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Althobiani MA, Shuttleworth R, Conway J, Dainton J, Duckworth A, Da Ponte AJ, Mandizha J, Lanario JW, Gibbons MA, Lines S, Scotton CJ, Hurst JR, Porter JC, Russell AM. Supporting self-management for patients with Interstitial Lung Diseases: Utility and acceptability of digital devices. PLOS Digit Health 2024; 3:e0000318. [PMID: 38190384 PMCID: PMC10773949 DOI: 10.1371/journal.pdig.0000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Patients diagnosed with Interstitial Lung Diseases (ILD) use devices to self-monitor their health and well-being. Little is known about the range of devices, selection, frequency and terms of use and overall utility. We sought to quantify patients' usage and experiences with home digital devices, and further evaluate their perceived utility and barriers to adaptation. METHODS A team of expert clinicians and patient partners interested in self-management approaches designed a 48-question cross-sectional electronic survey; specifically targeted at individuals diagnosed with ILD. The survey was critically appraised by the interdisciplinary self-management group at Royal Devon University Hospitals NHS Foundation Trust during a 6-month validation process. The survey was open for participation between September 2021 and December 2022, and responses were collected anonymously. Data were analysed descriptively for quantitative aspects and through thematic analysis for qualitative input. RESULTS 104 patients accessed the survey and 89/104 (86%) reported a diagnosis of lung fibrosis, including 46/89 (52%) idiopathic pulmonary fibrosis (IPF) with 57/89 (64%) of participants diagnosed >3 years and 59/89 (66%) female. 52/65(80%) were in the UK; 33/65 (51%) reported severe breathlessness medical research council MRC grade 3-4 and 32/65 (49%) disclosed co-morbid arthritis or joint problems. Of these, 18/83 (22%) used a hand- held spirometer, with only 6/17 (35%) advised on how to interpret the readings. Pulse oximetry devices were the most frequently used device by 35/71 (49%) and 20/64 (31%) measured their saturations more than once daily. 29/63 (46%) of respondents reported home-monitoring brought reassurance; of these, for 25/63 (40%) a feeling of control. 10/57 (18%) felt it had a negative effect, citing fluctuating readings as causing stress and 'paranoia'. The most likely help-seeking triggers were worsening breathlessness 53/65 (82%) and low oxygen saturation 43/65 (66%). Nurse specialists were the most frequent source of help 24/63 (38%). Conclusion: Patients can learn appropriate technical skills, yet perceptions of home-monitoring are variable; targeted assessment and tailored support is likely to be beneficial.
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Affiliation(s)
| | - Rebecca Shuttleworth
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - John Conway
- Exeter Patients in Collaboration for Pulmonary Fibrosis Research (EPIC-PF), Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Jonathan Dainton
- Exeter Patients in Collaboration for Pulmonary Fibrosis Research (EPIC-PF), Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Anna Duckworth
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Ana Jorge Da Ponte
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Jessica Mandizha
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Joseph W. Lanario
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Michael A. Gibbons
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - Sarah Lines
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Chris J. Scotton
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
| | - John R. Hurst
- Department of Medicine, University College London, London, United Kingdom
| | - Joanna C. Porter
- Department of Medicine, University College London, London, United Kingdom
| | - Anne-Marie Russell
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Exeter Respiratory Innovations Center, University of Exeter, Exeter, United Kingdom
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Dixon G, Hague S, Mulholland S, Adamali H, Khin AMN, Thould H, Connon R, Minnis P, Murtagh E, Khan F, Toor S, Lawrence A, Naqvi M, West A, Coker RK, Ward K, Yazbeck L, Hart S, Garfoot T, Newman K, Rivera-Ortega P, Stranks L, Beirne P, Bradley J, Rowan C, Agnew S, Ahmad M, Spencer LG, Aigbirior J, Fahim A, Wilson AM, Butcher E, Chong SG, Saini G, Zulfikar S, Chua F, George PM, Kokosi M, Kouranos V, Molyneaux P, Renzoni E, Vitri B, Wells AU, Nicol LM, Bianchi S, Kular R, Liu H, John A, Barth S, Wickremasinghe M, Forrest IA, Grimes I, Simpson AJ, Fletcher SV, Jones MG, Kinsella E, Naftel J, Wood N, Chalmers J, Crawshaw A, Crowley LE, Dosanjh D, Huntley CC, Walters GI, Gatheral T, Plum C, Bikmalla S, Muthusami R, Stone H, Rodrigues JC, Tsaneva-Atanasova K, Scotton CJ, Gibbons MA, Barratt SL. Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK. ERJ Open Res 2024; 10:00529-2023. [PMID: 38226064 PMCID: PMC10789269 DOI: 10.1183/23120541.00529-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/17/2023] [Indexed: 01/17/2024] Open
Abstract
Background Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting. Methods 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey. Results 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD. Conclusion We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting.
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Affiliation(s)
- Giles Dixon
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
- South West Peninsula ILD Network, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Samuel Hague
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Sarah Mulholland
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Huzaifa Adamali
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Aye Myat Noe Khin
- South West Peninsula ILD Network, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Hannah Thould
- South West Peninsula ILD Network, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Roisin Connon
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Paul Minnis
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Eoin Murtagh
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Fasihul Khan
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sameen Toor
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Marium Naqvi
- Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Alex West
- Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Robina K. Coker
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Katie Ward
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Leda Yazbeck
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Simon Hart
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Theresa Garfoot
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kate Newman
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Pilar Rivera-Ortega
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lachlan Stranks
- Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Paul Beirne
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Sarah Agnew
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospital NHS FT, Liverpool, UK
| | - Mahin Ahmad
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospital NHS FT, Liverpool, UK
| | - Lisa G. Spencer
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospital NHS FT, Liverpool, UK
| | - Joshua Aigbirior
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Ahmed Fahim
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Andrew M. Wilson
- Norfolk and Norwich University Hospital NHS Foundation Trust, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Sy Giin Chong
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gauri Saini
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Felix Chua
- Royal Brompton and Harefield Hospitals, London, UK
| | | | - Maria Kokosi
- Royal Brompton and Harefield Hospitals, London, UK
| | | | | | | | | | | | | | - Stephen Bianchi
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Raman Kular
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - HuaJian Liu
- Southern Health and Social Care Trust, Portadown, UK
| | | | - Sarah Barth
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Ian A. Forrest
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Ian Grimes
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - A. John Simpson
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Sophie V. Fletcher
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Centre and School of Clinical and Experimental Sciences, Faulty of Medicine, University of Southampton, Southampton, UK
| | - Mark G. Jones
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Centre and School of Clinical and Experimental Sciences, Faulty of Medicine, University of Southampton, Southampton, UK
| | - Emma Kinsella
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Jennifer Naftel
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola Wood
- University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Jodie Chalmers
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anjali Crawshaw
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Louise E. Crowley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Davinder Dosanjh
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher C. Huntley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gareth I. Walters
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timothy Gatheral
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancashire and South Cumbria ILD Service, Lancaster, UK
| | - Catherine Plum
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancashire and South Cumbria ILD Service, Lancaster, UK
| | - Shiva Bikmalla
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Raja Muthusami
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Helen Stone
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Jonathan C.L. Rodrigues
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department of Health, University of Bath, Bath, UK
| | - Krasimira Tsaneva-Atanasova
- Department of Mathematics and Statistics, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
- EPSRC Hub for Quantitative Modelling in Healthcare, University of Exeter, Exeter, UK
- Living Systems Institute, University of Exeter, Exeter, UK
| | - Chris J. Scotton
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Michael A. Gibbons
- South West Peninsula ILD Network, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
- These authors contributed equally
| | - Shaney L. Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
- These authors contributed equally
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Chong DLW, Mikolasch TA, Sahota J, Rebeyrol C, Garthwaite HS, Booth HL, Heightman M, Denneny EK, José RJ, Khawaja AA, Duckworth A, Labelle M, Scotton CJ, Porter JC. Investigating the role of platelets and platelet-derived transforming growth factor-β in idiopathic pulmonary fibrosis. Am J Physiol Lung Cell Mol Physiol 2023; 325:L487-L499. [PMID: 37643008 PMCID: PMC10639018 DOI: 10.1152/ajplung.00227.2022] [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: 08/01/2022] [Revised: 07/17/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
Transforming growth factor-β1 (TGFβ1) is the key profibrotic cytokine in idiopathic pulmonary fibrosis (IPF), but the primary source of this cytokine in this disease is unknown. Platelets have abundant stores of TGFβ1, although the role of these cells in IPF is ill-defined. In this study, we investigated whether platelets, and specifically platelet-derived TGFβ1, mediate IPF disease progression. Patients with IPF and non-IPF patients were recruited to determine platelet reactivity, and separate cohorts of patients with IPF were followed for mortality. To study whether platelet-derived TGFβ1 modulates pulmonary fibrosis (PF), mice with a targeted deletion of TGFβ1 in megakaryocytes and platelets (TGFβ1fl/fl.PF4-Cre) were used in the well-characterized bleomycin-induced pulmonary fibrosis (PF) animal model. In a discovery cohort, we found significantly higher mortality in patients with IPF who had elevated platelet counts within the normal range. However, our validation cohort did not confirm this observation, despite significantly increased platelets, neutrophils, active TGFβ1, and CCL5, a chemokine produced by inflammatory cells, in the blood, lung, and bronchoalveolar lavage (BAL) of patients with IPF. In vivo, we showed that despite platelets being readily detected within the lungs of bleomycin-treated mice, neither the degree of pulmonary inflammation nor fibrosis was significantly different between TGFβ1fl/fl.PF4-Cre and control mice. Our results demonstrate for the first time that platelet-derived TGFβ1 does not significantly mediate inflammation or fibrosis in a PF animal model. Furthermore, our human studies revealed blood platelet counts do not consistently predict mortality in IPF but other platelet-derived mediators, such as C-C chemokine ligand 5 (CCL5), may promote neutrophil recruitment and human IPF.NEW & NOTEWORTHY Platelets are a rich source of profibrotic TGFβ; however, the role of platelets in idiopathic pulmonary fibrosis (IPF) is unclear. We identified that patients with IPF have significantly more platelets, neutrophils, and active TGFβ in their airways than control patients. Using an animal model of IPF, we demonstrated that platelet-derived TGFβ does not significantly drive lung fibrosis or inflammation. Our findings offer a better understanding of platelets in both human and animal studies of IPF.
