1
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Clay S, Alladina J, Smith NP, Visness CM, Wood RA, O'Connor GT, Cohen RT, Khurana Hershey GK, Kercsmar CM, Gruchalla RS, Gill MA, Liu AH, Kim H, Kattan M, Bacharier LB, Rastogi D, Rivera-Spoljaric K, Robison RG, Gergen PJ, Busse WW, Villani AC, Cho JL, Medoff BD, Gern JE, Jackson DJ, Ober C, Dapas M. Gene-based association study of rare variants in children of diverse ancestries implicates TNFRSF21 in the development of allergic asthma. J Allergy Clin Immunol 2024; 153:809-820. [PMID: 37944567 PMCID: PMC10939893 DOI: 10.1016/j.jaci.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/25/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Most genetic studies of asthma and allergy have focused on common variation in individuals primarily of European ancestry. Studying the role of rare variation in quantitative phenotypes and in asthma phenotypes in populations of diverse ancestries can provide additional, important insights into the development of these traits. OBJECTIVE We sought to examine the contribution of rare variants to different asthma- or allergy-associated quantitative traits in children with diverse ancestries and explore their role in asthma phenotypes. METHODS We examined whole-genome sequencing data from children participants in longitudinal studies of asthma (n = 1035; parent-identified as 67% Black and 25% Hispanic) to identify rare variants (minor allele frequency < 0.01). We assigned variants to genes and tested for associations using an omnibus variant-set test between each of 24,902 genes and 8 asthma-associated quantitative traits. On combining our results with external data on predicted gene expression in humans and mouse knockout studies, we identified 3 candidate genes. A burden of rare variants in each gene and in a combined 3-gene score was tested for its associations with clinical phenotypes of asthma. Finally, published single-cell gene expression data in lower airway mucosal cells after allergen challenge were used to assess transcriptional responses to allergen. RESULTS Rare variants in USF1 were significantly associated with blood neutrophil count (P = 2.18 × 10-7); rare variants in TNFRSF21 with total IgE (P = 6.47 × 10-6) and PIK3R6 with eosinophil count (P = 4.10 × 10-5) reached suggestive significance. These 3 findings were supported by independent data from human and mouse studies. A burden of rare variants in TNFRSF21 and in a 3-gene score was associated with allergy-related phenotypes in cohorts of children with mild and severe asthma. Furthermore, TNFRSF21 was significantly upregulated in bronchial basal epithelial cells from adults with allergic asthma but not in adults with allergies (but not asthma) after allergen challenge. CONCLUSIONS We report novel associations between rare variants in genes and allergic and inflammatory phenotypes in children with diverse ancestries, highlighting TNFRSF21 as contributing to the development of allergic asthma.
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Affiliation(s)
- Selene Clay
- Department of Human Genetics, University of Chicago, Chicago, Ill.
| | - Jehan Alladina
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Neal P Smith
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Mass; Massachusetts General Hospital Cancer Center, Boston, Mass
| | | | - Robert A Wood
- Pediatric Allergy and Immunology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - George T O'Connor
- Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Robyn T Cohen
- Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | | | - Carolyn M Kercsmar
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rebecca S Gruchalla
- Internal Medicine and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Michelle A Gill
- Pediatric Infectious Diseases, St. Louis Children's Hospital, St Louis, Mo
| | - Andrew H Liu
- Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - Haejin Kim
- Allergy and Immunology, Henry Ford Health, Detroit, Mich
| | - Meyer Kattan
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Deepa Rastogi
- Division of Pulmonology and Sleep Medicine, Children's National Hospital, Washington, DC
| | - Katherine Rivera-Spoljaric
- Department of Pediatric Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - Rachel G Robison
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn; Ann & Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Rockville, Md
| | - William W Busse
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Alexandra-Chloe Villani
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Mass; Massachusetts General Hospital Cancer Center, Boston, Mass
| | - Josalyn L Cho
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | - Matthew Dapas
- Department of Human Genetics, University of Chicago, Chicago, Ill
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2
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Brazee PL, Cartier A, Kuo A, Haring AM, Nguyen T, Hariri LP, Griffith JW, Hla T, Medoff BD, Knipe RS. Augmentation of Endothelial S1PR1 Attenuates Postviral Pulmonary Fibrosis. Am J Respir Cell Mol Biol 2024; 70:119-128. [PMID: 37934676 PMCID: PMC10848698 DOI: 10.1165/rcmb.2023-0286oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/07/2023] [Indexed: 11/09/2023] Open
Abstract
Respiratory viral infections are frequent causes of acute respiratory distress syndrome (ARDS), a disabling condition with a mortality of up to 46%. The pulmonary endothelium plays an important role in the development of ARDS as well as the pathogenesis of pulmonary fibrosis; however, the therapeutic potential to modulate endothelium-dependent signaling to prevent deleterious consequences has not been well explored. Here, we used a clinically relevant influenza A virus infection model, endothelial cell-specific transgenic gain-of-function and loss-of-function mice as well as pharmacologic approaches and in vitro modeling, to define the mechanism by which S1PR1 expression is dampened during influenza virus infection and determine whether therapeutic augmentation of S1PR1 has the potential to reduce long-term postviral fibrotic complications. We found that the influenza virus-induced inflammatory milieu promoted internalization of S1PR1, which was pharmacologically inhibited with paroxetine, an inhibitor of GRK2. Moreover, genetic overexpression or administration of paroxetine days after influenza virus infection was sufficient to reduce postviral pulmonary fibrosis. Taken together, our data suggest that endothelial S1PR1 signaling provides critical protection against long-term fibrotic complications after pulmonary viral infection. These findings support the development of antifibrotic strategies that augment S1PR1 expression in virus-induced ARDS to improve long-term patient outcomes.
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Affiliation(s)
- Patricia L. Brazee
- Center for Immunology and Inflammatory Diseases, Division of Pulmonary and Critical Care
| | - Andreane Cartier
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Kuo
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexis M. Haring
- Center for Immunology and Inflammatory Diseases, Division of Pulmonary and Critical Care
| | - Trong Nguyen
- Center for Immunology and Inflammatory Diseases, Division of Pulmonary and Critical Care
| | - Lida P. Hariri
- Department of Pathology, Massachusetts General Hospital, and
| | - Jason W. Griffith
- Center for Immunology and Inflammatory Diseases, Division of Pulmonary and Critical Care
| | - Timothy Hla
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin D. Medoff
- Center for Immunology and Inflammatory Diseases, Division of Pulmonary and Critical Care
| | - Rachel S. Knipe
- Center for Immunology and Inflammatory Diseases, Division of Pulmonary and Critical Care
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3
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Corleis B, Tzouanas CN, Wadsworth MH, Cho JL, Linder AH, Schiff AE, Zessin B, Stei F, Dorhoi A, Dickey AK, Medoff BD, Shalek AK, Kwon DS. Tobacco smoke exposure recruits inflammatory airspace monocytes that establish permissive lung niches for Mycobacterium tuberculosis. Sci Transl Med 2023; 15:eadg3451. [PMID: 38055798 DOI: 10.1126/scitranslmed.adg3451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
Tobacco smoking doubles the risk of active tuberculosis (TB) and accounts for up to 20% of all active TB cases globally. How smoking promotes lung microenvironments permissive to Mycobacterium tuberculosis (Mtb) growth remains incompletely understood. We investigated primary bronchoalveolar lavage cells from current and never smokers by performing single-cell RNA sequencing (scRNA-seq), flow cytometry, and functional assays. We observed the enrichment of immature inflammatory monocytes in the lungs of smokers compared with nonsmokers. These monocytes exhibited phenotypes consistent with recent recruitment from blood, ongoing differentiation, increased activation, and states similar to those with chronic obstructive pulmonary disease. Using integrative scRNA-seq and flow cytometry, we identified CD93 as a marker for a subset of these newly recruited smoking-associated lung monocytes and further provided evidence that the recruitment of monocytes into the lung was mediated by CCR2-binding chemokines, including CCL11. We also show that these cells exhibit elevated inflammatory responses upon exposure to Mtb and accelerated intracellular growth of Mtb compared with mature macrophages. This elevated Mtb growth could be inhibited by anti-inflammatory small molecules, providing a connection between smoking-induced pro-inflammatory states and permissiveness to Mtb growth. Our findings suggest a model in which smoking leads to the recruitment of immature inflammatory monocytes from the periphery to the lung, which results in the accumulation of these Mtb-permissive cells in the airway. This work defines how smoking may lead to increased susceptibility to Mtb and identifies host-directed therapies to reduce the burden of TB among those who smoke.
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Affiliation(s)
- Björn Corleis
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
- Institute of Immunology, Friedrich-Loeffler-Institute, Greifswald-Insel Riems, 17493, Germany
| | - Constantine N Tzouanas
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
- Institute for Medical Engineering & Science (IMES), Department of Chemistry, and Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02139, USA
| | - Marc H Wadsworth
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
- Institute for Medical Engineering & Science (IMES), Department of Chemistry, and Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02139, USA
| | - Josalyn L Cho
- Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Alice H Linder
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Abigail E Schiff
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Björn Zessin
- Institute of Immunology, Friedrich-Loeffler-Institute, Greifswald-Insel Riems, 17493, Germany
| | - Fabian Stei
- Institute of Immunology, Friedrich-Loeffler-Institute, Greifswald-Insel Riems, 17493, Germany
| | - Anca Dorhoi
- Institute of Immunology, Friedrich-Loeffler-Institute, Greifswald-Insel Riems, 17493, Germany
| | - Amy K Dickey
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alex K Shalek
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
- Institute for Medical Engineering & Science (IMES), Department of Chemistry, and Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02139, USA
- Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Douglas S Kwon
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
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4
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Fisher CR, Mba Medie F, Luu RJ, Gaibler RB, Mulhern TJ, Miller CR, Zhang CJ, Rubio LD, Marr EE, Vijayakumar V, Gabriel EP, Lopez Quezada L, Zhang CH, Anderson KS, Jorgensen WL, Alladina JW, Medoff BD, Borenstein JT, Gard AL. A High-Throughput, High-Containment Human Primary Epithelial Airway Organ-on-Chip Platform for SARS-CoV-2 Therapeutic Screening. Cells 2023; 12:2639. [PMID: 37998374 PMCID: PMC10669988 DOI: 10.3390/cells12222639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
COVID-19 emerged as a worldwide pandemic in early 2020, and while the rapid development of safe and efficacious vaccines stands as an extraordinary achievement, the identification of effective therapeutics has been less successful. This process has been limited in part by a lack of human-relevant preclinical models compatible with therapeutic screening on the native virus, which requires a high-containment environment. Here, we report SARS-CoV-2 infection and robust viral replication in PREDICT96-ALI, a high-throughput, human primary cell-based organ-on-chip platform. We evaluate unique infection kinetic profiles across lung tissue from three human donors by immunofluorescence, RT-qPCR, and plaque assays over a 6-day infection period. Enabled by the 96 devices/plate throughput of PREDICT96-ALI, we also investigate the efficacy of Remdesivir and MPro61 in a proof-of-concept antiviral study. Both compounds exhibit an antiviral effect against SARS-CoV-2 in the platform. This demonstration of SARS-CoV-2 infection and antiviral dosing in a high-throughput organ-on-chip platform presents a critical capability for disease modeling and therapeutic screening applications in a human physiology-relevant in vitro system.
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Affiliation(s)
- Christine R. Fisher
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Felix Mba Medie
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Rebeccah J. Luu
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Robert B. Gaibler
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Thomas J. Mulhern
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Caitlin R. Miller
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Chelsea J. Zhang
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Logan D. Rubio
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Elizabeth E. Marr
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Vidhya Vijayakumar
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Elizabeth P. Gabriel
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Landys Lopez Quezada
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Chun-Hui Zhang
- Department of Chemistry, Yale University, New Haven, CT 06520, USA (W.L.J.)
| | - Karen S. Anderson
- Department of Pharmacology, Yale University, New Haven, CT 06520, USA;
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT 06520, USA
| | | | - Jehan W. Alladina
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (J.W.A.); (B.D.M.)
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; (J.W.A.); (B.D.M.)
| | - Jeffrey T. Borenstein
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
| | - Ashley L. Gard
- Bioengineering Division, Draper, Cambridge, MA 02139, USA; (C.R.F.); (F.M.M.); (R.J.L.); (R.B.G.); (T.J.M.); (V.V.); (E.P.G.); (L.L.Q.); (J.T.B.)
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5
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Alladina J, Smith NP, Kooistra T, Slowikowski K, Kernin IJ, Deguine J, Keen HL, Manakongtreecheep K, Tantivit J, Rahimi RA, Sheng SL, Nguyen ND, Haring AM, Giacona FL, Hariri LP, Xavier RJ, Luster AD, Villani AC, Cho JL, Medoff BD. A human model of asthma exacerbation reveals transcriptional programs and cell circuits specific to allergic asthma. Sci Immunol 2023; 8:eabq6352. [PMID: 37146132 PMCID: PMC10440046 DOI: 10.1126/sciimmunol.abq6352] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Abstract
Asthma is a chronic disease most commonly associated with allergy and type 2 inflammation. However, the mechanisms that link airway inflammation to the structural changes that define asthma are incompletely understood. Using a human model of allergen-induced asthma exacerbation, we compared the lower airway mucosa in allergic asthmatics and allergic non-asthmatic controls using single-cell RNA sequencing. In response to allergen, the asthmatic airway epithelium was highly dynamic and up-regulated genes involved in matrix degradation, mucus metaplasia, and glycolysis while failing to induce injury-repair and antioxidant pathways observed in controls. IL9-expressing pathogenic TH2 cells were specific to asthmatic airways and were only observed after allergen challenge. Additionally, conventional type 2 dendritic cells (DC2 that express CD1C) and CCR2-expressing monocyte-derived cells (MCs) were uniquely enriched in asthmatics after allergen, with up-regulation of genes that sustain type 2 inflammation and promote pathologic airway remodeling. In contrast, allergic controls were enriched for macrophage-like MCs that up-regulated tissue repair programs after allergen challenge, suggesting that these populations may protect against asthmatic airway remodeling. Cellular interaction analyses revealed a TH2-mononuclear phagocyte-basal cell interactome unique to asthmatics. These pathogenic cellular circuits were characterized by type 2 programming of immune and structural cells and additional pathways that may sustain and amplify type 2 signals, including TNF family signaling, altered cellular metabolism, failure to engage antioxidant responses, and loss of growth factor signaling. Our findings therefore suggest that pathogenic effector circuits and the absence of proresolution programs drive structural airway disease in response to type 2 inflammation.
