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Kitsios GD, Blacka S, Jacobs JJ, Mirza T, Naqvi A, Gentry H, Murray C, Wang X, Golubykh K, Qurashi H, Dodia A, Risbano M, Benigno M, Emir B, Weinstein E, Bramson C, Jiang L, Dai F, Szigethy E, Mellors JW, Methe B, Sciurba FC, Nouraie SM, Morris A. Subphenotypes of self-reported symptoms and outcomes in long COVID: a prospective cohort study with latent class analysis. BMJ Open 2024; 14:e077869. [PMID: 38485476 PMCID: PMC10941166 DOI: 10.1136/bmjopen-2023-077869] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To characterise subphenotypes of self-reported symptoms and outcomes (SRSOs) in postacute sequelae of COVID-19 (PASC). DESIGN Prospective, observational cohort study of subjects with PASC. SETTING Academic tertiary centre from five clinical referral sources. PARTICIPANTS Adults with COVID-19 ≥20 days before enrolment and presence of any new self-reported symptoms following COVID-19. EXPOSURES We collected data on clinical variables and SRSOs via structured telephone interviews and performed standardised assessments with validated clinical numerical scales to capture psychological symptoms, neurocognitive functioning and cardiopulmonary function. We collected saliva and stool samples for quantification of SARS-CoV-2 RNA via quantitative PCR. OUTCOMES MEASURES Description of PASC SRSOs burden and duration, derivation of distinct PASC subphenotypes via latent class analysis (LCA) and relationship with viral load. RESULTS We analysed baseline data for 214 individuals with a study visit at a median of 197.5 days after COVID-19 diagnosis. Participants reported ever having a median of 9/16 symptoms (IQR 6-11) after acute COVID-19, with muscle-aches, dyspnoea and headache being the most common. Fatigue, cognitive impairment and dyspnoea were experienced for a longer time. Participants had a lower burden of active symptoms (median 3 (1-6)) than those ever experienced (p<0.001). Unsupervised LCA of symptoms revealed three clinically active PASC subphenotypes: a high burden constitutional symptoms (21.9%), a persistent loss/change of smell and taste (20.6%) and a minimal residual symptoms subphenotype (57.5%). Subphenotype assignments were strongly associated with self-assessments of global health, recovery and PASC impact on employment (p<0.001) as well as referral source for enrolment. Viral persistence (5.6% saliva and 1% stool samples positive) did not explain SRSOs or subphenotypes. CONCLUSIONS We identified three distinct PASC subphenotypes. We highlight that although most symptoms progressively resolve, specific PASC subpopulations are impacted by either high burden of constitutional symptoms or persistent olfactory/gustatory dysfunction, requiring prospective identification and targeted preventive or therapeutic interventions.
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Affiliation(s)
- Georgios D Kitsios
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawna Blacka
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jana J Jacobs
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Taaha Mirza
- Internal Medicine Residency Program, UPMC in Central Pa, Harrisburg, Pennsylvania, USA
| | - Asma Naqvi
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Heather Gentry
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cathy Murray
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xiaohong Wang
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Konstantin Golubykh
- Internal Medicine Residency Program, UPMC in Central Pa, Harrisburg, Pennsylvania, USA
| | - Hafiz Qurashi
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Akash Dodia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Risbano
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | - Feng Dai
- Pfizer Inc, New York, New York, USA
| | - Eva Szigethy
- Department of Psychiatry and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John W Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Barbara Methe
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Emphysema Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seyed Mehdi Nouraie
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alison Morris
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Bhatt SP, Nakhmani A, Fortis S, Strand MJ, Silverman EK, Wilson CG, Sciurba FC, Bodduluri S. STAR Has Better Discrimination for Mortality than ERS/ATS COPD Severity Classification. Am J Respir Crit Care Med 2024. [PMID: 38306311 DOI: 10.1164/rccm.202311-2172le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/02/2024] [Indexed: 02/04/2024] Open
Affiliation(s)
- Surya P Bhatt
- University of Alabama at Birmingham, Pulmonary, Allergy and Critical Care Medicine, Birmingham, Alabama, United States;
| | - Arie Nakhmani
- University of Alabama at Birmingham, Electrical and Computer Engineering, Birmingham, Alabama, United States
| | - Spyridon Fortis
- University of Iowa Hospitals and Clinics, 21782, Division of Pulmonary, Critical Care and Occupation Medicine, Iowa City, Iowa, United States
| | - Matthew J Strand
- National Jewish Health, Biostatistics, Denver, Colorado, United States
| | - Edwin K Silverman
- Brigham and Women's Hospital Channing Division of Network Medicine, 1869, Boston, Massachusetts, United States
| | | | - Frank C Sciurba
- University of Pittsburgh, Division of Pulmonary, Allergy & Critical Care Medicine, Pittsburgh, Pennsylvania, United States
| | - Sandeep Bodduluri
- University of Alabama at Birmingham, Pulmonary, Allergy and Critical Care Medicine, Birmingham, Alabama, United States
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Bhatt SP, Nakhmani A, Fortis S, Strand MJ, Silverman EK, Sciurba FC, Bodduluri S. Reply to Neder, to Ogata et al., and to Graham. Am J Respir Crit Care Med 2024; 209:343-345. [PMID: 38033318 PMCID: PMC10840780 DOI: 10.1164/rccm.202311-2016le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/30/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Surya P. Bhatt
- UAB Lung Imaging Lab
- Division of Pulmonary, Allergy, and Critical Care Medicine, and
| | - Arie Nakhmani
- UAB Lung Imaging Lab
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Spyridon Fortis
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Hospital, Iowa City, Iowa
| | - Matthew J. Strand
- Division of Biostatistics and Bioinformatics, Office of Academic Affairs, National Jewish Health, Denver, Colorado
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Frank C. Sciurba
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sandeep Bodduluri
- UAB Lung Imaging Lab
- Division of Pulmonary, Allergy, and Critical Care Medicine, and
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Ware SA, Kliment CR, Giordano L, Redding KM, Rumsey WL, Bates S, Zhang Y, Sciurba FC, Nouraie SM, Kaufman BA. Cell-free DNA levels associate with COPD exacerbations and mortality. Respir Res 2024; 25:42. [PMID: 38238743 PMCID: PMC10797855 DOI: 10.1186/s12931-023-02658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024] Open
Abstract
THE QUESTION ADDRESSED BY THE STUDY Good biological indicators capable of predicting chronic obstructive pulmonary disease (COPD) phenotypes and clinical trajectories are lacking. Because nuclear and mitochondrial genomes are damaged and released by cigarette smoke exposure, plasma cell-free mitochondrial and nuclear DNA (cf-mtDNA and cf-nDNA) levels could potentially integrate disease physiology and clinical phenotypes in COPD. This study aimed to determine whether plasma cf-mtDNA and cf-nDNA levels are associated with COPD disease severity, exacerbations, and mortality risk. MATERIALS AND METHODS We quantified mtDNA and nDNA copy numbers in plasma from participants enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE, n = 2,702) study and determined associations with relevant clinical parameters. RESULTS Of the 2,128 participants with COPD, 65% were male and the median age was 64 (interquartile range, 59-69) years. During the baseline visit, cf-mtDNA levels positively correlated with future exacerbation rates in subjects with mild/moderate and severe disease (Global Initiative for Obstructive Lung Disease [GOLD] I/II and III, respectively) or with high eosinophil count (≥ 300). cf-nDNA positively associated with an increased mortality risk (hazard ratio, 1.33 [95% confidence interval, 1.01-1.74] per each natural log of cf-nDNA copy number). Additional analysis revealed that individuals with low cf-mtDNA and high cf-nDNA abundance further increased the mortality risk (hazard ratio, 1.62 [95% confidence interval, 1.16-2.25] per each natural log of cf-nDNA copy number). ANSWER TO THE QUESTION Plasma cf-mtDNA and cf-nDNA, when integrated into quantitative clinical measurements, may aid in improving COPD severity and progression assessment.
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Affiliation(s)
- Sarah A Ware
- Department of Medicine, Division of Cardiology, Center for Metabolism and Mitochondrial Medicine, University of Pittsburgh School of Medicine, 200 Lothrop Street BST W1044, Pittsburgh, PA, 15261, USA
| | - Corrine R Kliment
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Luca Giordano
- Department of Medicine, Division of Cardiology, Center for Metabolism and Mitochondrial Medicine, University of Pittsburgh School of Medicine, 200 Lothrop Street BST W1044, Pittsburgh, PA, 15261, USA
| | - Kevin M Redding
- Department of Medicine, Division of Cardiology, Center for Metabolism and Mitochondrial Medicine, University of Pittsburgh School of Medicine, 200 Lothrop Street BST W1044, Pittsburgh, PA, 15261, USA
| | - William L Rumsey
- GlaxoSmithKline Respiratory Therapeutic Area Unit, Collegeville, PA, USA
| | - Stewart Bates
- GlaxoSmithKline Respiratory Therapeutic Area Unit, Stevenage, UK
| | - Yingze Zhang
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank C Sciurba
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - S Mehdi Nouraie
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Montefiore Hospital, NW628 3459 Fifth Avenue, Pittsburgh, PA, 15213, USA.
| | - Brett A Kaufman
- Department of Medicine, Division of Cardiology, Center for Metabolism and Mitochondrial Medicine, University of Pittsburgh School of Medicine, 200 Lothrop Street BST W1044, Pittsburgh, PA, 15261, USA.
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Brock JM, Kontogianni K, Sciurba FC, Criner GJ, Herth F. Utility of rehabilitation prior to bronchoscopic lung volume reduction: post hoc analysis of the VENT trial. ERJ Open Res 2024; 10:00735-2023. [PMID: 38259808 PMCID: PMC10801745 DOI: 10.1183/23120541.00735-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 01/24/2024] Open
Abstract
Background and objective Rehabilitation programmes are a valuable treatment modality for patients with COPD to increase exercise capacity and quality of life. The utility of pulmonary rehabilitation prior to bronchoscopic lung volume reduction (BLVR) is unclear. Methods We performed a post hoc analysis of the Valve for Emphysema Palliation Trial (VENT) trial, the first multicentre randomised trial comparing the safety and efficacy of BLVR. Patients completed a pulmonary rehabilitation programme prior to BLVR over 6-10 weeks and maintained by daily practice, consisting of endurance training, strength training and upper/lower limb exercise. Lung function and exercise parameters (6-min walk distance (6MWD)) were assessed before and after rehabilitation and we tried to identify predictors for pulmonary rehabilitation benefit. Results Lung function and exercise capacity of 403 patients (mean±sd age 63.3±7.4 years, 37.5% female, mean±sd forced expiratory volume in 1 s 30.1±7.6 L) were analysed. Exercise capacity significantly improved from 331.6±98.8 m to 345.6±95.3 m (p<0.001) in 6-min walk testing (6MWT), with 40.3% showing clinically meaningful improvements. Patients also experienced less dyspnoea after 6MWT, while pulmonary function parameters did not change significantly overall. Patients with lower exercise capacity at screening (6MWD <250 m) benefited more from pulmonary rehabilitation. The indication and prerequisites for BLVR were still present in all patients after pulmonary rehabilitation. Conclusion The national mandatory requirements for rehabilitation prior to BLVR, which apply to all COPD patients, should be reconsidered and specified for COPD patients who really benefit.
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Affiliation(s)
- Judith Maria Brock
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Konstantina Kontogianni
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Frank C Sciurba
- Pulmonary Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Felix Herth
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
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Sciurba FC, Dransfield MT, Kim V, Marchetti N, Comellas A, Hogarth DK, Majid A. Bronchial rheoplasty for chronic bronchitis: 2-year results from a US feasibility study with RheOx. BMJ Open Respir Res 2023; 10:e001710. [PMID: 38151258 PMCID: PMC10753755 DOI: 10.1136/bmjresp-2023-001710] [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: 03/16/2023] [Accepted: 11/30/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Chronic bronchitis (CB), a phenotype of chronic obstructive pulmonary disease (COPD) characterised by persistent cough and mucus hypersecretion, is associated with poor outcomes despite guideline-based treatment. Bronchial rheoplasty (BR) with the RheOx system delivers non-thermal pulsed electric fields to the lower airway epithelium and submucosa to reduce mucus producing cells. Early phase clinical trials including 1-year follow-up have demonstrated reduction in airway goblet cell hyperplasia and improvement in CB symptoms. METHODS The current multicentre observational BR study enrolled 21 patients with CB at six centres in the USA, with bilateral treatment and 2-year follow-up. Entry criteria included elevated cough and sputum scores from COPD Assessment Test (CAT) and forced expiratory volume in one second<80% predicted. Safety was assessed by serious adverse event (SAE) incidence through 24 months. Clinical utility was evaluated using changes in the CAT, the St. George's Respiratory Questionnaire (SGRQ) and by comparing exacerbation rates before and following intervention. RESULTS No procedure-related or device-related SAEs occurred. Mean (SD) changes from baseline in CAT at 12 and 24 months were -9.0 (6.7) (p<0.0001) and -5.6 (7.1) (p<0.0047) and in SGRQ were -16.6 (13.2) (p<0.0001) and -11.8 (19.2) (p<0.0227), respectively. There was a 34% reduction in moderate and a 64% reduction in severe COPD exacerbation events compared with the year prior to treatment. CONCLUSIONS This study extends the findings from previous feasibility studies, demonstrating that BR can be performed safely and may significantly improve symptoms and health-related quality of life for patients with CB through 24 months. TRAIL REGISTRATION NUMBER NCT03631472.
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Affiliation(s)
- Frank C Sciurba
- Emphysema Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark T Dransfield
- Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, Lung Health Center, University of Alabama, Birmingham, Alabama, USA
| | - Victor Kim
- Division of Pulmonary and Critical Care Medicine, Thoracic Medicine and Surgery, School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Nathaniel Marchetti
- Pulmonary and Critical Care Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Douglas Kyle Hogarth
- Pulmonary/Critical Care, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Metz TD, Clifton RG, Gallagher R, Gross RS, Horwitz LI, Jacoby VL, Martin-Herz SP, Peralta-Carcelen M, Reeder HT, Beamon CJ, Chan J, Chang AA, Costantine MM, Fitzgerald ML, Foulkes AS, Gibson KS, Güthe N, Habli M, Hackney DN, Hoffman MK, Hoffman MC, Hughes BL, Katz SD, Laleau V, Mallett G, Mendez-Figueroa H, Monzon V, Palatnik A, Palomares KTS, Parry S, Pettker CM, Plunkett BA, Poppas A, Reddy UM, Rouse DJ, Saade GR, Sandoval GJ, Schlater SM, Sciurba FC, Simhan HN, Skupski DW, Sowles A, Thaweethai T, Thomas GL, Thorp JM, Tita AT, Weiner SJ, Weigand S, Yee LM, Flaherman VJ. Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design. PLoS One 2023; 18:e0285351. [PMID: 38128008 PMCID: PMC10734909 DOI: 10.1371/journal.pone.0285351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/10/2023] [Indexed: 12/23/2023] Open
Abstract
IMPORTANCE Pregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER-Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads. METHODS RECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators. DISCUSSION RECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero. CLINICAL TRIALS.GOV IDENTIFIER Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011.
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Affiliation(s)
- Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health Hospitals and Clinics, Salt Lake City, UT, United States of America
| | - Rebecca G. Clifton
- Biostatistics Center, The George Washington University, Washington, DC, United States of America
| | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Rachel S. Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Leora I. Horwitz
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Susanne P. Martin-Herz
- Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Myriam Peralta-Carcelen
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Carmen J. Beamon
- Department of Maternal Fetal Medicine, WakeMed Health and Hospitals, Raleigh, NC, United States of America
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
| | - A. Ann Chang
- Women’s Health Research Clinical Center, University of California, San Francisco, San Francisco, CA, United States of America
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Megan L. Fitzgerald
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Kelly S. Gibson
- Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH, United States of America
| | - Nick Güthe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Mounira Habli
- Division Maternal Fetal Medicine, Trihealth Good Samaritan Hospital Maternal Fetal Medicine, Cincinnati, OH, United States of America
| | - David N. Hackney
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center: UH Cleveland Medical Center, Cleveland, OH, United States of America
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, United States of America
| | - M. Camille Hoffman
- Department of Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Brenna L. Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States of America
| | - Stuart D. Katz
- Department of Medicine, New York University School of Medicine, New York City, NY, United States of America
| | - Victoria Laleau
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Gail Mallett
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas McGovern Medical School: The University of Texas Health Science Center at Houston John P. and Katherine G. McGovern Medical School, Houston, TX, United States of America
| | - Vanessa Monzon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Kristy T. S. Palomares
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Peter’s University Hospital, New Brunswick, NJ, United States of America
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Christian M. Pettker
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States of America
| | - Beth A. Plunkett
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States of America
| | - Athena Poppas
- Division of Cardiology, Brown University Warren Alpert Medical School, Providence, RI, United States of America
| | - Uma M. Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York City, NY, United States of America
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, RI, United States of America
| | - George R. Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America
| | - Grecio J. Sandoval
- Biostatistics Center, The George Washington University, Rockville, MD, United States of America
| | - Shannon M. Schlater
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States of America
| | - Frank C. Sciurba
- Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Daniel W. Skupski
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America
| | - Amber Sowles
- Department of Obstetrics and Gynecology, University of Utah Health Hospitals and Clinics, Salt Lake City, UT, United States of America
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Gelise L. Thomas
- Clinical and Translational Science Collaborative of Cleveland, Case Western Reserve University, Cleveland, OH, United States of America
| | - John M. Thorp
- Department of Obstetrics and Gynecology, UNC: The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Alan T. Tita
- Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Steven J. Weiner
- Biostatistics Center, The George Washington University, Washington, DC, United States of America
| | - Samantha Weigand
- Department of Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States of America
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Au DH, Gleason E, Hunter-Merrill R, Barón AE, Collins M, Ronneberg C, Lv N, Rise P, Wai TH, Plumley R, Wisniewski SR, Sciurba FC, Kim DY, Simonelli P, Krishnan JA, Wendt CH, Feemster LC, Criner GJ, Maddipati V, Mohan A, Ma J. Lifestyle Intervention and Excess Weight in Chronic Obstructive Pulmonary Disease (COPD): INSIGHT COPD Randomized Clinical Trial. Ann Am Thorac Soc 2023; 20:1743-1751. [PMID: 37769182 PMCID: PMC10704228 DOI: 10.1513/annalsats.202305-458oc] [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: 05/19/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023] Open
Abstract
Rationale: Being overweight or obese is common among patients with chronic obstructive pulmonary disease (COPD), but whether interventions targeted at weight loss improve functional impairments is unknown. Objectives: INSIGHT (Intervention Study in Overweight Patients with COPD) tested whether a pragmatic low-intensity lifestyle intervention would lead to better physical functional status among overweight or obese participants with COPD. Methods: The trial was a 12-month, multicenter, patient-level pragmatic clinical trial. Participants were recruited from April 2017 to August 2019 from 38 sites across the United States and randomized to receive usual care or usual care plus lifestyle intervention. The intervention was a self-directed video program delivering the Diabetes Prevention Program's Group Lifestyle Balance curriculum. Results: The primary outcome was 6-minute-walk test distance at 12 months. Priority secondary outcomes were postwalk modified Borg dyspnea at 12 months and weight at 12 months. Participants (N = 684; mean age, 67.0 ± 8.0 yr [standard deviation]; 41.2% female) on average were obese (body mass index, 33.0 ± 4.6 kg/m2) with moderate COPD (forced expiratory volume in 1 second % predicted, 58.1 ± 15.7%). At 12 months, participants randomized to the intervention arm walked farther (adjusted difference, 42.3 ft [95% confidence interval (CI), 7.9-76.7 ft]; P = 0.02), had less dyspnea at the end of the 6-minute-walk test (adjusted difference, -0.36 [95% CI, -0.63 to -0.09]; P = 0.008), and had greater weight loss (adjusted difference, -1.34 kg [95% CI, -2.33 to -0.34 kg]; P = 0.008) than control participants. The intervention did not improve the odds of achieving clinically meaningful thresholds of walk distance (98.4 ft) or dyspnea (1 unit) but did achieve meaningful thresholds of weight loss (3% and 5%). Conclusions: Among participants with COPD who were overweight or obese, a self-guided low-intensity video-based lifestyle intervention led to modest weight loss but did not lead to clinically important improvements in physical functional status and dyspnea. Clinical trial registered with www.clinicaltrials.gov (NCT02634268).