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Affiliation(s)
- Deborah L W Chong
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Theresia A Mikolasch
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Jagdeep Sahota
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Carine Rebeyrol
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Helen S Garthwaite
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Helen L Booth
- Interstitial Lung Disease Service, University College London Hospital, London, United Kingdom
| | - Melissa Heightman
- Interstitial Lung Disease Service, University College London Hospital, London, United Kingdom
| | - Emma K Denneny
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Ricardo J José
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Akif A Khawaja
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Anna Duckworth
- Department of Clinical and Biomedical Science, University of Exeter, Exeter, United Kingdom
| | - Myriam Labelle
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Chris J Scotton
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
- Department of Clinical and Biomedical Science, University of Exeter, Exeter, United Kingdom
| | - Joanna C Porter
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
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Mikolasch TA, George PM, Sahota J, Nancarrow T, Barratt SL, Woodhead FA, Kouranos V, Cope VS, Creamer AW, Fidan S, Ganeshan B, Hoy L, Mackintosh JA, Shortman R, Duckworth A, Fallon J, Garthwaite H, Heightman M, Adamali HI, Lines S, Win T, Wollerton R, Renzoni EA, Steward M, Wells AU, Gibbons M, Groves AM, Gooptu B, Scotton CJ, Porter JC. Multi-center evaluation of baseline neutrophil-to-lymphocyte (NLR) ratio as an independent predictor of mortality and clinical risk stratifier in idiopathic pulmonary fibrosis. EClinicalMedicine 2023; 55:101758. [PMID: 36483266 PMCID: PMC9722446 DOI: 10.1016/j.eclinm.2022.101758] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal disorder with a variable disease trajectory. The aim of this study was to assess the potential of neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in IPF. Methods We adopted a two-stage discovery (n = 71) and validation (n = 134) design using patients from the UCL partners (UCLp) cohort. We then combined discovery and validation cohorts and included an additional 794 people with IPF, using real-life data from 5 other UK centers, to give a combined cohort of 999 patients. Data were collected from patients presenting over a 13-year period (2006-2019) with mean follow up of 3.7 years (censoring: 2018-2020). Findings In the discovery analysis, we showed that high values of NLR (>/ = 2.9 vs < 2.9) were associated with increased risk of mortality in IPF (HR 2.04, 95% CI 1.09-3.81, n = 71, p = 0.025). This was confirmed in the validation (HR 1.91, 95% CI 1.15-3.18, n = 134, p = 0.0114) and combined cohorts (HR 1.65, n = 999, 95% CI 1.39-1.95; p < 0·0001). NLR correlated with GAP stage and GAP index (p < 0.0001). Stratifying patients by NLR category (low/high) showed significant differences in survival for GAP stage 2 (p < 0.0001), however not for GAP stage 1 or 3. In a multivariate analysis, a high NLR was an independent predictor of mortality/progression after adjustment for individual GAP components and steroid/anti-fibrotic use (p < 0·03). Furthermore, incorporation of baseline NLR in a modified GAP-stage/index, GAP-index/stage-plus, refined prognostic ability as measured by concordance (C)-index. Interpretation We have identified NLR as a widely available test that significantly correlates with lung function, can predict outcomes in IPF and refines cohort staging with GAP. NLR may allow timely prioritisation of at-risk patients, even in the absence of lung function. Funding Breathing Matters, GSK, CF Trust, BLF-Asthma, MRC, NIHR Alpha-1 Foundation.
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Affiliation(s)
- Theresia A. Mikolasch
- CITR, UCL Respiratory, UCL, London, UK
- Interstitial Lung Disease Service, UCLH NHS Trust, London, UK
| | - Peter M. George
- Interstitial Lung Disease Unit, Royal Brompton Hospital, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Jagdeep Sahota
- CITR, UCL Respiratory, UCL, London, UK
- Interstitial Lung Disease Service, UCLH NHS Trust, London, UK
| | - Thomas Nancarrow
- College of Medicine & Health, University of Exeter, Exeter, UK
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Shaney L. Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Felix A. Woodhead
- Institute for Lung Health and Leicester Interstitial Lung Disease Service and NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3, UK
- Department of Respiratory Sciences and Leicester Institute of Structural & Chemical Biology University of Leicester, Henry Wellcome Building, Lancaster Road, Leicester, LE1 5HB, UK
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, UK
- National Heart and Lung Institute, Imperial College London, UK
| | | | - Andrew W. Creamer
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Silan Fidan
- Institute for Lung Health and Leicester Interstitial Lung Disease Service and NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3, UK
- Department of Respiratory Sciences and Leicester Institute of Structural & Chemical Biology University of Leicester, Henry Wellcome Building, Lancaster Road, Leicester, LE1 5HB, UK
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK
| | - Luke Hoy
- Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK
| | - John A. Mackintosh
- Interstitial Lung Disease Unit, Royal Brompton Hospital, UK
- The Prince Charles Hospital, Queensland, Australia
| | - Robert Shortman
- Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK
| | - Anna Duckworth
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Janet Fallon
- Department of Respiratory Medicine, Somerset Lung Centre, Musgrove Park Hospital, Taunton, UK
| | | | | | - Huzaifa I. Adamali
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Sarah Lines
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Thida Win
- Lister Hospital, North East Herts Trust, Stevenage UK
| | - Rebecca Wollerton
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Elisabetta A. Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Matthew Steward
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Michael Gibbons
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Ashley M. Groves
- Institute of Nuclear Medicine, UCL and Department of Nuclear Medicine UCLH, UK
| | - Bibek Gooptu
- Institute for Lung Health and Leicester Interstitial Lung Disease Service and NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3, UK
- Department of Respiratory Sciences and Leicester Institute of Structural & Chemical Biology University of Leicester, Henry Wellcome Building, Lancaster Road, Leicester, LE1 5HB, UK
| | - Chris J. Scotton
- College of Medicine & Health, University of Exeter, Exeter, UK
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Joanna C. Porter
- CITR, UCL Respiratory, UCL, London, UK
- Interstitial Lung Disease Service, UCLH NHS Trust, London, UK
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5
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Tomlinson OW, Markham L, Wollerton RL, Knight BA, Duckworth A, Gibbons MA, Scotton CJ, Williams CA. Validity and repeatability of cardiopulmonary exercise testing in interstitial lung disease. BMC Pulm Med 2022; 22:485. [PMID: 36550475 PMCID: PMC9784077 DOI: 10.1186/s12890-022-02289-0] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET), and its primary outcome of peak oxygen uptake (VO2peak), are acknowledged as biomarkers in the diagnostic and prognostic management of interstitial lung disease (ILD). However, the validity and repeatability of CPET in those with ILD has yet to be fully characterised, and this study fills this evidence gap. METHODS Twenty-six people with ILD were recruited, and 21 successfully completed three CPETs. Of these, 17 completed two valid CPETs within a 3-month window, and 11 completed two valid CPETs within a 6-month window. Technical standards from the European Respiratory Society established validity, and repeatability was determined using mean change, intraclass correlation coefficient and typical error. RESULTS Every participant (100%) who successfully exercised to volitional exhaustion produced a maximal, and therefore valid, CPET. Approximately 20% of participants presented with a plateau in VO2, the primary criteria for establishing a maximal effort. The majority of participants otherwise presented with secondary criteria of respiratory exchange ratios in excess of 1.05, and maximal heart rates in excess of their predicted values. Repeatability analyses identified that the typical error (expressed as percent of coefficient of variation) was 20% over 3-months in those reaching volitional exhaustion. CONCLUSION This work has, for the first time, fully characterised how patients with ILD respond to CPET in terms of primary and secondary verification criteria, and generated novel repeatability data that will prove useful in the assessment of disease progression, and future evaluation of therapeutic regimens where VO2peak is used as an outcome measure.
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Affiliation(s)
- Owen W. Tomlinson
- grid.8391.30000 0004 1936 8024Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK ,Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Laura Markham
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Rebecca L. Wollerton
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Bridget A. Knight
- grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK ,grid.477603.1NIHR Exeter Clinical Research Facility, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK
| | - Anna Duckworth
- grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Michael A. Gibbons
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Chris J. Scotton
- grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Craig A. Williams
- grid.8391.30000 0004 1936 8024Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK ,Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK
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6
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van Moorsel CHM, van der Vis JJ, Duckworth A, Scotton CJ, Benschop C, Ellinghaus D, Ruven HJT, Quanjel MJR, Grutters JC. The MUC5B Promoter Polymorphism Associates With Severe COVID-19 in the European Population. Front Med (Lausanne) 2021; 8:668024. [PMID: 34888316 PMCID: PMC8650310 DOI: 10.3389/fmed.2021.668024] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/22/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Diversity in response on exposure to severe acute respiratory syndrome coronavirus 2 may be related to the innate immune response in the elderly. The mucin MUC5B is an important component of the innate immune response and expression levels are associated with the MUC5B promoter polymorphism, rs35705950. The high expressing T-allele is a risk allele for the non-infectious aging lung disease idiopathic pulmonary fibrosis (IPF). We investigated if MUC5B rs35705950 associates with severe COVID-19. Methods: In this retrospective candidate gene case-control study we recruited 108 Dutch patients (69% male, median age 66 years, 77% white) requiring hospitalization for COVID-19 (22% ICU stay, 24% died). For validation, genotypes were obtained from the UK-Biobank (n = 436, 57% male, median age 70 years, 27% died), for replication data from the severe COVID-19 GWAS group from Italy (n = 835) and Spain (n = 775) was used, each with a control cohort (n = 356,735, n = 1,255, n = 950, respectively). MUC5B association analysis was performed including adjustment for age and sex. Results: The rs35705950 T-allele frequency was significantly lower in Dutch white patients (n = 83) than in controls (0.04 vs. 0.10; p = 0.02). This was validated in the UK biobank cohort (0.08 vs. 0.11; p = 0.001). While age and sex differed significantly between cases and control, comparable results were obtained with age and sex as confounding variables in a multivariate analysis. The association was replicated in the Italian (p = 0.04), and Spanish (p = 0.03) case-control cohorts. Meta-analysis showed a negative association for the T-allele with COVID-19 (OR = 0.75 (CI: 0.67–0.85); p = 6.63 × 10−6). Conclusions: This study shows that carriage of the T-allele of MUC5B rs35705950 confers protection from development of severe COVID-19. Because the T-allele is a known risk allele for IPF, this study provides further evidence for the existence of trade-offs between optimal mucin expression levels in the aging lung.