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Affiliation(s)
- Jehan Alladina
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Neal P. Smith
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Tristan Kooistra
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kamil Slowikowski
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Isabela J. Kernin
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jacques Deguine
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Henry L. Keen
- Iowa Institute of Human Genetics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kasidet Manakongtreecheep
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jessica Tantivit
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Rod A. Rahimi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Susan L. Sheng
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nhan D. Nguyen
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexis M. Haring
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Francesca L. Giacona
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Ramnik J. Xavier
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Center for Computational and Integrative Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew D. Luster
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra-Chloé Villani
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Josalyn L. Cho
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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6
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Knipe RS, Nurunnabi M, Probst CK, Spinney JJ, Abe E, Bose RJC, Ha K, Logue A, Nguyen T, Servis R, Drummond M, Haring A, Brazee PL, Medoff BD, McCarthy JR. Myofibroblast-specific inhibition of the Rho kinase-MRTF-SRF pathway using nanotechnology for the prevention of pulmonary fibrosis. Am J Physiol Lung Cell Mol Physiol 2023; 324:L190-L198. [PMID: 36625494 PMCID: PMC9925159 DOI: 10.1152/ajplung.00086.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/19/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Pulmonary fibrosis is characterized by the accumulation of myofibroblasts in the lung and progressive tissue scarring. Fibroblasts exist across a spectrum of states, from quiescence in health to activated myofibroblasts in the setting of injury. Highly activated myofibroblasts have a critical role in the establishment of fibrosis as the predominant source of type 1 collagen and profibrotic mediators. Myofibroblasts are also highly contractile cells and can alter lung biomechanical properties through tissue contraction. Inhibiting signaling pathways involved in myofibroblast activation could therefore have significant therapeutic value. One of the ways myofibroblast activation occurs is through activation of the Rho/myocardin-related transcription factor (MRTF)/serum response factor (SRF) pathway, which signals through intracellular actin polymerization. However, concerns surrounding the pleiotropic and ubiquitous nature of these signaling pathways have limited the translation of inhibitory drugs. Herein, we demonstrate a novel therapeutic antifibrotic strategy using myofibroblast-targeted nanoparticles containing a MTRF/SRF pathway inhibitor (CCG-1423), which has been shown to block myofibroblast activation in vitro. Myofibroblasts were preferentially targeted via the angiotensin 2 receptor, which has been shown to be selectively upregulated in animal and human studies. These nanoparticles were nontoxic and accumulated in lung myofibroblasts in the bleomycin-induced mouse model of pulmonary fibrosis, reducing the number of these activated cells and their production of profibrotic mediators. Ultimately, in a murine model of lung fibrosis, a single injection of these drugs containing targeted nanoagents reduced fibrosis as compared with control mice. This approach has the potential to deliver personalized therapy by precisely targeting signaling pathways in a cell-specific manner, allowing increased efficacy with reduced deleterious off-target effects.
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Affiliation(s)
- Rachel S Knipe
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Md Nurunnabi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Clemens K Probst
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jillian J Spinney
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Abe
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rajendran J C Bose
- Biomedical Research and Translational Medicine, Masonic Medical Research Institute, Utica, New York
| | - Khanh Ha
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Biomedical Research and Translational Medicine, Masonic Medical Research Institute, Utica, New York
| | - Amanda Logue
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Trong Nguyen
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rachel Servis
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew Drummond
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alexis Haring
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Patricia L Brazee
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Andrew M. Tager Fibrosis Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jason R McCarthy
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Biomedical Research and Translational Medicine, Masonic Medical Research Institute, Utica, New York
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7
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Villalba JA, Hilburn CF, Garlin MA, Elliott GA, Li Y, Kunitoki K, Poli S, Alba GA, Madrigal E, Taso M, Price MC, Aviles AJ, Araujo-Medina M, Bonanno L, Boyraz B, Champion SN, Harris CK, Helland TL, Hutchison B, Jobbagy S, Marshall MS, Shepherd DJ, Barth JL, Hung YP, Ly A, Hariri LP, Turbett SE, Pierce VM, Branda JA, Rosenberg ES, Mendez-Pena J, Chebib I, Rosales IA, Smith RN, Miller MA, Rosas IO, Hardin CC, Baden LR, Medoff BD, Colvin RB, Little BP, Stone JR, Mino-Kenudson M, Shih AR. Vasculopathy and Increased Vascular Congestion in Fatal COVID-19 and Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2022; 206:857-873. [PMID: 35671465 PMCID: PMC9799276 DOI: 10.1164/rccm.202109-2150oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rationale: The leading cause of death in coronavirus disease 2019 (COVID-19) is severe pneumonia, with many patients developing acute respiratory distress syndrome (ARDS) and diffuse alveolar damage (DAD). Whether DAD in fatal COVID-19 is distinct from other causes of DAD remains unknown. Objective: To compare lung parenchymal and vascular alterations between patients with fatal COVID-19 pneumonia and other DAD-causing etiologies using a multidimensional approach. Methods: This autopsy cohort consisted of consecutive patients with COVID-19 pneumonia (n = 20) and with respiratory failure and histologic DAD (n = 21; non-COVID-19 viral and nonviral etiologies). Premortem chest computed tomography (CT) scans were evaluated for vascular changes. Postmortem lung tissues were compared using histopathological and computational analyses. Machine-learning-derived morphometric analysis of the microvasculature was performed, with a random forest classifier quantifying vascular congestion (CVasc) in different microscopic compartments. Respiratory mechanics and gas-exchange parameters were evaluated longitudinally in patients with ARDS. Measurements and Main Results: In premortem CT, patients with COVID-19 showed more dilated vasculature when all lung segments were evaluated (P = 0.001) compared with controls with DAD. Histopathology revealed vasculopathic changes, including hemangiomatosis-like changes (P = 0.043), thromboemboli (P = 0.0038), pulmonary infarcts (P = 0.047), and perivascular inflammation (P < 0.001). Generalized estimating equations revealed significant regional differences in the lung microarchitecture among all DAD-causing entities. COVID-19 showed a larger overall CVasc range (P = 0.002). Alveolar-septal congestion was associated with a significantly shorter time to death from symptom onset (P = 0.03), length of hospital stay (P = 0.02), and increased ventilatory ratio [an estimate for pulmonary dead space fraction (Vd); p = 0.043] in all cases of ARDS. Conclusions: Severe COVID-19 pneumonia is characterized by significant vasculopathy and aberrant alveolar-septal congestion. Our findings also highlight the role that vascular alterations may play in Vd and clinical outcomes in ARDS in general.
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Affiliation(s)
- Julian A. Villalba
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Caroline F. Hilburn
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Michelle A. Garlin
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts;,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | | | - Yijia Li
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Keiko Kunitoki
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts;,Department of Psychiatry
| | - Sergio Poli
- Department of Medicine, Mount Sinai Medical Center, Miami Beach, Florida
| | - George A. Alba
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine
| | - Emilio Madrigal
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Manuel Taso
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Melissa C. Price
- Division of Thoracic Imaging and Intervention, Department of Radiology
| | | | | | - Liana Bonanno
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Baris Boyraz
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Samantha N. Champion
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,C. S. Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital Charlestown HealthCare Center, Charlestown, Massachusetts;,Miami-Dade County Medical Examiner Department, Miami, Florida
| | - Cynthia K. Harris
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Timothy L. Helland
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Bailey Hutchison
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Soma Jobbagy
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Michael S. Marshall
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Daniel J. Shepherd
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | | | - Yin P. Hung
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Amy Ly
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Lida P. Hariri
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine
| | - Sarah E. Turbett
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Virginia M. Pierce
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Pediatric Infectious Disease Unit, MassGeneral Hospital for Children, Boston, Massachusetts
| | - John A. Branda
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Eric S. Rosenberg
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Ivan Chebib
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Ivy A. Rosales
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Immunopathology Research Laboratory, and
| | - Rex N. Smith
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Immunopathology Research Laboratory, and
| | - Miles A. Miller
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ivan O. Rosas
- Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Charles C. Hardin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine
| | - Lindsey R. Baden
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine
| | - Robert B. Colvin
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Immunopathology Research Laboratory, and
| | - Brent P. Little
- Division of Thoracic Imaging and Intervention, Department of Radiology,,Division of Cardiothoracic Imaging, Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - James R. Stone
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Mari Mino-Kenudson
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Angela R. Shih
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
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8
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Nandy S, Berigei SR, Keyes CM, Muniappan A, Auchincloss HG, Lanuti M, Roop BW, Shih AR, Colby TV, Medoff BD, Suter MJ, Villiger M, Hariri LP. Polarization-Sensitive Endobronchial Optical Coherence Tomography for Microscopic Imaging of Fibrosis in Interstitial Lung Disease. Am J Respir Crit Care Med 2022; 206:905-910. [PMID: 35675552 DOI: 10.1164/rccm.202112-2832le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sreyankar Nandy
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | | | - Colleen M Keyes
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Ashok Muniappan
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Hugh G Auchincloss
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Michael Lanuti
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | | | - Angela R Shih
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | | | - Benjamin D Medoff
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Melissa J Suter
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Martin Villiger
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Lida P Hariri
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
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9
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Yang Y, Santos DM, Pantano L, Knipe R, Abe E, Logue A, Pronzati G, Black KE, Spinney JJ, Giacona F, Bieler M, Godbout C, Nicklin P, Wyatt D, Tager AM, Seither P, Herrmann FE, Medoff BD. Screening for Inhibitors of YAP Nuclear Localization Identifies Aurora Kinase A as a Modulator of Lung Fibrosis. Am J Respir Cell Mol Biol 2022; 67:36-49. [PMID: 35377835 PMCID: PMC9798384 DOI: 10.1165/rcmb.2021-0428oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 04/04/2022] [Indexed: 01/01/2023] Open
Abstract
Idiopathic pulmonary fibrosis is a progressive lung disease with limited therapeutic options that is characterized by pathological fibroblast activation and aberrant lung remodeling with scar formation. YAP (Yes-associated protein) is a transcriptional coactivator that mediates mechanical and biochemical signals controlling fibroblast activation. We previously identified HMG-CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors (statins) as YAP inhibitors based on a high-throughput small-molecule screen in primary human lung fibroblasts. Here we report that several Aurora kinase inhibitors were also identified from the top hits of this screen. MK-5108, a highly selective inhibitor for AURKA (Aurora kinase A), induced YAP phosphorylation and cytoplasmic retention and significantly reduced profibrotic gene expression in human lung fibroblasts. The inhibitory effect on YAP nuclear translocation and profibrotic gene expression is specific to inhibition of AURKA, but not Aurora kinase B or C, and is independent of the Hippo pathway kinases LATS1 and LATS2 (Large Tumor Suppressor 1 and 2). Further characterization of the effects of MK-5108 demonstrate that it inhibits YAP nuclear localization indirectly via effects on actin polymerization and TGFβ (Transforming Growth Factor β) signaling. In addition, MK-5108 treatment reduced lung collagen deposition in the bleomycin mouse model of pulmonary fibrosis. Our results reveal a novel role for AURKA in YAP-mediated profibrotic activity in fibroblasts and highlight the potential of small-molecule screens for YAP inhibitors for identification of novel agents with antifibrotic activity.
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Affiliation(s)
- Yang Yang
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniela M Santos
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lorena Pantano
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rachel Knipe
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Abe
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amanda Logue
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gina Pronzati
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Katharine E Black
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jillian J Spinney
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Francesca Giacona
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Andrew M Tager
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Franziska E Herrmann
- Immunology and Respiratory Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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10
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Hariri LP, Flashner BM, Kanarek DJ, O'Donnell WJ, Soskis A, Ziehr DR, Frank A, Nandy S, Berigei SR, Sharma A, Mathisen D, Keyes CM, Lanuti M, Muniappan A, Shepard JAO, Mino-Kenudson M, Ly A, Hung YP, Castelino FV, Ott HC, Medoff BD, Christiani DC. E-Cigarette Use, Small Airway Fibrosis, and Constrictive Bronchiolitis. NEJM Evid 2022; 1:10.1056/evidoa2100051. [PMID: 37122361 PMCID: PMC10137322 DOI: 10.1056/evidoa2100051] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Vaping, including the use of electronic cigarettes (e-cigarettes), has become increasingly prevalent, yet the associated long-term health risks are largely unknown. Given the prevalence of use, particularly among adolescents early in their lifespan, it is vital to understand the potential chronic pathologic sequelae of vaping. METHODS We present the cases of four patients with chronic lung disease associated with e-cigarette use characterized by clinical evaluation, with pulmonary function tests (PFTs), chest high-resolution computed tomography (HRCT), endobronchial optical coherence tomography (EB-OCT) imaging, and histopathologic assessment. RESULTS Each patient presented with shortness of breath and chest pain in association with a 3- to 8-year history of e-cigarette use, with mild progressive airway obstruction on PFTs and/or chest HRCT findings demonstrating evidence of air trapping and bronchial wall thickening. EB-OCT imaging performed in two patients showed small airway–centered fibrosis with bronchiolar narrowing and lumen irregularities. The predominant histopathologic feature on surgical lung biopsy was small airway–centered fibrosis, including constrictive bronchiolitis and MUC5AC overexpression in all patients. Patients who ceased vaping had a partial, but not complete, reversal of disease over 1 to 4 years. CONCLUSIONS After thorough evaluation for other potential etiologies, vaping was considered to be the most likely common causal etiology for all patients due to the temporal association of symptomatic chronic lung disease with e-cigarette use and partial improvement in symptoms after e-cigarette cessation. In this series, we associate the histopathologic pattern of small airway–centered fibrosis, including constrictive bronchiolitis, with vaping, potentially defining a clinical and pathologic entity associated with e-cigarette use. (Funded in part by the National Institutes of Health.)
