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Solanki N, Beck B, Labadia M, Smith K, Peterson L, King S, Micklewright S, Pennington E, Farooq S, Zhang P, Aronica M, Zein J, Khatri S, Comhair S, Erzurum S. The role of ACT score in mepolizumab discontinuation. J Asthma 2024; 61:550-560. [PMID: 38064231 DOI: 10.1080/02770903.2023.2293067] [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: 10/07/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Mepolizumab is a therapy for severe asthma. We have little knowledge of the characteristics of people in the US that discontinue mepolizumab in clinical care. OBJECTIVE To investigate the real-world efficacy and time to clinical discontinuation of mepolizumab, we evaluated individuals with asthma started on mepolizumab at the Cleveland Clinic. We hypothesized that individuals that discontinue mepolizumab have more severe and uncontrolled asthma at baseline. METHODS Between 2016 and 2022, patients who started on mepolizumab consented to be assessed over 18 months. At baseline, a questionnaire including demographic and medical history was collected. Laboratory findings such as ACT score, FENO (Fractional Excretion of Nitric Oxide), and spirometry were recorded. At the conclusion of the observation period, the participants were divided into two categories: Group A and Group B. RESULTS Group B [N = 28] discontinued mepolizumab (p < 0.05) at an average of 5.8 months (SD 4.2 months). Group A [N = 129] stayed on the therapy for at least 1 year. A participant with an ACT score less than 13 has an odds ratio of 6.64 (95% CI, 2.1 - 26.0) of discontinuing mepolizumab therapy. For a male, the odds of discontinuing mepolizumab therapy is 3.39 (95% CI, 1.1-11.2). CONCLUSION In this real-world study, we find that high eosinophil count may not be adequate in screening which individuals will benefit from mepolizumab. Up to 17% of patients fail therapy within 6 months, with male sex and low ACT score increasing risk of mepolizumab discontinuation at Cleveland Clinic.
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Affiliation(s)
- Neha Solanki
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brittany Beck
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Monica Labadia
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin Smith
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura Peterson
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephanie King
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Sobia Farooq
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peng Zhang
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Aronica
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joe Zein
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sumita Khatri
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Suzy Comhair
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serpil Erzurum
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Samant M, Krings JG, Lew D, Goss CW, Koch T, McGregor MC, Boomer J, Hall CS, Schechtman KB, Sheshadri A, Peterson S, Erzurum S, DePew Z, Morrow LE, Hogarth DK, Tejedor R, Trevor J, Wechsler ME, Sam A, Shi X, Choi J, Castro M. Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders. Chest 2024; 165:775-784. [PMID: 38123124 PMCID: PMC11026166 DOI: 10.1016/j.chest.2023.12.015] [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: 03/09/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are defined poorly. RESEARCH QUESTION Do baseline radiographic and clinical characteristics exist that predict response to BT? STUDY DESIGN AND METHODS We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across eight academic medical centers. Participants received three separate BT treatments and were monitored at 3-month intervals for 1 year after BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test results of ≥ 3 or Asthma Quality of Life Questionnaire of ≥ 0.5. Regression analyses were used to evaluate the association between pretreatment clinical and quantitative CT scan measures with subsequent BT response. RESULTS From 2006 through 2017, 88 participants received BT, with 70 participants (79.5%) identified as responders by Asthma Control Test or Asthma Quality of Life Questionnaire criteria. Responders were less likely to undergo an asthma-related ICU admission in the prior year (3% vs 25%; P = .01). On baseline quantitative CT imaging, BT responders showed less air trapping percentage (OR, 0.90; 95% CI, 0.82-0.99; P = .03), a greater Jacobian determinant (OR, 1.49; 95% CI, 1.05-2.11), greater SD of the Jacobian determinant (OR, 1.84; 95% CI, 1.04-3.26), and greater anisotropic deformation index (OR, 3.06; 95% CI, 1.06-8.86). INTERPRETATION To our knowledge, this is the largest study to evaluate baseline quantitative CT imaging and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on quantitative CT imaging, were predictors of future BT response. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01185275; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Maanasi Samant
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - James G Krings
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Daphne Lew
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Charles W Goss
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Tammy Koch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Mary Clare McGregor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Jonathan Boomer
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Chase S Hall
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Ken B Schechtman
- Division of Biostatistics, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Ajay Sheshadri
- Division of Pulmonary Critical Care Medicine, Department of Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Serpil Erzurum
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Zachary DePew
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Creighton University Medical Center, Omaha, NE
| | - Lee E Morrow
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Creighton University Medical Center, Omaha, NE
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - Richard Tejedor
- Division of Pulmonary and Critical Care, Department of Medicine, LSU Health Sciences Center, New Orleans, LA
| | - Jennifer Trevor
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Afshin Sam
- Division of Pulmonary and Critical Care, Department of Medicine, University of Arizona, Tuscon, AZ
| | - Xiaosong Shi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Jiwoong Choi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS.
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3
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Lowery MM, Hill NS, Wang L, Rosenzweig EB, Bhat A, Erzurum S, Finet JE, Jellis CL, Kaur S, Kwon DH, Nawabit R, Radeva M, Beck GJ, Frantz RP, Hassoun PM, Hemnes AR, Horn EM, Leopold JA, Rischard FP, Mehra R. Sleep-Related Hypoxia, Right Ventricular Dysfunction, and Survival in Patients With Group 1 Pulmonary Arterial Hypertension. J Am Coll Cardiol 2023; 82:1989-2005. [PMID: 37968017 PMCID: PMC11060475 DOI: 10.1016/j.jacc.2023.09.806] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Group 1 pulmonary arterial hypertension (PAH) is a progressive fatal condition characterized by right ventricular (RV) failure with worse outcomes in connective tissue disease (CTD). Obstructive sleep apnea and sleep-related hypoxia may contribute to RV dysfunction, though the relationship remains unclear. OBJECTIVES The aim of this study was to prospectively evaluate the association of the apnea-hypopnea index (AHI) and sleep-related hypoxia with RV function and survival. METHODS Pulmonary Vascular Disease Phenomics (National Heart, Lung, and Blood Institute) cohort participants (patients with group 1 PAH, comparators, and healthy control participants) with sleep studies were included. Multimodal RV functional measures were examined in association with AHI and percentage of recording time with oxygen saturation <90% (T90) per 10-unit increment. Linear models, adjusted for demographics, oxygen, diffusing capacity of the lungs for carbon monoxide, pulmonary hypertension medications, assessed AHI and T90, and RV measures. Log-rank test/Cox proportional hazards models adjusted for demographics, oxygen, and positive airway pressure were constructed for transplantation-free survival analyses. RESULTS Analysis included 186 participants with group 1 PAH with a mean age of 52.6 ± 14.1 years; 71.5% were women, 80.8% were Caucasian, and there were 43 events (transplantation or death). AHI and T90 were associated with decreased RV ejection fraction (on magnetic resonance imaging), by 2.18% (-2.18; 95% CI: -4.00 to -0.36; P = 0.019) and 0.93% (-0.93; 95% CI: -1.47 to -0.40; P < 0.001), respectively. T90 was associated with increased RV systolic pressure (on echocardiography), by 2.52 mm Hg (2.52; 95% CI: 1.61 to 3.43; P < 0.001); increased mean pulmonary artery pressure (on right heart catheterization), by 0.27 mm Hg (0.27; 95% CI: 0.05 to 0.49; P = 0.019); and RV hypertrophy (on electrocardiography), 1.24 mm (1.24; 95% CI: 1.10 to 1.40; P < 0.001). T90, but not AHI, was associated with a 17% increased 5-year risk for transplantation or death (HR: 1.17; 95% CI: 1.07 to 1.28). In non-CTD-associated PAH, T90 was associated with a 21% increased risk for transplantation or death (HR: 1.21; 95% CI: 1.08 to 1.34). In CTD-associated PAH, T90 was associated with RV dysfunction, but not death or transplantation. CONCLUSIONS Sleep-related hypoxia was more strongly associated than AHI with measures of RV dysfunction, death, or transplantation overall and in group 1 non-CTD-associated PAH but only with RV dysfunction in CTD-associated PAH. (Pulmonary Vascular Disease Phenomics Program [PVDOMICS]; NCT02980887).
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Affiliation(s)
- Megan M Lowery
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lu Wang
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Department of Pediatrics and Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Aparna Bhat
- Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serpil Erzurum
- Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - J Emanuel Finet
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine L Jellis
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sunjeet Kaur
- Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah H Kwon
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rawan Nawabit
- Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Milena Radeva
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gerald J Beck
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Evelyn M Horn
- Perkin Heart Failure Center, Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Franz P Rischard
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, Arizona, USA
| | - Reena Mehra
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA; Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA; Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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4
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Gauthier M, Kale SL, Oriss TB, Gorry M, Ramonell RP, Dalton K, Ray P, Fahy JV, Seibold MA, Castro M, Jarjour N, Gaston B, Bleecker ER, Meyers DA, Moore W, Hastie AT, Israel E, Levy BD, Mauger D, Erzurum S, Comhair SA, Wenzel SE, Ray A. CCL5 is a potential bridge between type 1 and type 2 inflammation in asthma. J Allergy Clin Immunol 2023; 152:94-106.e12. [PMID: 36893862 PMCID: PMC10330021 DOI: 10.1016/j.jaci.2023.02.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/06/2023] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Type 1 (T1) inflammation (marked by IFN-γ expression) is now consistently identified in subsets of asthma cohorts, but how it contributes to disease remains unclear. OBJECTIVE We sought to understand the role of CCL5 in asthmatic T1 inflammation and how it interacts with both T1 and type 2 (T2) inflammation. METHODS CCL5, CXCL9, and CXCL10 messenger RNA expression from sputum bulk RNA sequencing, as well as clinical and inflammatory data were obtained from the Severe Asthma Research Program III (SARP III). CCL5 and IFNG expression from bronchoalveolar lavage cell bulk RNA sequencing was obtained from the Immune Mechanisms in Severe Asthma (IMSA) cohort and expression related to previously identified immune cell profiles. The role of CCL5 in tissue-resident memory T-cell (TRM) reactivation was evaluated in a T1high murine severe asthma model. RESULTS Sputum CCL5 expression strongly correlated with T1 chemokines (P < .001 for CXCL9 and CXCL10), consistent with a role in T1 inflammation. CCL5high participants had greater fractional exhaled nitric oxide (P = .009), blood eosinophils (P < .001), and sputum eosinophils (P = .001) in addition to sputum neutrophils (P = .001). Increased CCL5 bronchoalveolar lavage expression was unique to a previously described T1high/T2variable/lymphocytic patient group in the IMSA cohort, with IFNG trending with worsening lung obstruction only in this group (P = .083). In a murine model, high expression of the CCL5 receptor CCR5 was observed in TRMs and was consistent with a T1 signature. A role for CCL5 in TRM activation was supported by the ability of the CCR5 inhibitor maraviroc to blunt reactivation. CONCLUSION CCL5 appears to contribute to TRM-related T1 neutrophilic inflammation in asthma while paradoxically also correlating with T2 inflammation and with sputum eosinophilia.
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Affiliation(s)
- Marc Gauthier
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
| | - Sagar Laxman Kale
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Timothy B Oriss
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Michael Gorry
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Richard P Ramonell
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Kathryn Dalton
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Prabir Ray
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - John V Fahy
- Division of Pulmonary Allergy and Critical Care, University of California, San Francisco, Calif
| | - Max A Seibold
- Center for Genes, Environment, and Health and Department of Pediatrics, National Jewish Health, Denver, Colo; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colo
| | - Mario Castro
- Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kan
| | - Nizar Jarjour
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine, Madison, Wis
| | - Benjamin Gaston
- Riley Hospital for Children and Indiana University School of Medicine Department of Pediatrics, Indianapolis, Ind
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Ariz
| | - Deborah A Meyers
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Ariz
| | - Wendy Moore
- Section on Pulmonary, Critical Care, Allergy & Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Annette T Hastie
- Section on Pulmonary, Critical Care, Allergy & Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Elliot Israel
- Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Bruce D Levy
- Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - David Mauger
- Division of Statistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - Serpil Erzurum
- Lerner Research Institute, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Suzy A Comhair
- Lerner Research Institute, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sally E Wenzel
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Environmental and Occupation Health, University of Pittsburgh School of Public Health, Pittsburgh, Pa
| | - Anuradha Ray
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pa
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5
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Naranjo M, Rosenzweig EB, Hemnes AR, Jacob M, Desai A, Hill NS, Larive AB, Finet JE, Leopold J, Horn E, Frantz R, Rischard F, Erzurum S, Beck G, Mathai SC, Hassoun PM. Frequency of acute vasodilator response (AVR) in incident and prevalent patients with pulmonary arterial hypertension: Results from the pulmonary vascular disease phenomics study. Pulm Circ 2023; 13:e12281. [PMID: 37614830 PMCID: PMC10442608 DOI: 10.1002/pul2.12281] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/07/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
The prevalence of acute vasodilator response (AVR) to inhaled nitric oxide (iNO) during right heart catheterization (RHC) is 12% in idiopathic pulmonary arterial hypertension (IPAH). AVR, however, is reportedly lower in other disease-associated pulmonary arterial hypertension (PAH), such as connective tissue disease (CTD). The prevalence of AVR in patients on PAH therapy (prevalent cases) is unknown. We sought to determine AVR prevalence in Group 1 PH in the PVDOMICS cohort of incident and prevalent patients undergoing RHC. AVR was measured in response to 100% O2 and O2 plus iNO, with positivity defined as (1) decrease in mean pulmonary artery pressure (mPAP) by ≥10 mmHg to a value ≤40 mmHg, with no change or an increase in cardiac output (definition 1); or (2) decrease in mPAP by ≥12% and pulmonary vascular resistance by ≥30% (definition 2). AVR rates and cumulative survival were compared between incident and prevalent patients. In 338 mainly prevalent (86%) patients, positive AVR to O2-only was <2%, and 5.1% to 16.9%, based on definition 1 and 2 criteria, respectively; following O2 + iNO. IPAH AVR prevalence (4.1%-18.7%) was similar to prior reports. AVR positivity was 7.7% to 15.4% in mostly CTD-PAH prevalent cases, and 2.6% to 11.8% in other PAH groups. Survival was 89% in AVR responders versus 77% in nonresponders from PAH diagnosis, and 91% versus 86% from PVDOMICS enrollment (log-rank test p = 0.04 and p = 0.05, respectively). In conclusion, AVR in IPAH patients is similar to prior studies. AVR in non-IPAH patients was higher than previously reported. The relationship between PAH therapy, AVR response, and survival warrants further investigation.