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Affiliation(s)
- Coline H M van Moorsel
- Department of Pulmonology, St Antonius ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands.,Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joanne J van der Vis
- Department of Pulmonology, St Antonius ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands.,Department of Clinical Chemistry, St Antonius ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Anna Duckworth
- College of Medicine & Health, Institute of Biomedical & Clinical Science, University of Exeter, Exeter, United Kingdom
| | - Chris J Scotton
- College of Medicine & Health, Institute of Biomedical & Clinical Science, University of Exeter, Exeter, United Kingdom
| | - Claudia Benschop
- Department of Pulmonology, St Antonius ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands.,Department of Medical Microbiology and Immunology, St Antonius ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
| | - David Ellinghaus
- Genetics and Bioinformatics Group, Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany.,Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, University of Copenhagen, Copenhagen, Denmark
| | - Henk J T Ruven
- Department of Clinical Chemistry, St Antonius ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Marian J R Quanjel
- Department of Pulmonology, St Antonius ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Jan C Grutters
- Department of Pulmonology, St Antonius ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands.,Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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7
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Pacitti D, Scotton CJ, Kumar V, Khan H, Wark PAB, Torregrossa R, Hansbro PM, Whiteman M. Gasping for Sulfide: A Critical Appraisal of Hydrogen Sulfide in Lung Disease and Accelerated Aging. Antioxid Redox Signal 2021; 35:551-579. [PMID: 33736455 DOI: 10.1089/ars.2021.0039] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hydrogen sulfide (H2S) is a gaseous signaling molecule involved in a plethora of physiological and pathological processes. It is primarily synthesized by cystathionine-β-synthase, cystathionine-γ-lyase, and 3-mercaptopyruvate sulfurtransferase as a metabolite of the transsulfuration pathway. H2S has been shown to exert beneficial roles in lung disease acting as an anti-inflammatory and antiviral and to ameliorate cell metabolism and protect from oxidative stress. H2S interacts with transcription factors, ion channels, and a multitude of proteins via post-translational modifications through S-persulfidation ("sulfhydration"). Perturbation of endogenous H2S synthesis and/or levels have been implicated in the development of accelerated lung aging and diseases, including asthma, chronic obstructive pulmonary disease, and fibrosis. Furthermore, evidence indicates that persulfidation is decreased with aging. Here, we review the use of H2S as a biomarker of lung pathologies and discuss the potential of using H2S-generating molecules and synthesis inhibitors to treat respiratory diseases. Furthermore, we provide a critical appraisal of methods of detection used to quantify H2S concentration in biological samples and discuss the challenges of characterizing physiological and pathological levels. Considerations and caveats of using H2S delivery molecules, the choice of generating molecules, and concentrations are also reviewed. Antioxid. Redox Signal. 35, 551-579.
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Affiliation(s)
- Dario Pacitti
- Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Chris J Scotton
- Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Vinod Kumar
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Haroon Khan
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Peter A B Wark
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Roberta Torregrossa
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Philip M Hansbro
- Faculty of Science, Centre for Inflammation, Centenary Institute, University of Technology Sydney, Sydney, Australia
| | - Matthew Whiteman
- Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
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8
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Chong DLW, Rebeyrol C, José RJ, Williams AE, Brown JS, Scotton CJ, Porter JC. ICAM-1 and ICAM-2 Are Differentially Expressed and Up-Regulated on Inflamed Pulmonary Epithelium, but Neither ICAM-2 nor LFA-1: ICAM-1 Are Required for Neutrophil Migration Into the Airways In Vivo. Front Immunol 2021; 12:691957. [PMID: 34484188 PMCID: PMC8415445 DOI: 10.3389/fimmu.2021.691957] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 01/21/2023] Open
Abstract
Neutrophil migration into the airways is an important process to fight infection and is mediated by cell adhesion molecules. The intercellular adhesion molecules, ICAM-1 (CD54) and ICAM-2 (CD102) are known ligands for the neutrophil integrins, lymphocyte function associated antigen (LFA)-1 (αLβ2; CD11a/CD18), and macrophage-1 antigen (Mac-1;αMβ2;CD11b/CD18) and are implicated in leukocyte migration into the lung. However, it is ill-defined how neutrophils exit the lung and the role for ICAMs in trans-epithelial migration (TEpM) across the bronchial or alveolar epithelium. We found that human and murine alveolar epithelium expressed ICAM-1, whilst the bronchial epithelium expressed ICAM-2, and both were up-regulated during inflammatory stimulation in vitro and in inflammatory lung diseases such as cystic fibrosis. Although β2 integrins interacting with ICAM-1 and -2 mediated neutrophil migration across human bronchial epithelium in vitro, neither ICAM-2 nor LFA-1 binding of ICAM-1 mediated murine neutrophil migration into the lung or broncho-alveolar space during LPS-induced inflammation in vivo. Furthermore, TEpM of neutrophils themselves resulted in increased epithelial junctional permeability and reduced barrier function in vitro. This suggests that although β2 integrins interacting with ICAMs may regulate low levels of neutrophil traffic in healthy lung or early in inflammation when the epithelial barrier is intact; these interactions may be redundant later in inflammation when epithelial junctions are disrupted and no longer limit TEpM.
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Affiliation(s)
- Deborah L. W. Chong
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, United Kingdom
| | - Carine Rebeyrol
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, United Kingdom
| | - Ricardo J. José
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, United Kingdom
| | - Andrew E. Williams
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, United Kingdom
| | - Jeremy S. Brown
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, United Kingdom
| | - Chris J. Scotton
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, United Kingdom
- Institute of Biomedical and Clinical Sciences, College of Medicine & Health, Exeter, United Kingdom
| | - Joanna C. Porter
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, United Kingdom
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9
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Duckworth A, Longhurst HJ, Paxton JK, Scotton CJ. The Role of Herpes Viruses in Pulmonary Fibrosis. Front Med (Lausanne) 2021; 8:704222. [PMID: 34368196 PMCID: PMC8339799 DOI: 10.3389/fmed.2021.704222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/24/2021] [Indexed: 12/29/2022] Open
Abstract
Pulmonary fibrosis (PF) is a serious lung disease which can result from known genetic or environmental exposures but is more commonly idiopathic (IPF). In familial PF (FPF), the majority of identified causal genes play key roles in the maintenance of telomeres, the protective end structures of chromosomes. Recent evidence suggests that short telomeres may also be implicated causally in a significant proportion of idiopathic cases. The possible involvement of herpes viruses in PF disease incidence and progression has been examined for many years, with some studies showing strong, statistically significant associations and others reporting no involvement. Evidence is thus polarized and remains inconclusive. Here we review the reported involvement of herpes viruses in PF in both animals and humans and present a summary of the evidence to date. We also present several possible mechanisms of action of the different herpes viruses in PF pathogenesis, including potential contributions to telomere attrition and cellular senescence. Evidence for antiviral treatment in PF is very limited but suggests a potential benefit. Further work is required to definitely answer the question of whether herpes viruses impact PF disease onset and progression and to enable the possible use of targeted antiviral treatments to improve clinical outcomes.
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Affiliation(s)
- Anna Duckworth
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Hilary J. Longhurst
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Dyskeratosis Congenita (DC) Action, London, United Kingdom
| | - Jane K. Paxton
- Dyskeratosis Congenita (DC) Action, London, United Kingdom
| | - Chris J. Scotton
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
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10
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Duckworth A, Gibbons MA, Allen RJ, Almond H, Beaumont RN, Wood AR, Lunnon K, Lindsay MA, Wain LV, Tyrrell J, Scotton CJ. Telomere length and risk of idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease: a mendelian randomisation study. Lancet Respir Med 2021; 9:285-294. [PMID: 33197388 DOI: 10.1016/s2213-2600(20)30364-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease accounting for 1% of UK deaths. In the familial form of pulmonary fibrosis, causal genes have been identified in about 30% of cases, and a majority of these causal genes are associated with telomere maintenance. Prematurely shortened leukocyte telomere length is associated with IPF and chronic obstructive pulmonary disease (COPD), a disease with similar demographics and shared risk factors. Using mendelian randomisation, we investigated evidence supporting a causal role for short telomeres in IPF and COPD. METHODS Mendelian randomisation inference of telomere length causality was done for IPF (up to 1369 cases) and COPD (13 538 cases) against 435 866 controls of European ancestry in UK Biobank. Polygenic risk scores were calculated and two-sample mendelian randomisation analyses were done using seven genetic variants previously associated with telomere length, with replication analysis in an IPF cohort (2668 cases vs 8591 controls) and COPD cohort (15 256 cases vs 47 936 controls). FINDINGS In the UK Biobank, a genetically instrumented one-SD shorter telomere length was associated with higher odds of IPF (odds ratio [OR] 4·19, 95% CI 2·33-7·55; p=0·0031) but not COPD (1·07, 0·88-1·30; p=0·51). Similarly, an association was found in the IPF replication cohort (12·3, 5·05-30·1; p=0·0015) and not in the COPD replication cohort (1·04, 0·71-1·53; p=0·83). Meta-analysis of the two-sample mendelian randomisation results provided evidence inferring that shorter telomeres cause IPF (5·81 higher odds of IPF, 95% CI 3·56-9·50; p=2·19 × 10-12). There was no evidence to infer that telomere length caused COPD (OR 1·07, 95% CI 0·90-1·27; p=0·46). INTERPRETATION Cellular senescence is hypothesised as a major driving force in IPF and COPD; telomere shortening might be a contributory factor in IPF, suggesting divergent mechanisms in COPD. Defining a key role for telomere shortening enables greater focus in telomere-related diagnostics, treatments, and the search for a cure in IPF. Investigation of therapies that improve telomere length is warranted. FUNDING Medical Research Council.
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Affiliation(s)
- Anna Duckworth
- Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK; Exeter Patients in Collaboration for PF, Exeter, UK
| | - Michael A Gibbons
- Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK; Exeter Patients in Collaboration for PF, Exeter, UK; Respiratory Medicine Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Richard J Allen
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Robin N Beaumont
- Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Andrew R Wood
- Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Katie Lunnon
- Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Mark A Lindsay
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Jess Tyrrell
- Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Chris J Scotton
- Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK; Exeter Patients in Collaboration for PF, Exeter, UK.
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11
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Mitchelmore PJ, Withers NJ, Sheldon CD, Scotton CJ, Brown AR. Culture-independent multilocus sequence typing of Pseudomonas aeruginosa for cross-infection screening. Diagn Microbiol Infect Dis 2021; 100:115315. [PMID: 33571861 DOI: 10.1016/j.diagmicrobio.2021.115315] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/22/2020] [Accepted: 01/17/2021] [Indexed: 02/02/2023]
Abstract
The genotyping of pathogens within cystic fibrosis cohorts is an important process, enabling the detection of transmissible and clinically-important strains. Traditionally this has been via culture-dependent processes. However, culture-independent investigation of respiratory samples is becoming more common, with such approaches highlighting the limitations of culture-based methods. In this study we describe the culture-independent application of multilocus sequence typing (MLST) for Pseudomonas aeruginosa, performed on DNA extracted from the sputa of cystic fibrosis patients. We compare the output to conventional culture-dependent MLST applied to the same samples and demonstrate high concordance. Culture-independent MLST enabled genotyping of culture-negative samples in patients from whom P. aeruginosa was intermittently isolated, and revealed the hidden presence of transmissible strains. Culture-independent MLST is also capable of highlighting samples containing multiple strains, albeit inconsistently. We conclude that culture-independent MLST can be a useful genotyping tool for screening cohorts and identifying patients that warrant further detailed investigation.
