monocytes and neutrophils in CF. Recruited lung mononuclear phagocytes were abundant in CF and were separated into the following three archetypes: activated monocytes, monocyte-derived macrophages, and heat shock-activated monocytes. Neutrophils were the most prevalent in CF, with a dominant immature proinflammatory archetype. Although CF monocytes exhibited proinflammatory features, both monocytes and neutrophils showed transcriptional evidence of abnormal phagocytic and cell-survival programs.Conclusions: Our findings offer an opportunity to understand subject-specific immune dysfunction and its contribution to divergent clinical courses in CF. As we progress toward personalized applications of therapeutic and genomic developments, we hope this inflammation-profiling approach will enable further discoveries that change the natural history of CF lung disease.
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Affiliation(s)
| | - Sara Khanal
- Section of Pulmonary, Critical Care, and Sleep Medicine
| | - Jose L Gomez
- Section of Pulmonary, Critical Care, and Sleep Medicine
| | - Maor Sauler
- Section of Pulmonary, Critical Care, and Sleep Medicine
| | | | | | - Xiting Yan
- Section of Pulmonary, Critical Care, and Sleep Medicine
| | - Sergio Poli
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and.,Division of Internal Medicine, Mount Sinai Medical Center, Miami, Florida
| | | | | | - Ivan O Rosas
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | | | - Emanuela M Bruscia
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Marie E Egan
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
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6
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Liou TG, Adler FR, Argel N, Asfour F, Brown PS, Chatfield BA, Daines CL, Durham D, Francis JA, Glover B, Heynekamp T, Hoidal JR, Jensen JL, Keogh R, Kopecky CM, Lechtzin N, Li Y, Lysinger J, Molina O, Nakamura C, Packer KA, Poch KR, Quittner AL, Radford P, Redway AJ, Sagel SD, Sprandel S, Taylor-Cousar JL, Vroom JB, Yoshikawa R, Clancy JP, Elborn JS, Olivier KN, Cox DR. Prospective multicenter randomized patient recruitment and sample collection to enable future measurements of sputum biomarkers of inflammation in an observational study of cystic fibrosis. BMC Med Res Methodol 2019; 19:88. [PMID: 31027503 PMCID: PMC6485181 DOI: 10.1186/s12874-019-0705-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/11/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Biomarkers of inflammation predictive of cystic fibrosis (CF) disease outcomes would increase the power of clinical trials and contribute to better personalization of clinical assessments. A representative patient cohort would improve searching for believable, generalizable, reproducible and accurate biomarkers. METHODS We recruited patients from Mountain West CF Consortium (MWCFC) care centers for prospective observational study of sputum biomarkers of inflammation. After informed consent, centers enrolled randomly selected patients with CF who were clinically stable sputum producers, 12 years of age and older, without previous organ transplantation. RESULTS From December 8, 2014 through January 16, 2016, we enrolled 114 patients (53 male) with CF with continuing data collection. Baseline characteristics included mean age 27 years (SD = 12), 80% predicted forced expiratory volume in 1 s (SD = 23%), 1.0 prior year pulmonary exacerbations (SD = 1.2), home elevation 328 m (SD = 112) above sea level. Compared with other patients in the US CF Foundation Patient Registry (CFFPR) in 2014, MWCFC patients had similar distribution of sex, age, lung function, weight and rates of exacerbations, diabetes, pancreatic insufficiency, CF-related arthropathy and airway infections including methicillin-sensitive or -resistant Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia cepacia complex, fungal and non-tuberculous Mycobacteria infections. They received CF-specific treatments at similar frequencies. CONCLUSIONS Randomly-selected, sputum-producing patients within the MWCFC represent sputum-producing patients in the CFFPR. They have similar characteristics, lung function and frequencies of pulmonary exacerbations, microbial infections and use of CF-specific treatments. These findings will plausibly make future interpretations of quantitative measurements of inflammatory biomarkers generalizable to sputum-producing patients in the CFFPR.
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Affiliation(s)
- Theodore G. Liou
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
- Intermountain Pediatric Cystic Fibrosis Center, Division of Pediatric Pulmonology, Department of Pediatrics, University of Utah, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Frederick R. Adler
- Departments of Mathematics, University of Utah, 155 South 1400 east, JWB 233, Salt Lake City, UT 84112 USA
- School of Biological Sciences, University of Utah, 257 South 1400 East, Salt Lake City, UT 84112 USA
| | - Natalia Argel
- Cystic Fibrosis Center, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016 USA
| | - Fadi Asfour
- Intermountain Pediatric Cystic Fibrosis Center, Division of Pediatric Pulmonology, Department of Pediatrics, University of Utah, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Perry S. Brown
- St. Luke’s Cystic Fibrosis Center of Idaho, 610 W. Hays Street, Boise, ID 83702 USA
| | - Barbara A. Chatfield
- Intermountain Pediatric Cystic Fibrosis Center, Division of Pediatric Pulmonology, Department of Pediatrics, University of Utah, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Cori L. Daines
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arizona Health Sciences, 1501 N. Campbell Avenue, Room 3301, PO Box 245073, Tucson, AZ 85724 USA
| | - Dixie Durham
- St. Luke’s Cystic Fibrosis Center of Idaho, 610 W. Hays Street, Boise, ID 83702 USA
| | - Jessica A. Francis
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
| | - Barbara Glover
- Cystic Fibrosis Center, 3006 S. Maryland Pkwy, Suite #315, Las Vegas, NV 89109 USA
| | - Theresa Heynekamp
- Adult Cystic Fibrosis Program, Division of Pulmonary, Critical Care and Sleep Medicine, DoIM MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131 USA
| | - John R. Hoidal
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