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Affiliation(s)
- Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Bess M Flashner
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - David J Kanarek
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Walter J O'Donnell
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Alyssa Soskis
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
- Division of Pulmonary and Critical Care Medicine, Duke University Hospital, Durham, NC
| | - David R Ziehr
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Angela Frank
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Sarita R Berigei
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Amita Sharma
- Harvard Medical School, Boston
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Douglas Mathisen
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Colleen M Keyes
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Michael Lanuti
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Ashok Muniappan
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | | | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Flavia V Castelino
- Harvard Medical School, Boston
- Division of Rheumatology, Massachusetts General Hospital, Boston
| | - Harald C Ott
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - David C Christiani
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
- Harvard T.H. Chan School of Public Health, Boston
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11
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Nandy S, Raphaely RA, Muniappan A, Shih A, Roop BW, Sharma A, Keyes CM, Colby TV, Auchincloss HG, Gaissert HA, Lanuti M, Morse CR, Ott HC, Wain JC, Wright CD, Garcia-Moliner ML, Smith ML, VanderLaan PA, Berigei SR, Mino-Kenudson M, Horick NK, Liang LL, Davies DL, Szabari MV, Caravan P, Medoff BD, Tager AM, Suter MJ, Hariri LP. Reply to Kalverda et al.: Endobronchial Optical Coherence Tomography: Shining New Light on Diagnosing Usual Interstitial Pneumonitis? Am J Respir Crit Care Med 2022; 205:968-971. [PMID: 35148493 PMCID: PMC9838623 DOI: 10.1164/rccm.202112-2737le] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Sreyankar Nandy
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Rebecca A. Raphaely
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Ashok Muniappan
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Angela Shih
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | - Amita Sharma
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Colleen M. Keyes
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | - Hugh G. Auchincloss
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Henning A. Gaissert
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Michael Lanuti
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Christopher R. Morse
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Harald C. Ott
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - John C. Wain
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts,St. Elizabeth’s Medical CenterBoston, Massachusetts
| | - Cameron D. Wright
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | | | - Paul A. VanderLaan
- Harvard Medical SchoolBoston, Massachusetts,Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | | | - Mari Mino-Kenudson
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Nora K. Horick
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | | | - Margit V. Szabari
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Peter Caravan
- Harvard Medical SchoolBoston, Massachusetts,Athinoula A. Martinos Center for Biomedical ImagingCharlestown, Massachusetts,Massachusetts General HospitalCharlestown, Massachusetts
| | - Benjamin D. Medoff
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Andrew M. Tager
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Melissa J. Suter
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Lida P. Hariri
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts,Corresponding author (e-mail: )
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12
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Knipe RS, Spinney JJ, Abe EA, Probst CK, Franklin A, Logue A, Giacona F, Drummond M, Griffith J, Brazee PL, Hariri LP, Montesi SB, Black KE, Hla T, Kuo A, Cartier A, Engelbrecht E, Christoffersen C, Shea BS, Tager AM, Medoff BD. Endothelial-Specific Loss of Sphingosine-1-Phosphate Receptor 1 Increases Vascular Permeability and Exacerbates Bleomycin-induced Pulmonary Fibrosis. Am J Respir Cell Mol Biol 2022; 66:38-52. [PMID: 34343038 PMCID: PMC8803357 DOI: 10.1165/rcmb.2020-0408oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 07/26/2021] [Indexed: 11/24/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive disease which leads to significant morbidity and mortality from respiratory failure. The two drugs currently approved for clinical use slow the rate of decline in lung function but have not been shown to halt disease progression or reverse established fibrosis. Thus, new therapeutic targets are needed. Endothelial injury and the resultant vascular permeability are critical components in the response to tissue injury and are present in patients with IPF. However, it remains unclear how vascular permeability affects lung repair and fibrosis following injury. Lipid mediators such as sphingosine-1-phosphate (S1P) are known to regulate multiple homeostatic processes in the lung including vascular permeability. We demonstrate that endothelial cell-(EC) specific deletion of the S1P receptor 1 (S1PR1) in mice (EC-S1pr1-/-) results in increased lung vascular permeability at baseline. Following a low-dose intratracheal bleomycin challenge, EC-S1pr1-/- mice had increased and persistent vascular permeability compared with wild-type mice, which was strongly correlated with the amount and localization of resulting pulmonary fibrosis. EC-S1pr1-/- mice also had increased immune cell infiltration and activation of the coagulation cascade within the lung. However, increased circulating S1P ligand in ApoM-overexpressing mice was insufficient to protect against bleomycin-induced pulmonary fibrosis. Overall, these data demonstrate that endothelial cell S1PR1 controls vascular permeability in the lung, is associated with changes in immune cell infiltration and extravascular coagulation, and modulates the fibrotic response to lung injury.
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Affiliation(s)
- Rachel S. Knipe
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
- Center for Immunology and Inflammatory Diseases
| | - Jillian J. Spinney
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
- Center for Immunology and Inflammatory Diseases
| | - Elizabeth A. Abe
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
- Center for Immunology and Inflammatory Diseases
| | - Clemens K. Probst
- Boston University School of Medicine, Boston University, Boston, Massachusetts
| | | | - Amanda Logue
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
- Center for Immunology and Inflammatory Diseases
| | - Francesca Giacona
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
- Center for Immunology and Inflammatory Diseases
| | - Matt Drummond
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
- Center for Immunology and Inflammatory Diseases
| | - Jason Griffith
- Division of Pulmonary and Critical Care Medicine
- Center for Immunology and Inflammatory Diseases
| | - Patricia L. Brazee
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
- Center for Immunology and Inflammatory Diseases
| | - Lida P. Hariri
- Andrew M. Tager Fibrosis Research Center
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sydney B. Montesi
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
| | - Katherine E. Black
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
- Center for Immunology and Inflammatory Diseases
| | - Timothy Hla
- Vascular Biology Program, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew Kuo
- Vascular Biology Program, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andreane Cartier
- Vascular Biology Program, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric Engelbrecht
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Rigshospitalet, and Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; and
| | - Barry S. Shea
- Division of Pulmonary, Critical Care, and Sleep Medicine, Rhode Island Hospital and Alpert Medical School, Providence, Rhode Island
| | - Andrew M. Tager
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
- Center for Immunology and Inflammatory Diseases
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine
- Andrew M. Tager Fibrosis Research Center
- Center for Immunology and Inflammatory Diseases
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13
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Nandy S, Raphaely RA, Muniappan A, Shih A, Roop BW, Sharma A, Keyes CM, Colby TV, Auchincloss HG, Gaissert HA, Lanuti M, Morse CR, Ott HC, Wain JC, Wright CD, Garcia-Moliner ML, Smith ML, VanderLaan PA, Berigei SR, Mino-Kenudson M, Horick NK, Liang LL, Davies DL, Szabari MV, Caravan P, Medoff BD, Tager AM, Suter MJ, Hariri LP. Diagnostic Accuracy of Endobronchial Optical Coherence Tomography for the Microscopic Diagnosis of Usual Interstitial Pneumonia. Am J Respir Crit Care Med 2021; 204:1164-1179. [PMID: 34375171 PMCID: PMC8759308 DOI: 10.1164/rccm.202104-0847oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Early, accurate diagnosis of interstitial lung disease (ILD) informs prognosis and therapy, especially in idiopathic pulmonary fibrosis (IPF). Current diagnostic methods are imperfect. High-resolution computed tomography has limited resolution, and surgical lung biopsy (SLB) carries risks of morbidity and mortality. Endobronchial optical coherence tomography (EB-OCT) is a low-risk, bronchoscope-compatible modality that images large lung volumes in vivo with microscopic resolution, including subpleural lung, and has the potential to improve the diagnostic accuracy of bronchoscopy for ILD diagnosis. Objectives: We performed a prospective diagnostic accuracy study of EB-OCT in patients with ILD with a low-confidence diagnosis undergoing SLB. The primary endpoints were EB-OCT sensitivity/specificity for diagnosis of the histopathologic pattern of usual interstitial pneumonia (UIP) and clinical IPF. The secondary endpoint was agreement between EB-OCT and SLB for diagnosis of the ILD fibrosis pattern. Methods: EB-OCT was performed immediately before SLB. The resulting EB-OCT images and histopathology were interpreted by blinded, independent pathologists. Clinical diagnosis was obtained from the treating pulmonologists after SLB, blinded to EB-OCT. Measurements and Main Results: We enrolled 31 patients, and 4 were excluded because of inconclusive histopathology or lack of EB-OCT data. Twenty-seven patients were included in the analysis (16 men, average age: 65.0 yr): 12 were diagnosed with UIP and 15 with non-UIP ILD. Average FVC and DlCO were 75.3% (SD, 18.5) and 53.5% (SD, 16.4), respectively. Sensitivity and specificity of EB-OCT was 100% (95% confidence interval, 75.8-100.0%) and 100% (79.6-100%), respectively, for both histopathologic UIP and clinical diagnosis of IPF. There was high agreement between EB-OCT and histopathology for diagnosis of ILD fibrosis pattern (weighted κ: 0.87 [0.72-1.0]). Conclusions: EB-OCT is a safe, accurate method for microscopic ILD diagnosis, as a complement to high-resolution computed tomography and an alternative to SLB.
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Affiliation(s)
- Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Rebecca A. Raphaely
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Ashok Muniappan
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Angela Shih
- Department of Pathology
- Harvard Medical School, Boston, Massachusetts
| | - Benjamin W. Roop
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
| | - Amita Sharma
- Department of Radiology, and
- Harvard Medical School, Boston, Massachusetts
| | - Colleen M. Keyes
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Thomas V. Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | | | - Michael Lanuti
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | | | - Harald C. Ott
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - John C. Wain
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
- St. Elizabeth’s Medical Center, Boston, Massachusetts
| | - Cameron D. Wright
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Maria L. Garcia-Moliner
- Department of Pathology, Rhode Island Hospital and Alpert Medical School, Providence, Rhode Island
| | - Maxwell L. Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Paul A. VanderLaan
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sarita R. Berigei
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
| | | | - Nora K. Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Margit V. Szabari
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Peter Caravan
- Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts; and
- Institute for Innovation in Imaging (i), Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Andrew M. Tager
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Melissa J. Suter
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Department of Pathology
- Harvard Medical School, Boston, Massachusetts
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14
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Alba GA, Ziehr DR, Rouvina JN, Hariri LP, Knipe RS, Medoff BD, Hibbert KA, Kowal A, Hoenstine C, Ginns LC, Lewis GD, Hardin CC. Exercise performance in patients with post-acute sequelae of SARS-CoV-2 infection compared to patients with unexplained dyspnea. EClinicalMedicine 2021; 39:101066. [PMID: 34476393 PMCID: PMC8401400 DOI: 10.1016/j.eclinm.2021.101066] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Dyspnea and exercise intolerance are commonly reported post-acute sequelae of SARS-CoV-2 infection (PASC), but routine diagnostic testing is often normal. Cardiopulmonary exercise testing (CPET) offers comprehensive assessment of dyspnea to characterize pulmonary PASC. METHODS We performed a retrospective cohort study of CPET performed on patients reporting dyspnea and/or exercise intolerance following confirmed Covid-19 between August 1, 2020 and March 1, 2021, and compared them to age- and sex-matched patients with unexplained dyspnea referred for CPET at the same center in the pre-Covid-19 era. FINDINGS Compared to matched unexplained dyspnea comparators, PASC patients shared similar medical comorbidities and subjective dyspnea at referral (mMRC score 1.6 ± 0.9 vs. 1.4 ± 0.9, P = 0.5). Fifteen (83.3%) PASC patients underwent high resolution computed tomography of the chest, of which half (46.7%) were normal, and 17 (94.4%) patients had pulmonary function testing, of which the majority (76.5%) were normal. All patients underwent CPET, and 12 (67%) had normal findings. Compared to matched comparators, PASC patients had similar peak oxygen consumption, oxygen consumption at ventilatory anaerobic threshold, and ventilatory efficiency measured by the minute ventilation to carbon dioxide production (VE/VCO2) slope. INTERPRETATION Despite prominent dyspnea, physiological abnormalities on CPET were mild across a range of initial Covid-19 severity and similar to matched comparators referred for dyspnea without antecedent SARS-CoV-2. FUNDING The project was supported by the NHLBI (R01HL131029, R01HL151841, U10HL110337, T32HL116275) and a KL2 award (5KL2TR002542-02) from Harvard Catalyst.
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Affiliation(s)
- George A. Alba
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - David R. Ziehr
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jennifer N. Rouvina
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Rachel S. Knipe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kathryn A. Hibbert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alyssa Kowal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Casey Hoenstine
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Leo C. Ginns
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Gregory D. Lewis
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - C. Corey Hardin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Corresponding author at: Massachusetts General Hospital, Boston, MA 02114, USA.
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15
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Zubiri L, Molina GE, Mooradian MJ, Cohen J, Durbin SM, Petrillo L, Boland GM, Juric D, Dougan M, Thomas MF, Faje AT, Rengarajan M, Guidon AC, Chen ST, Okin D, Medoff BD, Nasrallah M, Kohler MJ, Schoenfeld SR, Karp-Leaf RS, Sise ME, Neilan TG, Zlotoff DA, Farmer JR, Bardia A, Sullivan RJ, Blum SM, Semenov YR, Villani AC, Reynolds KL. Effect of a multidisciplinary Severe Immunotherapy Complications Service on outcomes for patients receiving immune checkpoint inhibitor therapy for cancer. J Immunother Cancer 2021; 9:e002886. [PMID: 34544895 PMCID: PMC8454442 DOI: 10.1136/jitc-2021-002886] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In 2017, Massachusetts General Hospital implemented the Severe Immunotherapy Complications (SIC) Service, a multidisciplinary care team for patients hospitalized with immune-related adverse events (irAEs), a unique spectrum of toxicities associated with immune checkpoint inhibitors (ICIs). This study's objectives were to evaluate the intervention's (1) effect on patient outcomes and healthcare utilization, and (2) ability to collect biological samples via a central infrastructure, in order to study the mechanisms responsible for irAEs. METHODS A hospital database was used to identify patients who received ICIs for a malignancy and were hospitalized with severe irAEs, before (April 2, 2016-October 3, 2017) and after (October 3, 2017-October 24, 2018) SIC Service initiation. The primary outcome was readmission rate after index hospitalization. Secondary outcomes included length of stay (LOS) for admissions, corticosteroid and non-steroidal second-line immunosuppression use, ICI discontinuation, and inpatient mortality. RESULTS In the pre-SIC period, 127 of 1169 patients treated with ICIs were hospitalized for irAEs; in the post-SIC period, 122 of 1159. After SIC service initiation, reductions were observed in irAE readmission rate (14.8% post-SIC vs 25.9% pre-SIC; OR 0.46; 95% CI 0.22 to 0.95; p=0.036) and readmission LOS (median 6 days post-SIC vs 7 days pre-SIC; 95% CI -16.03 to -0.14; p=0.046). No significant pre-initiation and post-initiation differences were detected in corticosteroid use, second-line immunosuppression, ICI discontinuation, or inpatient mortality rates. The SIC Service collected 789 blood and tissue samples from 234 patients with suspected irAEs. CONCLUSIONS This is the first study to report that establishing a highly subspecialized care team focused on irAEs is associated with improved patient outcomes and reduced healthcare utilization. Furthermore, the SIC Service successfully integrated blood and tissue collection safety into routine care.