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Affiliation(s)
- Philip J Mitchelmore
- Institute of Biomedical and Clinical Sciences, St Luke's Campus, University of Exeter Medical School, Exeter, UK; Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, UK.
| | - Nicholas J Withers
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, UK
| | - Christopher D Sheldon
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, UK
| | - Chris J Scotton
- Institute of Biomedical and Clinical Sciences, St Luke's Campus, University of Exeter Medical School, Exeter, UK
| | - Alan R Brown
- Biosciences, College of Life and Environmental Sciences, Stocker Road, University of Exeter, Exeter, UK
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12
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Chong DLW, Trinder S, Labelle M, Rodriguez-Justo M, Hughes S, Holmes AM, Scotton CJ, Porter JC. Platelet-derived transforming growth factor-β1 promotes keratinocyte proliferation in cutaneous wound healing. J Tissue Eng Regen Med 2020; 14:645-649. [PMID: 32068954 PMCID: PMC7216944 DOI: 10.1002/term.3022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 04/15/2019] [Revised: 11/25/2019] [Accepted: 01/27/2020] [Indexed: 01/08/2023]
Abstract
Platelets are a recognised potent source of transforming growth factor‐β1 (TGFβ1), a cytokine known to promote wound healing and regeneration by stimulating dermal fibroblast proliferation and extracellular matrix deposition. Platelet lysate has been advocated as a novel personalised therapeutic to treat persistent wounds, although the precise platelet‐derived growth factors responsible for these beneficial effects have not been fully elucidated. The aim of this study was to investigate the specific role of platelet‐derived TGFβ1 in cutaneous wound healing. Using a transgenic mouse with a targeted deletion of TGFβ1 in megakaryocytes and platelets (TGFβ1fl/fl.PF4‐Cre), we show for the first time that platelet‐derived TGFβ1 contributes to epidermal and dermal thickening and cellular turnover after excisional skin wounding. In vitro studies demonstrate that human dermal fibroblasts stimulated with platelet lysate containing high levels of platelet‐derived TGFβ1 did not exhibit enhanced collagen deposition or proliferation, suggesting that platelet‐derived TGFβ1 is not a key promoter of these wound healing processes. Interestingly, human keratinocytes displayed enhanced TGFβ1‐driven proliferation in response to platelet lysate, reminiscent of our in vivo findings. In summary, our novel findings define and emphasise an important role of platelet‐derived TGFβ1 in epidermal remodelling and regeneration processes during cutaneous wound healing.
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Affiliation(s)
- Deborah L W Chong
- Centre for Inflammation and Tissue Repair, UCL, Bloomsbury Campus, London, UK
| | - Sarah Trinder
- Department of Inflammation, UCL, Royal Free Campus, London, UK
| | - Myriam Labelle
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Sian Hughes
- Department of Histopathology, UCL, Bloomsbury Campus, London, UK
| | - Alan M Holmes
- Department of Inflammation, UCL, Royal Free Campus, London, UK.,Drug Discovery Group, Translational Research Office, School of Pharmacy, UCL, London, UK
| | - Chris J Scotton
- Centre for Inflammation and Tissue Repair, UCL, Bloomsbury Campus, London, UK.,Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Exeter, UK
| | - Joanna C Porter
- Centre for Inflammation and Tissue Repair, UCL, Bloomsbury Campus, London, UK
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13
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Kotkowiak W, Wengel J, Scotton CJ, Pasternak A. Improved RE31 Analogues Containing Modified Nucleic Acid Monomers: Thermodynamic, Structural, and Biological Effects. J Med Chem 2019; 62:2499-2507. [PMID: 30735377 DOI: 10.1021/acs.jmedchem.8b01806] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
RE31 is a 31-nt DNA aptamer, consisting of the G-quadruplex and a duplex domain, which is able to effectively prolong thrombin time. This article reports on the influence of certain modified nucleotide residues on thermodynamic and biological properties as well as the folding topology of RE31. Particularly, the effect of the presence of nucleosides in unlocked nucleic acid (UNA), locked nucleic acid (LNA), or β-l-RNA series was evaluated. The studies presented herein show that all modified residues can influence thermal and biological stabilities of G-quadruplex in a position-dependent manner. The aptamers modified simultaneously with UNA at the T15 position and LNAs in the duplex part possess the highest value of melting temperature and a 2-fold higher anticoagulant effect. Importantly, RE31 variants modified with nucleosides in UNA, LNA, or β-l-RNA series exhibit unchanged G-quadruplex folding topology. Crucially, introduction of any of the modified residues into RE31 causes prolongation of aptamer stability in human serum.
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Affiliation(s)
- Weronika Kotkowiak
- Department of Nucleic Acids Bioengineering, Institute of Bioorganic Chemistry , Polish Academy of Sciences , Noskowskiego 12/14 , 61-704 Poznan , Poland
| | - Jesper Wengel
- Department of Physics, Chemistry, and Pharmacy, Biomolecular Nanoscale Engineering Center , University of Southern Denmark , Campusvej 55 , Odense M 5230 , Denmark
| | - Chris J Scotton
- Institute of Biomedical and Clinical Science, College of Medicine & Health , University of Exeter, St Luke's Campus , Exeter EX1 2LU , U.K
| | - Anna Pasternak
- Department of Nucleic Acids Bioengineering, Institute of Bioorganic Chemistry , Polish Academy of Sciences , Noskowskiego 12/14 , 61-704 Poznan , Poland
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14
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Tabish TA, Scotton CJ, J Ferguson DC, Lin L, der Veen AV, Lowry S, Ali M, Jabeen F, Ali M, Winyard PG, Zhang S. Biocompatibility and toxicity of graphene quantum dots for potential application in photodynamic therapy. Nanomedicine (Lond) 2018; 13:1923-1937. [DOI: 10.2217/nnm-2018-0018] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Achieving reliably high production of reactive oxygen species (ROS) in photodynamic therapy (PDT) remains challenging. Graphene quantum dots (GQDs) hold great promise for PDT. However, the photochemical processes leading to GQD-derived ROS generation have not yet been fully elucidated. Materials & methods: Physicochemical characteristics of GQDs were comprehensively investigated, including electron paramagnetic resonance analysis of singlet oxygen production. Dark toxicity was assessed in vitro and in vivo. Results: GQDs demonstrated excellent photoluminescent features, corrosion resistance, high water solubility, high photo/pH-stability, in vitro and in vivo biocompatibility and very efficient singlet oxygen/ROS generation. Conclusion: The enhanced ROS generation, combined with good biocompatibility and minimal toxicity in vitro and in vivo support the potential of GQDs for future PDT application.
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Affiliation(s)
- Tanveer A Tabish
- Centre for Graphene Science, College of Engineering, Mathematics & Physical Sciences, University of Exeter, Stocker Road, Exeter, EX4 4QF UK
| | - Chris J Scotton
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Daniel C J Ferguson
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Liangxu Lin
- Centre for Graphene Science, College of Engineering, Mathematics & Physical Sciences, University of Exeter, Stocker Road, Exeter, EX4 4QF UK
| | - Anienke van der Veen
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Sophie Lowry
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Muhammad Ali
- Department of Zoology, Government College University, Faisalabad, 38000, Pakistan
| | - Farhat Jabeen
- Department of Zoology, Government College University, Faisalabad, 38000, Pakistan
| | - Muhammad Ali
- Faculty of Animal Sciences, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Paul G Winyard
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Shaowei Zhang
- Centre for Graphene Science, College of Engineering, Mathematics & Physical Sciences, University of Exeter, Stocker Road, Exeter, EX4 4QF UK
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Smoktunowicz N, Platé M, Stern AO, D'Antongiovanni V, Robinson E, Chudasama V, Caddick S, Scotton CJ, Jarai G, Chambers RC. TGFβ upregulates PAR-1 expression and signalling responses in A549 lung adenocarcinoma cells. Oncotarget 2018; 7:65471-65484. [PMID: 27566553 PMCID: PMC5323169 DOI: 10.18632/oncotarget.11472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 02/12/2016] [Accepted: 08/06/2016] [Indexed: 12/13/2022] Open
Abstract
The major high-affinity thrombin receptor, proteinase activated receptor-1 (PAR-1) is expressed at low levels by the normal epithelium but is upregulated in many types of cancer, including lung cancer. The thrombin-PAR-1 signalling axis contributes to the activation of latent TGFβ in response to tissue injury via an αvβ6 integrin-mediated mechanism. TGFβ is a pleiotropic cytokine that acts as a tumour suppressor in normal and dysplastic cells but switches into a tumour promoter in advanced tumours. In this study we demonstrate that TGFβ is a positive regulator of PAR-1 expression in A549 lung adenocarcinoma cells, which in turn increases the sensitivity of these cells to thrombin signalling. We further demonstrate that this effect is Smad3-, ERK1/2- and Sp1-dependent. We also show that TGFβ-mediated PAR-1 upregulation is accompanied by increased expression of integrin αv and β6 subunits. Finally, TGFβ pre-stimulation promotes increased migratory potential of A549 to thrombin. These data have important implications for our understanding of the interplay between coagulation and TGFβ signalling responses in lung cancer.
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Affiliation(s)
- Natalia Smoktunowicz
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Manuela Platé
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Alejandro Ortiz Stern
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Vanessa D'Antongiovanni
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Eifion Robinson
- Department of Chemistry, University College London, London, UK
| | - Vijay Chudasama
- Department of Chemistry, University College London, London, UK
| | - Stephen Caddick
- Department of Chemistry, University College London, London, UK
| | - Chris J Scotton
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Gabor Jarai
- Novartis Institutes of Biomedical Research, Horsham, UK
| | - Rachel C Chambers
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
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Gibbons MA, Scotton CJ. Delving Deep into the Proteome of Lung Fibrosis Brings Plasma Cells to the Surface. Am J Respir Crit Care Med 2017; 196:1238-1240. [PMID: 28696776 DOI: 10.1164/rccm.201706-1186ed] [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)
- Michael A Gibbons
- 1 Institute of Biomedical and Clinical Science University of Exeter Medical School Exeter, United Kingdom and.,2 Respiratory Department Royal Devon and Exeter NHS Foundation Trust Exeter, United Kingdom
| | - Chris J Scotton
- 1 Institute of Biomedical and Clinical Science University of Exeter Medical School Exeter, United Kingdom and
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17
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Barratt SL, Blythe T, Jarrett C, Ourradi K, Shelley-Fraser G, Day MJ, Qiu Y, Harper S, Maher TM, Oltean S, Hames TJ, Scotton CJ, Welsh GI, Bates DO, Millar AB. Differential Expression of VEGF-A xxx Isoforms Is Critical for Development of Pulmonary Fibrosis. Am J Respir Crit Care Med 2017; 196:479-493. [PMID: 28661183 DOI: 10.1164/rccm.201603-0568oc] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [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: 11/16/2022] Open
Abstract
RATIONALE Fibrosis after lung injury is related to poor outcome, and idiopathic pulmonary fibrosis (IPF) can be regarded as an exemplar. Vascular endothelial growth factor (VEGF)-A has been implicated in this context, but there are conflicting reports as to whether it is a contributory or protective factor. Differential splicing of the VEGF-A gene produces multiple functional isoforms including VEGF-A165a and VEGF-A165b, a member of the inhibitory family. To date there is no clear information on the role of VEGF-A in IPF. OBJECTIVES To establish VEGF-A isoform expression and functional effects in IPF. METHODS We used tissue sections, plasma, and lung fibroblasts from patients with IPF and control subjects. In a bleomycin-induced lung fibrosis model we used wild-type MMTV mice and a triple transgenic mouse SPC-rtTA+/-TetoCre+/-LoxP-VEGF-A+/+ to conditionally induce VEGF-A isoform deletion specifically in the alveolar type II (ATII) cells of adult mice. MEASUREMENTS AND MAIN RESULTS IPF and normal lung fibroblasts differentially expressed and responded to VEGF-A165a and VEGF-A165b in terms of proliferation and matrix expression. Increased VEGF-A165b was detected in plasma of progressing patients with IPF. In a mouse model of pulmonary fibrosis, ATII-specific deficiency of VEGF-A or constitutive overexpression of VEGF-A165b inhibited the development of pulmonary fibrosis, as did treatment with intraperitoneal delivery of VEGF-A165b to wild-type mice. CONCLUSIONS These results indicate that changes in the bioavailability of VEGF-A sourced from ATII cells, namely the ratio of VEGF-Axxxa to VEGF-Axxxb, are critical in development of pulmonary fibrosis and may be a paradigm for the regulation of tissue repair.
