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Gutor SS, Salinas RI, Nichols DS, Bazzano JMR, Han W, Gokey JJ, Vasiukov G, West JD, Newcomb DC, Dikalova AE, Richmond BW, Dikalov SI, Blackwell TS, Polosukhin VV. Repetitive sulfur dioxide exposure in mice models post-deployment respiratory syndrome. Am J Physiol Lung Cell Mol Physiol 2024; 326:L539-L550. [PMID: 38410870 DOI: 10.1152/ajplung.00239.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
Soldiers deployed to Iraq and Afghanistan have a higher prevalence of respiratory symptoms than nondeployed military personnel and some have been shown to have a constellation of findings on lung biopsy termed post-deployment respiratory syndrome (PDRS). Since many of the subjects in this cohort reported exposure to sulfur dioxide (SO2), we developed a model of repetitive exposure to SO2 in mice that phenocopies many aspects of PDRS, including adaptive immune activation, airway wall remodeling, and pulmonary vascular (PV) disease. Although abnormalities in small airways were not sufficient to alter lung mechanics, PV remodeling resulted in the development of pulmonary hypertension and reduced exercise tolerance in SO2-exposed mice. SO2 exposure led to increased formation of isolevuglandins (isoLGs) adducts and superoxide dismutase 2 (SOD2) acetylation in endothelial cells, which were attenuated by treatment with the isoLG scavenger 2-hydroxybenzylamine acetate (2-HOBA). In addition, 2-HOBA treatment or Siruin-3 overexpression in a transgenic mouse model prevented vascular remodeling following SO2 exposure. In summary, our results indicate that repetitive SO2 exposure recapitulates many aspects of PDRS and that oxidative stress appears to mediate PV remodeling in this model. Together, these findings provide new insights regarding the critical mechanisms underlying PDRS.NEW & NOTEWORTHY We developed a mice model of "post-deployment respiratory syndrome" (PDRS), a condition in Veterans with unexplained exertional dyspnea. Our model successfully recapitulates many of the pathological and physiological features of the syndrome, revealing involvement of the ROS-isoLGs-Sirt3-SOD2 pathway in pulmonary vasculature pathology. Our study provides additional knowledge about effects and long-term consequences of sulfur dioxide exposure on the respiratory system, serving as a valuable tool for future PDRS research.
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Affiliation(s)
- Sergey S Gutor
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Rodrigo I Salinas
- Department of Chemistry, Emory University, Atlanta, Georgia, United States
| | - David S Nichols
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Julia M R Bazzano
- Department of Surgery, Emory University, Atlanta, Georgia, United States
| | - Wei Han
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jason J Gokey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Georgii Vasiukov
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States
| | - James D West
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Dawn C Newcomb
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Anna E Dikalova
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Bradley W Richmond
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Veterans Affairs Medical Center, Nashville, Tennessee, United States
| | - Sergey I Dikalov
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Timothy S Blackwell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Veterans Affairs Medical Center, Nashville, Tennessee, United States
| | - Vasiliy V Polosukhin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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2
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Gutor SS, Richmond BW, Agrawal V, Brittain EL, Shaver CM, Wu P, Boyle TK, Mallugari RR, Douglas K, Piana RN, Johnson JE, Miller RF, Newman JH, Blackwell TS, Polosukhin VV. Pulmonary Vascular Disease in Veterans with Post-Deployment Respiratory Syndrome. Cardiovasc Pathol 2024:107640. [PMID: 38604505 DOI: 10.1016/j.carpath.2024.107640] [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: 12/12/2023] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024] Open
Abstract
Exertional dyspnea has been documented in U.S. military personnel after deployment to Iraq and Afghanistan. We studied whether continued exertional dyspnea in this patient population is associated with pulmonary vascular disease (PVD). We performed detailed histomorphometry of pulmonary vasculature in 52 Veterans with biopsy-proven post-deployment respiratory syndrome (PDRS) and then recruited five of these same Veterans with continued exertional dyspnea to undergo a follow-up clinical evaluation, including symptom questionnaire, pulmonary function testing, surface echocardiography, and right heart catheterization (RHC). Morphometric evaluation of pulmonary arteries showed significantly increased intima and media thicknesses, along with collagen deposition (fibrosis), in Veterans with PDRS compared to non-diseased (ND) controls. In addition, pulmonary veins in PDRS showed increased intima and adventitia thicknesses with prominent collagen deposition compared to controls. Of the five Veterans involved in our clinical follow-up study, three had borderline or overt right ventricle (RV) enlargement by echocardiography and evidence of pulmonary hypertension (PH) on RHC. Together, our studies suggest that PVD with predominant venular fibrosis is common in PDRS and development of pulmonary hypertension may explain exertional dyspnea and exercise limitation in some Veterans with PDRS.