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Affiliation(s)
- Mario Naranjo
- Division of Pulmonary and Critical Care Medicine, Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Anna R. Hemnes
- Division of Allergy, Pulmonary and Critical Care MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Miriam Jacob
- Department of Cardiovascular MedicineCleveland ClinicClevelandOhioUSA
| | - Ankit Desai
- Department of Medicine, College of MedicineThe University of ArizonaTucsonArizonaUSA
| | - Nicholas S. Hill
- Division of Pulmonary, Critical Care, and Sleep MedicineTufts Medical CenterBostonMassachusettsUSA
| | - A. Brett Larive
- Department of Quantitative Health SciencesCleveland ClinicClevelandOhioUSA
| | - J. Emanuel Finet
- Department of Cardiovascular MedicineCleveland ClinicClevelandOhioUSA
| | - Jane Leopold
- Department of Cardiovascular Medicine, Brigham and Women's HospitalHarvard UniversityBostonMassachusettsUSA
| | - Evelyn Horn
- Division of CardiologyWeill Cornell UniversityNew YorkNew YorkUSA
| | - Robert Frantz
- Department of Cardiovascular MedicineMayo ClinicRochesterMinnesotaUSA
| | - Franz Rischard
- Department of Medicine, College of MedicineThe University of ArizonaTucsonArizonaUSA
| | - Serpil Erzurum
- Department of Inflammation and ImmunityCleveland ClinicClevelandOhioUSA
| | - Gerald Beck
- Department of Quantitative Health SciencesCleveland ClinicClevelandOhioUSA
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
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6
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Sun Y, Stenson K, Mohan ML, Gupta MK, Wanner N, Asosingh K, Erzurum S, Naga Prasad SV. Hypoxia Sensing of β-Adrenergic Receptor Is Regulated by Endosomal PI3Kγ. Circ Res 2023; 132:690-703. [PMID: 36779349 PMCID: PMC10023460 DOI: 10.1161/circresaha.122.321735] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/31/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Impaired beta-adrenergic receptor (β1 and β2AR) function following hypoxia underlies ischemic heart failure/stroke. Activation of PI3Kγ (phosphoinositide 3-kinase γ) by beta-adrenergic receptor leads to feedback regulation of the receptor by hindering beta-adrenergic receptor dephosphorylation through inhibition of PP2A (protein phosphatase 2A). However, little is known about PI3Kγ feedback mechanism in regulating hypoxia-mediated β1 and β2AR dysfunction and cardiac remodeling. METHODS Human embryonic kidney 293 cells or mouse adult cardiomyocytes and C57BL/6 (WT) or PI3Kγ knockout (KO) mice were subjected to hypoxia. Cardiac plasma membranes and endosomes were isolated and evaluated for β1 and β2AR density and function, PI3Kγ activity and β1 and β2AR-associated PP2A activity. Metabolic labeling was performed to assess β1 and β2AR phosphorylation and epinephrine/norepinephrine levels measured post-hypoxia. RESULTS Hypoxia increased β1 and β2AR phosphorylation, reduced cAMP, and led to endosomal accumulation of phosphorylated β2ARs in human embryonic kidney 293 cells and WT cardiomyocytes. Acute hypoxia in WT mice resulted in cardiac remodeling and loss of adenylyl cyclase activity associated with increased β1 and β2AR phosphorylation. This was agonist-independent as plasma and cardiac epinephrine and norepinephrine levels were unaltered. Unexpectedly, PI3Kγ activity was selectively increased in the endosomes of human embryonic kidney 293 cells and WT hearts post-hypoxia. Endosomal β1- and β2AR-associated PP2A activity was inhibited upon hypoxia in human embryonic kidney 293 cells and WT hearts showing regulation of beta-adrenergic receptors by PI3Kγ. This was accompanied with phosphorylation of endogenous inhibitor of protein phosphatase 2A whose phosphorylation by PI3Kγ inhibits PP2A. Increased β1 and β2AR-associated PP2A activity, decreased beta-adrenergic receptor phosphorylation, and normalized cardiac function was observed in PI3Kγ KO mice despite hypoxia. Compared to WT, PI3Kγ KO mice had preserved cardiac response to challenge with β1AR-selective agonist dobutamine post-hypoxia. CONCLUSIONS Agonist-independent activation of PI3Kγ underlies hypoxia sensing as its ablation leads to reduction in β1- and β2AR phosphorylation and amelioration of cardiac dysfunction.
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Affiliation(s)
- Yu Sun
- Departments of Cardiovascular and Metabolic Sciences (Y.S., K.S., M.L.M., M.K.G., S.V., N.P.), Lerner Research Institute, Cleveland Clinic, OH
| | - Kate Stenson
- Departments of Cardiovascular and Metabolic Sciences (Y.S., K.S., M.L.M., M.K.G., S.V., N.P.), Lerner Research Institute, Cleveland Clinic, OH
| | - Maradumane L Mohan
- Departments of Cardiovascular and Metabolic Sciences (Y.S., K.S., M.L.M., M.K.G., S.V., N.P.), Lerner Research Institute, Cleveland Clinic, OH
| | - Manveen K Gupta
- Departments of Cardiovascular and Metabolic Sciences (Y.S., K.S., M.L.M., M.K.G., S.V., N.P.), Lerner Research Institute, Cleveland Clinic, OH
| | - Nick Wanner
- Inflammation and Immunity (N.W., K.A., S.E.), Lerner Research Institute, Cleveland Clinic, OH
| | - Kewal Asosingh
- Inflammation and Immunity (N.W., K.A., S.E.), Lerner Research Institute, Cleveland Clinic, OH
| | - Serpil Erzurum
- Inflammation and Immunity (N.W., K.A., S.E.), Lerner Research Institute, Cleveland Clinic, OH
| | - Sathyamangla V Naga Prasad
- Departments of Cardiovascular and Metabolic Sciences (Y.S., K.S., M.L.M., M.K.G., S.V., N.P.), Lerner Research Institute, Cleveland Clinic, OH
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7
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Gauthier M, Kale S, Oriss T, Gorry M, Ramonell R, Scholl K, Ray P, Fahy J, Seibold M, Castro M, Jarjour N, Gaston B, Bleecker E, Meyers D, Moore W, Hastie A, Israel E, Levy B, Mauger D, Erzurum S, Comhair S, Wenzel S, Ray A. CCL5 is a Potential Bridge Between Type 1 and Type 2 Inflammation in Asthma. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.696] [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: 02/05/2023]
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8
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Asosingh K, Frimel M, Zlojutro V, Grant D, Stephens O, Wenger D, Fouras A, DiFilippo F, Erzurum S. Preclinical Four-Dimensional Functional Lung Imaging and Quantification of Regional Airflow: A New Standard in Lung Function Evaluation in Murine Models. Am J Respir Cell Mol Biol 2022; 67:423-429. [PMID: 35687482 PMCID: PMC9564925 DOI: 10.1165/rcmb.2022-0055ma] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/10/2022] [Indexed: 02/06/2023] Open
Abstract
The current standard for lung function evaluation in murine models is based on forced oscillation technology, which provides a measure of the total airway function but cannot provide information on regional heterogeneity in function. Limited detection of regional airflow may contribute to a discontinuity between airway inflammation and airflow obstruction in models of asthma. Here, we describe quantification of regional airway function using novel dynamic quantitative imaging and analysis to quantify and visualize lung motion and regional pulmonary airflow in four dimensions (4D). Furthermore, temporo-spatial specific ventilation (ml/ml) is used to determine ventilation heterogeneity indices for lobar and sublobar regions, which are directly compared to ex vivo biological analyses in the same sublobar regions. In contrast, oscillation-based technology in murine genetic models of asthma have failed to demonstrate lung function change despite altered inflammation, whereas 4D functional lung imaging demonstrated diminished regional lung function in genetic models relative to wild-type mice. Quantitative functional lung imaging assists in localizing the regional effects of airflow. Our approach reveals repeatable and consistent differences in regional airflow between lung lobes in all models of asthma, suggesting that asthma is characterized by regional airway dysfunctions that are often not detectable in composite measures of lung function. 4D functional lung imaging technology has the potential to transform discovery and development in murine models by mapping out regional areas heterogeneously affected by the disease, thus deciphering pathobiology with greater precision.
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Affiliation(s)
- Kewal Asosingh
- Department of Inflammation and Immunity Lerner Research Institute and Respiratory Institute and
| | - Matthew Frimel
- Department of Inflammation and Immunity Lerner Research Institute and Respiratory Institute and
| | - Violetta Zlojutro
- Department of Inflammation and Immunity Lerner Research Institute and Respiratory Institute and
| | - Dillon Grant
- Department of Inflammation and Immunity Lerner Research Institute and Respiratory Institute and
| | | | - David Wenger
- 4DMedical Research and Development, Los Angeles, California
| | - Andreas Fouras
- 4DMedical Research and Development, Los Angeles, California
| | | | - Serpil Erzurum
- Department of Inflammation and Immunity Lerner Research Institute and Respiratory Institute and
- Cleveland Clinic, Cleveland, Ohio; and
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9
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Oliveira SD, Erewele E, Castellon M, Schwartz A, Williams DL, Morrell N, Bonini M, Silva CLM, Lutz SE, Erzurum S, Minshall RD. Abstract 388: Role Of The Antiapoptotic C-iap2 On The Generation Of An Endothelial Memory In Schistosomiasis-associated Pulmonary Arterial Hypertension. Arterioscler Thromb Vasc Biol 2022. [DOI: 10.1161/atvb.42.suppl_1.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction:
Schistosomiasis-associated Pulmonary Arterial Hypertension (Sch-PAH) is a life-threatening complication of chronic
S. mansoni
infection, which can evolve to heart failure and death. During PAH, hyperproliferation of apoptosis-resistant endothelial cells (ECs) has been extensively reported, but therapeutic approaches to reverse this pathological phenotype remain clinically challenging.
Hypothesis:
Thus, our hypothesis is that antigenic molecules from
S. mansoni
eggs amplify the secretion of inhibitor of apoptosis protein 2 (c-IAP2), leading to generation of an abnormal EC memory of survival and the development of PAH.
Methods/Results:
Previously, we showed that depletion of the anti-apoptotic protein Caveolin-1 (Cav-1) via shedding of extracellular vesicles (EVs) leads to the survival of an abnormal EC phenotype through an unclear mechanism. Analysis of survival-associated genes in isolated murine lung ECs from
Flk1
+/GFP
;Cav1
-/-
mice, revealed high expression of the anti-apoptotic genes BIRC3 and BIRC5 (which encodes cIAP2 and survivin, respectively) when compared to control ECs. Interesting, exposure to 1 μg/mL of the major
S. mansoni
egg antigen Sm-p40 induced time-dependent phosphorylation of Cav-1 at residue Tyr14 in human lung microvascular EC (HMVEC-L: 228.2 +/- 38.28% of control; p<0.05; n=4), culminating in c-IAP2 expression with no difference on the constitutive expression of c-IAP1. Furthermore, Sm-p40 treatment of HMVEC-L in the presence of pro-inflammatory mediators IL-6, TNF-α, and ATP induced a significant release of EVs containing c-IAP2. Finally, in vivo analysis of lungs from
S. mansoni
-infected mice confirmed a significant decrease in Cav-1 expression unique to the egg-dependent granuloma area, indicating that local inflammatory response due to egg-derived antigenic molecules is essential for reprogramming and survival of an abnormal EC phenotype during Sch-PAH.
Conclusions:
Our data suggest that
S. mansoni
-induced Cav-1 depletion promotes the secretion of the anti-apoptotic c-IAP2 protein, which may be critical for prolonged survival of a pathogenic EC phenotype during the development of Sch-PAH.
