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Boesch RP. Instrumental swallowing studies for the prevention of pulmonary morbidity in children and the importance of multi-disciplinary teams. J Pediatr (Rio J) 2024; 100:455-457. [PMID: 38821487 PMCID: PMC11361879 DOI: 10.1016/j.jped.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Affiliation(s)
- R Paul Boesch
- Mayo Clinic, Division of Pediatric Pulmonology, Rochester, MN, USA.
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2
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Bae S, Loloci G, Lee DY, Jang HJ, Jeong J, Choi WI. Association between Antacid Exposure and Risk of Interstitial Lung Diseases. Tuberc Respir Dis (Seoul) 2024; 87:185-193. [PMID: 38111098 PMCID: PMC10990614 DOI: 10.4046/trd.2023.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/07/2023] [Accepted: 12/17/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The mechanisms leading to lung fibrosis are still under investigation. This study aimed to demonstrate whether antacids could prevent the development of interstitial lung disease (ILD). METHODS This population-based longitudinal cohort study was conducted between January 2006 and December 2010 in South Korea. Eligible subjects were ≥40 years of age, exposed to proton pump inhibitors (PPI)±histamine-2 receptor antagonists (H-2 blockers) or H-2 blockers only, and had no history of ILD between 2004 and 2005. Exposure to antacids was defined as the administration of either PPI or H-2 receptor antagonists for >14 days, whereas underexposure was defined as antacid treatment administered for less than 14 days. Newly developed ILDs, including idiopathic pulmonary fibrosis (IPF), were counted during the 5-year observation period. The association between antacid exposure and ILD development was evaluated using adjusted Cox regression models with variables, such as age, sex, smoking history, and comorbidities. RESULTS The incidence rates of ILD with/without antacid use were 43.2 and 33.8/100,000 person-years, respectively and those of IPF were 14.9 and 22.9/100,000 person-years, respectively. In multivariable analysis, exposure to antacid before the diagnosis of ILD was independently associated with a reduced development of ILD (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.45 to 0.71; p<0.001), while antacid exposure was not associated with development of IPF (HR, 0.88; 95% CI, 0.72 to 1.09; p=0.06). CONCLUSION Antacid exposure may be independently associated with a decreased risk of ILD development.
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Affiliation(s)
- Soohyun Bae
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Gjustina Loloci
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
- German Hospital of Tirana, Tirana, Albania
| | - Dong Yoon Lee
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Hye Jin Jang
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Jihyeon Jeong
- Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Won-Il Choi
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
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3
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Newton CA, Noth I, Raghu G. Gastro-oesophageal reflux and idiopathic pulmonary fibrosis: sorting the chicken and the egg by genetic link. Eur Respir J 2023; 62:2301878. [PMID: 38128953 PMCID: PMC10990001 DOI: 10.1183/13993003.01878-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Chad A Newton
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Ganesh Raghu
- Center for Interstitial Lung Diseases, University of Washington Medical Center, Seattle, WA, USA
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4
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Kim JS, Kim J, Yin X, Hiura GT, Anderson MR, Hoffman EA, Raghu G, Noth I, Manichaikul A, Rich SS, Smith BM, Podolanczuk AJ, Garcia CK, Barr RG, Prince MR, Oelsner EC. Associations of hiatus hernia with CT-based interstitial lung changes: the MESA Lung Study. Eur Respir J 2023; 61:2103173. [PMID: 35777776 PMCID: PMC10203882 DOI: 10.1183/13993003.03173-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/02/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hiatus hernia (HH) is prevalent in adults with pulmonary fibrosis. We hypothesised that HH would be associated with markers of lung inflammation and fibrosis among community-dwelling adults and stronger among MUC5B (rs35705950) risk allele carriers. METHODS In the Multi-Ethnic Study of Atherosclerosis, HH was assessed from cardiac and full-lung computed tomography (CT) scans performed at Exam 1 (2000-2002, n=3342) and Exam 5 (2010-2012, n=3091), respectively. Percentage of high attenuation areas (HAAs; percentage of voxels with attenuation between -600 and -250 HU) was measured from cardiac and lung scans. Interstitial lung abnormalities (ILAs) were examined from Exam 5 scans (n=2380). Regression models were used to examine the associations of HH with HAAs, ILAs and serum matrix metalloproteinase-7 (MMP-7), and adjusted for age, sex, race/ethnicity, educational attainment, smoking, height, weight and scanner parameters for HAA analysis. RESULTS HH detected from Exam 5 scans was associated with a mean percentage difference in HAAs of 2.23% (95% CI 0.57-3.93%) and an increase of 0.48% (95% CI 0.07-0.89%) per year, particularly in MUC5B risk allele carriers (p-value for interaction=0.02). HH was associated with ILAs among those <80 years of age (OR for ILAs 1.78, 95% CI 1.14-2.80) and higher serum MMP-7 level among smokers (p-value for smoking interaction=0.04). CONCLUSIONS HH was associated with more HAAs over time, particularly among MUC5B risk allele carriers, and ILAs in younger adults, and may be a risk factor in the early stages of interstitial lung disease.
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Affiliation(s)
- John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jinhye Kim
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
- Department of Radiology, Westchester Medical Center, Valhalla, NY, USA
| | - Xiaorui Yin
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Grant T Hiura
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Eric A Hoffman
- Department of Radiology, Carver School of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ganesh Raghu
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Imre Noth
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ani Manichaikul
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Stephen S Rich
- Center for Public Health Genomics and Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Benjamin M Smith
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Anna J Podolanczuk
- Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, NY, USA
| | - Christine Kim Garcia
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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5
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Gastroesophageal Reflux and Esophageal Motility Disorder After Lung Transplant: Influence on the Transplanted Graft. Transplant Proc 2021; 53:1989-1997. [PMID: 33994181 DOI: 10.1016/j.transproceed.2021.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Esophageal pathology has been identified as a bad prognostic factor in lung transplantation (LTx). This study aims to assess the esophageal disorders present post-LTx, under treatment with proton pump inhibitors, and their putative impact on the graft. METHODS Prospective, observational study of LTx patients. Digestive factors were assessed by manometry and pH-metry at 6 months post-LTx and under proton pump inhibitor treatment. We assessed the association between esophageal disorders and graft function and acute rejection (AR) and chronic lung allograft dysfunction (CLAD). RESULTS Out of 76 post-LTx patients, 27% showed gastroesophageal reflux disease (GERD), 55% showed inadequate gastric inhibition, and 59% showed esophageal motility disorders (EMDs). We observed a greater incidence of AR from 3 months post-LTx in the presence of EMD (P ≤ .05). No significant differences were observed in GERD or EMD prevalence or in survival between patients with or without CLAD. The maximum forced expiratory volume in 1 second (FEV1) achieved after bilateral LTx was significantly (P = .022) lower in patients with EMD vs without EMD. CONCLUSION At 6 months post-LTx, there is a high percentage of esophageal disorders (GERD and EMDs). No esophageal disorder is associated with CLAD or with survival, although EMDs are associated with a greater incidence of AR and lower graft function.
