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Gerhardt F, Fiessler E, Olsson KM, Kayser MZ, Kovacs G, Gall H, Ghofrani HA, Badr Eslam R, Lang IM, Benjamin N, Grünig E, Halank M, Lange TJ, Ulrich S, Leuchte H, Held M, Klose H, Ewert R, Wilkens H, Pizarro C, Skowasch D, Wissmüller M, Hellmich M, Olschewski H, Hoeper MM, Rosenkranz S. Positive Vasoreactivity Testing in Pulmonary Arterial Hypertension: Therapeutic Consequences, Treatment Patterns, and Outcomes in the Modern Management Era. Circulation 2024. [PMID: 38606558 DOI: 10.1161/circulationaha.122.063821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/21/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Among patients with pulmonary arterial hypertension (PAH), acute vasoreactivity testing during right heart catheterization may identify acute vasoresponders, for whom treatment with high-dose calcium channel blockers (CCBs) is recommended. However, long-term outcomes in the current era remain largely unknown. We sought to evaluate the implications of acute vasoreactivity response for long-term response to CCBs and other outcomes. METHODS Patients diagnosed with PAH between January 1999 and December 2018 at 15 pulmonary hypertension centers were included and analyzed retrospectively. In accordance with current guidelines, acute vasoreactivity response was defined by a decrease of mean pulmonary artery pressure by ≥10 mm Hg to reach <40 mm Hg, without a decrease in cardiac output. Long-term response to CCBs was defined as alive with unchanged initial CCB therapy with or without other initial PAH therapy and World Health Organization functional classification I/II or low European Society of Cardiology/European Respiratory Society risk status at 12 months after initiation of CCBs. Patients were followed for up to 5 years; clinical measures, outcome, and subsequent treatment patterns were captured. RESULTS Of 3702 patients undergoing right heart catheterization for PAH diagnosis, 2051 had idiopathic, hereditary, or drug-induced PAH, of whom 1904 (92.8%) underwent acute vasoreactivity testing. A total of 162 patients fulfilled acute vasoreactivity response criteria and received an initial CCB alone (n=123) or in combination with another PAH therapy (n=39). The median follow-up time was 60.0 months (interquartile range, 30.8-60.0), during which overall survival was 86.7%. At 12 months, 53.2% remained on CCB monotherapy, 14.7% on initial CCB plus another initial PAH therapy, and the remaining patients had the CCB withdrawn or PAH therapy added. CCB long-term response was found in 54.3% of patients. Five-year survival was 98.5% in long-term responders versus 73.0% in nonresponders. In addition to established vasodilator responder criteria, pulmonary artery compliance at acute vasoreactivity testing, low risk status and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels at early follow-up correlated with long-term response and predicted survival. CONCLUSIONS Our data display heterogeneity within the group of vasoresponders, with a large subset failing to show a sustained satisfactory clinical response to CCBs. This highlights the necessity for comprehensive reassessment during early follow-up. The use of pulmonary artery compliance in addition to current measures may better identify those likely to have a good long-term response.
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Affiliation(s)
- Felix Gerhardt
- Department of Cardiology, Heart Center at the University Hospital Cologne, Germany (F.G., E.F., M.W., S.R.)
- Cologne Cardiovascular Research Center, University of Cologne, Germany (F.G., E.F., M.W., S.R.)
| | - Eva Fiessler
- Department of Cardiology, Heart Center at the University Hospital Cologne, Germany (F.G., E.F., M.W., S.R.)
- Cologne Cardiovascular Research Center, University of Cologne, Germany (F.G., E.F., M.W., S.R.)
| | - Karen M Olsson
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Germany (K.M.O., M.Z.K., M.M.H.)
- German Center for Lung Research, Neuherberg, Germany (K.M.O., M.Z.K., H.G., H.A.G., E.G., H.L., M.M.H.)
| | - Moritz Z Kayser
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Germany (K.M.O., M.Z.K., M.M.H.)
- German Center for Lung Research, Neuherberg, Germany (K.M.O., M.Z.K., H.G., H.A.G., E.G., H.L., M.M.H.)
| | - Gabor Kovacs
- Klinische Abteilung für Lungenkrankheiten, Klinik für Innere Medizin, Medizinische Universität Graz, Austria (G.K., H.O.)
- Ludwig Boltzmann Institut für Lungengefäßforschung, Graz, Austria (G.K., H.O.)
| | - Henning Gall
- German Center for Lung Research, Neuherberg, Germany (K.M.O., M.Z.K., H.G., H.A.G., E.G., H.L., M.M.H.)
- Abteilung Pneumologie, Medizinische Klink II, Universitätsklinikum Gießen und Marburg, Universities of Gießen & Marburg Lung Center, Standort Gießen, Germany (H.G., H.A.G.)
| | - H Ardeschir Ghofrani
- German Center for Lung Research, Neuherberg, Germany (K.M.O., M.Z.K., H.G., H.A.G., E.G., H.L., M.M.H.)
- Abteilung Pneumologie, Medizinische Klink II, Universitätsklinikum Gießen und Marburg, Universities of Gießen & Marburg Lung Center, Standort Gießen, Germany (H.G., H.A.G.)
| | - Roza Badr Eslam
- Klinik für Innere Medizin II, Abteilung Kardiologie, Medizinische Universität Wien, Austria (R.B.E., I.M.L.)
| | - Irene M Lang
- Klinik für Innere Medizin II, Abteilung Kardiologie, Medizinische Universität Wien, Austria (R.B.E., I.M.L.)
| | - Nicola Benjamin
- Zentrum für Pulmonale Hypertonie, Thoraxklinik, Universitätsklinikum Heidelberg, Germany (N.B., E.G.)
| | - Ekkehard Grünig
- German Center for Lung Research, Neuherberg, Germany (K.M.O., M.Z.K., H.G., H.A.G., E.G., H.L., M.M.H.)
- Zentrum für Pulmonale Hypertonie, Thoraxklinik, Universitätsklinikum Heidelberg, Germany (N.B., E.G.)
| | - Michael Halank
- Medizinische Klinik I, Universitätsklinik Carl Gustav Carus, TU Dresden, Germany (M. Halank)
| | - Tobias J Lange
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Germany (T.J.L.)
| | - Silvia Ulrich
- Klinik für Pneumologie, Universitätsspital Zürich, Switzerland (S.U.)
| | - Hanno Leuchte
- German Center for Lung Research, Neuherberg, Germany (K.M.O., M.Z.K., H.G., H.A.G., E.G., H.L., M.M.H.)
- Klinik der barmherzigen Schwestern, Krhs Neuwittelsbach, LMU München, Germany (H.L.)
| | - Matthias Held
- Medizinische Klinik mit Schwerpunkt Pneumologie, Missioklinik Würzburg, Germany (M. Held)
| | - Hans Klose
- Centrum für Pulmonale Hypertonie Hamburg, Sektion Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Germany (H.K.)
| | - Ralf Ewert
- Klinik für Innere Medizin, Pneumologie/Infektiologie, Universitätsklinik Greifswald, Germany (R.E.)
| | - Heinrike Wilkens
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg, Germany (H.W.)
| | - Carmen Pizarro
- Medizinische Klinik II, Universitätsklinikum Bonn, Germany (C.P., D.S.)
| | - Dirk Skowasch
- Medizinische Klinik II, Universitätsklinikum Bonn, Germany (C.P., D.S.)
| | - Max Wissmüller
- Department of Cardiology, Heart Center at the University Hospital Cologne, Germany (F.G., E.F., M.W., S.R.)
- Cologne Cardiovascular Research Center, University of Cologne, Germany (F.G., E.F., M.W., S.R.)
| | - Martin Hellmich
- Institut für Medizinische Statistik und Bioinformatik, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Germany (M. Hellmich)
| | - Horst Olschewski
- Klinische Abteilung für Lungenkrankheiten, Klinik für Innere Medizin, Medizinische Universität Graz, Austria (G.K., H.O.)
- Ludwig Boltzmann Institut für Lungengefäßforschung, Graz, Austria (G.K., H.O.)
| | - Marius M Hoeper
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Germany (K.M.O., M.Z.K., M.M.H.)
- German Center for Lung Research, Neuherberg, Germany (K.M.O., M.Z.K., H.G., H.A.G., E.G., H.L., M.M.H.)
| | - Stephan Rosenkranz
- Department of Cardiology, Heart Center at the University Hospital Cologne, Germany (F.G., E.F., M.W., S.R.)
- Cologne Cardiovascular Research Center, University of Cologne, Germany (F.G., E.F., M.W., S.R.)
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Zeder K, Marsh LM, Avian A, Brcic L, Birnhuber A, Douschan P, Foris V, Sassmann T, Hoetzenecker K, Böhm P, Kwapiszewska G, Olschewski A, Olschewski H, Kovacs G. Compartment-specific remodeling patterns in end-stage chronic obstructive pulmonary disease with and without severe pulmonary hypertension. J Heart Lung Transplant 2024:S1053-2498(24)01087-8. [PMID: 38382583 DOI: 10.1016/j.healun.2024.02.1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024] Open
Abstract
RATIONALE In end-stage COPD patients, severe pulmonary hypertension (PH) is frequently associated with less severe airway obstruction as compared to mild or no PH. However, the histologic correlate of this finding is not clear. OBJECTIVE To quantify remodeling of pulmonary arteries, airways and parenchyma in random samples of explanted end-stage COPD lungs. METHODS We quantified thickening of small pulmonary arteries, remodeling of small airways and the degree of emphysema (mean interseptal distance, MID) with dedicated software. As primary objective, we compared COPD patients with severe PH (SevPH-COPD) with age- and sex matched MildPH-COPD. For comparison, we also investigated COPD lungs with no PH (NoPH-COPD), idiopathic PAH (IPAH), and healthy donors. RESULTS We included n=17 SevPH-COPD (mPAP=43 [39-45]mmHg), n=17 MildPH-COPD (mPAP=28 [24-31]mmHg), n=5 NoPH-COPD (mPAP=18 [16-19]mmHg), n=10 IPAH (mPAP=72 [65-91]mmHg) and n=10 healthy donor lungs. SevPH-COPD vs. MildPH-COPD was characterized by better preserved forced vital capacity (51%vs.40%predicted,p<0.05), less emphysema (MID 169µmvs.279µm,p<0.001), and less PAS-positive and CD45-positive mucosa cells (15%vs.22%,p=0.063 and 5%vs.7%,p=0.058) suggesting less airway inflammation. Over the full range of COPD, intimal and medial thickening were strongly correlated with mPAP (r=0.676,p<0.001 and r=0.595,p<0.001). MID was negatively correlated with mPAP (r=-0.556,p<0.001) and was highest in NoPH-COPD (mean 281µm), suggesting that emphysema per se is not associated with PH. CONCLUSION End-stage COPD with severe PH is characterized by pronounced pulmonary vascular remodeling, less inflammation of small airways and less emphysema as compared to COPD with mild PH or no PH, suggesting that COPD with severe PH may represent a unique phenotype of COPD.
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Affiliation(s)
- Katarina Zeder
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Luka Brcic
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Diagnostic and Research Institute of Pathology, Medical University of Graz
| | - Anna Birnhuber
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Philipp Douschan
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Vasile Foris
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Teresa Sassmann
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria, Vienna, Austria
| | - Panja Böhm
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria, Vienna, Austria
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria; Institute for Lung Health, Giessen, Germany
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Pienn M, Gertz RJ, Gerhardt F, Kröger JR, Zaytoun H, Reimer RP, Kaplan A, Wissmüller M, Kovacs G, Rosenkranz S, Olschewski H, Bunck AC. CT-derived lung vessel morphology correlates with prognostic markers in precapillary pulmonary hypertension. J Heart Lung Transplant 2024; 43:54-65. [PMID: 37619642 DOI: 10.1016/j.healun.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/30/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND While computed tomography pulmonary angiography (CTPA) is an integral part of the work-up in patients with suspected pulmonary hypertension (PH), there is no established CTPA-derived prognostic marker. We aimed to assess whether quantitative readouts of lung vessel morphology correlate with established prognostic indicators in PH. METHODS We applied a fully-automatic in-house developed algorithm for segmentation of arteries and veins to determine lung vessel morphology in patients with precapillary PH who underwent right heart catheterization and CTPA between May 2016 and May 2019. Primary endpoint of this retrospective study was the calculation of receiver operating characteristics for identifying low and high mortality risk according to the 3-strata risk assessment model presented in the current guidelines. RESULTS We analyzed 73 patients, median age 65 years (interquartile range (IQR): 54-76), female/male ratio 35/38, median mean pulmonary arterial pressure 37 mm Hg (IQR: 30-46), and found significant correlations with important prognostic factors in pulmonary arterial hypertension. N-terminal pro-brain natriuretic peptide, cardiac index, mixed venous oxygen saturation, and 6-minute walking distance were correlated with the ratio of the number of arteries over veins with vessel diameters of 6-10 mm (Spearman correlation coefficients ρ = 0.64, p < 0.001; ρ = -0.60, p < 0.001; ρ = -0.47, p = 0.005; ρ = -0.45, p = 0.001, respectively). This ratio predicted a low- and high-risk score with an area under the curve of 0.73 (95% confidence interval (CI): 0.56-0.90) and 0.86 (95% CI: 0.74-0.97), respectively. CONCLUSIONS The ratio of the number of arteries over veins with diameters between 6 and 10 mm is significantly correlated with prognostic markers in pulmonary hypertension and predicts low and high mortality risk.
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Affiliation(s)
- Michael Pienn
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Roman J Gertz
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Felix Gerhardt
- Department of Cardiology and Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan R Kröger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Hasan Zaytoun
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robert P Reimer
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anil Kaplan
- Department of Cardiology and Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Max Wissmüller
- Department of Cardiology and Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Stephan Rosenkranz
- Department of Cardiology and Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander C Bunck
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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4
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Nizhnikava V, Reiter U, Kovacs G, Reiter C, Kräuter C, Olschewski H, Fuchsjäger M, Reiter G. Myocardial strain parameters in pulmonary hypertension are determined by changes in volumetric function rather than by hemodynamic alterations. Eur J Radiol 2024; 170:111187. [PMID: 37995513 DOI: 10.1016/j.ejrad.2023.111187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To investigate associations of cardiac magnetic resonance feature-tracking-derived left (LV) and right ventricular (RV) global myocardial peak strains and strain rates with volumetric function and hemodynamic parameters to identify the major determinants of myocardial strain alterations in pulmonary hypertension (PH). METHODS Sixty-seven patients with PH or at risk of developing PH underwent right heart catheterization (RHC) and cine realtime imaging at 3 T. RHC parameters included mean pulmonary arterial pressure (mPAP), which was used for the diagnosis of PH. LV and RV volumetric function and feature-tracking-derived global radial, circumferential, and longitudinal (GLS) peak strains, together with their strain rates, were evaluated from cine images using routine software. Furthermore, myocardial strain parameters of 24 healthy subjects were evaluated as controls. Means were compared by t-test; relationships between parameters were investigated by correlation and regression analysis. RESULTS Compared to controls, RV-GLS, all RV systolic strain rates and the LV systolic longitudinal strain rate showed lower magnitudes in PH (RV-GLS: -21 ± 4% vs. -16 ± 5%, p < 0.0001); the strongest univariate correlate to mPAP was the RV-GLS (r = 0.59). All LV and RV strain parameters yielded stronger correlations with their respective ejection fractions. In bi-linear models using mPAP and ejection fraction as predictors, mPAP remained significant only for diastolic LV radial and circumferential strain rates. CONCLUSION Impairment of myocardial strains is more strongly associated with alterations in LV and RV volumetric function parameters than elevated mPAP, therefore limiting diagnostic information of myocardial strain parameters in PH.
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Affiliation(s)
- Volha Nizhnikava
- Department of Radiology, Medical University of Graz, Austria; Department of Radiology, Kantonsspital Graubuenden, Chur, Switzerland.
| | - Ursula Reiter
- Department of Radiology, Medical University of Graz, Austria.
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria & LBI for Lung Vascular Research Graz, Austria.
| | - Clemens Reiter
- Department of Radiology, Medical University of Graz, Austria.
| | - Corina Kräuter
- Department of Radiology, Medical University of Graz, Austria.
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria & LBI for Lung Vascular Research Graz, Austria.
| | | | - Gert Reiter
- Department of Radiology, Medical University of Graz, Austria; Research & Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria.