| | - Judy L. Jensen
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
| | - Ruth Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Room G36, Keppel Street, London, WC1E 7HT UK
| | - Carol M. Kopecky
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045 USA
| | - Noah Lechtzin
- Division of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD 21287 USA
| | - Yanping Li
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
| | - Jerimiah Lysinger
- Montana Cystic Fibrosis Center, Billings Clinic, 2800 10th Avenue N, Billings, MT 59101 USA
| | - Osmara Molina
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arizona Health Sciences, 1501 N. Campbell Avenue, Room 3301, PO Box 245073, Tucson, AZ 85724 USA
| | - Craig Nakamura
- Cystic Fibrosis Center, 3006 S. Maryland Pkwy, Suite #315, Las Vegas, NV 89109 USA
| | - Kristyn A. Packer
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
| | - Katie R. Poch
- Division of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206 USA
| | - Alexandra L. Quittner
- Former: Department of Psychology, University of Miami, Miami, FL USA
- Present Address: Miami Children’s Research Institute, Nicklaus Children’s Hospital, 3100 SW 62nd Ave, Miami, FL 33155 USA
| | - Peggy Radford
- Cystic Fibrosis Center, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016 USA
| | - Abby J. Redway
- Adult Cystic Fibrosis Program, Division of Pulmonary, Critical Care and Sleep Medicine, DoIM MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131 USA
| | - Scott D. Sagel
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045 USA
| | - Shawna Sprandel
- Montana Cystic Fibrosis Center, Billings Clinic, 2800 10th Avenue N, Billings, MT 59101 USA
| | - Jennifer L. Taylor-Cousar
- Division of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206 USA
- Division of Pulmonology, Department of Pediatrics, National Jewish Health, 1400 Jackson St, Denver, CO 80206 USA
| | - Jane B. Vroom
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
- Intermountain Pediatric Cystic Fibrosis Center, Division of Pediatric Pulmonology, Department of Pediatrics, University of Utah, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Ryan Yoshikawa
- Cystic Fibrosis Center, 3006 S. Maryland Pkwy, Suite #315, Las Vegas, NV 89109 USA
| | - John P. Clancy
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229-3026 USA
| | - J. Stuart Elborn
- Faculty of Medicine, Health and Life Sciences, Queen’s University Belfast, 90 Lisburn Road, Belfast, BT9 6AG UK
| | - Kenneth N. Olivier
- Laboratory of Chronic Airway Infection, Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Drive MSC1454, Building 10-CRC, Room 1408A, Bethesda, MD 20892 USA
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7
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Polymorphonuclear Leukocytes or Hydrogen Peroxide Enhance Biofilm Development of Mucoid Pseudomonas aeruginosa. Mediators Inflamm 2018; 2018:8151362. [PMID: 30116152 PMCID: PMC6079396 DOI: 10.1155/2018/8151362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/13/2018] [Accepted: 04/16/2018] [Indexed: 01/05/2023] Open
Abstract
Pseudomonas aeruginosa is an opportunistic pathogenic bacterium involved in many human infections, including pneumonia, diabetic foot ulcers, and ventilator-associated pneumonia. P. aeruginosa cells usually undergo mucoid conversion during chronic lung infection in patients with cystic fibrosis (CF) and resist destruction by polymorphonuclear leukocytes (PMNs), which release free oxygen radicals (ROS), such as H2O2. PMNs are the main leucocytes in the CF sputum of patients who are infected with P. aeruginosa, which usually forms biofilms. Here, we report that PMNs or H2O2 can promote biofilm formation by mucoid P. aeruginosa FRD1 with the use of the hanging-peg method. The mucoid strain infecting CF patients overproduces alginate. In this study, PMNs and H2O2 promoted alginate production, and biofilms treated with PMNs or H2O2 exhibited higher expression of alginate genes. Additionally, PMNs increased the activity of GDP-mannose dehydrogenase, which is the key enzyme in alginate biosynthesis. Our results demonstrate that PMNs or H2O2 can enhance mucoid P. aeruginosa biofilms.
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8
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McElvaney OJ, Gunaratnam C, Reeves EP, McElvaney NG. A specialized method of sputum collection and processing for therapeutic interventions in cystic fibrosis. J Cyst Fibros 2018; 18:203-211. [PMID: 29960875 DOI: 10.1016/j.jcf.2018.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/12/2018] [Accepted: 06/04/2018] [Indexed: 11/30/2022]
Abstract
Cystic fibrosis (CF) lung disease is characterized by aggressive neutrophil-dominated inflammation mediated in large part by neutrophil elastase (NE), an omnivorous protease released by activated or disintegrating neutrophils and a key therapeutic target. To date, several short-term studies have shown that anti-NE compounds can inhibit NE and have anti-inflammatory effects. However, progression to large-scale or multicenter clinical trials has been hampered by the fact that the current gold standard methodology of evaluating airway NE inhibition, bronchoalveolar lavage (BAL), is invasive, difficult to standardize across sites and excludes those with severe lung disease. Attempts to utilize sputum that is either spontaneously expectorated (SS) or induced (IS) have been hindered by poor reproducibility, often due to the various processing methods employed. In this study, we evaluate TEmperature-controlled Two-step Rapid Isolation of Sputum (TETRIS), a specialized method for the acquisition and processing of SS and IS. Using TETRIS, we show for the first time that NE activity and cytokine levels are comparable in BAL, SS and IS samples taken from the same people with CF (PWCF) on the same day once this protocol is used. We correlate biomarkers in TETRIS-processed IS and clinical outcome measures including FEV1, and show stability and reproducible inhibition of NE over time in IS processed by TETRIS. The data offer a tremendous opportunity to evaluate prognosis and therapeutic interventions in CF and to study the full spectrum of people with PWCF, many of whom have been excluded from previous studies due to being unfit for BAL or unable to expectorate sputum.