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Ghisa M, Marinelli C, Savarino V, Savarino E. Idiopathic pulmonary fibrosis and GERD: links and risks. Ther Clin Risk Manag 2019; 15:1081-1093. [PMID: 31564886 PMCID: PMC6733342 DOI: 10.2147/tcrm.s184291] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/11/2019] [Indexed: 01/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) and idiopathic pulmonary fibrosis (IPF) are two pathological conditions often strictly related, even if a clear relationship of causality has not been demonstrated. GERD is a frequent comorbidity in IPF patients, as demonstrated using combined multichannel intraluminal impedance-pH, despite being mostly clinically silent. According to that, it has been hypothesized that microaspiration of gastric material may play a fundamental role in the fibrotic transformation of pulmonary parenchyma. In contrast, it cannot be excluded that IPF may favor GERD by increasing the negative intrathoracic pressure. Therefore, this relationship is uncertain as well as not univocal. Nevertheless, the latest international guidelines recommend the use of proton pump inhibitors (PPIs) in IPF based on several data showing that PPIs can stabilize lung function, reduce disease flares and hospitalizations. On the contrary, recent studies not only question the relevance of these results, but also associate the use of PPIs with an increased risk of lung infections and a negative prognostic outcome. The aim of this review is to analyze the possible links between GERD and IPF and their possible therapeutic implications, trying to translate this scientific evidence into useful information for clinical practice.
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Affiliation(s)
- Matteo Ghisa
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Carla Marinelli
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Vincenzo Savarino
- Gastrointestinal Unit, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Edoardo Savarino
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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7
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Chen S, Chen H, Cheng Y, Wei Y, Zhou X, Li T, Zhu J, Wang Q. Gastric Acid and Pepsin Work Together in Simulated Gastric Acid Inhalation Leading to Pulmonary Fibrosis in Rats. Med Sci Monit 2019; 25:6153-6164. [PMID: 31419218 PMCID: PMC6708284 DOI: 10.12659/msm.915628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The clinical association between gastroesophageal reflux disease (GERD) and idiopathic pulmonary fibrosis (IPF) has been known for many years, but it is still unclear. The present study investigated the association between experimentally simulated aspiration and pulmonary fibrosis. Material/Methods A total of 120 male Sprague-Dawley rats were randomly divided into a negative control group, a bleomycin group, and 3 simulated aspiration groups. The bleomycin group was administered a one-time intratracheal injection of bleomycin, whereas the 3 simulated aspiration groups were treated either with an intratracheal instillation of gastric fluid combined with pepsin, with pepsin alone, or with hydrochloric acid, all twice a week, and the negative control group was administered normal saline twice a week. Lung tissues were collected to evaluate pathological changes and the mRNA expression levels of connective tissue growth factor (CTGF), type I collagen, and transforming growth factor. Results The results demonstrated that the degree of fibrosis in the early stage was low in each of the 3 simulated aspiration groups, but gradually increased over time. The expression levels of the downstream factor of fibrosis, CTGF, and type I collagen also reflected this trend. Conclusions The study demonstrates that aspiration of gastric contents can cause pulmonary fibrosis, and mixed aspiration of pepsin and gastric fluid can accelerate this process. This study provides strong evidence in support of a potential association between human GERD and IPF.
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Affiliation(s)
- Shi Chen
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - HongYu Chen
- Department of Gastroenterology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Yue Cheng
- Department of Rheumatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Yu Wei
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - XianMei Zhou
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Tian Li
- Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing, Jiangsu, China (mainland)
| | - JiPing Zhu
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Qian Wang
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
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8
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Margaritopoulos GA, Kokosi MA, Wells AU. Diagnosing complications and co-morbidities of fibrotic interstitial lung disease. Expert Rev Respir Med 2019; 13:645-658. [PMID: 31215263 DOI: 10.1080/17476348.2019.1632196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Interstitial lung diseases (ILDs) represent a heterogeneous group of rare disorders that include more than 200 entities, mostly associated with high mortality. In recent years, the progress regarding the understanding of the pathogenesis of these diseases led to the approval of specific treatments. In ILDs, the presence of comorbidities has a significant impact on the quality of life and the survival of patients and, therefore, their diagnosis and treatment has a pivotal role in management and could improve overall outcome. Areas covered: We discuss key diagnostic issues with regard to the most frequent comorbidities in ILDs. Treatment options are also discussed as the decision to investigate more definitively in order to identify specific comorbidities (including lung cancer, pulmonary hypertension, GE reflux, and obstructive sleep apnoea) is critically dependent upon whether comorbidity-specific treatments are likely to be helpful in individual patients, judged on a case by case basis. Expert opinion: The extent to which clinicians proactively pursue the identification of comorbidities depends on realistic treatment goals in individual patients.
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Affiliation(s)
| | - Maria A Kokosi
- a Interstitial Lung Disease Unit , Royal Brompton Hospital , London , UK
| | - Athol U Wells
- a Interstitial Lung Disease Unit , Royal Brompton Hospital , London , UK
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9
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Jo HE, Corte TJ, Glaspole I, Grainge C, Hopkins PMA, Moodley Y, Reynolds PN, Chapman S, Walters EH, Zappala C, Allan H, Keir GJ, Cooper WA, Mahar AM, Ellis S, Macansh S, Goh NS. Gastroesophageal reflux and antacid therapy in IPF: analysis from the Australia IPF Registry. BMC Pulm Med 2019; 19:84. [PMID: 31053121 PMCID: PMC6499965 DOI: 10.1186/s12890-019-0846-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/11/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Gastroesophageal reflux disease (GORD) is highly prevalent in idiopathic pulmonary fibrosis (IPF) and may play a role in its pathogenesis. Recent IPF treatment guidelines suggest that all patients with IPF be considered for antacid therapy. However, emerging evidence suggests that antacid therapy does not improve IPF patient outcomes and may increase the risk of pulmonary infection. METHODS Using prospectively collected data from the Australian IPF Registry including use of antacid therapy, GORD diagnosis and GORD symptoms, the relationship of these GORD variables to survival and disease progression was assessed. The severity of GORD symptoms using the frequency scale for symptoms of GORD (FSSG) and its relationships to outcomes was also assessed for the first time in an IPF cohort. RESULTS Five hundred eighty-seven (86%) of the 684 patients in the Australian IPF Registry were eligible for inclusion. Patients were mostly male (69%), aged 71.0 ± 8.5 years with moderate disease (FVC 81.7 ± 21.5%; DLco 48.5 ± 16.4%). Most patients were taking antacids (n = 384; 65%), though fewer had a diagnosis of GORD (n = 243, 41.4%) and typical GORD symptoms were even less common (n = 171, 29.1%). The mean FSSG score was 8.39 ± 7.45 with 43% (n = 251) having a score > 8. Overall, there was no difference in survival or disease progression, regardless of antacid treatment, GORD diagnosis or GORD symptoms. CONCLUSIONS Neither the use of antacid therapy nor the presence of GORD symptoms affects longer term outcomes in IPF patients. This contributes to the increasing evidence that antacid therapy may not be beneficial in IPF patients and that GORD directed therapy should be considered on an individual basis to treat the symptoms of reflux.
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Affiliation(s)
- Helen E Jo
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia.
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia.
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
| | - Ian Glaspole
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- Department of Allergy and Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher Grainge
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter M A Hopkins
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Yuben Moodley
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Paul N Reynolds
- Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sally Chapman
- Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - E Haydn Walters
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- University of Tasmania, Hobart, TAS, Australia
| | - Christopher Zappala
- Department of Thoracic Medicine, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | | | - Gregory J Keir
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Wendy A Cooper
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- Tissue pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Annabelle M Mahar
- Tissue pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Samantha Ellis
- Department of Radiology, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Nicole S Goh
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory Medicine, Austin Hospital, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
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10
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Roark R, Sydor M, Chatila AT, Umar S, Guerra RDL, Bilal M, Guturu P. Management of gastroesophageal reflux disease. Dis Mon 2019; 66:100849. [PMID: 30798984 DOI: 10.1016/j.disamonth.2019.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastroesophageal reflux disease (GERD) continues to be one of the most prevalent gastrointestinal tract disorders. Management of GERD is individualized for each patient depending on severity of symptoms, complications of GERD and patient/physician preference. The different management options include life style modification, pharmacological therapy, minimally invasive procedures and surgery. The final decision regarding management should be made based on an individualized patient centered approach on a case-by-case basis in consultation with a multidisciplinary team including primary care physician, gastroenterologist and surgeon. We provide a comprehensive review for the management of GERD.