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Olschewski H, Zeder K, Douschan P, Sassmann T, Foris V, Olschewski A, Kovacs G. Let's Talk About Respiratory Swings! Am J Respir Crit Care Med 2023; 208:1338-1340. [PMID: 37871311 PMCID: PMC10765390 DOI: 10.1164/rccm.202309-1637le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/20/2023] [Indexed: 10/25/2023] Open
Affiliation(s)
- Horst Olschewski
- Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Katarina Zeder
- Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Philipp Douschan
- Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany; and
| | - Teresa Sassmann
- Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Vasile Foris
- Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Experimental Anesthesiology, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Gabor Kovacs
- Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
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6
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Bordag N, Nagy BM, Zügner E, Ludwig H, Foris V, Nagaraj C, Biasin V, Bodenhofer U, Magnes C, Maron BA, Ulrich S, Lange TJ, Hötzenecker K, Pieber T, Olschewski H, Olschewski A. Lipidomics for diagnosis and prognosis of pulmonary hypertension. medRxiv 2023:2023.05.17.23289772. [PMID: 37292870 PMCID: PMC10246148 DOI: 10.1101/2023.05.17.23289772] [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: 06/10/2023]
Abstract
Background Pulmonary hypertension (PH) poses a significant health threat with high morbidity and mortality, necessitating improved diagnostic tools for enhanced management. Current biomarkers for PH lack functionality and comprehensive diagnostic and prognostic capabilities. Therefore, there is a critical need to develop biomarkers that address these gaps in PH diagnostics and prognosis. Methods To address this need, we employed a comprehensive metabolomics analysis in 233 blood based samples coupled with machine learning analysis. For functional insights, human pulmonary arteries (PA) of idiopathic pulmonary arterial hypertension (PAH) lungs were investigated and the effect of extrinsic FFAs on human PA endothelial and smooth muscle cells was tested in vitro. Results PA of idiopathic PAH lungs showed lipid accumulation and altered expression of lipid homeostasis-related genes. In PA smooth muscle cells, extrinsic FFAs caused excessive proliferation and endothelial barrier dysfunction in PA endothelial cells, both hallmarks of PAH.In the training cohort of 74 PH patients, 30 disease controls without PH, and 65 healthy controls, diagnostic and prognostic markers were identified and subsequently validated in an independent cohort. Exploratory analysis showed a highly impacted metabolome in PH patients and machine learning confirmed a high diagnostic potential. Fully explainable specific free fatty acid (FFA)/lipid-ratios were derived, providing exceptional diagnostic accuracy with an area under the curve (AUC) of 0.89 in the training and 0.90 in the validation cohort, outperforming machine learning results. These ratios were also prognostic and complemented established clinical prognostic PAH scores (FPHR4p and COMPERA2.0), significantly increasing their hazard ratios (HR) from 2.5 and 3.4 to 4.2 and 6.1, respectively. Conclusion In conclusion, our research confirms the significance of lipidomic alterations in PH, introducing innovative diagnostic and prognostic biomarkers. These findings may have the potential to reshape PH management strategies.
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Affiliation(s)
- Natalie Bordag
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- CBmed GmbH, Center for Biomarker Research in Medicine, Graz, Austria
- BioMedTech, Graz, Austria
| | - Bence Miklos Nagy
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Elmar Zügner
- Institute for Biomedical Research and Technologies (HEALTH), Joanneum Research Forschungsgesellschaft m.b.H, Graz, Austria
| | - Helga Ludwig
- School of Informatics, Communications, and Media, University of Applied Sciences Upper Austria, Hagenberg, Austria
| | - Vasile Foris
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Chandran Nagaraj
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- BioMedTech, Graz, Austria
| | - Valentina Biasin
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Physiology, Otto Loewi Research Centre, Medical University of Graz, Graz, Austria
| | - Ulrich Bodenhofer
- School of Informatics, Communications, and Media, University of Applied Sciences Upper Austria, Hagenberg, Austria
| | - Christoph Magnes
- Institute for Biomedical Research and Technologies (HEALTH), Joanneum Research Forschungsgesellschaft m.b.H, Graz, Austria
| | - Bradley A. Maron
- University of Maryland School of Medicine, Baltimore, MD and The University of Maryland-Institute for Health Computing, Bethesda, MD, USA
| | - Silvia Ulrich
- Clinic of Pulmonology, University and University Hospital of Zurich, Zürich, Switzerland
| | - Tobias J. Lange
- Department of Internal Medicine II, Pulmonology and Critical Care, Kreisklinik Bad Reichenhall, Bad Reichenhall, Germany
- Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Konrad Hötzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Pieber
- CBmed GmbH, Center for Biomarker Research in Medicine, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz Austria
- BioMedTech, Graz, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioMedTech, Graz, Austria
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
- BioMedTech, Graz, Austria
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7
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Horner A, Olschewski H, Hartl S, Valipour A, Funk GC, Studnicka M, Merkle M, Kaiser B, Wallner EM, Brecht S, Lamprecht B. Physical Activity, Depression and Quality of Life in COPD - Results from the CLARA II Study. Int J Chron Obstruct Pulmon Dis 2023; 18:2755-2767. [PMID: 38050481 PMCID: PMC10693753 DOI: 10.2147/copd.s435278] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023] Open
Abstract
Background Symptoms of depression, pain and limitations in physical activity may affect quality of life in COPD patients independent from their respiratory burden. We aimed to analyze the associations of these factors in outpatients with COPD in Austria in a stable phase of disease. Methods We conducted a national, cross-sectional study among patients with COPD. For depression, the Patient Health Questionnaire-9 (PHQ-9) and for respiratory symptoms the St. George's Respiratory Questionnaire for COPD patients (SGRQ-C) were used along with 10-point scales for physical activity and pain. Results After exclusion of 211 patients due to non-obstructive spirometry or missing data, 630 patients (62.5% men; mean age 66.8 ± 8.6 (SD) years; mean FEV1%pred. 54.3 ± 16.5 (SD)) were analyzed. Of these, 47% reported one or more exacerbations in the previous year, 10.4% with hospitalization. A negative depression score was found in 54% and a score suggesting severe depression (PHQ-9 score ≥ 15) in 4.7%. In a multivariate linear regression model, self-reported pain, dyspnea, and number of exacerbations were predictors for higher PHQ-9-scores. A negative pain score was found in 43.8%, and a score suggesting severe pain in 2.9% (8-10 points of 10-point scale). Patients reporting severe pain were more often female, had more exacerbations, and reported more respiratory and depressive symptoms, a lower quality of life, and less physical activity. About 46% of patients rated their physical activity as severely impaired. These patients were significantly older, had more exacerbations, concomitant heart disease, a higher pain and depression score, and a lower quality of life (SGRQ-C - total score and all subscores). Conclusions In Austria, nearly half of stable COPD outpatients reported symptoms of depression, which were associated with lower levels of self-reported physical activity, more pain, and respiratory symptoms. The associations were particularly strong for depression with SGRQ-C.
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Affiliation(s)
- Andreas Horner
- Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Sylvia Hartl
- Department of Respiratory and Critical Care Medicine, Klinik Penzing and Sigmund Freud University, Medical School, Vienna, Austria
| | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Georg-Christian Funk
- Department of Internal and Respiratory Medicine, Klinik Ottakring, Vienna, Austria
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Monika Merkle
- Specialist Office for Pulmonology Dr. Merkle, Vienna, Austria
| | - Bernhard Kaiser
- Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria
| | | | | | - Bernd Lamprecht
- Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria
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8
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Douschan P, Egenlauf B, Gall H, Grünig E, Hager A, Heberling M, Koehler T, Olschewski H, Seyfarth HJ, Yogeswaran A, Ulrich S, Kovacs G. [New definition and classification of pulmonary hypertension]. Pneumologie 2023; 77:854-861. [PMID: 37963475 DOI: 10.1055/a-2145-4648] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
In the recent ESC/ERS guidelines on the diagnosis and management of pulmonary hypertension (PH) several important changes have been made in respect of the definition and classification of PH.The mPAP cut-off for defining PH was lowered. PH is now defined by an mPAP > 20 mmHg assessed by right heart catheterization. Moreover, the PVR threshold for defining precapillary PH was lowered. Precapillary PH is now defined by a PVR > 2 WU and a pulmonary arterial wedge pressure (PAWP) ≤ 15 mmHg. Furthermore, the increasing evidence for the clinical relevance of pulmonary exercise hemodynamics led to the reintroduction of exercise pulmonary hypertension (EPH) 1. EPH is characterized by a mPAP/CO-slope > 3 mmHg/L/min during exercise testing. In the classification of PH five groups are distinguished: Pulmonary arterial hypertension (group 1), PH associated with left heart disease (group 2), PH associated with lung diseases and/or hypoxia (Group 3), PH associated with pulmonary artery obstructions (group 4) and PH with unclear and/or multi-factorial mechanisms (group 5).In the following guideline-translation we focus on novel aspects regarding the definition and classification of PH and to provide additional background information.
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Affiliation(s)
- Philipp Douschan
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Benjamin Egenlauf
- Zentrum für Pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany
- Abteilung für Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Henning Gall
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Alfred Hager
- Department for Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Melanie Heberling
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Med. Klinik I, Bereich Pneumologie, Dresden, Deutschland
| | - Thomas Koehler
- Universitätsklinikum Freiburg, Department Innere Medizin, Klinik für Pneumologie, Freiburg, Deutschland
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Hans-Jürgen Seyfarth
- Department of Pneumology, Medical Clinic II, University Hospital of Leipzig, Leipzig, Germany
| | - Athiththan Yogeswaran
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Silvia Ulrich
- Klinik für Pneumologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
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9
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Mutgan AC, Jandl K, Radic N, Valzano F, Kolb D, Hoffmann J, Foris V, Wilhelm J, Boehm PM, Hoetzenecker K, Olschewski A, Olschewski H, Heinemann A, Wygrecka M, Marsh LM, Kwapiszewska G. Pentastatin, a matrikine of the collagen IVα5, is a novel endogenous mediator of pulmonary endothelial dysfunction. Am J Physiol Cell Physiol 2023; 325:C1294-C1312. [PMID: 37694286 DOI: 10.1152/ajpcell.00391.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
Deposition of basement membrane components, such as collagen IVα5, is associated with altered endothelial cell function in pulmonary hypertension. Collagen IVα5 harbors a functionally active fragment within its C-terminal noncollageneous (NC1) domain, called pentastatin, whose role in pulmonary endothelial cell behavior remains unknown. Here, we demonstrate that pentastatin serves as a mediator of pulmonary endothelial cell dysfunction, contributing to pulmonary hypertension. In vitro, treatment with pentastatin induced transcription of immediate early genes and proinflammatory cytokines and led to a functional loss of endothelial barrier integrity in pulmonary arterial endothelial cells. Mechanistically, pentastatin leads to β1-integrin subunit clustering and Rho/ROCK activation. Blockage of the β1-integrin subunit or the Rho/ROCK pathway partially attenuated the pentastatin-induced endothelial barrier disruption. Although pentastatin reduced the viability of endothelial cells, smooth muscle cell proliferation was induced. These effects on the pulmonary vascular cells were recapitulated ex vivo in the isolated-perfused lung model, where treatment with pentastatin-induced swelling of the endothelium accompanied by occasional endothelial cell apoptosis. This was reflected by increased vascular permeability and elevated pulmonary arterial pressure induced by pentastatin. This study identifies pentastatin as a mediator of endothelial cell dysfunction, which thus might contribute to the pathogenesis of pulmonary vascular disorders such as pulmonary hypertension.NEW & NOTEWORTHY This study is the first to show that pentastatin, the matrikine of the basement membrane (BM) collagen IVα5 polypeptide, triggers rapid pulmonary arterial endothelial cell barrier disruption, activation, and apoptosis in vitro and ex vivo. Mechanistically, pentastatin partially acts through binding to the β1-integrin subunit and the Rho/ROCK pathway. These findings are the first to link pentastatin to pulmonary endothelial dysfunction and, thus, suggest a major role for BM-matrikines in pulmonary vascular diseases such as pulmonary hypertension.
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Affiliation(s)
- Ayse Ceren Mutgan
- Division of Physiology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Katharina Jandl
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Nemanja Radic
- Division of Physiology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Francesco Valzano
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Dagmar Kolb
- Core Facility Ultrastructure Analysis, Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Julia Hoffmann
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Vasile Foris
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Jochen Wilhelm
- Institute for Lung Health, Member of the German Lung Center (DZL), Giessen, Germany
| | - Panja M Boehm
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Akos Heinemann
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Malgorzata Wygrecka
- Institute for Lung Health, Member of the German Lung Center (DZL), Giessen, Germany
- Center for Infection and Genomics of the Lung, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Leigh M Marsh
- Division of Physiology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Grazyna Kwapiszewska
- Division of Physiology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Institute for Lung Health, Member of the German Lung Center (DZL), Giessen, Germany
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10
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Jandl K, Berg JL, Birnhuber A, Fliesser E, Borek I, Seeliger B, David S, Schmidt JJ, Gorkiewicz G, Zacharias M, Welte T, Olschewski H, Heinemann A, Wygrecka M, Kwapiszewska G. Basement membrane product, endostatin, as a link between inflammation, coagulation and vascular permeability in COVID-19 and non-COVID-19 acute respiratory distress syndrome. Front Immunol 2023; 14:1188079. [PMID: 37283766 PMCID: PMC10241244 DOI: 10.3389/fimmu.2023.1188079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 06/08/2023] Open
Abstract
Background Immune cell recruitment, endothelial cell barrier disruption, and platelet activation are hallmarks of lung injuries caused by COVID-19 or other insults which can result in acute respiratory distress syndrome (ARDS). Basement membrane (BM) disruption is commonly observed in ARDS, however, the role of newly generated bioactive BM fragments is mostly unknown. Here, we investigate the role of endostatin, a fragment of the BM protein collagen XVIIIα1, on ARDS associated cellular functions such as neutrophil recruitment, endothelial cell barrier integrity, and platelet aggregation in vitro. Methods In our study we analyzed endostatin in plasma and post-mortem lung specimens of patients with COVID-19 and non-COVID-19 ARDS. Functionally, we investigated the effect of endostatin on neutrophil activation and migration, platelet aggregation, and endothelial barrier function in vitro. Additionally, we performed correlation analysis for endostatin and other critical plasma parameters. Results We observed increased plasma levels of endostatin in our COVID-19 and non-COVID-19 ARDS cohort. Immunohistochemical staining of ARDS lung sections depicted BM disruption, alongside immunoreactivity for endostatin in proximity to immune cells, endothelial cells, and fibrinous clots. Functionally, endostatin enhanced the activity of neutrophils, and platelets, and the thrombin-induced microvascular barrier disruption. Finally, we showed a positive correlation of endostatin with soluble disease markers VE-Cadherin, c-reactive protein (CRP), fibrinogen, and interleukin (IL)-6 in our COVID-19 cohort. Conclusion The cumulative effects of endostatin on propagating neutrophil chemotaxis, platelet aggregation, and endothelial cell barrier disruption may suggest endostatin as a link between those cellular events in ARDS pathology.
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Affiliation(s)
- Katharina Jandl
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Johannes Lorenz Berg
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Otto Loewi Research Center, Division of Physiology and Pathophysiology, Medical University of Graz, Graz, Austria
| | - Anna Birnhuber
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Otto Loewi Research Center, Division of Physiology and Pathophysiology, Medical University of Graz, Graz, Austria
| | | | - Izabela Borek
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Benjamin Seeliger
- Department of Respiratory Medicine/Infectious Diseases, Hannover Medical School, Member of the German Lung Center (DZL), Hannover, Germany
| | - Sascha David
- Institute of Intensive Care, University Hospital Zurich, Zurich, Switzerland
| | - Julius J. Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Gregor Gorkiewicz
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - Martin Zacharias
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - Tobias Welte
- Department of Respiratory Medicine/Infectious Diseases, Hannover Medical School, Member of the German Lung Center (DZL), Hannover, Germany
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Akos Heinemann
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Graz, Austria
| | - Malgorzata Wygrecka
- Center for Infection and Genomics of the Lung, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center (DZL), Giessen, Germany
- Institute for Lung Health, Member of the German Lung Center (DZL), Giessen, Germany
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Otto Loewi Research Center, Division of Physiology and Pathophysiology, Medical University of Graz, Graz, Austria
- Institute for Lung Health, Member of the German Lung Center (DZL), Giessen, Germany
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11
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Myronenko O, Foris V, Crnkovic S, Olschewski A, Rocha S, Nicolls MR, Olschewski H. Endotyping COPD: hypoxia-inducible factor-2 as a molecular "switch" between the vascular and airway phenotypes? Eur Respir Rev 2023; 32:220173. [PMID: 36631133 PMCID: PMC9879331 DOI: 10.1183/16000617.0173-2022] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/08/2022] [Indexed: 01/13/2023] Open
Abstract
COPD is a heterogeneous disease with multiple clinical phenotypes. COPD endotypes can be determined by different expressions of hypoxia-inducible factors (HIFs), which, in combination with individual susceptibility and environmental factors, may cause predominant airway or vascular changes in the lung. The pulmonary vascular phenotype is relatively rare among COPD patients and characterised by out-of-proportion pulmonary hypertension (PH) and low diffusing capacity of the lung for carbon monoxide, but only mild-to-moderate airway obstruction. Its histologic feature, severe remodelling of the small pulmonary arteries, can be mediated by HIF-2 overexpression in experimental PH models. HIF-2 is not only involved in the vascular remodelling but also in the parenchyma destruction. Endothelial cells from human emphysema lungs express reduced HIF-2α levels, and the deletion of pulmonary endothelial Hif-2α leads to emphysema in mice. This means that both upregulation and downregulation of HIF-2 have adverse effects and that HIF-2 may represent a molecular "switch" between the development of the vascular and airway phenotypes in COPD. The mechanisms of HIF-2 dysregulation in the lung are only partly understood. HIF-2 levels may be controlled by NAD(P)H oxidases via iron- and redox-dependent mechanisms. A better understanding of these mechanisms may lead to the development of new therapeutic targets.