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Affiliation(s)
| | - Thomas Blythe
- 1 Academic Respiratory Unit, School of Clinical Sciences
| | | | | | - Golda Shelley-Fraser
- 2 Department of Histopathology, Cheltenham and Gloucestershire NHS Trust, Cheltenham, United Kingdom
| | | | | | | | - Toby M Maher
- 5 NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom
| | - Sebastian Oltean
- 6 Department of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom
| | - Thomas J Hames
- 7 University of Exeter Medical School, Exeter, United Kingdom; and
| | - Chris J Scotton
- 7 University of Exeter Medical School, Exeter, United Kingdom; and
| | | | - David O Bates
- 8 Cancer Biology, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Ann B Millar
- 1 Academic Respiratory Unit, School of Clinical Sciences
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18
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Mitchelmore PJ, Randall J, Bull MJ, Moore KA, O'Neill PA, Paszkiewicz K, Mahenthiralingam E, Scotton CJ, Sheldon CD, Withers NJ, Brown AR. Molecular epidemiology of Pseudomonas aeruginosa in an unsegregated bronchiectasis cohort sharing hospital facilities with a cystic fibrosis cohort. Thorax 2017; 73:thoraxjnl-2016-209889. [PMID: 28844058 DOI: 10.1136/thoraxjnl-2016-209889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/19/2016] [Revised: 08/04/2017] [Accepted: 08/14/2017] [Indexed: 11/04/2022]
Abstract
While Pseudomonas aeruginosa (PA) cross-infection is well documented among patients with cystic fibrosis (CF), the equivalent risk among patients with non-CF bronchiectasis (NCFB) is unclear, particularly those managed alongside patients with CF. We performed analysis of PA within a single centre that manages an unsegregated NCFB cohort alongside a segregated CF cohort. We found no evidence of cross-infection between the two cohorts or within the segregated CF cohort. However, within the unsegregated NCFB cohort, evidence of cross-infection was found between three (of 46) patients. While we do not presently advocate any change in the management of our NCFB cohort, longitudinal surveillance is clearly warranted.
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Affiliation(s)
- Philip J Mitchelmore
- Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Exeter, UK
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Joanna Randall
- Department of Microbiology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Matthew J Bull
- Division of Organisms and Environment Research, Cardiff School of Biosciences, Cardiff University, Cardiff, UK
| | - Karen A Moore
- Department of Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Paul A O'Neill
- Department of Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Konrad Paszkiewicz
- Department of Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Eshwar Mahenthiralingam
- Division of Organisms and Environment Research, Cardiff School of Biosciences, Cardiff University, Cardiff, UK
| | - Chris J Scotton
- Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Exeter, UK
| | - Christopher D Sheldon
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Nicholas J Withers
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Alan R Brown
- Department of Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
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20
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Davies GF, Greenhough BJ, Hobson-West P, Kirk RGW, Applebee K, Bellingan LC, Berdoy M, Buller H, Cassaday HJ, Davies K, Diefenbacher D, Druglitrø T, Escobar MP, Friese C, Herrmann K, Hinterberger A, Jarrett WJ, Jayne K, Johnson AM, Johnson ER, Konold T, Leach MC, Leonelli S, Lewis DI, Lilley EJ, Longridge ER, McLeod CM, Miele M, Nelson NC, Ormandy EH, Pallett H, Poort L, Pound P, Ramsden E, Roe E, Scalway H, Schrader A, Scotton CJ, Scudamore CL, Smith JA, Whitfield L, Wolfensohn S. Developing a Collaborative Agenda for Humanities and Social Scientific Research on Laboratory Animal Science and Welfare. PLoS One 2016; 11:e0158791. [PMID: 27428071 PMCID: PMC4948886 DOI: 10.1371/journal.pone.0158791] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/22/2016] [Indexed: 11/19/2022] Open
Abstract
Improving laboratory animal science and welfare requires both new scientific research and insights from research in the humanities and social sciences. Whilst scientific research provides evidence to replace, reduce and refine procedures involving laboratory animals (the '3Rs'), work in the humanities and social sciences can help understand the social, economic and cultural processes that enhance or impede humane ways of knowing and working with laboratory animals. However, communication across these disciplinary perspectives is currently limited, and they design research programmes, generate results, engage users, and seek to influence policy in different ways. To facilitate dialogue and future research at this interface, we convened an interdisciplinary group of 45 life scientists, social scientists, humanities scholars, non-governmental organisations and policy-makers to generate a collaborative research agenda. This drew on methods employed by other agenda-setting exercises in science policy, using a collaborative and deliberative approach for the identification of research priorities. Participants were recruited from across the community, invited to submit research questions and vote on their priorities. They then met at an interactive workshop in the UK, discussed all 136 questions submitted, and collectively defined the 30 most important issues for the group. The output is a collaborative future agenda for research in the humanities and social sciences on laboratory animal science and welfare. The questions indicate a demand for new research in the humanities and social sciences to inform emerging discussions and priorities on the governance and practice of laboratory animal research, including on issues around: international harmonisation, openness and public engagement, 'cultures of care', harm-benefit analysis and the future of the 3Rs. The process outlined below underlines the value of interdisciplinary exchange for improving communication across different research cultures and identifies ways of enhancing the effectiveness of future research at the interface between the humanities, social sciences, science and science policy.
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Affiliation(s)
- Gail F. Davies
- Department of Geography, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Beth J Greenhough
- School of Geography and the Environment and Keble College, University of Oxford, Oxford, United Kingdom
| | - Pru Hobson-West
- Centre for Applied Bioethics, School of Veterinary Medicine and Science, University of Nottingham, Leicestershire, United Kingdom
| | - Robert G. W. Kirk
- Centre for the History of Science, Technology and Medicine (CHSTM), Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Ken Applebee
- Biological Services, Health Schools, King's College London, London, United Kingdom
| | | | - Manuel Berdoy
- Biomedical Services, University of Oxford, Oxford, United Kingdom
| | - Henry Buller
- Department of Geography, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Helen J. Cassaday
- School of Psychology, University of Nottingham, University Park, Nottingham, United Kingdom
| | - Keith Davies
- Joint Biological Services, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | | | - Tone Druglitrø
- TIK – Centre for Technology, Innovation and Culture, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | | - Carrie Friese
- Department of Sociology, London School of Economics, London, United Kingdom
| | - Kathrin Herrmann
- Institute of Pharmacology and Toxicology Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Amy Hinterberger
- Department of Sociology, University of Warwick, Coventry, United Kingdom
| | | | - Kimberley Jayne
- Centre for Research in Animal Behaviour, Psychology, University of Exeter, Exeter, United Kingdom
| | - Adam M. Johnson
- Biological Services Facility (BSF), Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Elizabeth R. Johnson
- Department of Environmental Studies, Hobart and William Smith Colleges, Geneva, New York, United States of America
| | - Timm Konold
- Animal Sciences Unit, Animal and Plant Health Agency Weybridge, Addlestone, United Kingdom
| | - Matthew C. Leach
- School of Agriculture, Food & Rural Development, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sabina Leonelli
- Exeter Centre for the Study of the Life Sciences (Egenis) & Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, United Kingdom
| | - David I. Lewis
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Elliot J. Lilley
- Research Animals Department, Science Group, RSPCA, Wilberforce Way, Southwater, West Sussex, United Kingdom
| | - Emma R. Longridge
- Biotechnology and Biological Sciences Research Council (BBSRC), Swindon, United Kingdom
| | - Carmen M. McLeod
- Faculty of Medicine & Health Sciences, University of Nottingham, Leicestershire, United Kingdom
| | - Mara Miele
- School of Planning and Geography, College of Art, Humanities and Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Nicole C. Nelson
- Department of the History of Science, University of Wisconsin—Madison, Madison, Wisconsin, United States of America
| | | | - Helen Pallett
- School of Environmental Sciences, University of East Anglia, Norwich, United Kingdom
| | - Lonneke Poort
- Faculteit of Law, VU University, Amsterdam, The Netherlands
| | - Pandora Pound
- School for Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Edmund Ramsden
- School of History, Queen Mary, University of London, London, United Kingdom
| | - Emma Roe
- Department of Geography and Environment, University of Southampton, Southampton, United Kingdom
| | - Helen Scalway
- Honorary Research Associate, Geography Department, Royal Holloway, University of London, London, United Kingdom
| | - Astrid Schrader
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, United Kingdom
| | - Chris J. Scotton
- Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Exeter, United Kingdom
| | | | - Jane A. Smith
- Faculty of Science, The Open University, Milton Keynes, United Kingdom
| | - Lucy Whitfield
- Named Veterinary Surgeons Group, Royal Veterinary College, London, United Kingdom
| | - Sarah Wolfensohn
- School of Veterinary Medicine, University of Surrey, Guildford, Surrey, United Kingdom
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21
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Jayasinghe SN, Auguste J, Scotton CJ. Platform Technologies for Directly Reconstructing 3D Living Biomaterials. Adv Mater 2015; 27:7794-7799. [PMID: 26508202 DOI: 10.1002/adma.201503001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/02/2015] [Indexed: 06/05/2023]
Abstract
Bio-electrospraying and cell electrospinning is explored for reconstructing living biomaterials for regenerative biology and medicine. The investigations carried out in this study demonstrate these approaches as platform biotechnologies for tissue reconstruction for repair, replacement, and rejuvenation of damaged and/or ageing tissues and/or organs.