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Affiliation(s)
- David H. Au
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Emily Gleason
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Rachel Hunter-Merrill
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Anna E. Barón
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Margaret Collins
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | | | - Nan Lv
- Department of Medicine and
| | - Peter Rise
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Travis Hee Wai
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Robert Plumley
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | | | - Frank C. Sciurba
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul Simonelli
- Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Christine H. Wendt
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Laura C. Feemster
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Veeranna Maddipati
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, East Carolina University, Greenville, North Carolina
| | - Arjun Mohan
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, East Carolina University, Greenville, North Carolina
| | - Jun Ma
- Division of Academic Internal Medicine and Geriatrics, University of Illinois Chicago, Chicago, Illinois
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9
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Silverman EK, Kim AY, Make BJ, Regan EA, Morrow JD, Hersh CP, O'Brien J, Crapo JD, Hansel NN, Criner G, Flenaugh EL, Conrad D, Casaburi R, Bowler RP, Hanania NA, Barr RG, Bhatt SP, Sciurba FC, Anzueto A, Han MK, McEvoy CE, Comellas AP, DeMeo DL, Rosiello R, Curtis JL, Uchida T, Wilson C, O'Rourke PP. Returning incidentally discovered Hepatitis C RNA-seq results to COPDGene study participants. NPJ Genom Med 2023; 8:36. [PMID: 37903807 PMCID: PMC10616181 DOI: 10.1038/s41525-023-00379-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/10/2023] [Indexed: 11/01/2023] Open
Abstract
The consequences of returning infectious pathogen test results identified incidentally in research studies have not been well-studied. Concerns include identification of an important health issue for individuals, accuracy of research test results, public health impact, potential emotional distress for participants, and need for IRB permissions. Blood RNA-sequencing analysis for non-human RNA in 3984 participants from the COPDGene study identified 228 participants with evidence suggestive for hepatitis C virus (HCV) infection. We hypothesized that incidentally discovered HCV results could be effectively returned to COPDGene participants with attention to the identified concerns. In conjunction with a COPDGene Participant Advisory Panel, we developed and obtained IRB approval for a process of returning HCV research results and an HCV Follow-Up Study questionnaire to capture information about previous HCV diagnosis and treatment information and participant reactions to return of HCV results. During phone calls following the initial HCV notification letter, 84 of 124 participants who could be contacted (67.7%) volunteered that they had been previously diagnosed with HCV infection. Thirty-one of these 124 COPDGene participants were enrolled in the HCV Follow-Up Study. Five of the 31 HCV Follow-Up Study participants did not report a previous diagnosis of HCV. For four of these participants, subsequent clinical HCV testing confirmed HCV infection. Thus, 30/31 Follow-Up Study participants had confirmed HCV diagnoses, supporting the accuracy of the HCV research test results. However, the limited number of participants in the Follow-Up Study precludes an accurate assessment of the false-positive and false-negative rates of the research RNA sequencing evidence for HCV. Most HCV Follow-Up Study participants (29/31) were supportive of returning HCV research results, and most participants found the process for returning HCV results to be informative and not upsetting. Newly diagnosed participants were more likely to be pleased to learn about a potentially curable infection (p = 0.027) and showed a trend toward being more frightened by the potential health risks of HCV (p = 0.11). We conclude that HCV results identified incidentally during transcriptomic research studies can be successfully returned to research study participants with a carefully designed process.
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Affiliation(s)
- Edwin K Silverman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Arthur Y Kim
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | | | - Jarrett D Morrow
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Craig P Hersh
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James O'Brien
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gerard Criner
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Eric L Flenaugh
- Pulmonary and Critical Care and Interventional Pulmonary Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Douglas Conrad
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - R Graham Barr
- Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Antonio Anzueto
- Pulmonary and Critical Care, University of Texas Health, and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Alejandro P Comellas
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Rosiello
- Department of Pulmonary and Critical Care, Reliant Medical Group, Worcester, MA, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Tricia Uchida
- Research Informatics Services, National Jewish Health, Denver, CO, USA
| | - Carla Wilson
- Research Informatics Services, National Jewish Health, Denver, CO, USA
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10
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Chen J, Xu Z, Sun L, Yu K, Hersh CP, Boueiz A, Hokanson JE, Sciurba FC, Silverman EK, Castaldi PJ, Batmanghelich K. Deep Learning Integration of Chest Computed Tomography Imaging and Gene Expression Identifies Novel Aspects of COPD. Chronic Obstr Pulm Dis 2023; 10:355-368. [PMID: 37413999 DOI: 10.15326/jcopdf.2023.0399] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Rationale Chronic obstructive pulmonary disease (COPD) is characterized by pathologic changes in the airways, lung parenchyma, and persistent inflammation, but the links between lung structural changes and blood transcriptome patterns have not been fully described. Objections The objective of this study was to identify novel relationships between lung structural changes measured by chest computed tomography (CT) and blood transcriptome patterns measured by blood RNA sequencing (RNA-seq). Methods CT scan images and blood RNA-seq gene expression from 1223 participants in the COPD Genetic Epidemiology (COPDGene®) study were jointly analyzed using deep learning to identify shared aspects of inflammation and lung structural changes that we labeled image-expression axes (IEAs). We related IEAs to COPD-related measurements and prospective health outcomes through regression and Cox proportional hazards models and tested them for biological pathway enrichment. Results We identified 2 distinct IEAs: IEAemph which captures an emphysema-predominant process with a strong positive correlation to CT emphysema and a negative correlation to forced expiratory volume in 1 second and body mass index (BMI); and IEAairway which captures an airway-predominant process with a positive correlation to BMI and airway wall thickness and a negative correlation to emphysema. Pathway enrichment analysis identified 29 and 13 pathways significantly associated with IEAemph and IEAairway, respectively (adjusted p<0.001). Conclusions Integration of CT scans and blood RNA-seq data identified 2 IEAs that capture distinct inflammatory processes associated with emphysema and airway-predominant COPD.
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Affiliation(s)
- Junxiang Chen
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Zhonghui Xu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Li Sun
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Ke Yu
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Craig P Hersh
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Adel Boueiz
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Edwin K Silverman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Peter J Castaldi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Kayhan Batmanghelich
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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11
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Zou RH, Nouraie SM, Karoleski C, Zhang Y, Sciurba FC, Forman DE, Bon J. Incident low muscle mass is associated with greater lung disease and lower circulating leptin in a tobacco-exposed longitudinal cohort. Respir Res 2023; 24:224. [PMID: 37737171 PMCID: PMC10515430 DOI: 10.1186/s12931-023-02521-3] [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: 05/16/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Muscle loss is prevalent in chronic obstructive pulmonary disease (COPD). Prior studies evaluating musculoskeletal dysfunction in COPD have focused on individuals with baseline low muscle mass. Currently, there is limited data evaluating clinical characteristics and outcomes associated with progression to incident low muscle mass in a tobacco-exposed cohort of individuals with baseline normal muscle mass. METHODS We evaluated 246 participants from a single-center longitudinal tobacco-exposed cohort with serial spirometry, thoracic imaging, dual energy x-ray absorptiometry (DXA) measurements, walk testing, and plasma adipokine measurements. DXA-derived fat free mass index (FFMI) and appendicular skeletal mass index (ASMI) were used as surrogates for muscle mass. Participants with incident low muscle mass (LM) at follow-up were characterized by FFMI < 18.4 kg/m2 in males and < 15.4 kg/m2 in females and/or ASMI < 7.25 kg/m2 in males and < 5.67 kg/m2 in females. RESULTS Twenty-five (10%) participants progressed to incident low muscle mass at follow-up. At baseline, the LM subgroup had greater active smoking prevalence (60% v. 38%, p = 0.04), lower FFMI (17.8 ± 1.7 kg/m2 v. 19.7 ± 2.9 kg/m2, p = 0.002), lower ASMI (7.3 ± 0.9 kg/m2 v. 8.2 ± 1.2 kg/m2, p = 0.0003), and lower plasma leptin (14.9 ± 10.1 ng/mL v. 24.0 ± 20.9 ng/mL, p = 0.04). At follow-up, the LM subgroup had higher COPD prevalence (68% v. 43%, p = 0.02), lower FEV1/FVC (0.63 ± 0.12 v. 0.69 ± 0.12, p = 0.02), lower %DLco (66.5 ± 15.9% v. 73.9 ± 16.8%, p = 0.03), and higher annual rate of FFMI decline (-0.17 kg/m2/year v. -0.04 kg/m2/year, p = 0.006). There were no differences in age, gender distribution, pack years smoking history, or walk distance. CONCLUSIONS We identified a subgroup of tobacco-exposed individuals with normal baseline muscle mass who progressed to incident DXA-derived low muscle mass. This subgroup demonstrated synchronous lung disease and persistently low circulating leptin levels. Our study suggests the importance of assessing for muscle loss in conjunction with lung function decline when evaluating individuals with tobacco exposure.
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Affiliation(s)
- Richard H Zou
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Emphysema COPD Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Mehdi Nouraie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Emphysema COPD Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chad Karoleski
- Emphysema COPD Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yingze Zhang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Emphysema COPD Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Emphysema COPD Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel E Forman
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Geriatrics, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jessica Bon
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Emphysema COPD Research Center, University of Pittsburgh, Pittsburgh, PA, USA.
- Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- UPMC Montefiore Hospital, NW628 3459 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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12
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Bhatt SP, Nakhmani A, Fortis S, Strand MJ, Silverman EK, Sciurba FC, Bodduluri S. FEV 1/FVC Severity Stages for Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:676-684. [PMID: 37339502 PMCID: PMC10515563 DOI: 10.1164/rccm.202303-0450oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/20/2023] [Indexed: 06/22/2023] Open
Abstract
Rationale: The diagnosis of chronic obstructive pulmonary disease (COPD) is based on a low FEV1/FVC ratio, but the severity of COPD is classified using FEV1% predicted (ppFEV1). Objectives: To test a new severity classification scheme for COPD using FEV1/FVC ratio, a more robust measure of airflow obstruction than ppFEV1. Methods: In COPDGene (Genetic Epidemiology of COPD) (N = 10,132), the severity of airflow obstruction was categorized by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-4 (ppFEV1 of ⩾80%, ⩾50-80%, ⩾30-50%, and <30%). A new severity classification (STaging of Airflow obstruction by Ratio; STAR) was tested in COPDGene-FEV1/FVC ⩾0.60 to <0.70, ⩾0.50 to <0.60, ⩾0.40 to <0.50, and <0.40, respectively, for stages 1-4-and applied to the combined Pittsburgh SCCOR and Emphysema COPD Research Registry for replication (N = 2,017). Measurements and Main Results: The agreements (weighted Bangdiwala B values) between GOLD and the new FEV1/FVC ratio severity stages were 0.89 in COPDGene and 0.88 in the Pittsburgh cohort. In COPDGene and the Pittsburgh cohort, compared with GOLD staging, STAR provided significant discrimination between the absence of airflow obstruction and stage 1 for all-cause mortality, respiratory quality of life, dyspnea, airway wall thickness, exacerbations, and lung function decline. No major differences were noted for emphysema, small airway disease, and 6-minute-walk distance. The STAR classification system identified a greater number of adults with stage 3/4 disease who would be eligible for lung transplantation and lung volume reduction procedure evaluations. Conclusions: The new STAR severity classification scheme provides discrimination for mortality that is similar to the GOLD classification but with a more uniform gradation of disease severity. STAR differentiates patients' symptoms, disease burden, and prognosis better than the existing scheme based on ppFEV1, and is less sensitive to race/ethnicity and other demographic characteristics.
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Affiliation(s)
- Surya P. Bhatt
- UAB Lung Imaging Lab
- Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Arie Nakhmani
- UAB Lung Imaging Lab
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Spyridon Fortis
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital, Iowa City, Iowa
| | - Matthew J. Strand
- Division of Biostatistics and Bioinformatics, Office of Academic Affairs, National Jewish Health, Denver, Colorado
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Frank C. Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sandeep Bodduluri
- UAB Lung Imaging Lab
- Division of Pulmonary, Allergy and Critical Care Medicine, and
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13
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Horwitz LI, Thaweethai T, Brosnahan SB, Cicek MS, Fitzgerald ML, Goldman JD, Hess R, Hodder SL, Jacoby VL, Jordan MR, Krishnan JA, Laiyemo AO, Metz TD, Nichols L, Patzer RE, Sekar A, Singer NG, Stiles LE, Taylor BS, Ahmed S, Algren HA, Anglin K, Aponte-Soto L, Ashktorab H, Bassett IV, Bedi B, Bhadelia N, Bime C, Bind MAC, Black LJ, Blomkalns AL, Brim H, Castro M, Chan J, Charney AW, Chen BK, Chen LQ, Chen P, Chestek D, Chibnik LB, Chow DC, Chu HY, Clifton RG, Collins S, Costantine MM, Cribbs SK, Deeks SG, Dickinson JD, Donohue SE, Durstenfeld MS, Emery IF, Erlandson KM, Facelli JC, Farah-Abraham R, Finn AV, Fischer MS, Flaherman VJ, Fleurimont J, Fonseca V, Gallagher EJ, Gander JC, Gennaro ML, Gibson KS, Go M, Goodman SN, Granger JP, Greenway FL, Hafner JW, Han JE, Harkins MS, Hauser KSP, Heath JR, Hernandez CR, Ho O, Hoffman MK, Hoover SE, Horowitz CR, Hsu H, Hsue PY, Hughes BL, Jagannathan P, James JA, John J, Jolley S, Judd SE, Juskowich JJ, Kanjilal DG, Karlson EW, Katz SD, Kelly JD, Kelly SW, Kim AY, Kirwan JP, Knox KS, Kumar A, Lamendola-Essel MF, Lanca M, Lee-lannotti JK, Lefebvre RC, Levy BD, Lin JY, Logarbo BP, Logue JK, Longo MT, Luciano CA, Lutrick K, Malakooti SK, Mallett G, Maranga G, Marathe JG, Marconi VC, Marshall GD, Martin CF, Martin JN, May HT, McComsey GA, McDonald D, Mendez-Figueroa H, Miele L, Mittleman MA, Mohandas S, Mouchati C, Mullington JM, Nadkarni GN, Nahin ER, Neuman RB, Newman LT, Nguyen A, Nikolich JZ, Ofotokun I, Ogbogu PU, Palatnik A, Palomares KTS, Parimon T, Parry S, Parthasarathy S, Patterson TF, Pearman A, Peluso MJ, Pemu P, Pettker CM, Plunkett BA, Pogreba-Brown K, Poppas A, Porterfield JZ, Quigley JG, Quinn DK, Raissy H, Rebello CJ, Reddy UM, Reece R, Reeder HT, Rischard FP, Rosas JM, Rosen CJ, Rouphael NG, Rouse DJ, Ruff AM, Saint Jean C, Sandoval GJ, Santana JL, Schlater SM, Sciurba FC, Selvaggi C, Seshadri S, Sesso HD, Shah DP, Shemesh E, Sherif ZA, Shinnick DJ, Simhan HN, Singh U, Sowles A, Subbian V, Sun J, Suthar MS, Teunis LJ, Thorp JM, Ticotsky A, Tita ATN, Tragus R, Tuttle KR, Urdaneta AE, Utz PJ, VanWagoner TM, Vasey A, Vernon SD, Vidal C, Walker T, Ward HD, Warren DE, Weeks RM, Weiner SJ, Weyer JC, Wheeler JL, Whiteheart SW, Wiley Z, Williams NJ, Wisnivesky JP, Wood JC, Yee LM, Young NM, Zisis SN, Foulkes AS. Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design. PLoS One 2023; 18:e0286297. [PMID: 37352211 PMCID: PMC10289397 DOI: 10.1371/journal.pone.0286297] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/12/2023] [Indexed: 06/25/2023] Open
Abstract
IMPORTANCE SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. METHODS RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. DISCUSSION RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options. REGISTRATION NCT05172024.
