Current status and preventive strategies of chronic obstructive pulmonary disease in China: a literature review

Exploring the association between socioeconomic inequalities in chronic respiratory disease and all-cause mortality in China: findings from the China Health and Retirement Longitudinal Study

Objective

Research on the inequality of chronic respiratory disease (CRD) is limited, and the association between CRD and all-cause mortality is not well-established. Investigating the distribution of CRD and its associated mortality risks is essential for improving CRD conditions and developing targeted intervention measures. This study aimed to explore the relationship between inequalities in CRD and all-cause mortality in China.

Methods

This study utilized nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020, wave 1-wave 5), including a total of 14,743 subjects. The concentration index was employed to measure socioeconomic-related inequality in CRD, and the concentration index decomposition method was used to describe its influencing factors. Cox proportional hazards regression model was employed to examine the association between CRD and all-cause mortality.

Results

The prevalence of CRD was 11.79% (95% CI: 10.98, 12.66) in China. The concentration index for CRD was -0.050 (95% CI: -0.075, -0.026), indicating a certain degree of inequality in its prevalence. Chronic lung disease (concentration index = -0.046, 95% CI: -0.073, -0.019), asthma (concentration index = -0.102, 95% CI: -0.148, -0.056), and asthma-chronic obstructive pulmonary disease overlap syndrome (concentration index = -0.114, 95% CI: -0.173, -0.055) also exhibited a pro-poor distribution. The decomposition analysis of the concentration index for CRD revealed that age, education level, and economic status played substantial roles in contributing to the observed inequality. Additionally, Cox regression analysis showed that participants with CRD had an increased risk of all-cause mortality (HR = 1.49, 95% CI: 1.34, 1.65).

Conclusion

Inequalities exists in CRDs in China, with the prevalence of these diseases primarily concentrated among economically disadvantaged groups. Additionally, CRD increases the risk of all-cause mortality. Addressing the root causes of economic inequalities and enhancing the educational attainment of individuals with low socioeconomic status can help improve the situation.

Treatment patterns for chronic obstructive pulmonary disease under the tiered medical system

China has implemented the "tiered medical services" policy since 2015, while there is a paucity of data evaluating the the current status of chronic obstructive pulmonary disease (COPD) management under the system. Characteristics and treatments from 11,905 COPD patients in 88 hospitals across different tiers in China were included and analyzed. We assessed the statistical significance of differences by one way analysis of variance (ANOVA) for continuous variables and with the chi-squared test for categorical variables. Patients in primary hospitals (Tier1) exhibited heightened exposure to risk factors including smoking, household biofuel, and family history of respiratory diseases, and displayed elevated COPD assessment test (CAT) and modified Medical Research Council (mMRC) dyspnea scale scores, and worse lung function, in comparison to tertiary (Tier3) hospitals (P < 0.001). However, the utilization of inhaled maintenance treatments in Tier1 hospitals is markedly lower than that in Tier3 hospitals (54.8% vs. 81.3%, P < 0.001). At odds with the patients with more severer symptoms (as indicated by CAT ≥ 10 or mMRC ≥ 2), a higher proportion relied exclusively on single bronchodilators in Tier1 hospitals was observed compared to secondary (Tier2) and Tier3 hospitals (37.7% vs. 32.1% vs. 26.3%, 40.0% vs. 29.8% vs. 25.6%, P<0.001). Dual bronchodilators (long-acting β2-agonists /long-acting muscarinic antagonist, LABA/LAMA) represented the least common medication regimen across all tiers of hospitals, albeit their usage rates increased in tandem with hospital tier (0.7% vs. 7.2% vs. 10.4%, P < 0.001). In addition, the use of inhalation therapies containing inhaled corticosteroids (ICS) in China's primary care is notably lower (16.9%) than the United States, the United Kingdom, and other middle-to-high-income countries (29.5-57.0%). There was compelling evidence pointing to greater disease severity in Tier1 hospitals, attributable to the lower and inappropriate utilization of inhaled maintenance treatments. This underscores the necessity for enhanced availability of medications and educational initiatives aimed at both physicians and patients within Tier1 hospitals.