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Affiliation(s)
- Leyre Zubiri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriel E Molina
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meghan J Mooradian
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Justine Cohen
- Division of Oncology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sienna M Durbin
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura Petrillo
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Genevieve M Boland
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dejan Juric
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Dougan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly F Thomas
- Division of Gastroenterology, Department of Medicine, Mass General Center for Cancer Research, Division of Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex T Faje
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Rengarajan
- Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda C Guidon
- Division of Neuromuscular Disorders, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Okin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mazen Nasrallah
- Division of Rheumatology, Allergy, Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Minna J Kohler
- Division of Rheumatology, Allergy, Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara R Schoenfeld
- Division of Rheumatology, Allergy, Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca S Karp-Leaf
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meghan E Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomas G Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel A Zlotoff
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jocelyn R Farmer
- Division of Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aditya Bardia
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan J Sullivan
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven M Blum
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yevgeniy R Semenov
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra-Chloé Villani
- Massachusetts General Hospital Center for Immunology and Inflammatory Diseases, Mass General Center for Cancer Research, Division of Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kerry L Reynolds
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Alladina J, Levy SD, Cho JL, Brait KL, Rao SR, Camacho A, Hibbert KA, Harris RS, Medoff BD, Januzzi JL, Thompson BT, Bajwa EK. Plasma Soluble Suppression of Tumorigenicity-2 Associates with Ventilator Liberation in Acute Hypoxemic Respiratory Failure. Am J Respir Crit Care Med 2021; 203:1257-1265. [PMID: 33400890 DOI: 10.1164/rccm.202005-1951oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Rationale: Standard physiologic assessments of extubation readiness in patients with acute hypoxemic respiratory failure (AHRF) may not reflect lung injury resolution and could adversely affect clinical decision-making and patient outcomes. Objectives: We hypothesized that elevations in inflammatory plasma biomarkers sST2 (soluble suppression of tumorigenicity-2) and IL-6 indicate ongoing lung injury in AHRF and better inform patient outcomes compared with standard clinical assessments. Methods: We measured daily plasma biomarkers and physiologic variables in 200 patients with AHRF for up to 9 days after intubation. We tested the associations of baseline values with the primary outcome of unassisted breathing at Day 29. We analyzed the ability of serial biomarker measurements to inform successful ventilator liberation. Measurements and Main Results: Baseline sST2 concentrations were higher in patients dead or mechanically ventilated versus breathing unassisted at Day 29 (491.7 ng/ml [interquartile range (IQR), 294.5-670.1 ng/ml] vs. 314.4 ng/ml [IQR, 127.5-550.1 ng/ml]; P = 0.0003). Higher sST2 concentrations over time were associated with a decreased probability of ventilator liberation (hazard ratio, 0.80 per log-unit increase; 95% confidence interval [CI], 0.75-0.83; P = 0.03). Patients with higher sST2 concentrations on the day of liberation were more likely to fail liberation compared with patients who remained successfully liberated (320.9 ng/ml [IQR, 181.1- 495.6 ng/ml] vs. 161.6 ng/ml [IQR, 95.8-292.5 ng/ml]; P = 0.002). Elevated sST2 concentrations on the day of liberation decreased the odds of successful liberation when adjusted for standard physiologic parameters (odds ratio, 0.325; 95% CI, 0.119-0.885; P = 0.03). IL-6 concentrations did not associate with outcomes. Conclusions: Using sST2 concentrations to guide ventilator management may more accurately reflect underlying lung injury and outperform traditional measures of readiness for ventilator liberation.
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Affiliation(s)
| | - Sean D Levy
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Josalyn L Cho
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Sowmya R Rao
- Boston University School of Public Health, Boston, Massachusetts; and
| | - Alexander Camacho
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | - R Scott Harris
- Division of Pulmonary and Critical Care Medicine and.,Vertex Pharmaceuticals, Boston, Massachusetts
| | | | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Ednan K Bajwa
- Division of Pulmonary and Critical Care Medicine and
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17
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Gard AL, Luu RJ, Miller CR, Maloney R, Cain BP, Marr EE, Burns DM, Gaibler R, Mulhern TJ, Wong CA, Alladina J, Coppeta JR, Liu P, Wang JP, Azizgolshani H, Fezzie RF, Balestrini JL, Isenberg BC, Medoff BD, Finberg RW, Borenstein JT. High-throughput human primary cell-based airway model for evaluating influenza, coronavirus, or other respiratory viruses in vitro. Sci Rep 2021; 11:14961. [PMID: 34294757 PMCID: PMC8298517 DOI: 10.1038/s41598-021-94095-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022] Open
Abstract
Influenza and other respiratory viruses present a significant threat to public health, national security, and the world economy, and can lead to the emergence of global pandemics such as from COVID-19. A barrier to the development of effective therapeutics is the absence of a robust and predictive preclinical model, with most studies relying on a combination of in vitro screening with immortalized cell lines and low-throughput animal models. Here, we integrate human primary airway epithelial cells into a custom-engineered 96-device platform (PREDICT96-ALI) in which tissues are cultured in an array of microchannel-based culture chambers at an air-liquid interface, in a configuration compatible with high resolution in-situ imaging and real-time sensing. We apply this platform to influenza A virus and coronavirus infections, evaluating viral infection kinetics and antiviral agent dosing across multiple strains and donor populations of human primary cells. Human coronaviruses HCoV-NL63 and SARS-CoV-2 enter host cells via ACE2 and utilize the protease TMPRSS2 for spike protein priming, and we confirm their expression, demonstrate infection across a range of multiplicities of infection, and evaluate the efficacy of camostat mesylate, a known inhibitor of HCoV-NL63 infection. This new capability can be used to address a major gap in the rapid assessment of therapeutic efficacy of small molecules and antiviral agents against influenza and other respiratory viruses including coronaviruses.
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Affiliation(s)
- A L Gard
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - R J Luu
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - C R Miller
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - R Maloney
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - B P Cain
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - E E Marr
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - D M Burns
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - R Gaibler
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - T J Mulhern
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - C A Wong
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - J Alladina
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - J R Coppeta
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - P Liu
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - J P Wang
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - H Azizgolshani
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | | | - J L Balestrini
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - B C Isenberg
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA
| | - B D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - R W Finberg
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - J T Borenstein
- Bioengineering Division, Draper, Cambridge, MA, 02139, USA.
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18
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Corleis B, Cho JL, Gates SJ, Linder AH, Dickey A, Lisanti-Park AC, Schiff AE, Ghebremichael M, Kohli P, Winkler T, Harris RS, Medoff BD, Kwon DS. Smoking and HIV-1 Infection Promote Retention of CD8+ T Cells in the Airway Mucosa. Am J Respir Cell Mol Biol 2021; 65:513-520. [PMID: 34166603 DOI: 10.1165/rcmb.2021-0168oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Smoking and HIV-1 infection are risk factors for COPD, which is among the most common comorbid conditions in people living with HIV-1. HIV-1 infection leads to persistent expansion of CD8+ T cells, and CD8+ T cell-mediated inflammation has been implicated in COPD pathogenesis. In this study, we investigated the effects of HIV-1 infection and smoking on T cell dynamics in patients at risk of COPD. Bronchoalveolar lavage (BAL), endobronchial brushings and blood from HIV-1 infected and uninfected non-smokers and smokers were analyzed by flow cytometry, and lungs were imaged by computed tomography. Chemokines were measured in BAL fluid, and CD8+ T cell chemotaxis in the presence of cigarette smoke extract was assessed in vitro. HIV-1 infection increased CD8+ T cells in the BAL, but this increase was abrogated by smoking. Smokers had reduced BAL levels of the T cell-recruiting chemokines CXCL10 and CCL5, and cigarette smoke extract inhibited CXCL10 and CCL5 production by macrophages and CD8+ T cell transmigration in vitro. In contrast to the BAL, CD8+ T cells in endobronchial brushings were increased in HIV-1 infected smokers, driven by an accumulation of effector memory T cells in the airway mucosa and an increase in tissue resident memory T cells. Mucosal CD8+ T cell numbers inversely correlated with lung aeration, suggesting an association with inflammation and remodeling. HIV-1 infection and smoking lead to retention of CD8+ T cells within the airway mucosa.
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Affiliation(s)
- Björn Corleis
- Ragon Institute, 200750, Charlestown, Massachusetts, United States.,Friedrich-Loeffler-Institute Federal Research Institute for Animal Health, 39023, Institute of Immunology, Greifswald - Insel Riems, Germany
| | - Josalyn L Cho
- University of Iowa Roy J and Lucille A Carver College of Medicine, 12243, Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, Iowa City, Iowa, United States;
| | - Samantha J Gates
- Ragon Institute, 200750, Charlestown, Massachusetts, United States
| | - Alice H Linder
- Ragon Institute, 200750, Charlestown, Massachusetts, United States
| | - Amy Dickey
- Massachusetts General Hospital, 2348, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | | | - Abigail E Schiff
- Ragon Institute, 200750, Charlestown, Massachusetts, United States
| | | | - Puja Kohli
- Massachusetts General Hospital, 2348, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Tilo Winkler
- Massachusetts General Hospital, 2348, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - R Scott Harris
- Massachusetts General Hospital, 2348, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Benjamin D Medoff
- Massachusetts General Hospital, 2348, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Douglas S Kwon
- Massachusetts General Hospital, 2348, Department of Medicine, Division of Infectious Diseases, Boston, Massachusetts, United States.,Ragon Institute, 200750, Charlestown, Massachusetts, United States
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19
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Molina GE, Zubiri L, Cohen JV, Durbin SM, Petrillo L, Allen IM, Murciano‐Goroff YR, Dougan M, Thomas MF, Faje AT, Rengarajan M, Guidon AC, Chen ST, Okin D, Medoff BD, Nasrallah M, Kohler MJ, Schoenfeld SR, Karp Leaf RS, Sise ME, Neilan TG, Zlotoff DA, Farmer JR, Mooradian MJ, Bardia A, Mai M, Sullivan RJ, Semenov YR, Villani AC, Reynolds KL. Temporal Trends and Outcomes Among Patients Admitted for Immune-Related Adverse Events: A Single-Center Retrospective Cohort Study from 2011 to 2018. Oncologist 2021; 26:514-522. [PMID: 33655682 PMCID: PMC8176966 DOI: 10.1002/onco.13740] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of this study was to characterize severe immune-related adverse events (irAEs) seen among hospitalized patients and to examine risk factors for irAE admissions and clinically relevant outcomes, including length of stay, immune checkpoint inhibitor (ICI) discontinuation, readmission, and death. METHODS Patients who received ICI therapy (ipilimumab, pembrolizumab, nivolumab, atezolizumab, durvalumab, avelumab, or any ICI combination) at Massachusetts General Hospital (MGH) and were hospitalized at MGH following ICI initiation between January 1, 2011, and October 24, 2018, were identified using pharmacy and hospital admission databases. Medical records of all irAE admissions were reviewed, and specialist review with defined criteria was performed. Demographic data, relevant clinical history (malignancy type and most recent ICI regimen), and key admission characteristics, including dates of admission and discharge, immunosuppressive management, ICI discontinuation, readmission, and death, were collected. RESULTS In total, 450 admissions were classified as irAE admissions and represent the study's cohort. Alongside the increasing use of ICIs at our institution, the number of patients admitted to MGH for irAEs has gradually increased every year from 9 in 2011 to 92 in 2018. The hospitalization rate per ICI recipient has declined over that same time period (25.0% in 2011 to 8.5% in 2018). The most common toxicities leading to hospitalization in our cohort were gastrointestinal (30.7%; n = 138), pulmonary (15.8%; n = 71), hepatic (14.2%; n = 64), endocrine (12.2%; n = 55), neurologic (8.4%; n = 38), cardiac (6.7%; n = 30), and dermatologic (4.4%; n = 20). Multivariable logistic regression revealed statistically significant increases in irAE admission risk for CTLA-4 monotherapy recipients (odds ratio [OR], 2.02; p < .001) and CTLA-4 plus PD-1 combination therapy recipients (OR, 1.88; p < .001), relative to PD-1/PD-L1 monotherapy recipients, and patients with multiple toxicity had a 5-fold increase in inpatient mortality. CONCLUSION This study illustrates that cancer centers must be prepared to manage a wide variety of irAE types and that CTLA-4 and combination ICI regimens are more likely to cause irAE admissions, and earlier. In addition, admissions for patients with multi-organ involvement is common and those patients are at highest risk of inpatient mortality. IMPLICATIONS FOR PRACTICE The number of patients admitted to Massachusetts General Hospital for immune-related adverse events (irAEs) has gradually increased every year and the most common admissions are for gastrointestinal (30.7%), pulmonary (15/8%), and hepatic (14.2%) events. Readmission rates are high (29% at 30 days, 49% at 180 days) and 64.2% have to permanently discontinue immune checkpoint inhibitor therapy. Importantly, multiple concurrent toxicities were seen in 21.6% (97/450) of irAE admissions and these patients have a fivefold increased risk of inpatient death.
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Affiliation(s)
- Gabriel E. Molina
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Leyre Zubiri
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Justine V. Cohen
- Division of Oncology, Department of Medicine, University of Pennsylvania, Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Sienna M. Durbin
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Laura Petrillo
- Division of Palliative Care, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Ian M. Allen
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Michael Dougan
- Division of Gastroenterology, Department of Medicine, Mass General Center for Cancer Research, Division of Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Molly F. Thomas
- Division of Gastroenterology, Department of Medicine, Mass General Center for Cancer Research, Division of Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Alexander T. Faje
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Michelle Rengarajan
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Amanda C. Guidon
- Division of Neuromuscular Disorders, Department of Neurology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Steven T. Chen
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Daniel Okin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Mazen Nasrallah
- Division of Rheumatology, Allergy, Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Minna J. Kohler
- Division of Rheumatology, Allergy, Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Sara R. Schoenfeld
- Division of Rheumatology, Allergy, Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Rebecca S. Karp Leaf
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Meghan E. Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Tomas G. Neilan
- Cardio‐Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Daniel A. Zlotoff
- Cardio‐Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Jocelyn R. Farmer
- Division of Allergy and Immunology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Meghan J. Mooradian
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Aditya Bardia
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Minh Mai
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Ryan J. Sullivan
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Yevgeniy R. Semenov
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Alexandra Chloé Villani
- Massachusetts General Hospital Center for Immunology and Inflammatory Diseases. Mass General Center for Cancer Research Division of Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Kerry L. Reynolds
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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20
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McNeill JN, Lau ES, Zern EK, Nayor M, Malhotra R, Liu EE, Bhat RR, Brooks LC, Farrell R, Sbarbaro JA, Schoenike MW, Medoff BD, Lewis GD, Ho JE. Association of obesity-related inflammatory pathways with lung function and exercise capacity. Respir Med 2021; 183:106434. [PMID: 33964816 DOI: 10.1016/j.rmed.2021.106434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Obesity has multifactorial effects on lung function and exercise capacity. The contributions of obesity-related inflammatory pathways to alterations in lung function remain unclear. RESEARCH QUESTION To examine the association of obesity-related inflammatory pathways with pulmonary function, exercise capacity, and pulmonary-specific contributors to exercise intolerance. METHOD We examined 695 patients who underwent cardiopulmonary exercise testing (CPET) with invasive hemodynamic monitoring at Massachusetts General Hospital between December 2006-June 2017. We investigated the association of adiponectin, leptin, resistin, IL-6, CRP, and insulin resistance (HOMA-IR) with pulmonary function and exercise parameters using multivariable linear regression. RESULTS Obesity-related inflammatory pathways were associated with worse lung function. Specifically, higher CRP, IL-6, and HOMA-IR were associated with lower percent predicted FEV1 and FVC with a preserved FEV1/FVC ratio suggesting a restrictive physiology pattern (P ≤ 0.001 for all). For example, a 1-SD higher natural-logged CRP level was associated with a nearly 5% lower percent predicted FEV1 and FVC (beta -4.8, s.e. 0.9 for FEV1; beta -4.9, s.e. 0.8 for FVC; P < 0.0001 for both). Obesity-related inflammatory pathways were associated with worse pulmonary vascular distensibility (adiponectin, IL-6, and CRP, P < 0.05 for all), as well as lower pulmonary artery compliance (IL-6 and CRP, P ≤ 0.01 for both). INTERPRETATION Our findings highlight the importance of obesity-related inflammatory pathways including inflammation and insulin resistance on pulmonary spirometry and pulmonary vascular function. Specifically, systemic inflammation as ascertained by CRP, IL-6 and insulin resistance are associated with restrictive pulmonary physiology independent of BMI. In addition, inflammatory markers were associated with lower exercise capacity and pulmonary vascular dysfunction.