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Affiliation(s)
- Sergey S Gutor
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Bradley W Richmond
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Veterans Affairs, Nashville VA, Nashville, TN; Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN
| | - Vineet Agrawal
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Evan L Brittain
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ciara M Shaver
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Pingsheng Wu
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Taryn K Boyle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ravinder R Mallugari
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Katrina Douglas
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Robert N Piana
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Joyce E Johnson
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Robert F Miller
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - John H Newman
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Timothy S Blackwell
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Veterans Affairs, Nashville VA, Nashville, TN; Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN
| | - Vasiliy V Polosukhin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
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3
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Richmond BW, Marshall CB, Blackburn JB, Tufenkjian TS, Lehmann BD, Han W, Newcomb D, Gutor SS, Hunt RP, Michell DL, Vickers KC, Polosukhin VV, Blackwell TS, Pietenpol JA. Loss of p73 Expression Contributes to Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2024; 209:153-163. [PMID: 37931077 PMCID: PMC10806417 DOI: 10.1164/rccm.202303-0503oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/06/2023] [Indexed: 11/08/2023] Open
Abstract
Rationale: Multiciliated cell (MCC) loss and/or dysfunction is common in the small airways of patients with chronic obstructive pulmonary disease (COPD), but it is unclear if this contributes to COPD lung pathology. Objectives: To determine if loss of p73 causes a COPD-like phenotype in mice and explore whether smoking or COPD impact p73 expression. Methods: p73floxE7-E9 mice were crossed with Shh-Cre mice to generate mice lacking MCCs in the airway epithelium. The resulting p73Δairway mice were analyzed using electron microscopy, flow cytometry, morphometry, forced oscillation technique, and single-cell RNA sequencing. Furthermore, the effects of cigarette smoke on p73 transcript and protein expression were examined using in vitro and in vivo models and in studies including airway epithelium from smokers and patients with COPD. Measurements and Main Results: Loss of functional p73 in the respiratory epithelium resulted in a near-complete absence of MCCs in p73Δairway mice. In adulthood, these mice spontaneously developed neutrophilic inflammation and emphysema-like lung remodeling and had progressive loss of secretory cells. Exposure of normal airway epithelium cells to cigarette smoke rapidly and durably suppressed p73 expression in vitro and in vivo. Furthermore, tumor protein 73 mRNA expression was reduced in the airways of current smokers (n = 82) compared with former smokers (n = 69), and p73-expressing MCCs were reduced in the small airways of patients with COPD (n = 11) compared with control subjects without COPD (n = 12). Conclusions: Loss of functional p73 in murine airway epithelium results in the absence of MCCs and promotes COPD-like lung pathology. In smokers and patients with COPD, loss of p73 may contribute to MCC loss or dysfunction.