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Affiliation(s)
- Russell Roark
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Michael Sydor
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Ahmed T Chatila
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Shifa Umar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, United States
| | - Ramiro De La Guerra
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, United States
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - Praveen Guturu
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
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11
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Lee JS. Gastroesophageal Reflux and IPF. Respir Med 2019. [DOI: 10.1007/978-3-319-99975-3_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Wang Z, Bonella F, Li W, Boerner EB, Guo Q, Kong X, Zhang X, Costabel U, Kreuter M. Gastroesophageal Reflux Disease in Idiopathic Pulmonary Fibrosis: Uncertainties and Controversies. Respiration 2018; 96:571-587. [PMID: 30308515 DOI: 10.1159/000492336] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/23/2018] [Indexed: 11/19/2022] Open
Abstract
The mechanisms of idiopathic pulmonary fibrosis (IPF), a rare, devastating disease with a median survival of 3-5 years, are not fully understood. Gastroesophageal reflux disease (GERD) is a frequent comorbidity encountered in IPF. Hypothetically, GERD-associated microaspiration may lead to persistent inflammation impairing lung infrastructure, thereby possibly accelerating the progression of IPF. IPF may increase intrathoracic pressure, which can aggravate GERD and vice versa. On the basis of the possible beneficial effects of antireflux or antacid therapy on lung function, acute exacerbation, and survival, the recent international IPF guideline recommends antacid therapies for patients with IPF, regardless of symptomatic GERD. However, due to newer conflicting data, several national guidelines do not support this recommendation. Elucidation of these questions by further clinical and bench-to-bedside research may provide us with rational clinical diagnostic and therapeutic approaches concerning GERD in IPF. The present review aims to discuss the latest data on the controversial association of IPF and GERD.
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Affiliation(s)
- Zheng Wang
- Department of Respiratory and Critical Medicine, Zhengzhou University People's Hospital, The Provincial People's Hospital Affiliated to Henan University, Zhengzhou,
| | - Francesco Bonella
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, Duisburg-Essen University, Essen, Germany
| | - Wenting Li
- Third Liver Unit, Department of Infectious Diseases and Hepatology, Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Eda B Boerner
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, Duisburg-Essen University, Essen, Germany
| | - Qiongya Guo
- Department of Digestive Diseases, Zhengzhou University People's Hospital, The Provincial People's Hospital Affiliated to Henan University, Zhengzhou, China
| | - Xianglong Kong
- Department of Respiratory Medicine, The First Hospital of Changsha, Changsha, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Medicine, Zhengzhou University People's Hospital, The Provincial People's Hospital Affiliated to Henan University, Zhengzhou, China
| | - Ulrich Costabel
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, Duisburg-Essen University, Essen, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, member of the German Center for Lung Research, Heidelberg, Germany
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13
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Ayala P, Vivar R, Montalva R, Olmos P, Meneses M, Borzone GR. Elastin degradation products in acute lung injury induced by gastric contents aspiration. Respir Res 2018; 19:165. [PMID: 30170599 PMCID: PMC6119254 DOI: 10.1186/s12931-018-0873-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/23/2018] [Indexed: 12/19/2022] Open
Abstract
Background Gastric contents aspiration is a high-risk condition for acute lung injury (ALI). Consequences range from subclinical pneumonitis to respiratory failure, depending on the volume of aspirate. A large increment in inflammatory cells, an important source of elastase, potentially capable of damaging lung tissue, has been described in experimental models of aspiration. We hypothesized that in early stages of aspiration-induced ALI, there is proteolytic degradation of elastin, preceding collagen deposition. Our aim was to evaluate whether after a single orotracheal instillation of gastric fluid, there is evidence of elastin degradation. Methods Anesthesized Sprague-Dawley rats received a single orotracheal instillation of gastric fluid and were euthanized 4, 12 and 24 h and at day 4 after instillation (n = 6/group). We used immunodetection of soluble elastin in lung tissue and BALF and correlated BALF levels of elastin degradation products with markers of ALI. We investigated possible factors involved in elastin degradation and evaluated whether a similar pattern of elastin degradation can be found in BALF samples of patients with interstitial lung diseases known to have aspirated. Non-parametric ANOVA (Kruskall-Wallis) and linear regression analysis were used. Results We found evidence of early proteolytic degradation of lung elastin. Elastin degradation products are detected both in lung tissue and BALF in the first 24 h and are significantly reduced at day 4. They correlate significantly with ALI markers, particularly PMN cell count, are independent of acidity and have a similar molecular weight as those obtained using pancreatic elastase. Evaluation of BALF from patients revealed the presence of elastin degradation products not present in controls that are similar to those found in BALF of rats treated with gastric fluid. Conclusions A single instillation of gastric fluid into the lungs induces early proteolytic degradation of elastin, in relation to the magnitude of alveolar-capillary barrier derangement. PMN-derived proteases released during ALI are mostly responsible for this damage. BALF from patients showed elastin degradation products similar to those found in rats treated with gastric fluid. Long-lasting effects on lung elastic properties could be expected under conditions of repeated instillations of gastric fluid in experimental animals or repeated aspiration events in humans.
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Affiliation(s)
- Pedro Ayala
- Department of Respiratory Diseases and Medical Research Center, Pontificia Universidad Católica de Chile, Marcoleta 350, piso 1, Santiago, Chile
| | - Raúl Vivar
- Department of Respiratory Diseases and Medical Research Center, Pontificia Universidad Católica de Chile, Marcoleta 350, piso 1, Santiago, Chile
| | - Rebeca Montalva
- Department of Respiratory Diseases and Medical Research Center, Pontificia Universidad Católica de Chile, Marcoleta 350, piso 1, Santiago, Chile
| | - Pablo Olmos
- Department of Diabetes and Nutrition, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel Meneses
- Pathology Unit, Instituto Nacional del Tórax, Santiago, Chile
| | - Gisella R Borzone
- Department of Respiratory Diseases and Medical Research Center, Pontificia Universidad Católica de Chile, Marcoleta 350, piso 1, Santiago, Chile.