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Affiliation(s)
- O J McElvaney
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - C Gunaratnam
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - E P Reeves
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - N G McElvaney
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
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9
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Dittrich AS, Kühbandner I, Gehrig S, Rickert-Zacharias V, Twigg M, Wege S, Taggart CC, Herth F, Schultz C, Mall MA. Elastase activity on sputum neutrophils correlates with severity of lung disease in cystic fibrosis. Eur Respir J 2018; 51:13993003.01910-2017. [PMID: 29545279 DOI: 10.1183/13993003.01910-2017] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/14/2018] [Indexed: 01/06/2023]
Abstract
Neutrophil elastase (NE) is a key risk factor for severity of cystic fibrosis (CF) lung disease. Recent studies identified increased NE activity on the surface of airway neutrophils from CF-like mice and patients with CF. However, the role of surface-bound NE in CF lung disease remains unknown. We determined the relationship between surface-bound NE activity and severity of lung disease in CF.Surface-bound NE activity was measured on sputum neutrophils from 35 CF patients and eight healthy controls using novel lipidated Förster resonance energy transfer reporters and correlated with free NE activity, neutrophil counts, interleukin-8, myeloperoxidase and antiproteases in sputum supernatant, and with lung function parameters.Surface-bound NE activity was increased in CF compared to healthy controls (p<0.01) and correlated with free NE activity (p<0.05) and other inflammation markers (p<0.001). Surface-bound and free NE activity correlated with forced expiratory volume in 1 s % predicted (p<0.01 and p<0.05), but only surface-bound NE activity correlated with plethysmographic functional residual capacity % pred (p<0.01) in patients with CF.We demonstrate that surface-bound NE activity on airway neutrophils correlates with severity of lung disease in patients with CF. Our results suggest that surface-bound NE activity may play an important role in the pathogenesis and serve as novel biomarker in CF lung disease.
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Affiliation(s)
- A Susanne Dittrich
- Dept of Translational Pulmonology and Division of Paediatric Pulmonology and Allergy and Cystic Fibrosis Centre, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), German Centre for Lung Research (DZL), Heidelberg, Germany.,Dept of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany.,Molecular Medicine Partnership Unit (MMPU), University of Heidelberg and European Molecular Biology Laboratory, Heidelberg, Germany
| | - Iris Kühbandner
- Dept of Translational Pulmonology and Division of Paediatric Pulmonology and Allergy and Cystic Fibrosis Centre, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), German Centre for Lung Research (DZL), Heidelberg, Germany.,Dept of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany
| | - Stefanie Gehrig
- Dept of Translational Pulmonology and Division of Paediatric Pulmonology and Allergy and Cystic Fibrosis Centre, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), German Centre for Lung Research (DZL), Heidelberg, Germany.,Molecular Medicine Partnership Unit (MMPU), University of Heidelberg and European Molecular Biology Laboratory, Heidelberg, Germany.,Cell Biology and Biophysics Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Verena Rickert-Zacharias
- Dept of Translational Pulmonology and Division of Paediatric Pulmonology and Allergy and Cystic Fibrosis Centre, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), German Centre for Lung Research (DZL), Heidelberg, Germany.,Molecular Medicine Partnership Unit (MMPU), University of Heidelberg and European Molecular Biology Laboratory, Heidelberg, Germany.,Cell Biology and Biophysics Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Matthew Twigg
- Airway Innate Immunity Group (AiIR), Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Sabine Wege
- Translational Lung Research Centre Heidelberg (TLRC), German Centre for Lung Research (DZL), Heidelberg, Germany.,Dept of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany
| | - Clifford C Taggart
- Airway Innate Immunity Group (AiIR), Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Felix Herth
- Translational Lung Research Centre Heidelberg (TLRC), German Centre for Lung Research (DZL), Heidelberg, Germany.,Dept of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Schultz
- Translational Lung Research Centre Heidelberg (TLRC), German Centre for Lung Research (DZL), Heidelberg, Germany.,Molecular Medicine Partnership Unit (MMPU), University of Heidelberg and European Molecular Biology Laboratory, Heidelberg, Germany.,Cell Biology and Biophysics Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Marcus A Mall
- Dept of Translational Pulmonology and Division of Paediatric Pulmonology and Allergy and Cystic Fibrosis Centre, University of Heidelberg, Heidelberg, Germany .,Translational Lung Research Centre Heidelberg (TLRC), German Centre for Lung Research (DZL), Heidelberg, Germany.,Molecular Medicine Partnership Unit (MMPU), University of Heidelberg and European Molecular Biology Laboratory, Heidelberg, Germany.,Dept of Paediatric Pulmonology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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10
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Yao Y, Welp T, Liu Q, Niu N, Wang X, Britto CJ, Krishnaswamy S, Chupp GL, Montgomery RR. Multiparameter Single Cell Profiling of Airway Inflammatory Cells. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2017; 92:12-20. [PMID: 27807928 PMCID: PMC5250532 DOI: 10.1002/cyto.b.21491] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 12/17/2022]
Abstract
Airway diseases affect over 7% of the U.S. population and millions of patients worldwide. Asthmatic patients have wide variation in clinical severity with different clinical and physiologic manifestations of disease that may be driven by distinct biologic mechanisms. Further, the immunologic underpinnings of this complex trait disease are heterogeneous and treatment success depends on defining subgroups of asthmatics. Because of the limited availability and number of cells from the lung, the active site, in-depth investigation has been challenging. Recent advances in technology support transcriptional analysis of cells from induced sputum. Flow cytometry studies have described cells present in the sputum but a detailed analysis of these subsets is lacking. Mass cytometry or CyTOF (Cytometry by Time-Of-Flight) offers tremendous opportunities for multiparameter single cell analysis. Experiments can now allow detection of up to ∼40 markers to facilitate unprecedented multidimensional cellular analyses. Here we demonstrate the use of CyTOF on primary airway samples obtained from well-characterized patients with asthma and cystic fibrosis. Using this technology, we quantify cellular frequency and functional status of defined cell subsets. Our studies provide a blueprint to define the heterogeneity among subjects and underscore the power of this single cell method to characterize airway immune status. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Yi Yao
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Tobias Welp
- Department of Genetics, Yale University School of Medicine, New Haven, CT
| | - Qing Liu
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Naiqian Niu
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Xiaomei Wang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Clemente J. Britto
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Smita Krishnaswamy
- Department of Genetics, Yale University School of Medicine, New Haven, CT
| | - Geoff L. Chupp
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Ruth R. Montgomery
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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11
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Müller U, Hentschel J, Janhsen WK, Hünniger K, Hipler UC, Sonnemann J, Pfister W, Böer K, Lehmann T, Mainz JG. Changes of Proteases, Antiproteases, and Pathogens in Cystic Fibrosis Patients' Upper and Lower Airways after IV-Antibiotic Therapy. Mediators Inflamm 2015; 2015:626530. [PMID: 26185365 PMCID: PMC4491395 DOI: 10.1155/2015/626530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/18/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In cystic fibrosis (CF) the upper (UAW) and lower airways (LAW) are reservoirs for pathogens like Pseudomonas aeruginosa. The consecutive hosts' release of proteolytic enzymes contributes to inflammation and progressive pulmonary destruction. Objectives were to assess dynamics of protease : antiprotease ratios and pathogens in CF-UAW and LAW sampled by nasal lavage (NL) and sputum before and after intravenous- (IV-) antibiotic therapy. METHODS From 19 IV-antibiotic courses of 17 CF patients NL (10 mL/nostril) and sputum were collected before and after treatment. Microbiological colonization and concentrations of NE/SLPI/CTSS (ELISA) and MMP-9/TIMP-1 (multiplex bead array) were determined. Additionally, changes of sinonasal symptoms were assessed (SNOT-20). RESULTS IV-antibiotic treatment had more pronounced effects on inflammatory markers in LAW, whereas trends to decrease were also found in UAW. Ratios of MMP-9/TIMP-1 were higher in sputum, and ratios of NE/SLPI were higher in NL. Remarkably, NE/SLPI ratio was 10-fold higher in NL compared to healthy controls. SNOT-20 scores decreased significantly during therapy (P = 0.001). CONCLUSION For the first time, changes in microbiological patterns in UAW and LAW after IV-antibiotic treatments were assessed, together with changes of protease/antiprotease imbalances. Delayed responses of proteases and antiproteases to IV-antibiotic therapy were found in UAW compared to LAW.
