1
|
Husain AN, Chapel DB, Attanoos R, Beasley MB, Brcic L, Butnor K, Chirieac LR, Churg A, Dacic S, Galateau-Salle F, Hiroshima K, Hung YP, Klebe S, Krausz T, Khoor A, Litzky L, Marchevsky A, Nabeshima K, Nicholson AG, Pavlisko EN, Roden AC, Roggli V, Sauter JL, Schulte JJ, Sheaff M, Travis WD, Tsao MS, Walts AE, Colby TV. Guidelines for Pathologic Diagnosis of Mesothelioma. Arch Pathol Lab Med 2024:499833. [PMID: 38586983 DOI: 10.5858/arpa.2023-0304-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/09/2024]
Abstract
CONTEXT.— Mesothelioma is an uncommon tumor that can be difficult to diagnose. OBJECTIVE.— To provide updated, practical guidelines for the pathologic diagnosis of mesothelioma. DATA SOURCES.— Pathologists involved in the International Mesothelioma Interest Group and others with expertise in mesothelioma contributed to this update. Reference material includes peer-reviewed publications and textbooks. CONCLUSIONS.— There was consensus opinion regarding guidelines for (1) histomorphologic diagnosis of mesothelial tumors, including distinction of epithelioid, biphasic, and sarcomatoid mesothelioma; recognition of morphologic variants and patterns; and recognition of common morphologic pitfalls; (2) molecular pathogenesis of mesothelioma; (3) application of immunohistochemical markers to establish mesothelial lineage and distinguish mesothelioma from common morphologic differentials; (4) application of ancillary studies to distinguish benign from malignant mesothelial proliferations, including BAP1 and MTAP immunostains; novel immunomarkers such as Merlin and p53; fluorescence in situ hybridization (FISH) for homozygous deletion of CDKN2A; and novel molecular assays; (5) practical recommendations for routine reporting of mesothelioma, including grading epithelioid mesothelioma and other prognostic parameters; (6) diagnosis of mesothelioma in situ; (7) cytologic diagnosis of mesothelioma, including use of immunostains and molecular assays; and (8) features of nonmalignant peritoneal mesothelial lesions.
Collapse
Affiliation(s)
- Aliya N Husain
- From the Department of Pathology, University of Chicago, Chicago, Illinois (Husain, Krausz)
| | - David B Chapel
- The Department of Pathology, University of Michigan, Ann Arbor (Chapel)
| | - Richard Attanoos
- The Department of Cellular Pathology and School of Medicine, University Hospital of Wales and Cardiff University, Cardiff, United Kingdom (Attanoos)
| | - Mary Beth Beasley
- The Department of Pathology, Mount Sinai Hospital, New York, New York (Beasley)
| | - Luka Brcic
- The Department Diagnostic and Research Institute of Pathology Medical University of Graz, Graz, Austria (Brcic)
| | - Kelly Butnor
- The Department of Pathology & Laboratory Medicine, University of Vermont College of Medicine, Burlington (Butnor)
| | - Lucian R Chirieac
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Chirieac)
| | - Andrew Churg
- The Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada (Churg)
| | - Sanja Dacic
- The Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dacic)
| | | | - Kenzo Hiroshima
- The Department of Biochemistry and Genetics, Chiba University Graduate School of Medicine, Chiba, Japan (Hiroshima)
| | - Yin P Hung
- The Department of Pathology, Massachusetts General Hospital, Boston (Hung)
| | - Sonja Klebe
- The Department of Anatomical Pathology, SA Pathology and Flinders University, Bedford Park SA, Australia (Klebe)
| | - Thomas Krausz
- From the Department of Pathology, University of Chicago, Chicago, Illinois (Husain, Krausz)
| | - Andras Khoor
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida (Khoor)
| | - Leslie Litzky
- The Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia (Litzky)
| | - Alberto Marchevsky
- The Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Marchevsky, Walts)
| | - Kazuki Nabeshima
- The Department of Clinical Pathology, Fukuoka Tokushukai Hospital, Kasuga City, Fukuoka Prefecture, Japan (Nabeshima)
| | - Andrew G Nicholson
- The Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (Nicholson)
| | - Elizabeth N Pavlisko
- The Department of Pathology, Duke University Medical Center, Durham, North Carolina (Pavlisko, Roggli)
| | - Anja C Roden
- The Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota (Roden)
| | - Victor Roggli
- The Department of Pathology, Duke University Medical Center, Durham, North Carolina (Pavlisko, Roggli)
| | - Jennifer L Sauter
- The Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Sauter, Travis)
| | - Jefree J Schulte
- The Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison (Schulte)
| | - Michael Sheaff
- The Department of Cellular Pathology, Barts Health NHS Trust, London, United Kingdom (Sheaff)
| | - William D Travis
- The Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Sauter, Travis)
| | - Ming-Sound Tsao
- The Department of Laboratory Medicine and Pathobiology, University of Health Network and University of Toronto, Toronto, Ontario, Canada (Tsao)
| | - Ann E Walts
- The Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Marchevsky, Walts)
| | - Thomas V Colby
- Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale (Emeritus) (Colby)
| |
Collapse
|
2
|
Pavlisko EN, Adam BA, Berry GJ, Calabrese F, Cortes-Santiago N, Glass CH, Goddard M, Greenland JR, Kreisel D, Levine DJ, Martinu T, Verleden SE, Weigt SS, Roux A. The 2022 Banff Meeting Lung Report. Am J Transplant 2024; 24:542-548. [PMID: 37931751 DOI: 10.1016/j.ajt.2023.10.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
The Lung Session of the 2022 16th Banff Foundation for Allograft Pathology Conference-held in Banff, Alberta-focused on non-rejection lung allograft pathology and novel technologies for the detection of allograft injury. A multidisciplinary panel reviewed the state-of-the-art of current histopathologic entities, serologic studies, and molecular practices, as well as novel applications of digital pathology with artificial intelligence, gene expression analysis, and quantitative image analysis of chest computerized tomography. Current states of need as well as prospective integration of the aforementioned tools and technologies for complete assessment of allograft injury and its impact on lung transplant outcomes were discussed. Key conclusions from the discussion were: (1) recognition of limitations in current standard of care assessment of lung allograft dysfunction; (2) agreement on the need for a consensus regarding the standardized approach to the collection and assessment of pathologic data, inclusive of all lesions associated with graft outcome (eg, non-rejection pathology); and (3) optimism regarding promising novel diagnostic modalities, especially minimally invasive, which should be integrated into large, prospective multicenter studies to further evaluate their utility in clinical practice for directing personalized therapies to improve graft outcomes.
Collapse
Affiliation(s)
- Elizabeth N Pavlisko
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
| | - Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Gerald J Berry
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Nahir Cortes-Santiago
- Department of Pathology and Immunology, Texas Children's Hospital, Houston, Texas, USA
| | - Carolyn H Glass
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Martin Goddard
- Pathology Department, Royal Papworth Hospital, NHS Trust, Papworth Everard, Cambridge, UK
| | - John R Greenland
- Department of Medicine, University of California, San Francisco, USA; Veterans Affairs Health Care System, San Francisco, California, USA
| | - Daniel Kreisel
- Department of Surgery, Department of Pathology and Immunology, Washington University, St. Louis, Missouri, USA
| | - Deborah J Levine
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, California, USA
| | - Tereza Martinu
- Division of Respirology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Stijn E Verleden
- Lung Transplant Unit, Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of ASTARC, University of Antwerp, Wilrijk, Belgium
| | - S Sam Weigt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Antoine Roux
- Department of Respiratory Medicine, Foch Hospital, Suresnes, France
| |
Collapse
|
3
|
Nel AE, Pavlisko EN, Roggli VL. The Interplay Between the Immune System, Tumor Suppressor Genes, and Immune Senescence in Mesothelioma Development and Response to Immunotherapy. J Thorac Oncol 2024; 19:551-564. [PMID: 38000500 DOI: 10.1016/j.jtho.2023.11.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
Despite efforts to ban asbestos mining and manufacturing, mesothelioma deaths in the United States have remained stable at approximately 2500 cases annually. This trend is not unique to the United States but is also a global phenomenon, associated with increased aging of populations worldwide. Although geoeconomic factors such as lack of regulations and continued asbestos manufacturing in resource-poor countries play a role, it is essential to consider biological factors such as immune senescence and increased genetic instability associated with aging. Recognizing that mesothelioma shares genetic instability and immune system effects with other age-related cancers is crucial because the impact of aging on mesothelioma is frequently assessed in the context of disease latency after asbestos exposure. Nevertheless, the long latency period, often cited as a reason for mesothelioma's elderly predominance, should not overshadow the shared mechanisms. This communication focuses on the role of immune surveillance in mesothelioma, particularly exploring the impact of immune escape resulting from altered TSG function during aging, contributing to the phylogenetic development of gene mutations and mesothelioma oncogenesis. The interplay between the immune system, TSGs, and aging not only shapes the immune landscape in mesothelioma but also contributes to the development of heterogeneous tumor microenvironments, significantly influencing responses to immunotherapy approaches and survival rates. By understanding the complex interplay between aging, TSG decline, and immune senescence, health care professionals can pave the way for more effective and personalized immunotherapies, ultimately offering hope for better outcomes in the fight against mesothelioma.
Collapse
Affiliation(s)
- Andre E Nel
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California; Division of NanoMedicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California.
| | | | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
4
|
Roggli VL, Pavlisko EN, Glass CH, Green CL, Liu B, Carney JM. Response to To the Editor-Environmental Research This letter is a critique of the paper by Roggli et al (1) regarding chronological trends of the fiber burden in mesothelioma cases. Environ Res 2024:118620. [PMID: 38447601 DOI: 10.1016/j.envres.2024.118620] [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] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
| | | | | | | | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center
| | | |
Collapse
|
5
|
Carney JM, Sporn TA, Roggli VL, Pavlisko EN. The diagnosis of asbestosis in the 21 st century: a clinicopathological correlation of 102 cases. Ultrastruct Pathol 2024; 48:137-148. [PMID: 38192052 DOI: 10.1080/01913123.2023.2299874] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
Asbestosis, defined as diffuse pulmonary fibrosis caused by inhalation of asbestos fibers, occurs after heavy exposures to asbestos dust over several decades. Because workplace exposures have been significantly curtailed since the banning of asbestos in insulation products, we were interested in examining the clinicopathological characteristics of cases diagnosed in the 21st century. The consultation files of one of the authors (VLR) were reviewed for cases of asbestosis diagnosed since 1/1/2001. 102 cases were identified, with a median age of 75 years (range: 45-89). There were 100 men and 2 women. The women were from Turkey and Brazil (none from the United States). Malignancies were present in 78 cases, including 38 lung cancers, 29 pleural mesotheliomas, and 8 peritoneal mesotheliomas. The grade of asbestosis was available in 88 cases (median severity of 2; scale: 1-4). Pleural plaque was present in 94% of cases. The most common exposure categories were insulators (39), shipyard workers (16), asbestos manufacturing (9), boiler workers (8) and pipefitter/welders (6). The median duration of exposure was 33 years (range: 2-49 years). Lung fiber burden analysis was performed in 34 cases, with amosite being the predominant fiber type. Results were compared with similar information for 475 cases diagnosed prior to 1/1/2001.