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Affiliation(s)
- Jenna N McNeill
- From the Cardiovascular Research Center, Division of Massachusetts General Hospital, Boston, MA, USA; Pulmonary and Critical Care, Division of Massachusetts General Hospital, Boston, MA, USA
| | - Emily S Lau
- From the Cardiovascular Research Center, Division of Massachusetts General Hospital, Boston, MA, USA; Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Emily K Zern
- From the Cardiovascular Research Center, Division of Massachusetts General Hospital, Boston, MA, USA; Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Nayor
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Rajeev Malhotra
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth E Liu
- From the Cardiovascular Research Center, Division of Massachusetts General Hospital, Boston, MA, USA
| | - Rohan R Bhat
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Liana C Brooks
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Robyn Farrell
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - John A Sbarbaro
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Mark W Schoenike
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin D Medoff
- Pulmonary and Critical Care, Division of Massachusetts General Hospital, Boston, MA, USA
| | - Gregory D Lewis
- Cardiology Division of Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer E Ho
- From the Cardiovascular Research Center, Division of Massachusetts General Hospital, Boston, MA, USA; Cardiology Division of Massachusetts General Hospital, Boston, MA, USA.
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21
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Schwartzstein RM, Medoff BD, Sharma A, Colson YL, Gainor J, Hariri LP. Case 4-2021: A 70-Year-Old Woman with Dyspnea on Exertion and Abnormal Findings on Chest Imaging. N Engl J Med 2021; 384:563-574. [PMID: 33567196 DOI: 10.1056/nejmcpc2027088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Richard M Schwartzstein
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
| | - Benjamin D Medoff
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
| | - Amita Sharma
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
| | - Yolonda L Colson
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
| | - Justin Gainor
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
| | - Lida P Hariri
- From the Department of Medicine, Beth Israel Deaconess Medical Center (R.M.S.), the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (B.D.M., J.G.), Radiology (A.S.), Surgery (Y.L.C.), and Pathology (L.P.H.), Harvard Medical School - all in Boston
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22
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Ziehr DR, Alladina J, Petri CR, Maley JH, Moskowitz A, Medoff BD, Hibbert KA, Thompson BT, Hardin CC. Reply to Yaroshetskiy et al.: Acute Respiratory Distress Syndrome in COVID-19: Do All These Patients Definitely Require Intubation and Mechanical Ventilation? Am J Respir Crit Care Med 2020; 202:1481-1482. [PMID: 32809839 PMCID: PMC7667895 DOI: 10.1164/rccm.202007-2972le] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- David R Ziehr
- Massachusetts General Hospital Boston, Massachusetts and.,Beth Israel Deaconess Medical Center Boston, Massachusetts
| | - Jehan Alladina
- Massachusetts General Hospital Boston, Massachusetts and
| | - Camille R Petri
- Massachusetts General Hospital Boston, Massachusetts and.,Beth Israel Deaconess Medical Center Boston, Massachusetts
| | - Jason H Maley
- Massachusetts General Hospital Boston, Massachusetts and.,Beth Israel Deaconess Medical Center Boston, Massachusetts
| | - Ari Moskowitz
- Beth Israel Deaconess Medical Center Boston, Massachusetts
| | | | | | | | - C Corey Hardin
- Massachusetts General Hospital Boston, Massachusetts and
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23
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Hariri LP, North CM, Shih AR, Israel RA, Maley JH, Villalba JA, Vinarsky V, Rubin J, Okin DA, Sclafani A, Alladina JW, Griffith JW, Gillette MA, Raz Y, Richards CJ, Wong AK, Ly A, Hung YP, Chivukula RR, Petri CR, Calhoun TF, Brenner LN, Hibbert KA, Medoff BD, Hardin CC, Stone JR, Mino-Kenudson M. Lung Histopathology in Coronavirus Disease 2019 as Compared With Severe Acute Respiratory Sydrome and H1N1 Influenza: A Systematic Review. Chest 2020; 159:73-84. [PMID: 33038391 PMCID: PMC7538870 DOI: 10.1016/j.chest.2020.09.259] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/20/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background Patients with severe coronavirus disease 2019 (COVID-19) have respiratory failure with hypoxemia and acute bilateral pulmonary infiltrates, consistent with ARDS. Respiratory failure in COVID-19 might represent a novel pathologic entity. Research Question How does the lung histopathology described in COVID-19 compare with the lung histopathology described in SARS and H1N1 influenza? Study Design and Methods We conducted a systematic review to characterize the lung histopathologic features of COVID-19 and compare them against findings of other recent viral pandemics, H1N1 influenza and SARS. We systematically searched MEDLINE and PubMed for studies published up to June 24, 2020, using search terms for COVID-19, H1N1 influenza, and SARS with keywords for pathology, biopsy, and autopsy. Using PRISMA-Individual Participant Data guidelines, our systematic review analysis included 26 articles representing 171 COVID-19 patients; 20 articles representing 287 H1N1 patients; and eight articles representing 64 SARS patients. Results In COVID-19, acute-phase diffuse alveolar damage (DAD) was reported in 88% of patients, which was similar to the proportion of cases with DAD in both H1N1 (90%) and SARS (98%). Pulmonary microthrombi were reported in 57% of COVID-19 and 58% of SARS patients, as compared with 24% of H1N1 influenza patients. Interpretation DAD, the histologic correlate of ARDS, is the predominant histopathologic pattern identified in lung pathology from patients with COVID-19, H1N1 influenza, and SARS. Microthrombi were reported more frequently in both patients with COVID-19 and SARS as compared with H1N1 influenza. Future work is needed to validate this histopathologic finding and, if confirmed, elucidate the mechanistic underpinnings and characterize any associations with clinically important outcomes.
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Affiliation(s)
- Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Angela R Shih
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Rebecca A Israel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jason H Maley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Vladimir Vinarsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jonah Rubin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Daniel A Okin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Alyssa Sclafani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jehan W Alladina
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jason W Griffith
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Michael A Gillette
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Yuval Raz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Christopher J Richards
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Alexandra K Wong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Raghu R Chivukula
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Whitehead Institute for Biomedical Research, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Camille R Petri
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Tiara F Calhoun
- Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Laura N Brenner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Kathryn A Hibbert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - C Corey Hardin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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24
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Faustino LD, Griffith JW, Rahimi RA, Nepal K, Hamilos DL, Cho JL, Medoff BD, Moon JJ, Vignali DAA, Luster AD. Interleukin-33 activates regulatory T cells to suppress innate γδ T cell responses in the lung. Nat Immunol 2020; 21:1371-1383. [PMID: 32989331 PMCID: PMC7578082 DOI: 10.1038/s41590-020-0785-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
Foxp3+ regulatory T (Treg) cells expressing the interleukin (IL)-33 receptor ST2 mediate tissue repair in response to IL-33. Whether Treg cells also respond to the alarmin IL-33 to regulate specific aspects of the immune response is not known. Here we describe an unexpected function of ST2+ Treg cells in suppressing the innate immune response in the lung to environmental allergens without altering the adaptive immune response. Following allergen exposure, ST2+ Treg cells were activated by IL-33 to suppress IL-17-producing γδ T cells. ST2 signaling in Treg cells induced Ebi3, a component of the heterodimeric cytokine IL-35 that was required for Treg cell-mediated suppression of γδ T cells. This response resulted in fewer eosinophil-attracting chemokines and reduced eosinophil recruitment into the lung, which was beneficial to the host in reducing allergen-induced inflammation. Thus, we define a fundamental role for ST2+ Treg cells in the lung as a negative regulator of the early innate γδ T cell response to mucosal injury.
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Affiliation(s)
- Lucas D Faustino
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason W Griffith
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rod A Rahimi
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Keshav Nepal
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel L Hamilos
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Josalyn L Cho
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin D Medoff
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James J Moon
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dario A A Vignali
- Department of Immunology, University of Pittsburgh School of Medicine and Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Andrew D Luster
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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25
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Kohli P, Kelly VJ, Hibbert KA, Corleis B, Kone M, Cho JL, DeFaria-Yeh D, Kwon DS, Medoff BD, Harris RS, Winkler T. PET Imaging Reveals Early Pulmonary Perfusion Abnormalities in HIV Infection Similar to Smoking. J Nucl Med 2020; 62:405-411. [PMID: 32764123 DOI: 10.2967/jnumed.120.245977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the most common noninfectious pulmonary disease among people living with HIV, independent of smoking. However, the cause for this enhanced susceptibility remains unclear, and the effects of HIV on pulmonary perfusion and ventilation are unknown. Methods: We used PET/CT in 46 smokers and nonsmokers, 23 of whom had documented HIV infection. Emphysema was assessed by CT and perfusion by 13N (13NN) PET scans. After removal of image noise, vertical and axial gradients in perfusion were calculated. We tested for differences in the total spatial heterogeneity of perfusion (CV2 Qtotal) and its components (CV2 Qtotal = CV2 Qvgrad [vertical gradient] + CV2 Qzgrad [axial gradient] + CV2 Qr [residual heterogeneity]) among groups. Results: There were no significant differences in demographic parameters among groups, and all subjects had minimal radiographic evidence of emphysema. Compared with controls, nonsmokers living with HIV had a significantly greater CV2 Qr/CV2 Qtotal (0.48 vs. 0.36, P = 0.05) and reduced CV2 Qvgrad/CV2 Qtotal (0.46 vs. 0.65, P = 0.038). Smokers also had a reduced CV2 Qvgrad/CV2 Qtotal, however, there was no significant difference in CV2 Qvgrad/CV2 Qtotal between smokers living with and without HIV (0.39 vs. 0.34, P = 0.58), despite a decreased vertical perfusion gradient (Qvgrad) in smokers living with HIV. Conclusion: In nonsmokers living with well-controlled HIV and minimal radiographic emphysema, HIV infection contributes to pulmonary perfusion abnormalities similar to smokers. These data indicate the onset of subclinical pulmonary perfusion abnormalities that could herald the development of significant lung disease in these susceptible individuals.
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Affiliation(s)
- Puja Kohli
- Division of Pulmonary and Critical Care at Massachusetts General Hospital, Boston, Massachusetts .,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vanessa J Kelly
- Division of Pulmonary and Critical Care at Massachusetts General Hospital, Boston, Massachusetts
| | - Kathryn A Hibbert
- Division of Pulmonary and Critical Care at Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Björn Corleis
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts
| | - Mamary Kone
- Division of Pulmonary and Critical Care at Massachusetts General Hospital, Boston, Massachusetts
| | - Josalyn L Cho
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Doreen DeFaria-Yeh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas S Kwon
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts.,Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care at Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - R Scott Harris
- Division of Pulmonary and Critical Care at Massachusetts General Hospital, Boston, Massachusetts
| | - Tilo Winkler
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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26
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Ziehr DR, Alladina J, Petri CR, Maley JH, Moskowitz A, Medoff BD, Hibbert KA, Thompson BT, Hardin CC. Reply to Epelbaum: Standards and Stereotypes in COVID-19. Am J Respir Crit Care Med 2020; 202:470-471. [PMID: 32510977 PMCID: PMC7397799 DOI: 10.1164/rccm.202005-1944le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- David R Ziehr
- Massachusetts General HospitalBoston, Massachusettsand.,Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | | | - Camille R Petri
- Massachusetts General HospitalBoston, Massachusettsand.,Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Jason H Maley
- Massachusetts General HospitalBoston, Massachusettsand.,Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Ari Moskowitz
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
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27
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Santos DM, Pantano L, Pronzati G, Grasberger P, Probst CK, Black KE, Spinney JJ, Hariri LP, Nichols R, Lin Y, Bieler M, Seither P, Nicklin P, Wyatt D, Tager AM, Medoff BD. Screening for YAP Inhibitors Identifies Statins as Modulators of Fibrosis. Am J Respir Cell Mol Biol 2020; 62:479-492. [PMID: 31944822 DOI: 10.1165/rcmb.2019-0296oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a lung disease with limited therapeutic options that is characterized by pathological fibroblast activation and aberrant lung remodeling with scar formation. YAP (Yes-associated protein) is a transcriptional coactivator that mediates mechanical and biochemical signals controlling fibroblast activation. In this study, we developed a high-throughput small-molecule screen for YAP inhibitors in primary human lung fibroblasts. Multiple HMG-CoA (hydroxymethylglutaryl-coenzyme A) reductase inhibitors (statins) were found to inhibit YAP nuclear localization via induction of YAP phosphorylation, cytoplasmic retention, and degradation. We further show that the mevalonate pathway regulates YAP activation, and that simvastatin treatment reduces fibrosis markers in activated human lung fibroblasts and in the bleomycin mouse model of pulmonary fibrosis. Finally, we show that simvastatin modulates YAP in vivo in mouse lung fibroblasts. Our results highlight the potential of small-molecule screens for YAP inhibitors and provide a mechanism for the antifibrotic activity of statins in idiopathic pulmonary fibrosis.
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Affiliation(s)
| | - Lorena Pantano
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Gina Pronzati
- Division of Pulmonary and Critical Care Medicine, and
| | | | | | | | | | - Lida P Hariri
- Division of Pulmonary and Critical Care Medicine, and.,Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Yufei Lin
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | - David Wyatt
- Biotherapeutics Discovery, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
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28
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Probst CK, Montesi SB, Medoff BD, Shea BS, Knipe RS. Vascular permeability in the fibrotic lung. Eur Respir J 2020; 56:13993003.00100-2019. [PMID: 32265308 PMCID: PMC9977144 DOI: 10.1183/13993003.00100-2019] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/26/2020] [Indexed: 12/26/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is thought to result from aberrant tissue repair processes in response to chronic or repetitive lung injury. The origin and nature of the injury, as well as its cellular and molecular targets, are likely heterogeneous, which complicates accurate pre-clinical modelling of the disease and makes therapeutic targeting a challenge. Efforts are underway to identify central pathways in fibrogenesis which may allow targeting of aberrant repair processes regardless of the initial injury stimulus. Dysregulated endothelial permeability and vascular leak have long been studied for their role in acute lung injury and repair. Evidence that these processes are of importance to the pathogenesis of fibrotic lung disease is growing. Endothelial permeability is increased in non-fibrosing lung diseases, but it resolves in a self-limited fashion in conditions such as bacterial pneumonia and acute respiratory distress syndrome. In progressive fibrosing diseases such as IPF, permeability appears to persist, however, and may also predict mortality. In this hypothesis-generating review, we summarise available data on the role of endothelial permeability in IPF and focus on the deleterious consequences of sustained endothelial hyperpermeability in response to and during pulmonary inflammation and fibrosis. We propose that persistent permeability and vascular leak in the lung have the potential to establish and amplify the pro-fibrotic environment. Therapeutic interventions aimed at recognising and "plugging" the leak may therefore be of significant benefit for preventing the transition from lung injury to fibrosis and should be areas for future research.
