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Tao H, Dong Y, Chen X, Peng L. Mediators of the association between gastro-oesophageal reflux disease and idiopathic pulmonary fibrosis. Eur Respir J 2023; 62:2300323. [PMID: 37857422 DOI: 10.1183/13993003.00323-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Heqing Tao
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, P.R. China
| | - Yongqiang Dong
- Department of Thyroid Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Xueqing Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, P.R. China
| | - Liang Peng
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, P.R. China
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2
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Alamer A, Jones R, Drinnan M, Simpson AJ, Griffin M, Patterson JM, Althuwaybi A, Ward C, Forrest IA. Oropharyngeal swallowing physiology and safety in patients with Idiopathic Pulmonary Fibrosis: a consecutive descriptive case series. BMC Pulm Med 2022; 22:422. [PMCID: PMC9670476 DOI: 10.1186/s12890-022-02232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Introduction
Dysphagia occurs in multiple respiratory pathophysiologies, increasing the risk of pulmonary complications secondary to aspiration. Reflux associated aspiration and a dysregulated lung microbiome is implicated in Idiopathic Pulmonary Fibrosis (IPF), but swallowing dysfunction has not been described. We aimed to explore oropharyngeal swallowing in IPF patients, without known swallowing dysfunction.
Methods
Fourteen consecutive outpatients with a secure diagnosis of IPF were recruited and the 10-item Eating Assessment Tool (Eat 10) used to assess patient perception of swallowing difficulty. Oropharyngeal swallowing was assessed in ten patients using Videofluoroscopy Swallow Studies (VFSS). The studies were rated using validated scales: Penetration-Aspiration Scale (PAS); standardised Modified Barium Swallow Impairment Profile (MBSImP).
Results
EAT-10 scores indicated frank swallowing difficulty in 4/14 patients. Videofluoroscopy Studies showed that 3/10 patients had airway penetration, and one aspirated liquid without a cough response. Median MBSImp for oral impairment was 5, range [3–7] and pharyngeal impairment 4, range [1–14] indicating, overall mild alteration to swallowing physiology.
Conclusion
We conclude that people with IPF can show a range of swallowing dysfunction, including aspiration into an unprotected airway. To our knowledge, this is the first report on swallowing physiology and safety in IPF. We believe a proportion of this group may be at risk of aspiration. Further work is indicated to fully explore swallowing in this vulnerable group.
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3
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MOTOC NS, MAIEREAN AD, MAN MA, ALEXESCU TG, CIUMARNEAN L, TONCA C, DOGARU G, TODEA DA, DOMOKOS B. The efficacy of pulmonary rehabilitation in improving the clinical status in
idiopathic pulmonary fibrosis. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fatal lung disease with a median survival rate of 2-4 years after diagnosis, occurring primarily in older adults. The diagnosis is suggested by histology or radiologic evidence of a usual interstitial pneumonia (UIP) pattern and exclusion of known cases of pulmonary fibrosis. There are some comorbidities associated with IPF such as pulmonary hypertension, emphysema, chronic obstructive pulmonary disease (COPD), asthma, lung cancer, cardiovascular disorders, gastroesophageal reflux disease (GERD), sleep disorders and psychiatric disturbances. The management of IPF focuses on the amelioration of symptoms, preserving lung function, improving health status, minimizing the adverse effects of therapy and improving survival. Pulmonary rehabilitation is suggested for IPF patients when adequate medical therapy controls poorly the disease progression and mental, physical or social consequences of the illness persist during daily life. Currently, there are only two approved available antifibrotic therapies, pirfenidone and nintedanib, capable to reduce disease progression and physical deterioration, but cure is elusive and improvements are hardly observed. In addition, there is a continuous need of non-drug therapy components which should be included in IPF patient management: education, psychosocial support, exercise training, nutrition, symptom management and palliative care, non-invasive ventilation and pulmonary transplant. These complementary therapies have been proven to improve dyspnea, exercise capacity, fatigue and quality of life.