Effect of Baduanjin exercise on health and functional status in patients with chronic obstructive pulmonary disease: a community-based, cluster-randomized controlled trial

Baduanjin has been shown to be an effective method of exercise for promoting body function in patients with chronic obstructive pulmonary disease (COPD). However, this method is rarely used by rural doctors in rural communities. The aim of this study was to compare the therapeutic effects of Baduanjin exercise with those of conventional pulmonary rehabilitation (CPR) implemented by rural doctors in patients with COPD. A total of 472 COPD patients from 18 village clinics were randomly allocated to the Baduanjin group (n = 158), CPR group (n = 154), or control group (n = 160). The Baduanjin group received six months of Baduanjin training, the CPR group received six months of rehabilitation training, and the control group received usual care. The primary outcomes were changes in health status, as measured by the COPD Assessment Test (CAT), and dyspnoea, as assessed via the modified Medical Research Council (mMRC) dyspnoea scale. The secondary outcomes included six-minute walking distance (6MWD) performance and anxiety and depression scores on the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively). Baseline data were collected before randomization, and outcomes were ascertained at the six-month follow-up by blinded assessors. After six months of training, compared with the control group, the Baduanjin group presented significant improvements in CAT scores (t = 5.121, P < 0.001), mMRC scale scores (t = 5.719, P < 0.001), 6MWD performance (t = 12.608, P < 0.001), HADS-A scores (t = 6.210, P < 0.001), and HADS-D scores (t = 2.945, P = 0.010). The CPR group also presented significant improvements in CAT scores (t = 4.725, P < 0.001), mMRC scale scores (t = 5.499, P < 0.001), 6MWD performance (t = 11.662, P < 0.001), HADS-A scores (t = 5.697, P < 0.001), and HADS-D scores (t = 2.671, P = 0.023). In contrast, the control group participants showed no significant changes in CAT scores (t = -0.252, P = 0.801), mMRC scale scores (t = -0.085, P = 0.932), 6MWD performance (t = -0.463, P = 0.644), HADS-A scores (t = -2.75, P = 0.783), or HADS-D scores (t = -0.281, P = 0.779). No adverse events were reported during the study. The positive effects of Baduanjin exercise on the subjective symptoms of COPD patients are similar to those of CPR. The trial was registered with the Chinese Clinical Trials Registry (reference: ChiCTR-TRC-12001958) (22/02/2012).

Effects of the teach-back method on the health status of patients with chronic obstructive pulmonary disease: a real-world community-based cluster-randomized controlled trial

Background

The teach-back method (TBM), also known as the "show-me" method, is a technique for verifying patients' understanding of health-related information that has been recommended for improving health literacy. However, the research on TBM effect on the outcomes of chronic obstructive pulmonary disease (COPD) patients is limited. Therefore, the aim of this study was to examine the effect of a TBM intervention on the health status of COPD patients.

Methods

This real-world community-based cluster-randomized controlled trial enrolled 1,688 patients with COPD from 18 communities in China. Participants received either TBM plus usual care (UC) or UC only. General practitioners were trained in TBM before the intervention. The primary outcomes were depression and anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes were health-related quality of life and dyspnea, as measured by the COPD Assessment Test (CAT). Dyspnea was assessed using the modified Medical Research Council (mMRC) dyspnea scale. Data on acute exacerbations and deaths were extracted from medical records. Lung function was expressed as the forced expiratory volume in 1 second as a percentage of the predicted value [FEV1 (% pred)].

Results

In total, 336 of the 853 COPD patients in the intervention group (TBM plus UC) had comorbid depression, compared with 329 of the 835 in the control group (UC only). The TBM group showed a significantly greater improvement in HADS depression and anxiety subscale scores (HADS-D and HADS-A, respectively) than the UC group at12 months (t =8.34, P<0.001; t=12.18, P<0.001). The CAT and mMRC scores were significantly lower in the TBM than UC group at 12 months (t=8.43, P<0.001; t=7.23, P<0.001). The numbers of acute exacerbations and deaths were significantly lower in the TBM than UC group at 12 months (mean MCF values were 0.35 and 0.56, respectively [difference of 0.22; 95% confidence interval (CI): -0.41, -0.02; χ2=9.63, P<0.001]. The FEV1 (% pred) was significantly higher in the TBM than UC group at 12 months (t=7.45, P<0.001).