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10
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Trivedi AP, Hall C, Goss CW, Lew D, Krings JG, McGregor MC, Samant M, Sieren JP, Li H, Schechtman KB, Schirm J, McEleney S, Peterson S, Moore WC, Bleecker ER, Meyers DA, Israel E, Washko GR, Levy BD, Leader JK, Wenzel SE, Fahy JV, Schiebler ML, Fain SB, Jarjour NN, Mauger DT, Reinhardt JM, Newell JD, Hoffman EA, Castro M, Sheshadri A, Levy B, Cernadas M, Washko GR, Haley K, Cardet JC, Duvall M, Forth V, Le M, Fandozzi E, O'Neill A, Gentile K, Cinelli M, Tulchinsky A, Lawrance G, Czajkowski R, Lemole P, Antunes W, McGinnis A, Klokeid K, Phipatanakul W, Sheehan W, Bartnikas L, Baxi S, Crestani E, Etsy B, Gaffin J, Hauptman M, Kantor D, Lai P, Louisias M, Nelson K, Permaul P, Schneider L, Wright L, Minnicozzi S, Maciag M, Haktanir-Abul M, Gunnlaugsson S, Burke-Roberts E, Cunningham A, Ansel-Kelly E, Waskosky S, Ramsey A, Feloney L, Wenzel S, Fajt M, Celedon J, Larkin A, Di P, Chu HW, Gauthier M, Wu W, Jain S, Camiolo M, Rauscher C, Luyster F, Rebovich P, Demas J, Wunderley R, Vitari C, Ilnicki M, Srollo D, Takosky C, Lanzo R, Leader J, Lapic DM, Etling E, Rhodes D, Burger J, Glover E, Peters A, Smith C, Bonfiglio N, Trudeau J, Bang SJ, Lin Q, Liu CH, Kupul S, Jarjour N, Denlinger L, Lemanske R, Fain S, Viswanathan R, Moss M, Jackson D, Sorkness R, Ramratnam S, Tattersall M, Crisafi G, Klaus D, Wollet L, Bach J, Johansson M, Schiebler M, Esnault S, Mathur S, Yakey J, Floerke H, Guadarrama A, Maddox A, Peters B, Beaman K, Sumino K, Castro M, Bacharier L, Gierada D, Woods J, Schechtman K, Patterson B, Sheshadri A, Coverstone A, Shifren A, Quirk J, Byers D, Krings J, McGregor MC, Samant M, Tarsi J, Koch T, Curtis V, Yin-Declue H, Boomer J, Saylor M, Frei S, Rowe L, Sajol G, Kozlowski J, Hoffman E, Allard E, Atha J, Ching-Long L, Fahy J, Woodruff P, Ly N, Bhakta N, Peters M, Moreno C, Baum A, Liu D, Kalra A, Orain X, Charbit A, Njoku N, Dunican E, Teague WG, Greenwald R, DeBoer M, Wavell K, deRonde K, Erzurum S, Carl J, Khatri S, Dweik R, Comhair S, Sharp J, Lempel J, Farha S, Taliercio R, Aronica M, Zein J, Koo M, Painter TA, Hopkins K, Lawrence J, Abi-Saleh S, Labadia M, Qirjaz E, Wehrmann R, Arbruster D, Markle T, Matuska B, Baicker-McKee S, Wyszynski P, Fitzgerald K, Ross K, Gaston B, Myers R, Craven D, Roesch E, Thomas R, Logan L, Veri L, Gluvna A, Wallace J, Pryor M, Smith S, Allerton P, Emrich T, Hilliard J, Krenicky J, Smith L, Ferrebee M, Moore W, Bleecker E, Meyers D, Peters S, Li X, Hastie A, Ortega V, Hawkins G, Krings J, Ampleford E, Pippins A, Field P, Rector B, Sprissler R, Fransway B, Fitzpatrick A, Stephenson S, Mauger DT, Phillips B. Quantitative CT Characteristics of Cluster Phenotypes in the Severe Asthma Research Program Cohorts. Radiology 2022; 304:450-459. [PMID: 35471111 PMCID: PMC9340243 DOI: 10.1148/radiol.210363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Clustering key clinical characteristics of participants in the Severe Asthma Research Program (SARP), a large, multicenter prospective observational study of patients with asthma and healthy controls, has led to the identification of novel asthma phenotypes. Purpose To determine whether quantitative CT (qCT) could help distinguish between clinical asthma phenotypes. Materials and Methods A retrospective cross-sectional analysis was conducted with the use of qCT images (maximal bronchodilation at total lung capacity [TLC], or inspiration, and functional residual capacity [FRC], or expiration) from the cluster phenotypes of SARP participants (cluster 1: minimal disease; cluster 2: mild, reversible; cluster 3: obese asthma; cluster 4: severe, reversible; cluster 5: severe, irreversible) enrolled between September 2001 and December 2015. Airway morphometry was performed along standard paths (RB1, RB4, RB10, LB1, and LB10). Corresponding voxels from TLC and FRC images were mapped with use of deformable image registration to characterize disease probability maps (DPMs) of functional small airway disease (fSAD), voxel-level volume changes (Jacobian), and isotropy (anisotropic deformation index [ADI]). The association between cluster assignment and qCT measures was evaluated using linear mixed models. Results A total of 455 participants were evaluated with cluster assignments and CT (mean age ± SD, 42.1 years ± 14.7; 270 women). Airway morphometry had limited ability to help discern between clusters. DPM fSAD was highest in cluster 5 (cluster 1 in SARP III: 19.0% ± 20.6; cluster 2: 18.9% ± 13.3; cluster 3: 24.9% ± 13.1; cluster 4: 24.1% ± 8.4; cluster 5: 38.8% ± 14.4; P < .001). Lower whole-lung Jacobian and ADI values were associated with greater cluster severity. Compared to cluster 1, cluster 5 lung expansion was 31% smaller (Jacobian in SARP III cohort: 2.31 ± 0.6 vs 1.61 ± 0.3, respectively, P < .001) and 34% more isotropic (ADI in SARP III cohort: 0.40 ± 0.1 vs 0.61 ± 0.2, P < .001). Within-lung Jacobian and ADI SDs decreased as severity worsened (Jacobian SD in SARP III cohort: 0.90 ± 0.4 for cluster 1; 0.79 ± 0.3 for cluster 2; 0.62 ± 0.2 for cluster 3; 0.63 ± 0.2 for cluster 4; and 0.41 ± 0.2 for cluster 5; P < .001). Conclusion Quantitative CT assessments of the degree and intraindividual regional variability of lung expansion distinguished between well-established clinical phenotypes among participants with asthma from the Severe Asthma Research Program study. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Verschakelen in this issue.
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11
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Sieren JC, Schroeder KE, Guo J, Asosingh K, Erzurum S, Hoffman EA. Menstrual cycle impacts lung structure measures derived from quantitative computed tomography. Eur Radiol 2021; 32:2883-2890. [PMID: 34928413 PMCID: PMC9038622 DOI: 10.1007/s00330-021-08404-9] [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: 06/11/2021] [Revised: 08/23/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Quantitative computed tomography (qCT) is being increasingly incorporated in research studies and clinical trials aimed at understanding lung disease risk, progression, exacerbations, and intervention response. Menstrual cycle-based changes in lung function are recognized; however, the impact on qCT measures is currently unknown. We hypothesize that the menstrual cycle impacts qCT-derived measures of lung structure in healthy women and that the degree of measurement change may be mitigated in subjects on cyclic hormonal birth control. METHODS Thirty-one non-smoking, healthy women with regular menstrual cycles (16 of which were on cyclic hormonal birth control) underwent pulmonary function testing and qCT imaging at both menses and early luteal phase time points. Data were evaluated to identify lung measurements which changed significantly across the two key time points and to compare degree of change across metrics for the sub-cohort with versus without birth control. RESULTS The segmental airway measurements were larger and mean lung density was higher at menses compared to the early luteal phase. The sub-cohort with cyclic hormonal birth control did not have less evidence of measurement difference over the menstrual cycle compared to the sub-cohort without hormonal birth control. CONCLUSIONS This study provides evidence that qCT-derived measures from the lung are impacted by the female menstrual cycle. This indicates studies seeking to use qCT as a more sensitive measure of cross-sectional differences or longitudinal changes in these derived lung measurements should consider acquiring data at a consistent time in the menstrual cycle for pre-menopausal women and warrants further exploration. KEY POINTS • Lung measurements from chest computed tomography are used in multicenter studies exploring lung disease progression and treatment response. • The menstrual cycle impacts lung structure measurements. • Cyclic variability should be considered when evaluating longitudinal change with CT in menstruating women.
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Affiliation(s)
- Jessica C Sieren
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA. .,Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA.
| | - Kimberly E Schroeder
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA
| | - Junfeng Guo
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA.,Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Kewal Asosingh
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Flow Cytometry Core, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serpil Erzurum
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, 200 Hawkins Dr. CC704GH, Iowa City, IA, 52242, USA.,Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
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12
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Farha S, Comhair S, Hou Y, Park MM, Sharp J, Peterson L, Willard B, Zhang R, DiFilippo FP, Neumann D, Tang WHW, Cheng F, Erzurum S. Metabolic endophenotype associated with right ventricular glucose uptake in pulmonary hypertension. Pulm Circ 2021; 11:20458940211054325. [PMID: 34888034 PMCID: PMC8649443 DOI: 10.1177/20458940211054325] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022] Open
Abstract
Alterations in metabolism and bioenergetics are hypothesized in the mechanisms
leading to pulmonary vascular remodeling and heart failure in pulmonary
hypertension (PH). To test this, we performed metabolomic analyses on 30 PH
individuals and 12 controls. Furthermore, using 2-[18F]fluoro-2-deoxy-D-glucose
positron emission tomography, we dichotomized PH patients into metabolic
phenotypes of high and low right ventricle (RV) glucose uptake and followed them
longitudinally. In support of metabolic alterations in PH and its progression,
the high RV glucose group had higher RV systolic pressure (p < 0.001), worse
RV function as measured by RV fractional area change and peak global
longitudinal strain (both p < 0.05) and may be associated with poorer
outcomes (33% death or transplantation in the high glucose RV uptake group
compared to 7% in the low RV glucose uptake group at five years follow-up,
log-ranked p = 0.07). Pathway enrichment analysis identified key metabolic
pathways including fructose catabolism, arginine-nitric oxide metabolism,
tricarboxylic acid cycle, and ketones metabolism. Integrative human
protein-protein interactome network analysis of metabolomic and transcriptomic
data identified key pathobiological pathways: arginine biosynthesis,
tricarboxylic acid cycle, purine metabolism, hypoxia-inducible factor 1, and
apelin signaling. These findings identify a PH metabolomic endophenotype, and
for the first time link this to disease severity and outcomes.
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Affiliation(s)
- Samar Farha
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Suzy Comhair
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yuan Hou
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Margaret M Park
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jacqueline Sharp
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Laura Peterson
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Belinda Willard
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Renliang Zhang
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - W H Wilson Tang
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Feixiong Cheng
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serpil Erzurum
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Baratchian M, McManus JM, Berk MP, Nakamura F, Mukhopadhyay S, Xu W, Erzurum S, Drazba J, Peterson J, Klein EA, Gaston B, Sharifi N. Androgen regulation of pulmonary AR, TMPRSS2 and ACE2 with implications for sex-discordant COVID-19 outcomes. Sci Rep 2021; 11:11130. [PMID: 34045511 PMCID: PMC8159988 DOI: 10.1038/s41598-021-90491-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/29/2021] [Indexed: 01/08/2023] Open
Abstract
The sex discordance in COVID-19 outcomes has been widely recognized, with males generally faring worse than females and a potential link to sex steroids. A plausible mechanism is androgen-induced expression of TMPRSS2 and/or ACE2 in pulmonary tissues that may increase susceptibility or severity in males. This hypothesis is the subject of several clinical trials of anti-androgen therapies around the world. Here, we investigated the sex-associated TMPRSS2 and ACE2 expression in human and mouse lungs and interrogated the possibility of pharmacologic modification of their expression with anti-androgens. We found no evidence for increased TMPRSS2 expression in the lungs of males compared to females in humans or mice. Furthermore, in male mice, treatment with the androgen receptor antagonist enzalutamide did not decrease pulmonary TMPRSS2. On the other hand, ACE2 and AR expression was sexually dimorphic and higher in males than females. ACE2 was moderately suppressible with enzalutamide administration. Our work suggests that sex differences in COVID-19 outcomes attributable to viral entry are independent of TMPRSS2. Modest changes in ACE2 could account for some of the sex discordance.
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Affiliation(s)
- Mehdi Baratchian
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Jeffrey M McManus
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Mike P Berk
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Fumihiko Nakamura
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Sanjay Mukhopadhyay
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, USA
| | - Weiling Xu
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Serpil Erzurum
- Respiratory Institute, Cleveland Clinic, Cleveland, USA.,Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Judy Drazba
- Imaging Core, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - John Peterson
- Imaging Core, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Eric A Klein
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Benjamin Gaston
- Herman Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, USA
| | - Nima Sharifi
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, USA. .,Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA. .,Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA.
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14
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Hastie AT, Mauger DT, Denlinger LC, Coverstone A, Castro M, Erzurum S, Jarjour N, Levy BD, Meyers DA, Moore WC, Phillips BR, Wenzel SE, Fahy JV, Israel E, Bleecker ER. Mixed Sputum Granulocyte Longitudinal Impact on Lung Function in the Severe Asthma Research Program. Am J Respir Crit Care Med 2021; 203:882-892. [PMID: 33545021 DOI: 10.1164/rccm.202009-3713oc] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Rationale: Some reports indicate longitudinal variability in sputum differential cell counts, whereas others describe stability. Highly variable sputum eosinophil percentages are associated with greater lung function loss than persistently elevated eosinophil percentages, but elevated neutrophils are linked to more severe asthma.Objectives: To examine sputum granulocyte stability or variability longitudinally and associations with important clinical characteristics.Methods: The SARP III (Severe Asthma Research Program III) cohort underwent comprehensive phenotype characterization at baseline and annually over 3 years. Adult subjects with acceptable sputum levels were assigned to one of three longitudinal sputum groups: eosinophils predominantly <2%, eosinophils predominantly ≥2%, or highly variable eosinophil percentages (>2 SDs determined from independent, repeated baseline eosinophil percentages). Subjects were similarly assigned to one of three longitudinal neutrophil groups with a 50% cut point.Measurements and Main Results: The group with predominantly <2% sputum eosinophils had the highest lung function (prebronchodilator FEV1% predicted, P < 0.01; FEV1/FVC ratio, P < 0.001) at baseline and throughout 3 years compared with other eosinophil groups. Healthcare use did not differ, although the highly variable eosinophil group reported more asthma exacerbations at Year 3. Longitudinal neutrophil groups showed few differences. However, a combination of predominantly ≥2% eosinophil and ≥50% neutrophil groups resulted in the lowest prebronchodilator FEV1% predicted (P = 0.049) compared with the combination with predominantly <2% eosinophils and<50% neutrophils.Conclusions: Subjects with predominantly ≥2% sputum eosinophils in combination with predominantly ≥50% neutrophils showed greater loss of lung function, whereas those with highly variable sputum eosinophils had greater healthcare use.