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Affiliation(s)
- Ulrike Müller
- Department of Pediatrics, Cystic Fibrosis Center, Jena University Hospital, 07740 Jena, Germany
| | - Julia Hentschel
- Department of Pediatrics, Cystic Fibrosis Center, Jena University Hospital, 07740 Jena, Germany
| | - Wibke K. Janhsen
- Department of Pediatrics, Cystic Fibrosis Center, Jena University Hospital, 07740 Jena, Germany
| | - Kerstin Hünniger
- Septomics Research Center, Friedrich Schiller University, 07745 Jena, Germany
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, Jena, Germany
| | | | - Jürgen Sonnemann
- Department of Pediatric Hematology and Oncology, Jena University Hospital, 07740 Jena, Germany
| | - Wolfgang Pfister
- Institute of Medical Microbiology, University of Jena, 07740 Jena, Germany
| | - Klas Böer
- Institute for Clinical Chemistry and Laboratory Diagnostics, Jena University Hospital, 07740 Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, 07740 Jena, Germany
| | - Jochen G. Mainz
- Department of Pediatrics, Cystic Fibrosis Center, Jena University Hospital, 07740 Jena, Germany
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12
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Carevic M, Singh A, Rieber N, Eickmeier O, Griese M, Hector A, Hartl D. CXCR4+ granulocytes reflect fungal cystic fibrosis lung disease. Eur Respir J 2015; 46:395-404. [PMID: 25929952 DOI: 10.1183/09031936.00173514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 03/19/2015] [Indexed: 12/21/2022]
Abstract
Cystic fibrosis airways are frequently colonised with fungi. However, the interaction of these fungi with immune cells and the clinical relevance in cystic fibrosis lung disease are incompletely understood.We characterised granulocytes in airway fluids and peripheral blood from cystic fibrosis patients with and without fungal colonisation, non-cystic fibrosis disease controls and healthy control subjects cross-sectionally and longitudinally and correlated these findings with lung function parameters.Cystic fibrosis patients with chronic fungal colonisation by Aspergillus fumigatus were characterised by an accumulation of a distinct granulocyte subset, expressing the HIV coreceptor CXCR4. Percentages of airway CXCR4(+) granulocytes correlated with lung disease severity in patients with cystic fibrosis.These studies demonstrate that chronic fungal colonisation with A. fumigatus in cystic fibrosis patients is associated with CXCR4(+) airway granulocytes, which may serve as a potential biomarker and therapeutic target in fungal cystic fibrosis lung disease.
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Affiliation(s)
- Melanie Carevic
- CF Centre, Dept of Pediatrics I, University of Tübingen, Tübingen, Germany
| | - Anurag Singh
- CF Centre, Dept of Pediatrics I, University of Tübingen, Tübingen, Germany
| | - Nikolaus Rieber
- CF Centre, Dept of Pediatrics I, University of Tübingen, Tübingen, Germany
| | - Olaf Eickmeier
- Dept of Pediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Christiane Herzog CF-Center, Goethe University, Frankfurt, Germany
| | - Matthias Griese
- Dept of Pediatrics, Ludwig-Maximilians-University, Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Andreas Hector
- CF Centre, Dept of Pediatrics I, University of Tübingen, Tübingen, Germany
| | - Dominik Hartl
- CF Centre, Dept of Pediatrics I, University of Tübingen, Tübingen, Germany
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13
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Pedersen F, Holz O, Lauer G, Quintini G, Kiwull-Schöne H, Kirsten AM, Magnussen H, Rabe KF, Goldmann T, Watz H. Multi-analyte profiling of inflammatory mediators in COPD sputum – The effects of processing. Cytokine 2015; 71:401-4. [DOI: 10.1016/j.cyto.2014.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 08/15/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
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14
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Protease-antiprotease imbalances differ between Cystic Fibrosis patients' upper and lower airway secretions. J Cyst Fibros 2014; 14:324-33. [PMID: 25286826 DOI: 10.1016/j.jcf.2014.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/31/2014] [Accepted: 09/02/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Balanced levels of proteases and anti-proteases are essential in host defense systems. In CF patients' lungs, elevated protease/anti-protease-ratios contribute to damage of airway tissue and premature death with the inherited disease. Little is known about upper airway protease equilibrium in CF. METHODS Neutrophil elastase (NE), Secretory leukocyte protease inhibitor (SLPI), matrix metalloproteinase (MMP)9, tissue inhibitors of metalloproteinase (TIMP)1, cathepsin S (CTSS) and the corresponding cellular distribution were assessed in the nasal lavage (NL) and sputum of 40 CF patients. RESULTS Concentrations of all proteases and anti-proteases were markedly higher in sputum than in NL (NE: 10-fold, SLPI: 5000-fold). Interestingly, the NE/SLPI ratio was 726-fold higher in NL compared to sputum, while the MMP9/TIMP1 ratio was 4.5-fold higher in sputum compared to NL. DISCUSSION This first study to compare protease/anti-protease networks of CF upper and lower airways by NL and sputum reveals substantial differences between both compartments' immunological responses. This finding may have implications for sinonasal and pulmonary treatment, possibly leading to new therapeutic approaches.