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Affiliation(s)
- Bradley W. Richmond
- Department of Veterans Affairs Medical Center, Nashville, Tennessee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and
- Department of Cell and Developmental Biology
| | - Clayton B. Marshall
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee; and
- Department of Biochemistry, and
| | - Jessica B. Blackburn
- Department of Veterans Affairs Medical Center, Nashville, Tennessee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and
| | - Tiffany S. Tufenkjian
- Department of Veterans Affairs Medical Center, Nashville, Tennessee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and
| | - Brian D. Lehmann
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee; and
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Wei Han
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and
| | - Dawn Newcomb
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and
| | - Sergey S. Gutor
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and
| | - Raphael P. Hunt
- Department of Veterans Affairs Medical Center, Nashville, Tennessee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and
| | | | - Kasey C. Vickers
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Vasiliy V. Polosukhin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and
| | - Timothy S. Blackwell
- Department of Veterans Affairs Medical Center, Nashville, Tennessee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and
- Department of Cell and Developmental Biology
| | - Jennifer A. Pietenpol
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee; and
- Department of Biochemistry, and
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DiGiovanni GT, Han W, Sherrill TP, Taylor CJ, Nichols DS, Geis NM, Singha UK, Calvi CL, McCall AS, Dixon MM, Liu Y, Jang JH, Gutor SS, Polosukhin VV, Blackwell TS, Kropski JA, Gokey JJ. Epithelial Yap/Taz are required for functional alveolar regeneration following acute lung injury. JCI Insight 2023; 8:e173374. [PMID: 37676731 PMCID: PMC10629815 DOI: 10.1172/jci.insight.173374] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
A hallmark of idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases is dysregulated repair of the alveolar epithelium. The Hippo pathway effector transcription factors YAP and TAZ are implicated as essential for type 1 and type 2 alveolar epithelial cell (AT1 and AT2) differentiation in the developing lung, yet aberrant activation of YAP/TAZ is a prominent feature of the dysregulated alveolar epithelium in IPF. In these studies, we sought to define the functional role of YAP/TAZ activity during alveolar regeneration. We demonstrated that Yap and Taz were normally activated in AT2 cells shortly after injury, and deletion of Yap/Taz in AT2 cells led to pathologic alveolar remodeling, failure of AT2-to-AT1 cell differentiation, increased collagen deposition, exaggerated neutrophilic inflammation, and increased mortality following injury induced by a single dose of bleomycin. Loss of Yap/Taz activity prior to an LPS injury prevented AT1 cell regeneration, led to intraalveolar collagen deposition, and resulted in persistent innate inflammation. These findings establish that AT2 cell Yap/Taz activity is essential for functional alveolar epithelial repair and prevention of fibrotic remodeling.
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Affiliation(s)
- Gianluca T. DiGiovanni
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wei Han
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Taylor P. Sherrill
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chase J. Taylor
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S. Nichols
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natalie M. Geis
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ujjal K. Singha
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carla L. Calvi
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - A. Scott McCall
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Molly M. Dixon
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yang Liu
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ji-Hoon Jang
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sergey S. Gutor
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vasiliy V. Polosukhin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy S. Blackwell
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee, USA
- Department of Veterans Affairs Medical Center, Nashville, Tennessee, USA
| | - Jonathan A. Kropski
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee, USA
- Department of Veterans Affairs Medical Center, Nashville, Tennessee, USA
| | - Jason J. Gokey
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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5
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Gutor SS, Miller RF, Blackwell TS, Polosukhin VV. Environmental and occupational bronchiolitis obliterans: new reality. EBioMedicine 2023; 95:104760. [PMID: 37598462 PMCID: PMC10458287 DOI: 10.1016/j.ebiom.2023.104760] [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: 02/03/2023] [Revised: 07/10/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023] Open
Abstract
Patients diagnosed with environmental/occupational bronchiolitis obliterans (BO) over the last 2 decades often present with an indolent evolution of respiratory symptoms without a history of high-level, acute exposure to airborne toxins. Exertional dyspnea is the most common symptom and standard clinical and radiographic evaluation can be non-diagnostic. Lung biopsies often reveal pathological abnormalities affecting all distal lung compartments. These modern cases of BO typically exhibit the constrictive bronchiolitis phenotype of small airway remodeling, along with lymphocytic inflammation. In addition, hypertensive-type remodeling of intrapulmonary vasculature, diffuse fibroelastosis of alveolar tissue, and fibrous thickening of visceral pleura are frequently present. The diagnosis of environmental/occupational BO should be considered in patients who present with subacute onset of exertional dyspnea and a history compatible with prolonged or recurrent exposure to environmental toxins. Important areas for future studies include development of less invasive diagnostic approaches and testing of novel agents for disease prevention and treatment.