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Affiliation(s)
- Oleh Myronenko
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Vasile Foris
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Slaven Crnkovic
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Sonia Rocha
- Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Mark R Nicolls
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
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12
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Jandl K, Marsh LM, Mutgan AC, Crnkovic S, Valzano F, Zabini D, Hoffmann J, Foris V, Gschwandtner E, Klepetko W, Prosch H, Flick H, Brcic L, Kern I, Heinemann A, Olschewski H, Kovacs G, Kwapiszewska G. Reply to Wang and Zhou. Am J Respir Crit Care Med 2023; 207:796-798. [PMID: 36638560 PMCID: PMC10037480 DOI: 10.1164/rccm.202212-2214le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Katharina Jandl
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Otto Loewi Research Center, Division of Pharmacology
| | - Leigh M. Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Otto Loewi Research Center, Division of Physiology
| | - Ayse Ceren Mutgan
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Otto Loewi Research Center, Division of Physiology
| | - Slaven Crnkovic
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Otto Loewi Research Center, Division of Physiology
| | - Francesco Valzano
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Diana Zabini
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Otto Loewi Research Center, Division of Physiology
| | - Julia Hoffmann
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Vasile Foris
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, and
| | | | | | - Helmut Prosch
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, and
| | - Luka Brcic
- Diagnostic and Research Center for Molecular BioMedicine, Diagnostic & Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Izidor Kern
- Cytology and Pathology Laboratory University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | | | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, and
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, and
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Otto Loewi Research Center, Division of Physiology
- Institute for Lung Health, Giessen, Germany
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13
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Bruni C, Occhipinti M, Pienn M, Camiciottoli G, Bartolucci M, Bosello SL, Payer C, Bálint Z, Larici AR, Tottoli A, Tofani L, De Lorenzis E, Lepri G, Bellando-Randone S, Spinella A, Giuggioli D, Masini F, Cuomo G, Lavorini F, Colagrande S, Olschewski H, Matucci-Cerinic M. Lung vascular changes as biomarkers of severity in systemic sclerosis-associated interstitial lung disease. Rheumatology (Oxford) 2023; 62:696-706. [PMID: 35708639 DOI: 10.1093/rheumatology/keac311] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES It has recently become possible to assess lung vascular and parenchymal changes quantitatively in thoracic CT images using automated software tools. We investigated the vessel parameters of patients with SSc, quantified by CT imaging, and correlated them with interstitial lung disease (ILD) features. METHODS SSc patients undergoing standard of care pulmonary function testing and CT evaluation were retrospectively evaluated. CT images were analysed for ILD patterns and total pulmonary vascular volume (PVV) extents with Imbio lung texture analysis. Vascular analysis (volumes, numbers and densities of vessels, separating arteries and veins) was performed with an in-house developed software. A threshold of 5% ILD extent was chosen to define the presence of ILD, and commonly used cut-offs of lung function were adopted. RESULTS A total of 79 patients [52 women, 40 ILD, mean age 56.2 (s.d. 14.2) years, total ILD extent 9.5 (10.7)%, PVV/lung volume % 2.8%] were enrolled. Vascular parameters for total and separated PVV significantly correlated with functional parameters and ILD pattern extents. SSc-associated ILD (SSc-ILD) patients presented with an increased number and volume of arterial vessels, in particular those between 2 and 4 mm of diameter, and with a higher density of arteries and veins of <6 mm in diameter. Considering radiological and functional criteria concomitantly, as well as the descriptive trends from the longitudinal evaluations, the normalized PVVs, vessel numbers and densities increased progressively with the increase/worsening of ILD extent and functional impairment. CONCLUSION In SSc patients CT vessel parameters increase in parallel with ILD extent and functional impairment, and may represent a biomarker of SSc-ILD severity.
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Affiliation(s)
- Cosimo Bruni
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Michael Pienn
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Gianna Camiciottoli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Department of CardioThoracoVascular, Careggi University Hospital, Florence
| | | | - Silvia Laura Bosello
- Department of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy
| | - Christian Payer
- Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria
| | - Zoltán Bálint
- Faculty of Physics, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Anna Rita Larici
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore.,Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome
| | - Alessandra Tottoli
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Lorenzo Tofani
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Department of Statistics, Computer Science, Applications, University of Florence, Florence
| | - Enrico De Lorenzis
- Department of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy
| | - Gemma Lepri
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Silvia Bellando-Randone
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Amelia Spinella
- Scleroderma Unit, Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria di Modena, Modena
| | - Dilia Giuggioli
- Scleroderma Unit, Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria di Modena, Modena
| | - Francesco Masini
- Department of Medicine of Precision, University of Campania L. Vanvitelli, Naples
| | - Giovanna Cuomo
- Department of Medicine of Precision, University of Campania L. Vanvitelli, Naples
| | - Federico Lavorini
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Department of CardioThoracoVascular, Careggi University Hospital, Florence
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, University of Florence, Florence, Italy
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
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14
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Foris V, Kovacs G, Avian A, Bálint Z, Douschan P, Ghanim B, Klepetko W, Olschewski A, Olschewski H. Apelin-17 to diagnose idiopathic pulmonary arterial hypertension: A biomarker study. Front Physiol 2023; 13:986295. [PMID: 36685176 PMCID: PMC9846527 DOI: 10.3389/fphys.2022.986295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
Background: NT-proBNP and GDF-15 are established blood-derived biomarkers for risk assessment in pulmonary hypertension (PH), despite limited sensitivity and specificity. Apelin has a crucial function in endothelial homeostasis, thus it might represent a new biomarker for PH. However, there are numerous circulating apelin isoforms, and their potential role in this setting is unknown. This study evaluated different apelin isoforms in PH patients and prospectively evaluated the role of apelin-17 in comparison with NT-proBNP and GDF-15 as diagnostic marker in idiopathic pulmonary arterial hypertension (IPAH). Methods: Based on our pilot study, we performed a power calculation for apelin-13, apelin-17, apelin-36, as predictor of IPAH vs healthy controls. Apelin-17 provided the best discriminatory power, and accordingly, we enrolled n = 31 patients with IPAH and n = 31 matched healthy controls in a prospective study. NT-proBNP and GDF-15 was determined in all patients. ROC curve analysis was performed to assess the diagnostic value of the markers and their combinations. Results: Apelin-17, NT-proBNP, and GDF-15 were significantly elevated in IPAH patients as compared to controls (p < .001). Apelin-17 detected IPAH with a sensitivity of 68% and a specificity of 93% at a cut-off value of >1,480 pg/ml (AUC 0.86, 95%CI:0.76-0.95) as compared to GDF-15 (sensitivity 86%; specificity 72%, AUC 0.81 (95%CI:0.7-0.92)) and NT-proBNP (sensitivity 86%; specificity 72% (AUC 0.85, 95%CI:0.75-0.95)). Combinations of these markers could be used to increase either specificity or sensitivity. Conclusion: Apelin-17 appears to be suitable blood derived diagnostic marker for idiopathic pulmonary arterial hypertension.
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Affiliation(s)
- Vasile Foris
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria,*Correspondence: Vasile Foris,
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Alexander Avian
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Zoltán Bálint
- Faculty of Physics, Babes-Bolyai University Cluj-Napoca, Cluj-Napoca, Romania
| | - Philipp Douschan
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Bahil Ghanim
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria,Experimental Anesthesiology, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
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15
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Zeder K, Olschewski H, Kovacs G. Updated definition of exercise pulmonary hypertension. Breathe (Sheff) 2022; 18:220232. [PMID: 36865934 PMCID: PMC9973500 DOI: 10.1183/20734735.0232-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/02/2022] [Indexed: 02/16/2023] Open
Abstract
In the recently published European Society of Cardiology/European Respiratory Society guidelines on the diagnosis and treatment of pulmonary hypertension (PH) the haemodynamic definitions of PH were updated and a new definition for exercise PH was introduced. Accordingly, exercise PH is characterised by a mean pulmonary arterial pressure/cardiac output (CO) slope >3 Wood units (WU) from rest to exercise. This threshold is supported by several studies demonstrating prognostic and diagnostic relevance of exercise haemodynamics in various patient cohorts. From a differential diagnostic point of view, an elevated pulmonary arterial wedge pressure/CO slope >2 WU may be suitable to identify post-capillary causes of exercise PH. Right heart catheterisation remains the gold standard to assess pulmonary haemodynamics both at rest and exercise. In this review, we discuss the evidence that led to the reintroduction of exercise PH in the PH definitions.
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Affiliation(s)
- Katarina Zeder
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria,Corresponding author: Gabor Kovacs ()
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16
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Douschan P, Avian A, Foris V, Sassmann T, Bachmaier G, Rosenstock P, Zeder K, Olschewski H, Kovacs G. Prognostic Value of Exercise as Compared to Resting Pulmonary Hypertension in Patients with Normal or Mildly Elevated Pulmonary Arterial Pressure. Am J Respir Crit Care Med 2022; 206:1418-1423. [PMID: 35925022 PMCID: PMC9746857 DOI: 10.1164/rccm.202112-2856le] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Philipp Douschan
- Medical University of GrazGraz, Austria,Ludwig Boltzmann Institute for Lung Vascular ResearchGraz, Austria,Corresponding author (e-mail: )
| | | | - Vasile Foris
- Medical University of GrazGraz, Austria,Ludwig Boltzmann Institute for Lung Vascular ResearchGraz, Austria
| | - Teresa Sassmann
- Medical University of GrazGraz, Austria,Ludwig Boltzmann Institute for Lung Vascular ResearchGraz, Austria
| | | | - Piet Rosenstock
- Medical University of GrazGraz, Austria,Ludwig Boltzmann Institute for Lung Vascular ResearchGraz, Austria
| | - Katarina Zeder
- Medical University of GrazGraz, Austria,Ludwig Boltzmann Institute for Lung Vascular ResearchGraz, Austria
| | - Horst Olschewski
- Medical University of GrazGraz, Austria,Ludwig Boltzmann Institute for Lung Vascular ResearchGraz, Austria
| | - Gabor Kovacs
- Medical University of GrazGraz, Austria,Ludwig Boltzmann Institute for Lung Vascular ResearchGraz, Austria
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17
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Nagel C, Olschewski H, Sorichter S, Uezgoer G, Diehm C, Huppert P, Iber T, Herth F, Harutyunova S, Marra AM, Benjamin N, Salkić A, Grünig E, Egenlauf B. Impairment of Inspiratory Muscle Function after COVID-19. Respiration 2022; 101:981-989. [DOI: 10.1159/000527361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Persistent symptoms after acute coronavirus-disease-2019 (COVID-19) are common, and there is no significant correlation with the severity of the acute disease. In long-COVID (persistent symptoms >4 weeks after acute COVID-19), respiratory symptoms are frequent, but lung function testing shows only mild changes that do not explain the symptoms. Although COVID-19 may lead to an impairment of the peripheral nervous system and skeletal muscles, respiratory muscle function has not been examined in this setting. <b><i>Methods:</i></b> In this study, we assessed the severity of dyspnea (NYHA-function class) in long-COVID patients and analyzed its association with body mass index (BMI), FEV1, forced vital capacity, other parameters of body plethysmography, diffusing capacity for carbon monoxide (DLCO), arterial blood gases, and inspiratory muscle function, assessed by airway occlusion pressure (P0.1) and maximal inspiratory pressure (PImax) in two respiratory clinics in Germany between Oct 2020 and Aug 2021. <b><i>Results:</i></b> A total of 116 patients were included in the study. The mean age was 50.2 ± 14.5 years; BMI, 26.7 ± 5.87 kg/m<sup>2</sup>; NYHA class I, 19%; II, 27%; III, 41%; and IV, 14%. While lung function values and computed tomography or conventional X-ray of the chest were in the normal range, inspiratory muscle function was markedly impaired. P01 was elevated to 154 ± 83%predicted and PImax was reduced to 41 ± 25%predicted. PImax reduction was strongly associated with the severity of dyspnea but independent of BMI, time after acute COVID-19 and most of the other parameters. <b><i>Conclusions:</i></b> This study shows that in long-COVID patients, respiratory symptoms may be mainly caused by reduced inspiratory muscle strength. Assessment of PImax and P0.1 might better explain dyspnea than classical lung function tests and DLCO. A prospective study is needed to confirm these results.
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18
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Crnkovic S, Valzano F, Fließer E, Gindlhuber J, Thekkekara Puthenparampil H, Basil M, Morley MP, Katzen J, Gschwandtner E, Klepetko W, Cantu E, Wolinski H, Olschewski H, Lindenmann J, Zhao YY, Morrisey EE, Marsh LM, Kwapiszewska G. Single-cell transcriptomics reveals skewed cellular communication and phenotypic shift in pulmonary artery remodeling. JCI Insight 2022; 7:153471. [PMID: 36099047 PMCID: PMC9714792 DOI: 10.1172/jci.insight.153471] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/12/2022] [Indexed: 02/04/2023] Open
Abstract
A central feature of progressive vascular remodeling is altered smooth muscle cell (SMC) homeostasis; however, the understanding of how different cell populations contribute to this process is limited. Here, we utilized single-cell RNA sequencing to provide insight into cellular composition changes within isolated pulmonary arteries (PAs) from pulmonary arterial hypertension and donor lungs. Our results revealed that remodeling skewed the balanced communication network between immune and structural cells, in particular SMCs. Comparative analysis with murine PAs showed that human PAs harbored heterogeneous SMC populations with an abundant intermediary cluster displaying a gradient transition between SMCs and adventitial fibroblasts. Transcriptionally distinct SMC populations were enriched in specific biological processes and could be differentiated into 4 major clusters: oxygen sensing (enriched in pericytes), contractile, synthetic, and fibroblast-like. End-stage remodeling was associated with phenotypic shift of preexisting SMC populations and accumulation of synthetic SMCs in neointima. Distinctly regulated genes in clusters built nonredundant regulatory hubs encompassing stress response and differentiation regulators. The current study provides a blueprint of cellular and molecular changes on a single-cell level that are defining the pathological vascular remodeling process.
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Affiliation(s)
- Slaven Crnkovic
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Physiology & Pathophysiology, Otto Loewi Research Center and
| | - Francesco Valzano
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Elisabeth Fließer
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Jürgen Gindlhuber
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Diagnostic and Research Institute of Pathology, Diagnostic and Research Center of Molecular BioMedicine, Medical University of Graz, Graz, Austria
| | | | - Maria Basil
- Penn Center for Pulmonary Biology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mike P. Morley
- Penn Center for Pulmonary Biology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeremy Katzen
- Penn Center for Pulmonary Biology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elisabeth Gschwandtner
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Edward Cantu
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Heimo Wolinski
- Institute of Molecular Biosciences and,Field of Excellence BioHealth, University of Graz, Graz, Austria
| | | | - Jörg Lindenmann
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - You-Yang Zhao
- Program for Lung and Vascular Biology, Section of Injury Repair and Regeneration, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA.,Departments of Pediatrics, Pharmacology, and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Edward E. Morrisey
- Penn Center for Pulmonary Biology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leigh M. Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Physiology & Pathophysiology, Otto Loewi Research Center and
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Physiology & Pathophysiology, Otto Loewi Research Center and,Institute of Lung Health, German Center for Lung Research (DZL), Giessen, Germany
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19
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Jandl K, Marsh LM, Mutgan AC, Crnkovic S, Valzano F, Zabini D, Hoffmann J, Foris V, Gschwandtner E, Klepetko W, Prosch H, Flick H, Brcic L, Kern I, Heinemann A, Olschewski H, Kovacs G, Kwapiszewska G. Impairment of the NKT-STAT1-CXCL9 Axis Contributes to Vessel Fibrosis in Pulmonary Hypertension Caused by Lung Fibrosis. Am J Respir Crit Care Med 2022; 206:981-998. [PMID: 35763380 DOI: 10.1164/rccm.202201-0142oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Pulmonary hypertension (PH) is a common, severe comorbidity in interstitial lung diseases such as pulmonary fibrosis (PF), and it has limited treatment options. Excessive vascular fibrosis and inflammation are often present in PH, but the underlying mechanisms are still not well understood. Objectives: To identify a novel functional link between natural killer T (NKT) cell activation and vascular fibrosis in PF-PH. Methods: Multicolor flow cytometry, secretome, and immunohistological analyses were complemented by pharmacological NKT cell activation in vivo, in vitro, and ex vivo. Measurements and Main Results: In pulmonary vessels of patients with PF-PH, increased collagen deposition was linked to a local NKT cell deficiency and decreased IL-15 concentrations. In a mouse model of PH caused by lung fibrosis, pharmacological NKT cell activation using a synthetic α-galactosylceramide analog (KRN7000) restored local NKT cell numbers and ameliorated vascular remodeling and right ventricular systolic pressure. Supplementation with activated NKT cells reduced collagen deposition in isolated human pulmonary arterial smooth muscle cells (hPASMCs) and in ex vivo precision-cut lung slices of patients with end-stage PF-PH. Coculture with activated NKT cells induced STAT1 signaling in hPASMCs. Secretome analysis of peripheral blood mononuclear cells identified CXCL9 and CXCL10 as indicators of NKT cell activation. Pharmacologically, CXCL9, but not CXCL10, potently inhibited collagen deposition in hPASMCs via the chemokine receptor CXCR3. Conclusions: Our results indicate that the absence of NKT cells impairs the STAT1-CXCL9-CXCR3 axis in PF-PH and that restoration of this axis by NKT cell activation may unravel a novel therapeutic strategy to target vascular fibrosis in interstitial lung disease.