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Affiliation(s)
- Leora I. Horwitz
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Shari B. Brosnahan
- Division of Pulmonary Critical Care and Sleep Medicine, NYU Langone Health, New York, New York, United States of America
| | - Mine S. Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Megan L. Fitzgerald
- Patient Led Research Collaboration on COVID-19, Washington, DC, United States of America
| | - Jason D. Goldman
- Division of Infectious Diseases, Providence Swedish Medical Center, Seattle, Washington, United States of America
| | - Rachel Hess
- Department of Population Health Sciences and Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - S. L. Hodder
- Department of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Michael R. Jordan
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Medford, Massachusetts, United States of America
| | - Jerry A. Krishnan
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Adeyinka O. Laiyemo
- Department of Medicine, Howard University, Washington, DC, United States of America
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Lauren Nichols
- Body Politic COVID-19 Support Group, Boston, Massachusetts, United States of America
| | - Rachel E. Patzer
- Department of Medicine and Surgery, Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Anisha Sekar
- Patient Led Research Collaboration on COVID-19, Washington, DC, United States of America
| | - Nora G. Singer
- Department of Medicine and Rheumatology, The MetroHealth Medical Center, Cleveland, Ohio, United States of America
| | - Lauren E. Stiles
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States of America
| | - Barbara S. Taylor
- Department of Medicine, Division of Infectious Diseases and Infectious Diseases, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Heather A. Algren
- Swedish Center for Research and Innovation, Providence Swedish Medical Center, Seattle, Washington, United States of America
| | - Khamal Anglin
- Department of Epidemiology and Biostatistics, University of California at San Francisco Institute of Global Health Sciences, San Francisco, San Francisco, California, United States of America
| | - Lisa Aponte-Soto
- College of Science and Health, Department of Health Sciences, DePaul University, Chicago, Illinois, United States of America
| | - Hassan Ashktorab
- Department of Medicine, Howard University, Washington, DC, United States of America
| | - Ingrid V. Bassett
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brahmchetna Bedi
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Nahid Bhadelia
- Center for Emerging Infectious Diseases Policy and Research, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Christian Bime
- Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lora J. Black
- Department of Clinical Research, Sanford Research, Sioux Falls, South Dakota, United States of America
| | - Andra L. Blomkalns
- Department of Emergency Medicine, Stanford University, Stanford, California, United States of America
| | - Hassan Brim
- Department of Pathology, Howard University, Washington, DC, United States of America
| | - Mario Castro
- Division of Pulmonary and Critical Care, University of Kansas Medical Center, Kansas City, Kansas City, United States of America
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Alexander W. Charney
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Benjamin K. Chen
- Division of Infectious Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Li Qing Chen
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Peter Chen
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - David Chestek
- Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Lori B. Chibnik
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Dominic C. Chow
- Department of Medicine, University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Helen Y. Chu
- Department of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Rebecca G. Clifton
- Department of Biostatistics, George Washington University, Washington, DC, United States of America
| | - Shelby Collins
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University Hospital, Columbus, Ohio, United States of America
| | - Sushma K. Cribbs
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Steven G. Deeks
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - John D. Dickinson
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Sarah E. Donohue
- Department of Research Services, University of Illinois College of Medicine, Peoria, Illinois, United States of America
| | - Matthew S. Durstenfeld
- Department of Medicine, Division of Cardiology at Zuckerberg San Francisco General, University of California San Francisco, San Francisco, California, United States of America
| | - Ivette F. Emery
- MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, United States of America
| | - Kristine M. Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Julio C. Facelli
- Department of Biomedical Informatics and Clinical and Translational Science Institute, University of Utah, Salt Lake City, Utah, United States of America
| | - Rachael Farah-Abraham
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Aloke V. Finn
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland, United States of America
| | - Melinda S. Fischer
- Department of Medicine, Division of Infectious Diseases and Infectious Diseases, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Judes Fleurimont
- Mile Square Health Center, University of Illinois Chicago, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Vivian Fonseca
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Emily J. Gallagher
- Department of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jennifer C. Gander
- Center for Research and Evaluation, Kaiser Permanente of Georgia, Atlanta, Georgia, United States of America
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Kelly S. Gibson
- Department of Obstetrics and Gynecology, MetroHealth System, Cleveland, Ohio, United States of America
| | - Minjoung Go
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Steven N. Goodman
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Joey P. Granger
- Department of Physiology & Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Frank L. Greenway
- Clinical Trials, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - John W. Hafner
- Department of Emergency Medicine, OSF Saint Francis Medical Center, Peoria, Illinois, United States of America
| | - Jenny E. Han
- Department of Pulmonary and Critical Care, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Michelle S. Harkins
- Department of Internal Medicine University of New Mexico, Health Science Center, Albuquerque, New Mexico, United States of America
| | - Kristine S. P. Hauser
- Clinical Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - James R. Heath
- Department of Bioengineering, Institute for Systems Biology, Seattle, Washington, United States of America
| | - Carla R. Hernandez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
| | - On Ho
- Seattle Children’s Therapeutics, Seattle, Washington, United States of America
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health Services, Newark, Delaware, United States of America
| | - Susan E. Hoover
- Department of Clinical Research, Sanford Research, Sioux Falls, South Dakota, United States of America
| | - Carol R. Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Harvey Hsu
- Department of Internal Medicine, University of Arizona, Phoenix, Arizona, United States of America
| | - Priscilla Y. Hsue
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Brenna L. Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America
| | - Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Judith A. James
- Department of Arthritis & Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America
| | - Janice John
- Department of Family Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, United States of America
| | - Sarah Jolley
- Department of Pulmonary and Critical Care Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - S. E. Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Joy J. Juskowich
- Department of Medicine, Division of Infectious Diseases, West Virginia School of Medicine, Morgantown, West Virginia, United States of America
| | - Diane G. Kanjilal
- Department of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Elizabeth W. Karlson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stuart D. Katz
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - J. Daniel Kelly
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Sara W. Kelly
- Department of Pediatrics & Department of Research Services, University of Illinois College of Medicine, Peoria, Illinois, United States of America
| | - Arthur Y. Kim
- Department of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - John P. Kirwan
- Department Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Kenneth S. Knox
- Department of Internal Medicine, University of Arizona, Phoenix, Arizona, United States of America
| | - Andre Kumar
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | | | - Margaret Lanca
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joyce K. Lee-lannotti
- Department of Internal Medicine and Neurology, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, United States of America
| | - R. Craig Lefebvre
- Communications Practice Area, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Bruce D. Levy
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Janet Y. Lin
- Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Brian P. Logarbo
- Tulane Center for Clinical Research, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Jennifer K. Logue
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Michele T. Longo
- Tulane Center for Clinical Neurosciences, Tulane School of Medicine, New Orleans, Louisiana, United States of America
| | - Carlos A. Luciano
- Department of Neurology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, United States of America
| | - Karen Lutrick
- Department of Family & Community Medicine, University of Arizona, College of Medicine – Tucson, Tucson, Arizona, United States of America
| | - Shahdi K. Malakooti
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Gail Mallett
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, United States of America
| | - Gabrielle Maranga
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Jai G. Marathe
- Department of Medicine, Section of Infectious Diseases, Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Vincent C. Marconi
- Department of Medicine, Infectious Diseases and Department of Global Health, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Gailen D. Marshall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Christopher F. Martin
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Heidi T. May
- Department of Cardiology, Intermountain Medical Center, Salt Lake City, Utah, United States of America
| | - Grace A. McComsey
- Department of Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Dylan McDonald
- Department of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Lucio Miele
- Department of Genetics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Murray A. Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, United States of America
| | - Christian Mouchati
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Janet M. Mullington
- Department of Neurology and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Girish N. Nadkarni
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Erica R. Nahin
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - Robert B. Neuman
- Division of Cardiology, Kaiser Permanente of Georgia, Atlanta, Georgia, United States of America
| | - Lisa T. Newman
- Department of Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Amber Nguyen
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Janko Z. Nikolich
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, Arizona, United States of America
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Princess U. Ogbogu
- Division of Pediatric Allergy, Immunology, and Rheumatology, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, United States of America
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Kristy T. S. Palomares
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Peter’s University Hospital, New Brunswick, New Jersey, United States of America
| | - Tanyalak Parimon
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sairam Parthasarathy
- Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Thomas F. Patterson
- Department of Medicine, Department of Infectious Disease, University of Texas Health, San Antonio, Texas, United States of America
| | - Ann Pearman
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Michael J. Peluso
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, California, United States of America
| | - Priscilla Pemu
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Christian M. Pettker
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Beth A. Plunkett
- Department of Obstetrics and Gynecology, NorthShore University Health System, Evanston, Illinois, United States of America
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, United States of America
| | - Athena Poppas
- Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - J. Zachary Porterfield
- Department of Internal Medicine, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky, United States of America
| | - John G. Quigley
- Department of Medicine, Division of Hematology/Oncology, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Candida J. Rebello
- Department of Nutrition and Chronic Disease, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Uma M. Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States of America
| | - Rebecca Reece
- Department of Medicine, Division of Infectious Diseases, West Virginia School of Medicine, Morgantown, West Virginia, United States of America
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Franz P. Rischard
- Department of Pulmonary and Critical Care, University of Arizona, Tucson, Arizona, United States of America
| | - Johana M. Rosas
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - Clifford J. Rosen
- MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, United States of America
| | - Nadine G. Rouphael
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, United States of America
| | - Adam M. Ruff
- Division of Pulmonary and Critical Care, University of Kansas Medical Center, Kansas City, Kansas City, United States of America
| | - Christina Saint Jean
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Grecio J. Sandoval
- Department of Biostatistics, George Washington University, Washington, DC, United States of America
| | - Jorge L. Santana
- Department of Medicine, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Shannon M. Schlater
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Frank C. Sciurba
- Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Caitlin Selvaggi
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center San Antonio, San Antonio, Texas, United States of America
| | - Howard D. Sesso
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Dimpy P. Shah
- Department of Population Health Sciences, Mays Cancer Center, University of Texas Health, San Antonio, Texas, United States of America
| | - Eyal Shemesh
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Zaki A. Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, United States of America
| | - Daniel J. Shinnick
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Upinder Singh
- Department of Internal Medicine, Stanford University, Stanford, California, United States of America
| | - Amber Sowles
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Vignesh Subbian
- Department of Biomedical Engineering, Department of Systems and Industrial Engineering, University of Arizona College of Engineering, Tucson, Arizona, United States of America
| | - Jun Sun
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Mehul S. Suthar
- Department of Pediatrics, Emory Vaccine Center, Emory University, Atlanta, Georgia, United States of America
| | - Larissa J. Teunis
- Health Services Research Center, Emory University, Atlanta, Georgia, United States of America
| | - John M. Thorp
- Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Amberly Ticotsky
- Department of Family Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, United States of America
| | - Alan T. N. Tita
- Department of Obstetrics and Gynecology and Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Robin Tragus
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Katherine R. Tuttle
- Department of Medicine, Division of Nephrology, University of Washington School of Medicine, Spokane, Washington, United States of America
| | - Alfredo E. Urdaneta
- Department of Emergency Medicine, Stanford University, Stanford, California, United States of America
| | - P. J. Utz
- Department of Internal Medicine, Stanford University, Stanford, California, United States of America
| | - Timothy M. VanWagoner
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Andrew Vasey
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Suzanne D. Vernon
- Department of Research, Bateman Horne Center, Salt Lake City, Utah, United States of America
| | - Crystal Vidal
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Tiffany Walker
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Honorine D. Ward
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - David E. Warren
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Ryan M. Weeks
- Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky, Lexington, Kentucky, United States of America
| | - Steven J. Weiner
- Department of Biostatistics, George Washington University, Washington, DC, United States of America
| | - Jordan C. Weyer
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jennifer L. Wheeler
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sidney W. Whiteheart
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, Kentucky, United States of America
| | - Zanthia Wiley
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Natasha J. Williams
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital of Los Angeles, Los Angeles, California, United States of America
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Natalie M. Young
- Swedish Center for Research and Innovation, Providence Swedish Medical Center, Seattle, Washington, United States of America
| | - Sokratis N. Zisis
- Department of Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Bledsoe J, Woller SC, Brooks M, Sciurba FC, Krishnan JA, Martin D, Hou P, Lin JY, Kindzelski A, Handberg E, Kirwan BA, Zaharris E, Castro L, Shapiro NL, Pepine CJ, Majercik S, Fu Z, Zhong Y, Venugopal V, Lai YH, Ridker PM, Connors JM. Clinically stable covid-19 patients presenting to acute unscheduled episodic care venues have increased risk of hospitalization: secondary analysis of a randomized control trial. BMC Infect Dis 2023; 23:325. [PMID: 37189091 PMCID: PMC10184108 DOI: 10.1186/s12879-023-08295-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/30/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Assessment for risks associated with acute stable COVID-19 is important to optimize clinical trial enrollment and target patients for scarce therapeutics. To assess whether healthcare system engagement location is an independent predictor of outcomes we performed a secondary analysis of the ACTIV-4B Outpatient Thrombosis Prevention trial. METHODS A secondary analysis of the ACTIV-4B trial that was conducted at 52 US sites between September 2020 and August 2021. Participants were enrolled through acute unscheduled episodic care (AUEC) enrollment location (emergency department, or urgent care clinic visit) compared to minimal contact (MC) enrollment (electronic contact from test center lists of positive patients).We report the primary composite outcome of cardiopulmonary hospitalizations, symptomatic venous thromboembolism, myocardial infarction, stroke, transient ischemic attack, systemic arterial thromboembolism, or death among stable outpatients stratified by enrollment setting, AUEC versus MC. A propensity score for AUEC enrollment was created, and Cox proportional hazards regression with inverse probability weighting (IPW) was used to compare the primary outcome by enrollment location. RESULTS Among the 657 ACTIV-4B patients randomized, 533 (81.1%) with known enrollment setting data were included in this analysis, 227 from AUEC settings and 306 from MC settings. In a multivariate logistic regression model, time from COVID test, age, Black race, Hispanic ethnicity, and body mass index were associated with AUEC enrollment. Irrespective of trial treatment allocation, patients enrolled at an AUEC setting were 10-times more likely to suffer from the adjudicated primary outcome, 7.9% vs. 0.7%; p < 0.001, compared with patients enrolled at a MC setting. Upon Cox regression analysis adjustment patients enrolled at an AUEC setting remained at significant risk of the primary composite outcome, HR 3.40 (95% CI 1.46, 7.94). CONCLUSIONS Patients with clinically stable COVID-19 presenting to an AUEC enrollment setting represent a population at increased risk of arterial and venous thrombosis complications, hospitalization for cardiopulmonary events, or death, when adjusted for other risk factors, compared with patients enrolled at a MC setting. Future outpatient therapeutic trials and clinical therapeutic delivery programs of clinically stable COVID-19 patients may focus on inclusion of higher-risk patient populations from AUEC engagement locations. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04498273.
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Affiliation(s)
- Joseph Bledsoe
- Intermountain Healthcare, Emergency Medicine and Trauma, Salt Lake City, UT, USA.
- Intermountain Medical Center, Department of Medicine, 5121 S. Cottonwood Drive, Murray, UT, 84157, USA.
| | - Scott C Woller
- Intermountain Medical Center, Department of Medicine, 5121 S. Cottonwood Drive, Murray, UT, 84157, USA
| | - Maria Brooks
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank C Sciurba
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, IL, USA
| | - Deborah Martin
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter Hou
- Brigham and Women's Hospital, Boston, MA, USA
| | - Janet Y Lin
- Department of Emergency Medicine, University of Illinois, Chicago, IL, USA
| | | | - Eileen Handberg
- School of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | - Lauren Castro
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, IL, USA
| | - Nancy L Shapiro
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Carl J Pepine
- School of Medicine, University of Florida, Gainesville, FL, USA
| | - Sarah Majercik
- Intermountain Healthcare, Emergency Medicine and Trauma, Salt Lake City, UT, USA
| | - Zhuxuan Fu
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yongqi Zhong
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vidya Venugopal
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yu-Hsuan Lai
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Metz TD, Clifton RG, Gallagher R, Gross RS, Horwitz LI, Jacoby VL, Martin-Herz SP, Peralta-Carcelen M, Reeder HT, Beamon CJ, Bind MA, Chan J, Chang AA, Chibnik LB, Costantine MM, Fitzgerald ML, Foulkes AS, Gibson KS, Güthe N, Habli M, Hackney DN, Hoffman MK, Hoffman MC, Hughes BL, Katz SD, Laleau V, Mallett G, Mendez-Figueroa H, Monzon V, Palatnik A, Palomares KT, Parry S, Peralta-Carcelen M, Pettker CM, Plunkett BA, Poppas A, Reddy UM, Rouse DJ, Saade GR, Sandoval GJ, Schlater SM, Sciurba FC, Simhan HN, Skupski DW, Sowles A, Thaweethai T, Thomas GL, Thorp JM, Tita AT, Weiner SJ, Weigand S, Yee LM, Flaherman VJ. Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design. medRxiv 2023:2023.04.24.23289025. [PMID: 37162923 PMCID: PMC10168506 DOI: 10.1101/2023.04.24.23289025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Importance Pregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER- Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads. Methods RECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators. Discussion RECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero. Registration NCT05172024.