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15
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Hector A, Kröner C, Carevic M, Bakele M, Rieber N, Riethmüller J, Griese M, Zissel G, Hartl D. The chemokine CCL18 characterises Pseudomonas infections in cystic fibrosis lung disease. Eur Respir J 2014; 44:1608-15. [PMID: 25142483 DOI: 10.1183/09031936.00070014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cystic fibrosis (CF) lung disease is characterised by chronic Pseudomonas aeruginosa infection and leukocyte infiltration. Chemokines recruit leukocytes to sites of infection. Gene expression analysis identified the chemokine CCL18 as upregulated in CF leukocytes. We hypothesised that CCL18 characterises infection and inflammation in patients with CF lung disease. Therefore, we quantified CCL18 protein levels in the serum and airway fluids of CF patients and healthy controls, and studied CCL18 protein production by airway cells ex vivo. These studies demonstrated that CCL18 levels were increased in the serum and airway fluids from CF patients compared with healthy controls. Within CF patients, CCL18 levels were increased in P. aeruginosa-infected CF patients. CCL18 levels in the airways, but not in serum, correlated with severity of pulmonary obstruction in CF. Airway cells isolated from P. aeruginosa-infected CF patients produced significantly higher amounts of CCL18 protein compared with airway cells from CF patients without P. aeruginosa infection or healthy controls. Collectively, these studies show that CCL18 levels characterise chronic P. aeruginosa infection and pulmonary obstruction in patients with CF. CCL18 may, thus, serve as a potential biomarker and therapeutic target in CF lung disease.
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Affiliation(s)
- Andreas Hector
- Dept of Pediatrics I and Interdisciplinary Center for Infectious Diseases, University of Tübingen, Tübingen, Germany Both authors contributed equally
| | - Carolin Kröner
- Dept of Pediatrics, Ludwig-Maximilians-University, Munich, Germany Both authors contributed equally
| | - Melanie Carevic
- Dept of Pediatrics I and Interdisciplinary Center for Infectious Diseases, University of Tübingen, Tübingen, Germany
| | - Martina Bakele
- Dept of Pediatrics I and Interdisciplinary Center for Infectious Diseases, University of Tübingen, Tübingen, Germany
| | - Nikolaus Rieber
- Dept of Pediatrics I and Interdisciplinary Center for Infectious Diseases, University of Tübingen, Tübingen, Germany
| | - Joachim Riethmüller
- Dept of Pediatrics I and Interdisciplinary Center for Infectious Diseases, University of Tübingen, Tübingen, Germany
| | - Matthias Griese
- Dept of Pediatrics, Ludwig-Maximilians-University, Munich, Germany
| | - Gernot Zissel
- Dept of Pneumology, Center for Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Dominik Hartl
- Dept of Pediatrics I and Interdisciplinary Center for Infectious Diseases, University of Tübingen, Tübingen, Germany
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16
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Kolpen M, Bjarnsholt T, Moser C, Hansen CR, Rickelt LF, Kühl M, Hempel C, Pressler T, Høiby N, Jensen PØ. Nitric oxide production by polymorphonuclear leucocytes in infected cystic fibrosis sputum consumes oxygen. Clin Exp Immunol 2014; 177:310-9. [PMID: 24611476 DOI: 10.1111/cei.12318] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 11/30/2022] Open
Abstract
Chronic Pseudomonas aeruginosa lung infection in cystic fibrosis (CF) patients is characterized by persisting mucoid biofilms in hypoxic endobronchial mucus. These biofilms are surrounded by numerous polymorphonuclear leucocytes (PMNs), which consume a major part of present molecular oxygen (O(2)) due to production of superoxide (O(2)(-)). In this study, we show that the PMNs also consume O(2) for production of nitric oxide (NO) by the nitric oxide synthases (NOS) in the infected endobronchial mucus. Fresh expectorated sputum samples (n = 28) from chronically infected CF patients (n = 22) were analysed by quantifying and visualizing the NO production. NO production was detected by optode measurements combined with fluorescence microscopy, flow cytometry and spectrophotometry. Inhibition of nitric oxide synthases (NOS) with N(G) -monomethyl-L-arginine (L-NMMA) resulted in reduced O(2) consumption (P < 0·0008, n = 8) and a lower fraction of cells with fluorescence from the NO-indicator 4-amino-5-methylamino-2',7'-difluorofluorescein diacetate (DAF-FM) (P < 0·002, n = 8). PMNs stained with DAF-FM and the superoxide indicator hydroethidine (HE) and host cells with inducible NOS (iNOS) were identified in the sputum. In addition, the production of the stable end-products of NO in CF sputum was correlated with the concentration of PMNs; NO(3)(-) (P < 0·04, r = 0·66, n = 10) and NO(2)(-) (P< 0·006, r = 0·78, n = 11). The present study suggests that besides consumption of O(2) for production of reactive oxygen species, the PMNs in CF sputum also consume O(2) for production of NO.