Collapse
Affiliation(s)
- John M Carney
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Thomas A Sporn
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | | |
Collapse
|
6
|
Carney JM, Roggli VL, Glass CH, Piña-Oviedo S, Pavlisko EN. The over diagnosis of diffuse mesothelioma: An analysis of 311 cases with recommendations for the avoidance of pitfalls. Ann Diagn Pathol 2024; 68:152248. [PMID: 38182448 DOI: 10.1016/j.anndiagpath.2023.152248] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The diagnosis of mesothelioma may be challenging. We investigated a large database of cases in order to determine the frequency with which a diagnosis of mesothelioma was made incorrectly and the most frequent causes of error. DESIGN A database including more than 4000 consultation cases of histologically confirmed mesothelioma was examined to identify cases in which mesothelioma was diagnosed by at least one pathologist when the available information pointed towards a different diagnosis. RESULTS There were 311 cases misdiagnosed as mesothelioma. The most common category was metastatic carcinoma to the pleura or peritoneum (129 cases: 73 lung carcinomas, 15 renal cell carcinomas). The next most common category was primary lung cancer (111 cases: 55 sarcomatoid carcinoma, 56 pseudomesotheliomatous carcinoma). The third most common category was primary malignancies arising from or near the serosal membranes (33 cases). The fourth most common category was fibrous pleurisy (38 cases). The most common errors were failure to consider important radiographic information regarding the gross distribution of tumor, lack of awareness or consideration of another malignancy, overreliance on certain immunohistochemical results, and failure to perform certain diagnostic histochemical, immunohistochemical, or ultrastructural studies. CONCLUSIONS There are a number of diagnostic pitfalls that can lead to the over diagnosis of mesothelioma. Careful attention to clinical and radiographic information as well as performance of appropriate ancillary tests can help to prevent such misdiagnoses. Detailed examples will be presented to assist in the avoidance of these pitfalls with emphasis on the most commonly observed errors.
Collapse
Affiliation(s)
- John M Carney
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Carolyn H Glass
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Sergio Piña-Oviedo
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | | |
Collapse
|
7
|
Charles DD, Pavlisko EN, Neff JL, Kang Y, Carney JM. Coinciding kappa AL amyloidosis and kappa light chain deposition disease in the lung. Virchows Arch 2023; 483:705-707. [PMID: 37535125 DOI: 10.1007/s00428-023-03610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/30/2023] [Accepted: 07/23/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Derald D Charles
- Department of Pathology, Duke University Health System, Durham, NC, USA
| | | | - Jadee L Neff
- Department of Pathology, Duke University Health System, Durham, NC, USA
| | - Yubin Kang
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - John M Carney
- Department of Pathology, Duke University Health System, Durham, NC, USA.
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA.
| |
Collapse
|
8
|
Pina-Oviedo S, Roggli VL, Sporn TA, Li H, Glass C, DiBernardo LR, Pavlisko EN. Diagnostic Approach to Pulmonary B-Cell Lymphomas in Small Biopsies, with Practical Recommendations to Avoid Misinterpretation. Diagnostics (Basel) 2023; 13:3321. [PMID: 37958219 PMCID: PMC10650405 DOI: 10.3390/diagnostics13213321] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Pulmonary lymphomas are rare. With the current less invasive approaches used to obtain material for diagnosis, the diagnosis of pulmonary lymphoma is now frequently established in a small biopsy rather than in a resection. Therefore, the diagnosis has become more challenging and requires correlation with the clinico-radiologic presentation and with ancillary studies (immunohistochemistry, flow cytometry, cytogenetics, and/or molecular analysis). Due to the rarity of pulmonary lymphomas, clinical suspicion of a lymphomatous process is low at initial presentation, and material may be only submitted for histopathology. For this reason, herein, we provide recommendations to arrive at the correct diagnosis of the most common lung B-cell lymphomas (marginal zone lymphoma of mucosa-associated lymphoid tissue, diffuse large B-cell lymphoma, intravascular large B-cell lymphoma, lymphomatoid granulomatosis) in the setting of small biopsies, utilizing only immunohistochemistry. The differential diagnosis varies according to the lymphoma subtype and includes reactive conditions, solid tumors, and other hematolymphoid malignancies. Although morphology and immunohistochemistry may be sufficient to establish a diagnosis, in some cases, the best recommendation is to obtain additional tissue via a VATS biopsy/wedge resection with material submitted for flow cytometry, cytogenetics, and/or molecular studies to be able to properly classify a pulmonary lymphoid process.
Collapse
Affiliation(s)
- Sergio Pina-Oviedo
- Department of Pathology, Duke University Medical Center, Durham, NC 27710-4000, USA (E.N.P.)
| | | | | | | | | | | | | |
Collapse
|
9
|
Spies CS, Ochoa TN, Pontula A, Harris CS, Snyder LD, Pavlisko EN, Hartwig MG. With Comparable Outcomes, Should Early-Stage Lung Cancer Be a Contraindication to Lung Transplant? Ann Thorac Surg 2023:S0003-4975(23)00934-7. [PMID: 37704001 DOI: 10.1016/j.athoracsur.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/27/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Active primary lung malignancy remains a strong contraindication to lung transplantation (LTx). However, outcomes are unclear for patients with early-stage non-small cell lung cancer (NSCLC) who undergo LTx. We hypothesize that patients with early-stage NSCLC incidentally discovered in the explanted lungs have survival comparable to LTx recipients without incidental cancer identified. METHODS We performed a single-center retrospective analysis of all LTx recipients from May 2007 to September 2021 with incidental cancer identified in the explanted lungs by pathologist report. Survival statistics were estimated using Kaplan-Meier analysis. RESULTS Of the 1586 LTx performed, 23 patients (1.5%) were found to have incidental lung cancer in the explanted lungs. The most common indications for LTx were interstitial lung disease (n = 13) and chronic obstructive pulmonary disease (n = 7), and the most common histologic diagnosis was adenocarcinoma (n = 14). In the cohort with stage I disease (n = 9), the 1- and 5-year unadjusted Kaplan-Meier survival rates were 88.9% and 51.9%, respectively. The 1- and 5-year survival rates for transplant recipients without incidental cancer findings at LTx during this period were 86.7% and 59.4%, respectively, and did not differ significantly between the 2 strata (P = .96). CONCLUSIONS Survival rates at 1 and 5 years were comparable between LTx recipients with incidentally noted pathologic stage I NSCLC and contemporary recipients without cancer. All cancer-related deaths occurred in recipients with incidentally noted advanced NSCLC. These results suggest that patients with pathologic stage I lung cancer at the time of transplant have outcomes comparable to those without cancer findings at the time of transplant.
Collapse
Affiliation(s)
- Connor S Spies
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Arya Pontula
- Faculty of Biology, Medicine, and Health, School of Medicine, University of Manchester, Manchester, United Kingdom; Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Laurie D Snyder
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Matthew G Hartwig
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
| |
Collapse
|
10
|
Kraft BD, Pavlisko EN, Roggli VL, Piantadosi CA, Suliman HB. Alveolar Mitochondrial Quality Control During Acute Respiratory Distress Syndrome. J Transl Med 2023; 103:100197. [PMID: 37307952 PMCID: PMC10257518 DOI: 10.1016/j.labinv.2023.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a leading cause of respiratory failure and death in patients in the intensive care unit. Experimentally, acute lung injury resolution depends on the repair of mitochondrial oxidant damage by the mitochondrial quality control (MQC) pathways, mitochondrial biogenesis, and mitophagy, but nothing is known about this in the human lung. In a case-control autopsy study, we compared the lungs of subjects dying of ARDS (n = 8; cases) and age-/gender-matched subjects dying of nonpulmonary causes (n = 7; controls). Slides were examined by light microscopy and immunofluorescence confocal microscopy, randomly probing for co-localization of citrate synthase with markers of oxidant stress, mitochondrial DNA damage, mitophagy, and mitochondrial biogenesis. ARDS lungs showed diffuse alveolar damage with edema, hyaline membranes, and neutrophils. Compared with controls, a high degree of mitochondrial oxidant damage was seen in type 2 epithelial (AT2) cells and alveolar macrophages by 8-hydroxydeoxyguanosine and malondialdehyde co-staining with citrate synthase. In ARDS, antioxidant protein heme oxygenase-1 and DNA repair enzyme N-glycosylase/DNA lyase (Ogg1) were found in alveolar macrophages but not in AT2 cells. Moreover, MAP1 light chain-3 (LC3) and serine/threonine-protein kinase (Pink1) staining were absent in AT2 cells, suggesting a mitophagy failure. Nuclear respiratory factor-1 staining was missing in the alveolar region, suggesting impaired mitochondrial biogenesis. Widespread hyperproliferation of AT2 cells in ARDS could suggest defective differentiation into type 1 cells. ARDS lungs show profuse mitochondrial oxidant DNA damage but little evidence of MQC activity in AT2 epithelium. Because these pathways are important for acute lung injury resolution, our findings support MQC as a novel pharmacologic target for ARDS resolution.
Collapse
Affiliation(s)
- Bryan D Kraft
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.
| | - Elizabeth N Pavlisko
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Victor L Roggli
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Claude A Piantadosi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina; Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Hagir B Suliman
- Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
11
|
Ghio AJ, Stewart M, Sangani RG, Pavlisko EN, Roggli VL. Asbestos and Iron. Int J Mol Sci 2023; 24:12390. [PMID: 37569765 PMCID: PMC10419076 DOI: 10.3390/ijms241512390] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Theories of disease pathogenesis following asbestos exposure have focused on the participation of iron. After exposure, an open network of negatively charged functional groups on the fiber surface complexes host metals with a preference for iron. Competition for iron between the host and the asbestos results in a functional metal deficiency. The homeostasis of iron in the host is modified by the cell response, including increased import to correct the loss of the metal to the fiber surface. The biological effects of asbestos develop in response to and are associated with the disruption of iron homeostasis. Cell iron deficiency in the host following fiber exposure activates kinases and transcription factors, which are associated with the release of mediators coordinating both inflammatory and fibrotic responses. Relative to serpentine chrysotile, the clearance of amphiboles is incomplete, resulting in translocation to the mesothelial surface of the pleura. Since the biological effect of asbestos is dependent on retention of the fiber, the sequestration of iron by the surface, and functional iron deficiency in the cell, the greater clearance (i.e., decreased persistence) of chrysotile results in its diminished impact. An inability to clear asbestos from the lower respiratory tract initiates a host process of iron biomineralization (i.e., asbestos body formation). Host cells attempt to mobilize the metal sequestered by the fiber surface by producing superoxide at the phagosome membrane. The subsequent ferrous cation is oxidized and undergoes hydrolysis, creating poorly crystalline iron oxyhydroxide (i.e., ferrihydrite) included in the coat of the asbestos body.