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Affiliation(s)
- Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health Hospitals and Clinics, Salt Lake City, UT, USA
| | - Rebecca G. Clifton
- Biostatistics Center, The George Washington University, Washington, DC, USA
| | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Rachel S. Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Leora I. Horwitz
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Susanne P. Martin-Herz
- Department of Pediatrics, Division of Developmental Medicine, University of California San Francisco, San Francisco, CA, San Francisco, CA, USA
| | | | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Carmen J. Beamon
- Department of Maternal Fetal Medicine, WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Marie-Abele Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - A. Ann Chang
- Women’s Health Research Clinical Center, University of California San Francisco, San Francisco, CA, USA
| | - Lori B. Chibnik
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Megan L. Fitzgerald
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Kelly S. Gibson
- Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH, USA
| | - Nick Güthe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Mounira Habli
- Division Maternal Fetal Medicine, Trihealth Good Samaritan Hospital Maternal Fetal Medicine, Cincinnati, OH, USA
| | - David N. Hackney
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center: UH Cleveland Medical Center, Cleveland, OH, USA
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - M. Camille Hoffman
- Department of Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brenna L. Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Stuart D. Katz
- Department of Medicine, New York University School of Medicine, New York City, NY, USA
| | - Victoria Laleau
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Gail Mallett
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas McGovern Medical School: The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, TX, USA
| | - Vanessa Monzon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kristy T.S. Palomares
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Peter’s University Hospital, New Brunswick, NJ, USA
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Christian M. Pettker
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Beth A. Plunkett
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Athena Poppas
- Division of Cardiology, Brown University Warren Alpert Medical School, PROVIDENCE, RI, USA
| | - Uma M. Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York City, NY, USA
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, RI, USA
| | - George R. Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Grecio J. Sandoval
- Biostatistics Center, The George Washington University, Rockville, MD, USA
| | - Shannon M. Schlater
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | - Frank C. Sciurba
- Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, pittsburgh, PA, USA
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel W. Skupski
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Amber Sowles
- Department of Obstetrics and Gynecology, University of Utah Health Hospitals and Clinics, Salt Lake City, UT, USA
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Gelise L. Thomas
- Clinical and Translational Science Collaborative of Cleveland, Case Western Reserve University, Cleveland, Ohio, Cleveland, OH, USA
| | - John M. Thorp
- Department of Obstetrics and Gynecology, UNC: The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alan T. Tita
- Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven J. Weiner
- Biostatistics Center, The George Washington University, Washington, DC, USA
| | - Samantha Weigand
- Department of Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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16
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O'Brien ME, Zou RH, Hyre N, Leader JK, Fuhrman CR, Sciurba FC, Nouraie M, Bon J. CT pectoralis muscle area is associated with DXA lean mass and correlates with emphysema progression in a tobacco-exposed cohort. Thorax 2023; 78:394-401. [PMID: 34853157 PMCID: PMC9156725 DOI: 10.1136/thoraxjnl-2021-217710] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 05/31/2021] [Accepted: 11/04/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Muscle loss is an important extrapulmonary manifestation of COPD. Dual energy X-ray absorptiometry (DXA) is the method of choice for body composition measurement but is not widely used for muscle mass evaluation. The pectoralis muscle area (PMA) is quantifiable by CT and predicts cross-sectional COPD-related morbidity. There are no studies that compare PMA with DXA measures or that evaluate longitudinal relationships between PMA and lung disease progression. METHODS Participants from our longitudinal tobacco-exposed cohort had baseline and 6-year chest CT (n=259) and DXA (n=164) data. Emphysema was quantified by CT density histogram parenchymal scoring using the 15th percentile technique. Fat-free mass index (FFMI) and appendicular skeletal mass index (ASMI) were calculated from DXA measurements. Linear regression model relationships were reported using standardised coefficient (β) with 95% CI. RESULTS PMA was more strongly associated with DXA measures than with body mass index (BMI) in both cross-sectional (FFMI: β=0.76 (95% CI 0.65 to 0.86), p<0.001; ASMI: β=0.76 (95% CI 0.66 to 0.86), p<0.001; BMI: β=0.36 (95% CI 0.25 to 0.47), p<0.001) and longitudinal (ΔFFMI: β=0.43 (95% CI 0.28 to 0.57), p<0.001; ΔASMI: β=0.42 (95% CI 0.27 to 0.57), p<0.001; ΔBMI: β=0.34 (95% CI 0.22 to 0.46), p<0.001) models. Six-year change in PMA was associated with 6-year change in emphysema (β=0.39 (95% CI 0.23 to 0.56), p<0.001) but not with 6-year change in airflow obstruction. CONCLUSIONS PMA is an accessible measure of muscle mass and may serve as a useful clinical surrogate for assessing skeletal muscle loss in smokers. Decreased PMA correlated with emphysema progression but not lung function decline, suggesting a difference in the pathophysiology driving emphysema, airflow obstruction and comorbidity risk.
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Affiliation(s)
- Michael Emmet O'Brien
- Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Richard H Zou
- Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nathan Hyre
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joseph K Leader
- Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl R Fuhrman
- Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Frank C Sciurba
- Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mehdi Nouraie
- Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jessica Bon
- Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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17
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Evankovich JW, Nouraie SM, Sciurba FC. A Model to Predict Residual Volume from Forced Spirometry Measurements in Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis 2023; 10:55-63. [PMID: 36563054 PMCID: PMC9995238 DOI: 10.15326/jcopdf.2022.0354] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Lung hyperinflation with elevated residual volume (RV) is associated with poor prognosis in adults with chronic obstructive pulmonary disease (COPD) and is a critical criterion for lung volume reduction selection. Here, we proposed that patterns within spirometric measures could represent the degree of hyperinflation. Methods Fractional polynomial multivariate regression was used to develop a prediction model based on age, biological sex, forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC) to estimate plethysmography measured RV in patients in the Pittsburgh Specialized Center for Clinically Oriented Research (SCCOR) cohort (n=450). Receiver operating characteristic area under the curve (ROC-AUC) and optimal cut-points from the model were identified. The model was validated in a separate cohort (n=793). Results The best fit model: RV %est=[FVC %predicted] x 3.46-[FEV1/FVC] x 179.80- [FVC % (sqrt)] x 79.53-[age] x 0.98- [sex] x 10.88 + 737.06, where [sex], m=1. R2 of observed versus %predicted RV was 0.71. The optimal cut-point to predict an RV % >175% was 161. At this cut-point, ROC-AUC was 0.95, with a sensitivity 0.95, specificity 0.86, positive predictive value (PPV) of 97%, negative predictive value (NPV) of 76%, positive likelihood ratio (LR) of 6.6, and negative LR of 0.06. In a validation cohort of COPD patients (n=793), the model performed similarly, with a sensitivity of 0.82, specificity of 0.83, PPV of 85%, NPV of 79%, positive LR of 4.7, and negative LR of 0.21. Conclusion In patients with COPD, a model using only spirometry, age, and biological sex can estimate elevated RV. This tool could facilitate the identification of candidates for lung volume reduction procedures and can be integrated into existing epidemiologic databases to investigate the clinical impact of hyperinflation.
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Affiliation(s)
- John W Evankovich
- Division of Pulmonary Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - S M Nouraie
- Division of Pulmonary Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Frank C Sciurba
- Division of Pulmonary Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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18
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Connors JM, Brooks MM, Sciurba FC, Krishnan JA, Bledsoe JR, Castro L, Eng H, Handberg E, Hou PC, Hulbert J, Kirwan BA, Lin JY, Martin D, Samuelson H, Shapiro NL, Zaharris E, Wisniewski SR, Ridker PM. Outpatient Randomized Controlled Trials in the Covid-19 Era and Beyond. NEJM Evid 2022; 1:EVIDctcs2200149. [PMID: 38319835 DOI: 10.1056/evidctcs2200149] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Outpatient Trials in the Covid-19 Era and BeyondA group of investigators had a meeting at the National Heart, Lung, and Blood Institute in May 2020 to discuss ways to decrease thrombotic complications among symptomatic outpatients with Covid-19. The investigators discuss their approach to three specific challenges: conducting a trial remotely, working through regulatory hurdles, and recruiting a diverse population of participants.
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19
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Han MK, Ye W, Wang D, White E, Arjomandi M, Barjaktarevic IZ, Brown SA, Buhr RG, Comellas AP, Cooper CB, Criner GJ, Dransfield MT, Drescher F, Folz RJ, Hansel NN, Kalhan R, Kaner RJ, Kanner RE, Krishnan JA, Lazarus SC, Maddipati V, Martinez FJ, Mathews A, Meldrum C, McEvoy C, Nyunoya T, Rogers L, Stringer WW, Wendt CH, Wise RA, Wisniewski SR, Sciurba FC, Woodruff PG. Bronchodilators in Tobacco-Exposed Persons with Symptoms and Preserved Lung Function. N Engl J Med 2022; 387:1173-1184. [PMID: 36066078 PMCID: PMC9741866 DOI: 10.1056/nejmoa2204752] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many persons with a history of smoking tobacco have clinically significant respiratory symptoms despite an absence of airflow obstruction as assessed by spirometry. They are often treated with medications for chronic obstructive pulmonary disease (COPD), but supporting evidence for this treatment is lacking. METHODS We randomly assigned persons who had a tobacco-smoking history of at least 10 pack-years, respiratory symptoms as defined by a COPD Assessment Test score of at least 10 (scores range from 0 to 40, with higher scores indicating worse symptoms), and preserved lung function on spirometry (ratio of forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] ≥0.70 and FVC ≥70% of the predicted value after bronchodilator use) to receive either indacaterol (27.5 μg) plus glycopyrrolate (15.6 μg) or placebo twice daily for 12 weeks. The primary outcome was at least a 4-point decrease (i.e., improvement) in the St. George's Respiratory Questionnaire (SGRQ) score (scores range from 0 to 100, with higher scores indicating worse health status) after 12 weeks without treatment failure (defined as an increase in lower respiratory symptoms treated with a long-acting inhaled bronchodilator, glucocorticoid, or antibiotic agent). RESULTS A total of 535 participants underwent randomization. In the modified intention-to-treat population (471 participants), 128 of 227 participants (56.4%) in the treatment group and 144 of 244 (59.0%) in the placebo group had at least a 4-point decrease in the SGRQ score (difference, -2.6 percentage points; 95% confidence interval [CI], -11.6 to 6.3; adjusted odds ratio, 0.91; 95% CI, 0.60 to 1.37; P = 0.65). The mean change in the percent of predicted FEV1 was 2.48 percentage points (95% CI, 1.49 to 3.47) in the treatment group and -0.09 percentage points (95% CI, -1.06 to 0.89) in the placebo group, and the mean change in the inspiratory capacity was 0.12 liters (95% CI, 0.07 to 0.18) in the treatment group and 0.02 liters (95% CI, -0.03 to 0.08) in the placebo group. Four serious adverse events occurred in the treatment group, and 11 occurred in the placebo group; none were deemed potentially related to the treatment or placebo. CONCLUSIONS Inhaled dual bronchodilator therapy did not decrease respiratory symptoms in symptomatic, tobacco-exposed persons with preserved lung function as assessed by spirometry. (Funded by the National Heart, Lung, and Blood Institute and others; RETHINC ClinicalTrials.gov number, NCT02867761.).
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Affiliation(s)
- MeiLan K Han
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Wen Ye
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Di Wang
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Emily White
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Mehrdad Arjomandi
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Igor Z Barjaktarevic
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Stacey-Ann Brown
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Russell G Buhr
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Alejandro P Comellas
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Christopher B Cooper
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Gerard J Criner
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Mark T Dransfield
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Frank Drescher
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Rodney J Folz
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Nadia N Hansel
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Ravi Kalhan
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Robert J Kaner
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Richard E Kanner
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Jerry A Krishnan
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Stephen C Lazarus
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Veeranna Maddipati
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Fernando J Martinez
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Anne Mathews
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Catherine Meldrum
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Charlene McEvoy
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Toru Nyunoya
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Linda Rogers
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - William W Stringer
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Christine H Wendt
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Robert A Wise
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Stephen R Wisniewski
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Frank C Sciurba
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Prescott G Woodruff
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
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Gorgone M, Singhvi D, Nouraie SM, Finkelman M, Zhang Y, Pu J, Chandra D, Zhang Y, Kitsios GD, Morris A, Sciurba FC, Bon J. Circulating 1,3-Beta-D-Glucan is Associated with Lung Function, Respiratory Symptoms, and Mediators of Matrix Degradation in Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis 2022; 9:325-335. [PMID: 35550241 PMCID: PMC9448008 DOI: 10.15326/jcopdf.2022.0290] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Introduction Factors beyond cigarette smoke likely contribute to chronic obstructive pulmonary disease (COPD) pathogenesis. Prior studies demonstrate fungal colonization of the respiratory tract and increased epithelial barrier permeability in COPD. We sought to determine whether 1,3-beta-d-glucan (BDG), a polysaccharide component of the fungal cell wall, is detectable in the plasma of individuals with COPD and associates with clinical outcomes and matrix degradation proteins. Methods BDG was measured in the plasma of current and former smokers with COPD. High BDG was defined as a value greater than the 95th percentile of BDG in smokers without airflow obstruction. Pulmonary function, emphysema, and symptoms were compared between COPD participants with high versus low BDG. The relationship between plasma BDG, matrix metalloproteinases (MMP) 1, 7, and 9, and tissue inhibitor of matrix metalloproteinases (TIMP) 1, 2, and 4 was assessed adjusting for age, sex, and smoking status. Results COPD participants with high BDG plasma levels (19.8%) had lower forced expiratory volume in 1 second to forced vital capacity ratios (median 31.9 versus 39.3, p=0.025), higher St George's Respiratory Questionnaire symptom scores (median 63.6 versus 57.4, p=0.016), and greater prevalence of sputum production (69.4% versus 52.0%) and exacerbations (69.4% versus 48%) compared to COPD participants with low BDG. BDG levels directly correlated with MMP1 (r=0.27, p<0.001) and TIMP1 (r=0.16, p=0.022) in unadjusted and adjusted analyses. Conclusions Elevated plasma BDG levels correlate with worse lung function, greater respiratory morbidity, and circulating markers of matrix degradation in COPD. These findings suggest that targeting dysbiosis or enhancing epithelial barrier integrity may have disease-modifying effects in COPD.
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Affiliation(s)
- Matthew Gorgone
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- *Authors contributed equally
| | - Deepti Singhvi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- *Authors contributed equally
| | - Seyed Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Malcolm Finkelman
- Associates of Cape Cod Incorporated, East Falmouth, Massachusetts, United States
| | - Yonglong Zhang
- Associates of Cape Cod Incorporated, East Falmouth, Massachusetts, United States
| | - Jiantao Pu
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Divay Chandra
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Yingze Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Georgios D. Kitsios
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Alison Morris
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Frank C. Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
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Connors JM, Brooks MM, Sciurba FC, Fu Z, Ridker PM. Clinical predictors of COVID-19 severity and bleeding in the ACTIV-4B COVID-19 outpatient thrombosis prevention trial. Am J Hematol 2022; 97:E235-E240. [PMID: 35358342 PMCID: PMC9073988 DOI: 10.1002/ajh.26553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Jean M. Connors
- Hematology Division Brigham and Women's Hospital Boston Massachusetts USA
| | - Maria M. Brooks
- Department of Epidemiology, School of Public Health University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Frank C. Sciurba
- Pulmonary Division University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
| | - Zhuxuan Fu
- Department of Epidemiology, School of Public Health University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Paul M. Ridker
- Division of Preventive Medicine Brigham and Women's Hospital Boston Massachusetts USA
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Roodenburg SA, Hartman JE, Deslée G, Herth FJ, Klooster K, Sciurba FC, Shah PL, Valipour A, Zoumot Z, Slebos DJ. Bronchoscopic Lung Volume Reduction Coil Treatment for Severe Emphysema: A Systematic Review and Meta-Analysis of Individual Participant Data. Respiration 2022; 101:697-705. [PMID: 35405678 PMCID: PMC9393810 DOI: 10.1159/000524148] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background Lung volume reduction coil (LVR-coil) treatment provides a minimally invasive treatment option for severe emphysema patients which has been studied in multiple clinical trials. Objectives The aim of the study was to assess the effect of LVR-coil treatment on pulmonary function, quality of life, and exercise capacity using individual participant data. Method PubMed, Web of Science, and EMBASE were searched until May 17, 2021. Prospective single-arm and randomized controlled trials that evaluated the effect of LVR-coil treatment on forced expiratory volume in 1 s (FEV<sub>1</sub>), residual volume (RV), St. George Respiratory Questionnaire (SGRQ) total score, and/or 6-min walk distance (6MWD) and were registered in an official clinical trial database were eligible for inclusion. Individual patient data were requested, and a linear mixed effects model was used to calculate overall treatment effects. Results Eight trials were included in the final analysis, representing 680 individual patients. LVR-coil treatment resulted in a significant improvement in FEV1 at 3- (0.09 L [95% confidence interval (95% CI): 0.06–0.12]) and 6-month follow-up (0.07 L [95% CI: 0.03–0.10]), a significant reduction in RV at 3- (−0.45L [95% CI: −0.62 to −0.28]), 6- (−0.33L [95% CI: −0.52 to −0.14]), and 12-month follow-up (−0.36L [95% CI: −0.64 to −0.08]), a significant reduction in SGRQ total score at 3- (−12.3 points [95% CI: −15.8 to −8.8]), 6- (−10.1 points [95% CI: −12.8 to −7.3]), and 12-month follow-up (−9.8 points [95% CI: −15.0 to −4.7]) and a significant increase in 6MWD at 3-month follow-up (38 m [95% CI: 18–58]). Conclusions LVR-coil treatment in emphysema patients results in sustained improvements in pulmonary function and quality of life and shorter lived improvements in exercise capacity. Since the owner of this LVR-coil has decided to stop the production and newer generations LVR-coils are currently being developed, these results can act as a reference for future studies and clinical guidance.
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Affiliation(s)
- Sharyn A. Roodenburg
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- *Sharyn A. Roodenburg,
| | - Jorine E. Hartman
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gaëtan Deslée
- Department of Pulmonary Medicine, University Hospital of Reims, Reims, France
| | - Felix J.F. Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Karin Klooster
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank C. Sciurba
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Pallav L. Shah
- Royal Brompton Hospital, London, United Kingdom
- Chelsea & Westminster Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperical College London, London, United Kingdom
| | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Floridsdorf, Austria
| | - Zaid Zoumot
- Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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23
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Giordano L, Gregory AD, Pérez Verdaguer M, Ware SA, Harvey H, DeVallance E, Brzoska T, Sundd P, Zhang Y, Sciurba FC, Shapiro SD, Kaufman BA. Extracellular Release of Mitochondrial DNA: Triggered by Cigarette Smoke and Detected in COPD. Cells 2022; 11:369. [PMID: 35159179 PMCID: PMC8834490 DOI: 10.3390/cells11030369] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/17/2022] Open
Abstract
Cigarette smoke (CS) is the most common risk factor for chronic obstructive pulmonary disease (COPD). The present study aimed to elucidate whether mtDNA is released upon CS exposure and is detected in the plasma of former smokers affected by COPD as a possible consequence of airway damage. We measured cell-free mtDNA (cf-mtDNA) and nuclear DNA (cf-nDNA) in COPD patient plasma and mouse serum with CS-induced emphysema. The plasma of patients with COPD and serum of mice with CS-induced emphysema showed increased cf-mtDNA levels. In cell culture, exposure to a sublethal dose of CSE decreased mitochondrial membrane potential, increased oxidative stress, dysregulated mitochondrial dynamics, and triggered mtDNA release in extracellular vesicles (EVs). Mitochondrial DNA release into EVs occurred concomitantly with increased expression of markers that associate with DNA damage responses, including DNase III, DNA-sensing receptors (cGAS and NLRP3), proinflammatory cytokines (IL-1β, IL-6, IL-8, IL-18, and CXCL2), and markers of senescence (p16 and p21); the majority of the responses are also triggered by cytosolic DNA delivery in vitro. Exposure to a lethal CSE dose preferentially induced mtDNA and nDNA release in the cell debris. Collectively, the results of this study associate markers of mitochondrial stress, inflammation, and senescence with mtDNA release induced by CSE exposure. Because high cf-mtDNA is detected in the plasma of COPD patients and serum of mice with emphysema, our findings support the future study of cf-mtDNA as a marker of mitochondrial stress in response to CS exposure and COPD pathology.