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Ayala P, Torres J, Vivar R, Olmos PR, Meneses M, Borzone GR. Changes in the pattern of fibrosis in the rat lung with repetitive orotracheal instillations of gastric contents: evidence of persistent collagen accumulation. Am J Physiol Lung Cell Mol Physiol 2018; 315:L390-L403. [PMID: 29745252 DOI: 10.1152/ajplung.00559.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recurrent aspiration of gastric contents has been associated with several interstitial lung diseases. Despite this association, the pathogenic role of aspiration in these diseases has been poorly studied and little is known about extracellular matrix (ECM) changes in animal models of repetitive events of aspiration. Our aim was to study the repair phase of lung injury induced by each of several instillations of gastric fluid in Sprague-Dawley rats to evaluate changes in ECM and their reversibility. Anesthetized animals received weekly orotracheal instillations of gastric fluid for 1, 2, 3, and 4 wk and were euthanized at day 7 after last instillation. For reversibility studies, another group received 7 weekly instillations and was euthanized at day 7 or 60 after last instillation. Biochemical and histological measurements were used to evaluate ECM changes. Lung hydroxyproline content increased progressively and hematoxylin and eosin, Masson's trichrome, and alpha-SMA stains showed that after a single instillation, intra-alveolar fibrosis predominated, whereas with repetitive instillations this fibrosis pattern became less prominent and interstitial fibrosis progressively became evident. Both type I and III collagen increased in intra-alveolar and interstitial fibrosis. Imbalance between matrix metalloproteinase-2 (MMP-2) activity and tissue inhibitor of metalloproteinase-2 (TIMP-2) expression was observed, favoring either collagen degradation or accumulation depending on the number of instillations. Caspase-3 activation was also dose dependent. ECM changes were partially reversible at long-term evaluation, since Masson bodies, granulomas, and foreign body giant cells disappeared, whereas interstitial collagen accumulated. In conclusion, repetitive lung instillations of gastric fluid induce progressive fibrotic changes in rat lung ECM that persist at long-term evaluation.
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Affiliation(s)
- Pedro Ayala
- Department of Respiratory Diseases and Medical Research Center, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Jorge Torres
- Department of Respiratory Diseases and Medical Research Center, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Raúl Vivar
- Department of Respiratory Diseases and Medical Research Center, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Pablo R Olmos
- Department of Diabetes and Nutrition, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Manuel Meneses
- Pathology Unit, Instituto Nacional del Tórax , Santiago , Chile
| | - Gisella R Borzone
- Department of Respiratory Diseases and Medical Research Center, Pontificia Universidad Católica de Chile , Santiago , Chile
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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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16
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Chronic microaspiration of bile acids induces lung fibrosis through multiple mechanisms in rats. Clin Sci (Lond) 2017; 131:951-963. [PMID: 28341659 DOI: 10.1042/cs20160926] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/19/2017] [Accepted: 03/23/2017] [Indexed: 12/22/2022]
Abstract
Gastroesophageal reflux (GER) and microaspiration of duodenogastric refluxate have been recognized as a risk factor for pulmonary fibrosis. Recent evidence suggests that bile acid microaspiration may contribute to the development of lung fibrosis. However, the molecular evidence is scarce and the underlying mechanisms remain to be elucidated. We have recently demonstrated that bile acids induce activation of alveolar epithelial cells (AECs) and lung fibroblasts in vitro In the present study, a rat model of bile acid microaspiration was established by weekly intratracheal instillation of three major bile acids including chenodeoxycholic acid (CDCA), deoxycholic acid (DCA), and lithocholic acid (LCA). Repeated microaspiration of CDCA, DCA, and LCA caused fibrotic changes, including alveolar wall thickening and extensive collagen deposition, in rat lungs. Bile acid microaspiration also induced alveolar epithelial-mesenchymal transition (EMT), as indicated by up-regulation of mesenchymal markers α-smooth muscle actin (α-SMA) and vimentin, as well as down-regulaton of epithelial markers E-cadherin and cytokeratin in alveolar epithelium of rat lungs. The expression of fibrogenic mediators, including transforming growth factor-β1 (TGF-β1), connective tissue growth factor (CTGF), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), and periostin, was significantly elevated in rat lungs exposed to microaspiration of bile acids. Furthermore, microaspiration of bile acids also induced p-Smad3 and farnesoid X receptor (FXR) expression in rat lungs. Our findings suggest that microaspiration of bile acids could promote the development of pulmonary fibrosis in vivo, possibly via stimulating fibrogenic mediator expression and activating TGF-β1/Smad3 signaling and FXR.
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17
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Margaritopoulos GA, Antoniou KM, Wells AU. Comorbidities in interstitial lung diseases. Eur Respir Rev 2017; 26:160027. [PMID: 28049126 PMCID: PMC9488735 DOI: 10.1183/16000617.0027-2016] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/16/2016] [Indexed: 12/20/2022] Open
Abstract
Fibrosing lung disorders include a large number of diseases with diverse behaviour. Patients can die because of the progression of their illness, remain stable or even improve after appropriate treatment has been instituted. Comorbidities, such as acute and chronic infection, gastro-oesophageal reflux, pulmonary hypertension, lung cancer, cardiovascular diseases, and obstructive sleep apnoea, can pre-exist or develop at any time during the course of the disease and, if unidentified and untreated, may impair quality of life, impact upon the respiratory status of the patients, and ultimately lead to disease progression and death. Therefore, early identification and accurate treatment of comorbidities is essential.
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Affiliation(s)
| | - Katerina M Antoniou
- Interstitial Lung Disease Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
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18
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Frenkel C, Telem DA, Pryor AD, Altieri MS, Shroyer KR, Regenbogen E. The effect of sleeve gastrectomy on extraesophageal reflux disease. Surg Obes Relat Dis 2016; 12:1263-1269. [DOI: 10.1016/j.soard.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/01/2015] [Accepted: 11/02/2015] [Indexed: 02/08/2023]
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Could prominent airway-centered fibroblast foci in lung biopsies predict underlying chronic microaspiration in idiopathic pulmonary fibrosis patients? Hum Pathol 2016; 53:1-7. [DOI: 10.1016/j.humpath.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/26/2016] [Accepted: 02/04/2016] [Indexed: 11/23/2022]
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20
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Ayala P, Meneses M, Olmos P, Montalva R, Droguett K, Ríos M, Borzone G. Acute lung injury induced by whole gastric fluid: hepatic acute phase response contributes to increase lung antiprotease protection. Respir Res 2016; 17:71. [PMID: 27301375 PMCID: PMC4907014 DOI: 10.1186/s12931-016-0379-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/17/2016] [Indexed: 11/28/2022] Open
Abstract
Background Gastric contents aspiration in humans is a risk factor for severe respiratory failure with elevated mortality. Although aspiration-induced local lung inflammation has been studied in animal models, little is known about extrapulmonary effects of aspiration. We investigated whether a single orotracheal instillation of whole gastric fluid elicits a liver acute phase response and if this response contributes to enrich the alveolar spaces with proteins having antiprotease activity. Methods In anesthetized Sprague-Dawley rats receiving whole gastric fluid, we studied at different times after instillation (4 h −7 days): changes in blood cytokines and acute phase proteins (fibrinogen and the antiproteases alpha1-antitrypsin and alpha2-macroglobulin) as well as liver mRNA expression of the two antiproteases. The impact of the systemic changes on lung antiprotease defense was evaluated by measuring levels and bioactivity of antiproteases in broncho-alveolar lavage fluid (BALF). Markers of alveolar-capillary barrier derangement were also studied. Non-parametric ANOVA (Kruskall-Wallis) and linear regression analysis were used. Results Severe peribronchiolar injury involving edema, intra-alveolar proteinaceous debris, hemorrhage and PMNn cell infiltration was seen in the first 24 h and later resolved. Despite a large increase in several lung cytokines, only IL-6 was found elevated in blood, preceding increased liver expression and blood concentration of both antiproteases. These changes, with an acute phase response profile, were significantly larger for alpha2-macroglobulin (40-fold increment in expression with 12-fold elevation in blood protein concentration) than for alpha1-antitrypsin (2–3 fold increment in expression with 0.5-fold elevation in blood protein concentration). Both the increment in capillary-alveolar antiprotease concentration gradient due to increased antiprotease liver synthesis and a timely-associated derangement of the alveolar-capillary barrier induced by aspiration, contributed a 58-fold and a 190-fold increase in BALF alpha1-antitrypsin and alpha2-macroglobulin levels respectively (p < 0.001). Conclusions Gastric contents-induced acute lung injury elicits a liver acute phase response characterized by increased mRNA expression of antiproteases and elevation of blood antiprotease concentrations. Hepatic changes act in concert with derangement of the alveolar capillary barrier to enrich alveolar spaces with antiproteases. These findings may have significant implications decreasing protease burden, limiting injury in this and other models of acute lung injury and likely, in recurrent aspiration.