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Affiliation(s)
- Clemens K. Probst
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sydney B. Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Barry S. Shea
- Division of Pulmonary and Critical Care Medicine, Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Rachel S. Knipe
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
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29
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Ziehr DR, Alladina J, Petri CR, Maley JH, Moskowitz A, Medoff BD, Hibbert KA, Thompson BT, Hardin CC. Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study. Am J Respir Crit Care Med 2020; 201:1560-1564. [PMID: 32348678 PMCID: PMC7301734 DOI: 10.1164/rccm.202004-1163le] [Citation(s) in RCA: 306] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- David R Ziehr
- Massachusetts General HospitalBoston, Massachusettsand.,Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | | | - Camille R Petri
- Massachusetts General HospitalBoston, Massachusettsand.,Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Jason H Maley
- Massachusetts General HospitalBoston, Massachusettsand.,Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | - Ari Moskowitz
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
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30
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Corleis B, Bucsan AN, Deruaz M, Vrbanac VD, Lisanti-Park AC, Gates SJ, Linder AH, Paer JM, Olson GS, Bowman BA, Schiff AE, Medoff BD, Tager AM, Luster AD, Khader SA, Kaushal D, Kwon DS. HIV-1 and SIV Infection Are Associated with Early Loss of Lung Interstitial CD4+ T Cells and Dissemination of Pulmonary Tuberculosis. Cell Rep 2020; 26:1409-1418.e5. [PMID: 30726727 PMCID: PMC6417097 DOI: 10.1016/j.celrep.2019.01.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/25/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023] Open
Abstract
Lung interstitial CD4+ T cells are critical for protection against pulmonary infections, but the fate of this population during HIV-1 infection is not well described. We studied CD4+ T cells in the setting of HIV-1 infection in human lung tissue, humanized mice, and a Mycobacterium tuberculosis (Mtb)/simian immunodeficiency virus (SIV) nonhuman primate co-infection model. Infection with a CCR5-tropic strain of HIV-1 or SIV results in severe and rapid loss of lung interstitial CD4+ T cells but not blood or lung alveolar CD4+ T cells. This is accompanied by high HIV-1 production in these cells in vitro and in vivo. Importantly, during early SIV infection, loss of lung interstitial CD4+ T cells is associated with increased dissemination of pulmonary Mtb infection. We show that lung interstitial CD4+ T cells serve as an efficient target for HIV-1 and SIV infection that leads to their early depletion and an increased risk of disseminated tuberculosis. Corleis et al. show that lung parenchymal CD4+ T cells are permissive to HIV-1-dependent cell death. CD4+ T cell loss is highly significant in the interstitium but not the alveolar space, and loss of interstitial CD4+ T cells is associated with extrapulmonary dissemination of M. tuberculosis.
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Affiliation(s)
- Björn Corleis
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Allison N Bucsan
- Tulane National Primate Research Center, Covington, LA, USA; Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Maud Deruaz
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Vladimir D Vrbanac
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Antonella C Lisanti-Park
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samantha J Gates
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alice H Linder
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey M Paer
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory S Olson
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brittany A Bowman
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Abigail E Schiff
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin D Medoff
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew M Tager
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew D Luster
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Shabaana A Khader
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Deepak Kaushal
- Tulane National Primate Research Center, Covington, LA, USA; Southwest National Primate Research Center, San Antonio, TX, USA
| | - Douglas S Kwon
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
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31
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Adams DC, Miller AJ, Applegate MB, Cho JL, Hamilos DL, Chee A, Holz JA, Szabari MV, Hariri LP, Harris RS, Griffith JW, Luster AD, Medoff BD, Suter MJ. Quantitative assessment of airway remodelling and response to allergen in asthma. Respirology 2019; 24:1073-1080. [PMID: 30845351 PMCID: PMC6732047 DOI: 10.1111/resp.13521] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE In vivo evaluation of the microstructural differences between asthmatic and non-asthmatic airways and their functional consequences is relevant to understanding and, potentially, treating asthma. In this study, we use endobronchial optical coherence tomography to investigate how allergic airways with asthma differ from allergic non-asthmatic airways in baseline microstructure and in response to allergen challenge. METHODS A total of 45 subjects completed the study, including 20 allergic, mildly asthmatic individuals, 22 non-asthmatic allergic controls and 3 healthy controls. A 3-cm airway segment in the right middle and right upper lobe were imaged in each subject immediately before and 24 h following segmental allergen challenge to the right middle lobe. Relationships between optical airway measurements (epithelial and mucosal thicknesses, mucosal buckling and mucus) and airway obstruction (FEV1 /FVC (forced expiratory volume in 1 s/forced vital capacity) and FEV1 % (FEV1 as a percentage of predictive value)) were investigated. RESULTS Significant increases at baseline and in response to allergen were observed for all four of our imaging metrics in the asthmatic airways compared to the non-asthmatic airways. Epithelial thickness and mucosal buckling exhibited a significant relationship to FEV1 /FVC in the asthmatic group. CONCLUSION Simultaneous assessments of airway microstructure, buckling and mucus revealed both structural and functional differences between the mildly asthmatic and control groups, with airway buckling seeming to be the most relevant factor. The results of this study demonstrate that a comprehensive, microstructural approach to assessing the airways may be important in future asthma studies as well as in the monitoring and treatment of asthma.
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Affiliation(s)
- David C Adams
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alyssa J Miller
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew B Applegate
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Josalyn L Cho
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel L Hamilos
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alex Chee
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jasmin A Holz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Margit V Szabari
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lida P Hariri
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Scott Harris
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason W Griffith
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew D Luster
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin D Medoff
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Melissa J Suter
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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32
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Affiliation(s)
- Josalyn L Cho
- 1 Division of Pulmonary, Critical Care and Occupational Medicine University of Iowa Iowa City, Iowa and
| | - Benjamin D Medoff
- 2 Division of Pulmonary and Critical Care Medicine Massachusetts General Hospital Boston, Massachusetts
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33
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Causton B, Pardo-Saganta A, Gillis J, Discipio K, Kooistra T, Rajagopal J, Xavier RJ, Cho JL, Medoff BD. CARMA3 Mediates Allergic Lung Inflammation in Response to Alternaria alternata. Am J Respir Cell Mol Biol 2019; 59:684-694. [PMID: 29958012 DOI: 10.1165/rcmb.2017-0181oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The airway epithelial cell (AEC) response to allergens helps initiate and propagate allergic inflammation in asthma. CARMA3 is a scaffold protein that mediates G protein-coupled receptor-induced NF-κB activation in airway epithelium. In this study, we demonstrate that mice with CARMA3-deficient AECs have reduced airway inflammation, as well as reduced type 2 cytokine levels in response to Alternaria alternata. These mice also have reduced production of IL-33 and IL-25, and reduced numbers of innate lymphoid cells in the lung. We also show that CARMA3-deficient human AECs have decreased production of proasthmatic mediators in response to A. alternata. Finally, we show that CARMA3 interacts with inositol 1,4,5-trisphosphate receptors in AECs, and that inhibition of CARMA3 signaling reduces A. alternata-induced intracellular calcium release. In conclusion, we show that CARMA3 signaling in AECs helps mediate A. alternata-induced allergic airway inflammation, and that CARMA3 is an important signaling molecule for type 2 immune responses in the lung.
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Affiliation(s)
- Benjamin Causton
- 1 Division of Pulmonary and Critical Care Medicine.,3 Center for Regenerative Medicine
| | - Ana Pardo-Saganta
- 1 Division of Pulmonary and Critical Care Medicine.,4 Center for Computational and Integrative Biology, and
| | - Jacob Gillis
- 1 Division of Pulmonary and Critical Care Medicine.,3 Center for Regenerative Medicine
| | - Katherine Discipio
- 1 Division of Pulmonary and Critical Care Medicine.,3 Center for Regenerative Medicine
| | - Tristan Kooistra
- 1 Division of Pulmonary and Critical Care Medicine.,3 Center for Regenerative Medicine
| | - Jayaraj Rajagopal
- 1 Division of Pulmonary and Critical Care Medicine.,4 Center for Computational and Integrative Biology, and
| | - Ramnik J Xavier
- 5 Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and.,2 Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts
| | - Josalyn L Cho
- 1 Division of Pulmonary and Critical Care Medicine.,3 Center for Regenerative Medicine
| | - Benjamin D Medoff
- 1 Division of Pulmonary and Critical Care Medicine.,3 Center for Regenerative Medicine
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34
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Knipe RS, Probst CK, Lagares D, Franklin A, Spinney JJ, Brazee PL, Grasberger P, Zhang L, Black KE, Sakai N, Shea BS, Liao JK, Medoff BD, Tager AM. The Rho Kinase Isoforms ROCK1 and ROCK2 Each Contribute to the Development of Experimental Pulmonary Fibrosis. Am J Respir Cell Mol Biol 2019; 58:471-481. [PMID: 29211497 DOI: 10.1165/rcmb.2017-0075oc] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Pulmonary fibrosis is thought to result from dysregulated wound repair after repetitive lung injury. Many cellular responses to injury involve rearrangements of the actin cytoskeleton mediated by the two isoforms of the Rho-associated coiled-coil-forming protein kinase (ROCK), ROCK1 and ROCK2. In addition, profibrotic mediators such as transforming growth factor-β, thrombin, and lysophosphatidic acid act through receptors that activate ROCK. Inhibition of ROCK activation may be a potent therapeutic strategy for human pulmonary fibrosis. Pharmacological inhibition of ROCK using nonselective ROCK inhibitors has been shown to prevent fibrosis in animal models; however, the specific roles of each ROCK isoform are poorly understood. Furthermore, the pleiotropic effects of this kinase have raised concerns about on-target adverse effects of ROCK inhibition such as hypotension. Selective inhibition of one isoform might be a better-tolerated strategy. In the present study, we used a genetic approach to determine the roles of ROCK1 and ROCK2 in a mouse model of bleomycin-induced pulmonary fibrosis. Using ROCK1- or ROCK2-haploinsufficient mice, we found that reduced expression of either ROCK1 or ROCK2 was sufficient to protect them from bleomycin-induced pulmonary fibrosis. In addition, we found that both isoforms contribute to the profibrotic responses of epithelial cells, endothelial cells, and fibroblasts. Interestingly, ROCK1- and ROCK2-haploinsufficient mice exhibited similar protection from bleomycin-induced vascular leak, myofibroblast differentiation, and fibrosis; however, ROCK1-haploinsufficient mice demonstrated greater attenuation of epithelial cell apoptosis. These findings suggest that selective inhibition of either ROCK isoform has the potential to be an effective therapeutic strategy for pulmonary fibrosis.
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Affiliation(s)
- Rachel S Knipe
- 1 Division of Pulmonary and Critical Care Medicine.,2 The Andrew M. Tager Fibrosis Research Center, and.,3 Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Clemens K Probst
- 1 Division of Pulmonary and Critical Care Medicine.,2 The Andrew M. Tager Fibrosis Research Center, and.,3 Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - David Lagares
- 1 Division of Pulmonary and Critical Care Medicine.,2 The Andrew M. Tager Fibrosis Research Center, and.,3 Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alicia Franklin
- 1 Division of Pulmonary and Critical Care Medicine.,2 The Andrew M. Tager Fibrosis Research Center, and.,3 Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jillian J Spinney
- 1 Division of Pulmonary and Critical Care Medicine.,2 The Andrew M. Tager Fibrosis Research Center, and.,3 Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Patricia L Brazee
- 4 Division of Pulmonary Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Paula Grasberger
- 1 Division of Pulmonary and Critical Care Medicine.,2 The Andrew M. Tager Fibrosis Research Center, and.,3 Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Linlin Zhang
- 5 Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Katharine E Black
- 1 Division of Pulmonary and Critical Care Medicine.,2 The Andrew M. Tager Fibrosis Research Center, and.,3 Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Norihiko Sakai
- 6 Division of Nephrology and.,7 Division of Blood Purification, Kanazawa University Hospital, Kanazawa, Japan; and
| | - Barry S Shea
- 8 Division of Pulmonary, Critical Care and Sleep Medicine, Rhode Island Hospital and Alpert Medical School, Providence, Rhode Island
| | - James K Liao
- 5 Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Benjamin D Medoff
- 1 Division of Pulmonary and Critical Care Medicine.,2 The Andrew M. Tager Fibrosis Research Center, and.,3 Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew M Tager
- 1 Division of Pulmonary and Critical Care Medicine.,2 The Andrew M. Tager Fibrosis Research Center, and.,3 Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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35
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Di Pilato M, Kim EY, Cadilha BL, Prüßmann JN, Nasrallah MN, Seruggia D, Usmani SM, Misale S, Zappulli V, Carrizosa E, Mani V, Ligorio M, Warner RD, Medoff BD, Marangoni F, Villani AC, Mempel TR. Targeting the CBM complex causes T reg cells to prime tumours for immune checkpoint therapy. Nature 2019; 570:112-116. [PMID: 31092922 PMCID: PMC6656391 DOI: 10.1038/s41586-019-1215-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/17/2019] [Indexed: 12/24/2022]
Abstract
Solid tumors are infiltrated by effector T cells (Teff) with the potential to control or reject them, as well as by regulatory T cells (Treg) that restrict the function of Teff and thereby promote tumor growth.1 The anti-tumor activity of Teff can be therapeutically unleashed and is now being exploited for the treatment of some forms of human cancer. However, weak tumor-associated inflammatory responses and the immune-suppressive function of Treg remain major hurdles to broader effectiveness of tumor immunotherapy.2 Here we show that upon disruption of the CARMA1-BCL10-MALT1 (CBM) signalosome complex, the majority of tumor-infiltrating Treg produce IFN-γ, followed by stunted tumor growth. Remarkably, genetic deletion of both or even just one allele of Carma1 in only a fraction of Treg, which avoided systemic autoimmunity, was sufficient to produce this anti-tumor effect, showing that not mere loss of suppressive function, but gain of effector activity by Treg initiates tumor control. Treg-production of IFN-γ was accompanied by macrophage activation and up-regulation of MHC-I on tumor cells. However, tumor cells also up-regulated expression of PD-L1, indicating activation of adaptive immune resistance.3 Consequently, PD-1 blockade concomitant with CARMA1-deletion caused rejection of tumors that otherwise do not respond to anti-PD-1 monotherapy. This effect was reproduced by pharmacological inhibition of the CBM protein MALT1. Our results demonstrate that partial disruption of the CBM complex and induction of IFN-γ-secretion in the preferentially self-reactive Treg pool does not cause systemic autoimmunity but is sufficient to prime the tumor environment for successful immune checkpoint therapy.