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Affiliation(s)
- Sergey S Gutor
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert F Miller
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy S Blackwell
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Veterans Affairs Medical Center, Nashville, TN, USA
| | - Vasiliy V Polosukhin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Han W, Tanjore H, Liu Y, Hunt RP, Gutor SS, Serezani APM, Blackwell TS. Identification and Characterization of Alveolar and Recruited Lung Macrophages during Acute Lung Inflammation. J Immunol 2023; 210:1827-1836. [PMID: 37042701 PMCID: PMC10192112 DOI: 10.4049/jimmunol.2200694] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
To precisely identify mouse resident alveolar macrophages (AMs) and bone marrow (BM)-derived macrophages, we developed a technique to separately label AMs and BM-derived macrophages with a fluorescent lipophilic dye followed by FACS. We showed that this technique overcomes issues in cell identification related to dynamic shifts in cell surface markers that occurs during lung inflammation. We then used this approach to track macrophage subsets at different time points after intratracheal (i.t.) instillation of Escherichia coli LPS. By isolating BM-derived macrophages and AMs, we demonstrated that BM-derived macrophages were enriched in expression of genes in signal transduction and immune system activation pathways whereas resident AMs were enriched in cellular processes, such as lysosome/phagosome pathways, efferocytosis, and metabolic pathways related to fatty acids and peroxisomes. Taken together, these data indicate that more accurate identification of macrophage origin can result in improved understanding of differential phenotypes and functions between AMs and BM-derived macrophages in the lungs.
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Affiliation(s)
- Wei Han
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Harikrishna Tanjore
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Yang Liu
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Raphael P Hunt
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Sergey S Gutor
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ana P M Serezani
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Timothy S Blackwell
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN
- Department of Veterans Affairs Medical Center, Nashville, TN
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7
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Gutor SS, Salinas RI, Nichols DS, Bazzano JMR, Han W, Gokey JJ, Vasiukov G, West JD, Newcomb DC, Dikalova AE, Richmond BW, Dikalov SI, Blackwell TS, Polosukhin VV. Repetitive Sulfur Dioxide Exposure in Mice Models Post-Deployment Respiratory Syndrome. bioRxiv 2023:2023.05.15.540867. [PMID: 37292948 PMCID: PMC10245576 DOI: 10.1101/2023.05.15.540867] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Soldiers deployed to Iraq and Afghanistan have a higher prevalence of respiratory symptoms than non-deployed military personnel and some have been shown to have a constellation of findings on lung biopsy termed post-deployment respiratory syndrome (PDRS). Since many of the deployers in this cohort reported exposure to sulfur dioxide (SO 2 ), we developed a model of repetitive exposure to SO 2 in mice that phenocopies many aspects of PDRS, including adaptive immune activation, airway wall remodeling, and pulmonary vascular disease (PVD). Although abnormalities in small airways were not sufficient to alter lung mechanics, PVD was associated with the development of pulmonary hypertension and reduced exercise tolerance in SO 2 exposed mice. Further, we used pharmacologic and genetic approaches to demonstrate a critical role for oxidative stress and isolevuglandins in mediating PVD in this model. In summary, our results indicate that repetitive SO 2 exposure recapitulates many aspects of PDRS and that oxidative stress may mediate PVD in this model, which may be helpful for future mechanistic studies examining the relationship between inhaled irritants, PVD, and PDRS.