Key words: idiopathic pulmonary fibrosis, rehabilitation, quality of life, palliative care,
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Affiliation(s)
- Nicoleta Stefania MOTOC
- 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania
| | - Anca Diana MAIEREAN
- 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania
| | - Milena Adina MAN
- 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania
| | - Teodora Gabriela ALEXESCU
- 2- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Internal Medicine, Cluj Napoca, Romania
| | - Lorena CIUMARNEAN
- 2- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Internal Medicine, Cluj Napoca, Romania
| | - Claudia TONCA
- 3- “Leon Daniello” Clinical Hospital of Pneumology, Cluj Napoca, Romania
| | - Gabriela DOGARU
- 4- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Rehabilitation, Cluj Napoca, Romania
| | - Doina Adina TODEA
- 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania
| | - Bianca DOMOKOS
- 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania
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4
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Bennett D, Fossi A, Chiarello G, Refini RM, Luzzi L, Paladini P, Materozzi M, Figura N, Nuti R, Rottoli P. Helicobacter pylori Infection Does Not Impact on Lung Transplant Outcome. Lung 2018; 197:95-99. [DOI: 10.1007/s00408-018-0178-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/07/2018] [Indexed: 12/25/2022]
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5
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Patrucco F, Venezia L, Gavelli F, Solidoro P. Helicobacter pylori and respiratory diseases: update for pneumologist. ACTA ACUST UNITED AC 2018. [DOI: 10.23736/s0026-4954.18.01824-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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6
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GONZÁLEZ I, ARAYA P, ROJAS A. Helicobacter Pylori Infection and Lung Cancer:
New Insights and Future Challenges. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:658-662. [PMID: 30201063 PMCID: PMC6137001 DOI: 10.3779/j.issn.1009-3419.2018.09.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori (H. pylori) is the causative agent of chronic gastritis and peptic ulcer diseases and is an important risk factor for the development functional dyspepsia, peptic ulceration, gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. H. pylori has very high rates of infection in human populations, and it is estimated that over 50% of the world population is infected. Recently, certain extra-gastric manifestations, linked to H. pylori infection, have been widely investigated. Noteworthy, a growing body of evidences supports an association between H. pylori infection with lung cancer. The present review intend to highlight not only the most recent evidences supporting this association, but also some missed points, which must be considered to validate this emerging association.
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Affiliation(s)
- Ileana GONZÁLEZ
- Biomedical Research Laboratories, Medicine Faculty, Catholic University of Maule, Talca, Chile
- Ileana GONZALEZ, E-mail:
| | - Paulina ARAYA
- Biomedical Research Laboratories, Medicine Faculty, Catholic University of Maule, Talca, Chile
| | - Armando ROJAS
- Biomedical Research Laboratories, Medicine Faculty, Catholic University of Maule, Talca, Chile
- Armando ROJAS, E-mail:
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7
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Antacid therapy in idiopathic pulmonary fibrosis: more questions than answers? THE LANCET RESPIRATORY MEDICINE 2017; 5:591-598. [DOI: 10.1016/s2213-2600(17)30219-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/29/2017] [Accepted: 04/07/2017] [Indexed: 02/08/2023]
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8
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Ebener S, Barnowski S, Wotzkow C, Marti TM, Lopez-Rodriguez E, Crestani B, Blank F, Schmid RA, Geiser T, Funke M. Toll-like receptor 4 activation attenuates profibrotic response in control lung fibroblasts but not in fibroblasts from patients with IPF. Am J Physiol Lung Cell Mol Physiol 2016; 312:L42-L55. [PMID: 27815256 DOI: 10.1152/ajplung.00119.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 11/02/2016] [Indexed: 12/22/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating lung disease with a median survival of 3 yr. IPF deteriorates upon viral or bacterial lung infection although pulmonary infection (pneumonia) in healthy lungs rarely induces fibrosis. Bacterial lipopolysaccharide (LPS) activates Toll-like receptor 4 (TLR4), initiating proinflammatory pathways. As TLR4 has already been linked to hepatic fibrosis and scleroderma, we now investigated the role of TLR4 in IPF fibroblasts. Lung tissue sections from patients with IPF were analyzed for TLR4 expression. Isolated normal human lung fibroblasts (NL-FB) and IPF fibroblasts (IPF-FB) were exposed to LPS and transforming growth factor-β (TGF-β) before expression analysis of receptors, profibrotic mediators, and cytokines. TLR4 is expressed in fibroblast foci of IPF lungs as well as in primary NL-FB and IPF-FB. As a model for a gram-negative pneumonia in the nonfibrotic lung, NL-FB and IPF-FB were coexposed to LPS and TGF-β. Whereas NL-FB produced significantly less connective tissue growth factor upon costimulation compared with TGF-β stimulation alone, IPF-FB showed significantly increased profibrotic markers compared with control fibroblasts after costimulation. Although levels of antifibrotic prostaglandin E2 were elevated after costimulation, they were not responsible for this effect. However, significant downregulation of TGF-β receptor type 1 in control fibroblasts seems to contribute to the reduced profibrotic response in our in vitro model. Normal and IPF fibroblasts thus differ in their profibrotic response upon LPS-induced TLR4 stimulation.
