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Jones RJ, De Bie EMDD, Groves E, Zalewska KI, Swietlik EM, Treacy CM, Martin JM, Polwarth G, Li W, Guo J, Baxendale HE, Coleman S, Savinykh N, Coghlan JG, Corris PA, Howard LS, Johnson MK, Church C, Kiely DG, Lawrie A, Lordan JL, Mackenzie Ross RV, Pepke Zaba J, Wilkins MR, Wort SJ, Fiorillo E, Orrù V, Cucca F, Rhodes CJ, Gräf S, Morrell NW, McKinney EF, Wallace C, Toshner M. Autoimmunity Is a Significant Feature of Idiopathic Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2022; 206:81-93. [PMID: 35316153 PMCID: PMC7613913 DOI: 10.1164/rccm.202108-1919oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/16/2022] [Indexed: 12/15/2022] Open
Abstract
Rationale: Autoimmunity is believed to play a role in idiopathic pulmonary arterial hypertension (IPAH). It is not clear whether this is causative or a bystander of disease and if it carries any prognostic or treatment significance. Objectives: To study autoimmunity in IPAH using a large cross-sectional cohort. Methods: Assessment of the circulating immune cell phenotype was undertaken using flow cytometry, and the profile of serum immunoglobulins was generated using a standardized multiplex array of 19 clinically validated autoantibodies in 473 cases and 946 control subjects. Additional glutathione S-transferase fusion array and ELISA data were used to identify a serum autoantibody to BMPR2 (bone morphogenetic protein receptor type 2). Clustering analyses and clinical correlations were used to determine associations between immunogenicity and clinical outcomes. Measurements and Main Results: Flow cytometric immune profiling demonstrates that IPAH is associated with an altered humoral immune response in addition to raised IgG3. Multiplexed autoantibodies were significantly raised in IPAH, and clustering demonstrated three distinct clusters: "high autoantibody," "low autoantibody," and a small "intermediate" cluster exhibiting high concentrations of ribonucleic protein complex. The high-autoantibody cluster had worse hemodynamics but improved survival. A small subset of patients demonstrated immunoglobulin reactivity to BMPR2. Conclusions: This study establishes aberrant immune regulation and presence of autoantibodies as key features in the profile of a significant proportion of patients with IPAH and is associated with clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Wei Li
- Heart and Lung Research Institute
| | | | | | | | - Natalia Savinykh
- Cambridge Biomedical Research Centre Phenotyping Hub, Department of Medicine, University of Cambridge
| | - J. Gerry Coghlan
- Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | | | | | - Martin K. Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Colin Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | | | | | | | - Martin R. Wilkins
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Edoardo Fiorillo
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Cagliari, Italy
| | - Valeria Orrù
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Cagliari, Italy
| | | | - Christopher J. Rhodes
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | | | - Eoin F. McKinney
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Chris Wallace
- Heart and Lung Research Institute
- Medical Research Council Biostatistics Unit
- Department of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
| | - Mark Toshner
- Heart and Lung Research Institute
- Royal Papworth Hospital, and
| | - the UK National Cohort Study of Idiopathic and Heritable PAH Consortium
- Heart and Lung Research Institute
- Cambridge Biomedical Research Centre Phenotyping Hub, Department of Medicine, University of Cambridge
- Royal Papworth Hospital, and
- Medical Research Council Biostatistics Unit
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Royal Free London National Health Service Foundation Trust, London, United Kingdom
- Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
- Hammersmith Hospital, London, United Kingdom
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Royal United Hospitals Bath National Health Service Foundation Trust, Bath, United Kingdom
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Royal Brompton Hospital, London, United Kingdom
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Cagliari, Italy
- University of Sassari, Sassari, Italy; and
- Department of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
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Swietlik EM, Ghataorhe P, Zalewska KI, Wharton J, Howard LS, Taboada D, Cannon JE, Morrell NW, Wilkins MR, Toshner M, Pepke-Zaba J, Rhodes CJ. Plasma metabolomics exhibit response to therapy in chronic thromboembolic pulmonary hypertension. Eur Respir J 2020; 57:13993003.03201-2020. [PMID: 33060150 PMCID: PMC8012591 DOI: 10.1183/13993003.03201-2020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/20/2020] [Indexed: 12/31/2022]
Abstract
Pulmonary hypertension is a condition with limited effective treatment options. Chronic thromboembolic pulmonary hypertension (CTEPH) is a notable exception, with pulmonary endarterectomy (PEA) often proving curative. This study investigated the plasma metabolome of CTEPH patients, estimated reversibility to an effective treatment and explored the source of metabolic perturbations.We performed untargeted analysis of plasma metabolites in CTEPH patients compared to healthy controls and disease comparators. Changes in metabolic profile were evaluated in response to PEA. A subset of patients were sampled at three anatomical locations and plasma metabolite gradients calculated.We defined and validated altered plasma metabolite profiles in patients with CTEPH. 12 metabolites were confirmed by receiver operating characteristic analysis to distinguish CTEPH and both healthy (area under the curve (AUC) 0.64-0.94, all p<2×10-5) and disease controls (AUC 0.58-0.77, all p<0.05). Many of the metabolic changes were notably similar to those observed in idiopathic pulmonary arterial hypertension (IPAH). Only five metabolites (5-methylthioadenosine, N1-methyladenosine, N1-methylinosine, 7-methylguanine, N-formylmethionine) distinguished CTEPH from chronic thromboembolic disease or IPAH. Significant corrections (15-100% of perturbation) in response to PEA were observed in some, but not all metabolites. Anatomical sampling identified 188 plasma metabolites, with significant gradients in tryptophan, sphingomyelin, methionine and Krebs cycle metabolites. In addition, metabolites associated with CTEPH and gradients showed significant associations with clinical measures of disease severity.We identified a specific metabolic profile that distinguishes CTEPH from controls and disease comparators, despite the observation that most metabolic changes were common to both CTEPH and IPAH patients. Plasma metabolite gradients implicate cardiopulmonary tissue metabolism of metabolites associated with pulmonary hypertension and metabolites that respond to PEA surgery could be a suitable noninvasive marker for evaluating future targeted therapeutic interventions.