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8
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Gutor SS, Richmond BW, Du RH, Wu P, Lee JW, Ware LB, Shaver CM, Novitskiy SV, Johnson JE, Newman JH, Rennard SI, Miller RF, Blackwell TS, Polosukhin VV. Characterization of Immunopathology and Small Airway Remodeling in Constrictive Bronchiolitis. Am J Respir Crit Care Med 2022; 206:260-270. [PMID: 35550018 PMCID: PMC9890264 DOI: 10.1164/rccm.202109-2133oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
Rationale: Constrictive bronchiolitis (ConB) is a relatively rare and understudied form of lung disease whose underlying immunopathology remains incompletely defined. Objectives: Our objectives were to quantify specific pathological features that differentiate ConB from other diseases that affect the small airways and to investigate the underlying immune and inflammatory phenotype present in ConB. Methods: We performed a comparative histomorphometric analysis of small airways in lung biopsy samples collected from 50 soldiers with postdeployment ConB, 8 patients with sporadic ConB, 55 patients with chronic obstructive pulmonary disease, and 25 nondiseased control subjects. We measured immune and inflammatory gene expression in lung tissue using the NanoString nCounter Immunology Panel from six control subjects, six soldiers with ConB, and six patients with sporadic ConB. Measurements and Main Results: Compared with control subjects, we found shared pathological changes in small airways from soldiers with postdeployment ConB and patients with sporadic ConB, including increased thickness of the smooth muscle layer, increased collagen deposition in the subepithelium, and lymphocyte infiltration. Using principal-component analysis, we showed that ConB pathology was clearly separable both from control lungs and from small airway disease associated with chronic obstructive pulmonary disease. NanoString gene expression analysis from lung tissue revealed T-cell activation in both groups of patients with ConB with upregulation of proinflammatory pathways, including cytokine-cytokine receptor interactions, NF-κB (nuclear factor-κB) signaling, TLR (Toll-like receptor) signaling, T-cell receptor signaling, and antigen processing and presentation. Conclusions: These findings indicate shared immunopathology among different forms of ConB and suggest that an ongoing T-helper cell type 1-type adaptive immune response underlies airway wall remodeling in ConB.
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Affiliation(s)
- Sergey S. Gutor
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Bradley W. Richmond
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
- Veterans Affairs Medical Center, Nashville, Tennessee
| | - Rui-Hong Du
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Pingsheng Wu
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
- Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Jae Woo Lee
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California; and
| | - Lorraine B. Ware
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ciara M. Shaver
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Sergey V. Novitskiy
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Joyce E. Johnson
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John H. Newman
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Stephen I. Rennard
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert F. Miller
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Timothy S. Blackwell
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
- Veterans Affairs Medical Center, Nashville, Tennessee
| | - Vasiliy V. Polosukhin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, and
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9
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Gutor SS, Richmond BW, Du RH, Wu P, Sandler KL, MacKinnon G, Brittain EL, Lee JW, Ware LB, Loyd JE, Johnson JE, Miller RF, Newman JH, Rennard SI, Blackwell TS, Polosukhin VV. Postdeployment Respiratory Syndrome in Soldiers With Chronic Exertional Dyspnea. Am J Surg Pathol 2021; 45:1587-1596. [PMID: 34081035 PMCID: PMC8585675 DOI: 10.1097/pas.0000000000001757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 11/26/2022]
Abstract
After deployment to Southwest Asia, some soldiers develop persistent respiratory symptoms, including exercise intolerance and exertional dyspnea. We identified 50 soldiers with a history of deployment to Southwest Asia who presented with unexplained dyspnea and underwent an unrevealing clinical evaluation followed by surgical lung biopsy. Lung tissue specimens from 17 age-matched, nonsmoking subjects were used as controls. Quantitative histomorphometry was performed for evaluation of inflammation and pathologic remodeling of small airways, pulmonary vasculature, alveolar tissue and visceral pleura. Compared with control subjects, lung biopsies from affected soldiers revealed a variety of pathologic changes involving their distal lungs, particularly related to bronchovascular bundles. Bronchioles from soldiers had increased thickness of the lamina propria, smooth muscle hypertrophy, and increased collagen content. In adjacent arteries, smooth muscle hypertrophy and adventitial thickening resulted in increased wall-to-lumen ratio in affected soldiers. Infiltration of CD4 and CD8 T lymphocytes was noted within airway walls, along with increased formation of lymphoid follicles. In alveolar parenchyma, collagen and elastin content were increased and capillary density was reduced in interalveolar septa from soldiers compared to control subjects. In addition, pleural involvement with inflammation and/or fibrosis was present in the majority (92%) of soldiers. Clinical follow-up of 29 soldiers (ranging from 1 to 15 y) showed persistence of exertional dyspnea in all individuals and a decline in total lung capacity. Susceptible soldiers develop a postdeployment respiratory syndrome that includes exertional dyspnea and complex pathologic changes affecting small airways, pulmonary vasculature, alveolar tissue, and visceral pleura.
