Glucocorticoids Elevate Pseudomonas aeruginosa Binding to Airway Epithelium by Upregulating Syndecan-1 Expression

Syndecan-1: a key player in health and disease

Syndecan-1 (SDC-1) is a transmembrane protein localized on the basolateral surface of epithelial cells, encompassing a core protein with heparin sulfate and chondroitin sulfate glycosaminoglycan side chains. SDC-1 is involved in a panoply of cellular mechanisms including cell-to-cell adhesion, extracellular matrix interactions, cell cycle modulation, and lipid clearance. Alterations in the expression and function of SDC-1 are implicated in numerous disease entities, making it an attractive diagnostic and therapeutic target. However, despite its broad involvement in several disease processes, the underlying mechanism contributing to its diverse functions, pathogenesis, and therapeutic uses remains underexplored. Therefore, this review examines the role of SDC-1 in health and disease, focusing on liver pathologies, inflammatory diseases, infectious diseases, and cancer, and sheds light on SDC-1-based therapeutic approaches. Moreover, it delves into the mechanisms through which SDC-1 contributes to these diseases, emphasizing cell-type specific mechanisms. By comprehensively summarizing the significance of SDC-1, its association with several diseases, and its underlying mechanisms of action, the findings of this review could inform future research directions toward the development of targeted therapies and early diagnosis for a multitude of disease entities.

Risk factors for Pseudomonas aeruginosa isolation in chronic obstructive pulmonary disease: a systematic review and meta-analysis

BACKGROUND

Pseudomonas aeruginosa (PA) isolation in patients with chronic obstructive pulmonary disease (COPD) has been associated with a poor prognosis. This meta-analysis aimed to determine significant risk factors for PA isolation among patients with COPD.

METHODS

A systematic literature retrieval from PubMed, Embase, Web of Science and China National Knowledge Infrastructure (CNKI) was conducted, including studies from January 2003 to September 2024. Case-control and cohort studies exploring the risk factors for PA isolation in patients with COPD were included in this analysis. A random-effects model was applied to estimate the pooled adjusted odds ratio (paOR) or hazard ratio (paHR) with the corresponding 95% confidence intervals (CI).

RESULTS

Thirteen eligible studies with a total of 25,802 participants were included in this meta-analysis. Prior systemic steroid therapy (paOR: 2.67; 95% CI: 1.29-5.53; P = 0.008), previous antibiotic treatment (paOR: 2.83; 95% CI: 1.14-6.97; P = 0.02), high "Body mass index, airflow Obstruction, Dyspnea, Exercise capacity" (BODE) index (paOR: 4.13; 95% CI: 1.67-10.23; P = 0.002), 6-min walking distance (6MWD) < 250 m (paOR: 4.27; 95% CI: 2.59-7.01; P < 0.001), COPD assessment test (CAT) score > 20 points (paOR: 2.49; 95% CI: 1.46-4.23; P = 0.001), hypoproteinemia (paOR: 2.62; 95%CI: 1.32-5.19; P = 0.006), hospitalizations in the previous year (paOR: 3.74; 95%CI: 1.22-11.49; P = 0.021), Bronchiectasis (paOR = 4.81; 95% CI: 3.66-6.33; P < 0.001) and prior PA isolation (paOR: 16.39; 95% CI: 7.65-35.10; P < 0.001) were associated with PA isolation in patients with COPD.

CONCLUSIONS

Our study identified nine risk factors associated with an increased risk of PA isolation in COPD patients. These findings are significant for the early identification of patients at risk for PA isolation, which might contribute to reducing mortality and improving clinical outcomes.

Advances in inhaled corticosteroids for the treatment of chronic obstructive pulmonary disease: what is their value today?

INTRODUCTION

As of today, there is still a need to determine which COPD patients may benefit from ICS therapy, whether ICSs are useful in COPD patients without chronic bronchitis, and whether long-acting bronchodilators can reduce the risk of exacerbations in frequent exacerbators even if ICSs are not used, and whether combination therapy including ICSs is helpful in infrequent exacerbators to optimise the use of ICSs in COPD. Nevertheless, in recent years, a fair amount of evidence has been produced that, at least in part, can help define the role of ICSs in COPD better.

AREAS COVERED

Herein, the authors provide an overview of current use of ICS in COPD and discuss their value to the current treatment armamentarium. The article includes discussion of which patients will benefit best from the use of ICSs, their potential uses and adverse effects.

EXPERT OPINION

There is growing agreement on why, in whom, and when ICS therapy can be used in COPD, although the consensus is still lacking because of the heterogeneity of COPD. The use of blood eosinophil counts (BECs) is only helpful in T2 inflammation, while there is a lack of biomarkers indicating the presence of T1 and T17 immunity, which is poorly responsive to ICS. Identifying ICS-sensitive endotypes using specific biomarkers that have yet to be identified and validated is likely to demonstrate that ICSs can influence the natural course of COPD in at least a subset of patients.