Conclusions

General practitioners can use TBM interventions to effectively reduce anxiety, depression, and dyspnea symptoms, decrease the frequency of exacerbations and likelihood of death, and improve health-related quality of life and pulmonary function in patients with COPD.

Trial Registration

The trial was registered on the Chinese Clinical Trials Registry (reference: ChiCTR-TRC-12001958).

Identification of symptom clusters and change trajectories in patients with acute exacerbation of chronic obstructive pulmonary disease

Aim and objectives

This study aimed to identify symptom cluster (SC) patterns and change trajectories in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), the correlation of the SCs with laboratory and imaging indicators, and the intrinsic association of the SCs with prognostic outcomes and disease burden.

Method

Symptom information was collected using a digital evaluation scoring system at the time of admission, on the third day after admission, and upon discharge. Laboratory and imaging examination data were compiled simultaneously. Exploratory factor analysis was used to identify the AECOPD SCs. The number of factors (clusters) was determined by examining factors with eigenvalues ≥1.0, using 0.50 for factor loadings as the minimum cut-off value. Spearman's correlation analysis was used to explore the link between the SCs and laboratory and imaging indicators, as well as the relationship between the severity of the symptoms in different clusters, prognostic outcomes, and disease burden.

Results

This study included 148 patients. Three SCs were identified: activity-nutrition SC, breath-sleep SC and respiratory SC. Correlation analysis indicated a connection between the activity-nutrition SC and the white blood cell count, and serum sodium and potassium levels, whereas the breath-sleep SC was correlated with white blood cells and eosinophil counts, serum potassium level, and pleural effusion. Additionally, the respiratory SC was associated with serum calcium and magnesium levels, the partial pressure of carbon dioxide, and C-reactive protein (CRP) level. There was a positive correlation between the activity-nutrition SC and hospitalization cost, as well as between the breath-sleep SC and both the hospitalization length and cost.

Conclusion

Patients with AECOPD presented three SCs that affected the length and cost of hospitalization. Concurrently, the severity of the symptoms in the clusters was related to white blood cell and eosinophil counts; serum sodium, potassium, calcium, and magnesium levels; CRP level; the partial pressure of carbon dioxide; and pleural effusion, indicating that the symptoms in each clusters may share related physiological mechanisms. An in-depth exploration of the pathogenesis and intervention paths of health problems is of great significance for promoting precision nursing.

Glucocorticoids in lung cancer: Navigating the balance between immunosuppression and therapeutic efficacy

Glucocorticoids (GCs), a class of hormones secreted by the adrenal glands, are released into the bloodstream to maintain homeostasis and modulate responses to various stressors. These hormones function by binding to the widely expressed GC receptor (GR), thereby regulating a wide range of pathophysiological processes, especially in metabolism and immunity. The role of GCs in the tumor immune microenvironment (TIME) of lung cancer (LC) has been a focal point of research. As immunosuppressive agents, GCs exert a crucial impact on the occurrence, progression, and treatment of LC. In the TIME of LC, GCs act as a constantly swinging pendulum, simultaneously offering tumor-suppressive properties while diminishing the efficacy of immune-based therapies. The present study reviews the role and mechanisms of GCs in the TIME of LC.

The Impact of Different Smoking Behavior on Pulmonary Function and Pulmonary Hypertension Among Chinese Male Patients with Chronic Obstructive Pulmonary Disease

Purpose

Cigarette smoking is the most recognized risk factor of chronic obstructive pulmonary disease (COPD) in China. However, there are no studies analyzing the impact of different smoking behaviors on pulmonary function and pulmonary hypertension (PH) among Chinese male patients with COPD.

Patients and Methods

Chinese male smokers with COPD performed pulmonary function tests. Clinical characteristics, smoking behavior features, spirometry and echocardiographic results were compared between the two groups stratified by initial smoking age (18 years old) or complicated PH.