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Affiliation(s)
- Katharina Jandl
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pharmacology
| | - Leigh M Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Physiology, Otto Loewi Research Center
| | - Ayse Ceren Mutgan
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Physiology, Otto Loewi Research Center
| | - Slaven Crnkovic
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Physiology, Otto Loewi Research Center
| | - Francesco Valzano
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Diana Zabini
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Physiology, Otto Loewi Research Center
| | - Julia Hoffmann
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Vasile Foris
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, and
| | | | | | - Helmut Prosch
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, and
| | - Luka Brcic
- Diagnostic and Research Center for Molecular BioMedicine, Diagnostic & Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Izidor Kern
- Cytology and Pathology Laboratory, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia; and
| | | | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, and
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, and
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
- Division of Physiology, Otto Loewi Research Center
- Institute for Lung Health, Giessen, Germany
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20
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Douschan P, Kovacs G, Sassmann T, Stadlbauer V, Avian A, Foris V, Tatscher E, Durchschein F, Rainer F, Spindelboeck W, Wagner M, Kniepeiss D, Zollner G, Bachmaier G, Fickert P, Olschewski H, Stauber RE. Pulmonary vascular disease and exercise hemodynamics in chronic liver disease. Respir Med 2022; 202:106987. [PMID: 36115317 DOI: 10.1016/j.rmed.2022.106987] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/27/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND & AIMS Portopulmonary hypertension (POPH) and hepatopulmonary syndrome (HPS) are severe pulmonary vascular complications of chronic liver disease and strongly associated with morbidity and mortality. The prevalence of these complications is relatively high in patients evaluated for liver transplantation, however it is virtually unknown in patients with stable chronic liver disease. METHODS We assessed the pulmonary hypertension (PH) and HPS prevalence in a prospective registry study of our liver out-patient clinic in a tertiary center. Between 2011 and 2016, consecutive patients with cirrhosis or non-cirrhotic portal hypertension were prospectively enrolled after written informed consent. We excluded patients with acute decompensation of liver disease and other causes of PH like severe chronic heart or lung diseases and chronic thromboembolic PH. HPS was diagnosed using contrast enhanced echocardiography and blood gas analysis. Patients were screened for PH using an algorithm implementing severity of dyspnea, echocardiography, cardiopulmonary exercise testing and exercise echocardiography employing a threshold of systolic pulmonary arterial pressure (SPAP) = 50 mmHg at peak exercise. If the algorithm indicated an increased PH risk, patients were invited for invasive investigations by means of right heart and hepatic vein catheter. We defined POPH as resting mPAP≥21 mmHg and PVR>3WU and PAWP<15 mmHg, mild PH as resting mPAP = 21-24 mmHg, and exercise PH as mPAP>30 mmHg and TPR >3 WU at peak exercise. RESULTS Two-hundred-five patients were enrolled (male 75%; cirrhosis 96%; median age 57 yrs). Sixty-seven patients (33%) fulfilled HPS criteria but only two (1.0%) for severe (PaO2:50-60 mmHg) or very severe HPS (PaO2<50 mmHg). In 18/77 patients (23%) undergoing exercise echocardiography, SPAP at peak exercise exceeded 50 mmHg. Finally, n = 3 (1.5%) patients were invasively diagnosed with POPH, n = 4 (2.9%) with mild PH and n = 2 with exercise PH. CONCLUSION In chronic liver disease, excluding acute decompensation and other causes of PH, POPH and severe HPS are rare findings while mild to moderate HPS and mild PH or exercise PH are more frequent.
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Affiliation(s)
- Philipp Douschan
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Gabor Kovacs
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
| | - Teresa Sassmann
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Vanessa Stadlbauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Vasile Foris
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Elisabeth Tatscher
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Franziska Durchschein
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Florian Rainer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Walter Spindelboeck
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Martin Wagner
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Daniela Kniepeiss
- Department of General, Visceral and Transplant Surgery, Transplant Center Graz, Medical University of Graz, Graz, Austria
| | - Gernot Zollner
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Gerhard Bachmaier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Peter Fickert
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Rudolf E Stauber
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
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21
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Sinha M, Zabini D, Guntur D, Nagaraj C, Enyedi P, Olschewski H, Kuebler WM, Olschewski A. Chloride channels in the lung: Challenges and perspectives for viral infections, pulmonary arterial hypertension, and cystic fibrosis. Pharmacol Ther 2022; 237:108249. [DOI: 10.1016/j.pharmthera.2022.108249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 10/16/2022]
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22
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Nikkho SM, Richter MJ, Shen E, Abman SH, Antoniou K, Chung J, Fernandes P, Hassoun P, Lazarus HM, Olschewski H, Piccari L, Psotka M, Saggar R, Shlobin OA, Stockbridge N, Vitulo P, Vizza CD, John Wort S, Nathan SD. CLINICAL SIGNIFICANCE OF PULMONARY HYPERTENSION IN INTERSTITIAL LUNG DISEASE A Consensus Statement from The Pulmonary Vascular Research Institute's Innovative Drug Development Initiative ‐ Group 3 Pulmonary Hypertension. Pulm Circ 2022; 12:e12127. [PMID: 36016668 PMCID: PMC9395696 DOI: 10.1002/pul2.12127] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Pulmonary hypertension (PH) has been linked to worse outcomes in chronic lung diseases. The presence of PH in the setting of underlying Interstitial Lung Disease (ILD) is strongly associated with decreased exercise and functional capacity, an increased risk of hospitalizations and death. Examining the scope of this issue and its impact on patients is the first step in trying to define a roadmap to facilitate and encourage future research in this area. The aim of our working group is to strengthen the communities understanding of PH due to lung diseases and to improve the care and quality of life of affected patients. This introductory statement provides a broad overview and lays the foundation for further in‐depth papers on specific topics pertaining to PH‐ILD.
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Affiliation(s)
| | - Manuel J. Richter
- Department of Internal Medicine Pulmonary Hypertension Division Universities of Giessen and Marburg Lung Center (UGMLC) Germany
| | - Eric Shen
- United Therapeutics Corporation, Global Medical Affairs Silver Spring MD USA
| | - Steven H. Abman
- University of Colorado ‐ Anschutz Medical Campus School of Medicine and Children's Hospital Aurora CO USA
| | - Katerina Antoniou
- University of Crete School of Medicine, Department of Thoracic Medicine Heraklion Crete Greece
| | - Jonathan Chung
- Department of Radiology The University of Chicago Medicine Chicago IL USA
| | - Peter Fernandes
- Bellerophon Therapeutics Inc, Regulatory Safety and Quality Department Warren NJ USA
| | - Paul Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Johns Hopkins University Baltimore MD
| | | | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine Medical University of Graz Graz Steiermark Austria
| | - Lucilla Piccari
- Department of Pulmonary Medicine Hospital del Mar, Pulmonary Hypertension Unit Barcelona Catalunya Spain
| | - Mitchell Psotka
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA; 2. Division of Cardiology and Nephrology Food and Drug Administration Silver Spring MD
| | - Rajan Saggar
- University of California Los Angeles David Geffen School of Medicine Lung & Heart‐Lung Transplant and Pulmonary Hypertension Programs Los Angeles CA USA
| | - Oksana A. Shlobin
- Inova Health System, Advanced Lung Disease and Transplant Program Falls Church VA USA
| | - Norman Stockbridge
- US Food and Drug Administration Division of Cardiology and Nephrology Silver Spring MD USA
| | - Patrizio Vitulo
- IRCCS Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Department of Pulmonary Medicine Palermo Sicilia Italy
| | | | - S. John Wort
- National Pulmonary Hypertension Service at Royal Brompton Hospital London. UK. National Heart and Lung Institute, Imperial College London UK
| | - Steven D. Nathan
- Advanced Lung Disease and Transplant Program Inova Heart and Vascular Institute Falls Church Virginia
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23
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Reiter G, Kovacs G, Reiter C, Schmidt A, Fuchsjäger M, Olschewski H, Reiter U. Left atrial acceleration factor as a magnetic resonance 4D flow measure of mean pulmonary artery wedge pressure in pulmonary hypertension. Front Cardiovasc Med 2022; 9:972142. [PMID: 35990987 PMCID: PMC9381926 DOI: 10.3389/fcvm.2022.972142] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background Mean pulmonary artery wedge pressure (PAWP) represents a right heart catheter (RHC) surrogate measure for mean left atrial (LA) pressure and is crucial for the clinical classification of pulmonary hypertension (PH). Hypothesizing that PAWP is related to acceleration of blood throughout the LA, we investigated whether an adequately introduced LA acceleration factor derived from magnetic resonance (MR) four-dimensional (4D) flow imaging could provide an estimate of PAWP in patients with known or suspected PH. Methods LA 4D flow data of 62 patients with known or suspected PH who underwent RHC and near-term 1.5 T cardiac MR (ClinicalTrials.gov identifier: NCT00575692) were retrospectively analyzed. Early diastolic LA peak outflow velocity (vE) as well as systolic (vS) and early diastolic (vD) LA peak inflow velocities were determined with prototype software to calculate the LA acceleration factor (α) defined as α = vE/[(vS + vD)/2]. Correlation, regression and Bland-Altman analysis were employed to investigate the relationship between α and PAWP, α-based diagnosis of elevated PAWP (>15 mmHg) was analyzed by receiver operating characteristic curve analysis. Results α correlated very strongly with PAWP (r = 0.94). Standard deviation of differences between RHC-derived PAWP and PAWP estimated from linear regression model (α = 0.61 + 0.10·PAWP) was 2.0 mmHg. Employing the linear-regression-derived cut-off α = 2.10, the α-based diagnosis of elevated PAWP revealed the area under the curve 0.97 with sensitivity/specificity 93%/92%. Conclusions The very close relationship between the LA acceleration factor α and RHC-derived PAWP suggests α as potential non-invasive parameter for the estimation of PAWP and the distinction between pre- and post-capillary PH.
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Affiliation(s)
- Gert Reiter
- Research & Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Austria
| | - Clemens Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Austria
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria
- *Correspondence: Ursula Reiter
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Gertz JR, Pienn M, Gerhardt F, Reimer PR, Kröger RJ, Maintz D, Rosenkranz S, Olschewski H, Bunck CA. Automatische Segmentierung der peripheren Pulmonalarterien und -venen für die Diagnose der Pulmonalen Hypertonie. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J R Gertz
- Uniklinik Köln, Institut für Diagnostische und Interventionelle Radiologie, Köln
| | - M Pienn
- Ludwig Boltzmann Institute Lung Vascular Research, Graz
| | - F Gerhardt
- Klinik III für Innere Medizin – Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin, Uniklinik Köln, Köln
| | - P R Reimer
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln
| | - R J Kröger
- Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Johannes Wesling Universitätsklinikum, Bochum
| | - D Maintz
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln
| | - S Rosenkranz
- Klinik III für Innere Medizin – Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin, Uniklinik Köln, Köln
| | - H Olschewski
- Ludwig Boltzmann Institute Lung Vacular Research, Graz
| | - C A Bunck
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln
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25
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Kovacs G, Avian A, Bachmaier G, Troester N, Tornyos A, Douschan P, Foris V, Sassmann T, Zeder K, Lindenmann J, Brcic L, Fuchsjaeger M, Agusti A, Olschewski H. Severe Pulmonary Hypertension in COPD: Impact on Survival and Diagnostic Approach. Chest 2022; 162:202-212. [PMID: 35092746 PMCID: PMC10808070 DOI: 10.1016/j.chest.2022.01.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 12/15/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Severe pulmonary hypertension (PH) is prognostically highly relevant in patients with COPD. The criteria for severe PH have been defined based on hemodynamic thresholds in right heart catheterization. RESEARCH QUESTION Can noninvasive clinical tools predict severe PH in patients with COPD? How does the mortality risk change with increasing severity of airflow limitation and pulmonary vascular disease? STUDY DESIGN AND METHODS We retrospectively analyzed all consecutive patients with COPD with suspected PH undergoing in-depth clinical evaluation, including right heart catheterization, in our PH clinic between 2005 and 2018. Clinical variables potentially indicative of severe PH or death were analyzed using univariate and stepwise multivariate logistic regression and Cox regression analysis adjusted for age and sex. RESULTS We included 142 patients with median FEV1 of 55.0% predicted (interquartile range [IQR], 42.4%-69.4% predicted) and mean pulmonary arterial pressure of 35 mm Hg (IQR, 27-43 mm Hg). A multivariate model combining echocardiographic systolic pulmonary arterial pressure of ≥ 56 mm Hg, N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels of ≥ 650 pg/mL, and pulmonary artery (PA) to ascending aorta (Ao) diameter ratio on chest CT scan of ≥ 0.93 predicted severe PH with high positive and negative predictive values (both 94%). After correction for age and sex, both airflow limitation (P = .002; Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages 1-2 vs stage 3: hazard ratio [HR], 1.56 [95% CI, 0.90-2.71]; GOLD stages 1-2 vs stage 4: HR, 3.45 [95% CI, 1.75-6.79]) and PH severity (P = .012; HR, 1.85 [95% CI, 1.15-2.99]) remained associated independently with survival. The combination of GOLD stages 3 and 4 airflow limitation and severe PH showed the poorest survival (HR for death, 3.26 [95% CI, 1.62-6.57; P = .001] vs GOLD stages 1-2 combined with nonsevere PH). INTERPRETATION In patients with COPD, the combination of echocardiography, NT-proBNP level, and PA to Ao diameter ratio predicts severe PH with high sensitivity and specificity. The contribution of severe PH and severe airflow limitation to impaired survival is comparable.
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Affiliation(s)
- Gabor Kovacs
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Graz, Austria
| | - Gerhard Bachmaier
- Institute for Medical Informatics, Statistics and Documentation, Graz, Austria
| | - Natascha Troester
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria
| | - Adrienn Tornyos
- Division of General Radiology, Department of Radiology, Graz, Austria
| | - Philipp Douschan
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Vasile Foris
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Teresa Sassmann
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria
| | - Katarina Zeder
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Jörg Lindenmann
- Department of Thoracic and Hyperbaric Surgery, University Clinic of Surgery, Graz, Austria
| | - Luka Brcic
- Institute for Pathology, Medical University of Graz, Graz, Austria
| | | | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Ciberes, Spain
| | - Horst Olschewski
- Department of Pulmonology, University Clinic of Internal Medicine, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
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26
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Nagaraj C, Li Y, Tang B, Bordag N, Guntur D, Enyedi P, Olschewski H, Olschewski A. Potassium Channels in the Transition from Fetal to the Neonatal Pulmonary Circulation. Int J Mol Sci 2022; 23:ijms23094681. [PMID: 35563072 PMCID: PMC9106051 DOI: 10.3390/ijms23094681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 12/10/2022] Open
Abstract
The transition from the fetal to the neonatal circulation includes dilatation of the pulmonary arteries (PA) and closure of the Ductus Arteriosus Botalli (DAB). The resting membrane potential and various potassium channel activities in smooth muscle cells (SMC) from fetal and neonatal PA and DAB obtained from the same species has not been systematically analyzed. The key issue addressed in this paper is how the resting membrane potential and the whole-cell potassium current (IK) change when PASMC or DABSMC are transitioned from hypoxia, reflecting the fetal state, to normoxia, reflecting the post-partal state. Patch-clamp measurements were employed to characterize whole-cell K+ channel activity in fetal and post-partal (newborn) PASMC and DABSMC. The main finding of this paper is that the SMC from both tissues use a similar set of K+ channels (voltage-dependent (Kv), calcium-sensitive (KCa), TASK-1 and probably also TASK-2 channels); however, their activity level depends on the cell type and the oxygen level. Furthermore, we provide the first evidence for pH-sensitive non-inactivating K+ current in newborn DABSMC and PASMC, suggesting physiologically relevant TASK-1 and TASK-2 channel activity, the latter particularly in the Ductus Arteriosus Botalli.
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Affiliation(s)
- Chandran Nagaraj
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (C.N.); (N.B.)
| | - Yingji Li
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (Y.L.); (B.T.); (D.G.)
| | - Bi Tang
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (Y.L.); (B.T.); (D.G.)
| | - Natalie Bordag
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (C.N.); (N.B.)
- Department of Dermatology and Venereology, Medical University of Graz, Auenbruggerplatz 8, 8036 Graz, Austria
| | - Divya Guntur
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (Y.L.); (B.T.); (D.G.)
| | - Péter Enyedi
- Department of Physiology, Faculty of Medicine, Semmelweis University, Tűzoltó utca 37-47, 1094 Budapest, Hungary;
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
| | - Andrea Olschewski
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (Y.L.); (B.T.); (D.G.)