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Affiliation(s)
- Emilia M Swietlik
- Dept of Medicine, University of Cambridge, Cambridge, UK.,National Pulmonary Hypertension Service, Royal Papworth Hospital, Cambridge, UK
| | - Pavandeep Ghataorhe
- National Heart and Lung Institute, Medicine, Imperial College London, London, UK
| | - Kasia I Zalewska
- National Pulmonary Hypertension Service, Royal Papworth Hospital, Cambridge, UK.,Respiratory Unit, University Hospital Llandough, Cardiff, UK
| | - John Wharton
- National Heart and Lung Institute, Medicine, Imperial College London, London, UK
| | - Luke S Howard
- National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust and NHLI, Imperial College, Hammersmith Hospital, London, UK
| | - Dolores Taboada
- National Pulmonary Hypertension Service, Royal Papworth Hospital, Cambridge, UK
| | - John E Cannon
- National Pulmonary Hypertension Service, Royal Papworth Hospital, Cambridge, UK
| | | | | | - Martin R Wilkins
- National Heart and Lung Institute, Medicine, Imperial College London, London, UK
| | - Mark Toshner
- Dept of Medicine, University of Cambridge, Cambridge, UK.,National Pulmonary Hypertension Service, Royal Papworth Hospital, Cambridge, UK
| | - Joanna Pepke-Zaba
- Dept of Medicine, University of Cambridge, Cambridge, UK.,National Pulmonary Hypertension Service, Royal Papworth Hospital, Cambridge, UK
| | - Christopher J Rhodes
- National Heart and Lung Institute, Medicine, Imperial College London, London, UK
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Zalewska KI, Swietlik EM, Hernandez JS, Cannon JE, Taboada D, Newnham M, Hadinnapola C, Morrell NW, Toshner MR, Zaba JP. S135 Circulating metabolites in chronic thromboembolic pulmonary hypertension and chronic thromboembolic pulmonary vascular occlusion. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.141] [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: 11/04/2022]
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Abstract
An 18-year-old man presented to primary care with a 2-year history of exclusively nocturnal 'noisy breathing'. He was otherwise asymptomatic. He had never smoked and was previously healthy. Spirometry showed a severely obstructive picture with forced expiratory volume in 1 s (FEV1) 1.87 L (44% predicted), forced vital capacity (FVC) 4.0 L (80%) and FEV1/FVC ratio of 47%. A diagnosis of asthma was suspected and a trial of inhaled bronchodilators and corticosteroids was initiated. Failure to improve symptoms led to referral to the Respiratory Clinic, where his mother replayed a recording of the 'noisy breathing' on her mobile phone. Subsequent examination revealed a stridor on expiration. Flow volume loop showed a plateau of the expiratory limb, consistent with intrathoracic upper airway obstruction. CT of the thorax revealed a massively dilated oesophagus, filled with food residue, reflecting an achalasia, causing lower tracheal compression. He is now being considered for a myotomy procedure.
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Affiliation(s)
- K I Zalewska
- Department of Respiratory Medicine, Ysbyty Gwynedd, Bangor, Gwynedd, UK Cardiff University, Rhondda Cynon Taf, UK
| | - G F A Benfield
- Department of Respiratory Medicine, Ysbyty Gwynedd, Bangor, Gwynedd, UK
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Affiliation(s)
- K I Zalewska
- Department of Respiratory Medicine, Ysbyty Gwynedd, Bangor, Gwynedd, UK
| | - A Brown
- Department of Respiratory Medicine, Ysbyty Gwynedd, Bangor, Gwynedd, UK
| | - D J McKeon
- Department of Respiratory Medicine, Ysbyty Gwynedd, Bangor, Gwynedd, UK
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