Results

The early-smoking group had more respiratory symptoms, more severe smoking behavior, worse pulmonary function with lower FEV1%pre (38.5% vs 70.2%) and FEV1/FVC% (47.5% vs 63.8%), and higher systolic pulmonary artery pressure (sPAP: 38.6 vs 33.9 mmHg) than the late-smoking group. Initiating smoking before adulthood was an independently contributing factor of ventilatory dysfunction and Global Initiative for Obstructive Lung Disease (GOLD) stage escalation. It also had a significant interaction with long smoking duration (≥30 years), characterized by markedly decreased lung volumes (VC%pre: 64.0% vs 84.5%), impaired diffusing capacity (DLCO%pre: 58.0% vs 76.8%) and severe emphysema (RV/TLC%pre: 145.2% vs 130.2%). COPD patients complicated with PH exhibited worse ventilatory function (FEV1%pre: 43.2% vs 56.2%), impaired diffusion capacity (DLCO%pre: 56.7% vs 77.1%) and decreased lung volume (VC%pre: 67.67% vs 75.38%). Both severe smoking behaviors and impaired pulmonary function had close correlations with sPAP.

Conclusion

The early-smoking group exhibited predominantly ventilation dysfunction and had complex interactions with long smoking duration to further affect lung volume and diffusion capacity. Different smoking behaviors influenced variations of pulmonary dysfunction and comorbid PH in patients with COPD.

Whole-course management of chronic obstructive pulmonary disease in primary healthcare: an internet of things-enabled prospective cohort study in China

BACKGROUND

Despite substantial progress in reducing the global burden of chronic obstructive pulmonary disease (COPD), traditional methods to promote understanding and management of COPD are insufficient. We developed an innovative model based on the internet of things (IoT) for screening and management of COPD in primary healthcare (PHC).

METHODS

Electronic questionnaire and IoT-based spirometer were used to screen residents. We defined individuals with a questionnaire score of 16 or higher as high-risk population, COPD was diagnosed according to 2021 Global Initiative for COPD (Global Initiative for Chronic Obstructive Lung Disease) criteria. High-risk individuals and COPD identified through the screening were included in the COPD PHC cohort study, which is a prospective, longitudinal observational study. We provide an overall description of the study's design framework and baseline data of participants.

RESULTS

Between November 2021 and March 2023, 162 263 individuals aged over 18 from 18 cities in China were screened, of those 43 279 high-risk individuals and 6902 patients with COPD were enrolled in the cohort study. In the high-risk population, the proportion of smokers was higher than that in the screened population (57.6% vs 31.4%), the proportion of males was higher than females (71.1% vs 28.9%) and in people underweight than normal weight (57.1% vs 32.0%). The number of high-risk individuals increased with age, particularly after 50 years old (χ2=37 239.9, p<0.001). Female patients are more common exposed to household biofuels (χ2=72.684, p<0.05). The majority of patients have severe respiratory symptoms, indicated by a CAT score of ≥10 (85.8%) or an Modified Medical Research Council Dyspnoea Scale score of ≥2 (65.5%).

CONCLUSION

Strategy based on IoT model help improve the detection rate of COPD in PHC. This cohort study has established a large clinical database that encompasses a wide range of demographic and relevant data of COPD and will provide invaluable resources for future research.

Clinical Utility of Chest Sonography in Chronic Obstructive Pulmonary Disease Patients Focusing on Diaphragmatic Measurements

BACKGROUND

There are many methods of evaluating diaphragmatic function, including trans-diaphragmatic pressure measurements, which are considered the key rule of diagnosis. We studied the clinical usefulness of chest ultrasonography in evaluating stable chronic obstructive pulmonary disease (COPD) patients and those in exacerbation, focusing on diaphragmatic measurements and their correlation with spirometry and other clinical parameters.

METHODS

In a prospective case-control study, we enrolled 100 COPD patients divided into 40 stable COPD patients and 60 patients with exacerbation. The analysis included 20 age-matched controls. In addition to the clinical assessment of the study population, radiological evaluation included chest radiographs and chest computed tomography. Transthoracic ultrasonography (TUS) was performed for all included subjects.