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Affiliation(s)
- Simone Ebener
- Department of Clinical Research, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.,Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sandra Barnowski
- Department of Clinical Research, University of Bern, Bern, Switzerland.,Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlos Wotzkow
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Thomas M Marti
- Department of Clinical Research, University of Bern, Bern, Switzerland.,Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elena Lopez-Rodriguez
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany; and
| | | | - Fabian Blank
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Ralph A Schmid
- Department of Clinical Research, University of Bern, Bern, Switzerland.,Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Geiser
- Department of Clinical Research, University of Bern, Bern, Switzerland.,Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuela Funke
- Department of Clinical Research, University of Bern, Bern, Switzerland; .,Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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9
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Stella GM, Gentile A, Baderacchi A, Meloni F, Milan M, Benvenuti S. Ockham's razor for the MET-driven invasive growth linking idiopathic pulmonary fibrosis and cancer. J Transl Med 2016; 14:256. [PMID: 27590450 PMCID: PMC5010719 DOI: 10.1186/s12967-016-1008-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/16/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) identifies a specific lung disorder characterized by chronic, progressive fibrosing interstitial pneumonia of unknown etiology, which lacks effective treatment. According to the current pathogenic perspective, the aberrant proliferative events in IPF resemble those occurring during malignant transformation. MAIN BODY Receptor tyrosine kinases (RTK) are known to be key players in cancer onset and progression. It has been demonstrated that RTK expression is sometimes also altered and even druggable in IPF. One example of an RTK-the MET proto-oncogene-is a key regulator of invasive growth. This physiological genetic program supports embryonic development and post-natal organ regeneration, as well as cooperating in the evolution of cancer metastasis when aberrantly activated. Growing evidence sustains that MET activation may collaborate in maintaining tissue plasticity and the regenerative potential that characterizes IPF. CONCLUSION The present work aims to elucidate-by applying the logic of simplicity-the bio-molecular mechanisms involved in MET activation in IPF. This clarification is crucial to accurately design MET blockade strategies within a fully personalized approach to IPF.
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Affiliation(s)
- Giulia M. Stella
- Pneumology Unit, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Piazzale Golgi 19, 27100 Pavia, Italy
- Investigational Clinical Oncology (INCO), IRCCS Candiolo Cancer Institute-FPO, Candiolo, 20060 Turin, Italy
| | - Alessandra Gentile
- Experimental Clinical Molecular Oncology (ECMO), IRCCS Candiolo Cancer Institute-FPO, Candiolo, 20060 Turin, Italy
| | - Alice Baderacchi
- Investigational Clinical Oncology (INCO), IRCCS Candiolo Cancer Institute-FPO, Candiolo, 20060 Turin, Italy
| | - Federica Meloni
- Pneumology Unit, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Piazzale Golgi 19, 27100 Pavia, Italy
| | - Melissa Milan
- Experimental Clinical Molecular Oncology (ECMO), IRCCS Candiolo Cancer Institute-FPO, Candiolo, 20060 Turin, Italy
| | - Silvia Benvenuti
- Experimental Clinical Molecular Oncology (ECMO), IRCCS Candiolo Cancer Institute-FPO, Candiolo, 20060 Turin, Italy
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10
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Tossier C, Dupin C, Plantier L, Leger J, Flament T, Favelle O, Lecomte T, Diot P, Marchand-Adam S. Hiatal hernia on thoracic computed tomography in pulmonary fibrosis. Eur Respir J 2016; 48:833-42. [PMID: 27174889 DOI: 10.1183/13993003.01796-2015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/03/2016] [Indexed: 11/12/2022]
Abstract
Gastro-oesophageal reflux has long been suspected of implication in the genesis and progression of idiopathic pulmonary fibrosis (IPF). We hypothesised that hiatal hernia may be more frequent in IPF than in other interstitial lung disease (ILD), and that hiatal hernia may be associated with more severe clinical characteristics in IPF.We retrospectively compared the prevalence of hiatal hernia on computed tomographic (CT) scans in 79 patients with IPF and 103 patients with other ILD (17 scleroderma, 54 other connective tissue diseases and 32 chronic hypersensitivity pneumonitis). In the IPF group, we compared the clinical, biological, functional, CT scan characteristics and mortality of patients with hiatal hernia (n=42) and without hiatal hernia (n=37).The prevalence of hiatal hernia on CT scan at IPF diagnosis was 53%, similar to ILD associated with scleroderma, but significantly higher than in the two other ILD groups. The size of the hiatal hernia was not linked to either fibrosis CT scan scores, or reduction in lung function in any group. Mortality from respiratory causes was significantly higher among IPF patients with hiatal hernia than among those without hiatal hernia (p=0.009).Hiatal hernia might have a specific role in IPF genesis, possibly due to pathological gastro-oesophageal reflux.