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Affiliation(s)
- Luca Giordano
- Center for Metabolism and Mitochondrial Medicine, Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (S.A.W.); (H.H.)
- Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.D.); (T.B.); (P.S.)
| | - Alyssa D. Gregory
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.D.G.); (Y.Z.); (F.C.S.); (S.D.S.)
| | - Mireia Pérez Verdaguer
- Department of Cell Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Sarah A. Ware
- Center for Metabolism and Mitochondrial Medicine, Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (S.A.W.); (H.H.)
| | - Hayley Harvey
- Center for Metabolism and Mitochondrial Medicine, Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (S.A.W.); (H.H.)
| | - Evan DeVallance
- Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.D.); (T.B.); (P.S.)
| | - Tomasz Brzoska
- Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.D.); (T.B.); (P.S.)
- Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Prithu Sundd
- Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.D.); (T.B.); (P.S.)
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.D.G.); (Y.Z.); (F.C.S.); (S.D.S.)
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Yingze Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.D.G.); (Y.Z.); (F.C.S.); (S.D.S.)
| | - Frank C. Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.D.G.); (Y.Z.); (F.C.S.); (S.D.S.)
| | - Steven D. Shapiro
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.D.G.); (Y.Z.); (F.C.S.); (S.D.S.)
| | - Brett A. Kaufman
- Center for Metabolism and Mitochondrial Medicine, Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (S.A.W.); (H.H.)
- Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.D.); (T.B.); (P.S.)
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24
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Connors JM, Brooks MM, Sciurba FC, Krishnan JA, Bledsoe JR, Kindzelski A, Baucom AL, Kirwan BA, Eng H, Martin D, Zaharris E, Everett B, Castro L, Shapiro NL, Lin JY, Hou PC, Pepine CJ, Handberg E, Haight DO, Wilson JW, Majercik S, Fu Z, Zhong Y, Venugopal V, Beach S, Wisniewski S, Ridker PM. Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial. JAMA 2021; 326:1703-1712. [PMID: 34633405 PMCID: PMC8506296 DOI: 10.1001/jama.2021.17272] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022]
Abstract
Importance Acutely ill inpatients with COVID-19 typically receive antithrombotic therapy, although the risks and benefits of this intervention among outpatients with COVID-19 have not been established. Objective To assess whether anticoagulant or antiplatelet therapy can safely reduce major adverse cardiopulmonary outcomes among symptomatic but clinically stable outpatients with COVID-19. Design, Setting, and Participants The ACTIV-4B Outpatient Thrombosis Prevention Trial was designed as a minimal-contact, adaptive, randomized, double-blind, placebo-controlled trial to compare anticoagulant and antiplatelet therapy among 7000 symptomatic but clinically stable outpatients with COVID-19. The trial was conducted at 52 US sites between September 2020 and June 2021; final follow-up was August 5, 2021. Prior to initiating treatment, participants were required to have platelet count greater than 100 000/mm3 and estimated glomerular filtration rate greater than 30 mL/min/1.73 m2. Interventions Random allocation in a 1:1:1:1 ratio to aspirin (81 mg orally once daily; n = 164), prophylactic-dose apixaban (2.5 mg orally twice daily; n = 165), therapeutic-dose apixaban (5 mg orally twice daily; n = 164), or placebo (n = 164) for 45 days. Main Outcomes and Measures The primary end point was a composite of all-cause mortality, symptomatic venous or arterial thromboembolism, myocardial infarction, stroke, or hospitalization for cardiovascular or pulmonary cause. The primary analyses for efficacy and bleeding events were limited to participants who took at least 1 dose of trial medication. Results On June 18, 2021, the trial data and safety monitoring board recommended early termination because of lower than anticipated event rates; at that time, 657 symptomatic outpatients with COVID-19 had been randomized (median age, 54 years [IQR, 46-59]; 59% women). The median times from diagnosis to randomization and from randomization to initiation of study treatment were 7 days and 3 days, respectively. Twenty-two randomized participants (3.3%) were hospitalized for COVID-19 prior to initiating treatment. Among the 558 patients who initiated treatment, the adjudicated primary composite end point occurred in 1 patient (0.7%) in the aspirin group, 1 patient (0.7%) in the 2.5-mg apixaban group, 2 patients (1.4%) in the 5-mg apixaban group, and 1 patient (0.7%) in the placebo group. The risk differences compared with placebo for the primary end point were 0.0% (95% CI not calculable) in the aspirin group, 0.7% (95% CI, -2.1% to 4.1%) in the 2.5-mg apixaban group, and 1.4% (95% CI, -1.5% to 5.0%) in the 5-mg apixaban group. Risk differences compared with placebo for bleeding events were 2.0% (95% CI, -2.7% to 6.8%), 4.5% (95% CI, -0.7% to 10.2%), and 6.9% (95% CI, 1.4% to 12.9%) among participants who initiated therapy in the aspirin, prophylactic apixaban, and therapeutic apixaban groups, respectively, although none were major. Findings inclusive of all randomized patients were similar. Conclusions and Relevance Among symptomatic clinically stable outpatients with COVID-19, treatment with aspirin or apixaban compared with placebo did not reduce the rate of a composite clinical outcome. However, the study was terminated after enrollment of 9% of participants because of an event rate lower than anticipated. Trial Registration ClinicalTrials.gov Identifier: NCT04498273.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Heather Eng
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | - Peter C. Hou
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | | | | | | | - Zhuxuan Fu
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yongqi Zhong
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Scott Beach
- University of Pittsburgh, Pittsburgh, Pennsylvania
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25
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Mkorombindo T, Tran-Nguyen TK, Yuan K, Zhang Y, Xue J, Criner GJ, Kim YI, Pilewski JM, Gaggar A, Cho MH, Sciurba FC, Duncan SR. HLA-C and KIR permutations influence chronic obstructive pulmonary disease risk. JCI Insight 2021; 6:e150187. [PMID: 34464355 PMCID: PMC8525585 DOI: 10.1172/jci.insight.150187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023] Open
Abstract
A role for hereditary influences in the susceptibility for chronic obstructive pulmonary disease (COPD) is widely recognized. Cytotoxic lymphocytes are implicated in COPD pathogenesis, and functions of these leukocytes are modulated by interactions between their killer cell Ig-like receptors (KIR) and human leukocyte antigen–Class I (HLA–Class I) molecules on target cells. We hypothesized HLA–Class I and KIR inheritance affect risks for COPD. HLA–Class I alleles and KIR genotypes were defined by candidate gene analyses in multiple cohorts of patients with COPD (total n = 392) and control smokers with normal spirometry (total n = 342). Compared with controls, patients with COPD had overrepresentations of HLA-C*07 and activating KIR2DS1, with underrepresentations of HLA-C*12. Particular HLA-KIR permutations were synergistic; e.g., the presence of HLA-C*07 + KIR2DS1 + HLA-C12null versus HLAC*07null + KIR2DS1null + HLA-C12 was associated with COPD, especially among HLA-C1 allotype homozygotes. Cytotoxicity of COPD lymphocytes was more enhanced by KIR stimulation than those of controls and was correlated with lung function. These data show HLA-C and KIR polymorphisms strongly influence COPD susceptibility and highlight the importance of lymphocyte-mediated cytotoxicity in COPD pathogenesis. Findings here also indicate that HLA-KIR typing could stratify at-risk patients and raise possibilities that HLA-KIR axis modulation may have therapeutic potential.
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Affiliation(s)
- Takudzwa Mkorombindo
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Thi K Tran-Nguyen
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kaiyu Yuan
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yingze Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jianmin Xue
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Young-Il Kim
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph M Pilewski
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amit Gaggar
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael H Cho
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven R Duncan
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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26
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Strollo HC, Nouraie SM, Hoth KF, Riley CM, Karoleski C, Zhang Y, Hanania NA, Bowler RP, Bon J, Sciurba FC. Association of Systemic Inflammation with Depressive Symptoms in Individuals with COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:2515-2522. [PMID: 34511896 PMCID: PMC8423410 DOI: 10.2147/copd.s322144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/16/2021] [Indexed: 01/02/2023] Open
Abstract
Rationale Depression is a prevalent comorbidity of chronic obstructive pulmonary disease (COPD) that, along with COPD, has been associated with inflammation. An association between inflammation and depression in COPD has not been validated in a large COPD cohort. Methods Individuals from the University of Pittsburgh SCCOR cohort and the COPDGene cohort with tobacco use history and airway obstruction (FEV1/FVC <0.7) were evaluated using the Beck Depression Inventory II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS), respectively. Participants completed symptom-related questionnaires and plasma IL-6 measurements. T-test, Fisher’s Exact tests and logistic regression were used for statistical analysis. Results The SCCOR cohort included 220 obstructed participants: 44% female and 21.4% with elevated depressive symptoms. GOLD staging distribution was predominantly stage I and II. The COPDGene cohort included 745 obstructed participants: 44% female and 13.0% with elevated depressive symptoms. GOLD distribution was predominantly stage II and III. In the SCCOR cohort, correlation between IL-6 and depressive symptoms trended toward significance (p= 0.08). Multivariable modeling adjusted for FEV1, age, gender and medical comorbidities showed a significant association (OR = 1.70, 95% CI = 1.08–2.69). IL-6 was significantly associated with elevated depressive symptoms in COPDGene in both univariate (p=0.001) and multivariable modeling (OR = 1.52, 95% CI =1.13–2.04). Conclusion Elevated plasma IL-6 levels are associated with depressive symptoms in individuals with COPD independent of airflow limitation and comorbid risk factors for depression. Our results suggest that systemic inflammation may play a significant and possibly bidirectional role in depression associated with COPD.
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Affiliation(s)
- Hilary C Strollo
- University of Pittsburgh Medical Center, Department of Medicine, Department of Pulmonary Allergy and Critical Care Medicine, Pittsburgh, PA, USA
| | - Seyed M Nouraie
- University of Pittsburgh Medical Center, Department of Medicine, Department of Pulmonary Allergy and Critical Care Medicine, Pittsburgh, PA, USA
| | - Karin F Hoth
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA
| | - Craig M Riley
- Chester County Hospital, University of Pennsylvania Health System, West Chester, PA, USA
| | - Chad Karoleski
- University of Pittsburgh Medical Center, Department of Medicine, Department of Pulmonary Allergy and Critical Care Medicine, Pittsburgh, PA, USA
| | - Yingze Zhang
- University of Pittsburgh Medical Center, Department of Medicine, Department of Pulmonary Allergy and Critical Care Medicine, Pittsburgh, PA, USA
| | - Nicola A Hanania
- Baylor College of Medicine, Department of Pulmonary, Critical Care and Sleep Medicine, Houston, TX, USA
| | - Russell P Bowler
- National Jewish Health, Department of Medicine, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Jessica Bon
- University of Pittsburgh Medical Center, Department of Medicine, Department of Pulmonary Allergy and Critical Care Medicine, Pittsburgh, PA, USA
| | - Frank C Sciurba
- University of Pittsburgh Medical Center, Department of Medicine, Department of Pulmonary Allergy and Critical Care Medicine, Pittsburgh, PA, USA
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27
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Pu J, Sechrist J, Meng X, Leader JK, Sciurba FC. A pilot study: Quantify lung volume and emphysema extent directly from two-dimensional scout images. Med Phys 2021; 48:4316-4325. [PMID: 34077564 DOI: 10.1002/mp.15019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The potential to compute volume metrics of emphysema from planar scout images was investigated in this study. The successful implementation of this concept will have a wide impact in different fields, and specifically, maximize the diagnostic potential of the planar medical images. METHODS We investigated our premise using a well-characterized chronic obstructive pulmonary disease (COPD) cohort. In this cohort, planar scout images from computed tomography (CT) scans were used to compute lung volume and percentage of emphysema. Lung volume and percentage of emphysema were quantified on the volumetric CT images and used as the "ground truth" for developing the models to compute the variables from the corresponding scout images. We trained two classical convolutional neural networks (CNNs), including VGG19 and InceptionV3, to compute lung volume and the percentage of emphysema from the scout images. The scout images (n = 1,446) were split into three subgroups: (1) training (n = 1,235), (2) internal validation (n = 99), and (3) independent test (n = 112) at the subject level in a ratio of 8:1:1. The mean absolute difference (MAD) and R-square (R2) were the performance metrics to evaluate the prediction performance of the developed models. RESULTS The lung volumes and percentages of emphysema computed from a single planar scout image were significantly linear correlated with the measures quantified using volumetric CT images (VGG19: R2 = 0.934 for lung volume and R2 = 0.751 for emphysema percentage, and InceptionV3: R2 = 0.977 for lung volume and R2 = 0.775 for emphysema percentage). The mean absolute differences (MADs) for lung volume and percentage of emphysema were 0.302 ± 0.247L and 2.89 ± 2.58%, respectively, for VGG19, and 0.366 ± 0.287L and 3.19 ± 2.14, respectively, for InceptionV3. CONCLUSIONS Our promising results demonstrated the feasibility of inferring volume metrics from planar images using CNNs.
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Affiliation(s)
- Jiantao Pu
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jacob Sechrist
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xin Meng
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph K Leader
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank C Sciurba
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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28
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Burtin C, Mohan D, Troosters T, Watz H, Hopkinson NS, Garcia-Aymerich J, Moy ML, Vogiatzis I, Rossiter HB, Singh S, Merrill DD, Hamilton A, Rennard SI, Fageras M, Petruzzelli S, Tal-Singer R, Tomaszewski E, Corriol-Rohou S, Rochester CL, Sciurba FC, Casaburi R, D-C Man W, Van Lummel RC, Cooper CB, Demeyer H, Spruit MA, Vaes A. Objectively measured physical activity as a COPD clinical trial outcome. Chest 2021; 160:2080-2100. [PMID: 34217679 DOI: 10.1016/j.chest.2021.06.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Reduced physical activity is common in COPD and is associated with poor outcomes. Physical activity is therefore a worthy target for intervention in clinical trials, however, trials evaluating physical activity have used heterogeneous methodologies. RESEARCH QUESTION What is the available evidence on the efficacy and/or effectiveness of various interventions to enhance objectively measured physical activity in patients with COPD, taking into account minimal preferred methodological quality of physical activity assessment? STUDY DESIGN AND METHODS In this narrative review, the COPD Biomarker Qualification Consortium (CBQC) task force searched three scientific databases for articles that reported the effect of an intervention on objectively-measured physical activity in COPD. Based on scientific literature and expert consensus, only studies with ≥7 measurement days and ≥4 valid days of ≥8 hours of monitoring were included in the primary analysis. RESULTS 37 of 110 (34%) identified studies fulfilled the criteria, investigating the efficacy and/or effectiveness of physical activity behavior change programs (n=7), mobile health or eHealth interventions (n=9), rehabilitative exercise (n=9), bronchodilation (n=6), lung volume reduction procedures (n=3) and other interventions (n=3). Results are generally variable, reflecting the large variation in study characteristics and outcomes. Few studies show an increase beyond the proposed minimal important change of 600-1100 daily steps, indicating that enhancing physical activity levels is a challenge. INTERPRETATION Only a third of clinical trials measuring objective physical activity in people with COPD fulfilled the pre-set criteria regarding physical activity assessment. Studies showed variable effects on physical activity even when investigating similar interventions.
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Affiliation(s)
- Chris Burtin
- Reval Rehabilitation Research Center- Biomed Biomedical Research Institute - Hasselt University - Diepenbeek, Belgium.