RESULTS

Multiple A lines (more than 3) were more frequent in COPD exacerbation than in stable patients, as was the case for B-lines. TUS significantly showed high specificity, negative predictive value, positive predictive value, and accuracy in detecting pleural effusion, consolidation, pneumothorax, and lung mass. Diaphragmatic measurements were significantly lower among stable COPD subjects than healthy controls. Diaphragmatic thickness and excursion displayed a significant negative correlation with body mass index and the dyspnea scale, and a positive correlation with spirometry measures. Patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D showed lower diaphragmatic measurements (thickness and excursion).

CONCLUSION

The TUS of COPD patients both in stable and exacerbated conditions and the assessment of diaphragm excursion and thickness by TUS in COPD patients and their correlations to disease-related factors proved informative and paved the way for the better management of COPD patients.

A noval pulmonary function evaluation method based on ResNet50 + SVR model and cough

Traditionally, the clinical evaluation of respiratory diseases was pulmonary function testing, which can be used for the detection of severity and prognosis through pulmonary function parameters. However, this method is limited by the complex process, which is impossible for patients to monitor daily. In order to evaluate pulmonary function parameters conveniently with less time and location restrictions, cough sound is the substitute parameter. In this paper, 371 cough sounds segments from 150 individuals were separated into 309 and 62 as the training and test samples. Short-time Fourier transform (STFT) was applied to transform cough sound into spectrogram, and ResNet50 model was used to extract 2048-dimensional features. Through support vector regression (SVR) model with biological attributes, the data were regressed with pulmonary function parameters, FEV1, FEV1%, FEV1/FVC, FVC, FVC%, and the performance of this models was evaluated with fivefold cross-validation. Combines with deep learning and machine learning technologies, the better results in the case of small samples were achieved. Using the coefficient of determination (R2), the ResNet50 + SVR model shows best performance in five basic pulmonary function parameters evaluation as FEV1(0.94), FEV1%(0.84), FEV1/FVC(0.68), FVC(0.92), and FVC%(0.72). This ResNet50 + SVR hybrid model shows excellent evaluation of pulmonary function parameters during coughing, making it possible to realize a simple and rapid evaluation for pneumonia patients. The technology implemented in this paper is beneficial in judge the patient's condition, realize early screening of respiratory diseases, evaluate postoperative disease changes and detect respiratory infectious diseases without time and location restrictions.

Exploration of the Mechanism of Shengxian Decoction Against Chronic Obstructive Pulmonary Disease Based on Network Pharmacology and Experimental Verification

Shengxian decoction (SXT) is clinically used in chronic obstructive pulmonary disease (COPD) treatment. This study aimed to explore the mechanism and target genes of SXT acting on COPD. Differentially expressed genes (DEGs) between COPD and controls were identified and then performed enrichment analysis. The effective active compounds and corresponding target genes were obtained from the traditional Chinese medicine systems pharmacology database. We also compiled COPD related genes from the GeneCards database. Through the protein-protein interaction (PPI) network and least absolute shrinkage and selection operator (LASSO) regression was performed to identify key genes. Molecular docking was used for docking of key genes and compounds. The expression of key genes was detected by quantitative real-time PCR in COPD patients and bronchial epithelial cells stimulated with cigarette stroke extract (CSE). We identified 1,458 intersected DEGs from GSE47460 and GSE57148 datasets. Compared with intersected DEGs, we obtained 33 SXT target COPD-related genes. PI3K-Akt signaling pathway, MAPK signaling pathway, and focal adhesion were enriched by these 33 genes, as well as intersected DEGs. According to LASSO regression, there were 12 genes considered as signature genes. Then we constructed active compounds and corresponding six target genes. Finally, HIF1A and IL1B were selected as key genes by combining PPI network. HIF1A and IL1B were all upregulated expression in COPD and CSE stimulated cells and recovered in SXT treated CSE stimulated cells. This study provides a scientific basis for the identification of active compounds and target genes of SXT in the treatment of COPD.

Socioeconomic differentials of trends in the prevalence and economic burden of chronic obstructive pulmonary disease in rural southwest China

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity, and imposes a substantial financial burden on society. However, few studies have examined the role of individual socioeconomic status (SES) in temporal trends of COPD prevalence and economic cost. This study aimed to uncover the changing prevalence and economic burden of COPD across socioeconomic gradients in rural southwest China.