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Affiliation(s)
- Annette T Hastie
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - David T Mauger
- Penn State College of Medicine, Penn State University, Hershey, Pennsylvania
| | | | | | - Mario Castro
- School of Medicine, Washington University, St. Louis, Missouri
| | | | | | - Bruce D Levy
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Wendy C Moore
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Brenda R Phillips
- Penn State College of Medicine, Penn State University, Hershey, Pennsylvania
| | | | - John V Fahy
- University of California-San Francisco, San Francisco, California
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15
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Weiss K, Wanner N, Queisser K, Frimel M, Nunn T, Myshrall T, Sangwan N, Erzurum S, Asosingh K. Barrier Housing and Gender Effects on Allergic Airway Disease in a Murine House Dust Mite Model. Immunohorizons 2021; 5:33-47. [PMID: 33478982 PMCID: PMC9404370 DOI: 10.4049/immunohorizons.2000096] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/01/2021] [Indexed: 11/19/2022] Open
Abstract
Allergic airway disease models use laboratory mice housed in highly controlled and hygienic environments, which provide a barrier between the mice and a predetermined list of specific pathogens excluded from the facility. In this study, we hypothesized that differences in facility barrier level and, consequently, the hygienic quality of the environment that mice inhabit impact the severity of pulmonary inflammation and lung function. Allergen-naive animals housed in the cleaner, high barrier (HB) specific pathogen-free facility had increased levels of inflammatory cytokines and higher infiltration of immune cells in the lung tissue but not in the bronchoalveolar lavage compared with mice housed in the less hygienic, low barrier specific pathogen-free facility. In both genders, house dust mite-induced airway disease was more severe in the HB than the low barrier facility. Within each barrier facility, female mice developed the most severe inflammation. However, allergen-naive male mice had worse lung function, regardless of the housing environment, and in the HB, the lung function in female mice was higher in the house dust mite model. Severe disease in the HB was associated with reduced lung microbiome diversity. The lung microbiome was altered across housing barriers, gender, and allergen-exposed groups. Thus, the housing barrier level impacts microbial-driven disease and gender phenotypes in allergic asthma. The housing of laboratory mice in more clean HB facilities aggravates lung immunity and causes a more severe allergic lung disease.
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Affiliation(s)
- Kelly Weiss
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH 44195
| | - Nicholas Wanner
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH 44195
| | - Kimberly Queisser
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH 44195
| | - Matthew Frimel
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH 44195
| | - Tina Nunn
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH 44195
| | - Timothy Myshrall
- Biological Resource Unit, Lerner Research Institute, Cleveland, OH 44195; and
| | - Naseer Sangwan
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH 44195
| | - Serpil Erzurum
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH 44195.,Respiratory Institute, The Cleveland Clinic, Cleveland, OH 44195
| | - Kewal Asosingh
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH 44195;
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16
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Abstract
In vascular research, clinical samples and samples from animal models are often used together to foster translation of preclinical findings to humans. General concepts of endothelia and murine-specific endothelial phenotypes were discussed in part 1 of this two part series. Here, in part 2, we present a comprehensive overview of human-specific endothelial phenotypes. Pan-endothelial cell markers, organ specific endothelial antigens, and flow cytometric immunophenotyping of blood-borne endothelial cells are reviewed.
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Affiliation(s)
- Dillon Grant
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicholas Wanner
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew Frimel
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serpil Erzurum
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kewal Asosingh
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA.,Flow Cytometry Core Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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17
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Grant D, Wanner N, Frimel M, Erzurum S, Asosingh K. Comprehensive phenotyping of endothelial cells using flow cytometry 1: Murine. Cytometry A 2020; 99:251-256. [PMID: 33345421 DOI: 10.1002/cyto.a.24292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/21/2022]
Abstract
The endothelium forms a selective barrier between circulating blood or lymph and surrounding tissue. Endothelial cells play an essential role in vessel homeostasis, and identification of these cells is critical in vascular biology research. However, characteristics of endothelial cells differ depending on the location and type of blood or lymph vessel. Endothelial cell subsets are numerous and often identified using different flow cytometric markers, making immunophenotyping these cells complex. In part 1 of this two part review series, we present a comprehensive overview of markers for the flow cytometric identification and phenotyping of murine endothelial subsets. These subsets can be distinguished using a panel of cell surface and intracellular markers shared by all endothelial cells in combination with additional markers of specialized endothelial cell types. This review can be used to determine the best markers for identifying and phenotyping desired murine endothelial cell subsets.
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Affiliation(s)
- Dillon Grant
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicholas Wanner
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew Frimel
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serpil Erzurum
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kewal Asosingh
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA.,Flow Cytometry Core Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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18
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Zhou Y, Hou Y, Shen J, Mehra R, Kallianpur A, Culver DA, Gack MU, Farha S, Zein J, Comhair S, Fiocchi C, Stappenbeck T, Chan T, Eng C, Jung JU, Jehi L, Erzurum S, Cheng F. A network medicine approach to investigation and population-based validation of disease manifestations and drug repurposing for COVID-19. PLoS Biol 2020; 18:e3000970. [PMID: 33156843 PMCID: PMC7728249 DOI: 10.1371/journal.pbio.3000970] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [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: 06/05/2020] [Revised: 12/10/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023] Open
Abstract
The global coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to unprecedented social and economic consequences. The risk of morbidity and mortality due to COVID-19 increases dramatically in the presence of coexisting medical conditions, while the underlying mechanisms remain unclear. Furthermore, there are no approved therapies for COVID-19. This study aims to identify SARS-CoV-2 pathogenesis, disease manifestations, and COVID-19 therapies using network medicine methodologies along with clinical and multi-omics observations. We incorporate SARS-CoV-2 virus-host protein-protein interactions, transcriptomics, and proteomics into the human interactome. Network proximity measurement revealed underlying pathogenesis for broad COVID-19-associated disease manifestations. Analyses of single-cell RNA sequencing data show that co-expression of ACE2 and TMPRSS2 is elevated in absorptive enterocytes from the inflamed ileal tissues of Crohn disease patients compared to uninflamed tissues, revealing shared pathobiology between COVID-19 and inflammatory bowel disease. Integrative analyses of metabolomics and transcriptomics (bulk and single-cell) data from asthma patients indicate that COVID-19 shares an intermediate inflammatory molecular profile with asthma (including IRAK3 and ADRB2). To prioritize potential treatments, we combined network-based prediction and a propensity score (PS) matching observational study of 26,779 individuals from a COVID-19 registry. We identified that melatonin usage (odds ratio [OR] = 0.72, 95% CI 0.56-0.91) is significantly associated with a 28% reduced likelihood of a positive laboratory test result for SARS-CoV-2 confirmed by reverse transcription-polymerase chain reaction assay. Using a PS matching user active comparator design, we determined that melatonin usage was associated with a reduced likelihood of SARS-CoV-2 positive test result compared to use of angiotensin II receptor blockers (OR = 0.70, 95% CI 0.54-0.92) or angiotensin-converting enzyme inhibitors (OR = 0.69, 95% CI 0.52-0.90). Importantly, melatonin usage (OR = 0.48, 95% CI 0.31-0.75) is associated with a 52% reduced likelihood of a positive laboratory test result for SARS-CoV-2 in African Americans after adjusting for age, sex, race, smoking history, and various disease comorbidities using PS matching. In summary, this study presents an integrative network medicine platform for predicting disease manifestations associated with COVID-19 and identifying melatonin for potential prevention and treatment of COVID-19.
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Affiliation(s)
- Yadi Zhou
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Yuan Hou
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Jiayu Shen
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Reena Mehra
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Asha Kallianpur
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Daniel A. Culver
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Michaela U. Gack
- Florida Research and Innovation Center, Cleveland Clinic, Port Saint Lucie, Florida, United States of America
| | - Samar Farha
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Joe Zein
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Suzy Comhair
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Claudio Fiocchi
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Thaddeus Stappenbeck
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Timothy Chan
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Jae U. Jung
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Lara Jehi
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Serpil Erzurum
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Feixiong Cheng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
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19
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Baratchian M, McManus JM, Berk M, Nakamura F, Mukhopadhyay S, Xu W, Erzurum S, Drazba J, Peterson J, Klein EA, Gaston B, Sharifi N. Sex, androgens and regulation of pulmonary AR, TMPRSS2 and ACE2. bioRxiv 2020:2020.04.21.051201. [PMID: 33083800 PMCID: PMC7574256 DOI: 10.1101/2020.04.21.051201] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The sex discordance in COVID-19 outcomes has been widely recognized, with males generally faring worse than females and a potential link to sex steroids. A plausible mechanism is androgen-induced expression of TMPRSS2 and/or ACE2 in pulmonary tissues that may increase susceptibility or severity in males. This hypothesis is the subject of several clinical trials of anti-androgen therapies around the world. Here, we investigated the sex-associated TMPRSS2 and ACE2 expression in human and mouse lungs and interrogated the possibility of pharmacologic modification of their expression with anti-androgens. We found no evidence for increased TMPRSS2 expression in the lungs of males compared to females in humans or mice. Furthermore, in male mice, treatment with the androgen receptor antagonist enzalutamide did not decrease pulmonary TMPRSS2. On the other hand, ACE2 and AR expression was sexually dimorphic and higher in males than females. ACE2 was moderately suppressible with enzalutamide therapy. Our work suggests that sex differences in COVID-19 outcomes attributable to viral entry are independent of TMPRSS2. Modest changes in ACE2 could account for some of the sex discordance.
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Affiliation(s)
- Mehdi Baratchian
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic
| | - Jeffrey M. McManus
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic
| | - Mike Berk
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic
| | - Fumihiko Nakamura
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic
| | | | - Weiling Xu
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic
- Respiratory Institute, Cleveland Clinic
| | - Serpil Erzurum
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic
- Respiratory Institute, Cleveland Clinic
| | - Judy Drazba
- Imaging Core, Lerner Research Institute, Cleveland Clinic
| | - John Peterson
- Imaging Core, Lerner Research Institute, Cleveland Clinic
| | - Eric A. Klein
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic
| | - Ben Gaston
- Herman Wells Center for Pediatric Research, Indiana University School of Medicine
| | - Nima Sharifi
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic
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20
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Jehi L, Ji X, Milinovich A, Erzurum S, Merlino A, Gordon S, Young JB, Kattan MW. Development and validation of a model for individualized prediction of hospitalization risk in 4,536 patients with COVID-19. PLoS One 2020; 15:e0237419. [PMID: 32780765 PMCID: PMC7418996 DOI: 10.1371/journal.pone.0237419] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [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: 04/24/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Coronavirus Disease 2019 is a pandemic that is straining healthcare resources, mainly hospital beds. Multiple risk factors of disease progression requiring hospitalization have been identified, but medical decision-making remains complex. OBJECTIVE To characterize a large cohort of patients hospitalized with COVID-19, their outcomes, develop and validate a statistical model that allows individualized prediction of future hospitalization risk for a patient newly diagnosed with COVID-19. DESIGN Retrospective cohort study of patients with COVID-19 applying a least absolute shrinkage and selection operator (LASSO) logistic regression algorithm to retain the most predictive features for hospitalization risk, followed by validation in a temporally distinct patient cohort. The final model was displayed as a nomogram and programmed into an online risk calculator. SETTING One healthcare system in Ohio and Florida. PARTICIPANTS All patients infected with SARS-CoV-2 between March 8, 2020 and June 5, 2020. Those tested before May 1 were included in the development cohort, while those tested May 1 and later comprised the validation cohort. MEASUREMENTS Demographic, clinical, social influencers of health, exposure risk, medical co-morbidities, vaccination history, presenting symptoms, medications, and laboratory values were collected on all patients, and considered in our model development. RESULTS 4,536 patients tested positive for SARS-CoV-2 during the study period. Of those, 958 (21.1%) required hospitalization. By day 3 of hospitalization, 24% of patients were transferred to the intensive care unit, and around half of the remaining patients were discharged home. Ten patients died. Hospitalization risk was increased with older age, black race, male sex, former smoking history, diabetes, hypertension, chronic lung disease, poor socioeconomic status, shortness of breath, diarrhea, and certain medications (NSAIDs, immunosuppressive treatment). Hospitalization risk was reduced with prior flu vaccination. Model discrimination was excellent with an area under the curve of 0.900 (95% confidence interval of 0.886-0.914) in the development cohort, and 0.813 (0.786, 0.839) in the validation cohort. The scaled Brier score was 42.6% (95% CI 37.8%, 47.4%) in the development cohort and 25.6% (19.9%, 31.3%) in the validation cohort. Calibration was very good. The online risk calculator is freely available and found at https://riskcalc.org/COVID19Hospitalization/. LIMITATION Retrospective cohort design. CONCLUSION Our study crystallizes published risk factors of COVID-19 progression, but also provides new data on the role of social influencers of health, race, and influenza vaccination. In a context of a pandemic and limited healthcare resources, individualized outcome prediction through this nomogram or online risk calculator can facilitate complex medical decision-making.
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Affiliation(s)
- Lara Jehi
- Neurological Institute, Chief Research Information Officer, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Xinge Ji
- Quantitative Health Science Department, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Alex Milinovich
- Quantitative Health Science Department, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Serpil Erzurum
- Respiratory Institute, Chair of the Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Amy Merlino
- Obstetrics and gynecology, Chief Medical Information Ofc., Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Steve Gordon
- Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - James B. Young
- Cardiology, Chief Academic Officer, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Michael W. Kattan
- Quantitative Health Science Department, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio, United States of America
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21
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Hou Y, Zhao J, Martin W, Kallianpur A, Chung MK, Jehi L, Sharifi N, Erzurum S, Eng C, Cheng F. New insights into genetic susceptibility of COVID-19: an ACE2 and TMPRSS2 polymorphism analysis. BMC Med 2020; 18:216. [PMID: 32664879 PMCID: PMC7360473 DOI: 10.1186/s12916-020-01673-z] [Citation(s) in RCA: 291] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has now been confirmed worldwide. Yet, COVID-19 is strangely and tragically selective. Morbidity and mortality due to COVID19 rise dramatically with age and co-existing health conditions, including cancer and cardiovascular diseases. Human genetic factors may contribute to the extremely high transmissibility of SARS-CoV-2 and to the relentlessly progressive disease observed in a small but significant proportion of infected individuals, but these factors are largely unknown. MAIN BODY In this study, we investigated genetic susceptibility to COVID-19 by examining DNA polymorphisms in ACE2 and TMPRSS2 (two key host factors of SARS-CoV-2) from ~ 81,000 human genomes. We found unique genetic susceptibility across different populations in ACE2 and TMPRSS2. Specifically, ACE2 polymorphisms were found to be associated with cardiovascular and pulmonary conditions by altering the angiotensinogen-ACE2 interactions, such as p.Arg514Gly in the African/African-American population. Unique but prevalent polymorphisms (including p.Val160Met (rs12329760), an expression quantitative trait locus (eQTL)) in TMPRSS2, offer potential explanations for differential genetic susceptibility to COVID-19 as well as for risk factors, including those with cancer and the high-risk group of male patients. We further discussed that polymorphisms in ACE2 or TMPRSS2 could guide effective treatments (i.e., hydroxychloroquine and camostat) for COVID-19. CONCLUSION This study suggested that ACE2 or TMPRSS2 DNA polymorphisms were likely associated with genetic susceptibility of COVID-19, which calls for a human genetics initiative for fighting the COVID-19 pandemic.