| | - Divya Mohan
- Medical Innovation, Value Evidence and Outcomes, GSK R&D - Collegeville, USA
| | | | - Henrik Watz
- Pulmonary Research institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center For Lung Research (DZL), Grosshansdorf, Germany
| | | | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Marilyn L Moy
- Pulmonary Section, VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Harry B Rossiter
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center - Torrance, USA; The University of Leeds - Leeds, UK
| | - Sally Singh
- Department of Respiratory Science, University of Leicester, UK
| | | | - Alan Hamilton
- Boehringer-Ingelheim (Canada) Ltd. - Burlington, Canada
| | - Stephen I Rennard
- Biopharma R&D, AstraZeneca - Cambridge, United Kingdom; University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Ruth Tal-Singer
- Medical Innovation, Value Evidence and Outcomes, GSK R&D - Collegeville, USA; COPD Foundation - Miami, FL, USA
| | | | | | - Carolyn L Rochester
- Section of Pulmonary, Critical care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Frank C Sciurba
- University of Pittsburgh, division of pulmonary allergy and critical care medicine - Pittsburgh, PA, USA
| | - Richard Casaburi
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center - Torrance, USA
| | - William D-C Man
- National Heart and Lung Institute, Imperial College London, UK; Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | | | | | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven - Leuven, Belgium; Department of Rehabilitation sciences, Ghent University, Ghent, Belgium
| | - Martijn A Spruit
- Department of Research & Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Anouk Vaes
- Department of Research & Development, CIRO, Horn, the Netherlands
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Pavord ID, Chapman KR, Bafadhel M, Sciurba FC, Bradford ES, Schweiker Harris S, Mayer B, Rubin DB, Yancey SW, Paggiaro P. Mepolizumab for Eosinophil-Associated COPD: Analysis of METREX and METREO. Int J Chron Obstruct Pulmon Dis 2021; 16:1755-1770. [PMID: 34163157 PMCID: PMC8215850 DOI: 10.2147/copd.s294333] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/09/2021] [Indexed: 12/05/2022] Open
Abstract
Background A pre-specified meta-analysis of individual patient data from the 52-week METREX and METREO trials, which investigated mepolizumab for chronic obstructive pulmonary disease (COPD) in patients with blood eosinophil counts ≥150 cells/µL (screening) or ≥300 cells/µL (prior year) and frequent exacerbations, enables more robust characterization of mepolizumab efficacy in COPD and exploration of the relationship between blood eosinophil count and treatment responses. Methods In METREX (117106/NCT02105948) and METREO (117113/NCT02105961), randomized patients received mepolizumab or placebo added to existing inhaled corticosteroid (ICS)–based triple maintenance therapy. The annual rate of moderate/severe exacerbations (primary endpoint) was compared between subcutaneous (SC) mepolizumab 100 mg versus placebo (primary comparison of interest) and all doses (100 mg and 300 mg SC) versus placebo in patients with blood eosinophil counts ≥150 cells/µL at screening or ≥300 cells/µL in the prior year. Secondary/other endpoints included time to first moderate/severe exacerbation, exacerbations leading to emergency department visit/hospitalization and health-related quality of life (HRQoL). A predictive model of the relationship between screening blood eosinophil counts and exacerbation rates included data from all randomized patients. Results In total, 1510 patients were randomized in METREX and METREO and 1136 patients were included in the pre-specified meta-analysis. From the meta-analysis, mepolizumab 100 mg SC significantly reduced annual moderate/severe exacerbation rates versus placebo by 18% (rate ratio: 0.82; 95% confidence interval: 0.71, 0.95; p=0.006) and delayed time to first moderate/severe exacerbation (hazard ratio: 0.80 [0.68, 0.94]; p=0.006). Mepolizumab 100 mg SC versus placebo numerically reduced exacerbations leading to ED visits/hospitalization and improved HRQoL. A modelling approach demonstrated increasing efficacy for moderate/severe exacerbations with increasing screening blood eosinophil count; this relationship was more pronounced for exacerbations requiring oral corticosteroids (post hoc). The all-doses comparison had similar results. Conclusion Mepolizumab reduces exacerbations in patients with eosinophil-associated COPD. Results suggest that blood eosinophil counts (≥150 cells/µL at screening or ≥300 cells/µL in the prior year) allow for identification of patients with COPD who experience exacerbations while treated with maximal ICS-based triple maintenance therapy who are likely to benefit from mepolizumab. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/YCq1mqQ5Xl4
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Affiliation(s)
- Ian D Pavord
- Nuffield Department of Medicine and Oxford Respiratory NIHR BRC, University of Oxford, Oxford, UK
| | - Kenneth R Chapman
- Asthma & Airway Centre, UHN and University of Toronto, Toronto, ON, Canada
| | - Mona Bafadhel
- Nuffield Department of Medicine and Oxford Respiratory NIHR BRC, University of Oxford, Oxford, UK
| | - Frank C Sciurba
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric S Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | | | | | - David B Rubin
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | - Steven W Yancey
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology, and Critical Care, University of Pisa, Pisa, Italy
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Gong M, Liu P, Sciurba FC, Stojanov P, Tao D, Tseng GC, Zhang K, Batmanghelich K. Unpaired data empowers association tests. Bioinformatics 2021; 37:785-792. [PMID: 33070196 PMCID: PMC8098021 DOI: 10.1093/bioinformatics/btaa886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/07/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
Abstract
Motivation There is growing interest in the biomedical research community to incorporate retrospective data, available in healthcare systems, to shed light on associations between different biomarkers. Understanding the association between various types of biomedical data, such as genetic, blood biomarkers, imaging, etc. can provide a holistic understanding of human diseases. To formally test a hypothesized association between two types of data in Electronic Health Records (EHRs), one requires a substantial sample size with both data modalities to achieve a reasonable power. Current association test methods only allow using data from individuals who have both data modalities. Hence, researchers cannot take advantage of much larger EHR samples that includes individuals with at least one of the data types, which limits the power of the association test. Results We present a new method called the Semi-paired Association Test (SAT) that makes use of both paired and unpaired data. In contrast to classical approaches, incorporating unpaired data allows SAT to produce better control of false discovery and to improve the power of the association test. We study the properties of the new test theoretically and empirically, through a series of simulations and by applying our method on real studies in the context of Chronic Obstructive Pulmonary Disease. We are able to identify an association between the high-dimensional characterization of Computed Tomography chest images and several blood biomarkers as well as the expression of dozens of genes involved in the immune system. Availability and implementation Code is available on https://github.com/batmanlab/Semi-paired-Association-Test. Supplementary information Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Mingming Gong
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA.,Department of Philosophy, Carnegie Mellon University, Pittsburgh, PA 15213, USA.,School of Mathematics and Statistics, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Peng Liu
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Frank C Sciurba
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Petar Stojanov
- Department of Philosophy, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Dacheng Tao
- Australia School of Computer Science, The University of Sydney, Sydney, NSW 2006, Australia
| | - George C Tseng
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Kun Zhang
- Department of Philosophy, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Kayhan Batmanghelich
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
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Martinez FJ, Yow E, Flaherty KR, Snyder LD, Durheim MT, Wisniewski SR, Sciurba FC, Raghu G, Brooks MM, Kim DY, Dilling DF, Criner GJ, Kim H, Belloli EA, Nambiar AM, Scholand MB, Anstrom KJ, Noth I. Effect of Antimicrobial Therapy on Respiratory Hospitalization or Death in Adults With Idiopathic Pulmonary Fibrosis: The CleanUP-IPF Randomized Clinical Trial. JAMA 2021; 325:1841-1851. [PMID: 33974018 PMCID: PMC8114133 DOI: 10.1001/jama.2021.4956] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Alteration in lung microbes is associated with disease progression in idiopathic pulmonary fibrosis. OBJECTIVE To assess the effect of antimicrobial therapy on clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS Pragmatic, randomized, unblinded clinical trial conducted across 35 US sites. A total of 513 patients older than 40 years were randomized from August 2017 to June 2019 (final follow-up was January 2020). INTERVENTIONS Patients were randomized in a 1:1 allocation ratio to receive antimicrobials (n = 254) or usual care alone (n = 259). Antimicrobials included co-trimoxazole (trimethoprim 160 mg/sulfamethoxazole 800 mg twice daily plus folic acid 5 mg daily, n = 128) or doxycycline (100 mg once daily if body weight <50 kg or 100 mg twice daily if ≥50 kg, n = 126). No placebo was administered in the usual care alone group. MAIN OUTCOMES AND MEASURES The primary end point was time to first nonelective respiratory hospitalization or all-cause mortality. RESULTS Among the 513 patients who were randomized (mean age, 71 years; 23.6% women), all (100%) were included in the analysis. The study was terminated for futility on December 18, 2019. After a mean follow-up time of 13.1 months (median, 12.7 months), a total of 108 primary end point events occurred: 52 events (20.4 events per 100 patient-years [95% CI, 14.8-25.9]) in the usual care plus antimicrobial therapy group and 56 events (18.4 events per 100 patient-years [95% CI, 13.2-23.6]) in the usual care group, with no significant difference between groups (adjusted HR, 1.04 [95% CI, 0.71-1.53; P = .83]. There was no statistically significant interaction between the effect of the prespecified antimicrobial agent (co-trimoxazole vs doxycycline) on the primary end point (adjusted HR, 1.15 [95% CI 0.68-1.95] in the co-trimoxazole group vs 0.82 [95% CI, 0.46-1.47] in the doxycycline group; P = .66). Serious adverse events occurring at 5% or greater among those treated with usual care plus antimicrobials vs usual care alone included respiratory events (16.5% vs 10.0%) and infections (2.8% vs 6.6%); adverse events of special interest included diarrhea (10.2% vs 3.1%) and rash (6.7% vs 0%). CONCLUSIONS AND RELEVANCE Among adults with idiopathic pulmonary fibrosis, the addition of co-trimoxazole or doxycycline to usual care, compared with usual care alone, did not significantly improve time to nonelective respiratory hospitalization or death. These findings do not support treatment with these antibiotics for the underlying disease. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02759120.
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Affiliation(s)
| | - Eric Yow
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Kevin R. Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Laurie D. Snyder
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Michael T. Durheim
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
- Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Stephen R. Wisniewski
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frank C. Sciurba
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ganesh Raghu
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle
| | - Maria M. Brooks
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel F. Dilling
- Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Hyun Kim
- Division of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis
| | - Elizabeth A. Belloli
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Anoop M. Nambiar
- Division of Pulmonary and Critical Care Medicine, University of Texas Health San Antonio
| | - Mary Beth Scholand
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City
| | - Kevin J. Anstrom
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville
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Chandra D, Gupta A, Kinney GL, Fuhrman CR, Leader JK, Diaz AA, Bon J, Barr RG, Washko G, Budoff M, Hokanson J, Sciurba FC. The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers. Chest 2021; 160:858-871. [PMID: 33971144 DOI: 10.1016/j.chest.2021.04.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Smokers manifest varied phenotypes of pulmonary impairment. RESEARCH QUESTION Which pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers? STUDY DESIGN AND METHODS We analyzed data from the University of Pittsburgh COPD Specialized Center for Clinically Oriented Research (SCCOR) cohort (n = 481) and the Genetic Epidemiology of COPD (COPDGene) cohort (n = 2,580). Participants were current and former smokers with > 10 pack-years of tobacco exposure. Data from the two cohorts were analyzed separately because of methodologic differences. Lung hyperinflation was assessed by plethysmography in the SCCOR cohort and by inspiratory and expiratory CT scan lung volumes in the COPDGene cohort. Subclinical CAD was assessed as the coronary artery calcium score, whereas clinical CAD was defined as a self-reported history of CAD or myocardial infarction (MI). Analyses were performed in all smokers and then repeated in those with airflow obstruction (FEV1 to FVC ratio, < 0.70). RESULTS Pulmonary phenotypes, including airflow limitation, emphysema, lung hyperinflation, diffusion capacity, and radiographic measures of airway remodeling, showed weak to moderate correlations (r < 0.7) with each other. In multivariate models adjusted for pulmonary phenotypes and CAD risk factors, lung hyperinflation was the only phenotype associated with calcium score, history of clinical CAD, or history of MI (per 0.2 higher expiratory and inspiratory CT scan lung volume; coronary calcium: OR, 1.2; 95% CI, 1.1-1.5; P = .02; clinical CAD: OR, 1.6; 95% CI, 1.1-2.3; P = .01; and MI in COPDGene: OR, 1.7; 95% CI, 1.0-2.8; P = .05). FEV1 and emphysema were associated with increased risk of CAD (P < .05) in models adjusted for CAD risk factors; however, these associations were attenuated on adjusting for lung hyperinflation. Results were the same in those with airflow obstruction and were present in both cohorts. INTERPRETATION Lung hyperinflation is associated strongly with clinical and subclinical CAD in smokers, including those with airflow obstruction. After lung hyperinflation was accounted for, FEV1 and emphysema no longer were associated with CAD. Subsequent studies should consider measuring lung hyperinflation and examining its mechanistic role in CAD in current and former smokers.
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Affiliation(s)
- Divay Chandra
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Aman Gupta
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Carl R Fuhrman
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA
| | - Joseph K Leader
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA
| | - Alejandro A Diaz
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jessica Bon
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - George Washko
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Matthew Budoff
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - John Hokanson
- Department of Epidemiology, University of Colorado, Denver, CO
| | - Frank C Sciurba
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
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Pratte KA, Curtis JL, Kechris K, Couper D, Cho MH, Silverman EK, DeMeo DL, Sciurba FC, Zhang Y, Ortega VE, O'Neal WK, Gillenwater LA, Lynch DA, Hoffman EA, Newell JD, Comellas AP, Castaldi PJ, Miller BE, Pouwels SD, Hacken NHTT, Bischoff R, Klont F, Woodruff PG, Paine R, Barr RG, Hoidal J, Doerschuk CM, Charbonnier JP, Sung R, Locantore N, Yonchuk JG, Jacobson S, Tal-Singer R, Merrill D, Bowler RP. Soluble receptor for advanced glycation end products (sRAGE) as a biomarker of COPD. Respir Res 2021; 22:127. [PMID: 33906653 PMCID: PMC8076883 DOI: 10.1186/s12931-021-01686-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Soluble receptor for advanced glycation end products (sRAGE) is a proposed emphysema and airflow obstruction biomarker; however, previous publications have shown inconsistent associations and only one study has investigate the association between sRAGE and emphysema. No cohorts have examined the association between sRAGE and progressive decline of lung function. There have also been no evaluation of assay compatibility, receiver operating characteristics, and little examination of the effect of genetic variability in non-white population. This manuscript addresses these deficiencies and introduces novel data from Pittsburgh COPD SCCOR and as well as novel work on airflow obstruction. A meta-analysis is used to quantify sRAGE associations with clinical phenotypes. METHODS sRAGE was measured in four independent longitudinal cohorts on different analytic assays: COPDGene (n = 1443); SPIROMICS (n = 1623); ECLIPSE (n = 2349); Pittsburgh COPD SCCOR (n = 399). We constructed adjusted linear mixed models to determine associations of sRAGE with baseline and follow up forced expiratory volume at one second (FEV1) and emphysema by quantitative high-resolution CT lung density at the 15th percentile (adjusted for total lung capacity). RESULTS Lower plasma or serum sRAGE values were associated with a COPD diagnosis (P < 0.001), reduced FEV1 (P < 0.001), and emphysema severity (P < 0.001). In an inverse-variance weighted meta-analysis, one SD lower log10-transformed sRAGE was associated with 105 ± 22 mL lower FEV1 and 4.14 ± 0.55 g/L lower adjusted lung density. After adjusting for covariates, lower sRAGE at baseline was associated with greater FEV1 decline and emphysema progression only in the ECLIPSE cohort. Non-Hispanic white subjects carrying the rs2070600 minor allele (A) and non-Hispanic African Americans carrying the rs2071288 minor allele (A) had lower sRAGE measurements compare to those with the major allele, but their emphysema-sRAGE regression slopes were similar. CONCLUSIONS Lower blood sRAGE is associated with more severe airflow obstruction and emphysema, but associations with progression are inconsistent in the cohorts analyzed. In these cohorts, genotype influenced sRAGE measurements and strengthened variance modelling. Thus, genotype should be included in sRAGE evaluations.
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Affiliation(s)
| | - Jeffrey L Curtis
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.,Medical Service, Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Katerina Kechris
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - David Couper
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dawn L DeMeo
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank C Sciurba
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yingze Zhang
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victor E Ortega
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Wanda K O'Neal
- Marsico Lung Institute (CF Research Center), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lucas A Gillenwater
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.,Computational Bioscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Eric A Hoffman
- Department of Radiology and Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - John D Newell
- Department of Radiology and Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, College of Medicine, University of Iowa Carver, Iowa City, IA, USA
| | - Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Simon D Pouwels
- Department of Pathology and Medical Biology, University of Groningen, Groningen, Netherlands
| | - Nick H T Ten Hacken
- Department of Pathology and Medical Biology, University of Groningen, Groningen, Netherlands
| | - Rainer Bischoff
- Department of Analytical Biochemistry, University of Groningen, Groningen, Netherlands
| | - Frank Klont
- Department of Analytical Biochemistry, University of Groningen, Groningen, Netherlands
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.,Cardiovascular Research Institute, University of California-San Francisco, San Francisco, CA, USA
| | - Robert Paine
- Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, UT, USA
| | - R Graham Barr
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University, New York, NY, USA
| | - John Hoidal
- Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, UT, USA
| | - Claire M Doerschuk
- Marsico Lung Institute (CF Research Center), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ruby Sung
- Research and Development, GlaxoSmithKline, Collegeville, PA, USA
| | | | - John G Yonchuk
- Research and Development, GlaxoSmithKline, Collegeville, PA, USA
| | - Sean Jacobson
- Department of Genetics, National Jewish Health, Denver, CO, USA
| | | | | | - Russell P Bowler
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
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Kliment CR, Nguyen JMK, Kaltreider MJ, Lu Y, Claypool SM, Radder JE, Sciurba FC, Zhang Y, Gregory AD, Iglesias PA, Sidhaye VK, Robinson DN. Adenine nucleotide translocase regulates airway epithelial metabolism, surface hydration and ciliary function. J Cell Sci 2021; 134:jcs.257162. [PMID: 33526710 DOI: 10.1242/jcs.257162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/13/2021] [Indexed: 01/10/2023] Open
Abstract
Airway hydration and ciliary function are critical to airway homeostasis and dysregulated in chronic obstructive pulmonary disease (COPD), which is impacted by cigarette smoking and has no therapeutic options. We utilized a high-copy cDNA library genetic selection approach in the amoeba Dictyostelium discoideum to identify genetic protectors to cigarette smoke. Members of the mitochondrial ADP/ATP transporter family adenine nucleotide translocase (ANT) are protective against cigarette smoke in Dictyostelium and human bronchial epithelial cells. Gene expression of ANT2 is reduced in lung tissue from COPD patients and in a mouse smoking model, and overexpression of ANT1 and ANT2 resulted in enhanced oxidative respiration and ATP flux. In addition to the presence of ANT proteins in the mitochondria, they reside at the plasma membrane in airway epithelial cells and regulate airway homeostasis. ANT2 overexpression stimulates airway surface hydration by ATP and maintains ciliary beating after exposure to cigarette smoke, both of which are key functions of the airway. Our study highlights a potential for upregulation of ANT proteins and/or of their agonists in the protection from dysfunctional mitochondrial metabolism, airway hydration and ciliary motility in COPD.This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Corrine R Kliment
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA .,Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Jennifer M K Nguyen
- Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Mary Jane Kaltreider
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - YaWen Lu
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Steven M Claypool
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Josiah E Radder
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Frank C Sciurba
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Yingze Zhang
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Alyssa D Gregory
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Pablo A Iglesias
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Venkataramana K Sidhaye
- Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Environmental Health Sciences and Engineering, Johns Hopkins University School of Public Health, Baltimore, MD 21205, USA
| | - Douglas N Robinson
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA .,Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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35
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Ash SY, San José Estépar R, Fain SB, Tal-Singer R, Stockley RA, Nordenmark LH, Rennard S, Han MK, Merrill D, Humphries SM, Diaz AA, Mason SE, Rahaghi FN, Pistenmaa CL, Sciurba FC, Vegas-Sánchez-Ferrero G, Lynch DA, Washko GR. Relationship between Emphysema Progression at CT and Mortality in Ever-Smokers: Results from the COPDGene and ECLIPSE Cohorts. Radiology 2021; 299:222-231. [PMID: 33591891 PMCID: PMC7997617 DOI: 10.1148/radiol.2021203531] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The relationship between emphysema progression and long-term outcomes is unclear. Purpose To determine the relationship between emphysema progression at CT and mortality among participants with emphysema. Materials and Methods In a secondary analysis of two prospective observational studies, COPDGene (clinicaltrials.gov, NCT00608764) and Evaluation of Chronic Obstructive Pulmonary Disease Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE; clinicaltrials.gov, NCT00292552), emphysema was measured at CT at two points by using the volume-adjusted lung density at the 15th percentile of the lung density histogram (hereafter, lung density perc15) method. The association between emphysema progression rate and all-cause mortality was analyzed by using Cox regression adjusted for ethnicity, sex, baseline age, pack-years, and lung density, baseline and change in smoking status, forced expiratory volume in 1 second, and 6-minute walk distance. In COPDGene, respiratory mortality was analyzed by using the Fine and Gray method. Results A total of 5143 participants (2613 men [51%]; mean age, 60 years ± 9 [standard deviation]) in COPDGene and 1549 participants (973 men [63%]; mean age, 62 years ± 8) in ECLIPSE were evaluated, of which 2097 (40.8%) and 1179 (76.1%) had emphysema, respectively. Baseline imaging was performed between January 2008 and December 2010 for COPDGene and January 2006 and August 2007 for ECLIPSE. Follow-up imaging was performed after 5.5 years ± 0.6 in COPDGene and 3.0 years ± 0.2 in ECLIPSE, and mortality was assessed over the ensuing 5 years in both. For every 1 g/L per year faster rate of decline in lung density perc15, all-cause mortality increased by 8% in COPDGene (hazard ratio [HR], 1.08; 95% CI: 1.01, 1.16; P = .03) and 6% in ECLIPSE (HR, 1.06; 95% CI: 1.00, 1.13; P = .045). In COPDGene, respiratory mortality increased by 22% (HR, 1.22; 95% CI: 1.13, 1.31; P < .001) for the same increase in the rate of change in lung density perc15. Conclusion In ever-smokers with emphysema, emphysema progression at CT was associated with increased all-cause and respiratory mortality. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Lee and Park in this issue.