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Affiliation(s)
- Suwan N Jayasinghe
- BioPhysics Group, Institute of Biomedical Engineering, Centre for Stem Cells and Regenerative Medicine, and Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Jensen Auguste
- Olaf Pharmaceuticals, Biotech Three, One Innovation Dr, Worcester, MA, 01605, USA
| | - Chris J Scotton
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter EX2 4TE, UK
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Smoktunowicz N, Alexander RE, Franklin L, Williams AE, Holman B, Mercer PF, Jarai G, Scotton CJ, Chambers RC. The anti-fibrotic effect of inhibition of TGFβ-ALK5 signalling in experimental pulmonary fibrosis in mice is attenuated in the presence of concurrent γ-herpesvirus infection. Dis Model Mech 2015; 8:1129-39. [PMID: 26138704 PMCID: PMC4582104 DOI: 10.1242/dmm.019984] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/26/2015] [Indexed: 02/06/2023] Open
Abstract
TGFβ-ALK5 pro-fibrotic signalling and herpesvirus infections have been implicated in the pathogenesis and exacerbation of pulmonary fibrosis. In this study we addressed the role of TGFβ-ALK5 signalling during the progression of fibrosis in a two-hit mouse model of murine γ-herpesvirus 68 (MHV-68) infection on the background of pre-existing bleomycin-induced pulmonary fibrosis. Assessment of total lung collagen levels in combination with ex vivo micro-computed tomography (µCT) analysis of whole lungs demonstrated that MHV-68 infection did not enhance lung collagen deposition in this two-hit model but led to a persistent and exacerbated inflammatory response. Moreover, µCT reconstruction and analysis of the two-hit model revealed distinguishing features of diffuse ground-glass opacities and consolidation superimposed on pre-existing fibrosis that were reminiscent of those observed in acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF). Virally-infected murine fibrotic lungs further displayed evidence of extensive inflammatory cell infiltration and increased levels of CCL2, TNFα, IL-1β and IL-10. Blockade of TGFβ-ALK5 signalling attenuated lung collagen accumulation in bleomycin-alone injured mice, but this anti-fibrotic effect was reduced in the presence of concomitant viral infection. In contrast, inhibition of TGFβ-ALK5 signalling in virally-infected fibrotic lungs was associated with reduced inflammatory cell aggregates and increased levels of the antiviral cytokine IFNγ. These data reveal newly identified intricacies for the TGFβ-ALK5 signalling axis in experimental lung fibrosis, with different outcomes in response to ALK5 inhibition depending on the presence of viral infection. These findings raise important considerations for the targeting of TGFβ signalling responses in the context of pulmonary fibrosis.
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Affiliation(s)
- Natalia Smoktunowicz
- Centre for Inflammation & Tissue Repair, University College London, London, WC1E 6JF, UK
| | - Robert E Alexander
- Centre for Inflammation & Tissue Repair, University College London, London, WC1E 6JF, UK
| | - Linda Franklin
- Centre for Inflammation & Tissue Repair, University College London, London, WC1E 6JF, UK
| | - Andrew E Williams
- Centre for Inflammation & Tissue Repair, University College London, London, WC1E 6JF, UK
| | - Beverley Holman
- Institute of Nuclear Medicine, University College London, NW1 2BU, UK
| | - Paul F Mercer
- Centre for Inflammation & Tissue Repair, University College London, London, WC1E 6JF, UK
| | - Gabor Jarai
- Novartis Institutes of Biomedical Research, Horsham, RH12 5AB, UK
| | - Chris J Scotton
- Centre for Inflammation & Tissue Repair, University College London, London, WC1E 6JF, UK
| | - Rachel C Chambers
- Centre for Inflammation & Tissue Repair, University College London, London, WC1E 6JF, UK
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Baliga RS, Scotton CJ, Trinder SL, Chambers RC, MacAllister RJ, Hobbs AJ. Intrinsic defence capacity and therapeutic potential of natriuretic peptides in pulmonary hypertension associated with lung fibrosis. Br J Pharmacol 2015; 171:3463-75. [PMID: 24641440 PMCID: PMC4105933 DOI: 10.1111/bph.12694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/22/2014] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND PURPOSE Idiopathic pulmonary fibrosis (IPF) is a progressive fibro-proliferative disorder refractory to current therapy commonly complicated by the development of pulmonary hypertension (PH); the associated morbidity and mortality are substantial. Natriuretic peptides possess vasodilator and anti-fibrotic actions, and pharmacological augmentation of their bioactivity ameliorates renal and myocardial fibrosis. Here, we investigated whether natriuretic peptides possess an intrinsic cytoprotective function preventing the development of pulmonary fibrosis and associated PH, and whether therapeutics targeting natriuretic peptide signalling demonstrate efficacy in this life-threatening disorder. EXPERIMENTAL APPROACH Pulmonary haemodynamics, right ventricular function and markers of lung fibrosis were determined in wild-type (WT) and natriuretic peptide receptor (NPR)-A knockout (KO) mice exposed to bleomycin (1 mg·kg−1). Human myofibroblast differentiation was studied in vitro. KEY RESULTS Exacerbated cardiac, vascular and fibrotic pathology was observed in NPR-A KO animals, compared with WT mice, exposed to bleomycin. Treatment with a drug combination that raised circulating natriuretic peptide levels (ecadotril) and potentiated natriuretic peptide-dependent signalling (sildenafil) reduced indices of disease progression, whether administered prophylactically or to animals with established lung disease. This positive pharmacodynamic effect was diminished in NPR-A KO mice. Atrial natriuretic peptide and sildenafil synergistically reduced TGFβ-induced human myofibroblast differentiation, a key driver of remodelling in IPF patients. CONCLUSIONS AND IMPLICATIONS These data highlight an endogenous host-defence capacity of natriuretic peptides in lung fibrosis and PH. A combination of ecadotril and sildenafil reversed the pulmonary haemodynamic aberrations and remodelling that characterize the disease, advocating therapeutic manipulation of natriuretic peptide bioactivity in patients with IPF.
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Affiliation(s)
- R S Baliga
- William Harvey Research Institute, Barts & The London School of Medicine, Queen Mary University of London, Charterhouse Square, London, UK
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Datta A, Alexander R, Sulikowski MG, Nicholson AG, Maher TM, Scotton CJ, Chambers RC. Evidence for a functional thymic stromal lymphopoietin signaling axis in fibrotic lung disease. J Immunol 2013; 191:4867-79. [PMID: 24081992 DOI: 10.4049/jimmunol.1300588] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Thymic stromal lymphopoietin (TSLP) recently has emerged as a key cytokine in the development of type 2 immune responses. Although traditionally associated with allergic inflammation, type 2 responses are also recognized to contribute to the pathogenesis of tissue fibrosis. However, the role of TSLP in the development of non-allergen-driven diseases, characterized by profibrotic type 2 immune phenotypes and excessive fibroblast activation, remains underexplored. Fibroblasts represent the key effector cells responsible for extracellular matrix production but additionally play important immunoregulatory roles, including choreographing immune cell recruitment through chemokine regulation. The aim of this study was to examine whether TSLP may be involved in the pathogenesis of a proto-typical fibrotic disease, idiopathic pulmonary fibrosis (IPF). We combined the immunohistochemical analysis of human IPF biopsy material with signaling studies by using cultured primary human lung fibroblasts and report for the first time, to our knowledge, that TSLP and its receptor (TSLPR) are highly upregulated in IPF. We further show that lung fibroblasts represent both a novel cellular source and target of TSLP and that TSLP induces fibroblast CCL2 release (via STAT3) and subsequent monocyte chemotaxis. These studies extend our understanding of TSLP as a master regulator of type 2 immune responses beyond that of allergic inflammatory conditions and suggest a novel role for TSLP in the context of chronic fibrotic lung disease.
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Affiliation(s)
- Arnab Datta
- Centre for Inflammation and Tissue Repair, University College London, London WC1E 6JF, United Kingdom
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25
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Scotton CJ, Hayes B, Alexander R, Datta A, Forty EJ, Mercer PF, Blanchard A, Chambers RC. Ex vivomicro-computed tomography analysis of bleomycin-induced lung fibrosis for preclinical drug evaluation. Eur Respir J 2013; 42:1633-45. [DOI: 10.1183/09031936.00182412] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Smoktunowicz N, Alexander R, Franklin L, Williams AE, Jarai G, Scotton CJ, Mercer PF, Chambers RC. S128 The Extrinsic Coagulation Pathway is Locally Upregulated in an Experimental Model of Viral Exacerbation of Pulmonary Fibrosis. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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27
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McNulty K, Sage EK, Alexander R, Scotton CJ, Janes SM. S130 Exogenous Macrophages Are Retained in Mouse Lungs After Injury and Target Therapeutic Transgenes to the Injured Lung Parenchyma. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jayasinghe SN, Warnes G, Scotton CJ. Macromol. Biosci. 10/2011. Macromol Biosci 2011. [DOI: 10.1002/mabi.201190029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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30
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Jayasinghe SN, Warnes G, Scotton CJ. Bio-electrosprayed living composite matrix implanted into mouse models. Macromol Biosci 2011; 11:1364-9. [PMID: 21755598 DOI: 10.1002/mabi.201100131] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/24/2011] [Indexed: 11/11/2022]
Abstract
We show that composite de novo structures can be generated using bio-electrosprays. Mouse lung fibroblasts are bio-electrosprayed directly with a biopolymer to form cell-bearing matrices, which are viable even when implanted subcutaneously into murine hosts. Generated cell-bearing matrices are assessed in-vitro and found to undergo all expected cellular behaviour. Subsequent in-vivo studies demonstrate the implanted living matrices integrating as expected with the surrounding microenvironment. The in-vitro and in-vivo studies elucidate and validate the ability for either bio-electrosprays or cell electrospinning to form a desired living architecture for undergoing investigation for repairing, replacing and rejuvenating damaged and/or ageing tissues.
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Affiliation(s)
- Suwan N Jayasinghe
- BioPhysics Group, Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, United Kingdom.