Collapse
Affiliation(s)
- Andrew J. Ghio
- US Environmental Protection Agency, Research Triangle Park, NC 27711, USA
| | - Matthew Stewart
- Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Rahul G. Sangani
- Department of Medicine, West Virginia University, Morgantown, WV 26506, USA;
| | - Elizabeth N. Pavlisko
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA; (E.N.P.); (V.L.R.)
| | - Victor L. Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA; (E.N.P.); (V.L.R.)
| |
Collapse
|
12
|
Roggl VL, Green CL, Liu B, Carney JM, Glass CH, Pavlisko EN. Chronological trends in the causation of malignant mesothelioma: Fiber burden analysis of 619 cases over four decades. Environ Res 2023; 230:114530. [PMID: 36965800 PMCID: PMC10542945 DOI: 10.1016/j.envres.2022.114530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/05/2022] [Indexed: 05/30/2023]
Abstract
Malignant mesothelioma is a relatively rare malignancy with a strong association with prior asbestos exposure. A percentage of cases is not related to asbestos, and fiber analysis of lung tissue is a useful methodology for identifying idiopathic or spontaneous cases. We have performed fiber analyses in more than 600 cases of mesothelioma over the past four decades and were interested in looking for trends in terms of fiber types and concentrations as well as percentages of cases not related to asbestos. Demographic information was also considered including patient age, gender, and tumor location (pleural vs. peritoneal). The histologic pattern of the tumor and the presence or absence of pleural plaques or asbestosis were noted. Fiber analysis was performed in 619 cases, using the sodium hypochlorite technique for digestion of lung tissue samples. Asbestos bodies were counted by light microscopy (LM) and coated and uncoated fibers by scanning electron microscopy (EM). The results were stratified over four decades. Trends that were observed included increasing patient age, increasing percentage of women, increasing percentage of peritoneal cases, and increasing percentage of epithelial histological type. There was a decreasing trend in the percentage of patients with concomitant asbestosis (p < 0.001). The percentage of cases with an elevated lung asbestos content decreased from 90.5% in the 1980s to 54.1% in the 2010s (p < 0.001). This trend also held when the analysis was limited to 490 cases of pleural mesothelioma in men (91.8% in the 1980s vs. 65.1% in the 2010s). There was a decrease in the median asbestos body count by LM from 1390 asbestos bodies per gram of wet lung in the 1980s to 38 AB/gm in the 2010s. Similar trends were observed for each of the asbestos fiber types as detected by EM. We conclude that there has been a progressive decrease in lung fiber content of mesothelioma patients during the past four decades, with an increasing percentage of cases not related to asbestos and an increase in median patient age.
Collapse
Affiliation(s)
- Victor L Roggl
- Department of Pathology, Duke University Medical Center, Durham, NC, 27710, USA.
| | - Cynthia L Green
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, 27710, USA
| | - Beiyu Liu
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, 27710, USA
| | - John M Carney
- Department of Pathology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Carolyn H Glass
- Department of Pathology, Duke University Medical Center, Durham, NC, 27710, USA
| | | |
Collapse
|
13
|
Pavlisko EN, Neely ML, Kopetskie H, Hwang DM, Farver CF, Wallace WD, Arrossi A, Illei P, Sever ML, Kirchner J, Frankel CW, Snyder LD, Martinu T, Shino MY, Zaffiri L, Williams N, Robien MA, Singer LG, Budev M, Tsuang W, Shah PD, Reynolds JM, Weigt SS, Belperio JA, Palmer SM, Todd JL. Prognostic implications of and clinical risk factors for acute lung injury and organizing pneumonia after lung transplantation: Data from a multicenter prospective cohort study. Am J Transplant 2022; 22:3002-3011. [PMID: 36031951 PMCID: PMC9925227 DOI: 10.1111/ajt.17183] [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: 02/17/2022] [Revised: 08/05/2022] [Accepted: 08/21/2022] [Indexed: 01/28/2023]
Abstract
We determined prognostic implications of acute lung injury (ALI) and organizing pneumonia (OP), including timing relative to transplantation, in a multicenter lung recipient cohort. We sought to understand clinical risks that contribute to development of ALI/OP. We analyzed prospective, histologic diagnoses of ALI and OP in 4786 lung biopsies from 803 adult lung recipients. Univariable Cox regression was used to evaluate the impact of early (≤90 days) or late (>90 days) posttransplant ALI or OP on risk for chronic lung allograft dysfunction (CLAD) or death/retransplantation. These analyses demonstrated late ALI/OP conferred a two- to threefold increase in the hazards of CLAD or death/retransplantation; there was no association between early ALI/OP and these outcomes. To determine risk factors for late ALI/OP, we used univariable Cox models considering donor/recipient characteristics and posttransplant events as candidate risks. Grade 3 primary graft dysfunction, higher degree of donor/recipient human leukocyte antigen mismatch, bacterial or viral respiratory infection, and an early ALI/OP event were significantly associated with increased late ALI/OP risk. These data from a contemporary, multicenter cohort underscore the prognostic implications of ALI/OP on lung recipient outcomes, clarify the importance of the timing of these events, and identify clinical risks to target for ALI/OP prevention.
Collapse
Affiliation(s)
| | - Megan L. Neely
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | | | - David M. Hwang
- Sunnybrook Health Sciences Centre, Ontario, Canada
- University Health Network, University of Toronto, Ontario, Canada
| | | | - W. Dean Wallace
- University of Southern California, Los Angeles, CA
- University of California Los Angeles, Los Angeles, CA
| | | | | | - Michelle L. Sever
- Rho, Durham, NC
- PPD Government and Public Health Services, Morrisville, NC
| | - Jerry Kirchner
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Courtney W. Frankel
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Laurie D. Snyder
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Tereza Martinu
- University Health Network, University of Toronto, Ontario, Canada
| | | | - Lorenzo Zaffiri
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Nikki Williams
- National Institute of Allergy and Infectious Diseases, Washington, DC
| | - Mark A. Robien
- National Institute of Allergy and Infectious Diseases, Washington, DC
| | - Lianne G. Singer
- University Health Network, University of Toronto, Ontario, Canada
| | | | | | | | - John M. Reynolds
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - S. Sam Weigt
- University of California Los Angeles, Los Angeles, CA
| | | | - Scott M. Palmer
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| | - Jamie L. Todd
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Duke University Medical Center, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Durham, NC
| |
Collapse
|
14
|
Shino MY, Todd JL, Neely ML, Kirchner J, Frankel CW, Snyder LD, Pavlisko EN, Fishbein GA, Schaenman JM, Mason K, Kesler K, Martinu T, Singer LG, Tsuang W, Budev M, Shah PD, Reynolds JM, Williams N, Robien MA, Palmer SM, Weigt SS, Belperio JA. Plasma CXCL9 and CXCL10 at allograft injury predict chronic lung allograft dysfunction. Am J Transplant 2022; 22:2169-2179. [PMID: 35634722 PMCID: PMC9427677 DOI: 10.1111/ajt.17108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/25/2023]
Abstract
Histopathologic lung allograft injuries are putative harbingers for chronic lung allograft dysfunction (CLAD). However, the mechanisms responsible are not well understood. CXCL9 and CXCL10 are potent chemoattractants of mononuclear cells and potential propagators of allograft injury. We hypothesized that these chemokines would be quantifiable in plasma, and would associate with subsequent CLAD development. In this prospective multicenter study, we evaluated 721 plasma samples for CXCL9/CXCL10 levels from 184 participants at the time of transbronchial biopsies during their first-year post-transplantation. We determined the association between plasma chemokines, histopathologic injury, and CLAD risk using Cox proportional hazards models. We also evaluated CXCL9/CXCL10 levels in bronchoalveolar lavage (BAL) fluid and compared plasma to BAL with respect to CLAD risk. Plasma CXCL9/CXCL10 levels were elevated during the injury patterns associated with CLAD, acute rejection, and acute lung injury, with a dose-response relationship between chemokine levels and CLAD risk. Importantly, there were strong interactions between injury and plasma CXCL9/CXCL10, where histopathologic injury associated with CLAD only in the presence of elevated plasma chemokines. We observed similar associations and interactions with BAL CXCL9/CXCL10 levels. Elevated plasma CXCL9/CXCL10 during allograft injury may contribute to CLAD pathogenesis and has potential as a minimally invasive immune monitoring biomarker.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nikki Williams
- National Institute of Allergy and Infectious Diseases; Washington DC
| | - Mark A. Robien
- National Institute of Allergy and Infectious Diseases; Washington DC
| | | | - S. Sam Weigt
- University of California Los Angeles; Los Angeles, CA
| | | |
Collapse
|
15
|
Ghio AJ, Pavlisko EN, Roggli VL, Todd NW, Sangani RG. Cigarette Smoke Particle-Induced Lung Injury and Iron Homeostasis. Int J Chron Obstruct Pulmon Dis 2022; 17:117-140. [PMID: 35046648 PMCID: PMC8763205 DOI: 10.2147/copd.s337354] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
It is proposed that the mechanistic basis for non-neoplastic lung injury with cigarette smoking is a disruption of iron homeostasis in cells after exposure to cigarette smoke particle (CSP). Following the complexation and sequestration of intracellular iron by CSP, the host response (eg, inflammation, mucus production, and fibrosis) attempts to reverse a functional metal deficiency. Clinical manifestations of this response can present as respiratory bronchiolitis, desquamative interstitial pneumonitis, pulmonary Langerhans’ cell histiocytosis, asthma, pulmonary hypertension, chronic bronchitis, and pulmonary fibrosis. If the response is unsuccessful, the functional deficiency of iron progresses to irreversible cell death evident in emphysema and bronchiectasis. The subsequent clinical and pathological presentation is a continuum of lung injuries, which overlap and coexist with one another. Designating these non-neoplastic lung injuries after smoking as distinct disease processes fails to recognize shared relationships to each other and ultimately to CSP, as well as the common mechanistic pathway (ie, disruption of iron homeostasis).