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Affiliation(s)
- Samuel Y Ash
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Raúl San José Estépar
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Sean B Fain
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Ruth Tal-Singer
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Robert A Stockley
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Lars H Nordenmark
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Stephen Rennard
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - MeiLan K Han
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Debora Merrill
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Stephen M Humphries
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Alejandro A Diaz
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Stefanie E Mason
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Farbod N Rahaghi
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Carrie L Pistenmaa
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Frank C Sciurba
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Gonzalo Vegas-Sánchez-Ferrero
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - David A Lynch
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - George R Washko
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
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- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
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36
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Chu JH, Zang W, Vukmirovic M, Yan X, Adams T, DeIuliis G, Hu B, Mihaljinec A, Schupp JC, Becich MJ, Hochheiser H, Gibson KF, Chen ES, Morris A, Leader JK, Wisniewski SR, Zhang Y, Sciurba FC, Collman RG, Sandhaus R, Herzog EL, Patterson KC, Sauler M, Strange C, Kaminski N. Gene coexpression networks reveal novel molecular endotypes in alpha-1 antitrypsin deficiency. Thorax 2021; 76:134-143. [PMID: 33303696 PMCID: PMC10794043 DOI: 10.1136/thoraxjnl-2019-214301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) is a genetic condition that causes early onset pulmonary emphysema and airways obstruction. The complete mechanisms via which AATD causes lung disease are not fully understood. To improve our understanding of the pathogenesis of AATD, we investigated gene expression profiles of bronchoalveolar lavage (BAL) and peripheral blood mononuclear cells (PBMCs) in AATD individuals. METHODS We performed RNA-Seq on RNA extracted from matched BAL and PBMC samples isolated from 89 subjects enrolled in the Genomic Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis (GRADS) study. Subjects were stratified by genotype and augmentation therapy. Supervised and unsupervised differential gene expression analyses were performed using Weighted Gene Co-expression Network Analysis (WGCNA) to identify gene profiles associated with subjects' clinical variables. The genes in the most significant WGCNA module were used to cluster AATD individuals. Gene validation was performed by NanoString nCounter Gene Expression Assay. RESULT We observed modest effects of AATD genotype and augmentation therapy on gene expression. When WGCNA was applied to BAL transcriptome, one gene module, ME31 (2312 genes), correlated with the highest number of clinical variables and was functionally enriched with numerous immune T-lymphocyte related pathways. This gene module identified two distinct clusters of AATD individuals with different disease severity and distinct PBMC gene expression patterns. CONCLUSIONS We successfully identified novel clusters of AATD individuals where severity correlated with increased immune response independent of individuals' genotype and augmentation therapy. These findings may suggest the presence of previously unrecognised disease endotypes in AATD that associate with T-lymphocyte immunity and disease severity.
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Affiliation(s)
- Jen-Hwa Chu
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Wenlan Zang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Milica Vukmirovic
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Xiting Yan
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Taylor Adams
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Giuseppe DeIuliis
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Buqu Hu
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Antun Mihaljinec
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jonas C Schupp
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael J Becich
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harry Hochheiser
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kevin F Gibson
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward S Chen
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alison Morris
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph K Leader
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Stephen R Wisniewski
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Yingze Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ronald G Collman
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert Sandhaus
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Erica L Herzog
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Karen C Patterson
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brigton, UK
| | - Maor Sauler
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Charlie Strange
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Naftali Kaminski
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Hartman JE, Criner GJ, Moore WH, van Rikxoort EM, Sciurba FC, Shah PL, Vliegenthart R, Welling JBA, Slebos DJ. HRCT characteristics of severe emphysema patients: Interobserver variability among expert readers and comparison with quantitative software. Eur J Radiol 2021; 136:109561. [PMID: 33516140 DOI: 10.1016/j.ejrad.2021.109561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/23/2020] [Accepted: 01/17/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE For a successful bronchoscopic lung volume reduction coil treatment it is important to place the coils in the most emphysematous lobes. Therefore assessment of the lobe with greatest destruction is essential. Our aims were to investigate the level of agreement among expert reviewers of HRCT-scans in emphysema patients and the comparison with QCT (quantitative computed tomography) software. METHOD Five experienced CT-assessors, conducted a visual assessment of the baseline HRCT-scans of emphysema patients who participated in the RENEW bronchoscopic lung volume reduction coil study. On the same HRCT-scans, a QCT analysis was performed. RESULTS In total 134 HRCT-scans were rated by all 5 experts. All 5 CT-assessors agreed on which was the most destructed lobe in 61 % of the left lungs (ƙ:0.459) and 60 % of the right lungs (ƙ:0.370). The consensus of the 5 assessors matched the QCT in the left lung for 77 % of the patients (ƙ:0.425) and in the right lung for 82 % (ƙ:0.524). CONCLUSIONS Our results show that the interobserver agreement between five expert CT-assessors was only fair to moderate when evaluating the most destructed lobe. CT-assessor consensus improved matching with QCT determination of lobar destruction compared to individual assessor determinations. Because some CT-features are associated with treatment outcomes and important for optimal patient selection of bronchoscopic lung volume reduction treatment, we recommend including more than one CT-reviewer and supported by QCT measurements.
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Affiliation(s)
- Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | | | - Frank C Sciurba
- University of Pittsburgh, Division of Pulmonary, Allergy and Critical Care Medicine, Pittsburgh, PA, USA
| | - Pallav L Shah
- Royal Brompton Hospital, London, UK; National Heart & Lung Institute, Imperial College, London, UK; Chelsea & Westminster Hospital, London, UK
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jorrit B A Welling
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Zhang Y, Tedrow J, Nouraie M, Li X, Chandra D, Bon J, Kass DJ, Fuhrman CR, Leader JK, Duncan SR, Kaminski N, Sciurba FC. Elevated plasma level of Pentraxin 3 is associated with emphysema and mortality in smokers. Thorax 2021; 76:335-342. [PMID: 33479043 DOI: 10.1136/thoraxjnl-2020-215356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pentraxin 3 (PTX3) influences innate immunity and inflammation, host defence, the complement cascade and angiogenesis. PTX3 expression in lung and blood of subjects with tobacco exposure, and its potential relationship with disease pattern and clinical outcome are poorly understood. METHODS Using independent platforms and cohorts, we identified associations of PTX3 gene expression in lung tissue and plasma from current and former tobacco smokers (with and without chronic obstructive pulmonary disease, COPD) to disease phenotypes including quantitative CT determined emphysema, lung function, symptoms and survival. Two putative regulatory variants of the PTX3 gene were examined for association with COPD manifestations. The relationship between plasma PTX3 and hyaluronic acid levels was further examined. RESULTS PTX3 gene expression in lung tissue was directly correlated with emphysema severity (p<0.0001). Circulating levels of PTX3 were inversely correlated with FEV1 (p=0.006), and positively associated with emphysema severity (p=0.004) and mortality (p=0.008). Two PTX3 gene regulatory variants were associated with a lower risk for emphysema and expiratory airflow obstruction, and plasma levels of PTX3 and hyaluronic acid were related. CONCLUSIONS These data show strong and overlapping associations of lung and blood PTX3 levels, and PTX3 regulatory gene variants, with the severity of airflow obstruction, emphysema and mortality among smokers. These findings have potential implications regarding the pathogenesis of smoking-related lung diseases and warrant further exploration for the use of PTX3 as a predictive biomarker.
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Affiliation(s)
- Yingze Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John Tedrow
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pulmonary Medicine and Respiratory Care, St Mary's of Michigan, Kalamazoo, Michigan, USA
| | - Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xiaoyun Li
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Divay Chandra
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel J Kass
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carl R Fuhrman
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph K Leader
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven R Duncan
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Naftali Kaminski
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Pu J, Leader JK, Bandos A, Ke S, Wang J, Shi J, Du P, Guo Y, Wenzel SE, Fuhrman CR, Wilson DO, Sciurba FC, Jin C. Automated quantification of COVID-19 severity and progression using chest CT images. Eur Radiol 2021; 31:436-446. [PMID: 32789756 PMCID: PMC7755837 DOI: 10.1007/s00330-020-07156-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/23/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To develop and test computer software to detect, quantify, and monitor progression of pneumonia associated with COVID-19 using chest CT scans. METHODS One hundred twenty chest CT scans from subjects with lung infiltrates were used for training deep learning algorithms to segment lung regions and vessels. Seventy-two serial scans from 24 COVID-19 subjects were used to develop and test algorithms to detect and quantify the presence and progression of infiltrates associated with COVID-19. The algorithm included (1) automated lung boundary and vessel segmentation, (2) registration of the lung boundary between serial scans, (3) computerized identification of the pneumonitis regions, and (4) assessment of disease progression. Agreement between radiologist manually delineated regions and computer-detected regions was assessed using the Dice coefficient. Serial scans were registered and used to generate a heatmap visualizing the change between scans. Two radiologists, using a five-point Likert scale, subjectively rated heatmap accuracy in representing progression. RESULTS There was strong agreement between computer detection and the manual delineation of pneumonic regions with a Dice coefficient of 81% (CI 76-86%). In detecting large pneumonia regions (> 200 mm3), the algorithm had a sensitivity of 95% (CI 94-97%) and specificity of 84% (CI 81-86%). Radiologists rated 95% (CI 72 to 99) of heatmaps at least "acceptable" for representing disease progression. CONCLUSION The preliminary results suggested the feasibility of using computer software to detect and quantify pneumonic regions associated with COVID-19 and to generate heatmaps that can be used to visualize and assess progression. KEY POINTS • Both computer vision and deep learning technology were used to develop computer software to quantify the presence and progression of pneumonia associated with COVID-19 depicted on CT images. • The computer software was tested using both quantitative experiments and subjective assessment. • The computer software has the potential to assist in the detection of the pneumonic regions, monitor disease progression, and assess treatment efficacy related to COVID-19.
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Affiliation(s)
- Jiantao Pu
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
| | - Joseph K Leader
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Andriy Bandos
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Shi Ke
- Department of Radiology, Xi'an Jiaotong University The First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Jing Wang
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Junli Shi
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Pang Du
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Youmin Guo
- Department of Radiology, Xi'an Jiaotong University The First Affiliated Hospital, Xi'an, Shaanxi, China
| | - Sally E Wenzel
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Carl R Fuhrman
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Chenwang Jin
- Department of Radiology, Xi'an Jiaotong University The First Affiliated Hospital, Xi'an, Shaanxi, China.
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40
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Valipour A, Shah PL, Herth FJ, Pison C, Schumann C, Hübner RH, Bonta PI, Kessler R, Gesierich W, Darwiche K, Lamprecht B, Perez T, Skowasch D, Deslee G, Marceau A, Sciurba FC, Gosens R, Hartman JE, Conway F, Duller M, Mayse M, Norman HS, Slebos DJ. Two-Year Outcomes for the Double-Blind, Randomized, Sham-Controlled Study of Targeted Lung Denervation in Patients with Moderate to Severe COPD: AIRFLOW-2. Int J Chron Obstruct Pulmon Dis 2020; 15:2807-2816. [PMID: 33177818 PMCID: PMC7652218 DOI: 10.2147/copd.s267409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose COPD exacerbations are associated with worsening clinical outcomes and increased healthcare costs, despite use of optimal medical therapy. A novel bronchoscopic therapy, targeted lung denervation (TLD), which disrupts parasympathetic pulmonary innervation of the lung, has been developed to reduce clinical consequences of cholinergic hyperactivity and its impact on COPD exacerbations. The AIRFLOW-2 study assessed the durability of safety and efficacy of TLD additive to optimal drug therapy compared to sham bronchoscopy and optimal drug therapy alone in subjects with moderate-to-severe, symptomatic COPD two years post randomization. Patients and Methods TLD was performed in COPD patients (FEV1 30-60% predicted, CAT≥10 or mMRC≥2) in a 1:1 randomized, sham-controlled, double-blinded multicenter study (AIRFLOW-2) using a novel lung denervation system (Nuvaira, Inc., USA). Subjects remained blinded until their 12.5-month follow-up visit when control subjects were offered the opportunity to undergo TLD. A time-to-first-event analysis on moderate and severe and severe exacerbations of COPD was performed. Results Eighty-two subjects (FEV1 41.6±7.4% predicted, 50.0% male, age 63.7±6.8 yrs, 24% with prior year respiratory hospitalization) were randomized. Time-to-first severe COPD exacerbation was significantly lengthened in the TLD arm (p=0.04, HR=0.38) at 2 years post-TLD therapy and trended towards similar attenuation for moderate and severe COPD exacerbations (p=0.18, HR=0.71). No significant changes in lung function or SGRQ-C were found 2 years post randomization between groups. Conclusion In a randomized trial, TLD demonstrated a durable effect of significantly lower risk of severe AECOPD over 2 years. Further, lung function and quality of life remained stable following TLD. Clinical Trial Registration NCT02058459.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Pallav L Shah
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
| | - Felix J Herth
- Thoraxklinik, Department of Pneumology and Critical Care Medicine and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
| | - Christophe Pison
- CHU Grenoble Alpes, Service Hospitalier Universitaire Pneumologie Physiologie; Université Grenoble Alpes, Grenoble, France
| | - Christian Schumann
- Clinic of Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Klinikverbund Allgaeu, Kempten and Immenstadt, Germany
| | - Ralf-Harto Hübner
- Charité Universitätsmedizin Berlin, Medizinische Klinik m. Schw. Infektiologie und Pneumologie, Campus Virchow, Berlin, Germany
| | - Peter I Bonta
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Wolfgang Gesierich
- Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik - University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
| | | | - Dirk Skowasch
- Department of Internal Medicine II - Cardiology/Pneumology, University of Bonn, Bonn, Germany
| | - Gaetan Deslee
- CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, Reims, France
| | - Armelle Marceau
- Service de Pneumologie, Hôpital Universitaire Bichat, Paris, France
| | - Frank C Sciurba
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Reinoud Gosens
- Department of Molecular Pharmacology, University of Groningen, Groningen, the Netherlands
| | - Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Francesca Conway
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
| | - Marina Duller
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | | | | | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - On behalf of the AIRFLOW-2 Trial Study Group
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
- Thoraxklinik, Department of Pneumology and Critical Care Medicine and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
- CHU Grenoble Alpes, Service Hospitalier Universitaire Pneumologie Physiologie; Université Grenoble Alpes, Grenoble, France
- Clinic of Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Klinikverbund Allgaeu, Kempten and Immenstadt, Germany
- Charité Universitätsmedizin Berlin, Medizinische Klinik m. Schw. Infektiologie und Pneumologie, Campus Virchow, Berlin, Germany
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
- Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik - University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
- CHU de Lille – Hôpital Calmette, Lille, France
- Department of Internal Medicine II - Cardiology/Pneumology, University of Bonn, Bonn, Germany
- CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, Reims, France
- Service de Pneumologie, Hôpital Universitaire Bichat, Paris, France
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Molecular Pharmacology, University of Groningen, Groningen, the Netherlands
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Nuvaira, Inc., Minneapolis, MN, USA
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Sun W, Tang Y, Tai YY, Handen A, Zhao J, Speyer G, Al Aaraj Y, Watson A, Romanelli ME, Sembrat J, Rojas M, Simon MA, Zhang Y, Lee J, Xiong Z, Dutta P, Vasamsetti SB, McNamara D, McVerry B, McTiernan CF, Sciurba FC, Kim S, Smith KA, Mazurek JA, Han Y, Vaidya A, Nouraie SM, Kelly NJ, Chan SY. SCUBE1 Controls BMPR2-Relevant Pulmonary Endothelial Function: Implications for Diagnostic Marker Development in Pulmonary Arterial Hypertension. JACC Basic Transl Sci 2020; 5:1073-1092. [PMID: 33294740 PMCID: PMC7691287 DOI: 10.1016/j.jacbts.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 12/27/2022]
Abstract
Utilizing publicly available ribonucleic acid sequencing data, we identified SCUBE1 as a BMPR2-related gene differentially expressed between induced pluripotent stem cell-endothelial cells derived from pulmonary arterial hypertension (PAH) patients carrying pathogenic BMPR2 mutations and control patients without mutations. Endothelial SCUBE1 expression was decreased by known triggers of PAH, and its down-regulation recapitulated known BMPR2-associated endothelial pathophenotypes in vitro. Meanwhile, SCUBE1 concentrations were reduced in plasma obtained from PAH rodent models and patients with PAH, whereas plasma concentrations were tightly correlated with hemodynamic markers of disease severity. Taken together, these data implicate SCUBE1 as a novel contributor to PAH pathogenesis with potential therapeutic, diagnostic, and prognostic applications.