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Affiliation(s)
- Pedro Ayala
- Department of Respiratory Diseases and Medical Research Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, piso 1, Santiago, Chile
| | | | - Pablo Olmos
- Department of Nutrition, Diabetes and Metabolism, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebeca Montalva
- Department of Respiratory Diseases and Medical Research Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, piso 1, Santiago, Chile
| | - Karla Droguett
- Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mariana Ríos
- Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gisella Borzone
- Department of Respiratory Diseases and Medical Research Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, piso 1, Santiago, Chile.
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21
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Chen B, Cai HR, Xue S, You WJ, Liu B, Jiang HD. Bile acids induce activation of alveolar epithelial cells and lung fibroblasts through farnesoid X receptor-dependent and independent pathways. Respirology 2016; 21:1075-80. [PMID: 27185272 DOI: 10.1111/resp.12815] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/28/2015] [Accepted: 01/19/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE The roles of bile acid microaspiration and bile acid-activated farnesoid X receptor (FXR) in the pathogenesis of idiopathic pulmonary fibrosis (IPF) remain unclear. We hypothesized that bile acids activate alveolar epithelial cells (AECs) and lung fibroblasts, which may be regulated by FXR activation. METHODS Human AECs and normal or IPF-derived lung fibroblast cells were incubated with the three major bile acids: lithocholic acid (LCA), deoxycholic acid (DCA) and chenodeoxycholic acid (CDCA). The AECs injury indices, epithelial-mesenchymal transition (EMT) and lung fibroblast activation were evaluated. FXR expression in IPF lungs and the roles of FXR and FXR-independent pathways in bile acid-induced profibrotic effects were also investigated. RESULTS LCA, DCA and CDCA reduced cell viability and increased intracellular reactive oxygen species (ROS) production in A549 cells. They all induced EMT, as shown by enhanced α-SMA and vimentin and decreased E-cadherin levels. LCA directly induced differentiation of lung fibroblasts to myofibroblasts. All three bile acids promoted cellular migration but not proliferation of lung fibroblasts. FXR expression was upregulated in IPF lungs, and inhibition of FXR restrained the bile acid-induced EMT and lung fibroblast activation. Differentiation and proliferation were enhanced in lung fibroblasts exposed to conditioned medium from bile acid-stimulated A549 cells, which contained increased levels of profibrotic factors. TGF-β/Smad3 signaling was also involved in the bile acid-induced EMT and lung fibroblast differentiation. CONCLUSION Bile acid microaspiration may promote the development of pulmonary fibrosis by inducing activation of AECs and lung fibroblasts via FXR-dependent and independent pathways.
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Affiliation(s)
- Bi Chen
- Department of Respiratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hou-Rong Cai
- Department of Respiratory Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Shan Xue
- Department of Respiratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Jie You
- Department of Respiratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Liu
- Department of Respiratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Han-Dong Jiang
- Department of Respiratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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22
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Gastroesophageal Reflux Disease in Children with Interstitial Lung Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 912:57-64. [DOI: 10.1007/5584_2016_229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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23
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Leung JH, Chang JC, Bell SM, Holzknecht ZE, Thomas SM, Everett ML, Parker W, Davis RD, Lin SS. The role of soluble and insoluble gastric fluid components in the pathogenesis of obliterative bronchiolitis in rat lung allografts. Transpl Int 2015; 29:253-61. [PMID: 26820489 DOI: 10.1111/tri.12715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/19/2015] [Accepted: 11/01/2015] [Indexed: 02/01/2023]
Abstract
Repetitive gastric fluid aspirations have been shown to lead to obliterans bronchiolitis (OB), but the component or components of gastric fluid that are responsible are unknown. This study investigates the role of particulates and, separately, soluble material in gastric fluid during the development of OB. Whole gastric fluid (WGF) was collected from male Fischer 344 (F344) rats and separated by centrifugation into particle reduced gastric fluid (PRGF) and particulate components resuspended in normal saline (PNS). Orthotopic left lung transplants from male Wistar-Kyoto rats into F344 rats were performed using a modification of the nonsuture external cuff technique with prolonged cold ischemia. Rats were subjected to weekly aspiration of 0.5 ml/kg of WGF (n = 9), PRGF (n = 10), PNS (n = 9), or normal saline (control, NS; n = 9) for 8 weeks following transplantation. Lung allografts treated with WGF, PRGF, or PNS developed a significantly greater percentage of OB-like lesions compared with the control. No statistical difference was observed when comparing the fibrosis grades or the percentage of OB lesions of WGF, PRGF, and PNS groups, suggesting that both soluble and insoluble components of gastric fluid can promote the development of aspiration-induced OB and fibrosis in lung allografts.
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Affiliation(s)
- Jason H Leung
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Jui-Chih Chang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA.,Division of Thoracic and Cardiovascular Surgery, Hualien Tzu Chi Hospital, Hualien, Taiwan.,Department of Surgery, Tzu Chi University, Hualien, Taiwan
| | - Sadé M Bell
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Zoie E Holzknecht
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Mary Lou Everett
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - William Parker
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - R Duane Davis
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Shu S Lin
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA.,Department of Immunology, Duke University Medical Center, Durham, NC, USA
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Araos JD, Ayala PS, Meneses M, Contreras R, Cutiño A, Montalva RM, Tazelaar HD, Borzone GR. Resolution of Lung Injury after a Single Event of Aspiration. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 185:2698-708. [DOI: 10.1016/j.ajpath.2015.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/05/2015] [Accepted: 07/01/2015] [Indexed: 01/21/2023]
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25
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Dirou S, Germaud P, Bruley des Varannes S, Magnan A, Blanc FX. [Gastro-esophageal reflux and chronic respiratory diseases]. Rev Mal Respir 2015; 32:1034-46. [PMID: 26071979 DOI: 10.1016/j.rmr.2015.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 03/06/2015] [Indexed: 01/22/2023]
Abstract
Gastroesophageal reflux disease (GERD) frequently occurs in association with chronic respiratory diseases although the casual link is not always clear. Several pathophysiological and experimental factors are considered to support a role for GERD in respiratory disease. Conversely, respiratory diseases and bronchodilator treatment can themselves exacerbate GERD. When cough or severe asthma is being investigated, GERD does not need to be systematically looked for and a therapeutic test with proton pump inhibitors is not always recommended. pH impedance monitoring is now the reference diagnostic tool to detect non acid reflux, a form of reflux for which proton pump inhibitor treatment is ineffective. Recent data have shown a potential role of GERD in idiopathic pulmonary fibrosis and bronchiolitis obliterans following lung transplantation, leading to discussions about the place of surgery in this context. However, studies using pH impedance monitoring are still needed to better understand and manage the association between GERD and chronic respiratory diseases.