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Affiliation(s)
- Yuan Hou
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Junfei Zhao
- Department of Systems Biology and Department of Biomedical Informatics, Herbert Irving Comprehensive Center, Columbia University, New York, NY, 10032, USA
| | - William Martin
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Asha Kallianpur
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, 44195, USA
| | - Mina K Chung
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, 44195, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Lara Jehi
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Nima Sharifi
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Serpil Erzurum
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, 44195, USA
- Department of Genetics and Genome Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Feixiong Cheng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, 44195, USA.
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA.
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22
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Zhou Y, Hou Y, Shen J, Kallianpur A, Zein J, Culver DA, Farha S, Comhair S, Fiocchi C, Gack MU, Mehra R, Stappenbeck T, Chan T, Eng C, Jung JU, Jehi L, Erzurum S, Cheng F. A Network Medicine Approach to Investigation and Population-based Validation of Disease Manifestations and Drug Repurposing for COVID-19. ChemRxiv 2020:12579137. [PMID: 32676577 PMCID: PMC7350981 DOI: 10.26434/chemrxiv.12579137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The global Coronavirus Disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to unprecedented social and economic consequences. The risk of morbidity and mortality due to COVID-19 increases dramatically in the presence of co-existing medical conditions while the underlying mechanisms remain unclear. Furthermore, there are no proven effective therapies for COVID-19. This study aims to identify SARS-CoV-2 pathogenesis, diseases manifestations, and COVID-19 therapies using network medicine methodologies along with clinical and multi-omics observations. We incorporate SARS-CoV-2 virus-host protein-protein interactions, transcriptomics, and proteomics into the human interactome. Network proximity measure revealed underlying pathogenesis for broad COVID-19-associated manifestations. Multi-modal analyses of single-cell RNA-sequencing data showed that co-expression of ACE2 and TMPRSS2 was elevated in absorptive enterocytes from the inflamed ileal tissues of Crohn's disease patients compared to uninflamed tissues, revealing shared pathobiology by COVID-19 and inflammatory bowel disease. Integrative analyses of metabolomics and transcriptomics (bulk and single-cell) data from asthma patients indicated that COVID-19 shared intermediate inflammatory endophenotypes with asthma (including IRAK3 and ADRB2). To prioritize potential treatment, we combined network-based prediction and propensity score (PS) matching observational study of 18,118 patients from a COVID-19 registry. We identified that melatonin (odds ratio (OR) = 0.36, 95% confidence interval (CI) 0.22-0.59) was associated with 64% reduced likelihood of a positive laboratory test result for SARS-CoV-2. Using PS-matching user active comparator design, melatonin was associated with 54% reduced likelihood of SARS-CoV-2 positive test result compared to angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors (OR = 0.46, 95% CI 0.24-0.86).
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Affiliation(s)
- Yadi Zhou
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Yuan Hou
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jiayu Shen
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Asha Kallianpur
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
| | - Joe Zein
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Daniel A. Culver
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Samar Farha
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Suzy Comhair
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Claudio Fiocchi
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Michaela U. Gack
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Reena Mehra
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Thaddeus Stappenbeck
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Timothy Chan
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Jae U. Jung
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Lara Jehi
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Serpil Erzurum
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Feixiong Cheng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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23
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Jehi L, Ji X, Milinovich A, Erzurum S, Rubin BP, Gordon S, Young JB, Kattan MW. Individualizing Risk Prediction for Positive Coronavirus Disease 2019 Testing: Results From 11,672 Patients. Chest 2020; 158:1364-1375. [PMID: 32533957 PMCID: PMC7286244 DOI: 10.1016/j.chest.2020.05.580] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is sweeping the globe. Despite multiple case-series, actionable knowledge to tailor decision-making proactively is missing. Research Question Can a statistical model accurately predict infection with COVID-19? Study Design and Methods We developed a prospective registry of all patients tested for COVID-19 in Cleveland Clinic to create individualized risk prediction models. We focus here on the likelihood of a positive nasal or oropharyngeal COVID-19 test. A least absolute shrinkage and selection operator logistic regression algorithm was constructed that removed variables that were not contributing to the model’s cross-validated concordance index. After external validation in a temporally and geographically distinct cohort, the statistical prediction model was illustrated as a nomogram and deployed in an online risk calculator. Results In the development cohort, 11,672 patients fulfilled study criteria, including 818 patients (7.0%) who tested positive for COVID-19; in the validation cohort, 2295 patients fulfilled criteria, including 290 patients who tested positive for COVID-19. Male, African American, older patients, and those with known COVID-19 exposure were at higher risk of being positive for COVID-19. Risk was reduced in those who had pneumococcal polysaccharide or influenza vaccine or who were on melatonin, paroxetine, or carvedilol. Our model had favorable discrimination (c-statistic = 0.863 in the development cohort and 0.840 in the validation cohort) and calibration. We present sensitivity, specificity, negative predictive value, and positive predictive value at different prediction cutoff points. The calculator is freely available at https://riskcalc.org/COVID19. Interpretation Prediction of a COVID-19 positive test is possible and could help direct health-care resources. We demonstrate relevance of age, race, sex, and socioeconomic characteristics in COVID-19 susceptibility and suggest a potential modifying role of certain common vaccinations and drugs that have been identified in drug-repurposing studies.
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Affiliation(s)
- Lara Jehi
- Neurological Institute, Cleveland Clinic, Cleveland, OH.
| | - Xinge Ji
- Quantitative Health Science Department, Cleveland Clinic, Cleveland, OH
| | - Alex Milinovich
- Quantitative Health Science Department, Cleveland Clinic, Cleveland, OH
| | - Serpil Erzurum
- Lerner Research Institute, the Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Brian P Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Steve Gordon
- Infectious Disease Department, Cleveland Clinic, Cleveland, OH
| | | | - Michael W Kattan
- Quantitative Health Science Department, Cleveland Clinic, Cleveland, OH
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McManus JM, Le THN, Min B, Asosingh K, Zein J, Erzurum S, Sharifi N. SAT-734 HSD3B1 Expression in the Human Immune System. J Endocr Soc 2020. [PMCID: PMC7208899 DOI: 10.1210/jendso/bvaa046.617] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
3β-hydroxysteroid dehydrogenase-1 (3βHSD1), catalyzing conversion of dehydroepiandrosterone (DHEA) to Δ 4-androstenedione, is an essential enzyme in the pathway toward production of biologically active androgens such as dihydrotestosterone from the adrenally produced precursor DHEA sulfate, the most predominant steroid hormone in circulation. We previously identified, in the gene (HSD3B1) that encodes 3βHSD1, a germline gain-of-function missense-encoding variant that has now been validated in several studies as predicting more rapid progression in prostate cancer patients treated with gonadal testosterone deprivation. Production of androgens from adrenal precursors is important not just in the context of prostate cancer but in other physiologic and pathophysiologic processes, which could include asthma. Androgens are associated with better lung function in both asthma and healthy cohorts, and increasing circulating androgen levels in males help explain the switchover in asthma being more common in boys than girls but then more common in women than men. A main treatment for asthma, as well as other inflammatory processes, is administration of glucocorticoids, yet unresponsiveness to glucocorticoids in a subset of patients remains a major problem. Systemic glucocorticoid administration suppresses adrenally produced DHEA and DHEA-S, suggesting a depleted pool for biologically active androgen production as a mechanism for glucocorticoid resistance. Our surprising preliminary data support a link between glucocorticoid responsiveness and the more active HSD3B1 allele: patients homozygous for the adrenal-permissive HSD3B1(1245C) allele exhibit better response to oral glucocorticoids than those homozygous for the adrenal-restrictive HSD3B1(1245A), with heterozygous patients falling in the middle. This suggests a model in which patients with the more active (adrenal-permissive) form of 3βHSD1 produce sufficient androgens despite the depleted pool of precursor hormones whereas patients with the less active (adrenal-restrictive) form cannot. To further elucidate the link between 3βHSD1 activity and immune response, we assayed HSD3B1 expression in different types of white blood cells. Leukocyte subsets from asthma patients and healthy controls were purified using fluorescence-activated cell sorting, and HSD3B1 expression was analyzed using qPCR. White blood cells of several types expressed HSD3B1 at levels comparable to or greater than both prostate cancer and placental choriocarcinoma cell lines with very robust 3βHSD1 activity. Further determining the cell type specific expression and activity of this key enzyme is an important step in unraveling the link between the HSD3B1 polymorphism and asthma along with potentially many other immune processes.
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Affiliation(s)
| | | | - Booki Min
- Cleveland Clinic, Cleveland, OH, USA
| | | | - Joe Zein
- Cleveland Clinic, Cleveland, OH, USA
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25
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Fajt M, Nouraie SM, Wojcik R, Trudeau J, Bleecker E, Meyers D, Jarjour N, Denlinger L, Castro M, Bacharier L, Israel E, Levy B, Phipatanakul W, Fitzpatrick A, Erzurum S, Gaston B, Moore W, Hastie A, Wenzel S. Age of Asthma Onset, not Severity, Predicts Environmental Allergy Clusters. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.223] [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: 11/25/2022]
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26
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Asosingh K, Lauruschkat CD, Alemagno M, Frimel M, Wanner N, Weiss K, Kessler S, Meyers DA, Bennett C, Xu W, Erzurum S. Arginine metabolic control of airway inflammation. JCI Insight 2020; 5:127801. [PMID: 31996482 DOI: 10.1172/jci.insight.127801] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 12/18/2019] [Indexed: 01/03/2023] Open
Abstract
Inducible nitric oxide synthase (iNOS) and arginase-2 (ARG2) share a common substrate, arginine. Higher expression of iNOS and exhaled NO are linked to airway inflammation in patients. iNOS deletion in animal models suggests that eosinophilic inflammation is regulated by arginine metabolism. Moreover, ARG2 is a regulator of Th2 response, as shown by the development of severe eosinophilic inflammation in ARG2-/- mice. However, potential synergistic roles of iNOS and ARG2 in asthma have not been explored. Here, we hypothesized that arginine metabolic fate via iNOS and ARG2 may govern airway inflammation. In an asthma cohort, ARG2 variant genotypes were associated with arginase activity. ARG2 variants with lower arginase activity, combined with levels of exhaled NO, identified a severe asthma phenotype. Airway inflammation was present in WT, ARG2-/-, iNOS-/-, and ARG2-/-/iNOS-/- mice but was greatest in ARG2-/-. Eosinophilic and neutrophilic infiltration in the ARG2-/- mice was abrogated in ARG2-/-/iNOS-/- animals. Similarly, angiogenic airway remodeling was greatest in ARG2-/- mice. Cytokines driving inflammation and remodeling were highest in lungs of asthmatic ARG2-/- mice and lowest in the iNOS-/-. ARG2 metabolism of arginine suppresses inflammation, while iNOS metabolism promotes airway inflammation, supporting a central role for arginine metabolic control of inflammation.
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Affiliation(s)
- Kewal Asosingh
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chris D Lauruschkat
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mario Alemagno
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew Frimel
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicholas Wanner
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kelly Weiss
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sean Kessler
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah A Meyers
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Carole Bennett
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Weiling Xu
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serpil Erzurum
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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27
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Oliveira SDS, Chen J, Castellon M, Mao M, Raj JU, Comhair S, Erzurum S, Silva CLM, Machado RF, Bonini MG, Minshall RD. Injury-Induced Shedding of Extracellular Vesicles Depletes Endothelial Cells of Cav-1 (Caveolin-1) and Enables TGF-β (Transforming Growth Factor-β)-Dependent Pulmonary Arterial Hypertension. Arterioscler Thromb Vasc Biol 2019; 39:1191-1202. [PMID: 30943774 PMCID: PMC7297129 DOI: 10.1161/atvbaha.118.312038] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Indexed: 12/14/2022]
Abstract
Objective- To determine whether pulmonary arterial hypertension is associated with endothelial cell (EC)-Cav-1 (caveolin-1) depletion, EC-derived extracellular vesicle cross talk with macrophages, and proliferation of Cav-1 depleted ECs via TGF-β (transforming growth factor-β) signaling. Approach and Results- Pulmonary vascular disease was induced in Sprague-Dawley rats by exposure to a single injection of VEGFRII (vascular endothelial growth factor receptor II) antagonist SU5416 (Su) followed by hypoxia (Hx) plus normoxia (4 weeks each-HxSu model) and in WT (wild type; Tie2.Cre-; Cav1 lox/lox) and EC- Cav1-/- (Tie2.Cre+; Cav1 fl/fl) mice (Hx: 4 weeks). We observed reduced lung Cav-1 expression in the HxSu rat model in association with increased Cav-1+ extracellular vesicle shedding into the circulation. Whereas WT mice exposed to hypoxia exhibited increased right ventricular systolic pressure and pulmonary microvascular thickening compared with the group maintained in normoxia, the remodeling was further increased in EC- Cav1-/- mice indicating EC Cav-1 expression protects against hypoxia-induced pulmonary hypertension. Depletion of EC Cav-1 was associated with reduced BMPRII (bone morphogenetic protein receptor II) expression, increased macrophage-dependent TGF-β production, and activation of pSMAD2/3 signaling in the lung. In vitro, in the absence of Cav-1, eNOS (endothelial NO synthase) dysfunction was implicated in the mechanism of EC phenotype switching. Finally, reduced expression of EC Cav-1 in lung histological sections from human pulmonary arterial hypertension donors was associated with increased plasma concentration of Cav-1, extracellular vesicles, and TGF-β, indicating Cav-1 may be a plasma biomarker of vascular injury and key determinant of TGF-β-induced pulmonary vascular remodeling. Conclusions- EC Cav-1 depletion occurs, in part, via Cav-1+ extracellular vesicle shedding into the circulation, which contributes to increased TGF-β signaling, EC proliferation, vascular remodeling, and pulmonary arterial hypertension.