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Affiliation(s)
- Sergey S. Gutor
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine
| | - Bradley W. Richmond
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine
- Veterans Affairs Medical Center
| | - Rui-Hong Du
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine
| | - Pingsheng Wu
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine
- Department of Biostatistics, Vanderbilt University School of Medicine
| | | | - Grant MacKinnon
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Evan L. Brittain
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jae Woo Lee
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA
| | - Lorraine B. Ware
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine
- Pathology, Microbiology and Immunology, Vanderbilt University Medical Center
| | - James E. Loyd
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine
| | - Joyce E. Johnson
- Pathology, Microbiology and Immunology, Vanderbilt University Medical Center
| | - Robert F. Miller
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine
| | - John H. Newman
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine
| | - Stephen I. Rennard
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha, NE
| | - Timothy S. Blackwell
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine
- Veterans Affairs Medical Center
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10
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Polosukhin VV, Gutor SS, Du RH, Richmond BW, Massion PP, Wu P, Cates JM, Sandler KL, Rennard SI, Blackwell TS. Small airway determinants of airflow limitation in chronic obstructive pulmonary disease. Thorax 2021; 76:1079-1088. [PMID: 33827979 PMCID: PMC8526883 DOI: 10.1136/thoraxjnl-2020-216037] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 11/06/2022]
Abstract
Background Although a variety of pathological changes have been described in small airways of patients with COPD, the critical anatomic features determining airflow limitation remain incompletely characterised. Methods We examined lung tissue specimens from 18 non-smokers without chronic lung disease and 55 former smokers with COPD for pathological features of small airways that could contribute to airflow limitation. Morphometric evaluation was performed for epithelial and subepithelial tissue thickness, collagen and elastin content, luminal mucus and radial alveolar attachments. Immune/inflammatory cells were enumerated in airway walls. Quantitative emphysema scoring was performed on chest CT scans. Results Small airways from patients with COPD showed thickening of epithelial and subepithelial tissue, mucus plugging and reduced collagen density in the airway wall (in severe COPD). In patients with COPD, we also observed a striking loss of alveolar attachments, which are connective tissue septa that insert radially into the small airway adventitia. While each of these parameters correlated with reduced airflow (FEV1), multivariable regression analysis indicated that loss of alveolar attachments was the major determinant of airflow limitation related to small airways. Neutrophilic infiltration of airway walls and collagen degradation in airway adventitia correlated with loss of alveolar attachments. In addition, quantitative analysis of CT scans identified an association between the extent of emphysema and loss of alveolar attachments. Conclusion In COPD, loss of radial alveolar attachments in small airways is the pathological feature most closely related to airflow limitation. Destruction of alveolar attachments may be mediated by neutrophilic inflammation.