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Affiliation(s)
- M Kolpen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Helsingør, Denmark
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17
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Gehrig S, Duerr J, Weitnauer M, Wagner CJ, Graeber SY, Schatterny J, Hirtz S, Belaaouaj A, Dalpke AH, Schultz C, Mall MA. Lack of neutrophil elastase reduces inflammation, mucus hypersecretion, and emphysema, but not mucus obstruction, in mice with cystic fibrosis-like lung disease. Am J Respir Crit Care Med 2014; 189:1082-92. [PMID: 24678594 DOI: 10.1164/rccm.201311-1932oc] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Recent evidence from clinical studies suggests that neutrophil elastase (NE) released in neutrophilic airway inflammation is a key risk factor for the onset and progression of lung disease in young children with cystic fibrosis (CF). However, the role of NE in the complex in vivo pathogenesis of CF lung disease remains poorly understood. OBJECTIVES To elucidate the role of NE in the development of key features of CF lung disease including airway inflammation, mucus hypersecretion, goblet cell metaplasia, bacterial infection, and structural lung damage in vivo. METHODS We used the Scnn1b-Tg mouse as a model of CF lung disease and determined effects of genetic deletion of NE (NE(-/-)) on the pulmonary phenotype. Furthermore, we used novel Foerster resonance energy transfer (FRET)-based NE reporter assays to assess NE activity in bronchoalveolar lavage from Scnn1b-Tg mice and sputum from patients with CF. MEASUREMENTS AND MAIN RESULTS Lack of NE significantly reduced airway neutrophilia, elevated mucin expression, goblet cell metaplasia, and distal airspace enlargement, but had no effect on airway mucus plugging, bacterial infection, or pulmonary mortality in Scnn1b-Tg mice. By using FRET reporters, we show that NE activity was elevated on the surface of airway neutrophils from Scnn1b-Tg mice and patients with CF. CONCLUSIONS Our results suggest that NE plays an important role in the in vivo pathogenesis and may serve as a therapeutic target for inflammation, mucus hypersecretion, and structural lung damage and indicate that additional rehydration strategies may be required for effective treatment of airway mucus obstruction in CF.
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18
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Wu X, Chen J, Li X, Zhao Y, Zughaier SM. Culture-free diagnostics of Pseudomonas aeruginosa infection by silver nanorod array based SERS from clinical sputum samples. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2014; 10:1863-70. [PMID: 24832961 DOI: 10.1016/j.nano.2014.04.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/19/2014] [Accepted: 04/26/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Pseudomonas aeruginosa can cause major infection in immunocompromised patients, and successful antibiotic treatment of the infection relies on accurate and rapid identification of the infectious agents. Here, we reported a culture-free diagnostic method based on the surface-enhanced Raman spectroscopy (SERS) of pyocyanin (PCN), a major biomarker of P. aeruginosa. This platform can detect PCN as low as 5 ppb or 2.38 × 10(-8) mol L(-1) in both aqueous solutions and spiked clinical sputum samples. It has also been used to dynamically monitor the excretion of PCN by P. aeruginosa during its growth. The presence of PCN has been detected by SERS in 15 clinical sputum samples, which indicates P. aeruginosa infection, with 95.6% sensitivity and 93.3% specificity. The system can advantageously process multiple specimens rapidly, overcomes the need for bacterial culture and diagnostic microbiology assays, and have widespread implications in the early detection of P. aeruginosa infection. FROM THE CLINICAL EDITOR A surface enhanced Raman spectroscopy method optimized for the detection of P. aureginosa infections is presented in this paper. The presence of pyocyanin, a marker of this bacterium has been detected in 15 clinical sputum samples utilizing this method. A sensitivity of 95.6% and 93.3% specificity was reported, which suggests that the method may enable culture-free high throughput rapid detection of this infection.
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Affiliation(s)
- Xiaomeng Wu
- Department of Food Science and Technology, University of Georgia, Athens, GA, USA; Nanoscale Science and Engineering Center, University of Georgia, Athens, GA, USA.
| | - Jing Chen
- Department of Food Science and Technology, University of Georgia, Athens, GA, USA; Nanoscale Science and Engineering Center, University of Georgia, Athens, GA, USA
| | - Xibo Li
- Science and Technology on Plasma Physics Laboratory, Research Center of Laser Fusion, China Academy of Engineering Physics, Mianyang, China; Department of Physics and Astronomy, University of Georgia, Athens, GA, USA; Nanoscale Science and Engineering Center, University of Georgia, Athens, GA, USA
| | - Yiping Zhao
- Department of Physics and Astronomy, University of Georgia, Athens, GA, USA; Nanoscale Science and Engineering Center, University of Georgia, Athens, GA, USA
| | - Susu M Zughaier
- Department of Microbiology and Immunology, Emory University School of Medicine, and Veterans Affair Medical Center, Atlanta, GA, USA.
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Willis VC, Demoruelle MK, Derber LA, Chartier-Logan CJ, Parish MC, Pedraza IF, Weisman MH, Norris JM, Holers VM, Deane KD. Sputum autoantibodies in patients with established rheumatoid arthritis and subjects at risk of future clinically apparent disease. ACTA ACUST UNITED AC 2014; 65:2545-54. [PMID: 23817979 DOI: 10.1002/art.38066] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 06/18/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the generation of rheumatoid arthritis (RA)-related autoantibodies in the lung. METHODS Simultaneous collection of serum and induced sputum was performed in 21 healthy controls, 49 at-risk subjects without inflammatory arthritis but at risk of RA due to family history or seropositivity for anti-citrullinated protein antibodies, and 14 subjects with early RA. Samples were tested for anti-cyclic citrullinated peptide 2 (anti-CCP2), anti-CCP3, anti-CCP3.1, rheumatoid factor isotypes IgM, IgG, and IgA, and total IgM, IgG, and IgA. RESULTS One or more autoantibodies were present in sputum of 39% of at-risk seronegative subjects, 65% of at-risk seropositive subjects, and 86% of subjects with early RA. In at-risk seronegative subjects, the rate of anti-CCP3.1 positivity and the median number of autoantibodies were elevated in sputum versus serum. In subjects with early RA, the rate of positivity for several individual autoantibodies and the median number of autoantibodies were higher in serum than in sputum. Results in at-risk seropositive subjects were intermediate between these groups. In at-risk subjects with autoantibody positivity in sputum, the ratios of autoantibody to total Ig were higher in sputum than in serum, suggesting that these autoantibodies are generated or sequestered in the lung. CONCLUSION RA-related autoantibodies are detectable in sputum in subjects at risk of RA and in subjects with early RA. In a subset of at-risk subjects, the presence of sputum autoantibodies in the absence of seropositivity, and the increased autoantibody-to-total Ig ratios in sputum, suggest that the lung may be a site of autoantibody generation in the early development of RA. These findings suggest an important role of the lung in the pathogenesis of RA.