Collapse
Affiliation(s)
- Andrew J Ghio
- Human Studies Facility, US Environmental Protection Agency, Chapel Hill, NC, 27514, USA
- Correspondence: Andrew J Ghio Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC, USA Email
| | | | | | - Nevins W Todd
- Department of Medicine, University of Maryland, Baltimore, MD, 21201, USA
| | - Rahul G Sangani
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| |
Collapse
|
16
|
Shino MY, Li N, Todd JL, Neely ML, Kopetskie H, Sever ML, Kirchner J, Frankel CW, Snyder LD, Pavlisko EN, Martinu T, Singer LG, Tsuang W, Budev M, Shah PD, Reynolds JM, Williams N, Robien MA, Palmer SM, Weigt SS, Belperio JA. Correlation between BAL CXCR3 chemokines and lung allograft histopathologies: A multicenter study. Am J Transplant 2021; 21:3401-3410. [PMID: 33840162 PMCID: PMC8502500 DOI: 10.1111/ajt.16601] [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: 12/10/2020] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 01/25/2023]
Abstract
The histopathologic diagnosis of acute allograft injury is prognostically important in lung transplantation with evidence demonstrating a strong and consistent association between acute rejection (AR), acute lung injury (ALI), and the subsequent development of chronic lung allograft dysfunction (CLAD). The pathogenesis of these allograft injuries, however, remains poorly understood. CXCL9 and CXCL10 are CXC chemokines induced by interferon-γ and act as potent chemoattractants of mononuclear cells. We hypothesized that these chemokines are involved in the mononuclear cell recruitment associated with AR and ALI. We further hypothesized that the increased activity of these chemokines could be quantified as increased levels in the bronchoalveolar lavage fluid. In this prospective multicenter study, we evaluate the incidence of histopathologic allograft injury development during the first-year post-transplant and measure bronchoalveolar CXCL9 and CXCL10 levels at the time of the biopsy. In multivariable models, CXCL9 levels were 1.7-fold and 2.1-fold higher during AR and ALI compared with "normal" biopsies without histopathology. Similarly, CXCL10 levels were 1.6-fold and 2.2-fold higher during these histopathologies, respectively. These findings support the association of CXCL9 and CXCL10 with episodes of AR and ALI and provide potential insight into the pathogenesis of these deleterious events.
Collapse
Affiliation(s)
| | - Ning Li
- University of California Los Angeles; Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nikki Williams
- National Institute of Allergy and Infectious Diseases; Washington DC
| | - Mark A. Robien
- National Institute of Allergy and Infectious Diseases; Washington DC
| | | | - S. Sam Weigt
- University of California Los Angeles; Los Angeles, CA
| | | |
Collapse
|
17
|
Wahidi MM, Davidson K, Shofer S, Mahmood K, Cheng G, Giovacchini C, Jones C, Jug R, Pavlisko EN, Wang X, Gu L, Weimholt C, Zhou Z, Chen A. Pilot Study of the Performance of 19-G Needle in Endobronchial Ultrasound-guided Transbronchial Aspiration for the Diagnosis and Testing of Molecular Markers in Lung Cancer. J Bronchology Interv Pulmonol 2021; 28:209-214. [PMID: 33273249 DOI: 10.1097/lbr.0000000000000736] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the standard for diagnosis and staging of lung cancer. Historically, 21- and 22-G needles have been paired with EBUS. We evaluated the performance of EBUS-TBNA using a larger 19-G needle in the assessment of tumor tissue obtained and success of testing for molecular markers. METHODS We prospectively enrolled adult patients with lymphadenopathy concerning for metastatic lung cancer. Patients underwent diagnostic EBUS-TBNA utilizing 19-G needles. Cases of non-small cell lung cancer (NSCLC) were evaluated for programmed cell death receptor ligand (PD-L1) expression. Cases of adenocarcinoma or undifferentiated NSCLC were further evaluated for 3 molecular markers for driver mutations: epidermal growth factor receptor (EGFR), c-ros oncogene 1 (ROS-1), and anaplastic lymphoma kinase (ALK). RESULTS Fifty patients were enrolled and underwent EBUS-TBNA using 19-G needles. PD-L1 assay was successfully performed in 90% of NSCLC cases. In adenocarcinoma or undifferentiated NSCLC cases, the success rate in testing was 90% for EGFR and 86% for ALK. ROS-1 testing had a success rate of 67%; 24% of these specimens had adequate tumor cells but there was technical difficulty with the assay. Block quality was judged by total number of tumor cells per hematoxylin and eosin-stained slide of each cell block (58% of specimens had >500 cells and 22% had 200 to 500 cells). There were no adverse events. CONCLUSION EBUS-TBNA using 19-G needles can obtain a high number of tumor cells and has a high rate of success in performing assays for PD-L1, EGFR, and ALK in NSCLC patients without an increase in adverse events. The success rate of ROS-1 testing was lower.
Collapse
Affiliation(s)
- Momen M Wahidi
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | | | - Scott Shofer
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - Kamran Mahmood
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - George Cheng
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - Coral Giovacchini
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - Claudia Jones
- Department of Pathology, Duke University Medical Center
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center
| | | | - Xiaofei Wang
- Department of Biostatistics and Bioinformatics, Duke University, Durham
| | - Lin Gu
- Department of Biostatistics and Bioinformatics, Duke University, Durham
| | | | | | - Alexander Chen
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
18
|
Zaffiri L, Frankel C, Bush EJ, Neely ML, Pavlisko EN, Mokrova IL, Luftig MA, Palmer SM. Evidence of Epstein-Barr virus heterogeneous gene expression in adult lung transplant recipients with posttransplant lymphoproliferative disorder. J Med Virol 2021; 93:5040-5047. [PMID: 33704812 PMCID: PMC9208898 DOI: 10.1002/jmv.26936] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 11/10/2022]
Abstract
Epstein-Barr virus (EBV)-driven posttransplant lymphoproliferative disorder (PTLD) is a serious complication following lung transplant. The extent to which the presence of EBV in PTLD tissue is associated with survival is uncertain. Moreover, whether the heterogeneity in expression of EBV latency programs is related to the timing of PTLD onset remains unexplored. We retrospectively performed a comprehensive histological evaluation of EBV markers at the tissue level in 34 adult lung transplant recipients with early- and late-onset PTLD. Early-onset PTLD, occurring within the first 12 months posttransplant, had higher odds to express EBV markers. The presence of EBV in PTLD was not associated with a difference in survival relative to EBV-negative tumors. However, we found evidence of heterogeneous expression of EBV latency programs, including type III, IIb, IIa, and 0/I. Our study suggests that the heterogeneous expression of EBV latency programs may represent a mechanism for immune evasion in patients with PLTD after lung transplants. The recognition of multiple EBV latency programs can be used in personalized medicine in patients who are nonresponsive to traditional types of chemotherapy and can be potentially evaluated in other types of solid organ transplants.
Collapse
Affiliation(s)
- Lorenzo Zaffiri
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Courtney Frankel
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Erika J Bush
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Megan L Neely
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | | | - Irina L Mokrova
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Micah A Luftig
- Department of Molecular Genetics and Microbiology, Duke Center for Virology, Duke University, Durham, North Carolina, USA
| | - Scott M Palmer
- Department of Medicine, Duke University, Durham, North Carolina, USA
| |
Collapse
|
19
|
Todd JL, Neely ML, Kopetskie H, Sever ML, Kirchner J, Frankel CW, Snyder LD, Pavlisko EN, Martinu T, Tsuang W, Shino MY, Williams N, Robien MA, Singer LG, Budev M, Shah PD, Reynolds JM, Palmer SM, Belperio JA, Weigt SS. Risk Factors for Acute Rejection in the First Year after Lung Transplant. A Multicenter Study. Am J Respir Crit Care Med 2020; 202:576-585. [PMID: 32379979 PMCID: PMC7427399 DOI: 10.1164/rccm.201910-1915oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 05/07/2020] [Indexed: 11/16/2022] Open
Abstract
Rationale: Acute rejection, manifesting as lymphocytic inflammation in a perivascular (acute perivascular rejection [AR]) or peribronchiolar (lymphocytic bronchiolitis [LB]) distribution, is common in lung transplant recipients and increases the risk for chronic graft dysfunction.Objectives: To evaluate clinical factors associated with biopsy-proven acute rejection during the first post-transplant year in a present-day, five-center lung transplant cohort.Methods: We analyzed prospective diagnoses of AR and LB from over 2,000 lung biopsies in 400 newly transplanted adult lung recipients. Because LB without simultaneous AR was rare, our analyses focused on risk factors for AR. Multivariable Cox proportional hazards models were used to assess donor and recipient factors associated with the time to the first AR occurrence.Measurements and Main Results: During the first post-transplant year, 53.3% of patients experienced at least one AR episode. Multivariable proportional hazards analyses accounting for enrolling center effects identified four or more HLA mismatches (hazard ratio [HR], 2.06; P ≤ 0.01) as associated with increased AR hazards, whereas bilateral transplantation (HR, 0.57; P ≤ 0.01) was associated with protection from AR. In addition, Wilcoxon rank-sum analyses demonstrated bilateral (vs. single) lung recipients, and those with fewer than four (vs. more than four) HLA mismatches demonstrated reduced AR frequency and/or severity during the first post-transplant year.Conclusions: We found a high incidence of AR in a contemporary multicenter lung transplant cohort undergoing consistent biopsy sampling. Although not previously recognized, the finding of reduced AR in bilateral lung recipients is intriguing, warranting replication and mechanistic exploration.
Collapse
Affiliation(s)
- Jamie L. Todd
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
- Duke Clinical Research Institute, and
| | | | | | | | | | - Courtney W. Frankel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
| | - Laurie D. Snyder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
- Duke Clinical Research Institute, and
| | | | - Tereza Martinu
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nikki Williams
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; and
| | - Mark A. Robien
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; and
| | - Lianne G. Singer
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - John M. Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
| | - Scott M. Palmer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
- Duke Clinical Research Institute, and
| | | | - S. Sam Weigt
- University of California Los Angeles, Los Angeles, California
| |
Collapse
|
20
|
Roggli VL, Carney JM, Sporn TA, Pavlisko EN. Response to letter regarding "Talc and mesothelioma: mineral fiber analysis of 65 cases with clinicopathological correlation". Ultrastruct Pathol 2020; 44:524-525. [PMID: 32700637 DOI: 10.1080/01913123.2020.1795019] [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: 10/23/2022]
Affiliation(s)
- Victor L Roggli
- Department of Pathology, Duke University Medical Center , Durham, NC, USA
| | - John M Carney
- Department of Pathology, Duke University Medical Center , Durham, NC, USA
| | - Thomas A Sporn
- Department of Pathology, Duke University Medical Center , Durham, NC, USA
| | | |
Collapse
|
21
|
Abstract
Malignant mesothelioma is strongly associated with prior asbestos exposure. Recently there has been interest in the role of talc exposure in the pathogenesis of mesothelioma. We have analyzed lung tissue samples from a large series of malignant mesothelioma patients. Asbestos bodies were counted by light microscopy and mineral fiber concentrations for fibers 5 µm or greater in length were determined by scanning electron microscopy equipped with an energy dispersive spectrometer. The values were compared with 20 previously published controls. Among 609 patients with mesothelioma, talc fibers were detected in 375 (62%) and exceeded our control values in 65 (11%). Elevated talc levels were found in 48/524 men (9.2%) and 17/85 women (20%). Parietal pleural plaques were identified in 30/51 informative cases (59%) and asbestosis in 5/62 informative cases (8%). Commercial amphiboles (amosite and/or crocidolite) were elevated in 52/65 (80%) and noncommercial amphiboles (tremolite, actinolite or anthophyllite) in 41/65 (63%). Both were elevated in 34/65 (52%). Asbestos body counts by light microscopy were elevated in 53/64 informative cases (83%). A history of working in industries associated with asbestos exposure and increased mesothelioma risk was identified in 36/48 cases in men, and a history of exposure as household contacts of an occupationally exposed individual was identified in 12/17 cases in women. We conclude that among patients with mesothelioma, the vast majority have talc levels indistinguishable from background. Of the remaining 11% with elevated talc levels, the vast majority (80%) have elevated levels of commercial amphibole fibers.