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Affiliation(s)
- Suellen D S Oliveira
- From the Department of Anesthesiology (S.D.S.O., M.C., R.D.M.), University of Illinois at Chicago
| | - Jiwang Chen
- Department of Medicine (J.C., M.M., R.F.M., M.G.B.), University of Illinois at Chicago
- Research Resources Center Cardiovascular Research Core (J.C., M.C.), University of Illinois at Chicago
| | - Maricela Castellon
- From the Department of Anesthesiology (S.D.S.O., M.C., R.D.M.), University of Illinois at Chicago
- Research Resources Center Cardiovascular Research Core (J.C., M.C.), University of Illinois at Chicago
| | - Mao Mao
- Department of Medicine (J.C., M.M., R.F.M., M.G.B.), University of Illinois at Chicago
| | - J Usha Raj
- Department of Pediatrics (J.U.R.), University of Illinois at Chicago
| | - Suzy Comhair
- Lerner Research Institute (S.C., S.E.), Cleveland Clinic Foundation, OH
| | - Serpil Erzurum
- Lerner Research Institute (S.C., S.E.), Cleveland Clinic Foundation, OH
| | - Claudia L M Silva
- Institute of Biomedical Science, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil (C.L.M.S.)
| | - Roberto F Machado
- Department of Medicine (J.C., M.M., R.F.M., M.G.B.), University of Illinois at Chicago
| | - Marcelo G Bonini
- Department of Medicine (J.C., M.M., R.F.M., M.G.B.), University of Illinois at Chicago
| | - Richard D Minshall
- From the Department of Anesthesiology (S.D.S.O., M.C., R.D.M.), University of Illinois at Chicago
- Department of Pharmacology (R.D.M.), University of Illinois at Chicago
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28
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Sahiner UM, Birben E, Erzurum S, Sackesen C, Kalayci Ö. Oxidative stress in asthma: Part of the puzzle. Pediatr Allergy Immunol 2018; 29:789-800. [PMID: 30069955 DOI: 10.1111/pai.12965] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [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: 05/29/2018] [Revised: 07/08/2018] [Accepted: 07/23/2018] [Indexed: 01/17/2023]
Abstract
An imbalance between the production of reactive oxygen species and the capacity of antioxidant defense mechanisms favoring oxidants is called oxidative stress and is implicated in asthmatic inflammation and severity. Major reactive oxygen species that are formed endogenously include hydrogen peroxide, superoxide anion, hydroxyl radical, and hypohalite radical; and the major antioxidants that fight against the endogenous and environmental oxidants are superoxide dismutase, catalase, and glutathione. Despite the well-known presence of oxidative stress in asthma, studies that target oxidative burden using a variety of nutritional, pharmacological, and environmental approaches have generally been disappointing. In this review, we summarize the current knowledge on oxidative stress and antioxidant imbalance in asthma. In addition, we focus on possible biomarkers of oxidative stress in asthma and on current and future treatment strategies using the modulation of oxidative stress to treat asthma patients.
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Affiliation(s)
- Umit M Sahiner
- Department of Pediatric Allergy and Asthma, Hacettepe University School of Medicine, Ankara, Turkey
| | - Esra Birben
- Department of Pediatric Allergy and Asthma, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serpil Erzurum
- Department of Pathobiology, Cleveland Clinic, Lerner Research Institute, and the Respiratory Institute, Cleveland, Ohio
| | - Cansin Sackesen
- Department of Pediatric Allergy, Koc University School of Medicine, Istanbul, Turkey
| | - Ömer Kalayci
- Department of Pediatric Allergy and Asthma, Hacettepe University School of Medicine, Ankara, Turkey
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29
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Asosingh K, Weiss K, Queisser K, Wanner N, Yin M, Aronica M, Erzurum S. Endothelial cells in the innate response to allergens and initiation of atopic asthma. J Clin Invest 2018; 128:3116-3128. [PMID: 29911993 DOI: 10.1172/jci97720] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 05/01/2018] [Indexed: 01/03/2023] Open
Abstract
Protease-activated receptor 2 (PAR-2), an airway epithelial pattern recognition receptor (PRR), participates in the genesis of house dust mite-induced (HDM-induced) asthma. Here, we hypothesized that lung endothelial cells and proangiogenic hematopoietic progenitor cells (PACs) that express high levels of PAR-2 contribute to the initiation of atopic asthma. HDM extract (HDME) protease allergens were found deep in the airway mucosa and breaching the endothelial barrier. Lung endothelial cells and PACs released the Th2-promoting cytokines IL-1α and GM-CSF in response to HDME, and the endothelium had PAC-derived VEGF-C-dependent blood vessel sprouting. Blockade of the angiogenic response by inhibition of VEGF-C signaling lessened the development of inflammation and airway remodeling in the HDM model. Reconstitution of the bone marrow in WT mice with PAR-2-deficient bone marrow also reduced airway inflammation and remodeling. Adoptive transfer of PACs that had been exposed to HDME induced angiogenesis and Th2 inflammation with remodeling similar to that induced by allergen challenge. Our findings identify that lung endothelium and PACs in the airway sense allergen and elicit an angiogenic response that is central to the innate nonimmune origins of Th2 inflammation.
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Affiliation(s)
| | | | | | | | - Mei Yin
- Imaging Core, Lerner Research Institute, and
| | - Mark Aronica
- Department of Inflammation and Immunity.,Respiratory Institute, the Cleveland Clinic, Cleveland, Ohio, USA
| | - Serpil Erzurum
- Department of Inflammation and Immunity.,Respiratory Institute, the Cleveland Clinic, Cleveland, Ohio, USA
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30
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Reichard A, Wanner N, Stuehr E, Alemagno M, Weiss K, Queisser K, Erzurum S, Asosingh K. Quantification of airway fibrosis in asthma by flow cytometry. Cytometry A 2018; 93:952-958. [PMID: 29659138 DOI: 10.1002/cyto.a.23373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/23/2018] [Accepted: 03/20/2018] [Indexed: 01/31/2023]
Abstract
Airway fibrosis is a prominent feature of asthma, contributing to the detrimental consequences of the disease. Fibrosis in the airway is the result of collagen deposition in the reticular lamina layer of the subepithelial tissue. Myofibroblasts are the leading cell type involved with this collagen deposition. Established methods of collagen deposition quantification present various issues, most importantly their inability to quantify current collagen biosynthesis occurring in airway myofibroblasts. Here, a novel method to quantify myofibroblast collagen expression in asthmatic lungs is described. Single cell suspensions of lungs harvested from C57BL/6 mice in a standard house dust mite model of asthma were employed to establish a flow cytometric method and compare collagen production in asthmatic and non-asthmatic lungs. Cells found to be CD45- αSMA+ , indicative of myofibroblasts, were gated, and median fluorescence intensity of the anti-collagen-I antibody labeling the cells was calculated. Lung myofibroblasts with no, medium, or high levels of collagen-I expression were distinguished. In asthmatic animals, collagen-I levels were increased in both medium and high expressers, and the number of myofibroblasts with high collagen-I content was elevated. Our findings determined that quantification of collagen-I deposition in myofibroblastic lung cells by flow cytometry is feasible in mouse models of asthma and indicative of increased collagen-I expression by asthmatic myofibroblasts. © 2018 International Society for Advancement of Cytometry.
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Affiliation(s)
- Andrew Reichard
- Department of Inflammation and Immunity, The Cleveland Clinic, Cleveland, Ohio
| | - Nicholas Wanner
- Department of Inflammation and Immunity, The Cleveland Clinic, Cleveland, Ohio
| | - Eric Stuehr
- Department of Inflammation and Immunity, The Cleveland Clinic, Cleveland, Ohio
| | - Mario Alemagno
- Department of Inflammation and Immunity, The Cleveland Clinic, Cleveland, Ohio
| | - Kelly Weiss
- Department of Inflammation and Immunity, The Cleveland Clinic, Cleveland, Ohio
| | - Kimberly Queisser
- Department of Inflammation and Immunity, The Cleveland Clinic, Cleveland, Ohio
| | - Serpil Erzurum
- Department of Inflammation and Immunity, The Cleveland Clinic, Cleveland, Ohio.,Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Kewal Asosingh
- Department of Inflammation and Immunity, The Cleveland Clinic, Cleveland, Ohio.,Flow Cytometry Core, Lerner Research Institute The Cleveland Clinic, Cleveland, Ohio
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31
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Saygin D, Wanner N, Rose JA, Naga Prasad SV, Tang WHW, Erzurum S, Asosingh K. Relative quantification of beta-adrenergic receptor in peripheral blood cells using flow cytometry. Cytometry A 2018; 93:563-570. [PMID: 29573550 DOI: 10.1002/cyto.a.23358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 11/11/2022]
Abstract
Beta-adrenergic receptors (β-ARs) play a critical role in many diseases. Quantification of β-AR density may have clinical implications in terms of assessing disease severity and identifying patients who could potentially benefit from beta-blocker therapy. Classical methods for β-AR quantification are based on labor-intensive and time-consuming radioligand binding assays. Here, we report optimization of a flow cytometry-based method utilizing a biotinylated β-AR ligand alprenolol as a probe and use of this method to quantify relative receptor expression in healthy controls (HC). Quantum™ MESF beads were used for quantification in absolute fluorescence units. The probe was chemically modified by adding a spacer moiety between biotin and alprenolol to stabilize receptor binding, thus preventing binding decay. Testing of three different standard cell fixation and permeabilization methods (formaldehyde fixation and saponin, Tween-20, or Triton-X 100 permeabilization) showed that the formaldehyde/Triton-X 100 method yielded the best results. β-AR expression was significantly higher in granulocytes compared to mononuclear cells. These data show that flow cytometric quantification of relative β-AR expression in circulating leukocytes is a suitable technology for large-scale clinical application. © 2018 International Society for Advancement of Cytometry.
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Affiliation(s)
- Didem Saygin
- Department of Pathobiology, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio
| | - Nicholas Wanner
- Department of Pathobiology, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio
| | - Jonathan A Rose
- Department of Internal Medicine, Beth Israel Deaconess Medical Center Harvard Medical School, Boston, Massachusetts
| | | | - W H Wilson Tang
- Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Serpil Erzurum
- Department of Pathobiology, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio.,Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kewal Asosingh
- Department of Pathobiology, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio.,Flow Cytometry Core Lerner Research Institute Cleveland Clinic, Cleveland, Ohio
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Abstract
Current dogma is that pathological hypertrophy of the right ventricle is a direct consequence of pulmonary vascular remodeling. However, progression of right ventricle dysfunction is not always lung-dependent. Increased afterload caused by pulmonary vascular remodeling initiates the right ventricle hypertrophy, but determinants leading to adaptive or maladaptive hypertrophy and failure remain unknown. Ischemia in a hypertrophic right ventricle may directly contribute to right heart failure. Rapidly enlarging cardiomyocytes switch from aerobic to anaerobic energy generation resulting in cell growth under relatively hypoxic conditions. Cardiac muscle reacts to an increased afterload by over-activation of the sympathetic system and uncoupling and downregulation of β-adrenergic receptors. Recent studies suggest that β blocker therapy in PH is safe, well tolerated, and preserves right ventricle function and cardiac output by reducing right ventricular glycolysis. Fibrosis, an evolutionary conserved process in host defense and wound healing, is dysregulated in maladaptive cardiac tissue contributing directly to right ventricle failure. Despite several mechanisms having been suggested in right heart disease, the causes of maladaptive cardiac remodeling remain unknown and require further research.
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Affiliation(s)
- Kewal Asosingh
- 1 2569 Department of Pathobiology, Cleveland Clinic, Cleveland, OH, USA
| | - Serpil Erzurum
- 1 2569 Department of Pathobiology, Cleveland Clinic, Cleveland, OH, USA.,2 2569 Lerner Research Institute and Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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33
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Husta BC, Raoof S, Erzurum S, Mehta AC. Tracheobronchopathy From Inhaled Corticosteroids. Chest 2017; 152:1296-1305. [PMID: 28864055 DOI: 10.1016/j.chest.2017.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/06/2017] [Accepted: 08/01/2017] [Indexed: 12/17/2022] Open
Abstract
Inhaled corticosteroids (ICSs) have become the mainstay of asthma control. They are also recommended as an add-on therapy to long-acting beta agonists and anticholinergics in moderate to severe COPD with recurrent exacerbations. Ultimately this clinical practice has led to the widespread use of ICSs, which are supported by a more favorable side effect profile than that of systemic steroids.