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Affiliation(s)
- S Dirou
- Université de Nantes, Nantes 44000, France; Institut du thorax, service de pneumologie, hôpital G. et R. Laënnec, CHU de Nantes, boulevard J.-Monod, 44093 Nantes cedex 1, France
| | - P Germaud
- Institut du thorax, service de pneumologie, hôpital G. et R. Laënnec, CHU de Nantes, boulevard J.-Monod, 44093 Nantes cedex 1, France
| | - S Bruley des Varannes
- Institut des maladies de l'appareil digestif, service d'hépatogastroentérologie et assistance nutritionnelle, CHU de Nantes, Nantes 44093, France; DHU2020 médecine personnalisée des maladies chroniques, Nantes 44000, France
| | - A Magnan
- Université de Nantes, Nantes 44000, France; Institut du thorax, service de pneumologie, hôpital G. et R. Laënnec, CHU de Nantes, boulevard J.-Monod, 44093 Nantes cedex 1, France; DHU2020 médecine personnalisée des maladies chroniques, Nantes 44000, France; Inserm, UMR1087, institut du thorax, Nantes 44093, France; CNRS, UMR 6291, Nantes 44000, France
| | - F-X Blanc
- Université de Nantes, Nantes 44000, France; Institut du thorax, service de pneumologie, hôpital G. et R. Laënnec, CHU de Nantes, boulevard J.-Monod, 44093 Nantes cedex 1, France; DHU2020 médecine personnalisée des maladies chroniques, Nantes 44000, France; Inserm, UMR1087, institut du thorax, Nantes 44093, France; CNRS, UMR 6291, Nantes 44000, France.
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Embarak S, Farag SE, Bihery AS, Ahmed AF, Yousef HY. Characteristics of gastro-esophageal reflux in patients with idiopathic pulmonary fibrosis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nihei M, Okazaki T, Ebihara S, Kobayashi M, Niu K, Gui P, Tamai T, Nukiwa T, Yamaya M, Kikuchi T, Nagatomi R, Ebihara T, Ichinose M. Chronic inflammation, lymphangiogenesis, and effect of an anti-VEGFR therapy in a mouse model and in human patients with aspiration pneumonia. J Pathol 2015; 235:632-45. [PMID: 25348279 DOI: 10.1002/path.4473] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 10/17/2014] [Accepted: 10/22/2014] [Indexed: 01/01/2023]
Abstract
Chronic inflammation induces lymphangiogenesis and blood vessel remodelling. Since aged pneumonia patients often have repeated episodes of aspiration pneumonia, the pathogenesis may involve chronic inflammation. For lymphangiogenesis, VEGFR-3 and its ligand VEGF-C are key factors. No previous studies have examined chronic inflammation or vascular changes in aspiration pneumonia or its mouse models. In lung inflammation, little is known about the effect of blocking VEGFR-3 on lung lymphangiogenesis and, moreover, its effect on the disease condition. This study aimed to establish a mouse model of aspiration pneumonia, examine the presence of chronic inflammation and vascular changes in the model and in patients, and evaluate the effect of inhibiting VEGFR-3 on the lymphangiogenesis and disease condition in this model. To induce aspiration pneumonia, we repeated inoculation of pepsin at low pH and LPS into mice for 21-28 days, durations in which bronchioalveolar lavage and plasma leakage in the lung suggested the presence of exaggerated inflammation. Conventional and immunohistochemical analysis of tracheal whole mounts suggested the presence of chronic inflammation, lymphangiogenesis, and blood vessel remodelling in the model. Quantitative RT-PCR of the trachea and lung suggested the involvement of lymphangiogenic factor VEGF-C, VEGFR-3, and pro-inflammatory cytokines. In the lung, the aspiration model showed the presence of chronic inflammation and exaggerated lymphangiogenesis. Treatment with the VEGFR inhibitor axitinib or the VEGFR-3 specific inhibitor SAR131675 impaired lymphangiogenesis in the lung and improved oxygen saturation in the aspiration model. Since the lung is the main site of aspiration pneumonia, the changes were intensive in the lung and mild in the trachea. Human lung samples also showed the presence of chronic inflammation and exaggerated lymphangiogenesis, suggesting the relevance of the model to the disease. These results suggest lymphatics in the lung as a new target of analysis and therapy in aspiration pneumonia.
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Affiliation(s)
- Mayumi Nihei
- Department of Respiratory Medicine, Tohoku University Hospital, Sendai, Japan
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Abstract
Pulmonary aspiration of gastric content is a serious anaesthetic complication that can lead to significant morbidity and mortality. Aspiration risk assessment is usually based on fasting times. However, fasting guidelines do not apply to urgent or emergent situations and to patients with certain co-morbidities. Gastric content and volume assessment is a new point-of-care ultrasound application that can help determine aspiration risk. This systematic review summarizes the current literature on bedside ultrasound assessment of gastric content and volume relevant to anaesthesia practice. Seventeen articles were identified using predetermined criteria. Studies were classified into those describing the sonographic characteristics of different types of gastric content (empty, clear fluid, solid), and those describing methods for quantitative assessment of gastric volume. A possible algorithm for the clinical application of this new tool is proposed, and areas that require further research are highlighted.
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Affiliation(s)
- P Van de Putte
- Department of Anaesthesiology, AZ Monica, Campus Deurne, Deurne, Belgium
| | - A Perlas
- Department of Anaesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada Department of Anaesthesia, University of Toronto, 399 Bathurst St., Toronto, ON, Canada M5 T 2S8
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Kilduff CE, Counter MJ, Thomas GA, Harrison NK, Hope-Gill BD. Effect of acid suppression therapy on gastroesophageal reflux and cough in idiopathic pulmonary fibrosis: an intervention study. COUGH 2014; 10:4. [PMID: 24876887 PMCID: PMC4038107 DOI: 10.1186/1745-9974-10-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/04/2014] [Indexed: 01/24/2023]
Abstract
Background Chronic cough affects more than 70 percent of patients with Idiopathic Pulmonary Fibrosis and causes significant morbidity. Gastroesophageal reflux is the cause of some cases of chronic cough; and also has a postulated role in the aetiology of Idiopathic Pulmonary Fibrosis. A high prevalence of acid; and more recently non-acid, reflux has been observed in Idiopathic Pulmonary Fibrosis cohorts. Therefore, gastroesophageal reflux may be implicated in the pathogenesis of cough in Idiopathic Pulmonary Fibrosis. Methods Eighteen subjects with Idiopathic Pulmonary Fibrosis underwent 24-hour oesophageal impedance and cough count monitoring after the careful exclusion of causes of chronic cough other than gastroesophageal reflux. All 18 were then treated with high dose acid suppression therapies. Fourteen subjects underwent repeat 24-hour oesophageal impedance and cough count monitoring after eight weeks. Results Total reflux and acid reflux frequencies were within the normal range in the majority of this cohort. The frequencies of non-acid and proximal reflux events were above the normal range. Following high dose acid suppression therapy there was a significant decrease in the number of acid reflux events (p = 0.02), but an increase in the number of non-acid reflux events (p = 0.01). There was no change in cough frequency (p = 0.70). Conclusions This study confirms that non-acid reflux is prevalent; and that proximal oesophageal reflux occurs in the majority, of subjects with Idiopathic Pulmonary Fibrosis. It is the first study to investigate the effect of acid suppression therapy on gastroesophageal reflux and cough in patients with Idiopathic Pulmonary Fibrosis. The observation that cough frequency does not improve despite verifiable reductions in oesophageal acid exposure challenges the role of acid reflux in Idiopathic Pulmonary Fibrosis associated cough. The finding that non-acid reflux is increased following the use of acid suppression therapies cautions against the widespread use of acid suppression in patients with Idiopathic Pulmonary Fibrosis given the potential role for non-acid reflux in the pathogenesis of cough and Idiopathic Pulmonary Fibrosis itself. Study registration The study was registered with the Cardiff and Vale University Local Health Board Research and Development Committee (09/CMC/4619) and the South East Wales Ethics Committee (09/WSE04/57).