Collapse
Affiliation(s)
- Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - John M Carney
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Thomas A Sporn
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | | |
Collapse
|
22
|
Todd JL, Kelly FL, Nagler A, Banner K, Pavlisko EN, Belperio JA, Brass D, Weigt SS, Palmer SM. Amphiregulin contributes to airway remodeling in chronic allograft dysfunction after lung transplantation. Am J Transplant 2020; 20:825-833. [PMID: 31665560 PMCID: PMC7042065 DOI: 10.1111/ajt.15667] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/04/2019] [Accepted: 10/17/2019] [Indexed: 01/25/2023]
Abstract
Chronic lung allograft dysfunction (CLAD), a condition of excess matrix deposition and airways fibrosis, limits survival after lung transplantation. Amphiregulin (Areg) is an epidermal growth factor receptor (EGFR) ligand suggested to regulate airway injury and repair. We sought to determine whether Areg expression increases in CLAD, localize the cellular source of Areg induction in CLAD, and assess its effects on airway matrix deposition. Lung fluid Areg protein was quantified in patients with or without CLAD. In situ hybridization was performed to localize Areg and EGFR transcript in CLAD and normal lung tissue. Expression of hyaluronan, a matrix constituent that accumulates in CLAD, was measured in Areg-exposed bronchial epithelial cells in the presence or absence of an EGFR inhibitor. We demonstrated that lung fluid Areg protein was significantly increased in CLAD in a discovery and replication cohort. Areg and EGFR transcripts were abundantly expressed within CLAD tissue, localized to basally distributed airway epithelial cells overlying fibrotic regions. Areg-exposed bronchial epithelial cells increased hyaluronan and hyaluronan synthase expression in an EGFR-dependent manner. Collectively, these novel observations suggest that Areg contributes to airway remodeling and CLAD. Moreover these data implicate a role for EGFR signaling in CLAD pathogenesis, suggesting novel therapeutic targets.
Collapse
Affiliation(s)
- Jamie L. Todd
- Duke University Medical Center; Department of Medicine; Division of Pulmonary, Allergy and Critical Care Medicine; Durham, North Carolina,Duke Clinical Research Institute; Duke University Medical Center; Durham, North Carolina
| | - Fran L. Kelly
- Duke University Medical Center; Department of Medicine; Division of Pulmonary, Allergy and Critical Care Medicine; Durham, North Carolina
| | - Andrew Nagler
- Duke University Medical Center; Department of Medicine; Division of Pulmonary, Allergy and Critical Care Medicine; Durham, North Carolina
| | - Kane Banner
- Duke University Medical Center; Department of Medicine; Division of Pulmonary, Allergy and Critical Care Medicine; Durham, North Carolina
| | | | - John A. Belperio
- University of California Los Angeles; Department of Medicine; Division of Pulmonary Medicine; Los Angeles, California
| | - David Brass
- Duke University Medical Center; Department of Medicine; Division of Pulmonary, Allergy and Critical Care Medicine; Durham, North Carolina
| | - S. Sam Weigt
- University of California Los Angeles; Department of Medicine; Division of Pulmonary Medicine; Los Angeles, California
| | - Scott M. Palmer
- Duke University Medical Center; Department of Medicine; Division of Pulmonary, Allergy and Critical Care Medicine; Durham, North Carolina,Duke Clinical Research Institute; Duke University Medical Center; Durham, North Carolina
| |
Collapse
|
23
|
Affiliation(s)
- John M. Carney
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | | | - Thomas A. Sporn
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Victor L. Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
24
|
Dragani TA, Colombo F, Pavlisko EN, Roggli VL. Response to comments on 'Malignant mesothelioma diagnosed at a younger age is associated with heavier asbestos exposure' by Farioli et al. and Oddone et al. Carcinogenesis 2019; 40:490-491. [PMID: 30357324 DOI: 10.1093/carcin/bgy145] [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] [Received: 09/10/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Francesca Colombo
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
25
|
Dragani TA, Colombo F, Pavlisko EN, Roggli VL. Corrigendum: Malignant mesothelioma diagnosed at a younger age is associated with heavier asbestos exposure. Carcinogenesis 2019; 40:492. [PMID: 30892588 DOI: 10.1093/carcin/bgz037] [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: 11/13/2022] Open
Affiliation(s)
- Tommaso A Dragani
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Colombo
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
26
|
Carney JM, Gray AL, Howell DN, Pavlisko EN. Parenteral administration of oral medications in lung transplant recipients: An underrecognized problem. Am J Transplant 2019; 19:1552-1559. [PMID: 30725518 DOI: 10.1111/ajt.15286] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/03/2019] [Accepted: 01/19/2019] [Indexed: 01/25/2023]
Abstract
Microcrystalline cellulose (MCC) is an insoluble material commonly used as a binder and filler in oral medications. Identification of pulmonary intravascular deposition of MCC in transbronchial biopsies from lung transplant (LT) recipients following parenteral injection of oral medications has only been reported once. A search of our surgical pathology electronic database was performed from January 1, 2000 to November 1, 2017 using the text "transplant transbronchial." The diagnosis field for all cases retrieved was then searched for the text "cellulose." These cases were queried for patient demographics and outcomes. Between January 1, 2000 and November 1, 2017, 1558 lung transplants were performed in 1476 individual patients at our institution; 12 were identified to have MCC in their lung tissue. Patients with MCC identified on biopsies were more likely to be transplanted for cystic fibrosis versus other indications and younger versus older. MCC identified in 2 of our cases was favored to be donor derived. Of the 12 patients, 6 (50%) are deceased. MCC within the pulmonary vasculature may be an indicator of increased complications, mortality, or shortened survival in LT recipients. Detecting intravascular MCC and distinguishing it from aspirated foreign material can be challenging. Awareness of the differential diagnosis for pulmonary foreign material is of paramount importance for the pathologist.
Collapse
Affiliation(s)
- John M Carney
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Alice L Gray
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - David N Howell
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | | |
Collapse
|
27
|
Dragani TA, Colombo F, Pavlisko EN, Roggli VL. Malignant mesothelioma diagnosed at a younger age is associated with heavier asbestos exposure. Carcinogenesis 2019; 39:1151-1156. [PMID: 29982378 DOI: 10.1093/carcin/bgy089] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/29/2018] [Indexed: 12/26/2022] Open
Abstract
Asbestos exposure is the main etiology of malignant mesothelioma, but there are conflicting data on whether the intensity of exposure modulates the development of this disease. This study considered 594 patients with malignant mesothelioma for whom count data on asbestos bodies and fibers (per gram of wet lung tissue) were available. The relationships between age at diagnosis (a time-to-event outcome variable) and these two measures of internal asbestos exposure, along with other possible modulating factors (sex, tumor location, histological subtype and childhood exposure), were assessed on multivariable Cox proportional hazard models, stratifying by decade of birth year. For both measures of asbestos in lung tissue, younger age at diagnosis was associated with higher internal measures of exposure to asbestos. Stratified Cox analyses showed that for each doubling in asbestos body count patients were 1.07 times more likely to be diagnosed at a younger age [hazard ratio (HR) = 1.07; 95% confidence interval (CI), 1.04-1.09; P = 2.2 × 10-7] and for each doubling in asbestos fiber count patients were 1.13 times more likely to be diagnosed at a younger age (HR = 1.13; 95% CI, 1.09-1.17; P = 8.6 × 10-11). None of the other variables considered were associated with age at diagnosis. Our finding that tumors become clinically apparent at a younger age in heavily exposed subjects suggests that asbestos is involved not only in the malignant mesothelioma tumor initiation but, somehow, also in the progression of the disease.
Collapse
Affiliation(s)
- Tommaso A Dragani
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Colombo
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
28
|
Leckey BD, Carney JM, Sun JM, Pavlisko EN. Novel intronic DICER1 variation associated with pleuropulmonary blastoma in two siblings. BMJ Case Rep 2019; 12:12/1/e227391. [PMID: 30665929 DOI: 10.1136/bcr-2018-227391] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pleuropulmonary blastomas (PPB) are rare aggressive paediatric lung malignancies associated with DICER1 variants. We present two cases, a 2-year-old girl with upper respiratory tract symptoms as well as a 6-month-old girl sibling undergoing screening due to family history of malignancy. Imaging of the 2-year-old girl revealed a large mass filling the right hemithorax which was determined to be a type II PPB after pathological examination. Imaging of the 6-month-old sibling demonstrated a small cystic lesion in the posterior basal segment of the right lower lobe which was determined to be a type 1r PPB after pathological examination. The 2-year-old girl received adjuvant chemotherapy while the baby sister underwent resection alone and both are alive and well at 12 months and 7 months, respectively. Sequence analysis in both cases confirmed the same DICER1 variation, c.2437-2A>G (likely pathogenic), which has not been previously described in the literature.
Collapse
Affiliation(s)
- Bruce D Leckey
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - John M Carney
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jessica M Sun
- Department of Pediatric Hematology Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth N Pavlisko
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
29
|
Roux A, Levine DJ, Zeevi A, Hachem R, Halloran K, Halloran PF, Gibault L, Taupin JL, Neil DAH, Loupy A, Adam BA, Mengel M, Hwang DM, Calabrese F, Berry G, Pavlisko EN. Banff Lung Report: Current knowledge and future research perspectives for diagnosis and treatment of pulmonary antibody-mediated rejection (AMR). Am J Transplant 2019; 19:21-31. [PMID: 29956477 DOI: 10.1111/ajt.14990] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 02/05/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 01/25/2023]
Abstract
The Lung session of the 2017 14th Banff Foundation for Allograft Pathology Conference, Barcelona focused on the multiple aspects of antibody-mediated rejection (AMR) in lung transplantation. Multidimensional approaches for AMR diagnosis, including classification, histological and immunohistochemical analysis, and donor- specific antibody (DSA) characterization with their current strengths and limitations were reviewed in view of recent research. The group also discussed the role of tissue gene expression analysis in the context of unmet needs in lung transplantation. The current best practice for monitoring of AMR and the therapeutic approach are summarized and highlighted in this report. The working group reached consensus of the major gaps in current knowledge and focused on the unanswered questions regarding pulmonary AMR. An important outcome of the meeting was agreement on the need for future collaborative research projects to address these gaps in the field of lung transplantation.