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20
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Local and systemic oxidative stress status in chronic obstructive pulmonary disease patients. Can Respir J 2013; 20:35-41. [PMID: 23457673 DOI: 10.1155/2013/985382] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Previous studies have indicated that oxidative stress plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). OBJECTIVES To study local and systemic oxidative stress status in COPD patients, and to clarify the relationship between local and systemic oxidative stress. METHODS Lipid peroxide malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD) and GSH peroxidase (GSH-PX) levels in induced sputum and plasma, as well as glucocorticoid receptor (GR) levels in peripheral blood leukocytes were examined in 43 acute exacerbation of COPD patients (group A), 35 patients with stable COPD (group B) and 28 healthy controls (14 smokers [group C]; 14 nonsmokers [group D]). RESULTS MDA levels in induced sputum and plasma decreased progressively in groups A to D, with significant differences between any two groups (P<0.001). GSH, SOD and GSH-PX levels in both induced sputum and plasma increased progressively in groups A to D, with significant differences between any two groups (P<0.001). GR levels in peripheral blood leukocytes decreased progressively in groups D to A (all comparisons P<0.001). Pearson analysis revealed strong correlations between MDA, GSH, SOD and GSH-PX levels in plasma and induced sputum. The activity of SOD in plasma and sputum were both positively correlated with GR levels (partial correlation coefficients 0.522 and 0.574, respectively [P<0.001]). CONCLUSIONS Oxidative stress levels were elevated in COPD patients. There was a correlation between local and systemic oxidative status in COPD, and between decreased SOD activity and decreased GR levels in COPD patients.
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21
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Griese M, Kappler M, Eismann C, Ballmann M, Junge S, Rietschel E, van Koningsbruggen-Rietschel S, Staab D, Rolinck-Werninghaus C, Mellies U, Köhnlein T, Wagner T, König S, Teschler H, Heuer HE, Kopp M, Heyder S, Hammermann J, Küster P, Honer M, Mansmann U, Beck-Speier I, Hartl D, Fuchs C, Hector A. Inhalation treatment with glutathione in patients with cystic fibrosis. A randomized clinical trial. Am J Respir Crit Care Med 2013; 188:83-9. [PMID: 23631796 DOI: 10.1164/rccm.201303-0427oc] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
RATIONALE Glutathione is the major antioxidant in the extracellular lining fluid of the lungs and depleted in patients with cystic fibrosis (CF). OBJECTIVES We aimed to assess glutathione delivered by inhalation as a potential treatment for CF lung disease. METHODS This randomized, double-blind, placebo-controlled trial evaluated inhaled glutathione in subjects with CF 8 years of age and older and FEV1 of 40-90% of predicted. Subjects were randomized to receive 646 mg glutathione in 4 ml (n = 73) or placebo (n = 80) via an investigational eFlow nebulizer every 12 hours for 6 months. MEASUREMENTS AND MAIN RESULTS FEV1 (absolute values), both as pre-post differences (P = 0.180) and as area under the curves (P = 0.205), were the primary efficacy endpoints, and were not different between the glutathione group and the placebo group over the 6-month treatment period. Exploratory analysis showed an increase of FEV1 from baseline over placebo of 100 ml or 2.2% predicted; this was significant at 3 months, but not later. Subjects receiving glutathione had neither fewer pulmonary exacerbations, nor better scores for quality of life. Whereas increased glutathione and metabolites in sputum demonstrated significant delivery to the lungs, there was no indication of diminished oxidative stress to proteins or lipids, and no evidence for anti-inflammatory or antiproteolytic actions of glutathione supplemented to the airways. The adverse event incidence was similar between glutathione and placebo. CONCLUSIONS Inhaled glutathione in the dose administered did not demonstrate clinically relevant improvements in lung function, pulmonary exacerbation frequency, or patient-reported outcomes. Glutathione delivery to the airways was not associated with changes in markers of oxidation, proteolysis, or inflammation. Clinical trial registered with www.clinicaltrials.gov (NCT00506688) and https://eudract.ema.europa.eu/index.html (EudraCT 2005-003870-88).
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Affiliation(s)
- Matthias Griese
- Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
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Goldmann T, Pedersen F, Seehase S, Marwitz S, Lang DS, Kirsten AM, Zabel P, Vollmer E, Magnussen H, Rabe KF, Watz H. The Effect of Dithiothreitol on the Transcriptome of Induced Sputum Cells. Respiration 2013; 86:262-263. [DOI: 10.1159/000348392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Hector A, Kormann M, Kammermeier J, Burdi S, Marcos V, Rieber N, Mays L, Illig T, Klopp N, Falkenstein F, Kappler M, Riethmueller J, Graepler-Mainka U, Stern M, Eickmeier O, Serve F, Zielen S, Döring G, Griese M, Hartl D. Expression and Regulation of Interferon-Related Development Regulator–1 in Cystic Fibrosis Neutrophils. Am J Respir Cell Mol Biol 2013; 48:71-7. [DOI: 10.1165/rcmb.2012-0061oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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24
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Sputum neutrophils in cystic fibrosis patients display a reduced respiratory burst. J Cyst Fibros 2012; 12:352-62. [PMID: 23267772 DOI: 10.1016/j.jcf.2012.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/03/2012] [Accepted: 11/04/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Few data exist on the functional activity of airway neutrophils in the milieu of the cystic fibrosis (CF) lung. We assessed reactive oxygen species (ROS) production by sputum neutrophils and the relationship to neutrophil viability. Identical assessments were made on peripheral blood neutrophils from CF patients. METHODS ROS production in sputum neutrophils was assessed in 31 CF patients at varying phases of clinical disease using flow cytometry. Twenty patients provided blood samples (including 16 who also provided a matched sputum sample). Neutrophil viability was determined using dual annexin V (apoptosis) and propidium iodide (necrosis) staining. Comparative peripheral blood data were obtained from 7 healthy controls. RESULTS ROS production was reduced in sputum compared to blood neutrophils and they demonstrated a higher level of necrosis. Subpopulations of neutrophils with different ROS production capacity were apparent in peripheral blood. Lung function was positively associated with both the proportion of blood neutrophils demonstrating increased ROS production and the proportion of apoptotic sputum neutrophils. CONCLUSIONS CF airway neutrophils display functional exhaustion. Healthier lungs in CF appear to be associated with subpopulations of blood neutrophils with increased oxidative burst capacity and evidence for increased neutrophil apoptosis within the airway.