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Affiliation(s)
- Claire E Kilduff
- Department of Respiratory Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Melanie J Counter
- Department of Gastrointestinal Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Gareth A Thomas
- Department of Gastrointestinal Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Benjamin D Hope-Gill
- Department of Respiratory Medicine, Cardiff and Vale University Health Board, Cardiff, UK
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Exogenous Surfactant Attenuates Lung Injury From Gastric-Acid Aspiration During Ex Vivo Reconditioning in Pigs. Transplantation 2014; 97:413-8. [DOI: 10.1097/01.tp.0000441320.10787.c5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Aspiration and allograft injury secondary to gastroesophageal reflux occur in the immediate post-lung transplantation period (prospective clinical trial). Ann Surg 2013; 258:705-11; discussion 711-2. [PMID: 24121257 DOI: 10.1097/sla.0b013e3182a6589b] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To provide novel pilot data to quantify reflux, aspiration, and allograft injury immediately post-lung transplantation. BACKGROUND Asymptomatic reflux/aspiration, associated with allograft dysfunction, occurs in lung transplant recipients. Early fundoplication has been advocated. Indications for surgery include elevated biomarkers of aspiration (bile salts) in bronchoalveolar lavage fluid (BALF). Measurements have been mostly documented after the immediate posttransplant period. We report the first prospective study of reflux/aspiration immediately posttransplantation to date. METHODS Lung transplant recipients were recruited over 12 months. At 1 month posttransplantation, patients completed a Reflux Symptom Index questionnaire and underwent objective assessment for reflux (manometry and pH/impedance). Testing was performed on maintenance proton pump inhibitor. BALF was assessed for pepsin, bile salts, interleukin-8 and neutrophils. RESULTS Eighteen lung transplant recipients, median age of 46 years (range: 22-59 years), were recruited. Eight of 18 patients had abnormal esophageal peristalsis. Five of 17 patients were positive on Reflux Symptom Index questionnaire. Twelve of 17 patients had reflux. Three patients exclusively had weakly acid reflux. Median acid exposure was 4.8% (range: 1%-79.9%) and median esophageal volume exposure was 1.6% (range: 0.7-5.5). There was a median of 72 reflux events (range: 27-147) per 24 hours. A correlation existed between Reflux Symptom Index score and proximal reflux (r = 0.533, P = 0.006). Pepsin was detected in 11 of 15 BALF samples signifying aspiration (median: 18 ng/mL; range: 0-43). Bile salts were undetectable, using spectrophotometry and rarely detectable using dual mass spectrometry (2/15) (levels 0.2 and 1.2 μmol/L). Lavage interleukin-8 and neutrophil levels were elevated. A correlation existed between proximal reflux events and neutrophilia (r = 0.52, P = 0.03). CONCLUSIONS Lung transplant recipients should be routinely assessed for reflux/aspiration within the first month posttransplant. Reflux/aspiration can be present early postoperatively. Pepsin was detected suggesting aspiration. Bile salts were rarely detected. Proximal reflux events correlated with neutrophilia, linked to allograft dysfunction and mortality. These results support the need for early assessment of reflux/aspiration, which may inform fundoplication.
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Addis MF, Pisanu S, Marogna G, Cubeddu T, Pagnozzi D, Cacciotto C, Campesi F, Schianchi G, Rocca S, Uzzau S. Production and release of antimicrobial and immune defense proteins by mammary epithelial cells following Streptococcus uberis infection of sheep. Infect Immun 2013; 81:3182-97. [PMID: 23774600 PMCID: PMC3754230 DOI: 10.1128/iai.00291-13] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 06/11/2013] [Indexed: 01/22/2023] Open
Abstract
Investigating the innate immune response mediators released in milk has manifold implications, spanning from elucidation of the role played by mammary epithelial cells (MECs) in fighting microbial infections to the discovery of novel diagnostic markers for monitoring udder health in dairy animals. Here, we investigated the mammary gland response following a two-step experimental infection of lactating sheep with the mastitis-associated bacterium Streptococcus uberis. The establishment of infection was confirmed both clinically and by molecular methods, including PCR and fluorescent in situ hybridization of mammary tissues. Proteomic investigation of the milk fat globule (MFG), a complex vesicle released by lactating MECs, enabled detection of enrichment of several proteins involved in inflammation, chemotaxis of immune cells, and antimicrobial defense, including cathelicidins and calprotectin (S100A8/S100A9), in infected animals, suggesting the consistent involvement of MECs in the innate immune response to pathogens. The ability of MECs to produce and release antimicrobial and immune defense proteins was then demonstrated by immunohistochemistry and confocal immunomicroscopy of cathelicidin and the calprotectin subunit S100A9 on mammary tissues. The time course of their release in milk was also assessed by Western immunoblotting along the course of the experimental infection, revealing the rapid increase of these proteins in the MFG fraction in response to the presence of bacteria. Our results support an active role of MECs in the innate immune response of the mammary gland and provide new potential for the development of novel and more sensitive tools for monitoring mastitis in dairy animals.
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Affiliation(s)
| | | | - Gavino Marogna
- Istituto Zooprofilattico della Sardegna G. Pegreffi, Sassari, Italy
| | - Tiziana Cubeddu
- Porto Conte Ricerche Srl, Tramariglio, Alghero (SS), Italy
- Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Sassari, Italy
| | | | - Carla Cacciotto
- Porto Conte Ricerche Srl, Tramariglio, Alghero (SS), Italy
- Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Sassari, Italy
| | - Franca Campesi
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, Sassari, Italy
| | | | - Stefano Rocca
- Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Sassari, Italy
| | - Sergio Uzzau
- Porto Conte Ricerche Srl, Tramariglio, Alghero (SS), Italy
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, Sassari, Italy
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Rafii R, Juarez MM, Albertson TE, Chan AL. A review of current and novel therapies for idiopathic pulmonary fibrosis. J Thorac Dis 2013; 5:48-73. [PMID: 23372951 DOI: 10.3978/j.issn.2072-1439.2012.12.07] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/25/2012] [Indexed: 12/30/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressively fibrotic interstitial lung disease that is associated with a median survival of 2-3 years from initial diagnosis. To date, there is no treatment approved for IPF in the United States, and only one pharmacological agent has been approved outside of the United States. Nevertheless, research over the past 10 years has provided us with a wealth of information on its histopathology, diagnostic work-up, and a greater understanding of its pathophysiology. Specifically, IPF is no longer thought to be a predominantly pro-inflammatory disorder. Rather, the fibrosis in IPF is increasingly understood to be the result of a fibroproliferative and aberrant wound healing cascade. The development of therapeutic targets has shifted in accord with this paradigm change. This review highlights the current understanding of IPF, and the recent as well as novel therapeutics being explored in clinical trials for the treatment of this devastating disease.