Collapse
Affiliation(s)
- A Roux
- Pneumology, Adult CF Center and Lung Transplantation Department, Foch Hospital, Suresnes, France.,Paris Translational Research Center for Organ Transplantation, French National institute of Health and Medical Research (INSERM). Unit UMR S970, Paris, France.,Versailles Saint-Quentin-en-Yvelines University, UPRES EA 220, Suresnes, France
| | - D J Levine
- Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - A Zeevi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Hachem
- Washington University, School of Medicine Division of Pulmonary & Critical Care, St. Louis, MO, USA
| | - K Halloran
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - P F Halloran
- Alberta Transplant Applied Genomics Center, University of Alberta, Edmonton, Alberta, Canada
| | - L Gibault
- Department of Pathology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J L Taupin
- Department of Immunology and Histocompatibility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D A H Neil
- Department of Pathology, Queen Elizabeth Hospital, Birmingham, UK
| | - A Loupy
- Paris Translational Research Center for Organ Transplantation, French National institute of Health and Medical Research (INSERM). Unit UMR S970, Paris, France
| | - B A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - M Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - D M Hwang
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada
| | - F Calabrese
- Department of Cardio-Thoracic and Vascular Sciences, Pathology Section, University of Padova, Italy
| | - G Berry
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - E N Pavlisko
- Department of Pathology, Duke University Hospital, Durham, NC, USA
| |
Collapse
|
30
|
Hussaini SMQ, Madut D, Tong BC, Pavlisko EN, Schell WA, Perfect JR, Thielman NM. Pulmonary blastomycosis presenting as primary lung cancer. BMC Infect Dis 2018; 18:336. [PMID: 30021526 PMCID: PMC6052517 DOI: 10.1186/s12879-018-3244-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blastomycosis is an endemic mycosis in North America that is caused by the dimorphic fungus Blastomyces dermatitidis. The illness is a systemic disease with a wide variety of pulmonary and extra-pulmonary manifestations. The initial presentation of blastomycosis may easily be mistaken for other infectious or non-infectious etiologies. CASE PRESENTATION We present the case of a 52-year-old African-American male and former smoker that presented to his primary care provider with a 2-week history of non-productive cough, night sweats and weight loss. Initially diagnosed with primary lung malignancy, the patient was subsequently found to have pulmonary blastomycosis mimicking lung cancer. The patient underwent a successful course of treatment with posaconazole. CONCLUSIONS Chronic blastomycosis can present with clinical and radiographic features indistinguishable from thoracic malignancies. There is no clinical syndrome specific for blastomycosis, thus a high degree of suspicion is required for early diagnosis. In this case report, we review recent evidence in radiographic features, diagnostic considerations and treatment of the disease.
Collapse
Affiliation(s)
- Syed Mohammed Qasim Hussaini
- Duke University School of Medicine, Durham, North Carolina, 27710, USA.,Duke-NUS Medical School, Singapore, 510568, Singapore
| | - Deng Madut
- Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University Medical Center, 310 Trent Drive, Durham, NC, 27710, USA
| | - Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, 27710, USA
| | | | - Wiley A Schell
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - John R Perfect
- Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University Medical Center, 310 Trent Drive, Durham, NC, 27710, USA
| | - Nathan M Thielman
- Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University Medical Center, 310 Trent Drive, Durham, NC, 27710, USA.
| |
Collapse
|
31
|
Abstract
Lipoplasty, or liposuction, the surgical process of removing excess fat, is an elective procedure with rising frequency in the United States. Fat embolism syndrome is a clinical diagnosis and is defined as fat in the circulation with an identifiable clinical pattern of signs and symptoms (eg, hypoxemia, respiratory insufficiency, neurologic impairment, and petechial rash) that occur in the appropriate clinical context. Fat embolism syndrome following liposuction is a life-threatening complication, although its incidence is low. Currently, there is no specific therapy for fat embolism syndrome, so prevention, early detection, and supportive therapy are critical. Many cases of fat embolism syndrome are undiagnosed or misdiagnosed; however, postmortem examination can provide the means for appropriate diagnosis. Therefore, a pathologist must keep a keen eye, as microscopic fat emboli are difficult to appreciate with routine tissue processing and staining.
Collapse
Affiliation(s)
| | - Elizabeth N. Pavlisko
- From the Department of Pathology, Duke University Health System, Durham, North Carolina
| |
Collapse
|
32
|
Butnor KJ, Rueckert J, Pavlisko EN, Sporn TA, Roggli VL. Malignant peritoneal mesothelioma in patients with endometriosis. J Clin Pathol 2018; 71:971-974. [DOI: 10.1136/jclinpath-2018-205099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 11/04/2022]
Abstract
AimsFlorid mesothelial hyperplasia is known to result from endometriosis. Well-differentiated papillary mesothelioma and multiloculated peritoneal inclusion cysts have also been described in women with endometriosis. To our knowledge, peritoneal diffuse malignant mesothelioma (MM) arising in the setting of endometriosis has not been reported. The purpose of this study is to report the clinicopathological characteristics of women with MM and endometriosis.MethodsThe surgical pathology files of a tertiary academic medical centre and the consultation files of one of the study authors were reviewed for cases of MM in females with and without endometriosis.ResultsSix women with MM and endometriosis ranging in age from 29 to 55 years (median=45 years) were identified. All had peritoneal MM and endometriosis involving the peritoneum and/or adnexa. Five had epithelioid MM and one had biphasic MM. Two had paraoccupational exposure to asbestos. The median age of women with MM and endometriosis (44.5 years) was significantly less than the median age of cases without endometriosis (58.0 years) (p value=0.01).ConclusionsTo our knowledge, this is the first report of MM in women with endometriosis. Interestingly, MM in the setting of endometriosis has only been observed in the peritoneum and not in other serosal cavities. The findings in the present study suggest that chronic serosal inflammation secondary to endometriosis may be an inducing factor in rare cases of MM of the peritoneum.
Collapse
|
33
|
Abstract
CONTEXT - Malignant mesothelioma (MM) is a component of the BAP1 tumor predisposition syndrome. Other than in BAP1 familial studies, nonmesothelial neoplasms in individuals with MM has not been comprehensively assessed. OBJECTIVE - To assess the spectrum and prevalence of nonmesothelial neoplasms in individuals with MM. DESIGN - Individuals with MM and second neoplasms were identified from a database of 3900 MM cases. The expected prevalence of each type of neoplasm was calculated and compared with the actual prevalence in the study population using available Surveillance, Epidemiology, and End Results data and other published data. RESULTS - Two hundred seventy nonmesothelial neoplasms were identified in 241 individuals (6% of the study population) with MM. Prostate adenocarcinoma was most common. Non-Hodgkin lymphoma, Hodgkin lymphoma, lung carcinoma, urothelial carcinoma, breast carcinoma, chronic lymphocytic leukemia, clear cell renal cell carcinoma, head and neck squamous cell carcinoma, papillary renal cell carcinoma, multiple myeloma/plasmacytoma, meningioma, pleomorphic undifferentiated sarcoma, chronic myelogenous leukemia, ocular melanoma, hepatocellular carcinoma, liposarcoma, and Wilms tumor all were more prevalent than expected. CONCLUSIONS - Nonmesothelial neoplasms are uncommon in individuals with MM, but certain tumor types are increased in prevalence. In an unselected study population with respect to BAP1 status, the prevalence of several tumor types described in BAP1 mutation carriers, including lung carcinoma, clear cell renal cell carcinoma, breast carcinoma, meningioma, pleomorphic undifferentiated sarcoma, and ocular melanoma, was increased.
Collapse
Affiliation(s)
| | | | | | - Victor L Roggli
- From the Department of Pathology and Laboratory Medicine, University of Vermont, Burlington (Dr Butnor); and the Department of Pathology, Duke University, Durham, North Carolina (Drs Pavlisko, Sporn, and Roggli)
| |
Collapse
|
34
|
Affiliation(s)
- Hakim Azfar Ali
- Division of Pulmonary, Allergy and Critical Care; Department of Medicine; Duke University Hospital; Durham NC USA
| | | | - Laurie D. Snyder
- Division of Pulmonary, Allergy and Critical Care; Department of Medicine; Duke University Hospital; Durham NC USA
| | - Michael Frank
- Department of Pediatrics; Duke University Hospital; Durham NC USA
| | - Scott M. Palmer
- Division of Pulmonary, Allergy and Critical Care; Department of Medicine; Duke University Hospital; Durham NC USA
| |
Collapse
|
35
|
Affiliation(s)
- Colby A Cantu
- Department of Pathology, Duke University Hospital, Durham, North Carolina, USA
| | | |
Collapse
|
36
|
Weyandt JD, Carney JM, Pavlisko EN, Xu M, Counter CM. Isoform-Specific Effects of Wild-Type Ras Genes on Carcinogen-Induced Lung Tumorigenesis in Mice. PLoS One 2016; 11:e0167205. [PMID: 27911940 PMCID: PMC5135096 DOI: 10.1371/journal.pone.0167205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/10/2016] [Indexed: 12/31/2022] Open
Abstract
The gene KRAS is commonly mutated in lung cancer to encode a constitutively active and oncogenic protein that is well established to initiate and maintain lung tumorigenesis. However, the remaining wild-type KRAS protein, or the other family members HRAS and NRAS, can still be activated in the presence of oncogenic KRAS. Moreover, loss of any one of these three genes has been shown to increase the sensitivity of mice to the carcinogen urethane, which induces Kras mutation-positive early lung lesions. To determine the contribution of progressively disrupting Hras and Nras genes on urethane lung tumorigenesis, mice with different combinations of wild-type and null alleles of Hras and Nras were exposed with urethane and tumor burden was assessed. As previously reported, loss of one allele of Hras increased the sensitivity of mice to this carcinogen, and this effect was further exacerbated by the loss of the second Hras allele. However, loss of one or both alleles of Nras failed to alter tumor burden, either in the absence or presence of Hras, after exposure to urethane. Additionally, no obvious difference between lung lesions in mice with wild-type versus null alleles was detected, suggesting that wild-type Ras proteins may exert a tumor suppressive effects at the time of initiation, although other interpretations are certainly possible. In summary, these data suggest that in some genetic backgrounds inactivation of different wild-type Ras genes can have different effects on urethane-induced lung tumorigenesis.