METHODS

Data were collected from two cross-sectional health interviews and examination surveys administered 10 years apart among individuals aged ≥ 35 years in rural China. A prevalence-based cost-of-illness method was used to estimate the cost of COPD. The individual socioeconomic position (SEP) index was constructed using principal component analysis. Post-bronchodilator spirometry tests were performed for each participant.

RESULTS

From 2011 to 2021, the prevalence of COPD increased from 8.7% to 12.8% (P < 0.01), while the economic cost of COPD increased 1.9-fold. Unit hospital costs and outpatient costs increased 1.57-fold and 1.47-fold, while unit medication costs fell by 10.6%. Increasing prevalence was also observed when the data were stratified by sex, age, ethnicity, level of education, level of income, and SEP (P < 0.05). Men, ethnic minorities, and those with a lower educational level, lower income, or lower SEP had a higher prevalence of COPD than their counterparts both in 2011 and 2021 (P < 0.05). Unit outpatient costs and medication costs increased with patients' SEP in both survey years (P < 0.05).

CONCLUSIONS

The prevalence and economic costs of COPD increased substantially across all socioeconomic gradients in rural southwest China in the decade from 2011 and 2021. Future COPD prevention and management interventions as well as efforts to improve access to affordable COPD medication and treatment should focus in particular on ethnic minority and low SEP populations.

Disease burden of COPD in the Chinese population: a systematic review

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease.

OBJECTIVES

This systematic review aimed to evaluate the disease burden of COPD in the Chinese population and to determine the factors influencing the economic burden of the disease.

DESIGN

This is a systematic review study.

DATA SOURCES AND METHODS

We searched PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure, WANGFANG Data, and VIP databases for studies regarding the disease burden of COPD in mainland China published before 31 December 2022. The Agency for Healthcare Research and Quality's recommendation rating tool assessed the cross-sectional studies' risk of bias.

RESULTS

A total of 45 studies were included. The disability-adjusted life years (DALYs) for COPD have generally decreased in the Chinese population over the past 30 years. The total number of DALYs due to COPD in China decreased from 26.12 million person-years to 19.92 million person-years, with an annual decline rate of 0.9%. Subjects aged 40 years and older make up the majority of those with COPD in the Chinese population, and the condition is more prevalent among males than females, in rural areas than urban places, and in the West than the East. The median direct medical cost of COPD ranges from 150 to 2014 USD per capita per year. Among 23 influencing factors, age, hospitalization days, hospital type, gender, and career were the most significant variables that had an impact on the economic burden of COPD patients.

CONCLUSION

The overall burden of COPD in China has been decreasing over the past 30 years. But there is a lack of standardized indicators for the economic burden of COPD patients in China, and it is recommended to establish a unified standard.

REGISTRATION

The systematic review protocol was prospectively registered with PROSPERO (No. CRD42023393429).

Analysis of the Clinical Efficacy and Molecular Mechanism of Xuefu Zhuyu Decoction in the Treatment of COPD Based on Meta-Analysis and Network Pharmacology

Background

Chronic obstructive pulmonary disease (COPD) is becoming a major public health burden worldwide. It is urgent to explore more effective and safer treatment strategy for COPD. Notably, Xuefu Zhuyu Decoction (XFZYD) is widely used to treat respiratory system diseases, including COPD, in China.

Objective

This study is aimed at comprehensively evaluating the therapeutic effects and molecular mechanism of XFZYD on COPD.

Methods

Original clinical studies were searched from eight literature databases. Meta-analysis was conducted using the Review Manager software (version 5.4.1). Network pharmacology and molecular docking experiments were utilized to explore the mechanisms of action of XFZYD.

Results

XFZYD significantly enhanced the efficacy of clinical treatment and improved the pulmonary function and hypoventilation of COPD patients. In addition, XFZYD significantly improved the hypercoagulability of COPD patients. The subgroup analysis suggested that XFZYD exhibited therapeutic effects on both stable and acute exacerbation of COPD. XFZYD exerted its therapeutic effects on COPD through multicomponent, multitarget, and multipathway characteristics. The intervention of the PI3K-AKT pathway may be the critical mechanism.