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Affiliation(s)
- Rokhsara Rafii
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Davis, School of Medicine and VA Northern California Health Care System, Sacramento, California, USA
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Tang T, Chang JC, Xie A, Davis RD, Parker W, Lin SS. Aspiration of gastric fluid in pulmonary allografts: effect of pH. J Surg Res 2012; 181:e31-8. [PMID: 22765998 DOI: 10.1016/j.jss.2012.06.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/31/2012] [Accepted: 06/15/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic aspiration of gastric fluid potentially plays a central role in the pathogenesis of obliterative bronchiolitis, which is often associated with chronic pulmonary allograft failure. It remains unknown whether pharmaceutical-induced increases in gastric pH might effectively prevent any putative pulmonary injury associated with chronic aspiration. MATERIALS AND METHODS To test the hypothesis that neutralization of gastric fluid would affect the development of aspiration-associated obliterative bronchiolitis, an established rat lung transplant model (WKY-to-F344) was utilized. Pulmonary allograft recipients were subjected to eight weekly aspirations of gastric fluid at pH 2.5 (low-pH), gastric fluid at pH 7.4 (neutralized-pH), or saline as a control. RESULTS Histologic analysis revealed that the fraction of airways affected with lesions consistent with obliterative bronchiolitis was 0.55 ± 0.08 (mean ± SEM) in rats receiving aspiration with low-pH gastric fluid, 0.49 ± 0.07 in animals receiving neutralized-pH gastric fluid, and 0.07 ± 0.05 in rats receiving normal saline only. The difference between groups receiving gastric fluid, regardless of pH, was significantly different from the saline control (P < 0.0001), whereas the difference between the groups receiving low-pH gastric fluid and neutralized-pH gastric fluid was not significant (P = 0.75). CONCLUSIONS Effective management of gastroesophageal reflux disease in lung transplant recipients should probably include more than neutralization of gastric fluid.
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Affiliation(s)
- Tao Tang
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Su KY, Thomas AD, Chang JC, Leung JH, Lee SM, Holzknecht ZE, Everett ML, Foster WM, Kraft M, Parker W, Davis RD, Lin SS. Chronic aspiration shifts the immune response from adaptive immunity to innate immunity in a murine model of asthma. Inflamm Res 2012; 61:863-73. [PMID: 22565668 DOI: 10.1007/s00011-012-0479-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 04/10/2012] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE AND DESIGN The hypothesis that aspiration of gastric fluid drives the anti-ovalbumin response toward a Th2 reaction even in animals not prone to Th2 responses was evaluated. SUBJECTS Forty-eight male C57BL/6 mice were used. METHODS Mice were sensitized and challenged with ovalbumin starting 5 weeks prior to the initiation of weekly aspirations of either gastric fluid or normal saline as a control. Weekly aspiration continued during the course of exposure to ovalbumin. TREATMENT Aspiration consisted of 50 μl of gastric fluid with 50 μl of 0.9 % normal saline used as a control. Antigen exposure consisted of sensitization to ovalbumin via intraperitoneal injection on days 0 and 14 and challenge on day 21 with aerosolized antigen for 30 min. RESULTS No evidence of a shift toward a Th2 response as a result of gastric fluid aspiration was seen in the Th1-prone strain utilized, although a profound down-regulation of a broad array of T cell-associated cytokines and chemokines and up-regulation of macrophage-associated markers was observed as a result of aspiration. CONCLUSIONS These data provide support for the hypothesis that the clinical association between asthma and gastroesophageal reflux disease (GERD) does not involve an exacerbation of asthma by GERD-associated aspiration of gastric fluid, but may cause immune reactions unrelated to the asthma pathology.
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Affiliation(s)
- Kuei-Ying Su
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Lee JS, Ryu JH, Elicker BM, Lydell CP, Jones KD, Wolters PJ, King TE, Collard HR. Gastroesophageal reflux therapy is associated with longer survival in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2011; 184:1390-4. [PMID: 21700909 DOI: 10.1164/rccm.201101-0138oc] [Citation(s) in RCA: 286] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Gastroesophageal reflux (GER) is highly prevalent in patients with idiopathic pulmonary fibrosis (IPF). Chronic microaspiration secondary to GER may play a role in the pathogenesis and natural history of IPF. OBJECTIVES To investigate the relationship between GER-related variables and survival time in patients with IPF. METHODS Regression analysis was used to investigate the relationship between GER-related variables and survival time in a retrospectively identified cohort of patients with well-characterized IPF from two academic medical centers. MEASUREMENTS AND MAIN RESULTS Two hundred four patients were identified for inclusion. GER-related variables were common in this cohort: reported symptoms of GER (34%), a history of GER disease (45%), reported use of GER medications (47%), and Nissen fundoplication (5%). These GER-related variables were significantly associated with longer survival time on unadjusted analysis. After adjustment, the use of GER medications was an independent predictor of longer survival time. In addition, the use of gastroesophageal reflux medications was associated with a lower radiologic fibrosis score. These findings were present regardless of center. CONCLUSIONS The reported use of GER medications is associated with decreased radiologic fibrosis and is an independent predictor of longer survival time in patients with IPF. These findings further support the hypothesis that GER and chronic microaspiration may play important roles in the pathobiology of IPF.
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Affiliation(s)
- Joyce S Lee
- Department of Medicine, University of California San Francisco, USA.
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Kuyama K, Sun Y, Yamamoto H. Aspiration pneumonia: With special reference to pathological and epidemiological aspects, a review of the literature. JAPANESE DENTAL SCIENCE REVIEW 2010. [DOI: 10.1016/j.jdsr.2009.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lee JS, Collard HR, Raghu G, Sweet MP, Hays SR, Campos GM, Golden JA, King TE. Does chronic microaspiration cause idiopathic pulmonary fibrosis? Am J Med 2010; 123:304-11. [PMID: 20362747 PMCID: PMC2851633 DOI: 10.1016/j.amjmed.2009.07.033] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 07/21/2009] [Accepted: 07/21/2009] [Indexed: 01/30/2023]
Abstract
Idiopathic pulmonary fibrosis is a diffuse fibrotic lung disease of unknown etiology with no effective treatment. Emerging data support a role for chronic microaspiration (ie, subclinical aspiration of small droplets) in the pathogenesis and natural history of idiopathic pulmonary fibrosis. However, the precise relationship between chronic microaspiration and idiopathic pulmonary fibrosis remains unknown. Gastroesophageal reflux, a presumed risk factor for microaspiration, has been strongly associated with idiopathic pulmonary fibrosis with an estimated prevalence of up to 90%. This review aims to describe the relationship between chronic microaspiration and idiopathic pulmonary fibrosis by laying out the clinical and biologic rationale for this relationship and exploring the scientific evidence available. The gaps in our current understanding of the diagnosis of chronic microaspiration and idiopathic pulmonary fibrosis and the ongoing uncertainties in management and treatment will be highlighted. Defining the role of chronic microaspiration in idiopathic pulmonary fibrosis is essential as it has potential clinical, pathobiological, and treatment implications for this deadly disease.
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Affiliation(s)
- Joyce S Lee
- Department of Medicine, University of California, San Francisco, CA, USA.
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Savarino E, Ghio M, Sammito G, Indiveri F, Savarino V. Gastroesophageal Reflux and Lung Disease in Systemic Sclerosis. Am J Respir Crit Care Med 2009. [DOI: 10.1164/ajrccm.179.12.1167a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Carlo-Stella N, Belloli L, Barbera R, Gambaro C, Rando G, Malesci A, Marasini B. Gastroesophageal Reflux and Lung Disease in Systemic Sclerosis. Am J Respir Crit Care Med 2009; 179:1167; author reply 1167-8. [DOI: 10.1164/ajrccm.179.12.1167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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