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Affiliation(s)
- Mauro Di Pilato
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Edward Y Kim
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Bruno L Cadilha
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Jasper N Prüßmann
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mazen N Nasrallah
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Davide Seruggia
- Harvard Medical School, Boston, MA, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Shariq M Usmani
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sandra Misale
- Harvard Medical School, Boston, MA, USA.,Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA
| | - Valentina Zappulli
- Department of Comparative Biomedicine and Food Science, University of Padua, Padova, Italy
| | - Esteban Carrizosa
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Vinidhra Mani
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Matteo Ligorio
- Harvard Medical School, Boston, MA, USA.,Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA
| | - Ross D Warner
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin D Medoff
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Francesco Marangoni
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Alexandra-Chloe Villani
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Thorsten R Mempel
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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36
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Cho JL, Ling MF, Adams DC, Faustino L, Islam SA, Afshar R, Griffith JW, Harris RS, Ng A, Radicioni G, Ford AA, Han AK, Xavier R, Kwok WW, Boucher R, Moon JJ, Hamilos DL, Kesimer M, Suter MJ, Medoff BD, Luster AD. Allergic asthma is distinguished by sensitivity of allergen-specific CD4+ T cells and airway structural cells to type 2 inflammation. Sci Transl Med 2017; 8:359ra132. [PMID: 27708065 DOI: 10.1126/scitranslmed.aag1370] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/19/2016] [Indexed: 01/08/2023]
Abstract
Despite systemic sensitization, not all allergic individuals develop asthma symptoms upon airborne allergen exposure. Determination of the factors that lead to the asthma phenotype in allergic individuals could guide treatment and identify novel therapeutic targets. We used segmental allergen challenge of allergic asthmatics (AA) and allergic nonasthmatic controls (AC) to determine whether there are differences in the airway immune response or airway structural cells that could drive the development of asthma. Both groups developed prominent allergic airway inflammation in response to allergen. However, asthmatic subjects had markedly higher levels of innate type 2 receptors on allergen-specific CD4+ T cells recruited into the airway. There were also increased levels of type 2 cytokines, increased total mucin, and increased mucin MUC5AC in response to allergen in the airways of AA subjects. Furthermore, type 2 cytokine levels correlated with the mucin response in AA but not AC subjects, suggesting differences in the airway epithelial response to inflammation. Finally, AA subjects had increased airway smooth muscle mass at baseline measured in vivo using novel orientation-resolved optical coherence tomography. Our data demonstrate that the development of allergic asthma is dependent on the responsiveness of allergen-specific CD4+ T cells to innate type 2 mediators as well as increased sensitivity of airway epithelial cells and smooth muscle to type 2 inflammation.
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Affiliation(s)
- Josalyn L Cho
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Morris F Ling
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - David C Adams
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Lucas Faustino
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Sabina A Islam
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Roshi Afshar
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jason W Griffith
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Robert S Harris
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Aylwin Ng
- Center for Computational and Integrative Biology and Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA 02142, USA
| | - Giorgia Radicioni
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Amina A Ford
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Andre K Han
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ramnik Xavier
- Center for Computational and Integrative Biology and Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA 02142, USA
| | - William W Kwok
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101, USA
| | - Richard Boucher
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - James J Moon
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Daniel L Hamilos
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mehmet Kesimer
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Melissa J Suter
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Benjamin D Medoff
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Andrew D Luster
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Adams DC, Hariri LP, Miller AJ, Wang Y, Cho JL, Villiger M, Holz JA, Szabari MV, Hamilos DL, Scott Harris R, Griffith JW, Bouma BE, Luster AD, Medoff BD, Suter MJ. Birefringence microscopy platform for assessing airway smooth muscle structure and function in vivo. Sci Transl Med 2017; 8:359ra131. [PMID: 27708064 DOI: 10.1126/scitranslmed.aag1424] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/19/2016] [Indexed: 12/30/2022]
Abstract
The inability to visualize airway smooth muscle (ASM) cells in vivo is a major obstacle in understanding their role in normal physiology and diseases. At present, there is no imaging modality available to assess ASM in vivo. Confocal endomicroscopy lacks the penetration depth and field of view, and conventional optical coherence tomography (OCT) does not have sufficient contrast to differentiate ASM from surrounding tissues. We have developed a birefringence microscopy platform that leverages the micro-organization of tissue to add further dimension to traditional OCT. We have used this technology to validate ASM measurements in ex vivo swine and canine studies, visualize and characterize volumetric representations of ASM in vivo, and quantify and predict ASM contractile force as a function of optical retardation. We provide in vivo images and volumetric assessments of ASM in living humans and document structural disease variations in subjects with mild asthma. The opportunity to link inflammatory responses to ASM responses and to link ASM responses to clinical responses and outcomes could lead to an increased understanding of diseases of the airway and, ultimately, to improved patient outcomes.
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Affiliation(s)
- David C Adams
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Lida P Hariri
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Alyssa J Miller
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Yan Wang
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Josalyn L Cho
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jasmin A Holz
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Margit V Szabari
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Daniel L Hamilos
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - R Scott Harris
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jason W Griffith
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Brett E Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Andrew D Luster
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Melissa J Suter
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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38
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Adams DC, Pahlevaninezhad H, Szabari MV, Cho JL, Hamilos DL, Kesimer M, Boucher RC, Luster AD, Medoff BD, Suter MJ. Automated segmentation and quantification of airway mucus with endobronchial optical coherence tomography. Biomed Opt Express 2017; 8:4729-4741. [PMID: 29082098 PMCID: PMC5654813 DOI: 10.1364/boe.8.004729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 05/31/2023]
Abstract
We propose a novel suite of algorithms for automatically segmenting the airway lumen and mucus in endobronchial optical coherence tomography (OCT) data sets, as well as a novel approach for quantifying the contents of the mucus. Mucus and lumen were segmented using a robust, multi-stage algorithm that requires only minimal input regarding sheath geometry. The algorithm performance was highly accurate in a wide range of airway and noise conditions. Mucus was classified using mean backscattering intensity and grey level co-occurrence matrix (GLCM) statistics. We evaluated our techniques in vivo in asthmatic and non-asthmatic volunteers.
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Affiliation(s)
- David C. Adams
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Hamid Pahlevaninezhad
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Equal contribution
| | - Margit V. Szabari
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Equal contribution
| | - Josalyn L. Cho
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Daniel L. Hamilos
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mehmet Kesimer
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Richard C. Boucher
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Andrew D. Luster
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Melissa J. Suter
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Kleinsteuber K, Corleis B, Rashidi N, Nchinda N, Lisanti A, Cho JL, Medoff BD, Kwon D, Walker BD. Standardization and quality control for high-dimensional mass cytometry studies of human samples. Cytometry A 2016; 89:903-913. [PMID: 27575385 DOI: 10.1002/cyto.a.22935] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Mass cytometry (CyTOF), a mass spectrometry-based single cell phenotyping technology, allows utilization of over 35 antibodies in a single sample and is a promising tool for translational human immunology studies. Although several analysis tools are available to interpret the complex data sets generated, a robust method for standardization and quality control within and across studies is needed. Here we report an efficient and easily adaptable method to monitor quality of individual samples in human immunology studies and to facilitate reproducible data analysis. Samples to be assessed are spiked with a defined amount of reference peripheral blood mononuclear cells from a healthy donor, derived from a single large blood draw. The presence of known standardized numbers and phenotypic profiles of these reference cells greatly facilitates sample analysis by allowing for: 1) quality control for consistent staining of each antibody in the panel, 2) identification of potential batch effects, and 3) implementation of a robust gating strategy. We demonstrate the utility of this method using peripheral blood and bronchoalveolar lavage samples from HIV+ patients by characterizing their CD8+ T-cell phenotypes and cytokine expression, respectively. Our results indicate that this method allows quality control of experimental conditions and results in highly reproducible population frequencies through a robust gating strategy. © 2016 International Society for Advancement of Cytometry.
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Affiliation(s)
- Katja Kleinsteuber
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA.,Howard Hughes Medical Institute (HHMI) Chevy Chase, Maryland, USA.,Heinrich-Pette Institute for Experimental Virology, Hamburg, Germany
| | - Björn Corleis
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Narges Rashidi
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Nzuekoh Nchinda
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA.,Howard Hughes Medical Institute (HHMI) Chevy Chase, Maryland, USA
| | - Antonella Lisanti
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Josalyn L Cho
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas Kwon
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA.,Infectious Disease Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bruce D Walker
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA. .,Howard Hughes Medical Institute (HHMI) Chevy Chase, Maryland, USA. .,Infectious Disease Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
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40
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Kelly VJ, Winkler T, Venegas JG, Kone M, Hamilos DL, Afshar R, Cho JL, Luster AD, Medoff BD, Harris RS. Allergic Non-Asthmatic Adults Have Regional Pulmonary Responses to Segmental Allergen Challenge. PLoS One 2015; 10:e0143976. [PMID: 26640951 PMCID: PMC4671597 DOI: 10.1371/journal.pone.0143976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/11/2015] [Indexed: 11/25/2022] Open
Abstract
Background Allergic non-asthmatic (ANA) adults experience upper airway symptoms of allergic disease such as rhinorrhea, congestion and sneezing without symptoms of asthma. The aim of this study was to utilize PET-CT functional imaging to determine whether allergen challenge elicits a pulmonary response in ANA subjects or whether their allergic disease is truly isolated to the upper airways. Methods In 6 ANA subjects, bronchoalveolar lavages (BAL) were performed at baseline and 24h after instillation of an allergen and a diluent in separate lung lobes. After instillation (10h), functional imaging was performed to quantify and compare regional perfusion, ventilation, fractional gas content (Fgas), and glucose uptake rate (Ki) between the baseline, diluent and allergen lobes. BAL cell counts were also compared. Results In ANA subjects, compared to the baseline and diluent lobes, perfusion and ventilation were significantly lower in the allergen lobe (median [inter-quartile range], baseline vs. diluent vs. allergen: Mean-normalized perfusion; 0.87 [0.85–0.97] vs. 0.90 [0.86–0.98] vs. 0.59 [0.55–0.67]; p<0.05. Mean-normalized ventilation 0.89 [0.88–0.98] vs. 0.95 [0.89–1.02] vs. 0.63 [0.52–0.67], p<0.05). In contrast, no significant differences were found in Fgas between baseline, diluent and allergen lobes or in Ki. Total cell counts, eosinophil and neutrophil cell counts (cells/ml BAL) were significantly greater in the allergen lobe compared to the baseline lobe (all P<0.05). Conclusions Despite having no clinical symptoms of a lower airway allergic response (cough and wheeze) allergic non-asthmatic subjects have a pulmonary response to allergen exposure which manifests as reduced ventilation and perfusion.
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Affiliation(s)
- Vanessa J Kelly
- Divisions of Pulmonary and Critical Care and Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Tilo Winkler
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jose G Venegas
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mamary Kone
- Divisions of Pulmonary and Critical Care and Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel L Hamilos
- Divisions of Pulmonary and Critical Care and Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Roshi Afshar
- Divisions of Pulmonary and Critical Care and Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.,Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Josalyn L Cho
- Divisions of Pulmonary and Critical Care and Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.,Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Andrew D Luster
- Divisions of Pulmonary and Critical Care and Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.,Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Benjamin D Medoff
- Divisions of Pulmonary and Critical Care and Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.,Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - R Scott Harris
- Divisions of Pulmonary and Critical Care and Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
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41
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Causton B, Ramadas RA, Cho JL, Jones K, Pardo-Saganta A, Rajagopal J, Xavier RJ, Medoff BD. CARMA3 Is Critical for the Initiation of Allergic Airway Inflammation. J Immunol 2015; 195:683-94. [PMID: 26041536 DOI: 10.4049/jimmunol.1402983] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/15/2015] [Indexed: 12/28/2022]
Abstract
Innate immune responses to allergens by airway epithelial cells (AECs) help initiate and propagate the adaptive immune response associated with allergic airway inflammation in asthma. Activation of the transcription factor NF-κB in AECs by allergens or secondary mediators via G protein-coupled receptors (GPCRs) is an important component of this multifaceted inflammatory cascade. Members of the caspase recruitment domain family of proteins display tissue-specific expression and help mediate NF-κB activity in response to numerous stimuli. We have previously shown that caspase recruitment domain-containing membrane-associated guanylate kinase protein (CARMA)3 is specifically expressed in AECs and mediates NF-κB activation in these cells in response to stimulation with the GPCR agonist lysophosphatidic acid. In this study, we demonstrate that reduced levels of CARMA3 in normal human bronchial epithelial cells decreases the production of proasthmatic mediators in response to a panel of asthma-relevant GPCR ligands such as lysophosphatidic acid, adenosine triphosphate, and allergens that activate GPCRs such as Alternaria alternata and house dust mite. We then show that genetically modified mice with CARMA3-deficient AECs have reduced airway eosinophilia and proinflammatory cytokine production in a murine model of allergic airway inflammation. Additionally, we demonstrate that these mice have impaired dendritic cell maturation in the lung and that dendritic cells from mice with CARMA3-deficient AECs have impaired Ag processing. In conclusion, we show that AEC CARMA3 helps mediate allergic airway inflammation, and that CARMA3 is a critical signaling molecule bridging the innate and adaptive immune responses in the lung.
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Affiliation(s)
- Benjamin Causton
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114; Division of Rheumatology, Allergy and Immunology, Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | | | - Josalyn L Cho
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114; Division of Rheumatology, Allergy and Immunology, Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | - Khristianna Jones
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114; Division of Rheumatology, Allergy and Immunology, Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129
| | - Ana Pardo-Saganta
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114; Center for Regenerative Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Jayaraj Rajagopal
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114; Center for Regenerative Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Ramnik J Xavier
- Center for Computational and Integrative Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114; and Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114; Division of Rheumatology, Allergy and Immunology, Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129;
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Khor B, Gagnon JD, Goel G, Roche MI, Conway KL, Tran K, Aldrich LN, Sundberg TB, Paterson AM, Mordecai S, Dombkowski D, Schirmer M, Tan PH, Bhan AK, Roychoudhuri R, Restifo NP, O'Shea JJ, Medoff BD, Shamji AF, Schreiber SL, Sharpe AH, Shaw SY, Xavier RJ. The kinase DYRK1A reciprocally regulates the differentiation of Th17 and regulatory T cells. eLife 2015; 4:e05920. [PMID: 25998054 PMCID: PMC4441007 DOI: 10.7554/elife.05920] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/27/2015] [Indexed: 12/12/2022] Open
Abstract
The balance between Th17 and T regulatory (Treg) cells critically modulates immune homeostasis, with an inadequate Treg response contributing to inflammatory disease. Using an unbiased chemical biology approach, we identified a novel role for the dual specificity tyrosine-phosphorylation-regulated kinase DYRK1A in regulating this balance. Inhibition of DYRK1A enhances Treg differentiation and impairs Th17 differentiation without affecting known pathways of Treg/Th17 differentiation. Thus, DYRK1A represents a novel mechanistic node at the branch point between commitment to either Treg or Th17 lineages. Importantly, both Treg cells generated using the DYRK1A inhibitor harmine and direct administration of harmine itself potently attenuate inflammation in multiple experimental models of systemic autoimmunity and mucosal inflammation. Our results identify DYRK1A as a physiologically relevant regulator of Treg cell differentiation and suggest a broader role for other DYRK family members in immune homeostasis. These results are discussed in the context of human diseases associated with dysregulated DYRK activity.