- Correspondence:
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Robinson I, Bertsch A, Leithner K, Stiegler P, Olschewski H, Hrzenjak A. Circulating microRNAs as molecular biomarkers for lung adenocarcinoma. Cancer Biomark 2022; 34:591-606. [DOI: 10.3233/cbm-210205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND: The potential of microRNAs (miRNAs) as molecular tumor biomarkers for early diagnosis and prognosis in lung cancer is still unclear. OBJECTIVE: To analyze expression of miRNAs in A549 lung adenocarcinoma (LUAD) cells and in primary, non-malignant bronchial epithelial (BE) cells from healthy donors. To analyze the most prominently deregulated miRNAs in plasma samples of LUAD patients and healthy donors. MATERIALS AND METHODS: The expression of 752 miRNAs in LUAD and BE cells was assessed by RT-qPCR with mean-centering restricted normalization. The relative plasma levels of 18 miRNAs in LUAD patients and healthy donors were analyzed using RT-qPCR and normalized to miR-191-5p and miR-16-3p. Putative interactions between miRNAs and their target genes were investigated in silico. RESULTS: Out of 752 miRNAs, 37 miRNAs were significantly deregulated in A549 cells compared to BE cells. MiR-15b-3p, miR-148a-3p, miR-193b-3p, and miR-195-5p were significantly deregulated in plasma samples of LUAD patients compared to donors. The target genes of those four miRNAs are involved in essential mechanisms in cancer development and progression. CONCLUSIONS: There are substantial differences between cancer and control miRNA expression in vitro and in plasma samples of LUAD patients compared to healthy donors. Four deregulated miRNAs are promising as a diagnostic biomarker for adenocarcinoma of the lung.
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Affiliation(s)
- Irina Robinson
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Alexandra Bertsch
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Katharina Leithner
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Philipp Stiegler
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Andelko Hrzenjak
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Medical University of Graz, Graz, Austria
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28
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Zeder K, Banfi C, Steinrisser-Allex G, Maron BA, Humbert M, Lewis GD, Berghold A, Olschewski H, Kovacs G. Diagnostic, prognostic and differential-diagnostic relevance of pulmonary hemodynamics during exercise - a systematic review. Eur Respir J 2022; 60:13993003.03181-2021. [PMID: 35332069 PMCID: PMC9556812 DOI: 10.1183/13993003.03181-2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/17/2022] [Indexed: 11/05/2022]
Abstract
The cardiopulmonary hemodynamic profile observed during exercise may identify patients with early stage pulmonary vascular and primary cardiac diseases, and is used clinically to inform prognosis. However, a standardised approach to interpreting hemodynamics is lacking.We performed a systematic literature search according to PRISMA guidelines to identify parameters that may be diagnostic for an abnormal hemodynamic response to exercise and offer optimal prognostic and differential-diagnostic value. We performed random-effects-meta-analyses of the normal values and reported effect sizes as weighted means and standard deviations (sd). Results of diagnostic and prognostic studies are reported descriptively.We identified n=45 eligible studies with n=5598 subjects. The mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope, pulmonary arterial wedge pressure (PAWP)/CO slope and peak cardiac index (or CO) provided the most consistent prognostic hemodynamic parameters during exercise. The best cut-offs for survival and cardiovascular events were mPAP/CO slope>3 Wood units (WU) and PAWP/CO slope>2 WU. A PAWP/CO slope cut-off>2 WU best differentiated pre- from post-capillary causes of PAP elevation during exercise. Upper limits of normal (defined as mean+2 sd) for the mPAP/CO and PAWP/CO slopes were strongly age-dependent and ranged in 30-to 70-year old healthy subjects from 1.6 to 3.3 WU and 0.6 to 1.8 WU, respectively.Increased mPAP/CO slope during exercise is associated with impaired survival and an independent, prognostically relevant cut-off>3 WU has been validated. A PAWP/CO slope>2 WU may be suitable for the differentiation between pre- and post-capillary causes of PAP increase during exercise.
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Affiliation(s)
- Katarina Zeder
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Chiara Banfi
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | | | - Bradley A Maron
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marc Humbert
- University Paris-Sud, Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Gregory D Lewis
- Division of Cardiology and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria .,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
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Birnhuber A, Jandl K, Biasin V, Fließer E, Valzano F, Marsh LM, Krolczik C, Olschewski A, Wilhelm J, Toller W, Heinemann A, Olschewski H, Wygrecka M, Kwapiszewska G. Pirfenidone exacerbates Th2-driven vasculopathy in a mouse model of SSc-ILD. Eur Respir J 2022; 60:13993003.02347-2021. [PMID: 35332068 DOI: 10.1183/13993003.02347-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/08/2022] [Indexed: 11/05/2022]
Abstract
Systemic sclerosis (SSc) is an autoimmune disease characterised by severe vasculopathy and fibrosis of various organs including the lung. Targeted treatment options for SSc-associated interstitial lung disease (SSc-ILD) are scarce. Here we assessed the effects of pirfenidone in a mouse model of SSc-ILD.Pulmonary function, inflammation and collagen deposition in response to pirfenidone were assessed in Fra-2-overexpressing (Fra-2 TG) and bleomycin-treated mice. In Fra-2 TG mice, lung transcriptome was analysed after pirfenidone treatment. In vitro, pirfenidone effects on human eosinophil and endothelial cell function were analysed using flow cytometry-based assays and electric cell-substrate impedance measurements, respectively.Pirfenidone treatment attenuated pulmonary remodelling in the bleomycin-model, but aggravated pulmonary inflammation, fibrosis, and vascular remodelling in Fra-2 TG mice. Pirfenidone increased interleukin (IL)-4 levels and eosinophil numbers in lung tissue of Fra-2 TG mice without directly affecting eosinophil activation and migration in vitro A pronounced immune response with high levels of cytokines/chemokines and disturbed endothelial integrity with low VE-cadherin levels were observed in pirfenidone-treated Fra-2 TG mice. In contrast, eosinophil, IL-4 and VE-cadherin levels were unchanged in bleomycin-treated mice and not influenced by pirfenidone. In vitro, pirfenidone exacerbated the IL-4 induced reduction of endothelial barrier resistance leading to higher leukocyte transmigration.This study shows that anti-fibrotic properties of pirfenidone may be overruled by unwanted interactions with pre-injured endothelium in a setting of high Th2 inflammation in a model of SSc-ILD. Careful ILD patient phenotyping may be required to exploit benefits of pirfenidone while avoiding therapy failure and additional lung damage in some patients.
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Affiliation(s)
- Anna Birnhuber
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria.,Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
| | - Katharina Jandl
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria.,Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Graz, Austria
| | - Valentina Biasin
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria.,Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
| | - Elisabeth Fließer
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria
| | - Francesco Valzano
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria
| | - Leigh M Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria
| | - Christina Krolczik
- Center for Infection and Genomics of the Lung, Universities of Giessen and Marburg Lung Center, Giessen, Germany. Member of the German Center for Lung Research
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria.,Department of Anaesthesiology and Intensive Care Medicina, Medical University of Graz, Graz, Austria
| | - Jochen Wilhelm
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Wolfgang Toller
- Department of Anaesthesiology and Intensive Care Medicina, Medical University of Graz, Graz, Austria
| | - Akos Heinemann
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria.,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Malgorzata Wygrecka
- Center for Infection and Genomics of the Lung, Universities of Giessen and Marburg Lung Center, Giessen, Germany. Member of the German Center for Lung Research
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research Graz, Graz, Austria .,Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria.,Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
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30
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Hochgerner M, Sturm EM, Schnoegl D, Kwapiszewska G, Olschewski H, Marsh LM. Low oxygen levels decrease adaptive immune responses and ameliorate experimental asthma in mice. Allergy 2022; 77:870-882. [PMID: 34309864 PMCID: PMC9290649 DOI: 10.1111/all.15020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND High-altitude therapy has been used as add-on treatment for allergic asthma with considerable success. However, the underlying mechanisms remain unclear. In order to investigate the possible therapeutic effects of high-altitude therapy on allergic asthma, we utilized a new in vivo mouse model. METHODS Mice were treated with house dust mite (HDM) extract over 4 weeks and co-exposed to 10% oxygen (Hyp) or room air for the final 2 weeks. Experimental asthma was assessed by airway hyper-responsiveness, mucus hypersecretion and inflammatory cell recruitment. Isolated immune cells from mouse and allergic patients were stimulated in vitro with HDM under Hyp and normoxia in different co-culture systems to analyse the adaptive immune response. RESULTS Compared to HDM-treated mice in room air, HDM-treated Hyp-mice displayed ameliorated mucosal hypersecretion and airway hyper-responsiveness. The attenuated asthma phenotype was associated with strongly reduced activation of antigen-presenting cells (APCs), effector cell infiltration and cytokine secretion. In vitro, hypoxia almost completely suppressed the HDM-induced adaptive immune response in both mouse and human immune cells. While hypoxia did not affect effector T-cell responses per-se, it interfered with antigen-presenting cell (APC) differentiation and APC/effector cell crosstalk. CONCLUSIONS Hypoxia-induced reduction in the Th2-response to HDM ameliorates allergic asthma in vivo. Hypoxia interferes with APC/T-cell crosstalk and confers an unresponsive phenotype to APCs.
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Affiliation(s)
| | - Eva M. Sturm
- Division of Pharmacology, Otto Loewi Research Center Medical University of Graz Graz Austria
| | - Diana Schnoegl
- Ludwig Boltzmann Institute for Lung Vascular Research Graz Austria
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research Graz Austria
- Division of Physiology Otto Loewi Research Center, Medical University of Graz Graz Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research Graz Austria
- Division of Pulmonology, Department of Internal Medicine Medical University of Graz Graz Austria
| | - Leigh M. Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research Graz Austria
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31
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Kovacs G, Olschewski H. The definition of pulmonary hypertension: history, practical implications and current controversies. Breathe (Sheff) 2022; 17:210076. [PMID: 35035548 PMCID: PMC8753640 DOI: 10.1183/20734735.0076-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/10/2021] [Accepted: 06/19/2021] [Indexed: 01/14/2023] Open
Abstract
The definition of pulmonary hypertension (PH) is based on a growing body of evidence and represents the result of ongoing discussions within the PH community over the past 50 years. In 2018, the most recent World Symposium on Pulmonary Hypertension introduced significant changes in the definition of PH by lowering the mean pulmonary arterial pressure threshold to >20 mmHg and (re)introducing the pulmonary vascular resistance ≥3 WU cut-off for all forms of pre-capillary PH. These changes and their potential clinical impact have been the subject of lively discussions in the community and some important questions and controversies have been identified. In this review we aim to present the development of the definition of PH over the past decades and discuss the main arguments that led to relevant modifications. In addition, we address the practical implications of the most recent changes and controversies that still exist. The definitions of PH and PAH reflect the upper limit of normal haemodynamic values, their prognostic relevance and practical considerations. With appropriate clinical context they represent the cornerstone of PH diagnosis and clinical decision making.https://bit.ly/3gRSyWz
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Affiliation(s)
- Gabor Kovacs
- Dept of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Horst Olschewski
- Dept of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
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Sassmann T, Douschan P, Foris V, Tröster N, Zeder K, Brcic L, Tornyos A, Bachmaier G, Fuchsjäger M, Olschewski H, Kovacs G. Abnormal pulmonary hemodynamics during exercise is associated with exercise capacity in COPD. Respir Res 2022; 23:331. [PMID: 36482405 PMCID: PMC9733173 DOI: 10.1186/s12931-022-02238-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/03/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a frequent complication in COPD and it is associated with decreased exercise capacity and poor prognosis. We hypothesized that even in COPD patients without significant PH at rest, abnormal pulmonary hemodynamics during exercise affect exercise capacity. METHODS Consecutive COPD patients with clinically indicated right heart catheterization and resting mean pulmonary arterial pressure (mPAP) < 25 mmHg and age- and sex-matched controls with the same limits of pulmonary hemodynamics but no chronic lung disease who underwent clinical work-up including invasive hemodynamic assessment during exercise, were retrospectively analyzed. Chi-square tests were used to evaluate differences between groups for categorical data and Fisher's exact test or Mann-Whitney-U-tests for continuous variables. Associations were analyzed with Spearman rank correlation tests. RESULTS We included n = 26 COPD patients (female/male: 16/10, 66 ± 11 yr, FEV1: 56 ± 25%predicted) and n = 26 matched controls (FEV1: 96 ± 22%predicted). At rest, COPD patients presented with slightly increased mPAP (21 (18-23) vs. 17 (14-20) mmHg, p = 0.022), and pulmonary vascular resistance (PVR) [2.5 (1.9-3.0) vs. 1.9 (1.5-2.4) WU, p = 0.020] as compared to controls. During exercise, COPD patients reached significantly higher mPAP [47 (40-52) vs. 38 (32-44) mmHg, p = 0.015] and PVR [3.1 (2.2-3.7) vs. 1.7 (1.1-2.9) WU, p = 0.028] values despite lower peak exercise level [50 (50-75) vs. 100 (75-125) Watt, p = 0.002]. The mPAP/cardiac output slope was increased in COPD vs. controls [6.9 (5.5-10.9) vs. 3.7 (2.4-7.4) mmHg/L/min, p = 0.007] and negatively correlated with both peak oxygen uptake (r = - 0.46, p = 0.007) and 6-min walk distance (r = - 0.46, p = 0.001). CONCLUSION Even in the absence of significant PH at rest, COPD patients reveal characteristic abnormalities in pulmonary hemodynamics during exercise, which may represent an important exercise-limiting factor.
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Affiliation(s)
- Teresa Sassmann
- grid.11598.340000 0000 8988 2476Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria ,grid.489038.e0000 0004 9291 7536Ludwig Boltzmann Institute for Lung Vascular Research, Stiftingtalstrasse 24, 8010 Graz, Austria
| | - Philipp Douschan
- grid.11598.340000 0000 8988 2476Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria ,grid.489038.e0000 0004 9291 7536Ludwig Boltzmann Institute for Lung Vascular Research, Stiftingtalstrasse 24, 8010 Graz, Austria
| | - Vasile Foris
- grid.11598.340000 0000 8988 2476Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria ,grid.489038.e0000 0004 9291 7536Ludwig Boltzmann Institute for Lung Vascular Research, Stiftingtalstrasse 24, 8010 Graz, Austria
| | - Natascha Tröster
- grid.11598.340000 0000 8988 2476Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Katarina Zeder
- grid.11598.340000 0000 8988 2476Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria ,grid.489038.e0000 0004 9291 7536Ludwig Boltzmann Institute for Lung Vascular Research, Stiftingtalstrasse 24, 8010 Graz, Austria
| | - Luka Brcic
- grid.11598.340000 0000 8988 2476Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Adrienn Tornyos
- grid.11598.340000 0000 8988 2476Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Gerhard Bachmaier
- grid.11598.340000 0000 8988 2476Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- grid.11598.340000 0000 8988 2476Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- grid.11598.340000 0000 8988 2476Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria ,grid.489038.e0000 0004 9291 7536Ludwig Boltzmann Institute for Lung Vascular Research, Stiftingtalstrasse 24, 8010 Graz, Austria
| | - Gabor Kovacs
- grid.11598.340000 0000 8988 2476Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria ,grid.489038.e0000 0004 9291 7536Ludwig Boltzmann Institute for Lung Vascular Research, Stiftingtalstrasse 24, 8010 Graz, Austria
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Bluemel G, Planque M, Madreiter-Sokolowski CT, Haitzmann T, Hrzenjak A, Graier WF, Fendt SM, Olschewski H, Leithner K. PCK2 opposes mitochondrial respiration and maintains the redox balance in starved lung cancer cells. Free Radic Biol Med 2021; 176:34-45. [PMID: 34520823 DOI: 10.1016/j.freeradbiomed.2021.09.007] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/21/2022]
Abstract
Cancer cells frequently lack nutrients like glucose, due to insufficient vascular networks. Mitochondrial phosphoenolpyruvate carboxykinase, PCK2, has recently been found to mediate partial gluconeogenesis and hence anabolic metabolism in glucose starved cancer cells. Here we show that PCK2 acts as a regulator of mitochondrial respiration and maintains the redox balance in nutrient-deprived human lung cancer cells. PCK2 silencing increased the abundance and interconversion of tricarboxylic acid (TCA) cycle intermediates, augmented mitochondrial respiration and enhanced glutathione oxidation under glucose and serum starvation, in a PCK2 re-expression reversible manner. Moreover, enhancing the TCA cycle by PCK2 inhibition severely reduced colony formation of lung cancer cells under starvation. As a conclusion, PCK2 contributes to maintaining a reduced glutathione pool in starved cancer cells besides mediating the biosynthesis of gluconeogenic/glycolytic intermediates. The study sheds light on adaptive responses in cancer cells to nutrient deprivation and shows that PCK2 confers protection against respiration-induced oxidative stress.
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Affiliation(s)
- Gabriele Bluemel
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Mélanie Planque
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Leuven, Belgium
| | - Corina T Madreiter-Sokolowski
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria; Energy Metabolism Laboratory, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Theresa Haitzmann
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Andelko Hrzenjak
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Wolfgang F Graier
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria; BioTechMed-Graz, Graz, Austria
| | - Sarah-Maria Fendt
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Leuven, Belgium
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Katharina Leithner
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; BioTechMed-Graz, Graz, Austria.