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Abstract
Pulmonary fibrosis represents the end stage of a number of heterogeneous conditions and is, to a greater or lesser degree, the hallmark of the interstitial lung diseases. It is characterized by the excessive deposition of extracellular matrix proteins within the pulmonary interstitium leading to the obliteration of functional alveolar units and in many cases, respiratory failure. While a small number of interstitial lung diseases have known aetiologies, most are idiopathic in nature, and of these, idiopathic pulmonary fibrosis is the most common and carries with it an appalling prognosis - median survival from the time of diagnosis is less than 3 years. This reflects the lack of any effective therapy to modify the course of the disease, which in turn is indicative of our incomplete understanding of the pathogenesis of this condition. Current prevailing hypotheses focus on dysregulated epithelial-mesenchymal interactions promoting a cycle of continued epithelial cell injury and fibroblast activation leading to progressive fibrosis. However, it is likely that multiple abnormalities in a myriad of biological pathways affecting inflammation and wound repair - including matrix regulation, epithelial reconstitution, the coagulation cascade, neovascularization and antioxidant pathways - modulate this defective crosstalk and promote fibrogenesis. This review aims to offer a pathogenetic rationale behind current therapies, briefly outlining previous and ongoing clinical trials, but will focus on recent and exciting advancements in our understanding of the pathogenesis of idiopathic pulmonary fibrosis, which may ultimately lead to the development of novel and effective therapeutic interventions for this devastating condition.
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Affiliation(s)
- Arnab Datta
- Centre for Respiratory Research, University College London, Rayne Institute, UK
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Affiliation(s)
- Chris J. Scotton
- Centre for Respiratory Research, University College London, Rayne Institute, London, United Kingdom
| | - Rachel C. Chambers
- Centre for Respiratory Research, University College London, Rayne Institute, London, United Kingdom
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Aguilar S, Scotton CJ, McNulty K, Nye E, Stamp G, Laurent G, Bonnet D, Janes SM. Bone marrow stem cells expressing keratinocyte growth factor via an inducible lentivirus protects against bleomycin-induced pulmonary fibrosis. PLoS One 2009; 4:e8013. [PMID: 19956603 PMCID: PMC2779453 DOI: 10.1371/journal.pone.0008013] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Accepted: 10/20/2009] [Indexed: 11/18/2022] Open
Abstract
Many common diseases of the gas exchange surface of the lung have no specific treatment but cause serious morbidity and mortality. Idiopathic Pulmonary Fibrosis (IPF) is characterized by alveolar epithelial cell injury, interstitial inflammation, fibroblast proliferation and collagen accumulation within the lung parenchyma. Keratinocyte Growth Factor (KGF, also known as FGF-7) is a critical mediator of pulmonary epithelial repair through stimulation of epithelial cell proliferation. During repair, the lung not only uses resident cells after injury but also recruits circulating bone marrow-derived cells (BMDC). Several groups have used Mesenchymal Stromal Cells (MSCs) as therapeutic vectors, but little is known about the potential of Hematopoietic Stem cells (HSCs). Using an inducible lentiviral vector (Tet-On) expressing KGF, we were able to efficiently transduce both MSCs and HSCs, and demonstrated that KGF expression is induced in a regulated manner both in vitro and in vivo. We used the in vivo bleomycin-induced lung fibrosis model to assess the potential therapeutic effect of MSCs and HSCs. While both populations reduced the collagen accumulation associated with bleomycin-induced lung fibrosis, only transplantation of transduced HSCs greatly attenuated the histological damage. Using double immunohistochemistry, we show that the reduced lung damage likely occurs through endogenous type II pneumocyte proliferation induced by KGF. Taken together, our data indicates that bone marrow transplantation of lentivirus-transduced HSCs can attenuate lung damage, and shows for the first time the potential of using an inducible Tet-On system for cell based gene therapy in the lung.
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Affiliation(s)
- Susana Aguilar
- Centre for Respiratory Research, Rayne Institute, University College London, London, United Kingdom
- Hematopoietic Stem Cell Laboratory, London Research Institute, Cancer Research UK, London, United Kingdom
| | - Chris J. Scotton
- Centre for Respiratory Research, Rayne Institute, University College London, London, United Kingdom
| | - Katrina McNulty
- Centre for Respiratory Research, Rayne Institute, University College London, London, United Kingdom
| | - Emma Nye
- Experimental Pathology Laboratory, London Research Institute, Cancer Research UK, London, United Kingdom
- Department of Histopathology, Imperial College London, London, United Kingdom
| | - Gordon Stamp
- Experimental Pathology Laboratory, London Research Institute, Cancer Research UK, London, United Kingdom
- Department of Histopathology, Imperial College London, London, United Kingdom
| | - Geoff Laurent
- Centre for Respiratory Research, Rayne Institute, University College London, London, United Kingdom
| | - Dominique Bonnet
- Hematopoietic Stem Cell Laboratory, London Research Institute, Cancer Research UK, London, United Kingdom
- * E-mail: (DB); (SJ)
| | - Sam M. Janes
- Centre for Respiratory Research, Rayne Institute, University College London, London, United Kingdom
- * E-mail: (DB); (SJ)
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Scotton CJ, Krupiczojc MA, Königshoff M, Mercer PF, Lee YCG, Kaminski N, Morser J, Post JM, Maher TM, Nicholson AG, Moffatt JD, Laurent GJ, Derian CK, Eickelberg O, Chambers RC. Increased local expression of coagulation factor X contributes to the fibrotic response in human and murine lung injury. J Clin Invest 2009; 119:2550-63. [PMID: 19652365 PMCID: PMC2735922 DOI: 10.1172/jci33288] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 06/03/2009] [Indexed: 01/13/2023] Open
Abstract
Uncontrolled activation of the coagulation cascade contributes to the pathophysiology of several conditions, including acute and chronic lung diseases. Coagulation zymogens are considered to be largely derived from the circulation and locally activated in response to tissue injury and microvascular leak. Here we report that expression of coagulation factor X (FX) is locally increased in human and murine fibrotic lung tissue, with marked immunostaining associated with bronchial and alveolar epithelia. FXa was a potent inducer of the myofibroblast differentiation program in cultured primary human adult lung fibroblasts via TGF-beta activation that was mediated by proteinase-activated receptor-1 (PAR1) and integrin alphavbeta5. PAR1, alphavbeta5, and alpha-SMA colocalized to fibrotic foci in lung biopsy specimens from individuals with idiopathic pulmonary fibrosis. Moreover, we demonstrated a causal link between FXa and fibrosis development by showing that a direct FXa inhibitor attenuated bleomycin-induced pulmonary fibrosis in mice. These data support what we believe to be a novel pathogenetic mechanism by which FXa, a central proteinase of the coagulation cascade, is locally expressed and drives the fibrotic response to lung injury. These findings herald a shift in our understanding of the origins of excessive procoagulant activity and place PAR1 central to the cross-talk between local procoagulant signaling and tissue remodeling.
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Affiliation(s)
- Chris J Scotton
- Centre for Respiratory Research, University College London, London, United Kingdom
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Atzori L, Lucattelli M, Scotton CJ, Laurent GJ, Bartalesi B, De Cunto G, Lunghi B, Chambers RC, Lungarella G. Absence of proteinase-activated receptor-1 signaling in mice confers protection from fMLP-induced goblet cell metaplasia. Am J Respir Cell Mol Biol 2009; 41:680-7. [PMID: 19307611 DOI: 10.1165/rcmb.2007-0386oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The morphological features of chronic obstructive pulmonary disease in man include emphysema and chronic bronchitis associated with mucus hypersecretion. These alterations can be induced in mice by a single intratracheal instillation of N-formyl-L-methionyl-L-leucyl-L-phenylalanine (fMLP), a chemoattractant and degranulating agent for neutrophils. The mechanisms underlying excessive mucus production and, in particular, goblet cell hyperplasia/metaplasia in chronic obstructive pulmonary disease remain poorly understood. The proteinase-activated receptors (PARs) are widely recognized for their modulatory properties during inflammation. In this study, we examined whether PAR-1 contributes to inflammation and lung damage induced by fMLP by comparing the response of PAR-1-deficient (PAR-1(-/-)) mice with that of wild-type (WT) mice. Mice were killed at various time points after fMLP instillation (200 microg/50 microl). WT mice developed emphysema and goblet cell metaplasia. The onset of pulmonary lesions was preceded by an increase in thrombin immunoreactivity in bronchial airways and alveolar tissue. This was followed by a decrease in PAR-1 immunoreactivity, and by an increase in IL-13 immunostaining on the luminal surface of airway epithelial cells. In PAR-1(-/-) mice, fMLP administration induced similar responses in terms of inflammation and emphysema, but these mice were protected from the development of goblet cell metaplasia. The involvement of PAR-1 in airway epithelial cell transdifferentiation was confirmed by demonstrating that intratracheal instillation of the selective PAR-1 agonist (TFLLR) induced goblet cell metaplasia in the airways of WT mice only. These data suggest that emphysema and goblet cell metaplasia occur independently, and that PAR-1 signaling through IL-13 stimulation may play an important role in inducing goblet cell metaplasia.
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Affiliation(s)
- Luigi Atzori
- Department of Toxicology, University of Cagliari, Cagliari, Italy
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Mercer PF, Johns RH, Scotton CJ, Krupiczojc MA, Königshoff M, Howell DCJ, McAnulty RJ, Das A, Thorley AJ, Tetley TD, Eickelberg O, Chambers RC. Pulmonary epithelium is a prominent source of proteinase-activated receptor-1-inducible CCL2 in pulmonary fibrosis. Am J Respir Crit Care Med 2008; 179:414-25. [PMID: 19060230 DOI: 10.1164/rccm.200712-1827oc] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
RATIONALE Studies in patients and experimental animals provide compelling evidence of the involvement of the major thrombin receptor, proteinase-activated receptor-1 (PAR(1)), and the potent chemokine, chemokine (CC motif) ligand-2 (CCL2)/monocyte chemotactic protein-1, in the pathogenesis of idiopathic pulmonary fibrosis (IPF). PAR(1) knockout mice are protected from bleomycin-induced lung inflammation and fibrosis and this protection is associated with marked attenuation in CCL2 induction. OBJECTIVES The aim of this study was to determine which cell types represent the major source of PAR(1)-inducible CCL2 in the fibrotic lung. METHODS Using immunohistochemistry and dual immunofluorescence, we examined PAR(1) and CCL2 expression in the bleomycin model and human IPF lung. PAR(1) and CCL2 gene expression was also assessed in laser-captured alveolar septae from patients with IPF. The ability of PAR(1) to induce CCL2 production by lung epithelial cells was also examined in vitro. MEASUREMENTS AND MAIN RESULTS We report for the first time that PAR(1) and CCL2 are coexpressed and co-up-regulated on the activated epithelium in fibrotic areas in IPF. Similar observations were found in bleomycin-induced lung injury. Furthermore, we show that thrombin is a potent inducer of CCL2 gene expression and protein release by cultured lung epithelial cells via a PAR(1)-dependent mechanism. CONCLUSIONS These data support the notion that PAR(1) activation on lung epithelial cells may represent an important mechanism leading to increased local CCL2 release in pulmonary fibrosis. Targeting PAR(1) on the pulmonary epithelium may offer a unique opportunity for therapeutic intervention in pulmonary fibrosis and other inflammatory and fibroproliferative conditions associated with excessive local generation of thrombin and CCL2 release.