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Affiliation(s)
- Bryan C Husta
- Lenox Hill Hospital, Hofstra Northwell School of Medicine, New York, NY
| | - Suhail Raoof
- Lenox Hill Hospital, Hofstra Northwell School of Medicine, New York, NY
| | - Serpil Erzurum
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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34
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Ketelaar ME, Van De Kant K, Dijk FN, Klaassen EMM, Grotenboer N, Nawijn MC, Dompeling E, Koppelman GH, Murray C, Foden P, Lowe L, Durrington H, Custovic A, Simpson A, Simpson AJ, Shaw DE, Sousa AR, Fleming LJ, Roberts G, Pandis I, Bansal AT, Corfield J, Wagers S, Djukanovic R, Chung KF, Sterk PJ, Vestbo J, Fowler SJ, Tebbutt SJ, Singh A, Shannon CP, Kim YW, Yang CX, Gauvreau GM, Fitzgerald JM, Boulet LP, O’Byrne PM, Begley N, Loudon A, Ray DW, Baos S, Cremades L, Calzada D, Lahoz C, Cárdaba B, Asosingh K, Lauruschkat C, Queisser K, Wanner N, Weiss K, Xu W, Erzurum S, Sokolowska M, Chen LY, Liu Y, Martinez-Anton A, Logun C, Alsaaty S, Cuento R, Cai R, Sun J, Quehenberger O, Armando A, Dennis E, Levine S, Shelhamer J, Choi K, Lazova S, Perenovska P, Miteva D, Priftis S, Petrova G, Yablanski V, Vlaev E, Rafailova H, Kumae T, Holmes LJ, Yorke J, Ryan DM, Chinratanapisit S, Matchimmadamrong K, Deerojanawong J, Karoonboonyanan W, Sritipsukho P, Youroukova V, Dimitrova D, Slavova Y, Lesichkova S, Tzocheva I, Parina S, Angelova S, Korsun N, Craiu M, Stan IV, Deliu M, Yavuz T, Sperrin M, Sahiner UM, Belgrave D, Sackesen CS, Kalayci Ö, Velikov P, Velikova T, Ivanova-Todorova E, Tumangelova-Yuzeir K, Kyurkchiev D, Megremis S, Constantinides B, Sotiropoulos AG, Xepapadaki P, Robertson D, Papadopoulos N, Wilkinson M, Portsmouth C, Ray D, Goodacre R, Valerieva A, Bobolea I, Vera DG, Gonzalez-Salazar G, Moreno CM, Rodriguez CF, De Las Cuevas Moreno N, Wang R, Satia I, Niven R, Smith JA, Southworth T, Plumb J, Gupta V, Pearson J, Ramis I, Lehner MD, Miralpeix M, Singh D, Satia I, Woodhead M, O’Byrne P, Smith JA, Forss C, Cook P, Brown S, Svedberg F, Stephenson K, Bertuzzi M, Bignell E, Enerbäck M, Cunoosamy D, Macdonald A, Liu C, Zhu L, Fukuda K, Zhang C, Ouyang S, Chen X, Qin L, Rachakonda S, Aronica M, Qin J, Li X, Larose MC, Archambault AS, Provost V, Chakir J, Laviolette M, Flamand N, Logan N, Ruckerl D, Allen JE, Sutherland TE, Hamelmann E, Vogelberg C, Goldstein S, Azzi GE, Engel M, Sigmund R, Szefler SJ, Mesquita R, Coentrão L, Veiga R, Paiva JA, Roncon-Albuquerque R, Porras WV, Moreno AG, Iglesias JM, Ramos GC, Acevedo YP, Alonso MAT, Del Mar Moro Moro M, Krcmova I, Novosad J, Hanania NA, Massanari M, Hecker H, Kassel E, Laforce C, Rickard K, Snelder S, Braunstahl GJ, Jones TL, Neville D, Heiden ER, Lanning E, Brown T, Rupani H, Babu KS, Chauhan AJ, Eldegeir MY, Chapman AA, Ferwana M, Caldron M. Abstracts from the 3rd International Severe Asthma Forum (ISAF). Clin Transl Allergy 2017. [PMCID: PMC5461526 DOI: 10.1186/s13601-017-0149-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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35
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Cahill KN, Katz HR, Cui J, Lai J, Kazani S, Crosby-Thompson A, Garofalo D, Castro M, Jarjour N, DiMango E, Erzurum S, Trevor JL, Shenoy K, Chinchilli VM, Wechsler ME, Laidlaw TM, Boyce JA, Israel E. KIT Inhibition by Imatinib in Patients with Severe Refractory Asthma. N Engl J Med 2017; 376:1911-1920. [PMID: 28514613 PMCID: PMC5568669 DOI: 10.1056/nejmoa1613125] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Mast cells are present in the airways of patients who have severe asthma despite glucocorticoid treatment; these cells are associated with disease characteristics including poor quality of life and inadequate asthma control. Stem cell factor and its receptor, KIT, are central to mast-cell homeostasis. We conducted a proof-of-principle trial to evaluate the effect of imatinib, a KIT inhibitor, on airway hyperresponsiveness, a physiological marker of severe asthma, as well as on airway mast-cell numbers and activation in patients with severe asthma. METHODS We conducted a randomized, double-blind, placebo-controlled, 24-week trial of imatinib in patients with poorly controlled severe asthma who had airway hyperresponsiveness despite receiving maximal medical therapy. The primary end point was the change in airway hyperresponsiveness, measured as the concentration of methacholine required to decrease the forced expiratory volume in 1 second by 20% (PC20). Patients also underwent bronchoscopy. RESULTS Among the 62 patients who underwent randomization, imatinib treatment reduced airway hyperresponsiveness to a greater extent than did placebo. At 6 months, the methacholine PC20 increased by a mean (±SD) of 1.73±0.60 doubling doses in the imatinib group, as compared with 1.07±0.60 doubling doses in the placebo group (P=0.048). Imatinib also reduced levels of serum tryptase, a marker of mast-cell activation, to a greater extent than did placebo (decrease of 2.02±2.32 vs. 0.56±1.39 ng per milliliter, P=0.02). Airway mast-cell counts declined in both groups. Muscle cramps and hypophosphatemia were more common in the imatinib group than in the placebo group. CONCLUSIONS In patients with severe asthma, imatinib decreased airway hyperresponsiveness, mast-cell counts, and tryptase release. These results suggest that KIT-dependent processes and mast cells contribute to the pathobiologic basis of severe asthma. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT01097694 .).
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Affiliation(s)
- Katherine N Cahill
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Howard R Katz
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Jing Cui
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Juying Lai
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Shamsah Kazani
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Allison Crosby-Thompson
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Denise Garofalo
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Mario Castro
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Nizar Jarjour
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Emily DiMango
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Serpil Erzurum
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Jennifer L Trevor
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Kartik Shenoy
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Vernon M Chinchilli
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Michael E Wechsler
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Tanya M Laidlaw
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Joshua A Boyce
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
| | - Elliot Israel
- From Brigham and Women's Hospital, Harvard Medical School, Boston (K.N.C., H.R.K., J.C., J.L., A.C.-T., D.G., T.M.L., J.A.B., E.I.), and Novartis Institutes for BioMedical Research, Cambridge (S.K.) - both in Massachusetts; Washington University, St. Louis (M.C.); University of Wisconsin, Madison (N.J.); Columbia University Medical Center, New York (E.D.); Cleveland Clinic, Cleveland (S.E.); University of Alabama at Birmingham, Birmingham (J.L.T.); Temple University, Philadelphia (K.S.), and Pennsylvania State University, Hershey (V.M.C.) - both in Pennsylvania; and National Jewish Health, Denver (M.E.W.)
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Rose JA, Wanner N, Cheong HI, Queisser K, Barrett P, Park M, Hite C, Naga Prasad SV, Erzurum S, Asosingh K. Flow Cytometric Quantification of Peripheral Blood Cell β-Adrenergic Receptor Density and Urinary Endothelial Cell-Derived Microparticles in Pulmonary Arterial Hypertension. PLoS One 2016; 11:e0156940. [PMID: 27270458 PMCID: PMC4896479 DOI: 10.1371/journal.pone.0156940] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 02/12/2016] [Accepted: 05/23/2016] [Indexed: 01/08/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a heterogeneous disease characterized by severe angiogenic remodeling of the pulmonary artery wall and right ventricular hypertrophy. Thus, there is an increasing need for novel biomarkers to dissect disease heterogeneity, and predict treatment response. Although β-adrenergic receptor (βAR) dysfunction is well documented in left heart disease while endothelial cell-derived microparticles (Ec-MPs) are established biomarkers of angiogenic remodeling, methods for easy large clinical cohort analysis of these biomarkers are currently absent. Here we describe flow cytometric methods for quantification of βAR density on circulating white blood cells (WBC) and Ec-MPs in urine samples that can be used as potential biomarkers of right heart failure in PAH. Biotinylated β-blocker alprenolol was synthesized and validated as a βAR specific probe that was combined with immunophenotyping to quantify βAR density in circulating WBC subsets. Ec-MPs obtained from urine samples were stained for annexin-V and CD144, and analyzed by a micro flow cytometer. Flow cytometric detection of alprenolol showed that βAR density was decreased in most WBC subsets in PAH samples compared to healthy controls. Ec-MPs in urine was increased in PAH compared to controls. Furthermore, there was a direct correlation between Ec-MPs and Tricuspid annular plane systolic excursion (TAPSE) in PAH patients. Therefore, flow cytometric quantification of peripheral blood cell βAR density and urinary Ec-MPs may be useful as potential biomarkers of right ventricular function in PAH.
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Affiliation(s)
- Jonathan A. Rose
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Nicholas Wanner
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Hoi I. Cheong
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Kimberly Queisser
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Patrick Barrett
- Flow Cytometry Core, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Margaret Park
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Corrine Hite
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Sathyamangla V. Naga Prasad
- Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Serpil Erzurum
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Kewal Asosingh
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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Park MM, Uzunaslan D, Chirakarnjanakorn S, Roach EC, Highland KB, Farha S, Erzurum S, Thomas J, Jellis C, Neumann D, DiFilippo F, Tang WW. RIGHT VENTRICULAR FDG-PET UPTAKE SUGGESTS A SHIFT TO GLYCOLYTIC METABOLISM IN THE SETTING OF RIGHT VENTRICULAR DYSFUNCTION RELATED TO PULMONARY ARTERIAL HYPERTENSION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32053-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gupta MK, Asosingh K, Aronica M, Comhair S, Cao G, Erzurum S, Panettieri RA, Naga Prasad SV. Defective Resensitization in Human Airway Smooth Muscle Cells Evokes β-Adrenergic Receptor Dysfunction in Severe Asthma. PLoS One 2015; 10:e0125803. [PMID: 26023787 PMCID: PMC4449172 DOI: 10.1371/journal.pone.0125803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/18/2015] [Indexed: 12/21/2022] Open
Abstract
β2-adrenergic receptor (β2AR) agonists (β2-agonist) are the most commonly used therapy for acute relief in asthma, but chronic use of these bronchodilators paradoxically exacerbates airway hyper-responsiveness. Activation of βARs by β-agonist leads to desensitization (inactivation) by phosphorylation through G-protein coupled receptor kinases (GRKs) which mediate β-arrestin binding and βAR internalization. Resensitization occurs by dephosphorylation of the endosomal βARs which recycle back to the plasma membrane as agonist-ready receptors. To determine whether the loss in β-agonist response in asthma is due to altered βAR desensitization and/or resensitization, we used primary human airway smooth muscle cells (HASMCs) isolated from the lungs of non-asthmatic and fatal-asthmatic subjects. Asthmatic HASMCs have diminished adenylyl cyclase activity and cAMP response to β-agonist as compared to non-asthmatic HASMCs. Confocal microscopy showed significant accumulation of phosphorylated β2ARs in asthmatic HASMCs. Systematic analysis of desensitization components including GRKs and β-arrestin showed no appreciable differences between asthmatic and non-asthmatic HASMCs. However, asthmatic HASMC showed significant increase in PI3Kγ activity and was associated with reduction in PP2A activity. Since reduction in PP2A activity could alter receptor resensitization, endosomal fractions were isolated to assess the agonist ready β2ARs as a measure of resensitization. Despite significant accumulation of β2ARs in the endosomes of asthmatic HASMCs, endosomal β2ARs cannot robustly activate adenylyl cyclase. Furthermore, endosomes from asthmatic HASMCs are associated with significant increase in PI3Kγ and reduced PP2A activity that inhibits β2AR resensitization. Our study shows that resensitization, a process considered to be a homeostasis maintaining passive process is inhibited in asthmatic HASMCs contributing to β2AR dysfunction which may underlie asthma pathophysiology and loss in asthma control.
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Affiliation(s)
- Manveen K. Gupta
- Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Kewal Asosingh
- Department of Pathology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Mark Aronica
- Department of Pathology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Suzy Comhair
- Department of Pathology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Gaoyuan Cao
- Airways Biology Initiative, Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Serpil Erzurum
- Department of Pathology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Reynold A. Panettieri
- Airways Biology Initiative, Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sathyamangla V. Naga Prasad
- Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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Teodorescu M, Broytman O, Curran-Everett D, Sorkness RL, Crisafi G, Bleecker ER, Erzurum S, Gaston BM, Wenzel SE, Jarjour NN. Obstructive Sleep Apnea Risk, Asthma Burden, and Lower Airway Inflammation in Adults in the Severe Asthma Research Program (SARP) II. J Allergy Clin Immunol Pract 2015; 3:566-75.e1. [PMID: 26004304 DOI: 10.1016/j.jaip.2015.04.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 03/04/2015] [Accepted: 04/02/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) may worsen asthma, but large studies are lacking and the underlying mechanisms are unknown. OBJECTIVE The objective of this study was to determine the prevalence of OSA risk among patients with asthma of different severity compared with normal controls (NC), and among asthmatics, to test the relationship of OSA risk with asthma burden and airway inflammation. METHODS Subjects with severe (SA, n = 94) and nonsevere asthma (NSA, n = 161), and NC (n = 146) were recruited in an add-on substudy, to the observational Severe Asthma Research Program (SARP) II; subjects completed sleep quality, sleepiness and OSA risk (Sleep Apnea scale of the Sleep Disorders Questionnaire [SA-SDQ]) questionnaires, and clinical assessments. Sputum was induced in a subset of asthmatics. RESULTS Relative to NC, despite similar sleep duration, the subjects with SA and NSA had worse sleep quality, were sleepier, and had higher SA-SDQ scores. Among asthmatics, higher SA-SDQ was associated with increased asthma symptoms, β-agonist use, health care utilization, and worse asthma quality of life. A significant association of SA-SDQ with sputum polymorphonuclear cells% was noted: each increase in SA-SDQ by its standard deviation (6.85 units) was associated with a rise in % sputum neutrophils of 7.78 (95% CI 2.33-13.22, P = .0006), independent of obesity and other confounders. CONCLUSIONS OSA symptoms are more prevalent among asthmatics, in whom they are associated with higher disease burden. OSA risk is associated with a neutrophilic airway inflammation in asthma, which suggests that OSA may be an important contributor to the neutrophilic asthma. Further studies are necessary to confirm these findings and better understand the mechanistic underpinnings of this relationship.