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Affiliation(s)
| | | | - Laurent Plantier
- Service de Pneumologie, CHRU Tours, Tours, France Université François Rabelais, UMR 1100, Tours, France INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, Tours, France
| | | | | | | | - Thierry Lecomte
- Service d'Hepato-gastro-enterologie Tours, CHRU Tours, Hôpital Bretonneau, Tours, France
| | - Patrice Diot
- Service de Pneumologie, CHRU Tours, Tours, France Université François Rabelais, UMR 1100, Tours, France INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, Tours, France
| | - Sylvain Marchand-Adam
- Service de Pneumologie, CHRU Tours, Tours, France Université François Rabelais, UMR 1100, Tours, France INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, Tours, France
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11
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Kreuter M, Kirsten D, Bahmer T, Penzel R, Claussen M, Ehlers-Tenenbaum S, Muley T, Palmowski K, Eichinger M, Leider M, Herth FJF, Rabe KF, Bittmann I, Warth A. Screening for Helicobacter pylori in Idiopathic Pulmonary Fibrosis Lung Biopsies. Respiration 2015; 91:3-8. [PMID: 26645213 DOI: 10.1159/000442449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/09/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing evidence suggests a role of gastro-oesophageal reflux (GER) in idiopathic pulmonary fibrosis (IPF) pathogenesis. Recently, an association between serum Helicobacter pylori (HP) antibody positivity and more severe disease was described, but HP has not been directly analysed in lung tissue so far. OBJECTIVE To investigate the presence of HP in the lung tissue of IPF patients. METHODS Two tertiary interstitial lung disease care centre databases were screened for available lung biopsy material from IPF patients. Clinical and radiological data, including presence of GER and antiacid medication, were evaluated. HP-specific PCR was carried out on the IPF lung biopsy specimens. RESULTS A total of 39 IPF patients were included, of whom 85% were male. The patients' median age was 66 years, their vital capacity was 79% predicted, and their diffusing capacity for carbon monoxide was 53% predicted. In all, 82% of the lung biopsies were surgical and 18% transbronchial. Comorbidities were GER disease in 23% (n = 9), sleep apnoea in 13% (n = 5) and hiatal hernia in 38% of the cases (n = 15). Proton pump inhibitors were prescribed at the time of biopsy in 21% of the cases (n = 9). After a median follow-up of 25 months (range 6-69), there were 1 death, 1 lung transplantation and 8 acute exacerbations without relevant differences between the GER and non-GER subgroups. HP DNA was not detected in any of the lung tissue samples. CONCLUSION The fact that no HP DNA was detected in the lung tissues calls into question the proposed relevance of HP to the direct pathogenesis of IPF.
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Affiliation(s)
- Michael Kreuter
- Centre for Interstitial and Rare Lung Diseases, Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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12
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Ding H, Han Y, Huang A, Meng Y, Hu H, Li X. [Preparation, identification and application of monoclonal antibody against urease subuint B of Helicobacter pylori]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi 2015; 460:721-726. [PMID: 25481185 DOI: 10.1016/j.bbrc.2015.03.096] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/17/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To prepare and characterize the monoclonal antibody (mAb) against Helicobacter pylori (Hp) and establish a competitive ELISA used for detection of Hp antibodies in the sera of Hp-infected patients. METHODS BALB/c mice were immunized with inactivated Hp to generate Hp mAb using the hybridoma technology. Hp mixed proteins including cytotoxin-associated gene A (CagA), vacuolating cytotoxin A (VacA) and urease, as well as inactivated Hp were applied to screen positive hybridoma. Selected Hp mAb was analyzed and characterized with ELISA and Western blotting, and then labeled with horseradish peroxidase (HRP) for establishing a competitive ELISA to detect Hp antibodies in the sera of Hp-infected patients. RESULTS One Hp mAb named as C3 was selected after screening large amount of hybridoma, and the C3 Hp mAb was special for IgG2a subtype with the affinity titer of 1×10(7). Western blotting, ELISA and mass spectrum analysis indicated that the C3 Hp mAb could recognize Hp urease subunit B specifically. Using the C3 Hp mAb, we developed a competitive ELISA which could be used to detect Hp antibodies in the sera of Hp-infected patients. CONCLUSION We successfully obtained one mAb that could specifically recognize Hp urease subunit B and developed a competitive ELISA using the Hp mAb.
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Affiliation(s)
- Huandi Ding
- Hybridoma and Antibody Center, School of Life Science, Xiamen 361005, China
| | - Ying Han
- Department of Clinical Laboratory, First Affiliated Hospital, Xiamen University, Xiamen 361005, China
| | - Angen Huang
- Hybridoma and Antibody Center, School of Life Science, Xiamen 361005, China
| | - Yuan Meng
- Hybridoma and Antibody Center, School of Life Science, Xiamen 361005, China
| | - Huaxin Hu
- Hybridoma and Antibody Center, School of Life Science, Xiamen 361005, China
| | - Xiaotong Li
- Hybridoma and Antibody Center, School of Life Science, Xiamen 361005, China
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