Collapse
Affiliation(s)
- Jamie D. Weyandt
- Department of Pharmacology & Cancer Biology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - John M. Carney
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Elizabeth N. Pavlisko
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - MengMeng Xu
- Department of Pharmacology & Cancer Biology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Christopher M. Counter
- Department of Pharmacology & Cancer Biology, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
| |
Collapse
|
37
|
Bao EL, Chystsiakova A, Brahmajothi MV, Sunday ME, Pavlisko EN, Wempe MF, Auten RL. Bronchopulmonary dysplasia impairs L-type amino acid transporter-1 expression in human and baboon lung. Pediatr Pulmonol 2016; 51:1048-1056. [PMID: 26918397 PMCID: PMC5814304 DOI: 10.1002/ppul.23402] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/29/2015] [Accepted: 01/31/2016] [Indexed: 11/11/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is an inflammatory lung disorder common in premature infants who undergo mechanical ventilation with supplemental oxygen. Inhaled nitric oxide (iNO) has been used to prevent experimental and clinical BPD. Earlier studies showed that NO effects in alveolar epithelial cells (AEC) are mediated by S-nitrosothiol uptake via L-type amino acid transporter-1 (LAT1). Because LAT1 expression could influence the efficacy of iNO therapy, we sought to determine whether pulmonary LAT1 expression is altered in preterm baboons with experimental BPD and in human newborns susceptible to developing BPD. Using fixed lung obtained from 125 d to 140 d gestation baboon models of BPD, LAT1 immunostaining was measured in control and BPD animals. In adult controls and in 140 d gestational controls (GC), LAT1 was expressed in both type I and type II AECs. In 140 d BPD lungs, LAT1 expression density in alveolar tissue was decreased. In 125 d GC baboons, LAT1 immunostaining was largely confined to cuboidal AECs, whereas animals given 14 d of mechanical ventilation exhibited diminished alveolar septal LAT1 Labeling. The pattern in adult human donor lung was comparable to that observed in adult baboons. LAT1 was expressed in lungs obtained from some but not all very premature newborns at autopsy. In human and baboon lung, adult and newborn, pulmonary vascular cells expressed LAT1. In summary, LAT1 is expressed in AECs and pulmonary vascular cells in baboons and humans. Experimental BPD in premature baboons decreases pulmonary LAT1 expression and alters its spatial localization. Heterogeneity of functional LAT1 could affect S-nitrosothiol importation, which could impair iNO therapy. Pediatr Pulmonol. 2016;51:1048-1056. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Erik L Bao
- Department of Pediatrics, Duke University Medical Center, Durham, 27710, North Carolina
| | | | - Mulugu V Brahmajothi
- Department of Pediatrics, Duke University Medical Center, Durham, 27710, North Carolina
| | - Mary E Sunday
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | | | - Michael F Wempe
- Department of Pharmaceutical Sciences, School of Pharmacy, Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado
| | - Richard L Auten
- Department of Pediatrics, Duke University Medical Center, Durham, 27710, North Carolina.
| |
Collapse
|
38
|
Butnor KJ, Pavlisko EN, Sporn TA, Roggli VL. Malignant peritoneal mesothelioma and Crohn disease. J Clin Pathol 2016; 70:228-232. [PMID: 27484913 DOI: 10.1136/jclinpath-2016-203945] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/01/2016] [Accepted: 07/10/2016] [Indexed: 12/15/2022]
Abstract
AIMS Mesothelial reaction simulating peritoneal diffuse malignant mesothelioma (MM) has been reported in the setting of Crohn ileitis. To our knowledge, peritoneal MM arising in patients with inflammatory bowel disease (IBD) has not been reported. The purpose of this study is to report the clinicopathological characteristics of patients with peritoneal MM and IBD. METHODS A database of approximately 3800 MM was reviewed for cases of MM in patients with IBD. RESULTS Three patients (0.08%) with peritoneal MM and Crohn disease (CD) were identified, including two women and one man ranging in age from 56 to 65 years. All had a long-standing history of diarrhoea and an established diagnosis of CD of 3 years or greater duration. Two had epithelial MM and one had biphasic MM. Only one had documented asbestos exposure. CONCLUSIONS Peritoneal MM occurs rarely in patients with IBD, but interestingly, has only been observed in the setting of CD and not in patients with ulcerative colitis. Chronic inflammation has been associated with the development of MM in rare instances and these three cases suggest that CD with transmural inflammation may also be a precursor. The precise role of CD-related transmural inflammation in the carcinogenesis of peritoneal MM remains to be determined.
Collapse
Affiliation(s)
- Kelly J Butnor
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Elizabeth N Pavlisko
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas A Sporn
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
39
|
de Ridder GG, Kraynie A, Pavlisko EN, Oury TD, Roggli VL. Asbestos content of lung tissue in patients with malignant peritoneal mesothelioma: A study of 42 cases. Ultrastruct Pathol 2016; 40:134-41. [DOI: 10.3109/01913123.2016.1170085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
40
|
Kraynie A, de Ridder GG, Sporn TA, Pavlisko EN, Roggli VL. Malignant mesothelioma not related to asbestos exposure: Analytical scanning electron microscopic analysis of 83 cases and comparison with 442 asbestos-related cases. Ultrastruct Pathol 2016; 40:142-6. [DOI: 10.3109/01913123.2016.1154633] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
41
|
Butnor KJ, Brownlee NA, Mahar A, Pavlisko EN, Sporn TA, Roggli VL. Diffuse malignant mesothelioma and synchronous lung cancer: A clinicopathological study of 18 cases. Lung Cancer 2016; 95:1-7. [PMID: 27040844 DOI: 10.1016/j.lungcan.2016.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/08/2016] [Accepted: 02/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the clinicopathologic characteristics of individuals with diffuse malignant mesothelioma (DMM) occurring concurrently with lung cancer (LC). MATERIALS AND METHODS A database of approximately 3800 patients with DMM was reviewed, from which 18 patients (0.5%) who had synchronous LC were identified. The clinicopathologic features, as well as the occupational exposure history and fiber burden analysis data were examined. RESULTS The patient median age was 68 years (range 58-84 years). Of the 18 patients (14 male, 4 female), 11 (61%) had epithelial, 5 (28%) had biphasic, and 2 (11%) had sarcomatoid DMM, with the majority (16 cases; 89%) originating in the pleura and only 2 were peritoneal. Among the histologic types of LC, adenocarcinoma was most frequent (12 cases; 67%), while 5 cases of squamous cell carcinoma, and 1 case of small cell carcinoma were observed. Three patients also had a history of prior malignancy (1 with testicular seminoma and bladder carcinoma and 2 with prostate carcinoma). Fifteen patients had a positive smoking history. All but 3 had documented asbestos exposure. Three had histologic features of asbestosis. Mineral analysis performed in 8 showed an elevated asbestos fiber burden in 4 (22%). Amosite was detected in 4 patients, crocidolite in 3, and non-commercial amphiboles in 5. CONCLUSION The finding of simultaneous carcinoma of the lung and DMM is distinctly unusual. The majority of patients are male smokers with pleural epithelial DMM and lung adenocarcinoma. This study represents the largest cohort of patients reported to date with synchronous malignant mesothelioma and lung cancer, and we propose guidelines for making a diagnosis of synchronous malignant mesothelioma and primary lung cancer.
Collapse
Affiliation(s)
- Kelly J Butnor
- Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710, United States.
| | - Noel A Brownlee
- Department of Pathology, Bon Secours Hospital, Greenville, SC 29414, United States.
| | - Annabelle Mahar
- Department of Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
| | - Elizabeth N Pavlisko
- Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710, United States.
| | - Thomas A Sporn
- Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710, United States.
| | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Box 3712, Durham, NC 27710, United States.
| |
Collapse
|
42
|
Abstract
We tested the postulate that iron homeostasis is altered among patients diagnosed to have asbestosis. Lung tissue from six individuals diagnosed to have had asbestosis at autopsy was stained for iron, ferritin, divalent metal transporter 1 (DMT1), and ferroportin 1 (FPN1). Slides from six individuals having pneumonectomy for lung cancer were employed as controls. Lung tissue from those patients with asbestosis demonstrated stainable iron, whereas control lung tissue did not. Staining for this metal was observed predominantly in airway and alveolar macrophages. Expression of the iron-related proteins ferritin, DMT1, and FPN1 was elevated in lung tissue from the six asbestosis patients relative to controls. This increased expression of iron-transport and iron-storage proteins was evident in both airway and alveolar epithelial cells. Asbestos bodies were abundant in lung tissue from patients diagnosed to have had asbestosis. While staining for iron, ferruginous bodies did not demonstrate uptake of antibodies for ferritin, DMT1, and FPN1. We conclude that iron homeostasis is altered in lung disease among those diagnosed to have asbestosis with an accumulation of the metal and a modified expression of iron-related proteins being evident.
Collapse
Affiliation(s)
- Andrew J Ghio
- National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina; and Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Elizabeth N Pavlisko
- National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina; and Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Victor L Roggli
- National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina; and Department of Pathology, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
43
|
Wallace WD, Li N, Andersen CB, Arrossi AV, Askar M, Berry GJ, DeNicola MM, Neil DA, Pavlisko EN, Reed EF, Remmelink M, Weigt SS, Weynand B, Zhang JQ, Budev MM, Farver CF. Banff study of pathologic changes in lung allograft biopsy specimens with donor-specific antibodies. J Heart Lung Transplant 2016; 35:40-48. [DOI: 10.1016/j.healun.2015.08.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 07/19/2015] [Accepted: 08/31/2015] [Indexed: 12/16/2022] Open
|
44
|
|
45
|
Verleden SE, Todd JL, Sato M, Palmer SM, Martinu T, Pavlisko EN, Vos R, Neyrinck A, Van Raemdonck D, Saito T, Oishi H, Keshavjee S, Greer M, Warnecke G, Gottlieb J, Haverich A. Impact of CLAD Phenotype on Survival After Lung Retransplantation: A Multicenter Study. Am J Transplant 2015; 15:2223-30. [PMID: 25940517 PMCID: PMC4943073 DOI: 10.1111/ajt.13281] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [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: 06/05/2014] [Revised: 02/04/2015] [Accepted: 02/14/2015] [Indexed: 01/25/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) remains a major problem after lung transplantation with no definitive treatment except redo lung transplantation (re-LTx) in selected candidates. However, CLAD is not a homogeneous entity and different phenotypes exist. Therefore, we aimed to evaluate the effect of CLAD phenotypes on survival after re-LTx for CLAD. Patients who underwent re-LTx for respiratory failure secondary to CLAD in four LTx centers between 2003 and 2013 were included in this retrospective analysis. Bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (rCLAD) were distinguished using pulmonary function, radiology and explant lung histopathology. Patient variables pre- and post-re-LTx were collected and analyzed. A total of 143 patients underwent re-LTx for CLAD resulting in 94 BOS (66%) and 49 rCLAD (34%) patients. Unadjusted and adjusted survival after re-LTx for rCLAD was worse compared to BOS (HR = 2.60, 1.59-4.24; p < 0.0001 and HR = 2.61, 1.51-4.51; p = 0.0006, respectively). Patients waiting at home prior to re-LTx experienced better survival compared to hospitalized patients (HR 0.40; 0.23-0.72; p = 0.0022). Patients with rCLAD redeveloped CLAD earlier and were more likely to redevelop rCLAD. Survival after re-LTx for rCLAD is worse compared to BOS. Consequently, re-LTx for rCLAD should be critically discussed, particularly when additional peri-operative risk factors are present.