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Affiliation(s)
- Bernard Khor
- Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, Harvard Medical School, Boston, United States
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
- Broad Institute of MIT and Harvard, Cambridge, United States
- Pathology Service, Massachusetts General Hospital, Boston, United States
| | - John D Gagnon
- Broad Institute of MIT and Harvard, Cambridge, United States
| | - Gautam Goel
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Marly I Roche
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, United States
| | - Kara L Conway
- Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, Harvard Medical School, Boston, United States
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
- Broad Institute of MIT and Harvard, Cambridge, United States
| | - Khoa Tran
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Leslie N Aldrich
- Broad Institute of MIT and Harvard, Cambridge, United States
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States
| | | | - Alison M Paterson
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, United States
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, United States
| | - Scott Mordecai
- Pathology Service, Massachusetts General Hospital, Boston, United States
| | - David Dombkowski
- Pathology Service, Massachusetts General Hospital, Boston, United States
| | | | - Pauline H Tan
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Atul K Bhan
- Pathology Service, Massachusetts General Hospital, Boston, United States
| | - Rahul Roychoudhuri
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Nicholas P Restifo
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - John J O'Shea
- Molecular Immunology and Inflammation Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, United States
| | - Benjamin D Medoff
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, United States
| | | | - Stuart L Schreiber
- Broad Institute of MIT and Harvard, Cambridge, United States
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, United States
| | - Arlene H Sharpe
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, United States
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, United States
| | - Stanley Y Shaw
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Ramnik J Xavier
- Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, Harvard Medical School, Boston, United States
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
- Broad Institute of MIT and Harvard, Cambridge, United States
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Cho JL, Medoff BD. Lung T cells in HIV infection. Driven to exhaustion? Am J Respir Crit Care Med 2015; 191:370-1. [PMID: 25679103 DOI: 10.1164/rccm.201501-0011ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Josalyn L Cho
- 1 Division of Pulmonary and Critical Care Medicine Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts and
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Abstract
Caspase recruitment domain-containing membrane-associated guanylate kinase protein-1 (CARMA1), a member of the membrane associated guanylate kinase (MAGUK) family of kinases, is essential for T lymphocyte activation and proliferation via T-cell receptor (TCR) mediated NF-κB activation. Recent studies suggest a broader role for CARMA1 regulating other T-cell functions as well as a role in non-TCR-mediated signaling pathways important for lymphocyte development and functions. In addition, CARMA1 has been shown to be an important component in the pathogenesis of several human diseases. Thus, comprehensively defining its mechanisms of action and regulation could reveal novel therapeutic targets for T-cell-mediated diseases and lymphoproliferative disorders.
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Affiliation(s)
- Marly I Roche
- Pulmonary and Critical Care Unit and the Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Nishino M, Medoff BD, Mark EJ, Matsubara O, O'Donnell WJ, Currier PF, Kradin RL. Variant alveolar lipoproteinosis: a syndrome with distinct clinical and pathological features. Pathol Int 2013; 61:509-17. [PMID: 21884300 DOI: 10.1111/j.1440-1827.2011.02710.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare condition in which pulmonary macrophages fail to clear surfactant, resulting in the alveolar accumulation of lipoproteinaceous debris. The histopathology of PAP is typified by diffuse filling of terminal airways with eosinophilic, PAS/diastase (PAS/D)-positive acellular material. We present five patients who showed histopathological changes in the lungs consistent with mild PAP. However, these cases were notable for the abundance of degenerating alveolar macrophages, weak PAS staining of lipoproteinaceous material and paucity of lamellated bodies on ultrastructural examination. Only one patient showed the CT finding of mosaiform 'crazy-paving' and the opalescent bronchoalveolar lavage fluid characteristic of PAP. In one case, therapeutic lung lavage based on a presumptive diagnosis of PAP exacerbated respiratory distress. Three patients showed partial or near-complete resolution of disease in response to high-dose corticosteroid therapy, a treatment approach that is generally ineffective in PAP. We conclude that distinguishing 'variant alveolar lipoproteinosis' from classical PAP is clinically important. Despite the otherwise typical appearance of lipoproteinaceous alveolar material in lung biopsies, the presence of degenerating foamy macrophages and atypical histochemical, ultrastructural and radiographic features suggest a steroid-responsive form of proteinosis that is likely pathogenetically distinct and may not be amenable to whole-lung lavage.
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Affiliation(s)
- Michiya Nishino
- Pathology Service Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Tata PR, Mou H, Pardo-Saganta A, Zhao R, Prabhu M, Law BM, Vinarsky V, Cho JL, Breton S, Sahay A, Medoff BD, Rajagopal J. Dedifferentiation of committed epithelial cells into stem cells in vivo. Nature 2013; 503:218-23. [PMID: 24196716 PMCID: PMC4035230 DOI: 10.1038/nature12777] [Citation(s) in RCA: 475] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 10/17/2013] [Indexed: 01/20/2023]
Abstract
Cellular plasticity contributes to the regenerative capacity of plants, invertebrates, teleost fishes and amphibians. In vertebrates, differentiated cells are known to revert into replicating progenitors, but these cells do not persist as stable stem cells. Here we present evidence that differentiated airway epithelial cells can revert into stable and functional stem cells in vivo. After the ablation of airway stem cells, we observed a surprising increase in the proliferation of committed secretory cells. Subsequent lineage tracing demonstrated that the luminal secretory cells had dedifferentiated into basal stem cells. Dedifferentiated cells were morphologically indistinguishable from stem cells and they functioned as well as their endogenous counterparts in repairing epithelial injury. Single secretory cells clonally dedifferentiated into multipotent stem cells when they were cultured ex vivo without basal stem cells. By contrast, direct contact with a single basal stem cell was sufficient to prevent secretory cell dedifferentiation. In analogy to classical descriptions of amphibian nuclear reprogramming, the propensity of committed cells to dedifferentiate is inversely correlated to their state of maturity. This capacity of committed cells to dedifferentiate into stem cells may have a more general role in the regeneration of many tissues and in multiple disease states, notably cancer.
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Affiliation(s)
- Purushothama Rao Tata
- 1] Center for Regenerative Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, Massachusetts 02114, USA [2] Departments of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts 02114, USA [3] Department of Internal Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA [4] Harvard Stem Cell Institute, Cambridge, Massachusetts 02138, USA
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Afshar R, Strassner JP, Seung E, Causton B, Cho JL, Harris RS, Hamilos DL, Medoff BD, Luster AD. Compartmentalized chemokine-dependent regulatory T-cell inhibition of allergic pulmonary inflammation. J Allergy Clin Immunol 2013; 131:1644-52. [PMID: 23632297 DOI: 10.1016/j.jaci.2013.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 02/08/2013] [Accepted: 03/04/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Induction of endogenous regulatory T (Treg) cells represents an exciting new potential modality for treating allergic diseases, such as asthma. Treg cells have been implicated in the regulation of asthma, but the anatomic location in which they exert their regulatory function and the mechanisms controlling the migration necessary for their suppressive function in asthma are not known. Understanding these aspects of Treg cell biology will be important for harnessing their power in the clinic. OBJECTIVE We sought to determine the anatomic location at which Treg cells exert their regulatory function in the sensitization and effector phases of allergic asthma and to determine the chemokine receptors that control the migration of Treg cells to these sites in vivo in both mice and human subjects. METHODS The clinical efficacy and anatomic location of adoptively transferred chemokine receptor-deficient CD4(+)CD25(+) forkhead box protein 3-positive Treg cells was determined in the sensitization and effector phases of allergic airway inflammation in mice. The chemokine receptor expression profile was determined on Treg cells recruited into the human airway after bronchoscopic segmental allergen challenge of asthmatic patients. RESULTS We show that CCR7, but not CCR4, is required on Treg cells to suppress allergic airway inflammation during the sensitization phase. In contrast, CCR4, but not CCR7, is required on Treg cells to suppress allergic airway inflammation during the effector phase. Consistent with our murine studies, human subjects with allergic asthma had an increase in CCR4-expressing functional Treg cells in the lungs after segmental allergen challenge. CONCLUSION The location of Treg cell function differs during allergic sensitization and allergen-induced recall responses in the lung, and this differential localization is critically dependent on differential chemokine function.
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Affiliation(s)
- Roshi Afshar
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
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Hariri LP, Applegate MB, Mino-Kenudson M, Mark EJ, Medoff BD, Luster AD, Bouma BE, Tearney GJ, Suter MJ. Volumetric optical frequency domain imaging of pulmonary pathology with precise correlation to histopathology. Chest 2013; 143:64-74. [PMID: 22459781 DOI: 10.1378/chest.11-2797] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related mortality. Radiology and bronchoscopy techniques do not have the necessary resolution to evaluate lung lesions on the microscopic scale, which is critical for diagnosis. Bronchial biopsy specimens can be limited by sampling error and small size. Optical frequency domain imaging (OFDI) provides volumetric views of tissue microstructure at near-histologic resolution and may be useful for evaluating pulmonary lesions to increase diagnostic accuracy. Bronchoscopic OFDI has been evaluated in vivo, but a lack of correlated histopathology has limited the ability to develop accurate image interpretation criteria. METHODS We performed OFDI through two approaches (airway-centered and parenchymal imaging) in 22 ex vivo lung specimens, using tissue dye to precisely correlate imaging and histology. RESULTS OFDI of normal airway allowed visualization of epithelium, lamina propria, cartilage, and alveolar attachments. Carcinomas exhibited architectural disarray, loss of normal airway and alveolar structure, and rapid light attenuation. Squamous cell carcinomas showed nested architecture. Atypical glandular formation was appreciated in adenocarcinomas, and uniform trabecular gland formation was seen in salivary gland carcinomas. Mucinous adenocarcinomas showed alveolar wall thickening with intraalveolar mucin. Interstitial fibrosis was visualized as signal-dense tissue, with an interstitial distribution in mild interstitial fibrotic disease and a diffuse subpleural pattern with cystic space formation in usual interstitial pneumonitis. CONCLUSIONS To our knowledge, this study is the first demonstration of volumetric OFDI with precise correlation to histopathology in lung pathology. We anticipate that OFDI may play a role in assessing airway and parenchymal pathology, providing fresh insights into the volumetric features of pulmonary disease.
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Affiliation(s)
- Lida P Hariri
- Department of Pathology, Boston; Wellman Center for Photomedicine, Boston; Harvard Medical School, Cambridge
| | - Matthew B Applegate
- Pulmonary and Critical Care Unit, Boston; Wellman Center for Photomedicine, Boston
| | | | - Eugene J Mark
- Department of Pathology, Boston; Harvard Medical School, Cambridge
| | - Benjamin D Medoff
- Pulmonary and Critical Care Unit, Boston; Harvard Medical School, Cambridge
| | - Andrew D Luster
- Rheumatology, Allergy and Immunology Division, Massachusetts General Hospital, Boston; Harvard Medical School, Cambridge
| | - Brett E Bouma
- Wellman Center for Photomedicine, Boston; Harvard Medical School, Cambridge; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA
| | - Guillermo J Tearney
- Department of Pathology, Boston; Wellman Center for Photomedicine, Boston; Harvard Medical School, Cambridge; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA
| | - Melissa J Suter
- Pulmonary and Critical Care Unit, Boston; Wellman Center for Photomedicine, Boston; Harvard Medical School, Cambridge.
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Wu Q, Gardiner GJ, Berry E, Wagner SR, Lu T, Clay BS, Moore TV, Ferreira CM, Williams JW, Luster AD, Medoff BD, Cannon JL, Sperling AI, Shilling RA. ICOS-expressing lymphocytes promote resolution of CD8-mediated lung injury in a mouse model of lung rejection. PLoS One 2013; 8:e72955. [PMID: 23967339 PMCID: PMC3742557 DOI: 10.1371/journal.pone.0072955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 07/21/2013] [Indexed: 01/07/2023] Open
Abstract
Acute rejection, a common complication of lung transplantation, may promote obliterative bronchiolitis leading to graft failure in lung transplant recipients. During acute rejection episodes, CD8(+) T cells can contribute to lung epithelial injury but the mechanisms promoting and controlling CD8-mediated injury in the lung are not well understood. To study the mechanisms regulating CD8(+) T cell-mediated lung rejection, we used a transgenic model in which adoptively transferred ovalbumin (OVA)-specific cytotoxic T lymphocytes (CTL) induce lung injury in mice expressing an ovalbumin transgene in the small airway epithelium of the lungs (CC10-OVA mice). The lung pathology is similar to findings in humans with acute lung transplant. In the presence of an intact immune response the inflammation resolves by day 30. Using CC10-OVA.RAG(-/-) mice, we found that CD4(+) T cells and ICOS(+/+) T cells were required for protection against lethal lung injury, while neutrophil depletion was not protective. In addition, CD4(+)Foxp3 (+) ICOS(+) T cells were enriched in the lungs of animals surviving lung injury and ICOS(+/+) Tregs promoted survival in animals that received ICOS(-/-) T cells. Direct comparison of ICOS(-/-) Tregs to ICOS(+/+) Tregs found defects in vitro but no differences in the ability of ICOS(-/-) Tregs to protect from lethal lung injury. These data suggest that ICOS affects Treg development but is not necessarily required for Treg effector function.
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Affiliation(s)
- Qiang Wu
- Center for Immunobiology, Division of Pulmonary and Critical Care Medicine, Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Gail J. Gardiner
- Center for Immunobiology, Division of Pulmonary and Critical Care Medicine, Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Elizabeth Berry
- Committee on Immunology & Section of Pulmonary and Critical Care Medicine, Department of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Sarah R. Wagner
- Center for Immunobiology, Division of Pulmonary and Critical Care Medicine, Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Tiffany Lu
- Committee on Immunology & Section of Pulmonary and Critical Care Medicine, Department of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Bryan S. Clay
- Committee on Immunology & Section of Pulmonary and Critical Care Medicine, Department of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Tamson V. Moore
- Committee on Immunology & Section of Pulmonary and Critical Care Medicine, Department of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Caroline M. Ferreira
- Committee on Immunology & Section of Pulmonary and Critical Care Medicine, Department of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Jesse W. Williams
- Committee on Immunology & Section of Pulmonary and Critical Care Medicine, Department of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Andrew D. Luster
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, United States of America
| | - Benjamin D. Medoff
- Pulmonary and Critical Care Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Judy L. Cannon
- Committee on Immunology & Section of Pulmonary and Critical Care Medicine, Department of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Anne I. Sperling
- Committee on Immunology & Section of Pulmonary and Critical Care Medicine, Department of Medicine, the University of Chicago, Chicago, Illinois, United States of America
| | - Rebecca A. Shilling
- Center for Immunobiology, Division of Pulmonary and Critical Care Medicine, Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
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Abstract
Pulmonary arterial hypertension (PAH) is a condition of unknown etiology whose pathological features include increased vascular resistance, perivascular inflammatory cell infiltration and pulmonary arteriolar remodeling. Although risk factors for PAH are poorly defined, recent studies indicate that obesity may be an important risk factor for this condition. The mechanisms leading to this association are largely unknown, but bioactive mediators secreted from adipose tissue have been implicated in this process. One of the most important mediators released from adipose tissue is the adipokine adiponectin. Adiponectin is highly abundant in the circulation of lean healthy individuals, and possesses well-described metabolic and antiinflammatory actions. Levels of adiponectin decrease with increasing body mass, and low levels are directly linked to the development of PAH in mice. Moreover, overexpression of adiponectin has been shown to protect mice from developing PAH in response to inflammation and hypoxia. Based on the findings from these studies, it is suggested that the effects of adiponectin are mediated, in part, through its antiinflammatory and antiproliferative properties. In this review, we discuss the emerging evidence demonstrating a role for adiponectin in lung vascular homeostasis and discuss how deficiency in this adipocyte-derived hormone might explain the recent association between obesity and PAH.
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Affiliation(s)
- Ross Summer
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
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