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Guntur D, Olschewski H, Enyedi P, Csáki R, Olschewski A, Nagaraj C. Revisiting the Large-Conductance Calcium-Activated Potassium (BKCa) Channels in the Pulmonary Circulation. Biomolecules 2021; 11:biom11111629. [PMID: 34827626 PMCID: PMC8615660 DOI: 10.3390/biom11111629] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 01/13/2023] Open
Abstract
Potassium ion concentrations, controlled by ion pumps and potassium channels, predominantly govern a cell′s membrane potential and the tone in the vessels. Calcium-activated potassium channels respond to two different stimuli-changes in voltage and/or changes in intracellular free calcium. Large conductance calcium-activated potassium (BKCa) channels assemble from pore forming and various modulatory and auxiliary subunits. They are of vital significance due to their very high unitary conductance and hence their ability to rapidly cause extreme changes in the membrane potential. The pathophysiology of lung diseases in general and pulmonary hypertension, in particular, show the implication of either decreased expression and partial inactivation of BKCa channel and its subunits or mutations in the genes encoding different subunits of the channel. Signaling molecules, circulating humoral molecules, vasorelaxant agents, etc., have an influence on the open probability of the channel in pulmonary arterial vascular cells. BKCa channel is a possible therapeutic target, aimed to cause vasodilation in constricted or chronically stiffened vessels, as shown in various animal models. This review is a comprehensive collation of studies on BKCa channels in the pulmonary circulation under hypoxia (hypoxic pulmonary vasoconstriction; HPV), lung pathology, and fetal to neonatal transition, emphasising pharmacological interventions as viable therapeutic options.
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Affiliation(s)
- Divya Guntur
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria;
| | - Horst Olschewski
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstraße 6, 8010 Graz, Austria;
| | - Péter Enyedi
- Department of Physiology, Semmelweis University, Tűzoltó utca 37-47, 1094 Budapest, Hungary; (P.E.); (R.C.)
| | - Réka Csáki
- Department of Physiology, Semmelweis University, Tűzoltó utca 37-47, 1094 Budapest, Hungary; (P.E.); (R.C.)
| | - Andrea Olschewski
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria;
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstraße 6, 8010 Graz, Austria;
- Correspondence:
| | - Chandran Nagaraj
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstraße 6, 8010 Graz, Austria;
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Rittchen S, Jandl K, Lanz I, Reiter B, Ferreirós N, Kratz D, Lindenmann J, Brcic L, Bärnthaler T, Atallah R, Olschewski H, Sturm EM, Heinemann A. Monocytes and Macrophages Serve as Potent Prostaglandin D 2 Sources during Acute, Non-Allergic Pulmonary Inflammation. Int J Mol Sci 2021; 22:ijms222111697. [PMID: 34769126 PMCID: PMC8584273 DOI: 10.3390/ijms222111697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Acute respiratory inflammation, most commonly resulting from bacterial or viral infection, is one of the leading causes of death and disability worldwide. The inflammatory lipid mediator prostaglandin D2 (PGD2) and its rate-limiting enzyme, hematopoietic PGD synthase (hPGDS), are well-known drivers of allergic pulmonary inflammation. Here, we sought to investigate the source and role of hPGDS-derived PGD2 in acute pulmonary inflammation. Murine bronchoalveolar monocytes/macrophages from LPS- but not OVA-induced lung inflammation released significant amounts of PGD2. Accordingly, human monocyte-derived macrophages expressed high basal levels of hPGDS and released significant levels of PGD2 after LPS/IFN-γ, but not IL-4 stimulation. Human peripheral blood monocytes secreted significantly more PGD2 than monocyte-derived macrophages. Using human precision-cut lung slices (PCLS), we observed that LPS/IFN-γ but not IL-4/IL-13 drive PGD2 production in the lung. HPGDS inhibition prevented LPS-induced PGD2 release by human monocyte-derived macrophages and PCLS. As a result of hPGDS inhibition, less TNF-α, IL-6 and IL-10 could be determined in PCLS-conditioned medium. Collectively, this dataset reflects the time-dependent release of PGD2 by human phagocytes, highlights the importance of monocytes and macrophages as PGD2 sources and suggests that hPGDS inhibition might be a potential therapeutic option for acute, non-allergic lung inflammation.
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Affiliation(s)
- Sonja Rittchen
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8010 Graz, Austria; (S.R.); (K.J.); (I.L.); (B.R.); (T.B.); (R.A.); (E.M.S.)
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria;
| | - Katharina Jandl
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8010 Graz, Austria; (S.R.); (K.J.); (I.L.); (B.R.); (T.B.); (R.A.); (E.M.S.)
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria;
| | - Ilse Lanz
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8010 Graz, Austria; (S.R.); (K.J.); (I.L.); (B.R.); (T.B.); (R.A.); (E.M.S.)
| | - Bernhard Reiter
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8010 Graz, Austria; (S.R.); (K.J.); (I.L.); (B.R.); (T.B.); (R.A.); (E.M.S.)
| | - Nerea Ferreirós
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany; (N.F.); (D.K.)
| | - Daniel Kratz
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany; (N.F.); (D.K.)
| | - Jörg Lindenmann
- Department of Surgery, Divison of Thoracic and Hyperbaric Surgery, Medical University of Graz, 8010 Graz, Austria;
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8010 Graz, Austria;
| | - Thomas Bärnthaler
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8010 Graz, Austria; (S.R.); (K.J.); (I.L.); (B.R.); (T.B.); (R.A.); (E.M.S.)
| | - Reham Atallah
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8010 Graz, Austria; (S.R.); (K.J.); (I.L.); (B.R.); (T.B.); (R.A.); (E.M.S.)
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria;
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, 8010 Graz, Austria
| | - Eva M. Sturm
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8010 Graz, Austria; (S.R.); (K.J.); (I.L.); (B.R.); (T.B.); (R.A.); (E.M.S.)
| | - Akos Heinemann
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8010 Graz, Austria; (S.R.); (K.J.); (I.L.); (B.R.); (T.B.); (R.A.); (E.M.S.)
- BioTechMed, 8010 Graz, Austria
- Correspondence: ; Tel.: +43-316-385-74112
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Geiger-Gritsch S, Olschewski H, Kocher F, Wurm R, Absenger G, Flicker M, Hermann A, Heininger P, Fiegl M, Zechmeister M, Endel F, Wild C, Pall G. Real-world experience with anti-PD-1/PD-L1 monotherapy in patients with non-small cell lung cancer : A retrospective Austrian multicenter study. Wien Klin Wochenschr 2021; 133:1122-1130. [PMID: 34528126 DOI: 10.1007/s00508-021-01940-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE As real-world data regarding immunotherapy for non-small cell lung cancer are lacking for Austria, we conducted a retrospective study in six hospitals to present data from real-world practice. METHODS Patients with metastatic non-small cell lung cancer were stratified into two groups, either patients with first-line pembrolizumab monotherapy (cohort 1) or patients with second-line nivolumab, pembrolizumab or atezolizumab monotherapy (cohort 2). Primary outcome measures were objective response rate and overall survival. A matched-pair analysis was performed to compare overall survival to patients from the Tyrolean Lung Cancer Project as a historical control group. RESULTS In total, 89 patients were identified, 42 patients in cohort 1 and 47 patients in cohort 2. The objective response rates were 43.3% and 31.4%, respectively. The median overall survival was 17.0 months (95% CI 11.7-21.5 months) in cohort 1 and 18.7 months (95% CI 9.5-23.4 months) in cohort 2. Treatment-related adverse events grades 3 and 4 were reported in 11.2% of patients. The matched-pair analysis showed a median overall survival of 15.2 months (95% CI 7.6-20.4 months) for first-line pembrolizumab monotherapy compared to 9.8 months (95% CI 7.8-11.6 months) for the historical control (p = 0.43). In cohort 2, a median overall survival of 20.3 months (95% CI 6.9-26.2 months) for second-line immunotherapy compared to 5.4 months (95% CI 3.2-11.7 months) for the historical control (p = 0.18) was shown. CONCLUSION The results are comparable with other real-world studies and, when matched to historical controls, support the improvement in outcomes made possible by these agents.
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Affiliation(s)
- Sabine Geiger-Gritsch
- HTA Austria-Austrian Institute for Health Technology Assessment GmbH, Garnisongasse 7/20, 1090, Vienna, Austria.
| | - Horst Olschewski
- Department of Internal Medicine, Division of Pulmonology, Medical University Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Florian Kocher
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Robert Wurm
- Department of Internal Medicine, Division of Pulmonology, Medical University Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Gudrun Absenger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Martin Flicker
- Department of Lung Diseases, Landeskrankenhaus Hochsteiermark, Vordernberger Straße 42, 8700, Leoben, Austria
| | - André Hermann
- Department of Internal Medicine, Division of Gastroenterology, Infectiology & Pneumology, Landeskrankenhaus Graz II West, Göstinger Straße 22, 8020, Graz, Austria
| | - Peter Heininger
- Medical Directorate, District Hospital Schwaz, Swarovskistraße 1-3, 6130, Schwaz, Austria
| | - Michael Fiegl
- Internal Medicine, Privatklinik Hochrum, Lärchenstraße 41, 6063, Rum, Austria
| | | | - Florian Endel
- Verein DEXHELPP, Neustiftgasse 57-59, 1070, Vienna, Austria
| | - Claudia Wild
- HTA Austria-Austrian Institute for Health Technology Assessment GmbH, Garnisongasse 7/20, 1090, Vienna, Austria
| | - Georg Pall
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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Fließer E, Birnhuber A, Marsh LM, Gschwandtner E, Klepetko W, Olschewski H, Kwapiszewska G. Dysbalance of ACE2 levels - a possible cause for severe COVID-19 outcome in COPD. J Pathol Clin Res 2021; 7:446-458. [PMID: 33978304 PMCID: PMC8239572 DOI: 10.1002/cjp2.224] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/22/2021] [Accepted: 04/21/2021] [Indexed: 12/23/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a serious threat to healthcare systems worldwide. Binding of the virus to angiotensin-converting enzyme 2 (ACE2) is an important step in the infection mechanism. However, it is unknown if ACE2 expression in patients with chronic lung diseases (CLDs), such as chronic obstructive pulmonary disease (COPD), idiopathic pulmonary arterial hypertension (IPAH), or pulmonary fibrosis (PF), is changed as compared to controls. We used lung samples from patients with COPD (n = 28), IPAH (n = 10), and PF (n = 10) as well as healthy control donor (n = 10) tissue samples to investigate the expression of ACE2 and related cofactors that might influence the course of SARS-CoV-2 infection. Expression levels of the ACE2 receptor, the putative receptor CD147/BSG, and the viral entry cofactors TMPRSS2 (transmembrane serine protease 2), EZR, and FURIN were determined by quantitative PCR and in open-access RNA sequencing datasets. Immunohistochemical and single-cell RNA sequencing (scRNAseq) analyses were used for localization and coexpression, respectively. Soluble ACE2 (sACE2) plasma levels were analyzed by enzyme-linked immunosorbent assay. In COPD as compared to donor, IPAH, and PF lung tissue, gene expression of ACE2, TMPRSS2, and EZR was significantly elevated, but circulating sACE2 levels were significantly reduced in COPD and PF plasma compared to healthy control and IPAH plasma samples. Lung tissue expressions of FURIN and CD147/BSG were downregulated in COPD. None of these changes were associated with changes in pulmonary hemodynamics. Histological analysis revealed coexpression of ACE2, TMPRSS2, and Ezrin in bronchial regions and epithelial cells. This was confirmed by scRNAseq analysis. There were no significant expression changes of the analyzed molecules in the lung tissue of IPAH and idiopathic PF as compared to control. In conclusion, we reveal increased ACE2 and TMPRSS2 expression in lung tissue with a concomitant decrease of protective sACE2 in COPD patients. These changes represent the possible risk factors for an increased susceptibility of COPD patients to SARS-CoV-2 infection.
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Affiliation(s)
| | - Anna Birnhuber
- Ludwig Boltzmann Institute for Lung Vascular ResearchGrazAustria
| | - Leigh M Marsh
- Ludwig Boltzmann Institute for Lung Vascular ResearchGrazAustria
| | - Elisabeth Gschwandtner
- Division of Thoracic Surgery, Department of SurgeryMedical University of ViennaViennaAustria
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of SurgeryMedical University of ViennaViennaAustria
| | | | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular ResearchGrazAustria
- Otto Loewi Research CenterMedical University of GrazGrazAustria
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Sharma N, Nagaraj C, Nagy BM, Marsh LM, Bordag N, Zabini D, Wygrecka M, Klepetko W, Gschwandtner E, Genové G, Heinemann A, Weir EK, Kwapiszewska G, Olschewski H, Olschewski A. RGS5 Determines Neutrophil Migration in the Acute Inflammatory Phase of Bleomycin-Induced Lung Injury. Int J Mol Sci 2021; 22:ijms22179342. [PMID: 34502263 PMCID: PMC8430858 DOI: 10.3390/ijms22179342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
The regulator of G protein signaling (RGS) represents a widespread system of controllers of cellular responses. The activities of the R4 subfamily of RGSs have been elucidated in allergic pulmonary diseases. However, the R4 signaling in other inflammatory lung diseases, with a strong cellular immune response, remained unexplored. Thus, our study aimed to discern the functional relevance of the R4 family member, RGS5, as a potential modulating element in this context. Gene profiling of the R4 subfamily showed increased RGS5 expression in human fibrosing lung disease samples. In line with this, RGS5 was markedly increased in murine lungs following bleomycin injury. RGS knock-out mice (RGS-/-) had preserved lung function while control mice showed significant combined ventilatory disorders three days after bleomycin application as compared to untreated control mice. Loss of RGS5 was associated with a significantly reduced neutrophil influx and tissue myeloperoxidase expression. In the LPS lung injury model, RGS5-/- mice also failed to recruit neutrophils into the lung, which was accompanied by reduced tissue myeloperoxidase levels after 24 h. Our in-vitro assays showed impaired migration of RGS5-/- neutrophils towards chemokines despite preserved Ca2+ signaling. ERK dephosphorylation might play a role in reduced neutrophil migration in our model. As a conclusion, loss of RGS5 preserves lung function and attenuates hyperinflammation in the acute phase of bleomycin-induced pulmonary fibrosis and LPS-induced lung injury. Targeting RGS5 might alleviate the severity of exacerbations in interstitial lung diseases.
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Affiliation(s)
- Neha Sharma
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria; (N.S.); (C.N.); (B.M.N.); (L.M.M.); (N.B.); (D.Z.); (G.K.); (H.O.)
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Chandran Nagaraj
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria; (N.S.); (C.N.); (B.M.N.); (L.M.M.); (N.B.); (D.Z.); (G.K.); (H.O.)
| | - Bence M. Nagy
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria; (N.S.); (C.N.); (B.M.N.); (L.M.M.); (N.B.); (D.Z.); (G.K.); (H.O.)
| | - Leigh M. Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria; (N.S.); (C.N.); (B.M.N.); (L.M.M.); (N.B.); (D.Z.); (G.K.); (H.O.)
| | - Natalie Bordag
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria; (N.S.); (C.N.); (B.M.N.); (L.M.M.); (N.B.); (D.Z.); (G.K.); (H.O.)
- Department of Dermatology and Venereology, Medical University of Graz, 8036 Graz, Austria
| | - Diana Zabini
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria; (N.S.); (C.N.); (B.M.N.); (L.M.M.); (N.B.); (D.Z.); (G.K.); (H.O.)
- Otto Loewi Research Center, Medical University of Graz, 8010 Graz, Austria
| | - Malgorzata Wygrecka
- Department of Biochemistry, Universities of Giessen and Marburg Lung Center, Justus Liebig University of Giessen, Friedrichstrasse 24, 35392 Giessen, Germany;
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (W.K.); (E.G.)
| | - Elisabeth Gschwandtner
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (W.K.); (E.G.)
| | - Guillem Genové
- Integrated CardioMetabolic Centre (ICMC), Department of Medicine, Karolinska Institute, 171 77 Huddinge, Sweden;
| | - Akos Heinemann
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8010 Graz, Austria;
| | - E Kenneth Weir
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria; (N.S.); (C.N.); (B.M.N.); (L.M.M.); (N.B.); (D.Z.); (G.K.); (H.O.)
- Otto Loewi Research Center, Medical University of Graz, 8010 Graz, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria; (N.S.); (C.N.); (B.M.N.); (L.M.M.); (N.B.); (D.Z.); (G.K.); (H.O.)
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, 8036 Graz, Austria
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria; (N.S.); (C.N.); (B.M.N.); (L.M.M.); (N.B.); (D.Z.); (G.K.); (H.O.)