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Affiliation(s)
- Mihaela Teodorescu
- James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wis; Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Center for Sleep Medicine and Sleep Research/Wisconsin Sleep, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Oleg Broytman
- James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wis; Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Douglas Curran-Everett
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colo; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Denver, Colo
| | - Ronald L Sorkness
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Gina Crisafi
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Eugene R Bleecker
- Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Serpil Erzurum
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Benjamin M Gaston
- Division of Respiratory Medicine, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Sally E Wenzel
- Asthma Institute, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Nizar N Jarjour
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Wu L, Zepp JA, Qian W, Martin BN, Ouyang W, Yin W, Bunting KD, Aronica M, Erzurum S, Li X. A novel IL-25 signaling pathway through STAT5. J Immunol 2015; 194:4528-34. [PMID: 25821217 DOI: 10.4049/jimmunol.1402760] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/16/2015] [Indexed: 11/19/2022]
Abstract
IL-25 is a member of the IL-17 family of cytokines that promotes Th2 cell-mediated inflammatory responses. IL-25 signals through a heterodimeric receptor (IL-25R) composed of IL-17RA and IL-17RB, which recruits the adaptor molecule Act1 for downstream signaling. Although the role of IL-25 in potentiating type 2 inflammation is well characterized by its ability to activate the epithelium as well as T cells, the components of its signaling cascade remain largely unknown. In this study, we found that IL-25 can directly activate STAT5 independently of Act1. Furthermore, conditional STAT5 deletion in T cells or epithelial cells led to a defective IL-25-initiated Th2 polarization as well as defective IL-25 enhancement of Th2 responses. Finally, we found that STAT5 is recruited to the IL-25R in a ligand-dependent manner through unique tyrosine residues on IL-17RB. Together, these findings reveal a novel Act1-independent IL-25 signaling pathway through STAT5 activation.
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Affiliation(s)
- Ling Wu
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195; Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106
| | - Jarod A Zepp
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195; Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195
| | - Wen Qian
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Bradley N Martin
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195; Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106
| | - Wenjun Ouyang
- Department of Immunology, Genentech, South San Francisco, CA 94080
| | - Weiguo Yin
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Kevin D Bunting
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA 30329; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322; and
| | - Mark Aronica
- Department of Pathobiology, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195
| | - Serpil Erzurum
- Department of Pathobiology, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195
| | - Xiaoxia Li
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195;
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Zepp JA, Wu L, Qian W, Ouyang W, Aronica M, Erzurum S, Li X. TRAF4-SMURF2-mediated DAZAP2 degradation is critical for IL-25 signaling and allergic airway inflammation. J Immunol 2015; 194:2826-37. [PMID: 25681341 DOI: 10.4049/jimmunol.1402647] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IL-25 promotes type 2 immunity by inducing the expression of Th2-associated cytokines. Although it is known that the IL-25R (IL-17RB) recruits the adaptor protein ACT1, the IL-25R signaling mechanism remains poorly understood. While screening for IL-25R components, we found that IL-25 responses were impaired in Traf4 (-/-) cells. Administering IL-25 to Traf4 (-/-) mice resulted in blunted airway eosinophilia and Th2 cytokine production. Notably, IL-25R recruitment of TRAF4 was required for the ACT1/IL-25R interaction. Mechanistically, TRAF4 recruited the E3-ligase SMURF2, to degrade the IL-25R-inhibitory molecule DAZAP2. Silencing Dazap2 increased ACT1/IL-25R interaction and IL-25 responsiveness. Moreover, a tyrosine within the IL-25R elicited DAZAP2 interference. This study indicates that TRAF4-SMURF2-mediated DAZAP2 degradation is a crucial initiating event for the IL-25 response.
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Affiliation(s)
- Jarod A Zepp
- Department of Immunology, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195; Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195
| | - Ling Wu
- Department of Immunology, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195; Department of Pathology, Case Western Reserve University, Cleveland, OH 44106
| | - Wen Qian
- Department of Immunology, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195
| | - Wenjun Ouyang
- Department of Immunology, Genentech, South San Francisco, CA 94080; and
| | - Mark Aronica
- Department of Pathobiology, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195
| | - Serpil Erzurum
- Department of Pathobiology, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195
| | - Xiaoxia Li
- Department of Immunology, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195; Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195;
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Farha S, Dweik R, Rahaghi F, Benza R, Hassoun P, Frantz R, Torres F, Quinn DA, Comhair S, Erzurum S, Asosingh K. Imatinib in pulmonary arterial hypertension: c-Kit inhibition. Pulm Circ 2015; 4:452-5. [PMID: 25621158 DOI: 10.1086/677359] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/13/2014] [Indexed: 02/05/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by severe remodeling of the pulmonary artery resulting in increased pulmonary artery pressure and right ventricular hypertrophy and, ultimately, failure. Bone marrow-derived progenitor cells play a critical role in vascular homeostasis and have been shown to be involved in the pathogenesis of PAH. A proliferation of c-Kit(+) hematopoietic progenitors and mast cells has been noted in the remodeled vessels in PAH. Imatinib, a tyrosine kinase inhibitor that targets c-Kit, has been shown to be beneficial for patients with PAH. Here we hypothesize that the clinical benefit of imatinib in PAH could be related to c-Kit inhibition of progenitor cell mobilization and maturation into mast cells. As a corollary to the phase 3 study using imatinib in PAH, blood samples were collected from 12 patients prior to starting study drug (baseline) and while on treatment at weeks 4 and 24. Eight were randomized to imatinib and 4 to placebo. Circulating c-Kit(+) and CD34(+)CD133(+) hematopoietic progenitors as well as biomarkers of mast cell numbers and activation were measured. Circulating CD34(+)CD133(+) and c-Kit(+) progenitor cells as well as c-Kit(+)/CD34(+)CD133(+) decreased with imatinib therapy (all P < 0.05). In addition, total tryptase, a marker of mast cell load, dropped with imatinib therapy (P = 0.02) and was related to pulmonary vascular resistance (R = 0.7, P = 0.02). The findings support c-Kit inhibition as a potential mechanism of action of imatinib in PAH and suggest that tryptase is a potential biomarker of response to therapy.
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Affiliation(s)
- Samar Farha
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raed Dweik
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Franck Rahaghi
- Department of Allergy and Critical Care Medicine, Cleveland Clinic Florida, Weston, Florida, USA
| | - Raymond Benza
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Paul Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Frantz
- Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fernando Torres
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Suzy Comhair
- Department of Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serpil Erzurum
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kewal Asosingh
- Department of Pathobiology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Rose JA, Erzurum S, Asosingh K. Biology and flow cytometry of proangiogenic hematopoietic progenitors cells. Cytometry A 2014; 87:5-19. [PMID: 25418030 DOI: 10.1002/cyto.a.22596] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/21/2014] [Accepted: 11/06/2014] [Indexed: 12/25/2022]
Abstract
During development, hematopoiesis and neovascularization are closely linked to each other via a common bipotent stem cell called the hemangioblast that gives rise to both hematopoietic cells and endothelial cells. In postnatal life, this functional connection between the vasculature and hematopoiesis is maintained by a subset of hematopoietic progenitor cells endowed with the capacity to differentiate into potent proangiogenic cells. These proangiogenic hematopoietic progenitors comprise a specific subset of bone marrow (BM)-derived cells that homes to sites of neovascularization and possess potent paracrine angiogenic activity. There is emerging evidence that this subpopulation of hematopoietic progenitors plays a critical role in vascular health and disease. Their angiogenic activity is distinct from putative "endothelial progenitor cells" that become structural cells of the endothelium by differentiation into endothelial cells. Proangiogenic hematopoietic progenitor cell research requires multidisciplinary expertise in flow cytometry, hematology, and vascular biology. This review provides a comprehensive overview of proangiogenic hematopoietic progenitor cell biology and flow cytometric methods to detect these cells in the peripheral blood circulation and BM.
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Affiliation(s)
- Jonathan A Rose
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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Carethers JM, Coughlin S, Diamond B, Erzurum S, Fried LP, Jameson JL, Kaushansky K, Klotman ME, Lemon S, Mitchell B, Rothman P, Sawyers C, Seidman C, Somlo S. The imperative to invest in science has never been greater. J Clin Invest 2014. [DOI: 10.1172/jci79469] [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: 11/17/2022] Open
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Okamoto T, Wheeler D, Liu Q, Chakravarti R, Janocha A, Dan L, Cristiano Q, Stuehr D, Erzurum S, Dweik R, McCurry K. Pre-clinical treatment with sodium nitrite improves the pulmonary function of rejected human lungs in an ex vivo lung perfusion model. Nitric Oxide 2014. [DOI: 10.1016/j.niox.2014.09.036] [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: 11/29/2022]
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Majors A, Subramanian A, Ruple L, Chakravarti R, Comhair S, Leahy R, Erzurum S, Stuehr D, Aronica M. Nitric oxide alters hyaluronan deposition by cultured airway smooth muscle cells and correlates with hyaluronan levels in asthmatics. Nitric Oxide 2014. [DOI: 10.1016/j.niox.2014.09.007] [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: 10/24/2022]
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Marozkina NV, Wang XQ, Stsiapura V, Fitzpatrick A, Carraro S, Hawkins GA, Bleecker E, Meyers D, Jarjour N, Fain SB, Wenzel S, Busse W, Castro M, Panettieri RA, Moore W, Lewis SJ, Palmer LA, Altes T, de Lange EE, Erzurum S, Teague WG, Gaston B. Phenotype of asthmatics with increased airway S-nitrosoglutathione reductase activity. Eur Respir J 2014; 45:87-97. [PMID: 25359343 DOI: 10.1183/09031936.00042414] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
S-Nitrosoglutathione is an endogenous airway smooth muscle relaxant. Increased airway S-nitrosoglutathione breakdown occurs in some asthma patients. We asked whether patients with increased airway catabolism of this molecule had clinical features that distinguished them from other asthma patients. We measured S-nitrosoglutathione reductase expression and activity in bronchoscopy samples taken from 66 subjects in the Severe Asthma Research Program. We also analysed phenotype and genotype data taken from the program as a whole. Airway S-nitrosoglutathione reductase activity was increased in asthma patients (p=0.032). However, only a subpopulation was affected and this subpopulation was not defined by a "severe asthma" diagnosis. Subjects with increased activity were younger, had higher IgE and an earlier onset of symptoms. Consistent with a link between S-nitrosoglutathione biochemistry and atopy: 1) interleukin 13 increased S-nitrosoglutathione reductase expression and 2) subjects with an S-nitrosoglutathione reductase single nucleotide polymorphism previously associated with asthma had higher IgE than those without this single nucleotide polymorphism. Expression was higher in airway epithelium than in smooth muscle and was increased in regions of the asthmatic lung with decreased airflow. An early-onset, allergic phenotype characterises the asthma population with increased S-nitrosoglutathione reductase activity.
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Affiliation(s)
- Nadzeya V Marozkina
- Dept of Paediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Xin-Qun Wang
- Dept of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Vitali Stsiapura
- Dept of Chemistry, University of Virginia, Charlottesville, VA, USA
| | | | | | | | - Eugene Bleecker
- Dept of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Deborah Meyers
- Dept of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Nizar Jarjour
- Dept of Medicine, University of Wisconsin, Madison, WI, USA
| | - Sean B Fain
- Dept of Medical Physics, University of Wisconsin, Madison, WI, USA
| | | | - William Busse
- Dept of Medicine, University of Wisconsin, Madison, WI, USA
| | - Mario Castro
- Dept of Medicine, Washington University, St. Louis, MO, USA
| | - Reynold A Panettieri
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Wendy Moore
- Dept of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Stephen J Lewis
- Dept of Paediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Lisa A Palmer
- Dept of Paediatrics, University of Virginia, Charlottesville, VA, USA
| | - Talissa Altes
- Dept of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Eduard E de Lange
- Dept of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Serpil Erzurum
- Dept of Pathobiology, Cleveland Clinic, Cleveland, OH, USA Dept of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - W Gerald Teague
- Dept of Paediatrics, University of Virginia, Charlottesville, VA, USA
| | - Benjamin Gaston
- Dept of Paediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
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Carethers JM, Coughlin S, Diamond B, Erzurum S, Fried LP, Jameson JL, Kaushansky K, Klotman ME, Lemon S, Mitchell B, Rothman P, Sawyers C, Seidman C, Somlo S. The imperative to invest in science has never been greater. J Clin Invest 2014; 124:3680-1. [PMID: 25180532 DOI: 10.1172/jci77894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Narula T, Farver C, Erzurum S, Aldred M, Lane C, Budev M, Akindipe O. Recurrence of Idiopathic Pulmonary Arterial Hypertension After Lung Transplantation. Chest 2014. [DOI: 10.1378/chest.1826554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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50
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Zein J, Comhair S, Bleecker E, Busse W, Calhoun W, Castro M, Chung KF, Dweik R, Fitzpatrick A, Gaston B, Israel E, Jarjour N, Moore W, Teague G, Wenzel S, Erzurum S. The Effect of Aging and Menopause on Asthma Severity in Women. Chest 2014. [DOI: 10.1378/chest.1783148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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