Conclusion

The application of XFZYD based on symptomatic relief and supportive treatment is a promising clinical decision. More preclinical and clinical studies are still needed to evaluate the safety and therapeutic effects of long-term use of XFZYD on COPD.

SRY-related high-mobility group box 9 (SOX9) alleviates cigarette smoke extract (CSE)-induced inflammatory injury in human bronchial epithelial cells by suppressing stromal interaction molecule 1 (STIM1) expression

BACKGROUND AND OBJECTIVE

Chronic obstructive pulmonary disease (COPD) is a chronic airway disease with airflow limitation and abnormal inflammatory response. It has been verified that SOX9 plays a key role in lung function of various lung diseases and SOX9 is closely associated with COPD. Additionally, literature has reported that STIM1 is involved in lung injury and is highly expressed in neutrophils from COPD patients. This study aimed to characterize the biological roles of SOX9 and STIM1 in the pathogenesis of COPD and to elucidate the regulatory mechanism.

METHODS

Human bronchial epithelial cells (BEAS-2B) were treated with CSE to construct in vitro COPD model. The levels of SOX9 and STIM1 in CSE-treated BEAS-2B cells were detected by western blot and RT-qPCR assay. Then, JASPAR datasets were utilized to analyze SOX9 binding sites in the promoter region of STIM1. Besides, luciferase reporter assay and ChIP assay were employed to validate the binding sites in STIM1 promoter region to SOX9. In addition, viability and apoptosis of BEAS-2B cells were assessed by utilizing MTT assay and TUNEL staining. ELISA kits and corresponding commercial kits were applied to measure the levels of TNF-α, IL-6, IL-1β, SOD, GSH-Px and MDA.

RESULTS

CSE treatment dose- and time-dependently reduced SOX9 expression in BEAS-2B cells. SOX9 overexpression enhanced the viability and suppressed the apoptosis of CSE-treated BEAS-2B cells as well as attenuated CSE-induced inflammation and oxidative stress. Then, it was validated that SOX9 bound to the promoter region of STIM1. Moreover, SOX9 overexpression-mediated impacts on cell viability, cell apoptosis, inflammation and oxidative stress in CSE-treated BEAS-2B cells were partially abolished by upregulation of STIM1.

CONCLUSION

To sum up, results here suggested that overexpression of SOX9 could mitigate inflammatory injury in CSE-treated bronchial epithelial cells by suppressing STIM1.

Identification of Dysregulated Mechanisms and Candidate Gene Markers in Chronic Obstructive Pulmonary Disease

Purpose

This study aimed to identify candidate gene markers that may facilitate chronic obstructive pulmonary disease (COPD) diagnosis and treatment.

Methods

The GSE47460 and GSE151052 datasets were analyzed to identify differentially expressed mRNAs (DEmRs) between COPD patients and controls. DEmRs that were differentially expressed in the same direction in both datasets were analyzed for functional enrichment and for coexpression. Genes from the largest three modules were tested for their ability to diagnose COPD based on the area under the receiver operating characteristic curve (AUC). Genes with AUC > 0.7 in both datasets were used to perform regression based on the "least absolute shrinkage and selection operator" in order to identify feature genes. We also identified differentially expressed miRNAs (DEmiRs) between COPD patients and controls using the GSE38974 dataset, then constructed a regulatory network. We also examined associations between feature genes and immune cell infiltration in COPD, and we identified methylation markers of COPD using the GSE63704 dataset.

Results

A total of 1350 genes differentially regulated in the same direction in the GSE47460 and GSE151052 datasets were found. The genes were significantly enriched in immune-related biological functions. Of 186 modules identified using MEGENA, the largest were C1_ 6, C1_ 3, and C1_ 2. Of the 22 candidate genes screened based on AUC, 11 feature genes emerged from analysis of a subset of GSE47460 data, which we validated using another subset of GSE47460 data as well as the independent GSE151052 dataset. Feature genes correlated significantly with infiltration by immune cells. The feature genes GPC4 and RS1 were predicted to be regulated by miR-374a-3p. We identified 117 candidate methylation markers of COPD, including PRRG4.

Conclusion

The feature genes we identified may be potential diagnostic markers and therapeutic targets in COPD. These findings provide new leads for exploring disease mechanisms and targeted treatments.