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, 8036 Graz, Austria
- Correspondence: ; Tel.: +43-(0)316-385-72057
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Zeder K, Avian A, Bachmaier G, Douschan P, Foris V, Sassmann T, Troester N, Brcic L, Fuchsjaeger M, Marsh LM, Maron BA, Olschewski H, Kovacs G. Elevated pulmonary vascular resistance predicts mortality in COPD patients. Eur Respir J 2021; 58:13993003.00944-2021. [PMID: 33986032 DOI: 10.1183/13993003.00944-2021] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/14/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Katarina Zeder
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Pulmonology, Dept of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Gerhard Bachmaier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Philipp Douschan
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Pulmonology, Dept of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Vasile Foris
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Pulmonology, Dept of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Teresa Sassmann
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Pulmonology, Dept of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Natascha Troester
- Division of Pulmonology, Dept of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Luka Brcic
- Dept of Pathology, Medical University of Graz, Graz, Austria
| | | | | | - Bradley A Maron
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria .,Division of Pulmonology, Dept of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Pulmonology, Dept of Internal Medicine, Medical University of Graz, Graz, Austria
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40
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Maron BA, Abman SH, Elliott CG, Frantz RP, Hopper RK, Horn EM, Nicolls MR, Shlobin OA, Shah SJ, Kovacs G, Olschewski H, Rosenzweig EB. Pulmonary Arterial Hypertension: Diagnosis, Treatment, and Novel Advances. Am J Respir Crit Care Med 2021; 203:1472-1487. [PMID: 33861689 PMCID: PMC8483220 DOI: 10.1164/rccm.202012-4317so] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The diagnosis and management of pulmonary arterial hypertension (PAH) includes several advances, such as a broader recognition of extrapulmonary vascular organ system involvement, validated point-of-care clinical assessment tools, and focus on the early initiation of multiple pharmacotherapeutics in appropriate patients. Indeed, a principal goal in PAH today is an early diagnosis for prompt initiation of treatment to achieve a minimal symptom burden; optimize the patient's biochemical, hemodynamic, and functional profile; and limit adverse events. To accomplish this end, clinicians must be familiar with novel risk factors and the revised hemodynamic definition for PAH. Fresh insights into the role of developmental biology (i.e., perinatal health) may also be useful for predicting incident PAH in early adulthood. Emergent or underused approaches to PAH management include a novel TGF-β ligand trap pharmacotherapy, remote pulmonary arterial pressure monitoring, next-generation imaging using inert gas-based magnetic resonance and other technologies, right atrial pacing, and pulmonary arterial denervation. These and other PAH state of the art advances are summarized here for the wider pulmonary medicine community.
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Affiliation(s)
- Bradley A Maron
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Steven H Abman
- Section of Pulmonary Medicine, Children's Hospital Colorado and the University of Colorado Anschutz Medical Center, University of Colorado, Aurora, Colorado
| | - C Greg Elliott
- Intermountain Medical Center and the University of Utah, Salt Lake City, Utah
| | - Robert P Frantz
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Rachel K Hopper
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Evelyn M Horn
- Division of Cardiology, Department of Medicine, Weill Cornell Graduate School of Medical Sciences, Cornell University, New York, New York
| | - Mark R Nicolls
- Veterans Affairs Palo Alto Health Care System and School of Medicine, Stanford University, Stanford, California
| | - Oksana A Shlobin
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, Virginia
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gabor Kovacs
- Department of Pulmonology, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; and
| | - Horst Olschewski
- Department of Pulmonology, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; and
| | - Erika B Rosenzweig
- Department of Pediatrics and.,Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Grünig E, MacKenzie A, Peacock AJ, Eichstaedt CA, Benjamin N, Nechwatal R, Ulrich S, Saxer S, Bussotti M, Sommaruga M, Ghio S, Gumbiene L, Palevičiūtė E, Jurevičienė E, Cittadini A, Stanziola AA, Marra AM, Kovacs G, Olschewski H, Barberà JA, Blanco I, Spruit MA, Franssen FME, Vonk Noordegraaf A, Reis A, Santos M, Viamonte SG, Demeyer H, Delcroix M, Bossone E, Johnson M. Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial. Eur Heart J 2021; 42:2284-2295. [PMID: 33232470 DOI: 10.1093/eurheartj/ehaa696] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/07/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). METHODS AND RESULTS For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n = 98; CTEPH n = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17-33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18-51 m; P < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 ± 2.5, P = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; χ2P = 0.027) and peak oxygen consumption (0.9 ± 0.5 mL/min/kg, P = 0.048) compared with the control group. CONCLUSION This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries.
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Affiliation(s)
- Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126 Heidelberg, Germany
| | - Alison MacKenzie
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Christina A Eichstaedt
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126 Heidelberg, Germany.,Laboratory for Molecular Diagnostics, Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Nicola Benjamin
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126 Heidelberg, Germany
| | | | - Silvia Ulrich
- Clinic of Pulmonology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Stéphanie Saxer
- Clinic of Pulmonology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Maurizio Bussotti
- Cardiac Rehabilitation Department, IRCCS Maugeri Clinical Scientific Institutes, Milan, Italy
| | - Marinella Sommaruga
- Cardiac Rehabilitation Department, IRCCS Maugeri Clinical Scientific Institutes, Milan, Italy
| | - Stefano Ghio
- Divisione di Cardiologia, Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
| | - Lina Gumbiene
- Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Eglė Palevičiūtė
- Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Elena Jurevičienė
- Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Antonio Cittadini
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Anna A Stanziola
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | - Alberto M Marra
- Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126 Heidelberg, Germany.,Department of Cardiovascular Imaging, IRCCS S.D.N., Naples, Italy
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Joan-Albert Barberà
- Department of Pulmonary Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona and Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona and Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Spain
| | - Martijn A Spruit
- Research and Development, Ciro, Horn, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Anton Vonk Noordegraaf
- Department of Pulmonology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Abílio Reis
- Department of Internal Medicine, Hospital Geral de Santo António, Porto, Portugal
| | - Mário Santos
- Department of Internal Medicine, Hospital Geral de Santo António, Porto, Portugal
| | | | - Heleen Demeyer
- Department of Pneumology, University Hospital Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Marion Delcroix
- Department of Pneumology, University Hospital Leuven, Leuven, Belgium
| | - Eduardo Bossone
- Department of Cardiology, Antonio Carderelli Hospital, Naples, Italy
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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Birnhuber A, Fliesser E, Gorkiewicz G, Zacharias M, Seeliger B, David S, Welte T, Schmidt J, Olschewski H, Wygrecka M, Kwapiszewska G. Between inflammation and thrombosis - endothelial cells in COVID-19. Eur Respir J 2021; 58:13993003.00377-2021. [PMID: 33958433 PMCID: PMC8112008 DOI: 10.1183/13993003.00377-2021] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/26/2021] [Indexed: 12/21/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing the current coronavirus disease (COVID-19) pandemic [1]. Over recent months, a plethora of novel research articles has been published, dealing with multiple aspects and manifestations of the disease. Increasing evidence points to a central role of endothelial cells in SARS-CoV-2 infection [2–5]. Early studies have already indicated increased expression of vascular and inflammatory factors (such as vascular cell adhesion molecule (VCAM)-1, interleukin (IL)-8 or monocyte-chemoattractant protein (MCP)-1) in COVID-19 lung tissue [2]. Such markers of endothelial dysfunction and altered endothelial cell integrity are important predictors of a poor outcome in SARS-CoV-2 infections [6], and they are associated with pulmonary oedema, intravascular thrombosis and acute respiratory distress syndrome (ARDS). The pulmonary endothelium is crucial for regulation of vascular tone, inflammatory responses, coagulation/fibrinolysis and maintenance of vascular homeostasis and permeability. Disturbances of these tightly regulated processes may directly contribute to morbidity and mortality. However, the exact mechanisms leading to pulmonary vasculopathy in COVID-19 are still unclear. Here, we provide an analysis of several important vascular markers implicated in the inflammatory response (E-selectin, intercellular cell adhesion molecule (ICAM)-1, VCAM-1), maintenance of microvascular integrity (CD31, vascular endothelial growth factor receptor (VEGFR)-2), platelet activation and coagulation (P-selectin, von Willebrand factor (vWF)) in lung tissue and plasma samples of COVID-19 patients. Elevated levels of several endothelial markers, including CD31, VEGFR-2, ICAM-1, VCAM-1, E-selectin, P-selectin and vWF, in lung tissue and circulation support an important role of the pulmonary endothelium in local and systemic COVID-19 pathologyhttps://bit.ly/3eQObIR
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Affiliation(s)
- Anna Birnhuber
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Authors contributed equally
| | - Elisabeth Fliesser
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Authors contributed equally
| | - Gregor Gorkiewicz
- Diagnostic and Research Institute of Pathology, Medical University Graz, Austria
| | - Martin Zacharias
- Diagnostic and Research Institute of Pathology, Medical University Graz, Austria
| | - Benjamin Seeliger
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Sascha David
- Institute of Intensive Care, University Hospital Zurich, Zurich, Switzerland
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Julius Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School
| | - Horst Olschewski
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Malgorzata Wygrecka
- Center for Infection and Genomics of the Lung, Universities of Giessen and Marburg Lung Center, Giessen, Germany. Member of the German Center for Lung Research.,Authors contributed equally
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria. .,Otto Loewi Research Center, Medical University of Graz, Graz, Austria.,Authors contributed equally
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Scheidl S, Avian A, Flick H, Gaal S, Greinix H, Olschewski H. Impact of smoking behavior on survival following allogeneic hematopoietic stem cell transplantation - smoking cessation matters. Nicotine Tob Res 2021; 23:1708-1715. [PMID: 33837775 DOI: 10.1093/ntr/ntab070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/09/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION There are only few data on the impact of smoking and smoking cessation on outcome of patients treated with allogeneic hematopoietic stem cell transplantation, a well established therapy for hematologic malignancies. METHODS In a retrospective cohort study design we examined impact of smoking and smoking cessation on survival among 309 eligible consecutive adults who underwent allogeneic hematopoietic stem cell transplantation using reduced-intensity (n=179) or myeloablative (n=130) conditioning between 1999 and 2018. RESULTS Smoking and was independently associated with increased mortality with a five-year overall survival of 25% in current smokers vs. 53% in never smokers vs. 48% in past smokers. Never smokers lived significantly longer (HR: 2.00, 95%CI: 1.19-3.35, p=0.008) and had a better event-free survival (HR: 2.11, 95%CI: 1.27-3.49, p=0.004) than current smokers. In the long run never smokers also lived significantly longer than past smokers (HR: 1.45, 95%CI: 1.16-1.81, p = 0.001). Patients who quit smoking prior to allogeneic hematopoietic stem cell transplantation showed a tendency towards increased survival compared to those continued smoking (HR: 1.53, 95%CI: 0.95-2.45, p = 0.078). In relation to life-time cigarette dose smokers with low-dose (1-10 pack-years) cigarette consumption lived significantly longer (HR: 1.60, 95%CI: 1.03-2.50, p=0.037) and had a better event-free survival (HR: 1.66, 95%CI: 1.07-2.58, p=0.025) than patients with high-dose (≥ 10 pack-years) cigarette consumption. CONCLUSIONS In allogeneic hematopoietic stem cell transplantation for hematologic malignancies, smoking history per se, life-time cigarette dose, and continued smoking, were significantly associated with increased all-cause mortality and reduced event-free survival. IMPLICATIONS Continued and past smoking represent established risk factors for malignant and non-malignant diseases, however, they are also a strong risk factor for a poor outcome after allogeneic hematopoietic stem cell transplantation for hematologic diseases. Our study shows that the hazard ratio for death after such a transplantation is doubled if patients continue smoking and even if they have quit smoking, their risk remains significantly elevated. This suggests that the smoking history provides important predictive factors for outcome of allogeneic hematopoietic stem cell transplantation and that smoking cessation should be implemented in the treatment of hematologic diseases as early as possible.
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Affiliation(s)
- Stefan Scheidl
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz
| | - Sonja Gaal
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hildegard Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz
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Mandras S, Kovacs G, Olschewski H, Broderick M, Nelsen A, Shen E, Champion H. Combination Therapy in Pulmonary Arterial Hypertension-Targeting the Nitric Oxide and Prostacyclin Pathways. J Cardiovasc Pharmacol Ther 2021; 26:453-462. [PMID: 33836637 PMCID: PMC8261771 DOI: 10.1177/10742484211006531] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a chronic and progressive disorder
characterized by vascular remodeling of the small pulmonary arteries, resulting
in elevated pulmonary vascular resistance and ultimately, right ventricular
failure. Expanded understanding of PAH pathophysiology as it pertains to the
nitric oxide (NO), prostacyclin (prostaglandin I2) (PGI2)
and endothelin-1 pathways has led to recent advancements in targeted drug
development and substantial improvements in morbidity and mortality. There are
currently several classes of drugs available to target these pathways including
phosphodiesterase-5 inhibitors (PDE5i), soluble guanylate cyclase (sGC)
stimulators, prostacyclin class agents and endothelin receptor antagonists
(ERAs). Combination therapy in PAH, either upfront or sequentially, has become a
widely adopted treatment strategy, allowing for simultaneous targeting of more
than one of these signaling pathways implicated in disease progression. Much of
the current treatment landscape has focused on initial combination therapy with
ambrisentan and tadalafil, an ERA and PDE5I respectively, following results of
the AMBITION study demonstrating combination to be superior to either agent
alone as upfront therapy. Consequently, clinicians often consider combination
therapy with other drugs and drug classes, as deemed clinically appropriate, for
patients with PAH. An alternative regimen that targets the NO and
PGI2 pathways has been adopted by some clinicians as an effective
and sometimes preferred therapeutic combination for PAH. Although there is a
paucity of prospective data, preclinical data and results from secondary data
analysis of clinical studies targeting these pathways may provide novel insights
into this alternative combination as a reasonable, and sometimes preferred,
alternative approach to combination therapy in PAH. This review of preclinical
and clinical data will discuss the current understanding of combination therapy
that simultaneously targets the NO and PGI2 signaling pathways,
highlighting the clinical advantages and theoretical biochemical interplay of
these agents.
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Affiliation(s)
| | - Gabor Kovacs
- Medical University of Graz, 580955Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Horst Olschewski
- Medical University of Graz, 580955Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | | | - Andrew Nelsen
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | - Eric Shen
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | - Hunter Champion
- Division of Cardiology, 12241Mercer University School of Medicine, Macon, GA, USA
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45
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Bauer PK, Flicker M, Fabian E, Flick H, Brcic L, Liegl-Atzwanger B, Janisch M, Fuchsjäger M, Olschewski H, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 170: A 33-year-old psychologist with severe dyspnea and right-sided chylothorax. Wien Klin Wochenschr 2021; 133:65-72. [PMID: 33119872 PMCID: PMC7840639 DOI: 10.1007/s00508-020-01753-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Philipp K Bauer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Martin Flicker
- Department of Internal Medicine, State Hospital Hochsteiermark, Leoben, Austria
| | - Elisabeth Fabian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | | | - Michael Janisch
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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46
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Smolle E, Leko P, Stacher-Priehse E, Brcic L, El-Heliebi A, Hofmann L, Quehenberger F, Hrzenjak A, Popper H, Olschewski H, Leithner K. P62.08 Expression Pattern and Prognostic Significance of Gluconeogenesis Enzymes in Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lesko J, Triebl A, Stacher-Priehse E, Fink-Neuböck N, Lindenmann J, Smolle-Jüttner FM, Köfeler HC, Hrzenjak A, Olschewski H, Leithner K. Phospholipid dynamics in ex vivo lung cancer and normal lung explants. Exp Mol Med 2021; 53:81-90. [PMID: 33408336 PMCID: PMC8080582 DOI: 10.1038/s12276-020-00547-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/22/2020] [Accepted: 11/04/2020] [Indexed: 01/29/2023] Open
Abstract
In cancer cells, metabolic pathways are reprogrammed to promote cell proliferation and growth. While the rewiring of central biosynthetic pathways is being extensively studied, the dynamics of phospholipids in cancer cells are still poorly understood. In our study, we sought to evaluate de novo biosynthesis of glycerophospholipids (GPLs) in ex vivo lung cancer explants and corresponding normal lung tissue from six patients by utilizing a stable isotopic labeling approach. Incorporation of fully 13C-labeled glucose into the backbone of phosphatidylethanolamine (PE), phosphatidylcholine (PC), and phosphatidylinositol (PI) was analyzed by liquid chromatography/mass spectrometry. Lung cancer tissue showed significantly elevated isotopic enrichment within the glycerol backbone of PE, normalized to its incorporation into PI, compared to that in normal lung tissue; however, the size of the PE pool normalized to the size of the PI pool was smaller in tumor tissue. These findings indicate enhanced PE turnover in lung cancer tissue. Elevated biosynthesis of PE in lung cancer tissue was supported by enhanced expression of the PE biosynthesis genes ETNK2 and EPT1 and decreased expression of the PC and PI biosynthesis genes CHPT1 and CDS2, respectively, in different subtypes of lung cancer in publicly available datasets. Our study demonstrates that incorporation of glucose-derived carbons into the glycerol backbone of GPLs can be monitored to study phospholipid dynamics in tumor explants and shows that PE turnover is elevated in lung cancer tissue compared to normal lung tissue.