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Key Words
- BMP, bone morphogenetic protein
- BMPR2
- EC, endothelial cell
- PAEC, pulmonary arterial endothelial cell
- PAH, pulmonary arterial hypertension
- PAP, pulmonary artery pressure
- PCWP, pulmonary capillary wedge pressure
- PH, pulmonary hypertension
- PVR, pulmonary vascular resistance
- RV, right ventricle
- SCUBE1
- WSPH, World Symposium on Pulmonary Hypertension
- endothelium
- iPSC-EC, induced pluripotent stem cell-endothelial cell
- mPAP, mean pulmonary artery pressure
- pulmonary hypertension
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Affiliation(s)
- Wei Sun
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ying Tang
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yi-Yin Tai
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam Handen
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jingsi Zhao
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gil Speyer
- Research Computing, Arizona State University, Tempe, Arizona, USA
| | - Yassmin Al Aaraj
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Annie Watson
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Makenna E Romanelli
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John Sembrat
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mauricio Rojas
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marc A Simon
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yingze Zhang
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Janet Lee
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zeyu Xiong
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Partha Dutta
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sathish Badu Vasamsetti
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dennis McNamara
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryan McVerry
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Charles F McTiernan
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Frank C Sciurba
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungchan Kim
- Center for Computational Systems Biology, Department of Electrical and Computer Engineering, Roy G. Perry College of Engineering, Prairie View A and M University, Prairie View, Texas, USA
| | - Kerri Akaya Smith
- Division of Pulmonary Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeremy A Mazurek
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuchi Han
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anjali Vaidya
- Cardiovascular Division, Temple University Health Systems, Philadelphia, Pennsylvania, USA
| | - Seyed Mehdi Nouraie
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Neil J Kelly
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stephen Y Chan
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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42
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Tran-Nguyen TK, Xue J, Feghali-Bostwick C, Sciurba FC, Kass DJ, Duncan SR. CD70 Activation Decreases Pulmonary Fibroblast Production of Extracellular Matrix Proteins. Am J Respir Cell Mol Biol 2020; 63:255-265. [PMID: 32320626 DOI: 10.1165/rcmb.2019-0450oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a lethal, medically refractory syndrome characterized by intrapulmonary accumulations of extracellular matrix (ECM) proteins produced by fibroblasts. Activation, clonal expansion, and differentiation of lymphocytes are also frequently present in IPF. Activated T cells are known to exert several effects that promote ECM production, but opposing homeostatic actions, wherein T cells can inhibit fibrosis, are less well understood. We found that CD27, a TNF receptor ubiquitously expressed on naive T cells, is downregulated on CD4 T cells of patients with IPF and that CD70, the sole ligand for CD27, is present on human pulmonary fibroblasts. We hypothesized that cognate engagements between lymphocyte CD27 and fibroblast CD70 could have functional consequences. Accordingly, a series of subsequent studies were conducted to examine the possible role of CD27-CD70 interactions in the regulation of fibrogenesis. Using IB, flow cytometry, RT-PCR, and kinomic assays, we found that fibroblast CD70 expression was inversely correlated with cell density and upregulated by TGF-β1 (transforming growth factor-β1). CD70 agonists, including T-cell-derived soluble CD27, markedly diminished fibroblast collagen and fibronectin synthesis, and these effects were potent enough to also inhibit profibrotic actions of TGF-β1 on ECM production in vitro and in two distinct ex vivo human skin models. CD70 activation was mediated by AKT (protein kinase B) and complex interconnected signaling pathways, and it was abated by prior CD70 knockdown. These results show that the CD70-CD27 axis modulates T-cell-fibroblast interactions and may be an important regulator of fibrosis and wound healing. Fibroblast CD70 could also be a novel target for specific mechanistically based antifibrosis treatments.
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Affiliation(s)
- Thi K Tran-Nguyen
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jianmin Xue
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Carol Feghali-Bostwick
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Frank C Sciurba
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Daniel J Kass
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Steven R Duncan
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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43
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Strand M, Austin E, Moll M, Pratte KA, Regan EA, Hayden LP, Bhatt SP, Boriek AM, Casaburi R, Silverman EK, Fortis S, Ruczinski I, Koegler H, Rossiter HB, Occhipinti M, Hanania NA, Gebrekristos HT, Lynch DA, Kunisaki KM, Young KA, Sieren JC, Ragland M, Hokanson JE, Lutz SM, Make BJ, Kinney GL, Cho MH, Pistolesi M, DeMeo DL, Sciurba FC, Comellas AP, Diaz AA, Barjaktarevic I, Bowler RP, Kanner RE, Peters SP, Ortega VE, Dransfield MT, Crapo JD. A Risk Prediction Model for Mortality Among Smokers in the COPDGene® Study. Chronic Obstr Pulm Dis 2020; 7:346-361. [PMID: 32877963 PMCID: PMC7883903 DOI: 10.15326/jcopdf.7.4.2020.0146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Risk factor identification is a proven strategy in advancing treatments and preventive therapy for many chronic conditions. Quantifying the impact of those risk factors on health outcomes can consolidate and focus efforts on individuals with specific high-risk profiles. Using multiple risk factors and longitudinal outcomes in 2 independent cohorts, we developed and validated a risk score model to predict mortality in current and former cigarette smokers. METHODS We obtained extensive data on current and former smokers from the COPD Genetic Epidemiology (COPDGene®) study at enrollment. Based on physician input and model goodness-of-fit measures, a subset of variables was selected to fit final Weibull survival models separately for men and women. Coefficients and predictors were translated into a point system, allowing for easy computation of mortality risk scores and probabilities. We then used the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) cohort for external validation of our model. RESULTS Of 9867 COPDGene participants with standard baseline data, 17.6% died over 10 years of follow-up, and 9074 of these participants had the full set of baseline predictors (standard plus 6-minute walk distance and computed tomography variables) available for full model fits. The average age of participants in the cohort was 60 for both men and women, and the average predicted 10-year mortality risk was 18% for women and 25% for men. Model time-integrated area under the receiver operating characteristic curve statistics demonstrated good predictive model accuracy (0.797 average), validated in the external cohort (0.756 average). Risk of mortality was impacted most by 6-minute walk distance, forced expiratory volume in 1 second and age, for both men and women. CONCLUSIONS Current and former smokers exhibited a wide range of mortality risk over a 10- year period. Our models can identify higher risk individuals who can be targeted for interventions to reduce risk of mortality, for participants with or without chronic obstructive pulmonary disease (COPD) using current Global initiative for obstructive Lung Disease (GOLD) criteria.
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Affiliation(s)
| | | | - Matthew Moll
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | | | | | | | - Richard Casaburi
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | | | | | - Ingo Ruczinski
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Harry B. Rossiter
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- University of Leeds, Leeds, United Kingdom
| | - Mariaelena Occhipinti
- University of Florence, Florence, Italy
- *Dr. Occhipinti is now at the Imaging Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | | | | | - Ken M. Kunisaki
- Minneapolis Veterans Administration Health Care System, Minnesota
| | | | | | | | | | - Sharon M. Lutz
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | | | | | - Dawn L. DeMeo
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | | | - Igor Barjaktarevic
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles
| | | | | | - Stephen P. Peters
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Victor E. Ortega
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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44
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Singh D, Bafadhel M, Brightling CE, Sciurba FC, Curtis JL, Martinez FJ, Pasquale CB, Merrill DD, Metzdorf N, Petruzzelli S, Tal-Singer R, Compton C, Rennard S. Blood Eosinophil Counts in Clinical Trials for Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2020; 202:660-671. [PMID: 32186896 PMCID: PMC7462391 DOI: 10.1164/rccm.201912-2384pp] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/17/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- Dave Singh
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester University National Health Service Hospital Trust, Manchester, United Kingdom
| | - Mona Bafadhel
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Christopher E. Brightling
- Institute for Lung Health, National Institute for Health Research Leicester Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, United Kingdom
| | - Frank C. Sciurba
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jeffrey L. Curtis
- Pulmonary and Critical Care Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Fernando J. Martinez
- Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
| | - Cara B. Pasquale
- COPD Patient-Powered Research Network, COPD Foundation, Washington, DC
| | - Debora D. Merrill
- COPD Biomarkers Qualification Consortium, COPD Foundation, Miami, Florida
| | - Norbert Metzdorf
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Ruth Tal-Singer
- COPD Biomarkers Qualification Consortium, COPD Foundation, Miami, Florida
| | - Christopher Compton
- Global Medical Affairs, Speciality and Primary Care, GlaxoSmithKline, Middlesex, United Kingdom
| | - Stephen Rennard
- Biopharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
- University of Nebraska Medical Center, Omaha, Nebraska; and
| | - on behalf of the COPD Foundation Eosinophil Working Group
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester University National Health Service Hospital Trust, Manchester, United Kingdom
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute for Lung Health, National Institute for Health Research Leicester Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, United Kingdom
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Pulmonary and Critical Care Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
- Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
- COPD Patient-Powered Research Network, COPD Foundation, Washington, DC
- COPD Biomarkers Qualification Consortium, COPD Foundation, Miami, Florida
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
- Global Clinical Development, Chiesi Farmaceutici, Parma, Italy
- Global Medical Affairs, Speciality and Primary Care, GlaxoSmithKline, Middlesex, United Kingdom
- Biopharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
- University of Nebraska Medical Center, Omaha, Nebraska; and
- Research and Development, AstraZeneca, Gaithersburg, Maryland
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45
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Müllerová H, Dransfield MT, Thomashow B, Jones PW, Rennard S, Karlsson N, Fageras M, Metzdorf N, Petruzzelli S, Rommes J, Sciurba FC, Tabberer M, Merrill D, Tal-Singer R. Clinical Development and Research Applications of the Chronic Obstructive Pulmonary Disease Assessment Test. Am J Respir Crit Care Med 2020; 201:1058-1067. [PMID: 31815521 DOI: 10.1164/rccm.201907-1369pp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Hana Müllerová
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Paul W Jones
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Stephen Rennard
- University of Nebraska, Omaha, Nebraska.,BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Malin Fageras
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | | | - Frank C Sciurba
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Maggie Tabberer
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | | | - Ruth Tal-Singer
- Value Evidence and Outcomes, Medical Innovation, Global Medical R&D, GlaxoSmithKline, Collegeville, Pennsylvania
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46
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Bodduluri S, Nakhmani A, Reinhardt JM, Wilson CG, McDonald ML, Rudraraju R, Jaeger BC, Bhakta NR, Castaldi PJ, Sciurba FC, Zhang C, Bangalore PV, Bhatt SP. Deep neural network analyses of spirometry for structural phenotyping of chronic obstructive pulmonary disease. JCI Insight 2020; 5:132781. [PMID: 32554922 DOI: 10.1172/jci.insight.132781] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/03/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUNDCurrently recommended traditional spirometry outputs do not reflect the relative contributions of emphysema and airway disease to airflow obstruction. We hypothesized that machine-learning algorithms can be trained on spirometry data to identify these structural phenotypes.METHODSParticipants enrolled in a large multicenter study (COPDGene) were included. The data points from expiratory flow-volume curves were trained using a deep-learning model to predict structural phenotypes of chronic obstructive pulmonary disease (COPD) on CT, and results were compared with traditional spirometry metrics and an optimized random forest classifier. Area under the receiver operating characteristic curve (AUC) and weighted F-score were used to measure the discriminative accuracy of a fully convolutional neural network, random forest, and traditional spirometry metrics to phenotype CT as normal, emphysema-predominant (>5% emphysema), airway-predominant (Pi10 > median), and mixed phenotypes. Similar comparisons were made for the detection of functional small airway disease phenotype (>20% on parametric response mapping).RESULTSAmong 8980 individuals, the neural network was more accurate in discriminating predominant emphysema/airway phenotypes (AUC 0.80, 95%CI 0.79-0.81) compared with traditional measures of spirometry, FEV1/FVC (AUC 0.71, 95%CI 0.69-0.71), FEV1% predicted (AUC 0.70, 95%CI 0.68-0.71), and random forest classifier (AUC 0.78, 95%CI 0.77-0.79). The neural network was also more accurate in discriminating predominant emphysema/small airway phenotypes (AUC 0.91, 95%CI 0.90-0.92) compared with FEV1/FVC (AUC 0.80, 95%CI 0.78-0.82), FEV1% predicted (AUC 0.83, 95%CI 0.80-0.84), and with comparable accuracy with random forest classifier (AUC 0.90, 95%CI 0.88-0.91).CONCLUSIONSStructural phenotypes of COPD can be identified from spirometry using deep-learning and machine-learning approaches, demonstrating their potential to identify individuals for targeted therapies.TRIAL REGISTRATIONClinicalTrials.gov NCT00608764.FUNDINGThis study was supported by NIH grants K23 HL133438 and R21EB027891 and an American Thoracic Foundation 2018 Unrestricted Research Grant. The COPDGene study is supported by NIH grants NHLBI U01 HL089897 and U01 HL089856. The COPDGene study (NCT00608764) is also supported by the COPD Foundation through contributions made to an Industry Advisory Committee comprising AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, and Sunovion.
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Affiliation(s)
- Sandeep Bodduluri
- UAB Lung Imaging Core.,UAB Lung Health Center.,Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Arie Nakhmani
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph M Reinhardt
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Carla G Wilson
- Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA
| | - Merry-Lynn McDonald
- UAB Lung Health Center.,Division of Pulmonary, Allergy and Critical Care Medicine, and
| | | | - Byron C Jaeger
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nirav R Bhakta
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University California, San Francisco, San Francisco, California, USA
| | - Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chengcui Zhang
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Purushotham V Bangalore
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Surya P Bhatt
- UAB Lung Imaging Core.,UAB Lung Health Center.,Division of Pulmonary, Allergy and Critical Care Medicine, and
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47
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Luyster FS, Wang J, Sciurba FC, Bon J. Longitudinal associations between sleep disturbance and disease severity in patients with COPD. Sleep Science Practice 2020. [DOI: 10.1186/s41606-020-00046-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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48
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Dransfield MT, Garner JL, Bhatt SP, Slebos DJ, Klooster K, Sciurba FC, Shah PL, Marchetti NT, Sue RD, Wright S, Rivas-Perez H, Wiese TA, Wahidi MM, Goulart de Oliveira H, Armstrong B, Radhakrishnan S, Shargill NS. Effect of Zephyr Endobronchial Valves on Dyspnea, Activity Levels, and Quality of Life at One Year. Results from a Randomized Clinical Trial. Ann Am Thorac Soc 2020; 17:829-838. [PMID: 32223724 PMCID: PMC7328183 DOI: 10.1513/annalsats.201909-666oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
Rationale: Bronchoscopic lung volume reduction with Zephyr Valves improves lung function, exercise tolerance, and quality of life of patients with hyperinflated emphysema and little to no collateral ventilation.Objectives:Post hoc analysis of patient-reported outcomes (PROs), including multidimensional measures of dyspnea, activity, and quality of life, in the LIBERATE (Lung Function Improvement after Bronchoscopic Lung Volume Reduction with Pulmonx Endobronchial Valves used in Treatment of Emphysema) study are reported.Methods: A total of 190 patients with severe heterogeneous emphysema and little to no collateral ventilation in the target lobe were randomized 2:1 to the Zephyr Valve or standard of care. Changes in PROs at 12 months in the two groups were compared: dyspnea with the Transitional Dyspnea Index (TDI), focal score; the Chronic Obstructive Pulmonary Disease Assessment Test (CAT; breathlessness on hill/stairs); Borg; the EXAcerbations of Chronic pulmonary disease Tool-PRO, dyspnea domain; activity with the TDI, magnitude of task/effort/functional impairment, CAT (limited activities), and the St. George's Respiratory Questionnaire (SGRQ), activity domain; and psychosocial status with the SGRQ, impacts domain, and CAT (confidence and energy).Results: At 12 months, patients using the Zephyr Valve achieved statistically significant and clinically meaningful improvements in the SGRQ; CAT; and the TDI, focal score, compared with standard of care. Improvements in the SGRQ were driven by the impacts and activity domains (P < 0.05 and P < 0.001, respectively). Reduction in CAT was through improvements in breathlessness (P < 0.05), energy level (P < 0.05), activities (P < 0.001), and increased confidence when leaving home (P < 0.05). The TDI measures of effort, task, and functional impairment were uniformly improved (P < 0.001). The EXAcerbations of Chronic Pulmonary Disease Tool (EXACT)-PRO, dyspnea domain, was significantly improved in the Zephyr Valve group. Improvements correlated with changes in residual volume and residual volume/TLC ratio.Conclusions: Patients with severe hyperinflated emphysema achieving lung volume reductions with Zephyr Valves experience improvements in multidimensional scores for breathlessness, activity, and psychosocial parameters out to at least 12 months.Clinical trial registered with www.clinicaltrials.gov (NCT01796392).
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Affiliation(s)
- Mark T. Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Justin L. Garner
- Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Surya P. Bhatt
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Karin Klooster
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Frank C. Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pallav L. Shah
- Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Nathaniel T. Marchetti
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Richard D. Sue
- St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Shawn Wright
- St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Hiram Rivas-Perez
- Department of Medicine, University of Louisville, Louisville, Kentucky
| | | | - Momen M. Wahidi
- Duke University Medical Center, Duke University, Durham, North Carolina
| | | | | | | | | | - for the LIBERATE Study Group
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
- Royal Brompton Hospital and Imperial College, London, United Kingdom
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
- St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
- Department of Medicine, University of Louisville, Louisville, Kentucky
- Norton Healthcare, Louisville, Kentucky
- Duke University Medical Center, Duke University, Durham, North Carolina
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- QST Consultations Ltd., Allendale, Michigan; and
- Pulmonx Corporation, Redwood City, California
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49
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Criner GJ, Sue R, Sciurba FC, Slebos DJ. Reply to Fitzmaurice et al.: The LIBERATE Trial: Options to Reduce the Risk of Post-procedural Pneumothorax and Length of Stay. Am J Respir Crit Care Med 2020; 198:1587-1588. [PMID: 30230349 DOI: 10.1164/rccm.201808-1477le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gerard J Criner
- Lewis Katz School of Medicine at Temple UniversityPhiladelphia, Pennsylvania
| | - Richard Sue
- St. Joseph's Hospital and Medical CenterPhoenix, Arizona
| | | | - Dirk-Jan Slebos
- University Medical Center GroningenGroningen, the Netherlands
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50
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Press VG, Gershon AS, Sciurba FC, Blagev DP. Concerns About Coronavirus Disease-Related Collateral Damage for Patients With COPD. Chest 2020; 158:866-868. [PMID: 32473947 PMCID: PMC7837125 DOI: 10.1016/j.chest.2020.05.549] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Valerie G Press
- Department of Medicine and Department of Pediatrics, University of Chicago, Chicago, IL.
| | | | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Denitza P Blagev
- Intermountain Healthcare and the Division of Pulmonary Medicine, University of Utah School of Medicine, Murray, UT
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