Collapse
Affiliation(s)
- Stijn E Verleden
- Lung Transplant Unit, University Hospitals Leuven and Department of experimental medicine, KULeuven, Belgium
| | - Jamie L Todd
- Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Masaaki Sato
- Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Scott M Palmer
- Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Tereza Martinu
- Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA,Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Robin Vos
- Lung Transplant Unit, University Hospitals Leuven and Department of experimental medicine, KULeuven, Belgium
| | - Arne Neyrinck
- Lung Transplant Unit, University Hospitals Leuven and Department of experimental medicine, KULeuven, Belgium
| | - Dirk Van Raemdonck
- Lung Transplant Unit, University Hospitals Leuven and Department of experimental medicine, KULeuven, Belgium
| | - Tomohito Saito
- Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hisashi Oishi
- Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mark Greer
- Division of pneumology, Hannover Medical School, Hannover, Germany,Member of the German Center of Lung Research
| | - Gregor Warnecke
- Division of Cardiothoracic surgery, Hannover Medical School, Hannover, Germany,Member of the German Center of Lung Research
| | - Jens Gottlieb
- Division of pneumology, Hannover Medical School, Hannover, Germany,Member of the German Center of Lung Research
| | - Axel Haverich
- Division of Cardiothoracic surgery, Hannover Medical School, Hannover, Germany,Member of the German Center of Lung Research
| |
Collapse
|
46
|
Englum BR, Pavlisko EN, Mack MC, Ganapathi AM, Schechter MA, Hanna JM, Hughes GC. Pseudoaneurysm formation after medtronic freestyle porcine aortic bioprosthesis implantation: a word of caution. Ann Thorac Surg 2014; 98:2061-7. [PMID: 25301369 DOI: 10.1016/j.athoracsur.2014.06.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/19/2014] [Accepted: 06/24/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND A growing literature describes aneurysmal deterioration after implantation of the stentless porcine aortic Medtronic Freestyle bioprosthesis (MFB; Medtronic Inc, Minneapolis, MN), with some suggesting inadequate tissue fixation with immune response as a cause. However, disjointed reports make the significance of these findings difficult to interpret. We address this concern by aggregating available data. METHODS We reviewed institutional data, the Food and Drug Administration's Manufacturer and User Facility Device Experience registry, and the medical literature for mention of aneurysm or pseudoaneurysm after MFB. Case details were aggregated, and the rate of aneurysmal deterioration was estimated. Immunohistopathologic examination of institutional explanted specimens was performed to elucidate a cause. RESULTS We found 42 cases of aneurysmal deterioration with adequate detail for analysis; all occurred with full root replacement and valve sizes ranging from 23 to 29 mm. The rate of aneurysmal deterioration considering all data sources was 1.1% (9 of 851; 95% confidence interval, 0.5% to 2.0%) vs 4.7% (4 of 86; 95% confidence interval, 1.3% to 11.5%) at our institution, where yearly surveillance imaging is performed. Rate of aneurysmal deterioration appeared constant until 5 years after the operation; however, events are reported out to 10 years. Consistent with previous reports, histopathology demonstrated an immune cell infiltrate in areas of MFB wall breakdown. CONCLUSIONS Aneurysmal deterioration is an increasingly described complication of MFB implantation as a full root, with an incidence as high as 4.7%. Given the observed immune reaction and lack of occurrence in smaller (19-mm and 21-mm) valve sizes, inadequate pressure fixation of larger valves is a potential etiology. Patients with MFB require annual surveillance imaging, and consideration of this complication should factor into preoperative decision making because treatment mandates redo root replacement, which may not be feasible in high-risk patients.
Collapse
Affiliation(s)
- Brian R Englum
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Molly C Mack
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Asvin M Ganapathi
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matthew A Schechter
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jennifer M Hanna
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - G Chad Hughes
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.
| |
Collapse
|
47
|
Todd JL, Wang X, Sugimoto S, Kennedy VE, Zhang HL, Pavlisko EN, Kelly FL, Huang H, Kreisel D, Palmer SM, Gelman AE. Hyaluronan contributes to bronchiolitis obliterans syndrome and stimulates lung allograft rejection through activation of innate immunity. Am J Respir Crit Care Med 2014; 189:556-66. [PMID: 24471427 DOI: 10.1164/rccm.201308-1481oc] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Although innate immunity is increasingly recognized to contribute to lung allograft rejection, the significance of endogenous innate ligands, such as hyaluronan (HA) fragments, in clinical or experimental lung transplantation is uncertain. OBJECTIVES To determine if HA is associated with clinical bronchiolitis obliterans syndrome (BOS) in lung transplant recipients, and evaluate the effect of low- or high-molecular-weight HA on experimental lung allograft rejection, including dependence on innate signaling pathways or effector cells. METHODS HA concentrations were measured in bronchoalveolar lavage and plasma samples from lung recipients with or without established BOS. BOS and normal lung tissues were assessed for HA localization and expression of HA synthases. Murine orthotopic lung recipients with established tolerance were treated with low- or high-molecular-weight HA under varied experimental conditions, including Toll-like receptor (TLR) 2/4 and myeloid differentiation protein 88 deficiency and neutrophil depletion. MEASUREMENTS AND MAIN RESULTS HA localized within areas of intraluminal small airways fibrosis in BOS lung tissue. Moreover, transcripts for HA synthase enzymes were significantly elevated in BOS versus normal lung tissues and both lavage fluid and plasma HA concentrations were increased in recipients with BOS. Treatment with low-molecular-weight HA abrogated tolerance in murine orthotopic lung recipients in a TLR2/4- and myeloid differentiation protein 88-dependent fashion and drove expansion of alloantigen-specific T lymphocytes. Additionally, TLR-dependent signals stimulated neutrophilia that promoted rejection. In contrast, high-molecular-weight HA attenuated basal allograft inflammation. CONCLUSIONS These data suggest that accumulation of HA could contribute to BOS by directly activating innate immune signaling pathways that promote allograft rejection and neutrophilia.
Collapse
Affiliation(s)
- Jamie L Todd
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, and
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Todd JL, Jain R, Pavlisko EN, Finlen Copeland CA, Reynolds JM, Snyder LD, Palmer SM. Impact of forced vital capacity loss on survival after the onset of chronic lung allograft dysfunction. Am J Respir Crit Care Med 2014; 189:159-66. [PMID: 24325429 DOI: 10.1164/rccm.201306-1155oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Emerging evidence suggests a restrictive phenotype of chronic lung allograft dysfunction (CLAD) exists; however, the optimal approach to its diagnosis and clinical significance is uncertain. OBJECTIVES To evaluate the hypothesis that spirometric indices more suggestive of a restrictive ventilatory defect, such as loss of FVC, identify patients with distinct clinical, radiographic, and pathologic features, including worse survival. METHODS Retrospective, single-center analysis of 566 consecutive first bilateral lung recipients transplanted over a 12-year period. A total of 216 patients developed CLAD during follow-up. CLAD was categorized at its onset into discrete physiologic groups based on spirometric criteria. Imaging and histologic studies were reviewed when available. Survival after CLAD diagnosis was assessed using Kaplan-Meier and Cox proportional hazards models. MEASUREMENTS AND MAIN RESULTS Among patients with CLAD, 30% demonstrated an FVC decrement at its onset. These patients were more likely to be female, have radiographic alveolar or interstitial changes, and histologic findings of interstitial fibrosis. Patients with FVC decline at CLAD onset had significantly worse survival after CLAD when compared with those with preserved FVC (P < 0.0001; 3-yr survival estimates 9% vs. 48%, respectively). The deleterious impact of CLAD accompanied by FVC loss on post-CLAD survival persisted in a multivariable model including baseline demographic and clinical factors (P < 0.0001; adjusted hazard ratio, 2.73; 95% confidence interval, 1.86-4.04). CONCLUSIONS At CLAD onset, a subset of patients demonstrating physiology more suggestive of restriction experience worse clinical outcomes. Further study of the biologic mechanisms underlying CLAD phenotypes is critical to improving long-term survival after lung transplantation.
Collapse
Affiliation(s)
- Jamie L Todd
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Survival post-lung transplantation remains limited to ∼ 50% at 5 years, far below survival after other solid organ transplants. Allograft rejection is a major cause of this limited survival. At least a third of lung transplant recipients experience acute rejection within 1 year posttransplantation. Acute rejection, though rarely a direct cause of death, represents the principal risk factor for chronic rejection, which is the greatest obstacle to long-term post-lung transplant survival. This article reviews in detail the two major subtypes of acute rejection: acute cellular rejection (ACR) and antibody-mediated rejection (AMR). ACR is diagnosed primarily by bronchoscopic transbronchial biopsies and is defined as perivascular or peribronchiolar lymphocytic infiltrates in the absence of infection. AMR remains poorly defined but is thought to involve anti-donor antibodies, allograft dysfunction, and pathological evidence of lung tissue injury or deposition of complement. Pathophysiological mechanisms, clinical presentation, clinical significance, known risk factors, and treatment strategies are discussed. Additionally, the limitations of current diagnostic modalities for both ACR and AMR are explained. Emerging data on the importance of donor-specific and non-donor-specific anti-human leukocyte antigen (anti-HLA) antibodies as well as non-HLA antibodies are presented. Larger cohorts have improved statistical analyses in recent years, leading to a clearer understanding of important topics related to ACR and AMR. Further collaborative studies and multicenter trials will be key in further advancing lung transplantation knowledge and improving outcomes in years to come.
Collapse
Affiliation(s)
- William McManigle
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
| | | | | |
Collapse
|
50
|
Pavlisko EN, Roggli VL, Sporn TA, Oury TD. Relationship between pulmonary emphysema and renal function in smokers. Chest 2013; 143:1516-1517. [PMID: 23648928 DOI: 10.1378/chest.13-0125] [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: 11/01/2022] Open
Affiliation(s)
| | - Victor L Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Thomas A Sporn
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Tim D Oury
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|