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Affiliation(s)
| | - Sergey S Gutor
- Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rui-Hong Du
- Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bradley W Richmond
- Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pierre P Massion
- Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pingsheng Wu
- Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin M Cates
- Pathology, Vanderbilt University, Nashville, Tennessee, USA
| | - Kim L Sandler
- Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen I Rennard
- Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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11
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Fedorova OS, Fedotova MM, Zvonareva OI, Mazeina SV, Kovshirina YV, Sokolova TS, Golovach EA, Kovshirina AE, Konovalova UV, Kolomeets IL, Gutor SS, Petrov VA, Hattendorf J, Ogorodova LM, Odermatt P. Opisthorchis felineus infection, risks, and morbidity in rural Western Siberia, Russian Federation. PLoS Negl Trop Dis 2020; 14:e0008421. [PMID: 32598389 PMCID: PMC7351239 DOI: 10.1371/journal.pntd.0008421] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 07/10/2020] [Accepted: 05/24/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The liver fluke, Opisthorchis felineus, is widely distributed throughout Europe and large parts of the Russian Federation. In Western Siberia, information about opisthorchiasis is lacking although infection may lead to severe liver and bile duct diseases. We aimed to assess the current prevalence of O. felineus infection along with associated risk factors and morbidity in rural Western Siberia. METHODS We conducted a community-based, cross-sectional study in the rural Shegarskiy district, Tomsk Oblast, Russian Federation. All household members (≥ 7 years) present on the survey day were enrolled (n = 600). Two stool samples per person were examined for helminth eggs, using PARASEP (DiaSys Ltd, UK). The number of eggs per gram (EPG) of feces was recorded. Each study participant was interviewed to determine risk factors, using a pre-tested questionnaire. An abdominal ultrasonography examination of liver and bile ducts was performed with a mobile, high resolution ultrasound device. In total, 488 persons completed assessments (two stool samples, completed questionnaires); of those, 436 individuals had an ultrasonography (US) examination. RESULTS We observed a prevalence of O. felineus infection of 60.2%. Significant risk factors for infection were the consumption of river fish (odds ratio from adjusted analysis [aOR] 2.4, 95% CI 1.52-3.95, p<0.001), particularly stock fish (OR from multivariable analysis [mOR] 3.2, 95% CI 2.63-3.80, p<0.001), smoked fish (mOR 1.5, 95% CI 1.24-1.72, p<0.001), frozen fish (mOR 1.6, 95% CI 1.29-2.02, p<0.001), and raw fish (mOR 1.4, 95% CI 1.05-1.84, p = 0.02); and fishing activities (mOR 1.2, 95% CI 1.03-1.43, p = 0.019). Women had a higher risk of infection than men. Infection was associated positively with age and negatively with socio-economic status. The respondents' general awareness of opisthorchiasis was quite high (93.2%), but their knowledge about infection transmission and prevention was insufficient. Children aged 7-18 years old had a lower level of awareness compared to adults. The abdominal ultrasonography results demonstrated a strong association between O. felineus infection and gallbladder stones (mOR 2.8, 95% CI 1.33-6.04, p = 0.007) and periductal fibrosis of intrahepatic bile ducts (mOR 1.9, 95% CI 1.08-3.46, p = 0.026). CONCLUSION O. felineus infection is highly prevalent in rural regions of Western Siberia, and associated with severe hepatobiliary pathology. Identified risk factors will be used to develop a comprehensive targeted O. felineus infection control program.
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Affiliation(s)
- Olga S. Fedorova
- Department of Faculty Pediatrics, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
- * E-mail:
| | - Marina M. Fedotova
- Department of Faculty Pediatrics, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | - Olga I. Zvonareva
- Department of Health, Ethics and Society, Maastricht University, Maastricht, the Netherlands
- Central Research laboratory, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | | | - Yulia V. Kovshirina
- Department of Infectious diseases and Epidemiology, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | - Tatiana S. Sokolova
- Department of Faculty Pediatrics, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | - Ekaterina A. Golovach
- Department of Faculty Pediatrics, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | - Anna E. Kovshirina
- Department of Faculty Pediatrics, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | - Uliana V. Konovalova
- Department of Faculty Pediatrics, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | - Ivan L. Kolomeets