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Affiliation(s)
- Paul F Mercer
- Centre for Respiratory Research, University College London, London, United Kingdom
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Deng X, Mercer PF, Scotton CJ, Gilchrist A, Chambers RC. Thrombin induces fibroblast CCL2/JE production and release via coupling of PAR1 to Galphaq and cooperation between ERK1/2 and Rho kinase signaling pathways. Mol Biol Cell 2008; 19:2520-33. [PMID: 18353977 DOI: 10.1091/mbc.e07-07-0720] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Uncontrolled activation of the coagulation cascade after tissue injury has been implicated in both inflammation and tissue fibrosis. Thrombin exerts pluripotent cellular effects via its high-affinity receptor, proteinase-activated receptor-1 (PAR(1)) and signaling via Galpha(i/o), Galpha(q), or Galpha(12/13). Activation of PAR(1) on fibroblasts, a key effector cell in fibrosis, results in the induction of several mediators, including the potent monocyte and fibrocyte chemoattractant CCL2. The aim of this study was to identify the G protein and signaling pathway involved in PAR(1)-mediated CCL2 production and release. Using a novel PAR(1) antagonist that blocks the interaction between PAR(1) and Galpha(q), we report for the first time that PAR(1) coupling to Galpha(q) is essential for thrombin-induced CCL2 gene expression and protein release in murine lung fibroblasts. We further demonstrate that these effects are mediated via the cooperation between ERK1/2 and Rho kinase signaling pathways: a calcium-independent protein kinase C (PKC), c-Raf, and ERK1/2 pathway was found to mediate PAR(1)-induced CCL2 gene transcription, whereas a phospholipase C, calcium-dependent PKC, and Rho kinase pathway influences CCL2 protein release. We propose that targeting the interaction between PAR(1) and Galpha(q) may allow us to selectively interfere with PAR(1) proinflammatory and profibrotic signaling, while preserving the essential role of other PAR(1)-mediated cellular responses.
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Affiliation(s)
- Xiaoling Deng
- Centre for Respiratory Research, University College London, London WC1E 6JJ, United Kingdom
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Krupiczojc MA, Scotton CJ, Chambers RC. Coagulation signalling following tissue injury: focus on the role of factor Xa. Int J Biochem Cell Biol 2008; 40:1228-37. [PMID: 18420447 DOI: 10.1016/j.biocel.2008.02.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 02/22/2008] [Accepted: 02/25/2008] [Indexed: 10/22/2022]
Abstract
The primary function of the coagulation cascade is to promote haemostasis and limit blood loss in response to tissue injury. However, it is now recognized that the physiological functions of the coagulation cascade extend beyond blood coagulation and that this cascade plays a pivotal role in influencing inflammatory and tissue repair responses via the activation of their signalling responses, the proteinase-activated receptors (PARs). Consequently, uncontrolled coagulation activity and PAR signalling contributes to the pathophysiology of several conditions, including thrombosis, arthritis, cancer, kidney disease, and acute and chronic lung injury. Much of the work thus far has focused on the role of thrombin-mediated signalling in the pathophysiology of these conditions. However, recent evidence suggests that coagulation proteinases upstream of thrombin, including factor Xa (FXa), may also signal via PARs and thus induce cellular effects independent of thrombin generation. These studies have highlighted a novel and important role for FXa signalling in influencing proinflammatory and pro-fibrotic effects following tissue injury. This article will provide an overview of FXa as a central proteinase of the coagulation cascade and will review more recent evidence that FXa signalling may contribute to inflammation and tissue remodelling. The novel opportunities that this may present for therapeutic intervention will also be highlighted.
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Howell DCJ, Johns RH, Lasky JA, Shan B, Scotton CJ, Laurent GJ, Chambers RC. Absence of proteinase-activated receptor-1 signaling affords protection from bleomycin-induced lung inflammation and fibrosis. Am J Pathol 2005; 166:1353-65. [PMID: 15855637 PMCID: PMC1606391 DOI: 10.1016/s0002-9440(10)62354-1] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Activation of the coagulation cascade is commonly observed in the lungs of patients with both acute and chronic inflammatory and fibrotic lung disorders, as well as in animal models of these disorders. The aim of this study was to examine the contribution of the major thrombin receptor, proteinase-activated receptor-1 (PAR-1), during the acute inflammatory and chronic fibrotic phases of lung injury induced by intratracheal instillation of bleomycin in mice. Inflammatory cell recruitment and increases in bronchoalveolar lavage fluid (BALF) protein were attenuated by 56 +/- 10% (P < 0.05) and 53 +/- 12% (P < 0.05), respectively, in PAR-1-deficient (PAR-1-/-) mice compared with wild-type (WT) mice. PAR-1-/- mice were also protected from bleomycin-induced pulmonary fibrosis with total lung collagen accumulation reduced by 59 +/- 5% (P < 0.05). The protection afforded by PAR-1 deficiency was accompanied by significant reductions in pulmonary levels of the potent PAR-1-inducible proinflammatory and profibrotic mediators, monocyte chemoattractant protein-1 (MCP-1), transforming growth factor-beta-1 (TGF-beta1), and connective tissue growth factor/fibroblast-inducible secreted protein-12 (CTGF/FISP12). In addition, PAR-1 was highly expressed in inflammatory and fibroproliferative lesions in lung sections obtained from patients with fibrotic lung disease. These data show for the first time that PAR-1 signaling plays a key role in experimentally induced lung injury, and they further identify PAR-1 as one of the critical receptors involved in orchestrating the interplay between coagulation, inflammation, and remodeling in response to tissue injury.
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Affiliation(s)
- David C J Howell
- Centre for Respiratory Research, University College London, The Rayne Institute, 5 University Street, London WC1E 6JJ, United Kingdom
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Scotton CJ, Martinez FO, Smelt MJ, Sironi M, Locati M, Mantovani A, Sozzani S. Transcriptional Profiling Reveals Complex Regulation of the Monocyte IL-1β System by IL-13. J Immunol 2005; 174:834-45. [PMID: 15634905 DOI: 10.4049/jimmunol.174.2.834] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IL-4 and IL-13 are prototypic Th2 cytokines that generate an "alternatively activated" phenotype in macrophages. We used high-density oligonucleotide microarrays to investigate the transcriptional profile induced in human monocytes by IL-13. After 8-h stimulation with IL-13, 142 genes were regulated (85 increased and 57 decreased). The majority of these genes were related to the inflammatory response and innate immunity; a group of genes related to lipid metabolism was also identified, with clear implications for atherosclerosis. In addition to characteristic markers of alternatively activated macrophages, a number of novel IL-13-regulated genes were seen. These included various pattern recognition receptors, such as CD1b/c/e, TLR1, and C-type lectin superfamily member 6. Several components of the IL-1 system were regulated. IL-1RI, IL-1RII, and IL-1Ra were all up-regulated, whereas the IL-1beta-converting enzyme, caspase 1, and IRAK-M were down-regulated. LPS-inducible caspase 1 enzyme activity was also reduced in IL-13-stimulated monocytes, with a consequent decrease in pro-IL-1beta processing. These data reveal that IL-13 has a potent effect on the transcriptional profile in monocytes. The IL-13-induced modulation of genes related to IL-1 clearly highlights the tightly controlled and complex levels of regulation of the production and response to this potent proinflammatory cytokine.
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Affiliation(s)
- Chris J Scotton
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Scotton CJ, Wilson JL, Scott K, Stamp G, Wilbanks GD, Fricker S, Bridger G, Balkwill FR. Multiple actions of the chemokine CXCL12 on epithelial tumor cells in human ovarian cancer. Cancer Res 2002; 62:5930-8. [PMID: 12384559] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Of 14 chemokine receptors investigated, only CXCR4 was expressed on ovarian cancer cells [C. J. Scotton et al., Cancer Res., 61: 4961-4965, 2001]. To further understand the role of this chemokine receptor in ovarian tumor biology, we studied the action of its ligand, CXCL12 (stromal cell-derived factor 1), on the CXCR4-expressing ovarian cancer cell lines IGROV. Ligand stimulation of the CXCR4 receptor resulted in sustained activation of Akt/protein kinase B and biphasic phosphorylation of p44/42 mitogen-activated protein kinase in IGROV. When IGROV cells were cultured under suboptimal conditions, CXCL12 stimulated their in vitro growth, an effect that was abrogated by neutralizing antibodies to CXCR4. This increase in cell number was attributable to stimulation of DNA synthesis, not protection from apoptosis. CXCL12 treatment of IGROV cells also induced mRNA and protein for tumor necrosis factor alpha, a cytokine that is expressed by tumor cells in ovarian cancer biopsies. IGROV cells invaded through Matrigel toward a CXCL12 gradient. Invasion was abrogated by the broad spectrum matrix metalloproteinase and TNFalpha converting enzyme inhibitor Marimastat and was partially inhibited by neutralizing antitumor necrosis factor alpha antibodies. These effects were not limited to the IGROV cell line. They could also be demonstrated in the CAOV-3 ovarian cancer cell line and primary ovarian tumor cells isolated from ovarian ascites. These biological effects of CXCL12 on IGROV cells were also inhibited by the small molecular weight CXCR4 antagonist AMD3100. Finally, we found abundant intracellular CXCL12 protein in tumor cells in 15 of 18 ovarian cancer biopsies but not in epithelial cells from normal ovary or borderline disease. The chemokine CXCL12 may have multiple biological effects in ovarian cancer, stimulating cell migration and invasion through extracellular matrix, as well as DNA synthesis and establishment of a cytokine network in situations that are suboptimal for tumor cell growth.
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Affiliation(s)
- Chris J Scotton
- Cancer Research U.K., Translational Oncology Laboratory, Bart's and the London, Queen Mary's School of Medicine and Dentistry, United Kingdom
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Scotton CJ, Wilson JL, Milliken D, Stamp G, Balkwill FR. Epithelial cancer cell migration: a role for chemokine receptors? Cancer Res 2001; 61:4961-5. [PMID: 11431324] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We investigated the possibility that chemokine gradients influence migration of human ovarian epithelial tumor cells. Of 14 chemokine receptors investigated, only CXCR4 was expressed on ovarian cancer cells. CXCR4 mRNA localized to a subpopulation of tumor cells in ovarian cancer biopsies. Ovarian cancer cell lines and cells freshly isolated from ascites expressed CXCR4 protein. The CXCR4 ligand, CXCL12, was found in ascites from 63 patients. CXCL12 elicited intracellular calcium flux and directed migration and changes in integrin expression in ovarian cancer cells. CXCR4 may influence cell migration in the peritoneum, a major route for ovarian cancer spread, and could be a therapeutic target.
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Affiliation(s)
- C J Scotton
- Imperial Cancer Research Fund Translational Oncology Laboratory, Barts and the Royal London School of Medicine and Dentistry, London EC1M 6BQ, United Kingdom
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