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Affiliation(s)
- Julia Lesko
- grid.11598.340000 0000 8988 2476Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, 8036 Graz, Austria
| | - Alexander Triebl
- grid.11598.340000 0000 8988 2476Core Facility Mass Spectrometry and Lipidomics, ZMF, Medical University of Graz, Graz, Austria
| | - Elvira Stacher-Priehse
- grid.11598.340000 0000 8988 2476Institute of Pathology, Medical University of Graz, Graz, Austria ,grid.6363.00000 0001 2218 4662Present Address: Institute of Pathology, Asklepios Clinic Munich-Gauting, Munich, Germany
| | - Nicole Fink-Neuböck
- grid.11598.340000 0000 8988 2476Division of Thoracic and Hyperbaric Surgery, Medical University of Graz, Graz, Austria
| | - Jörg Lindenmann
- grid.11598.340000 0000 8988 2476Division of Thoracic and Hyperbaric Surgery, Medical University of Graz, Graz, Austria
| | - Freyja-Maria Smolle-Jüttner
- grid.11598.340000 0000 8988 2476Division of Thoracic and Hyperbaric Surgery, Medical University of Graz, Graz, Austria
| | - Harald C. Köfeler
- grid.11598.340000 0000 8988 2476Core Facility Mass Spectrometry and Lipidomics, ZMF, Medical University of Graz, Graz, Austria
| | - Andelko Hrzenjak
- grid.11598.340000 0000 8988 2476Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, 8036 Graz, Austria ,grid.489038.eLudwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Horst Olschewski
- grid.11598.340000 0000 8988 2476Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, 8036 Graz, Austria ,grid.489038.eLudwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Katharina Leithner
- grid.11598.340000 0000 8988 2476Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, 8036 Graz, Austria
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Eller P, Flick H, Schilcher G, Moazedi-Fürst F, Eller K, Talakic E, Hermann J, Allanore Y, Olschewski H. Successful treatment of severe interstitial pneumonia by removal of circulating autoantibodies: a case series. BMC Pulm Med 2021; 21:13. [PMID: 33407317 PMCID: PMC7788864 DOI: 10.1186/s12890-020-01386-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/20/2020] [Indexed: 12/01/2022] Open
Abstract
Background There is only limited clinical data on the benefit of intense immunosuppression in patients with severe interstitial pneumonia associated with autoimmune features or new-onset connective tissue disease. Case presentation We here report a series of three consecutive patients suffering from severe interstitial lung disease necessitating endotracheal intubation and mechanical ventilation. The first two patients fulfilled many diagnostic criteria for new-onset antisynthetase syndrome, the third patient for systemic lupus erythematosus. We decided to implement aggressive immunosuppressive strategies in these critically-ill patients including therapeutic plasma exchange, immunoadsorption, cyclophosphamide and rituximab. All three patients improved from respiratory failure, were successfully weaned from the respirator, and eventually dismissed from hospital with ongoing immunosuppressive therapy. Conclusion Patients suffering from severe connective tissue disease-associated interstitial lung disease and respiratory failure may benefit from an aggressive immunosuppressive regimen and extracorporeal blood purification with rapid reduction of circulating autoantibodies. The impressive clinical responses in this small case series warrant a controlled clinical trial.
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Affiliation(s)
- Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gernot Schilcher
- Intensive Care Unit, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Florentine Moazedi-Fürst
- Division of Rheumatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Emina Talakic
- Department of Radiology, Medical University of Graz, Graz, Austria
| | - Josef Hermann
- Division of Rheumatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Yannick Allanore
- Université Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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49
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Swietlik EM, Greene D, Zhu N, Megy K, Cogliano M, Rajaram S, Pandya D, Tilly T, Lutz KA, Welch CC, Pauciulo MW, Southgate L, Martin JM, Treacy CM, Penkett CJ, Stephens JC, Bogaard HJ, Church C, Coghlan G, Coleman AW, Condliffe R, Eichstaedt CA, Eyries M, Gall H, Ghio S, Girerd B, Grünig E, Holden S, Howard L, Humbert M, Kiely DG, Kovacs G, Lordan J, Machado RD, MacKenzie Ross RV, McCabe C, Moledina S, Montani D, Olschewski H, Pepke-Zaba J, Price L, Rhodes CJ, Seeger W, Soubrier F, Suntharalingam J, Toshner MR, Vonk Noordegraaf A, Wharton J, Wild JM, Wort SJ, Lawrie A, Wilkins MR, Trembath RC, Shen Y, Chung WK, Swift AJ, Nichols WC, Morrell NW, Gräf S. Bayesian Inference Associates Rare KDR Variants with Specific Phenotypes in Pulmonary Arterial Hypertension. Circ Genom Precis Med 2020; 14. [PMID: 33320693 PMCID: PMC7892262 DOI: 10.1161/circgen.120.003155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
Background - Approximately 25% of patients with pulmonary arterial hypertension (PAH) have been found to harbor rare mutations in disease-causing genes. To identify missing heritability in PAH we integrated deep phenotyping with whole-genome sequencing data using Bayesian statistics. Methods - We analyzed 13,037 participants enrolled in the NIHR BioResource - Rare Diseases (NBR) study, of which 1,148 were recruited to the PAH domain. To test for genetic associations between genes and selected phenotypes of pulmonary hypertension (PH), we used the Bayesian rare-variant association method BeviMed. Results - Heterozygous, high impact, likely loss-of-function variants in the Kinase Insert Domain Receptor (KDR) gene were strongly associated with significantly reduced transfer coefficient for carbon monoxide (KCO, posterior probability (PP)=0.989) and older age at diagnosis (PP=0.912). We also provide evidence for familial segregation of a rare nonsense KDR variant with these phenotypes. On computed tomographic imaging of the lungs, a range of parenchymal abnormalities were observed in the five patients harboring these predicted deleterious variants in KDR. Four additional PAH cases with rare likely loss-of-function variants in KDR were independently identified in the US PAH Biobank cohort with similar phenotypic characteristics. Conclusions - The Bayesian inference approach allowed us to independently validate KDR, which encodes for the Vascular Endothelial Growth Factor Receptor 2 (VEGFR2), as a novel PAH candidate gene. Furthermore, this approach specifically associated high impact likely loss-of-function variants in the genetically constrained gene with distinct phenotypes. These findings provide evidence for KDR being a clinically actionable PAH gene and further support the central role of the vascular endothelium in the pathobiology of PAH.
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Affiliation(s)
- Emilia M. Swietlik
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
| | - Daniel Greene
- Department of Haematology (D.G., K.M., C.J.P., J.C.S., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
| | - Na Zhu
- Department of Pediatrics (N.Z., C.C.L.W.), Columbia University, NY
- Department of Systems Biology (N.Z., Y.S.), Columbia University, NY
| | - Karyn Megy
- Department of Haematology (D.G., K.M., C.J.P., J.C.S., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
| | - Marcella Cogliano
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield (M.C., J.M.W., A.L., A.J.S.)
| | - Smitha Rajaram
- Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom (S.R.)
| | - Divya Pandya
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
| | - Tobias Tilly
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
| | - Katie A. Lutz
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center (K.A.L., M.W.P., A.W.C., W.C.N.)
| | | | - Michael W. Pauciulo
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center (K.A.L., M.W.P., A.W.C., W.C.N.)
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (M.W.P., W.C.N.)
| | - Laura Southgate
- Molecular & Clinical Sciences Research Institute, St George’s, University of London, United Kingdom (L.S., R.D.M.)
| | - Jennifer M. Martin
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
| | - Carmen M. Treacy
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
| | - Christopher J. Penkett
- Department of Haematology (D.G., K.M., C.J.P., J.C.S., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
| | - Jonathan C. Stephens
- Department of Haematology (D.G., K.M., C.J.P., J.C.S., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
| | - Harm J. Bogaard
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (H.J.B., A.V.N.)
| | - Colin Church
- Golden Jubilee National Hospital, Glasgow (C.C.)
| | | | - Anna W. Coleman
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center (K.A.L., M.W.P., A.W.C., W.C.N.)
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (R.C., D.G.K.)
| | - Christina A. Eichstaedt
- Laboratory for Molecular Genetic Diagnostics, Institute of Human Genetics, Heidelberg University (C.A.E.)
- Center for Pulmonary Hypertension, Thoraxklinik gGmbH Heidelberg at Heidelberg University Hospital (C.A.E., E.G.)
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany (C.A.E., E.G.)
| | - Mélanie Eyries
- Département de génétique, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris & UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France (M.E., F.S.)
| | - Henning Gall
- University of Giessen & Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary Institute (CPI), Giessen, Germany (H.G., W.S.)
| | - Stefano Ghio
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (S. Ghio)
| | - Barbara Girerd
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay (B.G., M.H., D.M.)
- AP-HP, Service de Pneumologie, Centre de référence de l’hypertension pulmonaire (B.G., M.H., D.M.)
- INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France (B.G., M.H., D.M.)
| | - Ekkehard Grünig
- Center for Pulmonary Hypertension, Thoraxklinik gGmbH Heidelberg at Heidelberg University Hospital (C.A.E., E.G.)
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany (C.A.E., E.G.)
| | - Simon Holden
- Addenbrooke’s Hospital NHS Foundation Trust, Cambridge (S.H., N.W.M.)
| | - Luke Howard
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
| | - Marc Humbert
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay (B.G., M.H., D.M.)
- AP-HP, Service de Pneumologie, Centre de référence de l’hypertension pulmonaire (B.G., M.H., D.M.)
- INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France (B.G., M.H., D.M.)
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (R.C., D.G.K.)
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research (G.K., H.O.)
- Medical University of Graz, Austria (G.K., H.O.)
| | - Jim Lordan
- Freeman Hospital, Newcastle upon Tyne (J.L.)
| | - Rajiv D. Machado
- Molecular & Clinical Sciences Research Institute, St George’s, University of London, United Kingdom (L.S., R.D.M.)
| | | | - Colm McCabe
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
- Royal Brompton & Harefield NHS Foundation Trust (C.M., L.P., S.J.W.)
| | | | - David Montani
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay (B.G., M.H., D.M.)
- AP-HP, Service de Pneumologie, Centre de référence de l’hypertension pulmonaire (B.G., M.H., D.M.)
- INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France (B.G., M.H., D.M.)
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research (G.K., H.O.)
- Medical University of Graz, Austria (G.K., H.O.)
| | - Joanna Pepke-Zaba
- Royal Papworth Hospital NHS Foundation Trust (J.P.-Z., M.R.T., N.W.M.)
| | - Laura Price
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
- Royal Brompton & Harefield NHS Foundation Trust (C.M., L.P., S.J.W.)
| | - Christopher J. Rhodes
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
| | - Werner Seeger
- University of Giessen & Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary Institute (CPI), Giessen, Germany (H.G., W.S.)
| | - Florent Soubrier
- Département de génétique, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris & UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France (M.E., F.S.)
| | | | - Mark R. Toshner
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
- Royal Papworth Hospital NHS Foundation Trust (J.P.-Z., M.R.T., N.W.M.)
| | - Anton Vonk Noordegraaf
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (H.J.B., A.V.N.)
| | - John Wharton
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
| | - James M. Wild
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield (M.C., J.M.W., A.L., A.J.S.)
| | - Stephen John Wort
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
- Royal Brompton & Harefield NHS Foundation Trust (C.M., L.P., S.J.W.)
| | | | | | | | - Allan Lawrie
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield (M.C., J.M.W., A.L., A.J.S.)
| | - Martin R. Wilkins
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
| | - Richard C. Trembath
- Department of Medical & Molecular Genetics, King’s College London, United Kingdom (R.C.T.)
| | - Yufeng Shen
- Department of Systems Biology (N.Z., Y.S.), Columbia University, NY
- Department of Biomedical Informatics (Y.S.), Columbia University, NY
| | | | - Andrew J. Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield (M.C., J.M.W., A.L., A.J.S.)
| | - William C. Nichols
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center (K.A.L., M.W.P., A.W.C., W.C.N.)
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (M.W.P., W.C.N.)
| | - Nicholas W. Morrell
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
- Addenbrooke’s Hospital NHS Foundation Trust, Cambridge (S.H., N.W.M.)
- Royal Papworth Hospital NHS Foundation Trust (J.P.-Z., M.R.T., N.W.M.)
| | - Stefan Gräf
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
- Department of Haematology (D.G., K.M., C.J.P., J.C.S., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
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50
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Studnicka M, Baumgartner B, Bolitschek J, Doberer D, Eber E, Eckmayr J, Hartl S, Hesse P, Jaksch P, Kink E, Kneussl M, Lamprecht B, Olschewski H, Pfleger A, Pohl W, Prior C, Puelacher C, Renner A, Steflitsch W, Stelzmüller I, Täubl H, Vonbank K, Wagner M, Wantke F, Wass R. [Masterplan 2025 of the Austrian Society of Pneumology (ASP)-the expected burden and management of respiratory diseases in Austria]. Wien Klin Wochenschr 2020; 132:89-113. [PMID: 32990821 DOI: 10.1007/s00508-020-01722-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Scientific Members of the Austrian Society of Pneumology describe the expected development in respiratory health and provide guidance towards patient-oriented and cost-efficient respiratory care in Austria.Methods: In November 2017, respiratory care providers (physicians, nurses, physiotherapists) together with patient's advocacy groups and experts in health development, collaborated in workshops on: respiratory health and the environment, bronchial asthma and allergy, COPD, pediatric respiratory disease, respiratory infections, sleep disorders, interventional pneumology, thoracic oncology and orphan diseases.Results: Respiratory disease is extremely prevalent and driven by ill-health behavior, i.e. cigarette smoking, over-eating and physical inactivity. For the majority of respiratory diseases increased prevalence, but decreased hospitalizations are expected.The following measures should be implemented to deal with future challenges:1. Screening and case-finding should be implemented for lung cancer and COPD.2. E-health solutions (telemedicine, personal apps) should be used to facilitate patient management.3. Regional differences in respiratory care should be reduced through E‑health and harmonization of health insurance benefits across Austria.4. Patient education and awareness, to reduce respiratory health illiteracy should be increased, which is essential for sleep disorders but relevant also for other respiratory diseases.5. Respiratory care should be inter-professional, provided via disease-specific boards beyond lung cancer (for ILDs, sleep, allergy)6. Programs for outpatient's pulmonary rehabilitation can have a major impact on respiratory health.7. Increased understanding of molecular pathways will drive personalized medicine, targeted therapy (for asthma, lung cancer) and subsequently health care costs.
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Affiliation(s)
- Michael Studnicka
- Landeskrankenhaus Salzburg, Universitätsklinik für Pneumologie/Lungenheilkunde, Müllner Hauptstraße 48, 5020, Salzburg, Österreich. .,Paracelsus Medical University, Salzburg, Österreich.
| | - Bernhard Baumgartner
- Abteilung für Pulmologie, Salzkammergut-Klinikum Vöcklabruck, Vöcklabruck, Österreich
| | - Josef Bolitschek
- Abteilung für Pneumologie, Ordensklinikum Linz GmbH Elisabethinen, Linz, Österreich
| | - Daniel Doberer
- Klin. Abteilung für Pulmologie, Medizinische Universität Wien, Wien, Österreich
| | - Ernst Eber
- Univ.-Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Josef Eckmayr
- Abteilung für Lungenkrankheiten, Klinikum Wels-Grieskirchen, Wels, Österreich
| | - Sylvia Hartl
- 2. Interne Lungenabteilung, Otto Wagner-Spital, Wien, Österreich
| | - Peter Hesse
- Ordination Dr. Judith & Dr. Peter Hesse, Schwechat, Österreich
| | - Peter Jaksch
- Klin. Abteilung für Thoraxchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Eveline Kink
- Lungenabteilung, LKH Graz II - Standort Enzenbach, Gratwein-Straßengel, Österreich
| | - Meinhard Kneussl
- ehem. 2. Medizinische Abteilung mit Pneumologie, Wilhelminenspital Wien, Wien, Österreich
| | - Bernd Lamprecht
- Klinik für Lungenheilkunde, Kepler Universitätsklinikum, Linz, Österreich
| | - Horst Olschewski
- Klinische Abteilung für Pulmonologie, LKH-Univ. Klinikum Graz, Graz, Österreich
| | - Andreas Pfleger
- Univ.-Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Wolfgang Pohl
- Abteilung für Atmungs- und Lungenerkrankungen, Krankenhaus Hietzing, Wien, Österreich
| | - Christian Prior
- Ordination Univ.-Prof. Dr. Christian Prior, Innsbruck, Österreich
| | | | - Andreas Renner
- Abteilung für Atmungs- und Lungenerkrankungen, Krankenhaus Hietzing, Wien, Österreich
| | - Wolfgang Steflitsch
- Wahlarzt-Ordination für Lungenheilkunde, Ollersbach bei Neulengbach, Österreich
| | | | - Helmut Täubl
- Standort Natters, Pulmologie, LKH Hochzirl-Natters, Natters, Österreich
| | - Karin Vonbank
- Klin. Abteilung für Pulmologie, Medizinische Universität Wien, Wien, Österreich
| | - Marlies Wagner
- Univ.-Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Felix Wantke
- FAZ Floridsdorfer Allergiezentrum GmbH, Wien, Österreich
| | - Romana Wass
- Klinik für Lungenheilkunde, Kepler Universitätsklinikum, Linz, Österreich
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