- Department of Faculty Pediatrics, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | - Sergey S. Gutor
- Central Research laboratory, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | - Vyacheslav A. Petrov
- Central Research laboratory, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ludmila M. Ogorodova
- Department of Faculty Pediatrics, Federal State Budget Educational Institution of Higher Education, Siberian State Medical University, Ministry of Healthcare of Russian Federation, Tomsk, Russian Federation
| | - Peter Odermatt
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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12
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Babokin VE, Shipulin VM, Minin SM, Batalov RE, Gutor SS, Lishmanov UB, Popov SV, Ilyinov VN, Andreev SL, Karpov RS. [Interrelation of Electrophysiological and Perfusion Changes in Patients With Left Ventricular Aneurysm]. Kardiologiia 2017; 56:11-15. [PMID: 28294853 DOI: 10.18565/cardio.2016.4.11-15] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study was aimed at identification of relations between perfusion and electrophysiological changes in left ventricular (LV) myocardium in patients with ischemic heart disease (IHD) with postinfarction LV aneurysm and ventricular tachycardia. The study enrolled 23 patients with the aforementioned disease. Preoperatively, apart from standard clinical examination of cardiosurgical patients, intracardiac electrophysiological study and perfusion single-photon emission computed tomography of myocardium with 99mTc-Technetril were performed. The patients were subjected to coronary artery bypass grafting and left ventricular reconstruction. Assessment of the outcomes showed that electrophysiological condition of left ventricle was dependent on myocardial perfusion. Electrophysologically normal myocardium with electric potential >1.5 mV, transient zone (0.5-1.5 mV) and zones with the potential <0.5 mV differed significantly by the percentage of perfusion: 61, 45, and 35%, respectively. Zones of delayed conduction and those of double potential were located mostly in transient zone of electrical potential conduction with the current amplitude of 0.5-1.5 mV and myocardial perfusion from 35 to 61%. Double potential zone was formed in the area of myocardium with better perfusion (perfusion defect of 55% with preserved metabolism) as opposed to the zone of delayed conduction, where perfusion defect was 40% with low level of metabolic activity. The obtained data has proven the presence of correlation between electrophysiology and perfusion of myocardium. This provides an opportunity to identify electrically unstable myocardial zones with the help of specific computer tomography of myocardium.
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Affiliation(s)
- V E Babokin
- 1M.F. Vladimirsky Moscow Region Research Clinical Institute, Moscow, Russia; 2Research Institute for Cardiology, Tomsk, Russia; 3Siberian State Medical University, Tomsk, Russia
| | - V M Shipulin
- 1M.F. Vladimirsky Moscow Region Research Clinical Institute, Moscow, Russia; 2Research Institute for Cardiology, Tomsk, Russia; 3Siberian State Medical University, Tomsk, Russia
| | - S M Minin
- 1M.F. Vladimirsky Moscow Region Research Clinical Institute, Moscow, Russia; 2Research Institute for Cardiology, Tomsk, Russia; 3Siberian State Medical University, Tomsk, Russia
| | - R E Batalov
- 1M.F. Vladimirsky Moscow Region Research Clinical Institute, Moscow, Russia; 2Research Institute for Cardiology, Tomsk, Russia; 3Siberian State Medical University, Tomsk, Russia
| | - S S Gutor
- 1M.F. Vladimirsky Moscow Region Research Clinical Institute, Moscow, Russia; 2Research Institute for Cardiology, Tomsk, Russia; 3Siberian State Medical University, Tomsk, Russia
| | - U B Lishmanov
- 1M.F. Vladimirsky Moscow Region Research Clinical Institute, Moscow, Russia; 2Research Institute for Cardiology, Tomsk, Russia; 3Siberian State Medical University, Tomsk, Russia
| | - S V Popov
- 1M.F. Vladimirsky Moscow Region Research Clinical Institute, Moscow, Russia; 2Research Institute for Cardiology, Tomsk, Russia; 3Siberian State Medical University, Tomsk, Russia
| | - V N Ilyinov
- 1M.F. Vladimirsky Moscow Region Research Clinical Institute, Moscow, Russia; 2Research Institute for Cardiology, Tomsk, Russia; 3Siberian State Medical University, Tomsk, Russia
| | - S L Andreev
- 1M.F. Vladimirsky Moscow Region Research Clinical Institute, Moscow, Russia; 2Research Institute for Cardiology, Tomsk, Russia; 3Siberian State Medical University, Tomsk, Russia
| | - R S Karpov
- 1M.F. Vladimirsky Moscow Region Research Clinical Institute, Moscow, Russia; 2Research Institute for Cardiology, Tomsk, Russia; 3Siberian State Medical University, Tomsk, Russia
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