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Hartl D, Gaggar A, Bruscia E, Hector A, Marcos V, Jung A, Greene C, McElvaney G, Mall M, Döring G. Innate immunity in cystic fibrosis lung disease. J Cyst Fibros 2012; 11:363-82. [PMID: 22917571 DOI: 10.1016/j.jcf.2012.07.003] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/29/2012] [Accepted: 07/02/2012] [Indexed: 12/16/2022]
Abstract
Chronic lung disease determines the morbidity and mortality of cystic fibrosis (CF) patients. The pulmonary immune response in CF is characterized by an early and non-resolving activation of the innate immune system, which is dysregulated at several levels. Here we provide a comprehensive overview of innate immunity in CF lung disease, involving (i) epithelial dysfunction, (ii) pathogen sensing, (iii) leukocyte recruitment, (iv) phagocyte impairment, (v) mechanisms linking innate and adaptive immunity and (iv) the potential clinical relevance. Dissecting the complex network of innate immune regulation and associated pro-inflammatory cascades in CF lung disease may pave the way for novel immune-targeted therapies in CF and other chronic infective lung diseases.
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Affiliation(s)
- D Hartl
- Department of Pediatrics I, University of Tübingen, Tübingen, Germany.
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26
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Hector A, Kormann MSD, Mack I, Latzin P, Casaulta C, Kieninger E, Zhou Z, Yildirim AÖ, Bohla A, Rieber N, Kappler M, Koller B, Eber E, Eickmeier O, Zielen S, Eickelberg O, Griese M, Mall MA, Hartl D. The chitinase-like protein YKL-40 modulates cystic fibrosis lung disease. PLoS One 2011; 6:e24399. [PMID: 21949714 PMCID: PMC3176766 DOI: 10.1371/journal.pone.0024399] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 08/08/2011] [Indexed: 02/07/2023] Open
Abstract
The chitinase-like protein YKL-40 was found to be increased in patients with severe asthma and chronic obstructive pulmonary disease (COPD), two disease conditions featuring neutrophilic infiltrates. Based on these studies and a previous report indicating that neutrophils secrete YKL-40, we hypothesized that YKL-40 plays a key role in cystic fibrosis (CF) lung disease, a prototypic neutrophilic disease. The aim of this study was (i) to analyze YKL-40 levels in human and murine CF lung disease and (ii) to investigate whether YKL-40 single-nucleotide polymorphisms (SNPs) modulate CF lung disease severity. YKL-40 protein levels were quantified in serum and sputum supernatants from CF patients and control individuals. Levels of the murine homologue BRP-39 were analyzed in airway fluids from CF-like βENaC-Tg mice. YKL-40SNPs were analyzed in CF patients. YKL-40 levels were increased in sputum supernatants and in serum from CF patients compared to healthy control individuals. Within CF patients, YKL-40 levels were higher in sputum than in serum. BRP-39 levels were increased in airways fluids from βENaC-Tg mice compared to wild-type littermates. In both CF patients and βENaC-Tg mice, YKL-40/BRP-39 airway levels correlated with the severity of pulmonary obstruction. Two YKL-40 SNPs (rs871799 and rs880633) were found to modulate age-adjusted lung function in CF patients. YKL-40/BRP-39 levelsare increased in human and murine CF airway fluids, correlate with pulmonary function and modulate CF lung disease severity genetically. These findings suggest YKL-40 as a potential biomarker in CF lung disease.
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Affiliation(s)
- Andreas Hector
- Department I, Children's Hospital, University of Tübingen, Tübingen, Germany
| | | | - Ines Mack
- Research Center, Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Philipp Latzin
- Department of Paediatrics, University of Berne, Inselspital, Berne, Switzerland
| | - Carmen Casaulta
- Department of Paediatrics, University of Berne, Inselspital, Berne, Switzerland
| | - Elisabeth Kieninger
- Department of Paediatrics, University of Berne, Inselspital, Berne, Switzerland
| | - Zhe Zhou
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University of Heidelberg, Heidelberg, Germany
| | - Ali Ö. Yildirim
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease (iLBD), University Hospital, Ludwig Maximilians University and Helmholtz ZentrumMünchen, Munich, Germany
| | - Alexander Bohla
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease (iLBD), University Hospital, Ludwig Maximilians University and Helmholtz ZentrumMünchen, Munich, Germany
| | - Nikolaus Rieber
- Department I, Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Matthias Kappler
- Research Center, Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Barbara Koller
- Department of Dermatology and Allergy, Ludwig-Maximilians-University, Munich, Germany
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Paediatric Department, Medical University of Graz, Graz, Austria
| | - Olaf Eickmeier
- Department of Pediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Frankfurt, Germany
| | - Stefan Zielen
- Department of Pediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Frankfurt, Germany
| | - Oliver Eickelberg
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease (iLBD), University Hospital, Ludwig Maximilians University and Helmholtz ZentrumMünchen, Munich, Germany
| | - Matthias Griese
- Research Center, Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Marcus A. Mall
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Dominik Hartl
- Department I, Children's Hospital, University of Tübingen, Tübingen, Germany
- * E-mail:
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